Link between change in cognition and left ventricular function following cardiac resynchronization therapy.
OBJECTIVE
In patients with heart failure, reduced cardiac ejection fraction has been associated with impaired cognition. Improving cardiac function may have beneficial effects on cognition; however, no controlled intervention studies have examined this possibility. Cardiac resynchronization therapy (CRT) is one intervention that has been shown to increase cardiac function. The goals of the current study were to (1) evaluate neuropsychological performance before and 3 months after crt and (2) examine follow-up neuropsychological performance of patients classified on the basis of extent of improved left ventricular ejection fraction (LVEF).


METHODS
Twenty-seven patients with moderate to severe heart failure completed a neuropsychological assessment, 6-minute walk test, and transthoracic echocardiography before and 3 months after CRT. Patients were classified on the basis of improvement in LVEF. Results of a multivariate analysis of variance revealed a significant effect of improvement in LVEF on change in cognition (Wilks Λ, P = .031).


RESULTS
Patients with improved LVEF demonstrated significant increases on measures of executive functioning (F = 8.57, P = .007) and visuospatial function (F = 7.52, P = .011) and less decline on global cognition (F = 5.73, P = .024) than those without LVEF improvement.


CONCLUSIONS
Findings provide preliminary evidence that improved LVEF in response to CRT is associated with enhanced cognitive outcomes within 3 months of CRT. Patients with improved LVEF showed better outcomes on measures of executive functioning, global cognition, and visuospatial functioning. Future, controlled, large-scale trials will be necessary to determine whether there is an underlying causal relationship linking increase in LVEF and cognition.
Hoth
Karin F
KF
Department of Medicine, National Jewish Health, University of Colorado Denver, CO 80206, USA. hothk@njhealth.org
Poppas
Athena
A
Ellison
Kristin E
KE
Paul
Robert H
RH
Sokobin
Andrew
A
Cho
Youngsoo
Y
Cohen
Ronald A
RA
D000704:Analysis of Variance; D002304:Cardiac Pacing, Artificial; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology / Q000517:prevention & control*; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011594:Psychometrics; D012307:Risk Factors; D013223:Statistics as Topic; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D013997:Time Factors; D016277:Ventricular Function, Left