Neurocognition and Cerebral Lesion Burden in High-Risk Patients Before Undergoing Transcatheter Aortic Valve Replacement: Insights From the SENTINEL Trial.
Neurocognition and Cerebral Lesion Burden in High-Risk Patients Before Undergoing Transcatheter Aortic Valve Replacement: Insights From the SENTINEL Trial.
- 2018
Available online through MWHC library: 2008 - present
BACKGROUND: TAVR studies have not shown a correlation between diffusion-weighted image changes and neurocognition. The authors wanted to determine the extent to which there was already impairment at baseline that correlated with cerebrovascular disease. CONCLUSIONS: There was a significant proportion of aortic stenosis patients with impaired cognition before TAVR, with a relationship between baseline cognitive function and lesion burden likely attributable to longstanding cerebrovascular disease. These findings underscore the importance of pre-interventional testing and magnetic resonance imaging in any research investigating post-surgical cognitive outcomes in patients with cardiovascular disease. Copyright (c) 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. METHODS: SENTINEL (Cerebral Protection in Transcatheter Aortic Valve Replacement) trial patients had cognitive assessments of attention, processing speed, executive function, and verbal and visual memory. Z-scores were based on normative means and SDs, combined into a primary composite z-score. Brain magnetic resonance images were obtained pre-TAVR on 3-T scanners with a T2 fluid-attenuated inversion recovery (FLAIR) sequence. Scores <=-1.5 SD below the normative mean (7th percentile) were considered impairment. Paired t tests compared within-subject scores, and chi-square goodness-of-fit compared the percentage of subjects below -1.5 SD. Correlation and regression analyses assessed the relationship between neurocognitive z-scores and T2 lesion volume. OBJECTIVES: The authors sought to determine baseline neurocognition before transcatheter aortic valve replacement (TAVR) and its correlations with pre-TAVR brain imaging. RESULTS: Among 234 patients tested, the mean composite z-score was -0.65 SD below the normative mean. Domain scores ranged from -0.15 SD for attention to -1.32 SD for executive function. On the basis of the >=1.5 SD normative reference, there were significantly greater percentages of impaired scores in the composite z-score (13.2%; p = 0.019), executive function (41.9%; p < 0.001), verbal memory (p < 0.001), and visual memory (p < 0.001). The regression model between FLAIR lesion volume and baseline cognition showed statistically significant negative correlations.
English
1936-8798
10.1016/j.jcin.2017.10.041 [doi] S1936-8798(17)32218-5 [pii]
*Aortic Valve Stenosis/co [Complications]
*Cerebrovascular Disorders/co [Complications]
*Cognition
*Cognition Disorders/co [Complications]
*Transcatheter Aortic Valve Replacement
Age Factors
Aged, 80 and over
Aortic Valve Stenosis/di [Diagnosis]
Aortic Valve Stenosis/su [Surgery]
Attention
Cerebrovascular Disorders/di [Diagnosis]
Cerebrovascular Disorders/px [Psychology]
Cognition Disorders/di [Diagnosis]
Cognition Disorders/px [Psychology]
Executive Function
Female
Humans
Magnetic Resonance Imaging
Male
Memory
Neuropsychological Tests
Risk Factors
Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
MedStar National Rehabilitation Network
Journal Article
Available online through MWHC library: 2008 - present
BACKGROUND: TAVR studies have not shown a correlation between diffusion-weighted image changes and neurocognition. The authors wanted to determine the extent to which there was already impairment at baseline that correlated with cerebrovascular disease. CONCLUSIONS: There was a significant proportion of aortic stenosis patients with impaired cognition before TAVR, with a relationship between baseline cognitive function and lesion burden likely attributable to longstanding cerebrovascular disease. These findings underscore the importance of pre-interventional testing and magnetic resonance imaging in any research investigating post-surgical cognitive outcomes in patients with cardiovascular disease. Copyright (c) 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. METHODS: SENTINEL (Cerebral Protection in Transcatheter Aortic Valve Replacement) trial patients had cognitive assessments of attention, processing speed, executive function, and verbal and visual memory. Z-scores were based on normative means and SDs, combined into a primary composite z-score. Brain magnetic resonance images were obtained pre-TAVR on 3-T scanners with a T2 fluid-attenuated inversion recovery (FLAIR) sequence. Scores <=-1.5 SD below the normative mean (7th percentile) were considered impairment. Paired t tests compared within-subject scores, and chi-square goodness-of-fit compared the percentage of subjects below -1.5 SD. Correlation and regression analyses assessed the relationship between neurocognitive z-scores and T2 lesion volume. OBJECTIVES: The authors sought to determine baseline neurocognition before transcatheter aortic valve replacement (TAVR) and its correlations with pre-TAVR brain imaging. RESULTS: Among 234 patients tested, the mean composite z-score was -0.65 SD below the normative mean. Domain scores ranged from -0.15 SD for attention to -1.32 SD for executive function. On the basis of the >=1.5 SD normative reference, there were significantly greater percentages of impaired scores in the composite z-score (13.2%; p = 0.019), executive function (41.9%; p < 0.001), verbal memory (p < 0.001), and visual memory (p < 0.001). The regression model between FLAIR lesion volume and baseline cognition showed statistically significant negative correlations.
English
1936-8798
10.1016/j.jcin.2017.10.041 [doi] S1936-8798(17)32218-5 [pii]
*Aortic Valve Stenosis/co [Complications]
*Cerebrovascular Disorders/co [Complications]
*Cognition
*Cognition Disorders/co [Complications]
*Transcatheter Aortic Valve Replacement
Age Factors
Aged, 80 and over
Aortic Valve Stenosis/di [Diagnosis]
Aortic Valve Stenosis/su [Surgery]
Attention
Cerebrovascular Disorders/di [Diagnosis]
Cerebrovascular Disorders/px [Psychology]
Cognition Disorders/di [Diagnosis]
Cognition Disorders/px [Psychology]
Executive Function
Female
Humans
Magnetic Resonance Imaging
Male
Memory
Neuropsychological Tests
Risk Factors
Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
MedStar National Rehabilitation Network
Journal Article