Aim:
To define the association of echocardiographic parameters of left atrial cardiomyopathy and left ventricular diastolic dysfunction with cognitive function in individuals free of clinically overt atrial fibrillation or stroke.
Methods:
Data from the first 10,000 participants of the population-based Hamburg City Health study were analysed. Of these, 8264 individuals underwent standardized transthoracic echocardiography and cognitive function testing at baseline. Parameters of left ventricular systolic and diastolic function as well as left atrial function were systematically assessed, including left atrial global peak strain. Cognitive function was quantified using the Animal Naming Test, the Trail Making Test A and B and a 10-word learning test. We performed linear regression analyses with incremental adjustment to examine the association of echocardiographic parameters with the performance on the neuropsychological tests.
Results:
After exclusion of 463 individuals with known AF and 309 individuals with prior/known stroke or severe depression, 7492 individuals were analysed (mean age 61.9 ± 8.4 years, 52.3 % women, median left ventricular ejection fraction 59% [25th/75th percentile 56/62 %], median left atrial volume index 25.0 ml/m² [25th/75th percentile 20/30 ml/m²]). In multivariable-adjusted analyses, E/e’-ratio was significantly associated with a worse performance on the Animal Naming Test (-0.24 per one standard deviation [SD] increase, 95% confidence interval [CI] -0.42 - [-0.06]), the Trail Making Test A (0.76 per one SD increase, 95% CI 0.35-1.17) and B (1.1 per one SD increase, 95% CI 0.09-2.11). Left atrial strain was associated with worse performance on Trail Making Test B (-1.39 per one SD increase, 95% CI -2.46 - [-0.32]). Increased left atrial volume index was associated with worse performance on the ANT (0.2, 95% CI 0.03-0.37).
Conclusions:
Subtle echocardiographic signs of atrial cardiomyopathy and left ventricular diastolic dysfunction are associated with worse performance on cognitive function tests in the middle-aged population in Hamburg.