109 - Beyond Cardiac Output: Physiological Improvement Predicts Memory Improvement Post LVAD Placement

Abstract

Background:Advanced heart failure (AHF) causes multi-system dysfunction, in addition to cognitive decline. The predominant model speculates cerebral hypoperfusion places patients at risk for cognitive decline. Left Ventricular Assist Device (LVAD) implant is growing exponentially as a treatment modality for AHF. Despite reports of improvement in multiple body systems following LVAD placement, including cognition, research examining physiological mechanisms impacting longitudinal outcomes of cognition is sparse. We have previously found improved cognition after LVAD implant in processing speed, verbal free recall memory, verbal recognition memory, and visual memory. Objective: We aimed to identify physiologic metrics that might correlate or predict neurologic improvement. Methods: We followed patients pre- and post-LVAD implantation (n = 17), comparing cognition and multiple physiological outcomes across time points (A: 3–6 months; B: 6–12 months; C: 2 years) for individuals using linear mixed models. Results: Cardiac output was related to improvements in verbal free recall 12 months post-implant, showing a linear relationship with regard to memory. Albumin levels also showed a linear relationship with verbal memory 12 months post-implant. Creatinine improvement predicted visual memory while improvement in sodium predicted improvement in both visual memory and verbal recognition memory. Findings expand the predominant model of improvements in cognition following LVAD placement to include related systemic physiological outcomes. Conclusion: These contribute to the limited extant research showing stable or modest improvements in cognition and provide further understanding of the physiologic mechanisms that may explain the effects of LVAD placement on neurocognition.