Abstract
Background
Cardiovascular patients with reduced cardiovascular output and capacity such as those with congestive heart failure (CHF) have demonstrated cognitive‐related dysfunction. The use of cardiac resynchronization therapy (CRT) is considered standard care for CHF patients who do not improve despite optimal medical therapy. Cardiac resynchronization therapy may improve neurocognitive and psychosocial functioning in patients by increasing cardiac output and cerebral perfusion.
Methods
A total of 20 patients were examined before and 3 months after CRT device implantation, via administration of standard neurocognitive and psychosocial testing measures.
Results
Significant improvements in neurocognitive measures of attention (Digit Span: t[20] = − 2.695 [55.94±9.27–62.31±10.05], P = 0.015) and information processing (Digit Symbol: t[20] = − 4.577, P < 0.001; Controlled Oral Word Association Test: t[20] = − 3.338, P = 0.004) were demonstrated. Improvements in cardiac‐specific quality of life were also significant (Minnesota Living with Heart Failure Questionnaire: t[16] = 3.544, P = 0.005 [55.17±18.23–36.75±18.00]; The Left Ventricular Dysfunction Questionnaire: t[16] = 3.544, P = 0.003 [63.43±23.35–43.29±21.62]).
Conclusion
These results represent clinically significant, qualitative, and quantitative cognitive functional benefits for patients from a neurocognitive and psychosocial perspective. Results suggest that biventricular pacing improves cardiovascular outcome and psychosocial functioning in patients with CHF. The future investigation of a larger sample would be beneficial in establishing the depth and breadth of this improvement. Copyright © 2010 Wiley Periodicals, Inc.
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References
- 1. Aranda JM Jr, Woo GW, Schofield RS, et al. Management of heart failure after cardiac resynchronization therapy: integrating advanced heart failure treatment with optimal device function. J Am Coll Cardiol 2005; 46: 2193–2198. [DOI] [PubMed] [Google Scholar]
- 2. Dzemali O, Bakhtiary F, Dogan S, et al. Perioperative biventricular pacing leads to improvement of hemodynamics in patients with reduced left‐ventricular function—interim results. Pacing Clin Electrophysiol 2006; 29: 1341–1345. [DOI] [PubMed] [Google Scholar]
- 3. Bradley DJ, Bradley EA, Baughman KL, et al. Cardiac resynchronization and death from progressive heart failure: a meta‐analysis of randomized controlled trials. JAMA 2003; 289: 730–740. [DOI] [PubMed] [Google Scholar]
- 4. Bristow MR, Saxon LA, Boehmer J, et al. Cardiac‐resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350: 2140–2150. [DOI] [PubMed] [Google Scholar]
- 5. Cleland JG, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005; 352: 1539–1549. [DOI] [PubMed] [Google Scholar]
- 6. Zuccala G, Cattel C, Manes‐Gravina E, et al. Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure. J Neurol Neurosurg Psychiatry 1997; 63: 509–512. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Zimpfer D, Wieselthaler G, Czerny M, et al. Neurocognitive function in patients with ventricular assist devices: a comparison of pulsatile and continuous blood flow devices. ASAIO J 2006; 52: 24–27. [DOI] [PubMed] [Google Scholar]
- 8. Clark AP, McDougall G. Cognitive impairment in heart failure. Dimens Crit Care Nurs 2006; 25: 93–100; quiz 101–102. [DOI] [PubMed] [Google Scholar]
- 9. Lezak MD, Howieson DB, Loring DW. Neuropsychological Assessment. New York, NY: Oxford University Press; 2004. [Google Scholar]
- 10. Conti JB, Sears SF. Cardiac resynchronization therapy: can we make our heart failure patients smarter? Trans Am Clin Climatol Assoc 2007; 118: 153–164. [PMC free article] [PubMed] [Google Scholar]
- 11. Folstein MF, Folstein SE, McHugh PR. “Mini‐mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–198. [DOI] [PubMed] [Google Scholar]
- 12. Wechsler D. Wechsler Adult Intelligence Scale‐III. San Antonio, TX: The Psychological Corporation; 1997. [Google Scholar]
- 13. Reitan RM. Validity of the Trail Making Test as an indicator of organic brain damage. Perceptual and Motor Skills 1958; 8: 271–276. [Google Scholar]
- 14. Benedict RHB, Schretlen D, Groninger L, et al. Hopkins Verbal Learning Test‐Revised: Normative data and analysis of inter‐form and test‐retest reliability. Clin Neuropsychol 1998; 12: 43–55. [Google Scholar]
- 15. Benton AL, Hamsher Kd. Multilingual Aphasia Examination. Iowa City, IA: AJA Associates; 1989. [Google Scholar]
- 16. Radloff LS. The CES‐D Scale: A self‐report depression scale for research in the general population. Appl Psychol Measurement. 1977; 1: 385–401. [Google Scholar]
- 17. Rector TS, Kubo SH, Cohn JN. Patients' self‐assessment of their congestive heart failure. Part 2: Content, reliability, and validity of a new measure, the Minnesota Living with Heart Failure Questionnaire. Heart Failure 1987; 3: 198–209. [Google Scholar]
- 18. O'Leary CJ, Jones PW. The left ventricular dysfunction questionnaire (LVD‐36): reliability, validity, and responsiveness. Heart 2000; 83: 634–640. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. Spielberger CD, Gorsuch RL, Lushene R, et al. Manual for the State‐Trait Anxiety Inventory (Self Evaluation Questionnaire: Form Y). Palo Alto, CA: Consulting Psychologist Press, Inc.; 1983. [Google Scholar]
- 20. Peeters A, Mamun AA, Willekens F, et al. A cardiovascular life history. A life course analysis of the original Framingham Heart Study cohort. Eur Heart J 2002; 23: 458–466. [DOI] [PubMed] [Google Scholar]
- 21. Vogels RL, Oosterman JM, van Harten B, et al. Profile of cognitive impairment in chronic heart failure. J Am Geriatr Soc 2007; 55: 1764–1770. [DOI] [PubMed] [Google Scholar]
- 22. Petrucci RJ, Truesdell KC, Carter A, et al. Cognitive dysfunction in advanced heart failure and prospective cardiac assist device patients. Ann Thorac Surg 2006; 81: 1738–1744. [DOI] [PubMed] [Google Scholar]
- 23. Braunwald E. Shattuck lecture—cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med 1997; 337: 1360–1369. [DOI] [PubMed] [Google Scholar]