title: Subacute Subclinical Brain Infarctions after Transcatheter Aortic Valve Implantation Negatively Impact Cognitive Function in Long-Term Follow-Up.
abstract: OBJECTIVE
  To date every post-procedural cerebrovascular embolic event (CVE) is dreaded for its potential to accelerate cognitive decline after transcatheter aortic valve implantation (TAVI). This study differentiates the impact of acute (procedural) and post-acute cerebrovascular embolic events (CVEs) on cognitive performance.
  
  
  METHODS
  Magnetic resonance imaging (MRI) before, early and late after TAVI was performed to quantify embolic burden. Quantification of diffusion- and T1-weighted lesions, as well as white-matter and total brain volumes, as well as cognitive function testing (MMSE) were assessed in 28 patients with a medium follow-up period of 34 months.
  
  
  RESULTS
  Procedural diffusion-weighted lesions were observed in 17 patients (61%), but demonstrated locoregional remnants only in a minority of patients in long-term follow-up (6.5%). Acute CVEs did not impact the trajectory of late silent brain infarctions (SBI), white-matter hyperintensities, and cerebral atrophy. Functionally, early CVEs did not affect cognitive function. In contrast, patients with "new" SBIs after TAVI had a trend to cognitive deterioration in long-term follow-up ("new"SBI: MMSE -1.4 / no "new"SBI: MMSE +1.5, p = 0.067). Interestingly, only a fraction of these "new" SBIs evolved from procedural CVEs (22.2%).
  
  
  CONCLUSIONS
  Aquired SBIs after TAVI, but not DW-CVE per se are associated with functional impairment long-term after TAVI. In the context of subacute thrombosis seen in TAVI prostheses, these findings set the stage for tailored stroke prevention and comprehensive surrogate endpoint definitions in neuroprotective trials.
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.|Department of Cardiology, University Hospital Bonn, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ghanem
authors.affiliation: Department of Radiology, University Hospital Cologne, Germany.|Department of Radiology, University Hospital Bonn, Germany.
authors.forename: Jonas
authors.initials: J
authors.lastname: Dörner
authors.affiliation: Department of Cardiology, University Hospital Bonn, Germany.
authors.forename: Leonie
authors.initials: L
authors.lastname: Schulze-Hagen
authors.affiliation: Department of Radiology, University Hospital Bonn, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Müller
authors.affiliation: Department of Cardiology, University Hospital Bonn, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Wilsing
authors.affiliation: Department of Cardiology, University Hospital Bonn, Germany.
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.affiliation: Department of Radiology, University Hospital Bonn, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Lütkens
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Frerker
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: Emergency Department, University Hospital Bonn, Bonn, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Gräff
authors.affiliation: Department of Radiology, University Hospital Bonn, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Schild
authors.affiliation: Department of Cardiology, University Hospital Bonn, Germany.
authors.forename: Nikos
authors.initials: N
authors.lastname: Werner
authors.affiliation: Department of Cardiology, University Hospital Bonn, Germany.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.affiliation: Department of Cardiology, University Hospital Bonn, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000503:physiopathology* / Q000601:surgery*; D003071:Cognition / Q000502:physiology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*