Cerebrovascular Disease Detected on Preprocedural Computed Tomography in Patients With Severe Aortic Stenosis Undergoing Aortic Valve Replacement

• Published in: Journal of the American Heart Association Vol. 13; no. 14; p. e035078
• Main Authors: Yamamoto, Ko, Ueda, Hiroyuki, Uchiyama, Daiji, Takeji, Yasuaki, Taniguchi, Tomohiko, Morimoto, Takeshi, Tabata, Hiroyuki, Ishizu, Kenichi, Morofuji, Toru, Hayashi, Masaomi, Isotani, Akihiro, Shirai, Shinichi, Ohno, Nobuhisa, Kakumoto, Shinichi, Ando, Kenji, Minatoya, Kenji, Kimura, Takeshi
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 16.07.2024; Wiley
• Subjects: Aged; Aged, 80 and over; aortic stenosis; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; aortic valve replacement; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Cerebrovascular Disorders - diagnostic imaging; Cerebrovascular Disorders - epidemiology; Cerebrovascular Disorders - etiology; Cerebrovascular Disorders - mortality; computed tomography; covert cerebrovascular disease; Female; Heart Valve Prosthesis Implantation - adverse effects; Humans; Incidence; Male; Middle Aged; Original Research; Predictive Value of Tests; Prevalence; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; stroke; Stroke - epidemiology; Stroke - etiology; Tomography, X-Ray Computed; Treatment Outcome; computed tomography; aortic stenosis; covert cerebrovascular disease; aortic valve replacement; stroke
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.124.035078

There is a scarcity of data on the prevalence and clinical impact of cerebrovascular disease detected on preprocedural computed tomography (CT) before aortic valve replacement (AVR) in patients with severe aortic stenosis. Among patients with severe aortic stenosis undergoing AVR, the authors compared clinical outcomes between patients with and without cerebrovascular disease detected on preprocedural CT, which was defined as chronic brain infarction or hemorrhage. The primary outcome measure in this study was a composite of all-cause death or stroke. Among 567 study patients, 200 patients (35.3%) had cerebrovascular disease on preprocedural CT. Among 200 patients with cerebrovascular disease on preprocedural CT, only 28.5% of patients had a clinical history of symptomatic stroke. The cumulative 3-year incidence of death or stroke was higher in patients with cerebrovascular disease on preprocedural CT than in those without cerebrovascular disease on preprocedural CT (40.7% versus 24.1%, log-rank <0.001). After adjusting for confounders, the higher risk of patients with cerebrovascular disease on preprocedural CT relative to those without remained significant for death or stroke (hazard ratio [HR], 1.42 [95% CI, 1.02-1.98]; =0.04). Among 200 patients with cerebrovascular disease on preprocedural CT, patients with prior symptomatic stroke compared with those without were not associated with higher adjusted risk for death or stroke (HR, 1.18 [95% CI, 0.72-1.94]; =0.52). Among patients with severe aortic stenosis undergoing AVR, a substantial proportion had cerebrovascular disease on preprocedural CT, with a clinical history of symptomatic stroke in one-fourth of patients. Regardless of history of symptomatic stroke, patients with cerebrovascular disease on preprocedural CT had worse clinical outcomes compared with those without cerebrovascular disease on preprocedural CT.