(Circulation. 1996;94:1339-1345.)
© 1996 American Heart Association, Inc.
Articles |
Cyclosporine May Affect Improvement of Cognitive Brain Function After Successful Cardiac Transplantation
the Department of Cardiothoracic Surgery (M.G., W.Y., G.L., P.S., N.K., B.B., E.W.); the Fourth Department of Internal Medicine (C.M., L.K., E.E., G.G.); the Department of Medical Computer Science (W.S.); and the Second Department of Internal Medicine (R.P.), University of Vienna, Austria.
Correspondence to Georg Grimm, MD, PhD, Second Department of Internal Medicine, General Hospital Klagenfurt, St Veiterstr 47, A-9020 Klagenfurt, Austria.
Background The effects of cardiac transplantation on cognitive brain function are uncertain.
Methods and Results We measured cognitive brain function and quality of life in out-of-hospital cardiac transplant candidates (n=55; ejection fraction, 19.9%; age, 54.8 years [means]). After transplantation, the patients were serially reevaluated at 4 months (n=25) and at 12 months (n=19). Brain function was measured objectively by cognitive P300 evoked potentials. Additionally, standard psychometric tests (Trail Making Test A, Mini-Mental State Examination, and Profile of Mood State test) were performed. Cognitive P300 evoked potentials were impaired in cardiac transplant candidates (359 ms, recorded at vertex) compared with 55 age- and sex-matched healthy subjects (345 ms, P<.01). Trail Making Test A was also abnormal (45 versus 31 seconds in 55 healthy subjects, P<.01). After transplantation, P300 measures were normalized at 4 months (345 ms, P<.05 versus before transplantation) but declined again at 12 months (352 ms, P=NS versus before transplantation). Stepwise multiple regression analysis revealed that cumulative cyclosporine dosage was the only predictor of individual cognitive brain function 4 months (753 mg/kg body wt, P<.05) and 12 months (2006 mg/kg body wt, P<.01) after transplantation, respectively.
Conclusions Objective cognitive P300 auditory evoked potential measurements indicate that cognitive brain function is significantly impaired in patients suffering from stable end-stage heart failure. Successful cardiac transplantation is effective to fully normalize impaired brain function. Subsequent relative long-term decline of cognitive brain function after successful cardiac transplantation is strongly suggested to be related to cumulative cyclosporine neurotoxicity.
Key Words: transplantation • cyclosporine • brain
This article has been cited by other articles:
 |
|
 |
|
  S. Martens, K. Neumann, C. Sodemann, H. Deschka, G. Wimmer-Greinecker, and A. Moritz Carbon Dioxide Field Flooding Reduces Neurologic Impairment After Open Heart Surgery Ann. Thorac. Surg., February 1, 2008; 85(2): 543 - 547. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. L.C. Vogels, P. Scheltens, J. M. Schroeder-Tanka, and H. C. Weinstein Cognitive impairment in heart failure: A systematic review of the literature Eur J Heart Fail, May 1, 2007; 9(5): 440 - 449. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Zuccala, G. Onder, E. Marzetti, M. R. L. Monaco, M. Cesari, A. Cocchi, P. Carbonin, R. Bernabei, and for the GIFA Study Group Use of angiotensin-converting enzyme inhibitors and variations in cognitive performance among patients with heart failure Eur. Heart J., February 1, 2005; 26(3): 226 - 233. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Zimpfer, M. Czerny, F. Vogt, P. Schuch, L. Kramer, E. Wolner, and M. Grimm Neurocognitive deficit following coronary artery bypass grafting: a prospective study of surgical patients and nonsurgical controls Ann. Thorac. Surg., August 1, 2004; 78(2): 513 - 518. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. Rodriguez Human Auditory Evoked Potentials in the Assessment of Brain Function During Major Cardiovascular Surgery Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2004; 8(2): 85 - 99. [Abstract] [PDF]
|
|
|
|
 |
|
 M. Grimm, D. Zimpfer, M. Czerny, J. Kilo, M.-T. Kasimir, L. Kramer, A. Krokovay, and E. Wolner Neurocognitive deficit following mitral valve surgery Eur. J. Cardiothorac. Surg., March 1, 2003; 23(3): 265 - 271. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Zuccala, G. Onder, C. Pedone, L. Carosella, M. Pahor, R. Bernabei, and A. Cocchi Hypotension and cognitive impairment: Selective association in patients with heart failure Neurology, December 11, 2001; 57(11): 1986 - 1992. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Kilo, M. Czerny, M. Gorlitzer, D. Zimpfer, H. Baumer, E. Wolner, and M. Grimm Cardiopulmonary bypass affects cognitive brain function after coronary artery bypass grafting Ann. Thorac. Surg., December 1, 2001; 72(6): 1926 - 1932. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. R. Malloy Correlation of Cerebral Metabolites With Clinical Outcome Among Patients With Severe Congestive Heart Failure Circulation, June 12, 2001; 103(23): 2771 - 2772. [Full Text] [PDF]
|
|
|
|
|
|
D Georgiadis, M Sievert, S Cencetti, F Uhlmann, M Krivokuca, S Zierz, and K Werdan Cerebrovascular reactivity is impaired in patients with cardiac failure Eur. Heart J., March 1, 2000; 21(5): 407 - 413. [Abstract] [PDF]
|
|
|
|
 |
|
 C. W. Lee, J.-H. Lee, J.-J. Kim, S.-W. Park, M.-K. Hong, S.-T. Kim, T.-H. Lim, and S.-J. Park Cerebral metabolic abnormalities in congestive heart failure detected by proton magnetic resonance spectroscopy J. Am. Coll. Cardiol., April 1, 1999; 33(5): 1196 - 1202. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. W. Miller Cyclosporine-Associated Neurotoxicity: The Need for a Better Guide for Immunosuppressive Therapy Circulation, September 15, 1996; 94(6): 1209 - 1211. [Full Text]
|
|