title: Prognostic value of cerebral injury following transfemoral aortic valve implantation.
abstract: OBJECTIVE
  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).
  
  
  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. ghanem@uni-bonn.de
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
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000097:blood / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D015897:Comorbidity; D038524:Diffusion Magnetic Resonance Imaging; D004185:Disability Evaluation; D005260:Female; D005263:Femoral Artery; D005858:Germany; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008019:Life Style; D016015:Logistic Models; D008297:Male; D009460:Neurologic Examination; D010751:Phosphopyruvate Hydratase / Q000097:blood; D010865:Pilot Projects; D011237:Predictive Value of Tests; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010751:Phosphopyruvate Hydratase