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. 2023 Oct 25;10(11):441.
doi: 10.3390/jcdd10110441.

Association between Neuron-Specific Enolase, Memory Function, and Postoperative Delirium after Transfemoral Aortic Valve Replacement

Jonathan Nübel  1   2 , Charlotte Buhre  1   2 , Meike Hoffmeister  2   3 , Stefanie Oess  2   3 , Oliver Labrenz  4 , Kerstin Jost  4 , Michael Hauptmann  2   5 , Julika Schön  6 , Georg Fritz  7 , Christian Butter  1 , Anja Haase-Fielitz  1   8
Affiliations

Association between Neuron-Specific Enolase, Memory Function, and Postoperative Delirium after Transfemoral Aortic Valve Replacement

Jonathan Nübel et al. J Cardiovasc Dev Dis. .

Abstract

Introduction: Although transfemoral aortic valve replacement (TAVR) is a safe treatment for elderly patients with severe aortic valve stenosis, postoperative microembolism has been described. In this secondary endpoint analysis of the POST-TAVR trial, we aimed to investigate whether changes in neuron-specific enolase (NSE)-a biomarker of neuronal damage-are associated with changes in memory function or postoperative delirium (POD).

Materials and methods: This was a prospective single-center study enrolling patients undergoing elective TAVR. Serum NSE was measured before and 24 h after TAVR. POD was diagnosed using CAM-ICU testing. Memory function was assessed before TAVR and before hospital discharge using the "Consortium to Establish a Registry for Alzheimer's Disease" (CERAD) word list and the digit span task (DST) implemented in "∆elta-App".

Results: Subjects' median age was 82 years (25th to 75th percentile: 77.5-85.0), 42.6% of subjects were women. CERAD scores significantly increased from pre- to post-TAVR, with p < 0.001. POD occurred in 4.4% (6/135) of subjects at median 2 days after TAVR. After TAVR, NSE increased from a median of 1.85 ng/mL (1.30-2.53) to 2.37 ng/mL (1.69-3.07), p < 0.001. The median increase in NSE was 40.4% (13.1-138.0) in patients with POD versus 17.3% (3.3-43.4) in those without POD (p = 0.17).

Conclusions: Memory function improved after TAVR, likely due to learning effects, with no association to change in NSE. Patients with POD appear to have significantly higher postoperative levels of NSE compared to patients without POD after TAVR. This finding suggests that neuronal damage, as indicated by NSE elevation, may not significantly impair assessed memory function after TAVR.

Keywords: TAVR; cognitive assessment; memory function; neuron-specific enolase; postoperative delirium.

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Conflict of interest statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Figures

Figure 1
Figure 1
Patient flow through the study.
Figure 2
Figure 2
(a) Neuron-specific enolase (NSE) before and after TAVR. Comparison of preoperative versus postoperative median serum NSE ng/(mL) concentration. (b) Postoperative median concentrations of neuron-specific enolase (NSE) by POD incidence. (c) Median increase in % change in NSE by POD incidence. Relative (%) change in NSE levels by POD groups with (+40.3%) and without (+17.3%) postoperative delirium (POD), p = 0.17.
Figure 2
Figure 2
(a) Neuron-specific enolase (NSE) before and after TAVR. Comparison of preoperative versus postoperative median serum NSE ng/(mL) concentration. (b) Postoperative median concentrations of neuron-specific enolase (NSE) by POD incidence. (c) Median increase in % change in NSE by POD incidence. Relative (%) change in NSE levels by POD groups with (+40.3%) and without (+17.3%) postoperative delirium (POD), p = 0.17.
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