Cerebrovascular Events after Transcatheter Aortic Valve Replacement: The Difficulty in Predicting the Unpredictable

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Cerebrovascular events (CVE) are significant complications after transcatheter aortic valve replacement (TAVR).
• Accurate prediction of CVE risk is crucial for patient management and procedural planning.
• Current risk stratification models may not fully capture CVE risk in TAVR patients.

Purpose of the Study:

• To develop and validate a novel risk prediction model for CVE following TAVR.
• To investigate the utility of multimodal imaging in enhancing CVE risk assessment.
• To compare the performance of the new model against existing risk scores.

Main Methods:

• Development of a risk model using pre-procedural data from 1365 TAVR patients (derivation cohort).
• Inclusion of multimodal imaging parameters: aortic valve area, aortic angulation, and calcification in specific aortic regions.
• Validation of the model in an independent cohort of 650 TAVR patients.

Main Results:

• A total of 72 (3.6%) patients experienced TAVR-related CVE.
• Key predictors identified: prior CVE history, larger aortic valve area, increased aortic angulation, and enhanced calcification in the right coronary cusp, LVOT, and ascending aorta.
• The new risk model demonstrated superior in-hospital CVE prediction (AUC 0.73) compared to EuroSCORE II and CHA2DS2-VASc scores.

Conclusions:

• Multimodal imaging offers a promising avenue for developing more accurate CVE risk models in TAVR patients.
• The developed risk model shows improved predictive performance for in-hospital CVE post-TAVR.
• This approach can aid in better patient selection and risk stratification for TAVR procedures.