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. 2023 Aug 25:14:1209905.
doi: 10.3389/fneur.2023.1209905. eCollection 2023.

Cognitive outcomes in patients treated with neuromuscular electrical stimulation after coronary artery bypass grafting

Vincenzina Lo Re  1 , Giovanna Russelli  2 , Emanuele Lo Gerfo  1   2 , Rossella Alduino  2 , Matteo Bulati  2 , Gioacchin Iannolo  2 , Danilo Terzo  3 , Gennaro Martucci  4 , Stefano Anzani  1   2 , Giovanna Panarello  4 , Gianvincenzo Sparacia  5 , Giuseppe Parla  5 , Federica Avorio  1 , Giuseppe Raffa  6 , Michele Pilato  6 , Aurelio Speciale  3 , Valentina Agnese  2 , Giuseppe Mamone  5 , Fabio Tuzzolino  2 , Giovan Battista Vizzini  7 , Pier Giulio Conaldi  2 , Fabrisia Ambrosio  8   9   10
Affiliations

Cognitive outcomes in patients treated with neuromuscular electrical stimulation after coronary artery bypass grafting

Vincenzina Lo Re et al. Front Neurol. .

Abstract

Objective: Mechanisms of neurocognitive injury as post-operative sequelae of coronary artery bypass grafting (CABG) are not understood. The systemic inflammatory response to surgical stress causes skeletal muscle impairment, and this is also worsened by immobility. Since evidence supports a link between muscle vitality and neuroprotection, there is a need to understand the mechanisms by which promotion of muscle activity counteracts the deleterious effects of surgery on long-term cognition.

Methods: We performed a clinical trial to test the hypothesis that adding neuromuscular electrical stimulation (NMES) to standard rehabilitation care in post-CABG patients promotes the maintenance of skeletal muscle strength and the expression of circulating neuroprotective myokines.

Results: We did not find higher serum levels of neuroprotective myokines, except for interleukin-6, nor better long-term cognitive performance in our intervention group. However, a greater increase in functional connectivity at brain magnetic resonance was seen between seed regions within the default mode, frontoparietal, salience, and sensorimotor networks in the NMES group. Regardless of the treatment protocol, patients with a Klotho increase 3 months after hospital discharge compared to baseline Klotho values showed better scores in delayed memory tests.

Significance: We confirm the potential neuroprotective effect of Klotho in a clinical setting and for the first time post-CABG.

Keywords: coronary artery bypass grafting (CABG); klotho; myokines; neuromuscular electrical stimulation (NMES); post-operative cognitive decline (POCD).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The graph shows mean effect size differences in resting-state network connectivity before and after usual care treatment. Mean effect sizes are represented as average normalized differences in Cohen’s d. There was a statistically significant (p 0.05 FDR) medium to large (Cohen’s d = 0.5 medium; Cohen’s d = 0.8 large) increase in functional connectivity in the default mode, frontoparietal, salience, and sensorimotor networks in patients after usual care treatment. False discovery rate (FDR).
Figure 2
Figure 2
Functional connectome in patients (A) PRE and (B) POST usual care treatment versus (C) PRE and (D) POST NMES treatment. There was a statistically significant (p < 0.05 FDR) increase in functional connectivity in the default mode, frontoparietal, salience, and sensorimotor networks in patients after usual care treatment compared to pre-treatment functional connectivity in the same networks. This increased functional connectivity in the default mode, frontoparietal, salience, and sensorimotor networks was even greater for individuals in the usual care plus NMES group, compared to pre-treatment functional connectivity in the same networks, since the pre-treatment functional connectivity showed a prominent reduction in global functional connectivity in this group. Neuromuscular electrical stimulation (NMES); false discovery rate (FDR).
Figure 3
Figure 3
The graph shows mean effect size differences in resting-state network connectivity before and after intervention in the NMES group. Mean effect sizes are represented as average normalized differences in Cohen’s d. There was a statistically significant (p 0.05 FDR) medium to large (Cohen’s d = 0.5 medium; Cohen’s d = 0.8 large) increase in functional connectivity in the default mode, frontoparietal, salience, and sensorimotor networks for individuals in the usual care plus NMES treatment group. Neuromuscular electrical stimulation (NMES); false discovery rate (FDR).
Figure 4
Figure 4
Partial and total RBANS scores in responders (blue) and non-responders for Klotho (red). Responders (blue) performed significantly better than non-responders (red) on the delayed memory test (p value = 0.02). A similar trend was also observed for all other cognitive tests included in RBANS without reaching significance. Performance of Premorbid Intelligence Quotient (PIQ) scores: The absence of differences between the PIQ of the two groups indicates that the differences in the NP tests are not attributable to different IQs. Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); premorbid intelligence quotient (PIQ).
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References

    1. Greaves D, Psaltis PJ, Ross TJ, Davis D, Smith AE, Boord MS, et al. . Cognitive outcomes following coronary artery bypass grafting: a systematic review and meta-analysis of 91, 829 patients. Int J Cardiol. (2019) 289:43–9. doi: 10.1016/j.ijcard.2019.04.065, PMID: - DOI - PMC - PubMed
    1. McDonagh DL, Berger M, Mathew JP, Graffagnino C, Milano CA, Newman MF. Neurological complications of cardiac surgery. Lancet Neurol. (2014) 13:490–502. doi: 10.1016/S1474-4422(14)70004-3, PMID: - DOI - PMC - PubMed
    1. Caso G, Vosswinkel JA, Garlick PJ, Barry MK, Bilfinger TV, McNurlan MA. Altered protein metabolism fgollowin coronary artery bypass graft (CABG) surgery. Clin Sci. (2008) 114:339–46. doi: 10.1042/CS20070278, PMID: - DOI - PubMed
    1. Fontes Cerqueira TC, Cerqueira Neto ML, Cacau LAP, Oliveira GU, Silva Júnior WMD, Carvalho VO, et al. . Ambulation capacity and functional outcome in patients undergoing neuromuscular electrical stimulation after cardiac valve surgery: a randomised clinical trial. Medicine. (2018) 97:e13012. doi: 10.1097/MD.0000000000013012, PMID: - DOI - PMC - PubMed
    1. Pedersen BK. Muscles and their myokines. J Exp Biol. (2011) 214:337–46. doi: 10.1242/jeb.048074, PMID: - DOI - PubMed

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