title: Aortic stiffness is an indicator of cognitive dysfunction before and after aortic valve replacement for aortic stenosis.
abstract: OBJECTIVE
  Post-cardiac surgical cognitive dysfunction occurs more commonly following valvular procedures. Cognitive function has been related to vascular health status; however, the relation between pre-existent arterial stiffness and perioperative cognitive dysfunction is yet to be defined. The objective of this study was to assess whether aortic stiffness is related to cognitive dysfunction in surgical aortic stenosis (AS) pre- and postoperatively.
  
  
  METHODS
  Between June 2010 and August 2012, patients undergoing aortic valve replacement (AVR) for AS were recruited for inclusion in this prospective observational study. Aortic pulse wave velocity (PWV) was used as a measure of aortic stiffness and cognitive function was assessed using the computerized Cambridge Neuropsychological Test Automated Battery (CANTAB) preoperatively and (409 ± 159 days) post-AVR.
  
  
  RESULTS
  Fifty-six patients (age 71 ± 8.4 years) were recruited. Of the total, 50 (89%) completed postoperative follow-up. Pre- and postoperatively, patients with normal PWV (PWV-norm) had significantly superior delayed memory, sustained visual attention and executive function compared with those with high PWV (PWV-high). Immediate memory and decision-making were similar between groups. Postoperatively, improvement in cognitive function was more marked in PWV-high compared with PWV-norm patients. In two models of multiple regression analysis, PWV as a continuous variable was independently related to all preoperative main cognitive components as well as postoperative executive function. PWV as a dichotomous variable was independently related to all pre- and postoperative main cognitive function components.
  
  
  CONCLUSIONS
  AVR may not be associated with an independent or homogeneous effect on cognitive decline. Aortic PWV might be useful as an additional indicator for cognitive dysfunction before and after surgical intervention for AS.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: Emaddin
authors.initials: E
authors.lastname: Kidher
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK leanne.harling@imperial.ac.uk.
authors.forename: Leanne
authors.initials: L
authors.lastname: Harling
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Sugden
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK.
authors.forename: Hutan
authors.initials: H
authors.lastname: Ashrafian
authors.affiliation: Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: Roberto
authors.initials: R
authors.lastname: Casula
authors.affiliation: Department of Cardiovascular Science, University of Sheffield, Sheffield, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Evans
authors.affiliation: Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: Petros
authors.initials: P
authors.lastname: Nihoyannopoulos
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001288:Attention; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D056344:Executive Function; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008568:Memory; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D059289:Vascular Stiffness
keywords: Aortic stenosis; Aortic stiffness; Cognitive function; Pulse wave velocity