Abstract 14523: Improvement in Cognitive Function After Heart Transplant and Mechanical Circulatory Support: Findings From the Sustaining Quality of Life of the Aged (Sustain-it) Study

IntroductionCognitive dysfunction (CD) is a common comorbidity affecting more than 50% of older patients (pts) with advanced heart failure (HF). Preliminary findings evaluating change in CD after heart transplantation (HT) or mechanical circulatory support (MCS) are conflicting. We compared cognitiv...

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Published in:Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A14523-A14523
Main Authors: Vorovich, Esther, Andrei, Adin-Cristian, Xu, Yao, Kao, Andrew, Hsich, Eileen M, Dew, Mary Amanda, Kormos, Robert L, Pham, Duc Thinh, Yancy, Clyde W, LaRue, Shane, Petty, Michael G, Cotts, William, Pamboukian, Salpy, Pagani, Francis D, Lampert, Brent, Johnson, Maryl R, Murray, Margaret A, Tekeda, Koji, Yuzefpolskaya, Melana, Silvestry, Scott, Spertus, John, Kirklin, James K, Collum, Craig, Grady, Kathleen
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Language:English
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Summary:IntroductionCognitive dysfunction (CD) is a common comorbidity affecting more than 50% of older patients (pts) with advanced heart failure (HF). Preliminary findings evaluating change in CD after heart transplantation (HT) or mechanical circulatory support (MCS) are conflicting. We compared cognitive function before and 6 months (mos) after HT with prior MCS (HT-MCS) or without prior MCS (HT non-MCS) and MCS as destination therapy (DT).MethodsA total of 393 pts from 13 U.S. sites listed for HT (n=238, 118 HT-MCS, 120 HT non-MCS) or scheduled for DT MCS (n=155), aged 60-80, were enrolled between 10/1/15-12/31/18 and completed the Montreal Cognitive Assessment (MoCA), a screening instrument (worst-to-best score range=0-30). CD was defined as a MoCA score < 26. We prospectively collected and compared MoCA scores before and 6 mos after surgery. Statistical analyses included t-tests, chi-square tests, and baseline and age adjusted linear regression models.ResultsThe majority of pts were white, male, well-educated and 45% had an ischemic HF etiology. The mean MOCA score and % with CD for the entire cohort at baseline and 6 mos after surgery were 25.1 ±3.3, and 47% and 25.8+3.0 and 40%, respectively. Age-adjusted mean MoCA scores were lower at baseline for DT MCS vs both HT groups, yet mean MoCA scores improved from baseline to 6 mos after surgery in all 3 groupsDT 23.8 vs 24.7 (p=0.016), HT MCS 25.4 vs 26.4 (p=0.041), and HT non-MCS 26.4 vs 27.1 (p=0.022) (see figure). After adjusting for age and baseline MoCA scores, there were no significant differences between groups at 6 mos follow-up (see figure).ConclusionsCD is common in advanced HF and improves after HT and DT MCS surgery. While DT pts had lower baseline MoCA scores, their scores were similar to HT recipient scores after surgery. These findings show that CD is partially reversible, and regardless of type of surgery, MoCA scores are similar among groups early after surgery.
ISSN:0009-7322
1524-4539
DOI:10.1161/circ.140.suppl_1.14523