Clinical Significance of Diffusion-Weighted Brain MRI Lesions After TAVR Results of a Patient-Level Pooled Analysis

被引：2

作者：

Lansky, Alexandra J. ^{[1
,2
]}

Grubman, Daniel ^{[1
,2
]}

Dwyer III, Michael G. ^{[3
,4
]}

Zivadinov, Robert ^{[3
,4
]}

Parise, Helen ^{[1
,2
]}

Moses, Jeffrey W. ^{[5
,6
]}

Shah, Tayyab ^{[1
,2
,7
]}

Pietras, Cody ^{[1
,2
]}

Tirziu, Daniela ^{[1
,2
]}

Gambone, Louise ^{[1
,2
]}

Leon, Martin B. ^{[5
,8
]}

Nazif, Tamim M. ^{[5
]}

Messe, Steven R. ^{[9
]}

机构：

[1] Yale Sch Med, Sect Cardiovasc Med Dept Internal Med, Sect Cardiovasc Med, New Haven, CT 06510 USA

[2] Yale Cardiovasc Res Grp, New Haven, CT USA

[3] Univ Buffalo State Univ New York, Buffalo Neuroimaging Anal Ctr Neurol, Sch Med & Biomed Sci, Buffalo, NY USA

[4] Univ Buffalo State Univ New York, Ctr Biomed Imaging, Buffalo, NY USA

[5] Columbia Univ, NewYork Presbyterian Hosp, Irving Med Ctr, New York, NY USA

[6] St Francis Hosp & Heart Ctr, Roslyn, NY USA

[7] Hosp Univ Penn, Div Cardiovasc Med, Philadelphia, PA USA

[8] Cardiovasc Res Fdn, New York, NY USA

[9] Hosp Univ Penn, Dept Neurol, Div Cardiol, Philadelphia, PA USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2024年 / 84卷 / 08期

关键词：

cerebral embolic protection; covert brain ischemia; transcatheter aortic valve replacement; AORTIC-VALVE IMPLANTATION; END-POINT DEFINITIONS; CEREBRAL EMBOLIC PROTECTION; RANDOMIZED EVALUATION; ACUTE STROKE; COGNITIVE OUTCOMES; REPLACEMENT; SILENT; DEVICE; COMPLICATIONS;

D O I：

10.1016/j.jacc.2024.05.055

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Acute brain infarction detected by diffusion-weighted magnetic resonance imaging (DW-MRI) is common after transcatheter aortic valve replacement (TAVR), but its clinical relevance is uncertain. Objectives The authors investigated the relationship between DW-MRI total lesion number (TLN), individual lesion volume (ILV), and total lesion volume (TLV) and clinical stroke outcomes after TAVR. Methods Patient-level data were pooled from 4 prospective TAVR embolic protection studies, with consistent predischarge DW-MRI acquisition and core laboratory analysis. C-statistic was used to determine the best DW-MRI measure associated with clinical stroke. Results A total of 495 of 603 patients undergoing TAVR completed the predischarge DW-MRI. At 30 days, the rate of clinical ischemic stroke was 6.9%. Acute ischemic brain injury was seen in 85% of patients with 5.5 +/- 7.3 discrete lesions per patient, mean ILV of 78.2 +/- 257.1 mm(3), and mean TLV of 555 +/- 1,039 mm(3). The C-statistic was 0.84 for TLV, 0.81 for number of lesions, and 0.82 for maximum ILV in predicting ischemic stroke. On the basis of the TLV cutpoint as defined by receiver operating characteristic (ROC), patients with a TLV >500 mm(3) (vs TLV <= 500 mm(3)) had more ischemic stroke (18.2% vs 2.3%; P < 0.0001), more disabling strokes (8.8% vs 0.9%; P < 0.0001), and less complete stroke recovery (44% vs 62.5%; P = 0.001) at 30 days. Conclusions Our study confirms that the number, size, and total volume of acute brain infarction defined by DW-MRI are each associated with clinical ischemic strokes, disabling strokes, and worse stroke recovery in patients undergoing TAVR and may have value as surrogate outcomes in stroke prevention trials. (A Prospective, Randomized Evaluation of the TriGuard (TM) HDH Embolic Deflection Device During TAVI [DEFLECT III]; NCT02070731) (A Study to Evaluate the Neuro-embolic Consequences of TAVR [NeuroTAVR]; NCT02073864) (The REFLECT Trial: Cerebral Protection to Reduce Cerebral Embolic Lesions After Transcatheter Aortic Valve Implantation [REFLECT I]; NCT02536196) (The REFLECT Trial: Cerebral Protection to Reduce Cerebral Embolic Lesions After

引用

页码：712 / 722

页数：11