Fixing Hearts and Protecting Minds

Hogan, Alexandra M.; Shipolini, Alex; Brown, Martin M.; Hurley, R. M.; Cormack, Francesca

doi:10.1161/circulationaha.112.000701

Cited by 34 publications

(19 citation statements)

References 108 publications

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“…A number of mechanisms have been identified that may explain the association between CABG and dementia 4. A recent meta-analysis of randomized controlled trials demonstrated that those who received CABG rather than PCI had significantly higher odds of stroke after a median follow-up period of 12 months (OR=1.69; 95% CI, 1.07-2.67) 32.…”

Section: Discussionmentioning

confidence: 99%

“…However, it remains unclear whether any increased risk of dementia associated with CABG is a consequence of the procedure, CAD itself, the progression of underlying disease, or a combination of these factors 2. CABG may increase dementia risk via mechanisms such as release of microemboli, hypoperfusion limiting the washout of microemboli and systemic inflammation, or decrease dementia risk due to other mechanisms such as improved cardiac output 4. Comparisons with alternative CAD treatments such as percutaneous coronary intervention (PCI) are therefore useful because they can shed light on the impact of the procedure itself 2…”

mentioning

confidence: 99%

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Coronary Artery Bypass Graft Surgery and Dementia Risk in the Cardiovascular Health Study

Kuźma

Airdrie

Littlejohns

et al. 2017

Alzheimer Disease &Amp; Associated Disorders

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Coronary Artery Bypass Graft Surgery and Dementia Risk in the Cardiovascular Health Study

Kuźma

Airdrie

Littlejohns

et al. 2017

Alzheimer Disease &Amp; Associated Disorders

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“…Improvements in cognition after cardiovascular surgery such as TAVI may be attributed to significant changes in hemodynamic parameters, particularly cardiac output [ 17 ]. Cardiac output is integral for meeting the metabolic demands of the brain [ 18 ]. However, insufficient cardiac output commonly seen in patients with severe aortic stenosis may lead to cerebral hypoperfusion, a primary contributor to cognitive decline [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Cognitive Outcomes following Transcatheter Aortic Valve Implantation: A Systematic Review

Lai

Herrmann

Saleem

et al. 2015

Cardiovascular Psychiatry and Neurology

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Severe aortic stenosis is the most common valvular heart disease in the elderly in the Western world and contributes to a large proportion of all deaths over the age of 70. Severe aortic stenosis is conventionally treated with surgical aortic valve replacement; however, the less invasive transcatheter aortic valve implantation (TAVI) is suggested for those at high surgical risk. While TAVI has been associated with improved survival and favourable outcomes, there is a higher incidence of cerebral microembolisms in TAVI patients. This finding is of concern given mechanistic links with cognitive decline, a symptom highly prevalent in those with cardiovascular disease. This paper reviews the literature assessing the possible link between TAVI and cognitive changes. Studies to date have shown that global cognition improves or remains unchanged over 3 months following TAVI while individual cognitive domains remain preserved over time. However, the association between TAVI and cognition remains unclear due to methodological limitations. Furthermore, while these studies have largely focused on memory, cognitive impairment in this population may be predominantly of vascular origin. Therefore, cognitive assessment focusing on domains important in vascular cognitive impairment, such as executive dysfunction, may be more helpful in elucidating the association between TAVI and cognition in the long term.

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“…Several genes involved with inflammation, cell death and neurologic dysfunction were increased in patients who would later develop NCD. Systemic inflammation has been shown to contribute to neurocognitive decline after CPB 7, 15, 16 . In a previous study we demonstrated that while an increase in preoperative inflammatory chemokines did not affect outcome, postoperative elevations in chemokines were associated with the development of delirium after CPB 17 .…”

Section: Discussionmentioning

confidence: 99%

Preoperative gene expression may be associated with neurocognitive decline after cardiopulmonary bypass

Sabe

Dalal

Chu

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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OBJECTIVE Despite advances in surgical techniques, neurocognitive decline (NCD) after cardiopulmonary bypass (CPB) remains a common and serious complication. We have previously demonstrated that patients with NCD have unique genetic responses 6 hours after CPB when compared with normal patients (NORM). We used genomic microarray to objectively investigate whether patients with NCD had associated preoperative gene expression profiles, and how these profiles changed up to four days after surgery. METHODS Cardiac surgery patients underwent neurocognitive assessments preoperatively and four days after surgery. Skeletal muscle was collected intra-operatively. Whole blood collected pre-CPB, 6 hours post-CPB, and on post-operative day four was hybridized to Affymetrix Gene Chip U133 Plus 2.0 microarrays. Gene expression in patients with NCD was compared with gene expression in the NORM group using JMP Genomics. Only genes that were commonly expressed in the two groups with a false discovery rate of 0.05 and a fold change of >1.5 were carried forward to pathway analysis using Ingenuity Pathway Analysis. Microarray gene expression was validated by Green real–time polymerase chain reaction and western blotting. RESULTS 17 out of 42 patients developed NCD. 54,675 common transcripts were identified on microarray in each group across all time points. Preoperatively there were 140 genes that were significantly altered between the NORM and NCD groups (p < 0.05). Pathway analysis demonstrated that preoperatively patients with NCD had increased regulation in genes associated with inflammation, cell death, and neurologic dysfunction. Interestingly, the number of significantly regulated genes between the two groups changed over each time point, and decreased from 140 preoperatively, to 64, six hours after CPB, and 25, four days after surgery. There was no correlation in gene expression between the blood and skeletal muscle. CONCLUSIONS Patients who developed NCD post-CPB had increased differential gene expression before surgery versus patient who did not develop NCD. While significant differences in gene expression also existed post-operatively, these differences gradually decreased over time. Preoperative gene expression may be associated with neurologic injury after CPB. Further investigation into these genetic pathways may help predict patient outcome and guide patient selection.

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Fixing Hearts and Protecting Minds

Cited by 34 publications

References 108 publications

Coronary Artery Bypass Graft Surgery and Dementia Risk in the Cardiovascular Health Study

Coronary Artery Bypass Graft Surgery and Dementia Risk in the Cardiovascular Health Study

Cognitive Outcomes following Transcatheter Aortic Valve Implantation: A Systematic Review

Preoperative gene expression may be associated with neurocognitive decline after cardiopulmonary bypass

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