The Role of Preoperative Chronic Hypertension in Neurocognitive Decline after Cardiac Surgery: A Retrospective Cohort Study.

Madigan E Stanley, Ronald K Phillips, Jun Feng, Guangbin Shi, Shawn Kant, Nicholas C Sellke, Neel R Sodha, Afshin Ehsan, Frank W Sellke
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Abstract

Introduction: Patients frequently experience transient postoperative neurocognitive decline (NCD) after cardiac surgery with cardiopulmonary bypass. The goal of this study is to describe preoperative high blood pressure as a risk factor for NCD and use genomic expression to uncover its contribution to the pathophysiology of NCD.

Methods: This is a retrospective analysis of cohort study at a single academic center. Patients undergoing cardiac surgery with the use of cardiopulmonary bypass were administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) preoperatively, at postoperative day four, and four weeks postoperatively. Electronic medical records were reviewed for all recorded blood pressure from the year preceding surgery and intraoperative blood pressures. Blood samples were collected six hours preoperatively and six hours postoperatively to assess messenger ribonucleic acid expression.

Results: Eighty-seven patients completed postoperative day four testing, of whom thirty-seven experienced NCD (42.5%). Chronically elevated systolic blood pressure over the year preceding surgery was correlated with greater negative change in RBANS score at postoperative day four (P=0.03). Upon genomic analysis, macrophage markers were upregulated preoperatively, and anti-inflammatory and neuroprotective genes were downregulated postoperatively among patients who had a mean systolic blood pressure ≥ 130 mmHg.

Conclusion: Chronic exposure to elevated preoperative systolic blood pressure may increase the risk of NCD. The contributing role of preoperative hypertension in NCD may be partly explained by reduced attenuation of oxidative stress, increased inflammation, and reduced neuroprotection and heme metabolism postoperatively. This must be considered when assessing patient risks for cardiac surgery.

术前慢性高血压在心脏手术后神经认知能力下降中的作用:一项回顾性队列研究。
导读:心脏手术合并体外循环后,患者经常出现短暂的术后神经认知能力下降(NCD)。本研究的目的是将术前高血压描述为非传染性疾病的一个危险因素,并利用基因组表达来揭示其对非传染性疾病病理生理的贡献。方法:回顾性分析单一学术中心的队列研究。接受心脏手术并使用体外循环的患者术前、术后第4天和术后4周给予可重复电池神经心理状态评估(rban)。检查了术前一年所有记录的血压和术中血压的电子病历。术前6小时和术后6小时采集血样,评估信使核糖核酸的表达。结果:87例患者完成了术后第4天的检测,其中37例发生了NCD(42.5%)。术前一年的收缩压长期升高与术后第4天rban评分的负变化相关(P=0.03)。基因组分析显示,在平均收缩压≥130 mmHg的患者中,术前巨噬细胞标志物上调,术后抗炎和神经保护基因下调。结论:术前收缩压长期升高可增加非传染性疾病的发生风险。术前高血压在非传染性疾病中的作用可以部分解释为氧化应激衰减减少、炎症增加、术后神经保护和血红素代谢降低。在评估患者进行心脏手术的风险时,必须考虑到这一点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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