Akhlaque Uddin1, Timothy A Fairbairn1, Ibrahim K Djoukhader1, Mark Igra1, Ananth Kidambi1, Manish Motwani1, Bernhard Herzog1, David P Ripley1, Tarique Al Musa1, Anthony J P Goddard1, Daniel J Blackman1, Sven Plein1, John P Greenwood2. 1. From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.). 2. From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.). j.greenwood@leeds.ac.uk.
Abstract
BACKGROUND: Incidence of cerebral microinfarcts is higher after transcatheter aortic valve implantation (TAVI) compared with surgical aortic valve replacement (SAVR). It is unknown whether these lesions persist and what direct impact they have on health-related quality of life. The objective was to identify predictors of cerebral microinfarction and measure their effect on health-related quality of life during 6 months after TAVI when compared with SAVR. METHODS AND RESULTS: Cerebral MRI was conducted at baseline, post procedure, and 6 months using diffusion-weighted imaging. Health-related quality of life was measured at baseline, 30 days, and 6 months with short form-12 health outcomes and EuroQol 5 dimensions questionnaires. One hundred eleven patients (TAVI, n=71; SAVR, n=40) were studied. The incidence (54 [77%] versus 17 [43%]; P=0.001) and number (3.4±4.9 versus 1.2±1.8; P=0.001) of new microinfarcts were greater after TAVI than after SAVR. The total volume per microinfarct was smaller in TAVI than in SAVR (0.23±0.24 versus 0.76±1.8 mL; P=0.04). The strongest associations for microinfarction were: TAVI (arch atheroma grade: r=0.46; P=0.0001) and SAVR (concomitant coronary artery bypass grafting: r=-0.33; P=0.03). Physical component score in TAVI increased after 30 days (32.1±6.6 versus 38.9±7.0; P<0.0001) and 6 months (40.4±9.3; P<0.0001); the improvement occurred later in SAVR (baseline: 34.9±10.6; 30 days: 35.9±10.2; 6 months: 42.8±11.2; P<0.001). After TAVI, there were no differences in the short form-12 health outcome scores according to the presence or size of new cerebral infarction. CONCLUSIONS: Cerebral microinfarctions are more common after TAVI compared with SAVR but seem to have no negative effect on early (30 days) or medium term (6 months) health-related quality of life. Aortic atheroma (TAVI) and concomitant coronary artery bypass grafting (SAVR) are independent risk factors for cerebral microinfarction.
BACKGROUND: Incidence of cerebral microinfarcts is higher after transcatheter aortic valve implantation (TAVI) compared with surgical aortic valve replacement (SAVR). It is unknown whether these lesions persist and what direct impact they have on health-related quality of life. The objective was to identify predictors of cerebral microinfarction and measure their effect on health-related quality of life during 6 months after TAVI when compared with SAVR. METHODS AND RESULTS: Cerebral MRI was conducted at baseline, post procedure, and 6 months using diffusion-weighted imaging. Health-related quality of life was measured at baseline, 30 days, and 6 months with short form-12 health outcomes and EuroQol 5 dimensions questionnaires. One hundred eleven patients (TAVI, n=71; SAVR, n=40) were studied. The incidence (54 [77%] versus 17 [43%]; P=0.001) and number (3.4±4.9 versus 1.2±1.8; P=0.001) of new microinfarcts were greater after TAVI than after SAVR. The total volume per microinfarct was smaller in TAVI than in SAVR (0.23±0.24 versus 0.76±1.8 mL; P=0.04). The strongest associations for microinfarction were: TAVI (arch atheroma grade: r=0.46; P=0.0001) and SAVR (concomitant coronary artery bypass grafting: r=-0.33; P=0.03). Physical component score in TAVI increased after 30 days (32.1±6.6 versus 38.9±7.0; P<0.0001) and 6 months (40.4±9.3; P<0.0001); the improvement occurred later in SAVR (baseline: 34.9±10.6; 30 days: 35.9±10.2; 6 months: 42.8±11.2; P<0.001). After TAVI, there were no differences in the short form-12 health outcome scores according to the presence or size of new cerebral infarction. CONCLUSIONS:Cerebral microinfarctions are more common after TAVI compared with SAVR but seem to have no negative effect on early (30 days) or medium term (6 months) health-related quality of life. Aortic atheroma (TAVI) and concomitant coronary artery bypass grafting (SAVR) are independent risk factors for cerebral microinfarction.
Authors: Michael J Mack; Michael A Acker; Annetine C Gelijns; Jessica R Overbey; Michael K Parides; Jeffrey N Browndyke; Mark A Groh; Alan J Moskowitz; Neal O Jeffries; Gorav Ailawadi; Vinod H Thourani; Ellen G Moquete; Alexander Iribarne; Pierre Voisine; Louis P Perrault; Michael E Bowdish; Michel Bilello; Christos Davatzikos; Ralph F Mangusan; Rachelle A Winkle; Peter K Smith; Robert E Michler; Marissa A Miller; Karen L O'Sullivan; Wendy C Taddei-Peters; Eric A Rose; Richard D Weisel; Karen L Furie; Emilia Bagiella; Claudia Scala Moy; Patrick T O'Gara; Steven R Messé Journal: JAMA Date: 2017-08-08 Impact factor: 56.272
Authors: Jonathon P Fanning; Allan J Wesley; Darren L Walters; Eamonn M Eeles; Adrian G Barnett; David G Platts; Andrew J Clarke; Andrew A Wong; Wendy E Strugnell; Cliona O'Sullivan; Oystein Tronstad; John F Fraser Journal: J Am Heart Assoc Date: 2016-11-15 Impact factor: 5.501
Authors: Tarique Al Musa; Akhlaque Uddin; Catherine Loveday; Laura E Dobson; Mark Igra; Fiona Richards; Peter P Swoboda; Anvesha Singh; Pankaj Garg; James R J Foley; Graham J Fent; Anthony J P Goddard; Christopher Malkin; Sven Plein; Daniel J Blackman; Gerald P McCann; John P Greenwood Journal: BMJ Open Date: 2019-01-21 Impact factor: 2.692