Key result
Higher postoperative MoCA scores are linked to ~26% lower mid-term post-transplant mortality.
Why the study?
Although postoperative cognitive impairment occurs in a substantial proportion of heart transplant recipients, its association with survival after heart transplantation had not been explored.
Does postoperative cognitive impairment predict worse mid-term survival in adult heart transplant recipients?
Cohort (n=43)
Does postoperative cognitive impairment predict worse mid-term survival in adult heart transplant recipients?
Hazard Ratio: 0.744 (95% CI 0.584–0.949)
p-value: p=0.017
Postoperative and preoperative cognitive impairments are associated with worse mid-term survival after heart transplantation, highlighting the potential value of routine neuropsychological assessments for risk stratification.
May support cognitive screening for post-transplant risk stratification; hypothesis-generating and requires prospective validation.
BACKGROUND: Heart transplantation is the definitive therapy for patients with end-stage heart failure. Antecedent studies reported that a substantial proportion of heart transplant recipients developed postoperative cognitive impairment in the long term. However, no studies have explored the association between postoperative cognitive impairment and survival after heart transplantation. METHODS: The data of 43 adult patients who underwent heart transplantation were consecutively enrolled and assessed using the MMSE and MoCA neuropsychological tests. Kaplan-Meier curves and Cox proportional hazards models were used for survival analyses. Primary component analysis was performed to integrate MoCA subtests into the "Attention factor," "Naming factor," and "Orientation factor." RESULTS: About 30% of the patients were diagnosed with short-term postoperative cognitive impairment. The impairment group was older and had lower baseline cognitive performances, larger LV diameter, worse MMSE decline and higher ratio of significant MoCA decline. Postoperative cognitive impairment was significantly associated with worse survival (P = .028). Multivariate Cox analyses showed that higher postoperative MoCA score was significantly associated with lower mid-term post-transplant mortality (HR = .744 [.584, .949], P = .017), in which "Attention factor" contributed to this association most (HR = .345 [.123, .970], P = .044) rather than "Naming factor" or "Orientation factor." Notably, preoperative cognitive impairment was closely related with postoperative cognitive impairment and also indicated the worse post-transplant survival (P = .015). CONCLUSION: Postoperative as well as preoperative cognitive impairments were associated with a worse mid-term survival after heart transplantation, indicating that neuropsychological assessments before and after heart transplantation should be routinely performed for heart transplant recipients for better risk stratification.
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Xiong et al. (2022) conducted a cohort in Heart transplantation (n=43). Higher postoperative MoCA score vs. Lower postoperative MoCA score was evaluated on Mid-term post-transplant mortality (HR 0.744, 95% CI 0.584-0.949, p=0.017). Higher postoperative MoCA scores were significantly associated with lower mid-term post-transplant mortality (HR 0.744; 95% CI 0.584-0.949; P=0.017).
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