Cognitive outcomes in patients treated with neuromuscular electrical stimulation after coronary artery bypass grafting
Vincenzina Lo Re, Giovanna Russelli, Emanuele Lo Gerfo, Rossella Alduino, Matteo Bulati, Gioacchin Iannolo, Danilo Terzo, Gennaro Martucci, Stefano Anzani, Giovanna Panarello, Gianvincenzo Sparacia, Giuseppe Parla, Federica Avorio, Giuseppe Maria Raffa, Michele Pilato, Aurelio Speciale, Valentina Agnese, Giuseppe Mamone, Fabio Tuzzolino, Giovanni Vizzini, Pier Giulio Conaldi, Fabrisia Ambrosio
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.