Ronald M Lazar1, Marykathryn A Pavol2, Tobias Bormann3, Michael G Dwyer4, Carlye Kraemer5, Roseann White6, Robert Zivadinov4, Jeffrey C Wertheimer7, Angelika Thöne-Otto8, Lisa D Ravdin9, Richard Naugle10, Dawn Mechanic-Hamilton11, William S Garmoe12, Anthony Y Stringer13, Heidi A Bender14, Samir R Kapadia15, Susheel Kodali16, Alexander Ghanem17, Axel Linke18, Roxana Mehran19, Renu Virmani20, Tamim Nazif16, Azin Parhizgar21, Martin B Leon16. 1. Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: rlazar@uabmc.edu. 2. Department of Neurology, Columbia University Medical Center, New York, New York. 3. Department of Neurology, Medical Center-University of Freiburg, Freiburg, Germany. 4. Buffalo Neuroimaging Analysis Center, SUNY/Buffalo, Buffalo, New York. 5. North American Science Associates, Minneapolis, Minnesota. 6. Duke Clinical Research Institute, Durham, North Carolina. 7. Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California. 8. Clinic for Cognitive Neurology, University of Leipzig, Leipzig, Germany. 9. Department of Neurology, Weill Medical College of Cornell University, New York, New York. 10. Neurological Institute, Cleveland Clinic, Cleveland, Ohio. 11. Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania. 12. Psychology Department, MedStar Health, Washington, DC. 13. Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia. 14. Department of Neurology, Mount Sinai School of Medicine, New York, New York. 15. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. 16. Department of Medicine, Columbia University Medical Center, New York, New York. 17. Department of Cardiology, Asklepios St Georg, Hamburg, Germany. 18. Herzzentrum Leipzig-Universitätsklinik, Leipzig, Germany. 19. Department of Medicine, Mount Sinai School of Medicine, New York, New York. 20. CV Path Institute, Gaithersburg, Maryland. 21. Claret Medical, Santa Rosa, California.
Abstract
OBJECTIVES: The authors sought to determine baseline neurocognition before transcatheter aortic valve replacement (TAVR) and its correlations with pre-TAVR brain imaging. 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. 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. 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. 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.
RCT Entities:
OBJECTIVES: The authors sought to determine baseline neurocognition before transcatheter aortic valve replacement (TAVR) and its correlations with pre-TAVR brain imaging. 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. 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. 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. CONCLUSIONS: There was a significant proportion of aortic stenosispatients 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.
Authors: Jonas A Hosp; Andrea Dressing; Ganna Blazhenets; Tobias Bormann; Alexander Rau; Marius Schwabenland; Johannes Thurow; Dirk Wagner; Cornelius Waller; Wolf D Niesen; Lars Frings; Horst Urbach; Marco Prinz; Cornelius Weiller; Nils Schroeter; Philipp T Meyer Journal: Brain Date: 2021-04-03 Impact factor: 13.501
Authors: Andrea Dressing; Tobias Bormann; Ganna Blazhenets; Nils Schroeter; Lea I Walter; Johannes Thurow; Dietrich August; Hanna Hilger; Katarina Stete; Kathrin Gerstacker; Susan Arndt; Alexander Rau; Horst Urbach; Siegbert Rieg; Dirk Wagner; Cornelius Weiller; Philipp T Meyer; Jonas A Hosp Journal: J Nucl Med Date: 2021-10-14 Impact factor: 11.082