Universität zu Köln

Ghanem, Alexander, Doerner, Jonas, Schulze-Hagen, Leonie, Mueller, Andreas, Wilsing, Marius, Sinning, Jan-Malte, Luetkens, Julian, Frerker, Christian, Kuck, Karl-Heinz, Graeff, Ingo, Schild, Hans, Werner, Nikos, Grube, Eberhard and Nickenig, Georg (2017). Subacute Subclinical Brain Infarctions after Transcatheter Aortic Valve Implantation Negatively Impact Cognitive Function in Long Term Follow-Up. PLoS One, 12 (1). SAN FRANCISCO: PUBLIC LIBRARY SCIENCE. ISSN 1932-6203

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Abstract

Aims To date every post-procedural cerebrovascular embolic event (CVE) is dreaded for its potential to accelerate cognitive decline after transcatheter aortic valve implantation (TAVI). This study differentiates the impact of acute (procedural) and post-acute cerebrovascular embolic events (CVEs) on cognitive performance. Methods Magnetic resonance imaging (MRI) before, early and late after TAVI was performed to quantify embolic burden. Quantification of diffusion- and T1-weighted lesions, as well as white matter and total brain volumes, as well as cognitive function testing (MMSE) were assessed in 28 patients with a medium follow-up period of 34 months. Results Procedural diffusion-weighted lesions were observed in 17 patients (61%), but demonstrated locoregional remnants only in a minority of patients in long-term follow-up (6.5%). Acute CVEs did not impact the trajectory of late silent brain infarctions (SBI), white-matter hyperintensities, and cerebral atrophy. Functionally, early CVEs did not affect cognitive function. In contrast, patients with new SBIs after TAVI had a trend to cognitive deterioration in long-term follow-up (newSBI: MMSE-1.4 / no newSBI: MMSE +1.5, p = 0.067). Interestingly, only a fraction of these new SBIs evolved from procedural CVEs (22.2%). Conclusions Aquired SBIs after TAVI, but not DW-CVE per se are associated with functional impairment long-term after TAVI. In the context of subacute thrombosis seen in TAVI prostheses, these findings set the stage for tailored stroke prevention and comprehensive surrogate endpoint definitions in neuroprotective trials.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Ghanem, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Doerner, Jonas UNSPECIFIED UNSPECIFIED UNSPECIFIED Schulze-Hagen, Leonie UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Wilsing, Marius UNSPECIFIED UNSPECIFIED UNSPECIFIED Sinning, Jan-Malte UNSPECIFIED UNSPECIFIED UNSPECIFIED Luetkens, Julian UNSPECIFIED UNSPECIFIED UNSPECIFIED Frerker, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuck, Karl-Heinz UNSPECIFIED UNSPECIFIED UNSPECIFIED Graeff, Ingo UNSPECIFIED UNSPECIFIED UNSPECIFIED Schild, Hans UNSPECIFIED UNSPECIFIED UNSPECIFIED Werner, Nikos UNSPECIFIED UNSPECIFIED UNSPECIFIED Grube, Eberhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Nickenig, Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-242736
DOI:	10.1371/journal.pone.0168852
Journal or Publication Title:	PLoS One
Volume:	12
Number:	1
Date:	2017
Publisher:	PUBLIC LIBRARY SCIENCE
Place of Publication:	SAN FRANCISCO
ISSN:	1932-6203
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language WHITE-MATTER; PROGNOSTIC VALUE; IMPAIRMENT; LESIONS; STROKE; SILENT; RISK; DEMENTIA; ATROPHY; HEALTH Multiple languages Multidisciplinary Sciences Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/24273