Advertisement

Association of Left Atrial Structure and Function With Cognitive Function in Adults With Metabolic Syndrome

  • Ines Gonzalez Casanova
    Correspondence
    Corresponding author: Tel: 812-855-3627; fax: 812-855-1294.
    Affiliations
    Department of Applied Health Science, Indiana University Bloomington School of Public Health, Bloomington, Indiana
    Search for articles by this author
  • Ángel M. Alonso-Gómez
    Affiliations
    Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain

    CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn), Carlos III Health Institute (ISCIII), Madrid, Spain
    Search for articles by this author
  • Dora Romaguera
    Affiliations
    CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn), Carlos III Health Institute (ISCIII), Madrid, Spain

    Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
    Search for articles by this author
  • Estefanía Toledo
    Affiliations
    CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn), Carlos III Health Institute (ISCIII), Madrid, Spain

    Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain

    Navarra's Health Research Institute (IdiSNA), Navarra Institute for Health Research, Pamplona, Spain
    Search for articles by this author
  • Elena Fortuny
    Affiliations
    Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain

    Cardiology Service, Manacor Hospital, Palma de Mallorca, Spain
    Search for articles by this author
  • Luis López
    Affiliations
    Cardiology Service, Son Espases University Hospital, Palma de Mallorca, Spain
    Search for articles by this author
  • Raúl Ramallal
    Affiliations
    Navarra's Health Research Institute (IdiSNA), Navarra Institute for Health Research, Pamplona, Spain

    Department of Cardiology, University Hospital of Navarra, Navarro Health Institute Osasunbidea, Pamplona, Spain
    Search for articles by this author
  • Jordi Salas-Salvadó
    Affiliations
    CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn), Carlos III Health Institute (ISCIII), Madrid, Spain

    Human Nutrition Unit, Department of Biochemistry and Biotechnology, Rovira i Virigili University, Reus, Spain

    Human Nutrition Unit, Pere Virgili Health Research Institute (IISPV), Reus, Spain
    Search for articles by this author
  • Lucas Tojal-Sierra
    Affiliations
    Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain

    CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn), Carlos III Health Institute (ISCIII), Madrid, Spain
    Search for articles by this author
  • Olga Castañer
    Affiliations
    CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn), Carlos III Health Institute (ISCIII), Madrid, Spain

    Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
    Search for articles by this author
  • Alvaro Alonso
    Affiliations
    Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
    Search for articles by this author
Published:September 13, 2022DOI:https://doi.org/10.1016/j.amjcard.2022.08.006
      Atrial fibrillation has been associated with cognitive impairment. Whether subclinical abnormalities in atrial function and substrate predisposing to atrial fibrillation impact cognitive function has received limited attention. We tested associations of echocardiographic markers of atrial structure and function with cognitive function and decrease in 510 participants with obesity and metabolic syndrome (mean age SD of 64.4 [5.2] years in men and 66.5 [3.9] years in women). Left atrial (LA) markers (volume index, emptying fraction, strain, function index, and stiffness index) were estimated based on transthoracic echocardiography. General cognitive functioning (Mini-mental state examination), verbal ability (verbal fluency test), memory and attention (Digit Span Tests), and processing speed and executive function (Trail-Making Tests A and B) were assessed at baseline and at 2-year follow-up. Multiple linear regression was used to test associations of atrial markers (modeled in SD units) with baseline and 2-year changes in cognitive scores adjusted for demographic and health covariates. LA structure and function were not associated with cognitive function at baseline. Larger LA volume index (standardized β [95% confidence interval] −0.13 [−0.22 to −0.03]), lower peak longitudinal strain (−0.11 [−0.20 to −0.01]), and higher stiffness index (−0.18 [−0.28 to −0.08]) were associated with 2-year worsening in Trail-Making Test A. Strain measurements were also associated with a 2-year change in the Controlled Oral Word Association Test. In conclusion, overall, adverse markers of LA structure and function were associated with 2-year detrimental executive function-related cognitive changes in a sample of participants at high risk for cardiovascular disease, highlighting LA substrate as a potential risk factor for cognitive decrease and dementia.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Santangeli P
        • Di Biase L
        • Bai R
        • Mohanty S
        • Pump A
        • Cereceda Brantes M
        • Horton R
        • Burkhardt JD
        • Lakkireddy D
        • Reddy YM
        • Casella M
        • Dello Russo A
        • Tondo C
        • Natale A
        Atrial fibrillation and the risk of incident dementia: a meta-analysis.
        Heart Rhythm. 2012; 9: 1761-1768
        • Islam MM
        • Poly TN
        • Walther BA
        • Yang HC
        • Wu CC
        • Lin MC
        • Chien SC
        • Li YC.
        Association Between atrial fibrillation and dementia: a meta-analysis.
        Front Aging Neurosci. 2019; 11 (305–305)
        • Madhavan M
        • Graff-Radford J
        • Piccini JP
        • Gersh BJ.
        Cognitive dysfunction in atrial fibrillation.
        Nat Rev Cardiol. 2018; 15: 744-756
        • Alonso A
        • Arenas de Larriva AP
        Atrial fibrillation, cognitive decline and dementia.
        Eur Cardiol. 2016; 11: 49-53
        • Gutierrez A
        • Norby FL
        • Maheshwari A
        • Rooney MR
        • Gottesman RF
        • Mosley TH
        • Lutsey PL
        • Oldenburg N
        • Soliman EZ
        • Alonso A
        • Chen LY.
        Association of abnormal P-wave indices With dementia and cognitive decline over 25 years: ARIC-NCS (the atherosclerosis risk in communities neurocognitive study).
        J Am Heart Assoc. 2019; 8e014553
        • Karadag B
        • Ozyigit T
        • Ozben B
        • Kayaoglu S
        • Altuntas Y.
        Relationship between left atrial volume index and cognitive decline in elderly patients with sinus rhythm.
        J Clin Neurosci. 2013; 20: 1074-1078
        • Martínez-González MA
        • Buil-Cosiales P
        • Corella D
        • Bulló M
        • Fitó M
        • Vioque J
        • Romaguera D
        • Martínez JA
        • Wärnberg J
        • López-Miranda J
        • Estruch R
        • Bueno-Cavanillas A
        • Arós F
        • Tur JA
        • Tinahones F
        • Serra-Majem L
        • Martín V
        • Lapetra J
        • Vázquez C
        • Pintó X
        • Vidal J
        • Daimiel L
        • Delgado-Rodríguez M
        • Matía P
        • Ros E
        • Fernández-Aranda F
        • Botella C
        • Portillo MP
        • Lamuela-Raventós RM
        • Marcos A
        • Sáez G
        • Gómez-Gracia E
        • Ruiz-Canela M
        • Toledo E
        • Alvarez-Alvarez I
        • Díez-Espino J
        • Sorlí JV
        • Basora J
        • Castañer O
        • Schröder H
        • Navarrete-Muñoz EM
        • Zulet MA
        • García-Rios A
        • Salas-Salvadó J
        • PREDIMED-Plus Study Investigators
        Cohort Profile: design and methods of the PREDIMED-Plus randomized trial.
        Int J Epidemiol. 2019; 48: 387-388o
        • Upton J
        • State MM.
        Examination.
        in: Gellman MD Turner JR Encyclopedia of Behavioral Medicine. Springer, New York2013: 1248-1249
        • Folstein MF
        • Folstein SE
        • McHugh PR.
        "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Mitchell AJ.
        A meta-analysis of the accuracy of the Mini-Mental State Examination in the detection of dementia and mild cognitive impairment.
        J Psychiatr Res. 2009; 43: 411-431
        • Wambach D
        • Lamar M
        • Swenson R
        • Penney DL
        • Kaplan E
        • Libon DJ.
        Digit span.
        in: Kreutzer JS DeLuca J Caplan B Encyclopedia of Clinical Neuropsychology. Springer, New York2011: 844-849
        • Wechsler D.
        WAIS-III, Wechsler intelligence scale for adults-III : application and correction manual.
        TEA, Madrid2001
        • Patterson J.
        Controlled oral word association test.
        in: Kreutzer JS DeLuca J Caplan B Encyclopedia of Clinical Neuropsychology. Springer, New York2011: 703-706
        • Llinàs-Reglà J
        • Vilalta-Franch J
        • López-Pousa S
        • Calvó-Perxas L
        • Torrents Rodas D
        • Garre-Olmo J
        The trail making test.
        Assessment. 2017; 24: 183-196
        • Nagueh SF
        • Smiseth OA
        • Appleton CP
        • Byrd 3rd, BF
        • Dokainish H
        • Edvardsen T
        • Flachskampf FA
        • Gillebert TC
        • Klein AL
        • Lancellotti P
        • Marino P
        • Oh JK
        • Popescu BA
        • Waggoner AD.
        Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
        J Am Soc Echocardiogr. 2016; 29: 277-314
        • Thomas L
        • Hoy M
        • Byth K
        • Schiller NB.
        The left atrial function index: a rhythm independent marker of atrial function.
        Eur J Echocardiogr. 2008; 9: 356-362
        • Machino-Ohtsuka T
        • Seo Y
        • Tada H
        • Ishizu T
        • Machino T
        • Yamasaki H
        • Igarashi M
        • Xu D
        • Sekiguchi Y
        • Aonuma K.
        Left atrial stiffness relates to left ventricular diastolic dysfunction and recurrence after pulmonary vein isolation for atrial fibrillation.
        J Cardiovasc Electrophysiol. 2011; 22: 999-1006
        • Lip GY
        • Nieuwlaat R
        • Pisters R
        • Lane DA
        • Crijns HJ.
        Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation.
        Chest. 2010; 137: 263-272
        • Sofi F
        • Macchi C
        • Abbate R
        • Gensini GF
        • Casini A.
        Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score.
        Public Health Nutr. 2014; 17: 2769-2782
        • Elosua R
        • Marrugat J
        • Molina L
        • Pons S
        • Pujol E.
        Validation of the Minnesota leisure time physical activity questionnaire in Spanish men. The MARATHOM Investigators.
        Am J Epidemiol. 1994; 139: 1197-1209
        • Kalantarian S
        • Stern TA
        • Mansour M
        • Ruskin JN.
        Cognitive impairment associated with atrial fibrillation: a meta-analysis.
        Ann Intern Med. 2013; 158: 338-346
        • Song R
        • Xu H
        • Dintica CS
        • Pan KY
        • Qi X
        • Buchman AS
        • Bennett DA
        • Xu W.
        Associations Between cardiovascular risk, structural brain changes, and cognitive decline.
        J Am Coll Cardiol. 2020; 75: 2525-2534
        • Szegedi I
        • Szapáry L
        • Csécsei P
        • Csanádi Z
        • Csiba L.
        Potential biological markers of atrial fibrillation: A chance to prevent cryptogenic stroke.
        BioMed Res Int. 2017; 2017 (8153024–8153024)
        • Russo C
        • Jin Z
        • Liu R
        • Iwata S
        • Tugcu A
        • Yoshita M
        • Homma S
        • Elkind MSV
        • Rundek T
        • Decarli C
        • Wright CB
        • Sacco RL
        • Di Tullio MR
        LA volumes and reservoir function are associated with subclinical cerebrovascular disease: the CABL (Cardiovascular Abnormalities and Brain Lesions) study.
        JACC Cardiovasc Imaging. 2013; 6: 313-323
        • Kresge HA
        • Khan OA
        • Wagener MA
        • Liu D
        • Terry JG
        • Nair S
        • Cambronero FE
        • Gifford KA
        • Osborn KE
        • Hohman TJ
        • Pechman KR
        • Bell SP
        • Wang TJ
        • Carr JJ
        • Jefferson AL.
        Subclinical compromise in cardiac strain relates to lower cognitive performances in older adults.
        J Am Heart Assoc. 2018; 7e007562
        • Tsang TS
        • Abhayaratna WP
        • Barnes ME
        • Miyasaka Y
        • Gersh BJ
        • Bailey KR
        • Cha SS
        • Seward JB.
        Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter?.
        J Am Coll Cardiol. 2006; 47: 1018-1023
        • Zhang MJ
        • Norby FL
        • Lutsey PL
        • Mosley TH
        • Cogswell RJ
        • Konety SH
        • Chao TF
        • Shah AM
        • Solomon SD
        • Alonso A
        • Chen LY.
        Association of left atrial enlargement and atrial fibrillation with cognitive function and decline: the ARIC-NCS.
        J Am Heart Assoc. 2019; 8e013197
        • Shibuya-Tayoshi S
        • Sumitani S
        • Kikuchi K
        • Tanaka T
        • Tayoshi SY
        • Ueno S-I
        • Ohmori T.
        Activation of the prefrontal cortex during the Trail-Making Test detected with multichannel near-infrared spectroscopy.
        Psychiatry Clin Neurosci. 2007; 61: 616-621