title: Diffusion-weighted MRI determined cerebral embolic infarction following transcatheter aortic valve implantation: assessment of predictive risk factors and the relationship to subsequent health status.
abstract: BACKGROUND
  'Silent' cerebral infarction and stroke are complications of transcatheter aortic valve implantation (TAVI).
  
  
  OBJECTIVE
  To assess the occurrence of cerebral infarction, identify predictive risk factors and examine the impact on patient health-related quality of life (HRQoL).
  
  
  METHODS
  Cerebral diffusion weighted MRI of 31 patients with aortic stenosis undergoing CoreValve TAVI was carried out. HRQoL was assessed at baseline and at 30 days by SF-12v2 and EQ5D questionnaires.
  
  
  RESULTS
  New cerebral infarcts occurred in 24/31 patients (77%) and stroke in 2 (6%). Stroke was associated with a greater number and volume of cerebral infarcts. Age (r=0.37, p=0.042), severity of atheroma (arch and descending aorta; r=0.91, p<0.001, r=0.69, p=0.001, respectively) and catheterisation time (r=0.45, p=0.02) were predictors of the number of new cerebral infarcts. HRQoL improved overall: SF-12v2 physical component summary increased significantly (32.4±6.2 vs 36.5±7.2; p=0.03) with no significant change in mental component summary (43.5±11.7 vs. 43.1±14.3; p=0.85). The EQ5D score and Visual Analogue Scale showed no significant change (0.56±0.26 vs. 0.59±0.31; p=0.70, and 54.2±19 vs. 58.2±24; p=0.43).
  
  
  CONCLUSIONS
  Multiple small cerebral infarcts occurred in 77% of patients with TAVI. The majority of infarcts were 'silent' with clinical stroke being associated with a both higher infarct number and volume. Increased age and the severity of aortic arch atheroma were independent risk factors for the development of new cerebral infarcts. Overall HRQoL improved and there was no association between the number of new cerebral infarcts and altered health status.
authors: Division of Cardiovascular and Neuronal Remodelling, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK. j.greenwood@leeds.ac.uk
authors: Timothy A
authors: TA
authors: Fairbairn
authors: Adam N
authors: AN
authors: Mather
authors: Petra
authors: P
authors: Bijsterveld
authors: Gillian
authors: G
authors: Worthy
authors: Stuart
authors: S
authors: Currie
authors: Anthony J P
authors: AJ
authors: Goddard
authors: Daniel J
authors: DJ
authors: Blackman
authors: Sven
authors: S
authors: Plein
authors: John P
authors: JP
authors: Greenwood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000209:etiology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006304:Health Status; D016127:Heart Valve Prolapse; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D009460:Neurologic Examination; D058226:Plaque, Atherosclerotic / Q000175:diagnosis; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology; D061205:Vascular Calcification / Q000628:therapy*