Mild cognitive impairment is associated with subclinical diastolic dysfunction in patients with chronic heart disease

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Abstract

Background To examine mild cognitive impairment and its associations with subclinical cardiac dysfunction in patients with chronic heart disease yet to develop the clinical syndrome of chronic heart failure (CHF). Methods and results Patients from the Nurse-led Intervention for Less Chronic Heart Failure Study (n = 373 with chronic heart disease other than CHF; 64 ± 11 years, 69% men) were screened for mild cognitive impairment [Montreal cognitive assessment (MoCA) score <26] and underwent echocardiographic/clinical profiling. We investigated associations of mild cognitive impairment and MoCA cognitive domain subscores with global cardiac status (normal' vs. diastolic dysfunction' vs. other cardiac abnormality') and individual echocardiographic parameters. Patients with mild cognitive impairment (n = 161; 43%) demonstrated a higher age-adjusted prevalence of diastolic dysfunction (37% vs. 24%; P < 0.05). Multivariate logistic regression (adjusted for age, sex, and other relevant clinical factors) indicated that the odds of mild cognitive impairment were two-times higher with diastolic dysfunction (P = 0.030) and 1.7-times higher with other cardiac abnormalities' (P = 0.082) vs. normal cardiac status. In turn, mild cognitive impairment was predicted by left-ventricular (LV) filling pressure (based on the ratio of early diastolic filling and annular velocities; adjusted odds ratio 1.07 per unit increase, P = 0.022), but not LV structural parameters. Specific deficits in the cognitive domains of executive functioning and visuo-constructional abilities were also independently predicted by diastolic dysfunction (P < 0.05). Conclusion Mild cognitive impairment is prevalent in patients with subclinical chronic heart disease at high-risk of CHF. Independent associations with LV diastolic dysfunction suggest a link between cardiac and cognitive functioning beyond shared risk factors.

Original languageEnglish
Pages (from-to)285-292
Number of pages8
JournalEuropean Heart Journal Cardiovascular Imaging
Volume19
Issue number3
DOIs
Publication statusPublished - 1 Mar 2018
Externally publishedYes

Keywords

  • cognitive impairment
  • diastolic dysfunction
  • echocardiography
  • left ventricular function
  • left ventricular hypertrophy

Cite this

@article{84a9be77d26a4e8a8fe8eaa25a0132c5,
title = "Mild cognitive impairment is associated with subclinical diastolic dysfunction in patients with chronic heart disease",
abstract = "Background To examine mild cognitive impairment and its associations with subclinical cardiac dysfunction in patients with chronic heart disease yet to develop the clinical syndrome of chronic heart failure (CHF). Methods and results Patients from the Nurse-led Intervention for Less Chronic Heart Failure Study (n = 373 with chronic heart disease other than CHF; 64 ± 11 years, 69{\%} men) were screened for mild cognitive impairment [Montreal cognitive assessment (MoCA) score <26] and underwent echocardiographic/clinical profiling. We investigated associations of mild cognitive impairment and MoCA cognitive domain subscores with global cardiac status (normal' vs. diastolic dysfunction' vs. other cardiac abnormality') and individual echocardiographic parameters. Patients with mild cognitive impairment (n = 161; 43{\%}) demonstrated a higher age-adjusted prevalence of diastolic dysfunction (37{\%} vs. 24{\%}; P < 0.05). Multivariate logistic regression (adjusted for age, sex, and other relevant clinical factors) indicated that the odds of mild cognitive impairment were two-times higher with diastolic dysfunction (P = 0.030) and 1.7-times higher with other cardiac abnormalities' (P = 0.082) vs. normal cardiac status. In turn, mild cognitive impairment was predicted by left-ventricular (LV) filling pressure (based on the ratio of early diastolic filling and annular velocities; adjusted odds ratio 1.07 per unit increase, P = 0.022), but not LV structural parameters. Specific deficits in the cognitive domains of executive functioning and visuo-constructional abilities were also independently predicted by diastolic dysfunction (P < 0.05). Conclusion Mild cognitive impairment is prevalent in patients with subclinical chronic heart disease at high-risk of CHF. Independent associations with LV diastolic dysfunction suggest a link between cardiac and cognitive functioning beyond shared risk factors.",
keywords = "cognitive impairment, diastolic dysfunction, echocardiography, left ventricular function, left ventricular hypertrophy",
author = "Sacre, {Julian W.} and Jocasta Ball and Chiew Wong and Chan, {Yih Kai} and Simon Stewart and Kingwell, {Bronwyn A.} and Carrington, {Melinda J.}",
year = "2018",
month = "3",
day = "1",
doi = "10.1093/ehjci/jex169",
language = "English",
volume = "19",
pages = "285--292",
journal = "European Heart Journal Cardiovascular Imaging",
issn = "2047-2404",
publisher = "Oxford University Press",
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TY - JOUR

T1 - Mild cognitive impairment is associated with subclinical diastolic dysfunction in patients with chronic heart disease

AU - Sacre, Julian W.

AU - Ball, Jocasta

AU - Wong, Chiew

AU - Chan, Yih Kai

AU - Stewart, Simon

AU - Kingwell, Bronwyn A.

AU - Carrington, Melinda J.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background To examine mild cognitive impairment and its associations with subclinical cardiac dysfunction in patients with chronic heart disease yet to develop the clinical syndrome of chronic heart failure (CHF). Methods and results Patients from the Nurse-led Intervention for Less Chronic Heart Failure Study (n = 373 with chronic heart disease other than CHF; 64 ± 11 years, 69% men) were screened for mild cognitive impairment [Montreal cognitive assessment (MoCA) score <26] and underwent echocardiographic/clinical profiling. We investigated associations of mild cognitive impairment and MoCA cognitive domain subscores with global cardiac status (normal' vs. diastolic dysfunction' vs. other cardiac abnormality') and individual echocardiographic parameters. Patients with mild cognitive impairment (n = 161; 43%) demonstrated a higher age-adjusted prevalence of diastolic dysfunction (37% vs. 24%; P < 0.05). Multivariate logistic regression (adjusted for age, sex, and other relevant clinical factors) indicated that the odds of mild cognitive impairment were two-times higher with diastolic dysfunction (P = 0.030) and 1.7-times higher with other cardiac abnormalities' (P = 0.082) vs. normal cardiac status. In turn, mild cognitive impairment was predicted by left-ventricular (LV) filling pressure (based on the ratio of early diastolic filling and annular velocities; adjusted odds ratio 1.07 per unit increase, P = 0.022), but not LV structural parameters. Specific deficits in the cognitive domains of executive functioning and visuo-constructional abilities were also independently predicted by diastolic dysfunction (P < 0.05). Conclusion Mild cognitive impairment is prevalent in patients with subclinical chronic heart disease at high-risk of CHF. Independent associations with LV diastolic dysfunction suggest a link between cardiac and cognitive functioning beyond shared risk factors.

AB - Background To examine mild cognitive impairment and its associations with subclinical cardiac dysfunction in patients with chronic heart disease yet to develop the clinical syndrome of chronic heart failure (CHF). Methods and results Patients from the Nurse-led Intervention for Less Chronic Heart Failure Study (n = 373 with chronic heart disease other than CHF; 64 ± 11 years, 69% men) were screened for mild cognitive impairment [Montreal cognitive assessment (MoCA) score <26] and underwent echocardiographic/clinical profiling. We investigated associations of mild cognitive impairment and MoCA cognitive domain subscores with global cardiac status (normal' vs. diastolic dysfunction' vs. other cardiac abnormality') and individual echocardiographic parameters. Patients with mild cognitive impairment (n = 161; 43%) demonstrated a higher age-adjusted prevalence of diastolic dysfunction (37% vs. 24%; P < 0.05). Multivariate logistic regression (adjusted for age, sex, and other relevant clinical factors) indicated that the odds of mild cognitive impairment were two-times higher with diastolic dysfunction (P = 0.030) and 1.7-times higher with other cardiac abnormalities' (P = 0.082) vs. normal cardiac status. In turn, mild cognitive impairment was predicted by left-ventricular (LV) filling pressure (based on the ratio of early diastolic filling and annular velocities; adjusted odds ratio 1.07 per unit increase, P = 0.022), but not LV structural parameters. Specific deficits in the cognitive domains of executive functioning and visuo-constructional abilities were also independently predicted by diastolic dysfunction (P < 0.05). Conclusion Mild cognitive impairment is prevalent in patients with subclinical chronic heart disease at high-risk of CHF. Independent associations with LV diastolic dysfunction suggest a link between cardiac and cognitive functioning beyond shared risk factors.

KW - cognitive impairment

KW - diastolic dysfunction

KW - echocardiography

KW - left ventricular function

KW - left ventricular hypertrophy

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U2 - 10.1093/ehjci/jex169

DO - 10.1093/ehjci/jex169

M3 - Article

VL - 19

SP - 285

EP - 292

JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

SN - 2047-2404

IS - 3

ER -