A Lower Cognitive Function in Patients with Severe Mitral Regurgitation Compared to those with Non-severe Mitral Regurgitation
Sulistiyati Bayu Utami, Fauzia Astari, Satrio Adi Wicaksono
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ABSTRACT
Background: Cognitive function includes cognitive domain such as memory, attention, execution function, psychomotor speed, language (speech), and visuospatial ability. Cardiac disease leads to cognitive impairment which may worsen its prognosis and further impact on increased mortality. However, there was limited study that explained the relationship between the severity of mitral regurgitation (MR) and cognitive function.
Aim: To compare the levels of cognitive function between patients with severe MR and non-severe MR.
Method: This was an observational study with cross-sectional design using consecutive sampling method. There were 276 subjects that consist of 134 subjects with severe MR and 142 subjects with non-severe MR, aged 20-65 years hospitalized in Dr.Kariadi hospital Semarang and Diponegoro National Hospital Semarang from February 2016 to February 2018. Subjects were examined for their cognitive function using MoCA-Ina score with blinding for their diagnosis. Statistical test were performed using chi-square test, Mann-Whitney test and non-parametric Spearman correlation test. p<0.05 was considered as statistically significant.
Results: Cognitive function by MoCA-Ina score in patients with severe MR was lower than those with non-severe MR (20.6 ± 3.9 vs 23.6 ± 4.2, p=0.000, respectively). There were higher proportions of atrial fibrillation, left atrial (LA) dilatation with LA diameter >40 mm, and left ventricle (LV) dilatation with LV diameter >55 mm, in group with severe MR compared to that with non-severe MR (p<0.05). There were larger LA diameter (47.5 ± 8.2 vs 41.8 ± 10.1, p=0.000) and larger LV diameter (56.9 ± 8.1 vs 49.2 ± 10.7, p=0.000) in group with severe MR compared to that with non-severe MR.
Conclusion: The severity of MR might impact on impaired cognitive function. This might be through LA remodeling and atrial fibrillation. Optimal management should be given in preventing cognitive decline in severe MR.
Keywords: Mitral regurgitation, severe MR, non severe MR, cognitive function, MoCA Ina score