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- Reinsfelt, Björn, et al.
(författare)
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Open-heart surgery increases cerebrospinal fluid levels of Alzheimer-associated amyloid β
- 2013
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Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 57:1, s. 82-88
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Neurocognitive dysfunction occurs frequently after open-heart surgery. It has been suggested that cognitive decline after cardiac surgery with cardiopulmonary bypass (CPB) could be a functional consequence of Alzheimer's disease (AD)-like neuropathological changes. The aim of the present study was to evaluate the cerebrospinal fluid (CSF) levels of amyloid β peptide (Aβ(1-42) ) and soluble fragments of amyloid precursor protein (sAPP) as well as the cerebral inflammatory response to open-heart surgery. METHODS: Ten patients undergoing aortic valve replacement with CPB were included. CSF was obtained the day before and 24h after surgery for assessment of CSF levels of Aβ(1-42) α-cleaved sAPP and β-cleaved sAPP (sAPP-β). Furthermore, CSF and serum levels of the inflammatory cytokines: tumour necrosis factor alpha (TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) were also assessed. RESULTS: Cardiac surgery with CPB increased CSF levels of Aβ(1-42) from 447±92 to 641±83ng/l (P=0.011), while CSF levels of sAPP-β decreased from 276±35 to 192±21ng/ml (P=0.031). CSF levels of TNF-α increased from ≤0.60 to 0.79±0.26ng/l (P=0.043), IL-6 from 1.89±0.53 to 22.8±6.9ng/l (P=0.003) and IL-8 from 39.8±7.8 to 139±18.3ng/l (P<0.001). CONCLUSIONS: Cardiac surgery with CPB causes a profound cerebral inflammatory response, which was accompanied by increased post-operative CSF levels of the AD biomarker Aβ(1-42) . We hypothesize that these changes may be relevant to Alzheimer-associated amyloid build-up in the brain and cognitive dysfunction after cardiac surgery with CPB.
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| 2. |
- Reinsfelt, Björn, et al.
(författare)
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Transcranial Doppler microembolic signals and serum marker evidence of brain injury during transcatheter aortic valve implantation.
- 2012
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Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 56:2, s. 240-24
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Recent studies have shown that transcatheter aortic valve implantation (TAVI) is associated with new foci of restricted diffusion on cerebral magnetic resonance imaging suggestive of cerebral microembolism. The aim of the present investigation was to quantify the cerebral embolic load and to evaluate during which phase of the TAVI procedure microembolism occurs. We also evaluated the association between the cerebral embolic load and post-procedural release of S100B, a serological marker of cerebral injury. METHODS: In 21 patients, we described the extent and intra-procedural distribution of microemboli during the TAVI procedure using the transcranial Doppler technique. S100B, a marker of astroglial injury, was measured for 24h after the procedure, and the area under the curve (AUC(24h) ) relating S100B to time was calculated. RESULTS: During the TAVI procedure, a mean of 282±169 emboli was detected, 37% occurred during manipulation of the aortic arch/root/valve by guide wires and catheters, 22% occurred immediately after balloon dilatation of the native valve and 41% occurred during frame expansion of the valve prosthesis. S100B increased in all patients with a peak at 1h after the procedure and returned to baseline after 4h. There was a positive correlation between the total amount of cerebral microemboli and the AUC(24h) for S100B (r=0.68, P<0.001). None of the patients developed neurological impairment. CONCLUSION: TAVI is associated with a substantial amount of cerebral microemboli. The microembolic load correlates to the degree of post-procedural release of a marker of cerebral injury.
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