Department of Medicine/Cardiology, University of Bonn, Bonn, Germany.
EuroIntervention. 2013 Mar;8(11):1296-306. doi: 10.4244/EIJV8I11A198.
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).
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.
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.
评估血清学、影像学和临床脑损伤指标对经导管主动脉瓣置换术（TAVI）后患者自理能力和生存的影响。
在 TAVI 前后 3 天，评估神经元特异性烯醇化酶（NSE）、脑弥散加权磁共振成像（DW-MRI）和利用国立卫生研究院卒中量表（NIHSS）评估的神经功能表现。自理能力采用既定评分系统（工具性日常生活活动评分、巴氏指数）进行评估。研究了脑损伤参数对 30 天和 1 年后自理能力和全因死亡率的影响。共纳入 61 例患者（逻辑 EuroSCORE：26.4±18.1，STS 评分：7.9±5.7），其中 39 例完成了影像学检查方案。NSE 升高、DW-MRI 中新的栓塞事件和 TAVI 后早期神经功能缺损的发生率分别为 52.4%、71.8%和 6.6%。较高的风险评分反映出并存的合并症程度对结局有显著影响。TAVI 后 1 年内，NSE 血浆水平和 DW-MRI 中新的栓塞与自理能力或生存均无相关性。
在这项观察性的初步研究中，“沉默性”脑损伤与依赖生活方式或 TAVI 后 1 年内的死亡率均无相关性。然而，需要进行长期随访以充分阐明沉默性卒中的影响。临床试验编号：NCT00883285。
