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Cerebrovascular Disease Detected on Preprocedural Computed Tomography in Patients With Severe Aortic Stenosis

Ko Yamamoto1, Hiroyuki Ueda2, Daiji Uchiyama2

  • 1Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan.

Journal of the American Heart Association
|July 9, 2024
PubMed

Insights

Prevalent cerebrovascular disease on preprocedural CT scans in severe aortic stenosis patients undergoing aortic valve replacement is linked to worse outcomes. This risk persists regardless of a prior stroke history.

Area of Science:

  • Cardiology
  • Neurology
  • Radiology

Background:

  • Limited data exists on cerebrovascular disease prevalence and impact before aortic valve replacement (AVR).
  • Severe aortic stenosis patients often undergo preprocedural computed tomography (CT) scans.
  • Cerebrovascular disease detection on CT may influence patient outcomes.

Purpose of the Study:

  • To determine the prevalence of cerebrovascular disease on preprocedural CT in severe aortic stenosis patients.
  • To compare clinical outcomes between patients with and without detected cerebrovascular disease before AVR.
  • To assess the impact of prior stroke history on outcomes in this cohort.

Main Methods:

  • Retrospective analysis of 567 patients with severe aortic stenosis undergoing AVR.
  • Preprocedural CT scans were evaluated for cerebrovascular disease (chronic brain infarction or hemorrhage).
  • Clinical outcomes, including all-cause death or stroke, were compared between groups over 3 years.

Main Results:

  • 35.3% of patients had cerebrovascular disease on preprocedural CT; only 28.5% had a symptomatic stroke history.
  • The 3-year incidence of death or stroke was significantly higher in patients with cerebrovascular disease (40.7% vs. 24.1%).
  • Cerebrovascular disease remained an independent predictor of adverse outcomes (HR, 1.42; P=0.04), irrespective of stroke history.

Conclusions:

  • A significant portion of severe aortic stenosis patients have undetected cerebrovascular disease on preprocedural CT.
  • Cerebrovascular disease detected on preprocedural CT is associated with worse clinical outcomes after AVR.
  • Preprocedural cerebrovascular disease impacts outcomes regardless of a patient's symptomatic stroke history.
Abstract

Keywords:
aortic stenosisaortic valve replacementcomputed tomographycovert cerebrovascular diseasestroke

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