Spatial QRS-T Angle and Cognitive Decline in Older Subjects

Article type: Research Article

Authors: Mahinrad, Simin^{a; b} | Ferguson, Ian^c | Macfarlane, Peter W.^d | Clark, Elaine N.^d | Stott, David J.^e | Ford, Ian^f | Mooijaart, Simon P.^a | Trompet, Stella^a | van Heemst, Diana^a | Jukema, J. Wouter^g | Sabayan, Behnam^{a; b; *}

Affiliations: [a] Department of Internal Medicine, Gerontology and Geriatrics Section, Leiden University Medical Center, Leiden, The Netherlands | [b] Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA | [c] School of Medicine and Medical Science, University College Dublin, Dublin, Ireland | [d] Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK | [e] Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK | [f] The Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK | [g] Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

Correspondence: [*] Correspondence to: Behnam Sabayan, MD, PhD, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Galter Suite 3 150, Chicago, IL 60611, USA. Tel.: +1 312 868 9432; E-mail: behnam.sabayan@northwestern.edu.

Abstract: Background:An abnormally wide spatial QRS-T angle on an ECG is a marker of heterogeneity in electrical activity of cardiac ventricles and is linked with cardiovascular events. Growing evidence suggests that cardiac dysfunction might signal future cognitive decline. Objective: In this study, we investigated whether spatial QRS-T angle associates with future cognitive decline in older subjects at high cardiovascular risk. Methods:We included 4,172 men and women (mean age 75.2±3.3 years) free of cardiac arrhythmias from the PROSPER cohort. Spatial QRS-T angle was calculated from baseline 12-lead ECGs using a matrix transformation method. Cognitive function was assessed using 4 neuropsychological tests including Stroop test, letter-digit coding test, immediate and delayed picture word learning tests. Cognitive function was assessed at baseline and repeatedly during a mean follow-up time of 3.2 years. Using linear mixed models, we calculated the annual changes of cognitive scores in sex-specific thirds of spatial QRS-T angle. Results:Participants with wider spatial QRS-T angle had a steeper decline in letter-digit coding test (β= –0.0106, p = 0.004), immediate picture-word learning test (β= –0.0049, p = 0.001), and delayed picture-word learning test (β= –0.0055, p = 0.013). All associations were independent of arrhythmias, cardiovascular risk factors, comorbidities, medication use, cardiovascular events, and other ECG abnormalities including QRS duration, QTc interval, T wave abnormalities, and left ventricular hypertrophy. Conclusion:Abnormal cardiac electrical activity characterized by wide spatial QRS-T angle associates with accelerated cognitive decline independent of conventional cardiovascular factors. These findings suggest a link between a non-traditional ECG measure of pre-clinical cardiac pathology and future cognitive decline.

Keywords: Cardiac dysfunction, cognitive function, old age, spatial QRS-T angle

DOI: 10.3233/JAD-180633

Journal: Journal of Alzheimer's Disease, vol. 67, no. 1, pp. 279-289, 2019