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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)
Author(s) -
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
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27122
Subject(s) - medicine , calcification , stenosis , cardiology , aortic valve , aortic valve stenosis , magnetic resonance imaging , radiology
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.