Malignant left ventricular hypertrophy and risk of cognitive impairment in SPRINT MIND trial

Abstract

BackgroundThe association of malignant left ventricular hypertrophy (LVH), a specific subphenotype of LVH characterized by elevated levels of high-sensitivity cardiac troponin (hs-cTnT) or N-terminal pro–B-type natriuretic peptide (NT-proBNP), with cognitive decline remains understudied. MethodsThis post-hoc analysis included a total of 8,027 (67.9±9.3 years) SPRINT MIND trial participants who had with at least one follow-up cognitive assessment. Participants were classified into six groups on the basis of LVH status on electrocardiogram (ECG), and elevations in levels of hs-cTnT ≥14 ng/L or NT-proBNP ≥125 pg/mL at baseline visit. Multivariate Cox proportional hazard models were used to examine the association of LVH/biomarker groups with incident probable dementia, mild cognitive impairment (MCI) and a composite of MCI/probable dementia. ResultsOver a median follow-up period of 5 years, there were 306, 597 and 818 incidents of MCI, probable dementia and a composite of MCI/probable dementia, respectively. Compared with participants without LVH and normal biomarker levels, those with concomitant LVH and elevated levels of both biomarkers were associated with a higher risk of probable dementia (HR, 2.50; 95% CI (1.26 – 4.95), MCI (HR, 1.78; 95% CI (0.99 – 3.23) and the composite of MCI/ probable dementia (HR, 1.89; 95% CI, 1.16 – 3.10). ConclusionsAmong SPRINT participants, malignant LVH is associated with incident probable dementia and mild cognitive impairment. These findings underscore the potential utility of measuring hs-cTnT and NT-proBNP levels when LVH is detected on ECG, aiding in the differentiation of individuals with a favorable risk for cognitive impairment from those with a higher risk.