Affiliations: Department of Neurology, Johns Hopkins University
School of Medicine, Baltimore, MD, USA | Department of Cardiac Surgery, Johns Hopkins
University School of Medicine, Baltimore, MD, USA | Johns Hopkins Bloomberg School of Public Health, Johns
Hopkins University, Baltimore, MD, USA | The Zanvyl-Krieger Mind Brain Institute, Johns Hopkins
University, Baltimore, MD, USA
Note: [] Corresponding author: Rebecca F. Gottesman, Meyer 6-113, 600
North Wolfe Street, Baltimore, MD 21287, USA. Tel.: +1 410 614 2381; Fax: +1
410 955 0672; E-mail: rgottesm@jhmi.edu
Abstract: Background and purpose: Impaired cardiac function can adversely
affect the brain via decreased perfusion. The purpose of this study was to
determine if cardiac ejection fraction (EF) is associated with cognitive
performance, and whether this is modified by low blood pressure. Methods: Neuropsychological testing evaluating multiple cognitive domains, measurement
of mean arterial pressure (MAP), and measurement of EF were performed in 234
individuals with coronary artery disease. The association between level of EF
and performance within each cognitive domain was explored, as was the
interaction between low MAP and EF. Results: Adjusted global cognitive
performance, as well as performance in visuoconstruction and motor speed, was
significantly directly associated with cardiac EF. This relationship was not
entirely linear, with a steeper association between EF and cognition at lower
levels of EF than at higher levels. Patients with low EF and low MAP at the
time of testing had worse cognitive performance than either of these alone,
particularly for the global and motor speed cognitive scores. Conclusions: Low EF may be associated with worse cognitive performance,
particularly among individuals with low MAP and for cognitive domains typically
associated with vascular cognitive impairment. Further care should be paid to
hypotension in the setting of heart failure, as this may exacerbate cerebral
hypoperfusion.
