Cardiac resynchronization therapy improves psycho-cognitive performance in patients with heart failure.
BACKGROUND
Reduced cognitive performance and high prevalence of depression have been reported in patients with congestive heart failure (CHF) and severe left ventricular dysfunction. However, effects of contemporary device therapy on cognitive performance and depression symptoms have not been studied thoroughly.


METHODS
Seventy-four consecutive CHF patients-45 receiving a biventricular defibrillator (CRT-D) and 29 receiving an implantable single or dual-chamber defibrillator (ICD) as a control group-were enrolled in this investigator-initiated, prospective, controlled, and investigator-blinded study. A set of neuropsychological tests (mini-mental state examination, DemTect, age-concentration test, and Beck depression inventory) was performed before, at 3 and at 6 months after device implantation.


RESULTS
DemTect-score improved significantly (F = 7.8; P = 0.007) after CRT-D-implantation compared with ICD. Age-concentration test revealed better concentration ability after CRT-D-implantation (F = 8.3; P = 0.005) compared with ICD. Under CRT-D mini-mental state examination showed a significant improvement (F = 4.2; P = 0.043). CRT with defibrillator therapy also improved depression revealed by beck depression inventory (F = 14.7; P< 0.001) compared with ICD.


CONCLUSIONS
This prospective study is the first to demonstrate psycho-cognitive improvement by resynchronization therapy in CHF patients with severe left ventricular dysfunction. In contrast to ICD therapy, the beneficial effect of CRT-D on psycho-cognitive performance might be attributed to improved cardiac function and haemodynamics.
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
David
D
Duncker
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Katrin
K
Friedel
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Thorben
T
König
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Hendrik
H
Schreyer
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Ulrich
U
Lüsebrink
Center for Psychiatric and Psychotherapeutic Care and Rehabilitation, Dr K. Fontheim's Hospital for Mental Health, Liebenburg, Germany.
Mareke
M
Duncker
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Hanno
H
Oswald
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany Heart Center Hannover, Hannover, Germany.
Gunnar
G
Klein
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany Heart Center Hannover, Hannover, Germany gardiwal@gmail.com.
Ajmal
A
Gardiwal
D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D003071:Cognition; D017147:Defibrillators, Implantable; D003863:Depression / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006333:Heart Failure / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D016037:Single-Blind Method; D013318:Stroke Volume; D016896:Treatment Outcome
Cardiac resynchronization therapy; Cerebrovascular circulation; Cognitive function; Heart failure