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
Department of Radiology, University of Bonn, Bonn, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany.
Catheter Cardiovasc Interv. 2018 Mar 1;91(4):774-782. doi: 10.1002/ccd.27122. Epub 2017 May 26.
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).
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.
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).
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)).
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.
研究经导管主动脉瓣植入术（TAVI）患者中主动脉瓣钙化和脑形态对急性围手术期脑血管事件（CVE）的影响。
主动脉瓣钙化和狭窄可通过超声心动图进行评估。脑磁共振成像（MRI）可描绘并量化灌注不足和血管栓塞的形态学征象，这在严重主动脉瓣狭窄患者中尤为重要。此外，接受TAVI的患者易发生临床无症状的围手术期CVE。
共119例接受TAVI的患者采用经食管超声心动图检查主动脉瓣钙化情况。所有患者在植入前和植入后立即采用专门的扫描方案进行脑MRI检查。在TAVI之前，对脑形态进行特征描述。TAVI之后，使用扩散加权成像（DWI）对脑部进行急性围手术期CVE发作情况的研究。
78例患者（65.5%）在TAVI术后的MRI上显示有急性围手术期CVE，且以左侧半球为主（57.5%）。瓣膜钙化程度与围手术期CVE相关。白质高信号负荷高的患者发生CVE的风险增加（比值比（OR）为2.36（95%置信区间：1.09 - 5.15；P = 0.037）），尤其是当白质高信号分布于脑室周围时（OR：3.27；95%置信区间：1.47 - 7.26；P = 0.0038）。
在接受TAVI的患者中，主动脉瓣钙化程度和脑室周围白质高信号负荷与急性围手术期CVE相关。未来需要进一步研究评估它们对长期临床结局的独立价值。
