TY  - BOOK
AU  - Garmoe, William
TI  - Neurocognition and Cerebral Lesion Burden in High-Risk Patients Before Undergoing Transcatheter Aortic Valve Replacement: Insights From the SENTINEL Trial
SN  - 1936-8798
PY  - 2018///
KW  - *Aortic Valve Stenosis/co [Complications]
KW  - *Cerebrovascular Disorders/co [Complications]
KW  - *Cognition
KW  - *Cognition Disorders/co [Complications]
KW  - *Transcatheter Aortic Valve Replacement
KW  - Age Factors
KW  - Aged, 80 and over
KW  - Aortic Valve Stenosis/di [Diagnosis]
KW  - Aortic Valve Stenosis/su [Surgery]
KW  - Attention
KW  - Cerebrovascular Disorders/di [Diagnosis]
KW  - Cerebrovascular Disorders/px [Psychology]
KW  - Cognition Disorders/di [Diagnosis]
KW  - Cognition Disorders/px [Psychology]
KW  - Executive Function
KW  - Female
KW  - Humans
KW  - Magnetic Resonance Imaging
KW  - Male
KW  - Memory
KW  - Neuropsychological Tests
KW  - Risk Factors
KW  - Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
KW  - MedStar National Rehabilitation Network
KW  - Journal Article
N1  - Available online through MWHC library: 2008 - present
N2  - 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
UR  - https://dx.doi.org/10.1016/j.jcin.2017.10.041
ER  -