Dataset Information

Cerebral Blood Flow in Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation.

ABSTRACT:

Background

Transcatheter aortic valve implantation (TAVI) is a minimally invasive, life-saving treatment for patients with severe aortic valve stenosis that improves quality of life. We examined cardiac output and cerebral blood flow in patients undergoing TAVI to test the hypothesis that improved cardiac output after TAVI is associated with an increase in cerebral blood flow.

Design

Prospective cohort study.

Setting

European high-volume tertiary multidisciplinary cardiac care.

Participants

Thirty-one patients (78.3 ±?4.6?years; 61% female) with severe symptomatic aortic valve stenosis.

Measurements

Noninvasive prospective assessment of cardiac output (L/min) by inert gas rebreathing and cerebral blood flow of the total gray matter (mL/100?g per min) using arterial spin labeling magnetic resonance imaging in resting state less than 24?hours before TAVI and at 3-month follow-up. Cerebral blood flow change was defined as the difference relative to baseline.

Results

On average, cardiac output in patients with severe aortic valve stenosis increased from 4.0 ±?1.1 to 5.4 ±?2.4 L/min after TAVI (P =?.003). The increase in cerebral blood flow after TAVI strongly varied between patients (7%?±?24%; P =?.41) and related to the increase in cardiac output, with an 8.2% (standard error = 2.3%; P =?.003) increase in cerebral blood flow per every additional liter of cardiac output following the TAVI procedure.

Conclusion

Following TAVI, there was an association of increase in cardiac output with increase in cerebral blood flow. These findings encourage future larger studies to determine the influence of TAVI on cerebral blood flow and cognitive function.

SUBMITTER: Vlastra W

PROVIDER: S-EPMC7894507 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Cerebral Blood Flow in Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation.

Vlastra Wieneke W van Nieuwkerk Astrid C AC Bronzwaer Anne-Sophie G T AGT Versteeg Adriaan A Bron Esther E EE Niessen Wiro J WJ Mutsaerts Henk J M M HJMM van der Ster Björn J P BJP Majoie Charles B L M CBLM Biessels Geert J GJ Nederveen Aart J AJ Daemen Mat J A P MJAP van Osch Matthias J P MJP Baan Jan J Piek Jan J JJ Van Lieshout Johannes J JJ Delewi Ronak R

Journal of the American Geriatrics Society 20201017 2

<h4>Background</h4>Transcatheter aortic valve implantation (TAVI) is a minimally invasive, life-saving treatment for patients with severe aortic valve stenosis that improves quality of life. We examined cardiac output and cerebral blood flow in patients undergoing TAVI to test the hypothesis that improved cardiac output after TAVI is associated with an increase in cerebral blood flow.<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>European high-volume tertiary multidisciplinary cardiac c ...[more]

PMID: 33068017

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Project description:Background The prevalence of calcific aortic stenosis and amyloid transthyretin cardiomyopathy (ATTR-CM) increase with age, and they often coexist. The objective was to determine the prevalence of ATTR-CM in patients with severe aortic stenosis and evaluate differences in presentations and outcomes of patients with concomitant ATTR-CM undergoing transcatheter aortic valve implantation. Methods and Results Prospective screening for ATTR-CM with Technetium99-3,3-diphosphono-1,2-propanodicarboxylic acid bone scintigraphy was performed in 315 patients referred with severe aortic stenosis between August 2019 and August 2021. Myocardial Technetium99-3,3-diphosphono-1,2-propanodicarboxylic acid tracer uptake was detected in 34 patients (10.8%), leading to a diagnosis of ATTR-CM in 30 patients (Perugini ≥2: 9.5%). Age (85.7±4.9 versus 82.8±4.5; P=0.001), male sex (82.4% versus 57.7%; P=0.005), and prior carpal tunnel surgery (17.6% versus 4.3%; P=0.007) were associated with coexisting ATTR-CM, as were ECG (discordant QRS voltage to left ventricular wall thickness [42% versus 12%; P<0.001]), echocardiographic (left ventricular ejection fraction 48.8±12.8 versus 58.4±10.8; P<0.001; left ventricular mass index, 144.4±45.8 versus 117.2±34.4g/m2; P<0.001), and hemodynamic parameters (mean aortic valve gradient, 23.4±12.6 versus 35.5±16.6; P<0.001; mean pulmonary artery pressure, 29.5±9.7 versus 25.8±9.5; P=0.037). Periprocedural (cardiovascular death: hazard ratio [HR], 0.71 [95% CI, 0.04-12.53]; stroke: HR, 0.46 [95% CI, 0.03-7.77]; pacemaker implantation: HR, 1.54 [95% CI, 0.69-3.43]) and 1-year clinical outcomes (cardiovascular death: HR, 1.04 [95% CI, 0.37-2.96]; stroke: HR, 0.34 [95% CI, 0.02-5.63]; pacemaker implantation: HR, 1.50 [95% CI, 0.67-3.34]) were similar between groups. Conclusions Coexisting ATTR-CM was observed in every 10th elderly patient with severe aortic stenosis referred for therapy. While patients with coexisting pathologies differ in clinical presentation and echocardiographic and hemodynamic parameters, peri-interventional risk and early clinical outcomes were comparable up to 1 year after transcatheter aortic valve implantation. REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT04061213.

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Dataset Information

Cerebral Blood Flow in Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation.

Background

Design

Setting

Participants

Measurements

Results

Conclusion

Publications

Cerebral Blood Flow in Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation.

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