title: Association between hypotension, low ejection fraction and cognitive performance in cardiac patients.
abstract: OBJECTIVE
  Impaired cardiac function can adversely affect the brain via decreased perfusion. The purpose of this study was to determine if cardiac ejection fraction (EF) is associated with cognitive performance, and whether this is modified by low blood pressure.
  
  
  METHODS
  Neuropsychological testing evaluating multiple cognitive domains, measurement of mean arterial pressure (MAP), and measurement of EF were performed in 234 individuals with coronary artery disease. The association between level of EF and performance within each cognitive domain was explored, as was the interaction between low MAP and EF.
  
  
  RESULTS
  Adjusted global cognitive performance, as well as performance in visuoconstruction and motor speed, was significantly directly associated with cardiac EF. This relationship was not entirely linear, with a steeper association between EF and cognition at lower levels of EF than at higher levels. Patients with low EF and low MAP at the time of testing had worse cognitive performance than either of these alone, particularly for the global and motor speed cognitive scores.
  
  
  CONCLUSIONS
  Low EF may be associated with worse cognitive performance, particularly among individuals with low MAP and for cognitive domains typically associated with vascular cognitive impairment. Further care should be paid to hypotension in the setting of heart failure, as this may exacerbate cerebral hypoperfusion.
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. rgottesm@jhmi.edu
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
authors.forename: Maura A
authors.initials: MA
authors.lastname: Grega
authors.forename: Maryanne M
authors.initials: MM
authors.lastname: Bailey
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zeger
authors.forename: William A
authors.initials: WA
authors.lastname: Baumgartner
authors.forename: Guy M
authors.initials: GM
authors.lastname: McKhann
authors.forename: Ola A
authors.initials: OA
authors.lastname: Selnes
mesh_terms: D000368:Aged; D001794:Blood Pressure; D003071:Cognition; D003072:Cognition Disorders / Q000150:complications / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009483:Neuropsychological Tests; D011597:Psychomotor Performance