Cognitive assessment using the revised Hasegawa's dementia scale to determine the mid-term outcomes following transcatheter aortic valve replacement.

Abstract

BACKGROUND:

Several predictors are available to guide patient selection for transcatheter aortic valve replacement (TAVR) to achieve better outcomes, and cognitive function is one of these predictors. This study investigated whether the revised Hasegawa's dementia scale (HDS-R) could independently predict mid-term outcomes following TAVR.

METHODS:

The study population comprised 455 patients with severe aortic stenosis who underwent TAVR at the Sakakibara Heart Institute between 2010 and 2018. The primary endpoint was all-cause mortality following TAVR. Patients were dichotomized into two groups according to the receiver operating characteristic analysis (HDS-R ≤23 and >23).

RESULTS:

Patients with HDS-R ≤23 were older, were more frail, were more likely to have peripheral artery disease, had lower serum albumin levels, had lower ejection fractions, and had smaller aortic valve areas than those with HDS-R >23. By definition, 81 of the 455 patients (17.8%) were considered to have dementia (HDS-R ≤20) before TAVR. The discriminatory performance for predicting all-cause mortality at 3 years was greater for dichotomization with 23/24 than that with 20/21 [area under the curve (AUC): 0.63, 95% confidence interval (CI): 0.50-0.76, p=0.047 vs. AUC: 0.52, 95% CI: 0.39-0.65, p=0.713]. From the Kaplan-Meier analysis, patients with HDS-R ≤23 had higher mortality rates than those with HDS-R >23 (86.8±3.3% and 75.4±4.7% at 3 years, respectively; log-rank p=0.001). The multivariate Cox regression analysis found that the HDS-R was independently associated with all-cause mortality (hazard ratio 2.11, 95% CI 1.21-3.69, p=0.008).

CONCLUSIONS:

Patients with HDS-R ≤23 were sicker and more frail and had greater cognitive impairment. Additionally, HDS-R could independently predict mid-term outcomes following TAVR.

• Authors: Mike Saji, Tetsuya Tobaru, Ryosuke Higuchi, Kenichi Hagiya, Itaru Takamisawa, Jun Shimizu, Nobuo Iguchi, Shuichiro Takanashi, Morimasa Takayama, Mitsuaki Isobe
• Journal: Journal of cardiology (J Cardiol) Vol. 74 Issue 3 Pg. 206-211 (Sep 2019) ISSN: 1876-4738 [Electronic] Netherlands
• PMID: 31015001 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Aortic Valve (surgery)
• Aortic Valve Stenosis (mortality, psychology, surgery)
• Cognition
• Dementia (complications, diagnosis)
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Multivariate Analysis
• Patient Selection
• Predictive Value of Tests
• Preoperative Period
• Proportional Hazards Models
• Risk Factors
• Time Factors
• Transcatheter Aortic Valve Replacement (mortality)
• Treatment Outcome