Aortic valve calcification volumes and chronic brain infarctions in patients undergoing transcatheter aortic valve implantation

被引：14

作者：

Vlastra, Wieneke ^{[1
]}

van den Boogert, Thomas P. W. ^{[1
]}

Krommenhoek, Thomas ^{[1
]}

Bronzwaer, Anne-Sophie G. T. ^{[2
,3
]}

Mutsaerts, Henk J. M. M. ^{[4
,5
]}

Achterberg, Hakim C. ^{[6
]}

Bron, Esther E. ^{[6
]}

Niessen, Wiro J. ^{[6
]}

Majoie, Charles B. L. M. ^{[4
,5
]}

Nederveen, Aart J. ^{[4
,5
]}

Baan, Jan ^{[1
]}

van Lieshout, Johannes J. ^{[2
,3
,7
]}

Piek, Jan J. ^{[1
]}

Planken, R. Nils ^{[4
,5
]}

Henriques, Jose P. S. ^{[1
]}

Delewi, Ronak ^{[1
]}

机构：

[1] Univ Amsterdam, Amsterdam UMC, Heart Ctr, Dept Clin & Expt Cardiol,Amsterdam Cardiovasc Sci, Amsterdam, Netherlands

[2] Univ Amsterdam, Amsterdam UMC, Dept Internal Med, Amsterdam, Netherlands

[3] Univ Amsterdam, Acad Med Ctr, Ctr Heart Failure Res, Lab Clin Cardiovasc Physiol, Amsterdam, Netherlands

[4] Univ Amsterdam, Locat AMC, Amsterdam Univ Med Ctr, Dept Radiol & Nucl Med, Amsterdam, Netherlands

[5] Univ Amsterdam, VUmc, Amsterdam, Netherlands

[6] Univ Med Ctr Rotterdam, Erasmus MC, Dept Radiol & Nucl Med, Biomed Imaging Grp Rotterdam, Rotterdam, Netherlands

[7] Univ Nottingham, Queens Med Ctr, Med Sch, Sch Life Sci,MRC Arthritis Res UK Ctr Musculoskel, Nottingham, England

来源：

INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING | 2019年 / 35卷 / 11期

关键词：

Transcatheter aortic valve implantation; Transcatheter aortic valve replacement; Silent brain infarctions; White matter hyperintensities; Cerebral embolizations; ATRIAL-FIBRILLATION; STROKE; DEMENTIA; DISEASE; RISK;

D O I：

10.1007/s10554-019-01663-0

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Chronic silent brain infarctions, detected as new white matter hyperintensities on magnetic resonance imaging (MRI) following transcatheter aortic valve implantation (TAVI), are associated with long-term cognitive deterioration. This is the first study to investigate to which extent the calcification volume of the native aortic valve (AV) measured with cardiac computed tomography angiography (CTA) predicts the increase in chronic white matter hyperintensity volume after TAVI. A total of 36 patients (79 +/- 5 years, median EuroSCORE II 1.9%, Q(1)-Q(3) 1.5-3.4%) with severe AV stenosis underwent fluid attenuation inversion recovery (FLAIR) MRI < 24 h prior to TAVI and at 3 months follow-up for assessment of cerebral white matter hyperintensity volume (mL). Calcification volumes (mm(3)) of the AV, aortic arch, landing zone and left ventricle were measured on the CTA pre-TAVI. The largest calcification volumes were found in the AV (median 692 mm(3)) and aortic arch (median 633 mm(3)), with a large variation between patients (Q(1)-Q(3) 482-1297 mm(3) and 213-1727 mm(3), respectively). The white matter hyperintensity volume increased in 72% of the patients. In these patients the median volume increase was of 1.1 mL (Q(1)-Q(3) 0.3-4.6 mL), corresponding with a 27% increase from baseline (Q(1)-Q(3) 7-104%). The calcification volume in the AV predicted the increase of white matter hyperintensity volume (Delta%), with a 35% increase of white matter hyperintensity volume, per 100 mm(3) of AV calcification volume (SE 8.5, p < 0.001). The calcification volumes in the aortic arch, landing zone and left ventricle were not associated with the increase in white matter hyperintensity volume. In 72% of the patients new chronic white matter hyperintensities developed 3 months after TAVI, with a median increase of 27%. A higher calcification volume in the AV was associated with a larger increase in the white matter hyperintensity volume. These findings show the potential for automated AV calcium screening as an imaging biomarker to predict chronic silent brain infarctions.

引用

页码：2123 / 2133

页数：11

共 23 条

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