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Hämmerle P, Aeschbacher S, Springer A, Eken C, Coslovsky M, Dutilh G, Moschovitis G, Rodondi N, Chocano P, Conen D, Osswald S, Kühne M, Zuern CS. Cardiac autonomic function and cognitive performance in patients with atrial fibrillation. Clin Res Cardiol 2021; 111:60-69. [PMID: 34156525 PMCID: PMC8766386 DOI: 10.1007/s00392-021-01900-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/16/2021] [Indexed: 12/14/2022]
Abstract
Background Atrial fibrillation (AF) is associated with loss of cognition and dementia. Cardiac autonomic dysfunction has been linked to cognitive decline. We aimed to investigate if reduced cardiac autonomic function (CAF) is associated with cognitive impairment in AF patients. Methods Patients with paroxysmal, persistent and permanent AF were enrolled from a multicenter cohort study if they had AF (“AF group”) or sinus rhythm (“SR group”) on a baseline 5 min ECG recording. Parameters quantifying CAF (heart rate variability triangular index (HRVI), mean heart rate (MHR), RMSSD, SDNN, total power and power in the VLF, LF, HF ranges) were calculated. We used the Montreal Cognitive Assessment (MoCA) to assess global cognitive function. Results 1685 AF patients with a mean age of 73 ± 8 years, 29% females, were included. MoCA score was 24.5 ± 3.2 in the AF group (N = 710 patients) and 25.4 ± 3.2 in the SR group (N = 975 patients). After adjusting for multiple confounders, lower HRVI was associated with lower MoCA scores, both in the SR group [β = 0.049; 95% confidence interval (CI) 0.016–0.081; p = 0.003] and in the AF group (β = 0.068; 95% CI 0.020–0.116; p = 0.006). In the AF group, higher MHR was associated with a poorer performance in the MoCA (β = − 0.008; 95% CI − 0.014 to − 0.002; p = 0.014). We found no convincing evidence of association for other CAF parameters with cognition. Conclusion Our data suggest that impaired CAF is associated with worse cognitive performance in patients with AF. Among standard HRV parameters, HRVI might be the most promising ECG index. Trial registration ClinicalTrials.gov Identifier: NCT02105844. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01900-4.
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Affiliation(s)
- Peter Hämmerle
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Anne Springer
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Ceylan Eken
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Coslovsky
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
- Department Clinical Research, University of Basel, Basel, Switzerland
| | - Gilles Dutilh
- Department Clinical Research, University of Basel, Basel, Switzerland
| | - Giorgio Moschovitis
- Department of Cardiology, Hospedale Regionale Di Lugano, Lugano, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Patricia Chocano
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - David Conen
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Stefan Osswald
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Christine S Zuern
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.
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Ogliari G, Mahinrad S, Stott DJ, Jukema JW, Mooijaart SP, Macfarlane PW, Clark EN, Kearney PM, Westendorp RGJ, de Craen AJM, Sabayan B. Resting heart rate, heart rate variability and functional decline in old age. CMAJ 2015; 187:E442-E449. [PMID: 26323697 DOI: 10.1503/cmaj.150462] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Heart rate and heart rate variability, markers of cardiac autonomic function, have been linked with cardiovascular disease. We investigated whether heart rate and heart rate variability are associated with functional status in older adults, independent of cardiovascular disease. METHODS We obtained data from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER). A total of 5042 participants were included in the present study, and mean follow-up was 3.2 years. Heart rate and heart rate variability were derived from baseline 10-second electrocardiograms. Heart rate variability was defined as the standard deviation of normal-to-normal RR intervals (SDNN). Functional status in basic (ADL) and instrumental (IADL) activities of daily living was measured using Barthel and Lawton scales, at baseline and during follow-up. RESULTS The mean age of the study population was 75.3 years. At baseline, higher heart rate was associated with worse ADL and IADL, and lower SDNN was related to worse IADL (all p values < 0.05). Participants in the highest tertile of heart rate (range 71-117 beats/min) had a 1.79-fold (95% confidence interval [CI] 1.45-2.22) and 1.35-fold (95% CI 1.12-1.63) higher risk of decline in ADL and IADL, respectively (p for trend < 0.001 and 0.001, respectively). Participants in the lowest tertile of SDNN (range 1.70-13.30 ms) had 1.21-fold (95% CI 1.00-1.46) and 1.25-fold (95% CI 1.05-1.48) higher risk of decline in ADL and IADL, respectively (both p for trends < 0.05). All associations were independent of sex, medications, cardiovascular risk factors and comorbidities. INTERPRETATION Higher resting heart rate and lower heart rate variability were associated with worse functional status and with higher risk of future functional decline in older adults, independent of cardiovascular disease. This study provides insight into the role of cardiac autonomic function in the development of functional decline.
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Affiliation(s)
- Giulia Ogliari
- Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands
| | - Simin Mahinrad
- Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands
| | - David J Stott
- Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands
| | - J Wouter Jukema
- Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands
| | - Peter W Macfarlane
- Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands
| | - Elaine N Clark
- Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands
| | - Patricia M Kearney
- Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands
| | - Rudi G J Westendorp
- Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands
| | - Behnam Sabayan
- Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands
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