Abstract 17119: Cerebral Embolic Infarcts Following Transcatheter Aortic Valve Implantation: A Diffusion-Weighted Magnetic Resonance Imaging Study and the Assessment of Subsequent Health Status.
Introduction: Transcatheter Aortic Valve Implantation (TAVI) is indicated in individuals with severe aortic valve stenosis and high predicted surgical mortality following a multidisciplinary team decision. Cerebral infarcts have been described following cardiac catheterization, cardiac surgery and TAVI. The incidence of new lesions post-TAVI on diffusion-weighted magnetic resonance imaging (DW-MRI) is between 72–84%, much higher than the presentation of clinical stroke (2–9%). Our aim was to investigate the impact of new infarcts on neurological function and overall health status.
Methods: Patients underwent cerebral DW-MRI and neurological examination before and after TAVI. Scans were reported independently by two neuroradiologists, blinded to the clinical details. Health status (Physical Component Summary (PCS) and Mental Component Summary (MCS)), was assessed at baseline and 30 days using the SF-12v2 questionnaire.
Results: Twenty two patients (age 82±5.5; female 73%) completed cerebral DW-MRI pre- and post TAVI (median 1 day, IQR 1–2.25 and 5.5, IQR 4–7, respectively). New cerebral infarcts occurred in 73% of patients, in both hemispheres and all territories. Average lesion size (2.35ml±4) and number 4.5 (range 0–26) suggested an embolic source. One patient developed a clinical stroke. Regression analysis of multiple risk factors (Age, EUROscore, diabetes, AF and procedural factors) showed age as the only independent predictor of embolic load (r=0.474; p 0.026). There was an insignificant trend between increased fluoroscopy time and number of lesions(r=0.385, p 0.077). Health status PCS increased significantly from baseline to 30 days (30.4±9.8 to 35.2±15.1, p=0.029) with no significant change in MCS (40.7±25.2 to 39.5±33). No correlation existed between number or volume of infarcts and change in either MCS or PCS. DISCUSSION Whilst new MRI detectable cerebral lesions occurred in 73% of TAVI patients, only 1 patient had new neurological signs. Age was the only predictor for number and volume of new infarcts. Importantly mental health status following TAVI does not decline and has no relationship to new cerebral infarcts. Furthermore, at 30 days our patients had a significant improvement in the physical component to their health status.
- © 2010 by American Heart Association, Inc.