Cerebral white matter lesion burden is associated with the degree of aortic valve calcification and predicts peri‐procedural cerebrovascular events in patients undergoing transcatheter aortic valve implantation (TAVI)

• Published in: Catheterization and cardiovascular interventions 2018-03, Vol.91 (4), p.774-782
• Main Authors: Doerner, Jonas, Kupczyk, Patrick A., Wilsing, Marius, Luetkens, Julian A., Storm, Klaus, Fimmers, Rolf, Hickethier, Tilman, Eichhorn, Lars, Naehle, Claas P., Schild, Hans H., Werner, Nikos, Nickenig, Georg, Ghanem, Alexander
• Format: Article
• Language: English
• Subjects: Aortic stenosis; Aortic valve; aortic valve disease; Brain; Calcification; Calcification (ectopic); cerebrovascular disease; Cerebrovascular system; Echocardiography; elderly patients; Electrocardiography; Embolism; Esophagus; Hemispheric laterality; imaging; Implantation; Magnetic resonance imaging; Morphology; Neuroimaging; NMR; Nuclear magnetic resonance; percutaneous intervention; Stenosis; Substantia alba; TTE/TEE
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.27122

Objectives To investigate the impact of aortic valve calcification and brain morphology on acute peri‐procedural cerebrovascular events (CVEs) in patients undergoing transcatheter aortic valve implantation (TAVI). Background Aortic valve calcification and stenosis can be assessed with echocardiography. Cerebral magnetic resonance imaging (MRI) depicts and quantifies morphological signs of hypoperfusion and vascular embolism, which is of special interest in patients with severe aortic stenosis. Furthermore, subjects who undergo TAVI are prone to suffer of clinically silent peri‐procedural CVEs. Methods A total of 119 patients referred to TAVI were investigated for aortic valve calcification using trans‐esophageal echocardiography. Cerebral MRI prior to and immediate after implantation was performed in all patients using a dedicated scan protocol. Prior to TAVI, brain morphology was characterized. Post TAVI, brains were investigated for the onset of acute peri‐procedural CVEs using diffusion weighted imaging (DWI). Results Seventy‐eight patients (65.5%) revealed acute peri‐procedural CVEs on MRI after TAVI with a favor of the left hemisphere (57.5%). The degree of valve calcification was associated with peri‐procedural CVEs. Patients with a high WML burden had an increased risk for CVEs ((OR) 2.36 (95% CI: 1.09–5.15; P = 0.037)), especially when distributed periventricular ((OR: 3.27; 95% CI: 1.47–7.26; P = 0.0038)). Conclusion In patients undergoing TAVI, the degree of aortic valve calcification and periventricular WML burden were correlated with acute peri‐procedural CVEs. Future studies are needed to evaluate their independent value for the long‐term clinical outcome.