Cognitive trajectory after transcatheter aortic valve implantation.

Abstract

BACKGROUND:

Transcatheter aortic valve implantation (TAVI) is known to be associated with silent cerebral injury, which could contribute to cognitive impairment. Considering its increasing use, thorough longitudinal investigation of cognitive trajectory after TAVI is pivotal.

METHODS AND RESULTS:

Repeatable battery for the assessment of neuropsychological status was performed before (E1), 3 days (E2), 3 months (E3), 1 (E4) year, and 2 years (E5) after TAVI. Baseline characteristics, procedural data, imaging parameters of brain injury (diffusion-weighted MRI), and the use of conceivable neuroprotective approaches were investigated for their effect on cognitive function. Cognitive performance was investigated in 111 patients (mean log EuroSCORE, 30±13%). Global cognitive function (repeatable battery for the assessment of neuropsychological status total score) increased transiently at E2 (P=0.02) and was comparable with baseline levels at E3, E4, and E5. Six patients (5.4%) demonstrated early cognitive decline. Persistence and late onset were seen infrequently (n=3, 2.7% and n=4, 3.6%, respectively). Hence, early cognitive decline was ruled out in 105 patients (94.6%), and a majority of patients (91%) demonstrated sustained cognitive performance throughout all investigated time points. Interestingly, only patient age (P=0.012), but not prior cerebrovascular events, cognitive status, direct TAVI, cerebral embolism in diffusion-weighted MRI, or the use of a cerebral embolic protection device was found to be independently associated with cognitive decline, linking higher age to cognitive impairment along the first 2 years after TAVI.

CONCLUSIONS:

Long-term cognitive performance was preserved in the great majority (91%) of patients throughout the first 2 years after TAVI, despite the high intrinsic risk for cognitive deterioration.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00883285.

• Authors: Alexander Ghanem, Justine Kocurek, Jan-Malte Sinning, Michael Wagner, Benjamin V Becker, Marieke Vogel, Thomas Schröder, Steffen Wolfsgruber, Mariuca Vasa-Nicotera, Christoph Hammerstingl, Jörg O Schwab, Daniel Thomas, Nikos Werner, Eberhard Grube, Georg Nickenig, Andreas Müller
• Journal: Circulation. Cardiovascular interventions (Circ Cardiovasc Interv) Vol. 6 Issue 6 Pg. 615-24 (Dec 2013) ISSN: 1941-7632 [Electronic] United States
• PMID: 24129642 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Aged, 80 and over
• Aortic Valve (surgery)
• Bicuspid Aortic Valve Disease
• Cardiac Catheterization (adverse effects)
• Cognition Disorders (diagnosis, epidemiology, etiology)
• Female
• Follow-Up Studies
• Heart Defects, Congenital (surgery)
• Heart Valve Diseases (surgery)
• Heart Valve Prosthesis
• Heart Valve Prosthesis Implantation (adverse effects)
• Humans
• Incidence
• Intracranial Embolism (complications, epidemiology)
• Longitudinal Studies
• Male
• Neuropsychological Tests
• Risk Factors
• Treatment Outcome