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Prevalence of Cerebral Microbleeds in Patients With Continuous-Flow Left Ventricular Assist Devices
Daisuke Yoshioka1, Shuhei Okazaki2,3, Koichi Toda4
1Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan yoshioka@surg1.med.osaka-u.ac.jp.
Background:
The prevalence of cerebral microbleeds (CMBs) in gradient echo T2*-weighted brain MRI has a positive correlation with hemorrhagic stroke incidence. However, the prevalence of CMBs in patients with left ventricular assist devices (LVADs) has not been evaluated. We evaluated the prevalence of CMBs and the relationship with hemorrhagic stroke incidence in patients with LVADs.
Method And Results:
We analyzed results from brain MRI in prospective examinations of 35 consecutive patients who had undergone LVAD explantation for heart transplantation or recovery since 2011. The number and distribution of CMBs were counted, then the relationship between baseline characteristics and adverse events during LVAD support were analyzed. The mean age was 37.7±12.4 years and the mean LVAD duration was 2.43±1.08 years. Thirty-four (97%) patients had at least one CMB. Nine (26%) developed hemorrhagic stroke during LVAD support, and patients with hemorrhagic stroke had a significantly greater number of CMBs compared with patients without hemorrhagic stroke (5 [interquartile range (IQR), 4-7] versus 9 [IQR, 5-23]; odds ratio 1.14 [95% Confidence Interval (CI), 1.02-1.32], P=0.05). There was no significant relationship between age, LVAD support duration, or systolic blood pressure during LVAD. However, patients who had at least one episode of bacteremia (9 [IQR, 4-16] versus 5 [IQR, 3-7], P=0.06) and pump pocket infection (14 [IQR, 4-27] versus 5 [IQR, 3-7], P=0.08) showed a trend toward a greater number of CMBs than patients without bacteremia.
Conclusions:
Thirty-four (97%) patients with continuous-flow LVAD had at least one CMB, and the number of CMBs were more prevalent in patients with hemorrhagic stroke and in patients with LVAD-related infection.
Insights
Cerebral microbleeds (CMBs) are highly prevalent in patients with left ventricular assist devices (LVADs), with nearly all patients showing at least one CMB. A higher number of CMBs correlated with increased risk of hemorrhagic stroke in LVAD patients.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Cerebral microbleeds (CMBs) on MRI correlate with hemorrhagic stroke risk.
- Prevalence of CMBs in left ventricular assist device (LVAD) patients is unknown.
- This study investigates CMB prevalence and hemorrhagic stroke incidence in LVAD patients.
Purpose of the Study:
- Evaluate CMB prevalence in LVAD patients.
- Determine the relationship between CMBs and hemorrhagic stroke incidence.
- Identify factors associated with CMBs in LVAD recipients.
Main Methods:
- Prospective analysis of brain MRI scans from 35 LVAD patients post-explantation.
- Quantification of CMB number and distribution.
- Correlation analysis between baseline characteristics, adverse events, and CMBs.
Main Results:
- 97% of LVAD patients (34/35) had at least one CMB.
- Hemorrhagic stroke occurred in 26% (9/35) of patients.
- Higher CMB counts were associated with hemorrhagic stroke (OR 1.14, P=0.05) and showed a trend with bacteremia and pump pocket infection.
Conclusions:
- CMBs are nearly universal in continuous-flow LVAD patients (97%).
- Increased CMBs are linked to hemorrhagic stroke in LVAD recipients.
- LVAD-related infections may also be associated with a higher CMB burden.
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