Preoperative blood-brain barrier disruption increased risk of postoperative cognitive decline after coronary artery bypass grafting: a prospective cohort study
Bibliographic record
Abstract
BACKGROUND: Cognitive decline after coronary artery bypass grafting (CABG) surgery is common and significantly impacts the long-term prognosis of coronary artery disease (CAD) patients. Nevertheless, the mechanisms of postoperative cognitive decline (POCD) and its early neuroimaging indicators remain unclear. OBJECTIVES: To explore whether blood-brain barrier disruption of computed tomography perfusion (CTP) is associated with POCD in patients with CABG. METHODS: The study involved 116 participants (mean age 63.85 ± 8.10 years) with CAD who underwent CABG surgery as part of the IACV Study. A CTP scan was performed before the surgery to assess the permeable surface (PS) values of the frontal and temporal lobes. The Montreal Cognitive Assessment (MoCA) neurological scale was used to measure cognitive function before the surgery and again before discharge. RESULTS: Overall, 24 (20.69%) developed POCD. All patients underwent the same anesthesia and postoperative analgesia, with no difference in postoperative blood loss and days of hospital discharge between the two groups. Patients with POCD exhibited higher PS in the right frontal lobe (0.20 [0.10, 0.30] vs 0.13 [0.07, 0.18], P = 0.009) and left frontal lobe (0.23 [0.11, 0.28] vs 0.14 [0.08, 0.22], P = 0.030). A notable decrease in total MoCA scores from 20.7 to 14.0 was seen in patients with POCD. Each 0.05 ml/100 g/min increase in PS of the right frontal lobe was associated with 1.32 times increase in the risk of developing POCD. Higher baseline PS values correlated with a greater decline in MoCA scores post-surgery ( ρ = -0.231, P = 0.0214). CONCLUSIONS: Almost one-fifth of patients develop POCD following CABG surgery, and preoperative elevation of frontal lobe PS is associated with POCD. These findings suggest that CTP-PS may serve as an imaging biomarker to identify patients at high risk for POCD.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".