Key result
In patients with severe mitral regurgitation, jugular venous reflux combined with high right atrial pressure was significantly associated with poorer global cognitive performance (MMSE B coefficient -2.83).
Why the study?
It was unknown whether patients with severe mitral regurgitation have poorer cognitive functions and whether jugular venous reflux is involved.
Does severe mitral regurgitation and associated jugular venous reflux impair cognitive function in adults?
Case-Control (n=80)
Single-blind
No
Does severe mitral regurgitation and associated jugular venous reflux impair cognitive function in adults?
In patients with severe mitral regurgitation, the combination of jugular venous reflux and elevated right atrial pressure is associated with worse global cognitive and visuospatial functions, suggesting a role for retrogradely transmitted venous pressure in brain-heart interactions.
Answers are grounded in this paper and cite their sources.
May warrant cognitive screening in SMR; leaves open JVR mediation pending prospective confirmation.
Cardiac diseases with elevated central venous pressure have higher frequency of jugular venous reflux (JVR), which is associated with decreased cerebral blood flow and white matter hyperintensities. Whether patients with severe mitral-regurgitation (SMR) have poorer cognitive functions and whether JVR is involved were determined in this pilot study. Patients with SMR and age/sex-matched controls were prospectively recruited. Neuropsychological tests such as global cognitive (Mini-Mental State Examination, MMSE), verbal memory, executive, and visuospatial domains were performed. Cardiac parameters by cardiac catheterisation and echocardiography, and the frequency of JVR by colour-coded duplex ultrasonography were obtained. Forty patients with SMR and 40 controls (71.1±12.2, 38-89 years; 75% men) were included. Compared with the controls, patients with SMR had lower scores in all neuropsychological tests but only MMSE and visuospatial test scores were statistically significant after adjusting for age, sex, and educational level. We further adjusted for cardiovascular risk factors; the significance remained in the visuospatial test but diminished in MMSE. Multivariate linear regression analyses adjusted for age, sex, and educational level showed that JVR combined with high right-atrial-pressure (RAP > 50th-percentile, 12 mmHg) was significantly associated with poorer performances in both MMSE [right JVR: B coefficient(95% confidence interval,p) = -2.83(-5.46-0.20, 0.036); left JVR: -2.77(-5.52-0.02, 0.048)] and visuospatial test [right JVR: -4.52(-8.89-0.16, 0.043); left JVR: -4.56(-8.81-0.30, 0.037)], with significances that remained after further adjusting for cardiovascular risk factors. Our pilot results suggest that retrogradely-transmitted venous pressure might be involved in the mechanisms mediating the relationship between cardiac diseases and brain functions.
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Sung et al. (2019) conducted a case-control in Severe mitral regurgitation (n=80). Jugular venous reflux combined with high right atrial pressure vs. Absence of jugular venous reflux and high right atrial pressure was evaluated on Mini-Mental State Examination (MMSE) score (B coefficient -2.83, 95% CI -5.46 to -0.20, p=0.036). In patients with severe mitral regurgitation, jugular venous reflux combined with high right atrial pressure was significantly associated with poorer global cognitive performance (MMSE B coefficient -2.83).
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