title: Prognostic value of cerebral injury following transfemoral aortic valve implantation.
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.
authors.affiliation: Department of Medicine/Cardiology, University of Bonn, Bonn, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ghanem
authors.forename: Andreas
authors.initials: A
authors.lastname: Müller
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.forename: Justine
authors.initials: J
authors.lastname: Kocurek
authors.forename: Benjamin V
authors.initials: BV
authors.lastname: Becker
authors.forename: Marieke
authors.initials: M
authors.lastname: Vogel
authors.forename: Mariuca
authors.initials: M
authors.lastname: Vasa-Nicotera
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Jörg O
authors.initials: JO
authors.lastname: Schwab
authors.forename: Claas P
authors.initials: CP
authors.lastname: Nähle
authors.forename: Daniel
authors.initials: D
authors.lastname: Thomas
authors.forename: Michael
authors.initials: M
authors.lastname: Wagner
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.forename: Nikos
authors.initials: N
authors.lastname: Werner
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig