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Impairment of Cognitive Function Increases Mortality Risk in Relation to Cardiac Sympathetic Denervation and Renal
Mirei Nabuchi1, Takahiro Doi1, Ryosuke Hatano1
1Department of Cardiology, Teine Keijinkai Hospita.
Insights
Cognitive impairment, reduced cardiac sympathetic function, and poor renal function independently predict cardiac events in heart failure (HF) patients. These factors synergistically increase mortality risk in HF.
Area of Science:
- Cardiology
- Neurology
- Nephrology
Background:
- The prognostic significance of cardiorenal interactions is established.
- The impact of cognitive impairment on cardiac prognosis, particularly concerning cardiac sympathetic innervation and renal function in heart failure (HF) patients, remains unclear.
Purpose of the Study:
- To investigate the independent and combined effects of cognitive function, cardiac sympathetic innervation, and renal function on cardiac prognosis in patients with heart failure.
Main Methods:
- 433 HF patients (LVEF <50%) underwent cognitive screening (Mini-Mental State Examination [MMSE] and neuropsychological tests).
- Cardiac sympathetic innervation was assessed using metaiodobenzylguanidine (MIBG) scintigraphy (standardized heart-to-mediastinum ratio [sHMR]).
- Renal function was evaluated by estimated glomerular filtration rate (eGFR); lethal cardiac events (CEs) were tracked for 14.8 months.
Main Results:
- CEs occurred in 84 patients.
- Patients with CEs had significantly lower MMSE scores, eGFR, and sHMR.
- Multivariate analysis identified MMSE score, eGFR, and sHMR as independent predictors of CEs.
- ROC analysis identified cutoff values (MMSE <26, sHMR <1.80, eGFR <47.0 mL/min/1.73 m²) for increased CE risk.
Conclusions:
- Impaired cognitive function is an independent predictor of cardiac mortality in HF patients.
- Cognitive impairment synergistically increases cardiac mortality risk in conjunction with impaired cardiac sympathetic function and renal function.
Background:
In contrast to the well-known prognostic values of the cardiorenal linkage, it remains unclear whether impaired cognitive function affects cardiac prognosis in relation to cardiac sympathetic innervation and renal function in patients with heart failure (HF).
Methods And Results:
A total of 433 consecutive HF patients with left ventricular ejection fraction (LVEF) <50% underwent the Mini-Mental State Examination (MMSE) and a neuropsychological test for screening of cognition impairment or subclinical dementia. Following metaiodobenzylguanidine (MIBG) scintigraphy, patient outcomes with a primary endpoint of lethal cardiac events (CEs) were evaluated for a mean period of 14.8 months. CEs were documented in 84 HF patients during follow-up. MMSE score, estimated glomerular filtration rate (eGFR) and standardized heart-to-mediastinum ratio of MIBG activity (sHMR) were significantly reduced in patients with CEs compared with patients without CEs. Furthermore, overall multivariate analysis revealed that these parameters were significant independent determinants of CEs. The cutoff values of MMSE score (<26), sHMR (<1.80) and eGFR (<47.0 mL/min/1.73 m2) determined by receiver operating characteristic (ROC) analysis successfully differentiated HF patients at more increased risk for CEs from other HF patients.
Conclusions:
Impairment of cognitive function is not only independently related to but also synergistically increases cardiac mortality risk in association with cardiac sympathetic function and renal function in patients with HF.
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