학술논문
Cerebral blood flow and neurocognition in patients undergoing transcatheter aortic valve replacement for severe aortic stenosis.
Document Type
Academic Journal
Author
Lazar RM; Department of Neurology, University of Alabama at Birmingham, 1720 7th Avenue South, SC650K, Birmingham, AL 35294, USA.; Department of Neurology, Columbia University Irving Medical Center, 710 W168th Street, NewYork, NY 10032, USA.; Myers T; Department of Neurology, University of Alabama at Birmingham, 1720 7th Avenue South, SC650K, Birmingham, AL 35294, USA.; Gropen TI; Department of Neurology, University of Alabama at Birmingham, 1720 7th Avenue South, SC650K, Birmingham, AL 35294, USA.; Leesar MA; Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.; Davies J; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.; Gerstenecker A; Department of Neurology, University of Alabama at Birmingham, 1720 7th Avenue South, SC650K, Birmingham, AL 35294, USA.; Norling A; Department of Neurology, University of Alabama at Birmingham, 1720 7th Avenue South, SC650K, Birmingham, AL 35294, USA.; Pavol MA; Department of Neurology, Columbia University Irving Medical Center, 710 W168th Street, NewYork, NY 10032, USA.; Marshall RS; Department of Neurology, Columbia University Irving Medical Center, 710 W168th Street, NewYork, NY 10032, USA.; Kodali S; Department of Medicine, Columbia University Irving Medical Center, NewYork, NY, USA.
Source
Publisher: Published by Oxford University Press on behalf of the European Society of Cardiology Country of Publication: England NLM ID: 9918282081406676 Publication Model: eCollection Cited Medium: Internet ISSN: 2752-4191 (Electronic) Linking ISSN: 27524191 NLM ISO Abbreviation: Eur Heart J Open Subsets: PubMed not MEDLINE
Subject
Language
English
Abstract
Aims: Aortic valve stenosis (AS) results in higher systolic pressure to overcome resistance from the stenotic valve, leading to heart failure and decline in cardiac output. There has been no assessment of cerebral blood flow (CBF) association with neurocognition in AS or the effects of valve replacement. The goal was to determine if AS is associated with altered cerebral haemodynamics and impaired neurocognition, and whether transcatheter aortic valve replacement (TAVR) improves haemodynamics and cognition.
Methods and Results: In 42 patients with planned TAVR, transcranial Doppler (TCD) assessed bilateral middle cerebral artery (MCA) mean flow velocities (MFVs); abnormality was <34.45 cm/s. The neurocognitive battery assessed memory, language, attention, visual-spatial skills, and executive function, yielding a composite Z -score. Impairment was <1.5 SDs below the normative mean. The mean age was 78 years, 59% Male, and the mean valve gradient was 46.87 mm/Hg. Mean follow-up was 36 days post-TAVR (range 27-55). Pre-TAVR, the mean MFV was 42.36 cm/s (SD = 10.17), and the mean cognitive Z -score was -0.22 SDs (range -1.99 to 1.08) below the normative mean. Among the 34 patients who returned after TAVR, the MFV was 41.59 cm/s (SD = 10.42), not different from baseline ( P = 0.66, 2.28-3.67). Post-TAVR, average Z-scores were 0.17 SDs above the normative mean, not meeting the pre-specified threshold for a clinically significant 0.5 SD change.
Conclusion: Among patients with severe AS, there was little impairment of MFV on TCD and no correlation with cognition. Transcatheter aortic valve replacement did not affect MFV or cognition. Assumptions about diminished CBF and improvement after TAVR were not supported.
Competing Interests: Conflict of interest: none declared.
(© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Methods and Results: In 42 patients with planned TAVR, transcranial Doppler (TCD) assessed bilateral middle cerebral artery (MCA) mean flow velocities (MFVs); abnormality was <34.45 cm/s. The neurocognitive battery assessed memory, language, attention, visual-spatial skills, and executive function, yielding a composite Z -score. Impairment was <1.5 SDs below the normative mean. The mean age was 78 years, 59% Male, and the mean valve gradient was 46.87 mm/Hg. Mean follow-up was 36 days post-TAVR (range 27-55). Pre-TAVR, the mean MFV was 42.36 cm/s (SD = 10.17), and the mean cognitive Z -score was -0.22 SDs (range -1.99 to 1.08) below the normative mean. Among the 34 patients who returned after TAVR, the MFV was 41.59 cm/s (SD = 10.42), not different from baseline ( P = 0.66, 2.28-3.67). Post-TAVR, average Z-scores were 0.17 SDs above the normative mean, not meeting the pre-specified threshold for a clinically significant 0.5 SD change.
Conclusion: Among patients with severe AS, there was little impairment of MFV on TCD and no correlation with cognition. Transcatheter aortic valve replacement did not affect MFV or cognition. Assumptions about diminished CBF and improvement after TAVR were not supported.
Competing Interests: Conflict of interest: none declared.
(© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)