This Article Full Text Full Text (PDF) All Versions of this Article: 37/6/1432    most recent 01.STR.0000221295.14547.c8v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bokesch, P. M. Articles by Dambinova, S. A. Search for Related Content PubMed PubMed Citation Articles by Bokesch, P. M. Articles by Dambinova, S. A. Related Collections Behavioral/psychosocial - CV surgery Other diagnostic testing CV surgery: coronary artery disease CV surgery: valvular disease

(Stroke. 2006;37:1432.)
© 2006 American Heart Association, Inc.

Original Contributions

NMDA Receptor Antibodies Predict Adverse Neurological Outcome After Cardiac Surgery in High-Risk Patients

Paula M. Bokesch, MD; Galina A. Izykenova, PhD; Joseph B. Justice, PhD; Kirk A. Easley, MS, MapStat Svetlana A. Dambinova, PhD, DSc

From the Department of Anesthesia (P.M.B.), Emory University; the Department of Chemistry (G.A.I., J.B.J., S.A.D.), Emory University; the Emory Biostatistics Consulting Center (K.A.E.), Emory University School of Medicine, Atlanta, Ga; and the Department of Neurology and Neurosurgery (S.A.D.), St Petersburg’s State Medical University, St Petersburg, Russia.

Reprint requests to Dr Galina Izykenova, 520 Emory Circle NE, Atlanta, GA 30307. E-mail galizy{at}aol.com

Background and Purpose— The goal of this study was to compare the predictive ability of S100B, N-methyl-D-aspartate (NMDA) receptor antibodies (NR2Ab) and C-reactive protein (CRP) for neurological deficits after cardiac surgery with cardiopulmonary bypass (CPB).

Methods— We investigated 557 high-risk adult patients who underwent coronary artery or valve replacement surgery using CPB as a substudy of a prospective, blinded, multicenter clinical trial. Serum concentrations of S100B (n=513 patients), NR2Ab (n=398) and CRP (n=510) were measured preoperatively, 24 and 48 hours after CPB. Neurological adverse events were assessed at baseline and postoperative days 1 and 2; neurocognitive function (mini-mental status examination) was assessed at baseline and on postoperative days 1, 7 and 28.

Results— Fifty-five (9.9%) patients had moderate or severe neurological adverse events (confusion/delirium, transient ischemic attack, or stroke) within 48 hours of CPB. Women had significantly more neurological complications than men (15.5% versus 7.8%; P=0.007). Ninety-six percent (24/25) of patients with NR2Ab concentrations 2.0 ng/mL preoperatively had neurological complications within 48 hours post-CPB, versus only 5.4% (20/373) of patients with NR2Ab concentrations <2.0 ng/mL, resulting in a 17.9-fold increase (95% CI, 11.6 to 27.6) in postoperative neurological complications for patients with high levels of NR2A antibodies. Preoperative serum S100B and CRP did not predict neurological complications from CPB. Decreased mini-mental status examination scores for orientation, attention and recall were associated with neurological adverse events early after CPB.

Conclusions— Preoperative serum concentrations of NR2Ab, but not S100B or CRP, are predictive of severe neurological adverse events after CPB. Patients with a positive NR2Ab test (2.0 ng/mL) preoperatively were nearly 18 times more likely to experience a postoperative neurological event than patients with a negative test (<2.0 ng/mL).

Key Words: brain ischemia • cardiac surgery • cardiopulmonary bypass

This article has been cited by other articles:

				H. Yuan, K. M. Vance, C. E. Junge, M. T. Geballe, J. P. Snyder, J. R. Hepler, M. Yepes, C.-M. Low, and S. F. Traynelis The Serine Protease Plasmin Cleaves the Amino-terminal Domain of the NR2A Subunit to Relieve Zinc Inhibition of the N-Methyl-D-aspartate Receptors J. Biol. Chem., May 8, 2009; 284(19): 12862 - 12873. [Abstract] [Full Text] [PDF]

				D. Pleasure Diagnostic and Pathogenic Significance of Glutamate Receptor Autoantibodies Arch Neurol, May 1, 2008; 65(5): 589 - 592. [Abstract] [Full Text] [PDF]