{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T09:21:38Z","timestamp":1770283298988,"version":"3.49.0"},"reference-count":36,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T00:00:00Z","timestamp":1698192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science, Research and Cultural Affairs of the State of Brandenburg"},{"name":"DFG"},{"name":"German Cardiac Society (DGK)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>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)\u2014a biomarker of neuronal damage\u2014are 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 \u201cConsortium to Establish a Registry for Alzheimer\u2019s Disease\u201d (CERAD) word list and the digit span task (DST) implemented in \u201c\u2206elta-App\u201d. Results: Subjects\u2019 median age was 82 years (25th to 75th percentile: 77.5\u201385.0), 42.6% of subjects were women. CERAD scores significantly increased from pre- to post-TAVR, with p &lt; 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\u20132.53) to 2.37 ng\/mL (1.69\u20133.07), p &lt; 0.001. The median increase in NSE was 40.4% (13.1\u2013138.0) in patients with POD versus 17.3% (3.3\u201343.4) 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.<\/jats:p>","DOI":"10.3390\/jcdd10110441","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T04:14:47Z","timestamp":1698207287000},"page":"441","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Association between Neuron-Specific Enolase, Memory Function, and Postoperative Delirium after Transfemoral Aortic Valve Replacement"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6051-8931","authenticated-orcid":false,"given":"Jonathan","family":"N\u00fcbel","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, 16321 Bernau, Germany"},{"name":"Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, 16816 Cottbus, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6582-9763","authenticated-orcid":false,"given":"Charlotte","family":"Buhre","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, 16321 Bernau, Germany"},{"name":"Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, 16816 Cottbus, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meike","family":"Hoffmeister","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, 16816 Cottbus, Germany"},{"name":"Institute of Biochemistry, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg an der Havel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefanie","family":"Oess","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, 16816 Cottbus, Germany"},{"name":"Institute of Biochemistry, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg an der Havel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Labrenz","sequence":"additional","affiliation":[{"name":"Department of Psychology, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kerstin","family":"Jost","sequence":"additional","affiliation":[{"name":"Department of Psychology, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Hauptmann","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg, 16816 Cottbus, Germany"},{"name":"Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julika","family":"Sch\u00f6n","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care, University Hospital Ruppin Brandenburg (UKRB), Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georg","family":"Fritz","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Pain Therapy, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, 16321 Bernau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Butter","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, 16321 Bernau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6881-2249","authenticated-orcid":false,"given":"Anja","family":"Haase-Fielitz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, 16321 Bernau, Germany"},{"name":"Institute of Social Medicine and Health System Research, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1161\/CIRCULATIONAHA.112.092544","article-title":"Cerebral embolization during transcatheter aortic valve im-plantation: A transcranial Doppler study","volume":"126","author":"Kahlert","year":"2012","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Fanning, J.P., Wesley, A.J., Platts, D.G., Walters, D.L., Eeles, E.M., Seco, M., Tronstad, O., Strugnell, W., Barnett, A.G., and Clarke, A.J. (2014). The silent and apparent neurological injury in transcatheter aortic valve implantation study (SANITY): Concept, design and rationale. BMC Cardiovasc. Disord., 14.","DOI":"10.1186\/1471-2261-14-45"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1016\/j.jacc.2009.12.026","article-title":"Risk and fate of cerebral embolism after transfemoral aortic valve implantation: A prospective pilot study with diffusion-weighted magnetic resonance imaging","volume":"55","author":"Ghanem","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/S0140-6736(13)60688-1","article-title":"Delirium in elderly people","volume":"383","author":"Inouye","year":"2014","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1111\/jgs.18104","article-title":"Postoperative delirium after transcatheter aortic valve replacement: An updated systematic review and meta-analysis","volume":"71","author":"Ma","year":"2023","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.1097\/CCM.0b013e318250acc0","article-title":"The association between brain volumes, delirium duration, and cognitive outcomes in intensive care unit survivors: The VISIONS cohort magnetic resonance imaging study","volume":"40","author":"Gunther","year":"2012","journal-title":"Crit. Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.amjcard.2018.10.022","article-title":"Neuron-Specific Enolase and Matrix Metalloproteinase 9 Signal Perioperative Silent Brain Infarction during or after Transcatheter Aortic Valve Implantation","volume":"123","author":"Fanning","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/978-94-017-7215-0_9","article-title":"Neuron-Specific Enolase as a Biomarker: Biochemical and Clinical Aspects","volume":"867","author":"Isgro","year":"2015","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Cheng, F., Yuan, Q., Yang, J., Wang, W., and Liu, H. (2014). The prognostic value of serum neuron-specific enolase in traumatic brain injury: Systematic review and meta-analysis. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0106680"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1186\/s13054-022-04263-y","article-title":"Predicting neurological outcome in adult patients with cardiac arrest: Systematic review and meta-analysis of prediction model performance","volume":"26","author":"Amacher","year":"2022","journal-title":"Crit. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1161\/01.STR.31.3.645","article-title":"Neurobehavioral outcome prediction after cardiac surgery: Role of neurobiochemical markers of damage to neuronal and glial brain tissue","volume":"31","author":"Herrmann","year":"2000","journal-title":"Stroke"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1055\/s-0038-1677511","article-title":"Serum Neuron-Specific Enolase Level as Predictor of Neurologic Outcome after Aortic Surgery","volume":"68","author":"Kimura","year":"2020","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Wang, X., Chen, X., Wu, F., Liu, Y., Yang, Y., Chen, W., Pan, Z., Hu, W., Zheng, F., and He, H. (2023). Relationship between postoperative biomarkers of neuronal injury and postoperative cognitive dysfunction: A meta-analysis. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0284728"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1055\/s-0035-1555115","article-title":"The Impact of Age on Cognition","volume":"36","author":"Murman","year":"2015","journal-title":"Semin. Hear."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1111\/psyg.12056","article-title":"The impact of subjective memory complaints on quality of life in community-dwelling older adults","volume":"14","author":"Maki","year":"2014","journal-title":"Psychogeriatrics"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_17","first-page":"196","article-title":"Memory Span Tests","volume":"12","author":"Humpstone","year":"1919","journal-title":"Psychol. Clin."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.medin.2009.04.003","article-title":"Confusion Assessment Method for diagnosing delirium in ICU patients (CAM-ICU): Cultural adaptation and validation of the Spanish version","volume":"34","author":"Tobar","year":"2010","journal-title":"Med. Intensiv."},{"key":"ref_19","unstructured":"Lezak, M.D., Howieson, D.B., Bigler, E.D., and Tranel, D. (2012). Neuropsychological Assessment, Oxford University Press."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.4244\/EIJV8I11A198","article-title":"Prognostic value of cerebral injury following transfemoral aortic valve implantation","volume":"8","author":"Ghanem","year":"2013","journal-title":"EuroIntervention"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"i41","DOI":"10.1093\/bja\/aep291","article-title":"Postoperative delirium and cognitive dysfunction","volume":"103","author":"Deiner","year":"2009","journal-title":"Br. J. Anaesth."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e825","DOI":"10.1097\/CCM.0000000000003299","article-title":"Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation\/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU","volume":"46","author":"Devlin","year":"2018","journal-title":"Crit. Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.hrtlng.2015.11.001","article-title":"Sensitivity and Specificity of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for Detecting Post-Cardiac Surgery Delirium: A Single-Center Study in Japan","volume":"45","author":"Nishimura","year":"2016","journal-title":"Heart Lung"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Humbert, M., Bula, C.J., Muller, O., Krief, H., and Monney, P. (2021). Delirium in older patients undergoing aortic valve replacement: Incidence, predictors, and cognitive prognosis. BMC Geriatr., 21.","DOI":"10.1186\/s12877-021-02100-5"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.bja.2020.06.063","article-title":"Postoperative delirium: Perioperative assessment, risk reduction, and management","volume":"125","author":"Jin","year":"2020","journal-title":"Br. J. Anaesth."},{"key":"ref_26","first-page":"8","article-title":"Association between serum biomarkers and postoperative delirium after cardiac surgery","volume":"26","author":"Gailiusas","year":"2019","journal-title":"Acta Med. Litu."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Mietani, K., Hasegawa-Moriyama, M., Inoue, R., Ogata, T., Shimojo, N., Kurano, M., Sumitani, M., and Uchida, K. (2021). Elevated neuron-specific enolase level is associated with postoperative delirium and detection of phosphorylated neurofilament heavy subunit: A prospective observational study. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0259217"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1159\/000329442","article-title":"Evaluation of a summary score of cognitive performance for use in trials in perioperative and critical care","volume":"31","author":"Burkhart","year":"2011","journal-title":"Dement. Geriatr. Cogn. Disord."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1111\/jgs.15123","article-title":"Cognitive Outcomes after Transcatheter Aortic Valve Implantation: A Metaanalysis","volume":"66","author":"Khan","year":"2018","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"209569","DOI":"10.1155\/2015\/209569","article-title":"Cognitive Outcomes following Transcatheter Aortic Valve Implantation: A Systematic Review","volume":"2015","author":"Lai","year":"2015","journal-title":"Cardiovasc. Psychiatry Neurol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1111\/jgs.15185","article-title":"Cognitive Function after Transcatheter Aortic Valve Replacement: Reassuring Findings for Now","volume":"66","author":"Afilalo","year":"2018","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1159\/000500777","article-title":"Test Administration Methods and Cognitive Test Scores in Older Adults with Hearing Loss","volume":"66","author":"Shen","year":"2020","journal-title":"Gerontology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"64358","DOI":"10.18632\/oncotarget.17825","article-title":"Systematic review and meta-analysis of the efficacy of serum neuron-specific enolase for early small cell lung cancer screening","volume":"8","author":"Huang","year":"2017","journal-title":"Oncotarget"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"E218","DOI":"10.25270\/jic\/21.00161","article-title":"Clinically Significant Incidental Findings on CT Imaging during TAVI Work-up: A Systematic Review and Meta-Analysis","volume":"34","author":"Ko","year":"2022","journal-title":"J. Invasive Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jocn.2018.08.020","article-title":"The neuron specific enolase (NSE) ratio offers benefits over absolute value thresholds in post-cardiac arrest coma prognosis","volume":"57","author":"Mui","year":"2018","journal-title":"J. Clin. Neurosci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1212\/01.wnl.0000191308.22233.88","article-title":"Prediction of poor outcome within the first 3 days of postanoxic coma","volume":"66","author":"Zandbergen","year":"2006","journal-title":"Neurology"}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/10\/11\/441\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:11:19Z","timestamp":1760130679000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/10\/11\/441"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,25]]},"references-count":36,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["jcdd10110441"],"URL":"https:\/\/doi.org\/10.3390\/jcdd10110441","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,25]]}}}