TY - JOUR
T1 - Long-Term Neurocognitive Outcome in Patients With Continuous Flow Left Ventricular Assist Device
AU - Cho, Sung Min
AU - Floden, Darlene
AU - Wallace, Kristie
AU - Hiivala, Nicholas
AU - Joseph, Susan
AU - Teuteberg, Jeffrey
AU - Rogers, Joseph G.
AU - Pagani, Francis D.
AU - Mokadam, Nahush
AU - Tirschwell, David
AU - Li, Song
AU - Starling, Randall C.
AU - Mahr, Claudius
AU - Uchino, Ken
N1 - Funding Information:
The authors acknowledge Brian M. Van Dorn, MS, Joao Vitor Dias Monteiro, PhD, and Timothy E. Hanson, PhD, of Medtronic Inc for their assistance in the statistical modeling.
Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/11
Y1 - 2021/11
N2 - Objectives: The authors sought to examine the long-term cognitive outcome of patients with continuous flow left ventricular assist device (CF-LVAD). Background: Data on long-term neurocognitive outcome in LVAD are limited. We examined the neurocognitive outcome of patients who received a CF-LVAD as destination therapy. Methods: Patients with HeartWare (HVAD) and HeartMate II who were enrolled in the ENDURANCE and ENDURANCE Supplemental trials were eligible. Cognition was evaluated with neuropsychological testing preoperatively and at 6, 12, and 24 months after implantation. General linear models identified demographic, disease, and treatment factors that predicted decline on each neurocognitive measure. Results: Of 668 patients who completed baseline testing and at least 1 follow-up evaluation, 552 were impaired at baseline on at least 1 cognitive measure. At each follow-up, approximately 23% of tested patients declined and 20% improved relative to baseline on at least 1 cognitive measure. Of those who were intact at baseline, only 10%-12% declined in delayed memory and 11%-16% declined in executive function at all 3 follow-ups. For patients impaired at baseline, delayed memory decline was associated with the HVAD device and male sex, whereas executive function decline was associated with the HVAD device and stroke during CF-LVAD support. For patients intact at baseline, male sex and history of hypertension were associated with decline in immediate memory and executive function, respectively. Conclusions: Neurocognitive function remained stable or improved for most patients (∼80%) with CF-LVAD at 6, 12, and 24 months after implantation. Male sex, hypertension, HVAD, and stroke were associated with cognitive decline.
AB - Objectives: The authors sought to examine the long-term cognitive outcome of patients with continuous flow left ventricular assist device (CF-LVAD). Background: Data on long-term neurocognitive outcome in LVAD are limited. We examined the neurocognitive outcome of patients who received a CF-LVAD as destination therapy. Methods: Patients with HeartWare (HVAD) and HeartMate II who were enrolled in the ENDURANCE and ENDURANCE Supplemental trials were eligible. Cognition was evaluated with neuropsychological testing preoperatively and at 6, 12, and 24 months after implantation. General linear models identified demographic, disease, and treatment factors that predicted decline on each neurocognitive measure. Results: Of 668 patients who completed baseline testing and at least 1 follow-up evaluation, 552 were impaired at baseline on at least 1 cognitive measure. At each follow-up, approximately 23% of tested patients declined and 20% improved relative to baseline on at least 1 cognitive measure. Of those who were intact at baseline, only 10%-12% declined in delayed memory and 11%-16% declined in executive function at all 3 follow-ups. For patients impaired at baseline, delayed memory decline was associated with the HVAD device and male sex, whereas executive function decline was associated with the HVAD device and stroke during CF-LVAD support. For patients intact at baseline, male sex and history of hypertension were associated with decline in immediate memory and executive function, respectively. Conclusions: Neurocognitive function remained stable or improved for most patients (∼80%) with CF-LVAD at 6, 12, and 24 months after implantation. Male sex, hypertension, HVAD, and stroke were associated with cognitive decline.
KW - cognition
KW - continuous flow left ventricular assist device
KW - left ventricular assist device
KW - neurocognitive outcome
KW - neurologic complication
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U2 - 10.1016/j.jchf.2021.05.016
DO - 10.1016/j.jchf.2021.05.016
M3 - Article
C2 - 34509403
AN - SCOPUS:85117228551
VL - 9
SP - 839
EP - 851
JO - JACC: Heart Failure
JF - JACC: Heart Failure
SN - 2213-1779
IS - 11
ER -