MedStar Authors catalog › Details for: Neurocognition and Cerebral Lesion Burden in High-Risk Patients Before Undergoing Transcatheter Aortic Valve Replacement: Insights From the SENTINEL Trial.
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Neurocognition and Cerebral Lesion Burden in High-Risk Patients Before Undergoing Transcatheter Aortic Valve Replacement: Insights From the SENTINEL Trial.

by Garmoe, William.
Citation: Jacc: Cardiovascular Interventions. 11(4):384-392, 2018 02 26.Journal: JACC. Cardiovascular interventions.Published: 2018ISSN: 1936-8798.Full author list: Lazar RM; Pavol MA; Bormann T; Dwyer MG; Kraemer C; White R; Zivadinov R; Wertheimer JC; Thone-Otto A; Ravdin LD; Naugle R; Mechanic-Hamilton D; Garmoe WS; Stringer AY; Bender HA; Kapadia SR; Kodali S; Ghanem A; Linke A; Mehran R; Virmani R; Nazif T; Parhizgar A; Leon MB.UI/PMID: 29397361.Subject(s): Age Factors | Aged, 80 and over | *Aortic Valve Stenosis/co [Complications] | Aortic Valve Stenosis/di [Diagnosis] | Aortic Valve Stenosis/su [Surgery] | Attention | *Cerebrovascular Disorders/co [Complications] | Cerebrovascular Disorders/di [Diagnosis] | Cerebrovascular Disorders/px [Psychology] | *Cognition | *Cognition Disorders/co [Complications] | 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] | *Transcatheter Aortic Valve ReplacementInstitution(s): MedStar National Rehabilitation NetworkActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: (Click here) Abbreviated citation: JACC Cardiovasc Interv. 11(4):384-392, 2018 02 26.Local Holdings: Available online through MWHC library: 2008 - present.Abstract: OBJECTIVES: The authors sought to determine baseline neurocognition before transcatheter aortic valve replacement (TAVR) and its correlations with pre-TAVR brain imaging.Abstract: 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.Abstract: 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.Abstract: 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.Abstract: 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.Abstract: Copyright (c) 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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