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Division of Cardiothoracic Surgery, University of California, San Diego, 200 West Arbor Dr, San Diego, CA 92103-8892
(Email: pthistlethwaite{at}ucsd.edu).
The study of the molecular causes of human disease is coming to the forefront of medicine since the sequencing of the human genome and the development of proteomic research. In the field of neurocognitive decline, the apolipoprotein E 
4 (APOE 4) allele has been associated with the development of Alzheimer's disease, C-reactive protein (CRP) polymorphisms have been linked to an increased risk of stroke, and the release of S100 protein and specific S100 polymorphisms have been correlated with the development of ischemic brain injury and dementia. As cardiac surgeons, we have an interest in understanding if certain populations of individuals with a specific inherited allele would be more susceptible to neurocognitive injury after cardiac surgery than the general population of patients undergoing the same procedure.
It is generally recognized that subtle cognitive decline occurs in a small population of patients after cardiac surgery, although the presence and pattern of such decline has varied in different studies. Although memory loss, mental decline, and physical slowing seen in a small cohort of patients after cardiac surgery are usually not severe enough to meet the criteria for dementia, they can lower the quality of life and add to hospitalization and out-of-hospital costs. Cognitive impairment after cardiac surgery is a multifactorial process, related to the pathophysiology of cerebral embolism, systemic inflammation, body temperature, and cerebral hemodynamics. Reports in the literature have suggested that mean arterial pressure during operation, degree of atherosclerotic aortic disease, and left ventricular thrombus, on-pump versus off-pump techniques, diabetes, female sex, preoperative mental impairment, and pre-existing history of vascular disease may all be associated postoperative cognitive decline. It is possible that genetic susceptibility also plays a role in this process.
The study presented by Silbert and colleagues [1] is essentially a negative study in that the apolipoprotein E 4 allele was not associated with the development of postoperative neurocognitive impairment, as assessed by neuropsychological testing at 3 and 12 months after coronary artery bypass grafting. Nonetheless, it is an important article in that it brings the field of genetics into the assessment of outcome of one of our most commonly performed procedures. With high-output gene sequencing and the creation of the National Center for Biotechnology Information (NCBI) Single Nucleotide Polymorphism Databank (http://www.ncbi.nlm.nih.gov/SNP) for genomic population comparison, one can hope that other specific alleles will be identified in patients that will help us in the future to define which individuals are more prone to neurologic complications after cardiac surgery.
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4 allele is not associated with cognitive dysfunction in cardiac surgery Ann Thorac Surg 2008;86:841-848.Related Article
4 Allele is not Associated With Cognitive Dysfunction in Cardiac Surgery
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