Diffusion-weighted MRI determined cerebral embolic infarction following transcatheter aortic valve implantation: assessment of predictive risk factors and the relationship to subsequent health status

• Published in: Heart (British Cardiac Society) Vol. 98; no. 1; pp. 18 - 23
• Main Authors: Fairbairn, Timothy A, Mather, Adam N, Bijsterveld, Petra, Worthy, Gillian, Currie, Stuart, Goddard, Anthony J P, Blackman, Daniel J, Plein, Sven, Greenwood, John P
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.01.2012; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: acute myocardial infarction; Aged; Aged, 80 and over; Aortic stenosis; Aortic Valve Stenosis - therapy; Biological and medical sciences; Calcification; Cardiac Catheterization - adverse effects; Cardiology. Vascular system; Cerebral Infarction - diagnosis; Cerebral Infarction - etiology; Clinical outcomes; Cognitive ability; Comorbidity; coronary intervention; coronary stenting; Diffusion; Diffusion Magnetic Resonance Imaging - methods; echocardiography; Female; Health Status; Heart surgery; Heart Valve Prolapse; Heart Valve Prosthesis Implantation - adverse effects; Humans; interventional cardiology; Intracranial Embolism - diagnosis; Intracranial Embolism - etiology; intravascular ultrasound; Magnetic Resonance Angiography - methods; Male; Medical sciences; Medical treatment; Mental health; Mortality; MRI; Neurologic Examination; Neurology; Plaque, Atherosclerotic - diagnosis; Quality of life; Questionnaires; Risk Factors; Software; Statistical analysis; Stroke; Stroke - diagnosis; Stroke - etiology; Studies; TAVI; Vascular Calcification - therapy; Vascular diseases and vascular malformations of the nervous system; Cerebral infarction; Nervous system diseases; Health; Cardiovascular disease; Implantation; Nuclear magnetic resonance imaging; Weight; Cerebral disorder; Vascular disease; Central nervous system disease; Risk factor; Medical imagery; Circulatory system; Cardiology; Diffusion; Predictive factor; Aortic valve; Cerebrovascular disease
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2011-300065

Background‘Silent’ cerebral infarction and stroke are complications of transcatheter aortic valve implantation (TAVI).ObjectiveTo assess the occurrence of cerebral infarction, identify predictive risk factors and examine the impact on patient health-related quality of life (HRQoL).MethodsCerebral diffusion weighted MRI of 31 patients with aortic stenosis undergoing CoreValve TAVI was carried out. HRQoL was assessed at baseline and at 30 days by SF-12v2 and EQ5D questionnaires.ResultsNew cerebral infarcts occurred in 24/31 patients (77%) and stroke in 2 (6%). Stroke was associated with a greater number and volume of cerebral infarcts. Age (r=0.37, p=0.042), severity of atheroma (arch and descending aorta; r=0.91, p<0.001, r=0.69, p=0.001, respectively) and catheterisation time (r=0.45, p=0.02) were predictors of the number of new cerebral infarcts. HRQoL improved overall: SF-12v2 physical component summary increased significantly (32.4±6.2 vs 36.5±7.2; p=0.03) with no significant change in mental component summary (43.5±11.7 vs 43.1±14.3; p=0.85). The EQ5D score and Visual Analogue Scale showed no significant change (0.56±0.26 vs 0.59±0.31; p=0.70, and 54.2±19 vs 58.2±24; p=0.43).ConclusionMultiple small cerebral infarcts occurred in 77% of patients with TAVI. The majority of infarcts were ‘silent’ with clinical stroke being associated with a both higher infarct number and volume. Increased age and the severity of aortic arch atheroma were independent risk factors for the development of new cerebral infarcts. Overall HRQoL improved and there was no association between the number of new cerebral infarcts and altered health status.