Subacute Subclinical Brain Infarctions after Transcatheter Aortic Valve Implantation Negatively Impact Cognitive Function in Long-Term Follow-Up
To date every post-procedural cerebrovascular embolic event (CVE) is dreaded for its potential to accelerate cognitive decline after transcatheter aortic valve implantation (TAVI). This study differentiates the impact of acute (procedural) and post-acute cerebrovascular embolic events (CVEs) on cogn...
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| creator | Ghanem, Alexander Dörner, Jonas Schulze-Hagen, Leonie Müller, Andreas Wilsing, Marius Sinning, Jan-Malte Lütkens, Julian Frerker, Christian Kuck, Karl-Heinz Gräff, Ingo Schild, Hans Werner, Nikos Grube, Eberhard Nickenig, Georg |
| description | To date every post-procedural cerebrovascular embolic event (CVE) is dreaded for its potential to accelerate cognitive decline after transcatheter aortic valve implantation (TAVI). This study differentiates the impact of acute (procedural) and post-acute cerebrovascular embolic events (CVEs) on cognitive performance.
Magnetic resonance imaging (MRI) before, early and late after TAVI was performed to quantify embolic burden. Quantification of diffusion- and T1-weighted lesions, as well as white-matter and total brain volumes, as well as cognitive function testing (MMSE) were assessed in 28 patients with a medium follow-up period of 34 months.
Procedural diffusion-weighted lesions were observed in 17 patients (61%), but demonstrated locoregional remnants only in a minority of patients in long-term follow-up (6.5%). Acute CVEs did not impact the trajectory of late silent brain infarctions (SBI), white-matter hyperintensities, and cerebral atrophy. Functionally, early CVEs did not affect cognitive function. In contrast, patients with "new" SBIs after TAVI had a trend to cognitive deterioration in long-term follow-up ("new"SBI: MMSE -1.4 / no "new"SBI: MMSE +1.5, p = 0.067). Interestingly, only a fraction of these "new" SBIs evolved from procedural CVEs (22.2%).
Aquired SBIs after TAVI, but not DW-CVE per se are associated with functional impairment long-term after TAVI. In the context of subacute thrombosis seen in TAVI prostheses, these findings set the stage for tailored stroke prevention and comprehensive surrogate endpoint definitions in neuroprotective trials. |
| doi_str_mv | 10.1371/journal.pone.0168852 |
| format | Article |
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Magnetic resonance imaging (MRI) before, early and late after TAVI was performed to quantify embolic burden. Quantification of diffusion- and T1-weighted lesions, as well as white-matter and total brain volumes, as well as cognitive function testing (MMSE) were assessed in 28 patients with a medium follow-up period of 34 months.
Procedural diffusion-weighted lesions were observed in 17 patients (61%), but demonstrated locoregional remnants only in a minority of patients in long-term follow-up (6.5%). Acute CVEs did not impact the trajectory of late silent brain infarctions (SBI), white-matter hyperintensities, and cerebral atrophy. Functionally, early CVEs did not affect cognitive function. In contrast, patients with "new" SBIs after TAVI had a trend to cognitive deterioration in long-term follow-up ("new"SBI: MMSE -1.4 / no "new"SBI: MMSE +1.5, p = 0.067). Interestingly, only a fraction of these "new" SBIs evolved from procedural CVEs (22.2%).
Aquired SBIs after TAVI, but not DW-CVE per se are associated with functional impairment long-term after TAVI. In the context of subacute thrombosis seen in TAVI prostheses, these findings set the stage for tailored stroke prevention and comprehensive surrogate endpoint definitions in neuroprotective trials.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0168852</identifier><identifier>PMID: 28056466</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Aged, 80 and over ; Aorta ; Aortic valve ; Atrophy ; Biology and Life Sciences ; Brain ; Brain Infarction - physiopathology ; Brain Infarction - surgery ; Cardiac arrhythmia ; Cardiology ; Cerebrovascular disease ; Cerebrovascular system ; Clinical trials ; Cognition - physiology ; Cognitive ability ; Councils ; Dementia ; Diffusion ; Diffusion Magnetic Resonance Imaging ; Female ; Follow-Up Studies ; Heart ; Heart valve diseases ; Heart Valve Prosthesis Implantation ; Humans ; Implantation ; Lesions ; Magnetic resonance ; Magnetic resonance imaging ; Male ; Medicine and Health Sciences ; Morphology ; Mortality ; Neuroimaging ; Neuroprotection ; NMR ; Nuclear magnetic resonance ; Older people ; Patients ; Prostheses ; Prosthetics ; Research and Analysis Methods ; Social Sciences ; Stroke ; Studies ; Substantia alba ; Surgery ; Systematic review ; Thromboembolism ; Thrombosis ; Transcatheter Aortic Valve Replacement - adverse effects</subject><ispartof>PloS one, 2017-01, Vol.12 (1), p.e0168852-e0168852</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Ghanem et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2017 Ghanem et al 2017 Ghanem et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c725t-8af923d91313d4df4fadde8d15baabb3442fd647b50fb0b92acbaf30610e82c13</citedby><cites>FETCH-LOGICAL-c725t-8af923d91313d4df4fadde8d15baabb3442fd647b50fb0b92acbaf30610e82c13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215955/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215955/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28056466$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ghanem, Alexander</creatorcontrib><creatorcontrib>Dörner, Jonas</creatorcontrib><creatorcontrib>Schulze-Hagen, Leonie</creatorcontrib><creatorcontrib>Müller, Andreas</creatorcontrib><creatorcontrib>Wilsing, Marius</creatorcontrib><creatorcontrib>Sinning, Jan-Malte</creatorcontrib><creatorcontrib>Lütkens, Julian</creatorcontrib><creatorcontrib>Frerker, Christian</creatorcontrib><creatorcontrib>Kuck, Karl-Heinz</creatorcontrib><creatorcontrib>Gräff, Ingo</creatorcontrib><creatorcontrib>Schild, Hans</creatorcontrib><creatorcontrib>Werner, Nikos</creatorcontrib><creatorcontrib>Grube, Eberhard</creatorcontrib><creatorcontrib>Nickenig, Georg</creatorcontrib><title>Subacute Subclinical Brain Infarctions after Transcatheter Aortic Valve Implantation Negatively Impact Cognitive Function in Long-Term Follow-Up</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>To date every post-procedural cerebrovascular embolic event (CVE) is dreaded for its potential to accelerate cognitive decline after transcatheter aortic valve implantation (TAVI). This study differentiates the impact of acute (procedural) and post-acute cerebrovascular embolic events (CVEs) on cognitive performance.
Magnetic resonance imaging (MRI) before, early and late after TAVI was performed to quantify embolic burden. Quantification of diffusion- and T1-weighted lesions, as well as white-matter and total brain volumes, as well as cognitive function testing (MMSE) were assessed in 28 patients with a medium follow-up period of 34 months.
Procedural diffusion-weighted lesions were observed in 17 patients (61%), but demonstrated locoregional remnants only in a minority of patients in long-term follow-up (6.5%). Acute CVEs did not impact the trajectory of late silent brain infarctions (SBI), white-matter hyperintensities, and cerebral atrophy. Functionally, early CVEs did not affect cognitive function. In contrast, patients with "new" SBIs after TAVI had a trend to cognitive deterioration in long-term follow-up ("new"SBI: MMSE -1.4 / no "new"SBI: MMSE +1.5, p = 0.067). Interestingly, only a fraction of these "new" SBIs evolved from procedural CVEs (22.2%).
Aquired SBIs after TAVI, but not DW-CVE per se are associated with functional impairment long-term after TAVI. In the context of subacute thrombosis seen in TAVI prostheses, these findings set the stage for tailored stroke prevention and comprehensive surrogate endpoint definitions in neuroprotective trials.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aorta</subject><subject>Aortic valve</subject><subject>Atrophy</subject><subject>Biology and Life Sciences</subject><subject>Brain</subject><subject>Brain Infarction - physiopathology</subject><subject>Brain Infarction - surgery</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology</subject><subject>Cerebrovascular disease</subject><subject>Cerebrovascular system</subject><subject>Clinical trials</subject><subject>Cognition - physiology</subject><subject>Cognitive ability</subject><subject>Councils</subject><subject>Dementia</subject><subject>Diffusion</subject><subject>Diffusion Magnetic Resonance Imaging</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heart valve diseases</subject><subject>Heart Valve Prosthesis Implantation</subject><subject>Humans</subject><subject>Implantation</subject><subject>Lesions</subject><subject>Magnetic resonance</subject><subject>Magnetic resonance imaging</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Morphology</subject><subject>Mortality</subject><subject>Neuroimaging</subject><subject>Neuroprotection</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Older people</subject><subject>Patients</subject><subject>Prostheses</subject><subject>Prosthetics</subject><subject>Research and Analysis Methods</subject><subject>Social Sciences</subject><subject>Stroke</subject><subject>Studies</subject><subject>Substantia alba</subject><subject>Surgery</subject><subject>Systematic review</subject><subject>Thromboembolism</subject><subject>Thrombosis</subject><subject>Transcatheter Aortic Valve Replacement - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ghanem, Alexander</au><au>Dörner, Jonas</au><au>Schulze-Hagen, Leonie</au><au>Müller, Andreas</au><au>Wilsing, Marius</au><au>Sinning, Jan-Malte</au><au>Lütkens, Julian</au><au>Frerker, Christian</au><au>Kuck, Karl-Heinz</au><au>Gräff, Ingo</au><au>Schild, Hans</au><au>Werner, Nikos</au><au>Grube, Eberhard</au><au>Nickenig, Georg</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Subacute Subclinical Brain Infarctions after Transcatheter Aortic Valve Implantation Negatively Impact Cognitive Function in Long-Term Follow-Up</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-01-05</date><risdate>2017</risdate><volume>12</volume><issue>1</issue><spage>e0168852</spage><epage>e0168852</epage><pages>e0168852-e0168852</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>To date every post-procedural cerebrovascular embolic event (CVE) is dreaded for its potential to accelerate cognitive decline after transcatheter aortic valve implantation (TAVI). This study differentiates the impact of acute (procedural) and post-acute cerebrovascular embolic events (CVEs) on cognitive performance.
Magnetic resonance imaging (MRI) before, early and late after TAVI was performed to quantify embolic burden. Quantification of diffusion- and T1-weighted lesions, as well as white-matter and total brain volumes, as well as cognitive function testing (MMSE) were assessed in 28 patients with a medium follow-up period of 34 months.
Procedural diffusion-weighted lesions were observed in 17 patients (61%), but demonstrated locoregional remnants only in a minority of patients in long-term follow-up (6.5%). Acute CVEs did not impact the trajectory of late silent brain infarctions (SBI), white-matter hyperintensities, and cerebral atrophy. Functionally, early CVEs did not affect cognitive function. In contrast, patients with "new" SBIs after TAVI had a trend to cognitive deterioration in long-term follow-up ("new"SBI: MMSE -1.4 / no "new"SBI: MMSE +1.5, p = 0.067). Interestingly, only a fraction of these "new" SBIs evolved from procedural CVEs (22.2%).
Aquired SBIs after TAVI, but not DW-CVE per se are associated with functional impairment long-term after TAVI. In the context of subacute thrombosis seen in TAVI prostheses, these findings set the stage for tailored stroke prevention and comprehensive surrogate endpoint definitions in neuroprotective trials.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28056466</pmid><doi>10.1371/journal.pone.0168852</doi><tpages>e0168852</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2017-01, Vol.12 (1), p.e0168852-e0168852 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1855775946 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Aged Aged, 80 and over Aorta Aortic valve Atrophy Biology and Life Sciences Brain Brain Infarction - physiopathology Brain Infarction - surgery Cardiac arrhythmia Cardiology Cerebrovascular disease Cerebrovascular system Clinical trials Cognition - physiology Cognitive ability Councils Dementia Diffusion Diffusion Magnetic Resonance Imaging Female Follow-Up Studies Heart Heart valve diseases Heart Valve Prosthesis Implantation Humans Implantation Lesions Magnetic resonance Magnetic resonance imaging Male Medicine and Health Sciences Morphology Mortality Neuroimaging Neuroprotection NMR Nuclear magnetic resonance Older people Patients Prostheses Prosthetics Research and Analysis Methods Social Sciences Stroke Studies Substantia alba Surgery Systematic review Thromboembolism Thrombosis Transcatheter Aortic Valve Replacement - adverse effects |
| title | Subacute Subclinical Brain Infarctions after Transcatheter Aortic Valve Implantation Negatively Impact Cognitive Function in Long-Term Follow-Up |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-09T22%3A02%3A45IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Subacute%20Subclinical%20Brain%20Infarctions%20after%20Transcatheter%20Aortic%20Valve%20Implantation%20Negatively%20Impact%20Cognitive%20Function%20in%20Long-Term%20Follow-Up&rft.jtitle=PloS%20one&rft.au=Ghanem,%20Alexander&rft.date=2017-01-05&rft.volume=12&rft.issue=1&rft.spage=e0168852&rft.epage=e0168852&rft.pages=e0168852-e0168852&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0168852&rft_dat=%3Cgale_plos_%3EA476655293%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1855775946&rft_id=info:pmid/28056466&rft_galeid=A476655293&rft_doaj_id=oai_doaj_org_article_c71ac0cd732a4941b8e8230f05483039&rfr_iscdi=true |