Prognostic value of cerebral injury following transfemoral aortic valve implantation
Alexander Ghanem, Andreas Müller, Jan-Malte Sinning, Justine Kocurek, Benjamin V Becker, Marieke Vogel, Mariuca Vasa-Nicotera, Christoph Hammerstingl, Jörg O Schwab, Claas P Nähle, Daniel Thomas, Michael Wagner, Eberhard Grube, Nikos Werner, Georg Nickenig, Alexander Ghanem, Andreas Müller, Jan-Malte Sinning, Justine Kocurek, Benjamin V Becker, Marieke Vogel, Mariuca Vasa-Nicotera, Christoph Hammerstingl, Jörg O Schwab, Claas P Nähle, Daniel Thomas, Michael Wagner, Eberhard Grube, Nikos Werner, Georg Nickenig
Abstract
Aims: To evaluate the impact of serological, imaging and clinical measures of cerebral injury on patient self-sufficiency and survival after transcatheter aortic valve implantation (TAVI).
Methods and results: Before and three days after TAVI, neuron-specific enolase (NSE), cerebral diffusion-weighted magnetic resonance imaging (DW-MRI) and neurological performance utilising National Institutes of Health Stroke Scale (NIHSS) were assessed. Self-sufficiency was determined with established score systems (instrumental activities of daily living score, Barthel Index). Parameters of cerebral injury were investigated for their impact on self-sufficiency and all-cause mortality after 30 days and one year. Sixty-one patients were enrolled (logistic EuroSCORE: 26.4±18.1, STS score: 7.9±5.7), of whom 39 completed the imaging protocol. The incidences of NSE increase, new embolic events in DW-MRI, and neurological deficit early after TAVI were 52.4%, 71.8% and 6.6%, respectively. The degree of concomitant comorbidities, reflected by higher risk scores, had significant impact on outcome. Plasma levels of NSE and new emboli in DW-MRI were neither related to self-sufficiency nor to survival one year after TAVI.
Conclusions: In this observational pilot study, "silent" cerebral injury is neither related to dependent lifestyle nor to mortality during the first year after TAVI. However, long-term follow-up is needed to elucidate fully the impact of silent stroke. Clinical trials number: NCT00883285.
Source: PubMed