title: Evaluation of methods to predict early long-term neurobehavioral outcome after coronary artery bypass grafting.
abstract: Postoperative cognitive decrease (POCD) represents the most frequent complication in modern cardiac surgery. The application of easily assessable surrogate parameters that predict long-term POCD at early time points is tempting. The aim of the present study was to analyze the predictive value of cerebral biomarkers, diffusion-weighted magnetic resonance imaging (DWI), and cognitive bedside testing after coronary artery bypass grafting (CABG). From 106 patients who underwent elective CABG, blood samples were drawn for the measurement of protein S100B and neuron-specific enolase release at baseline, at the end of surgery, and 48 hours afterward. Cerebral DWI was carried out before and 2 to 4 days after surgery. Cognitive functioning was assessed before, 2 to 4 days (bedside testing) after, and 3 months after CABG. On DWI, lesions were detected in 15.1% of patients. Biomarker levels and the presence of acute ischemic lesions on DWI were not associated with long-term POCD. Early POCD was correlated with 3-month POCD (r = 0.46, p <0.001). Ninety-one percent of patients who had shown moderate to severe POCD (<-1.5 z scores) in the early phase still had decreased memory functioning at 3 months compared to baseline (likelihood ratio 5.23). Early POCD was asserted as the only predictor for long-term POCD in a stepwise multiple linear regression model (R(2) = 0.20, p <0.001), excluding age, length of surgery, aortic clamping and cardiopulmonary bypass duration, the number of anastomoses, and postoperative neuron-specific enolase and S100B levels. In conclusion, the results show that in contrast to biomarkers, DWI, age, or intraoperative variables, early neuropsychological bedside testing predicts long-term POCD after CABG with acceptable accuracy.
authors.affiliation: Department of Neurology, Justus-Liebig University, Giessen, Germany.
authors.forename: Tibo
authors.initials: T
authors.lastname: Gerriets
authors.forename: Niko
authors.initials: N
authors.lastname: Schwarz
authors.forename: Georg
authors.initials: G
authors.lastname: Bachmann
authors.forename: Manfred
authors.initials: M
authors.lastname: Kaps
authors.forename: Wolf-Peter
authors.initials: WP
authors.lastname: Kloevekorn
authors.forename: Gebhard
authors.initials: G
authors.lastname: Sammer
authors.forename: Marlene
authors.initials: M
authors.lastname: Tschernatsch
authors.forename: Rainer
authors.initials: R
authors.lastname: Nottbohm
authors.forename: Franz
authors.initials: F
authors.lastname: Blaes
authors.forename: Markus
authors.initials: M
authors.lastname: Schönburg
mesh_terms: D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000523:psychology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008568:Memory / Q000502:physiology*; D008875:Middle Aged; D009483:Neuropsychological Tests; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors