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Published on: March 26, 2018
Clinical implications of cerebral microbleeds in patients who undergo transcatheter aortic valve replacement
Yusuke Uemura1, Akihito Tanaka2, Yuta Ozaki1
1Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan.
Background:
The prognostic implications of cerebral microbleeds (CMBs) in patients who undergo transcatheter aortic valve replacement (TAVR) have not been fully elucidated. Therefore, we aimed to investigate the association between the presence of CMBs and adverse outcomes post-TAVR.
Methods:
In this single-center retrospective study, we included 124 patients who underwent brain magnetic resonance imaging before TAVR. The outcomes of interest were the subsequent incidences of stroke and all-cause death or admission for heart failure.
Results:
CMBs were identified in 32.2 % of the included patients. The median follow-up duration was 954 (interquartile range, 553-1306) days. The incidence of stroke after TAVR was comparable between patients with and without CMBs. Conversely, all-cause death or admission for heart failure was significantly higher in patients with CMBs than in those without (log-rank P = 0.010). Multivariate Cox regression analysis revealed that the presence of CMBs was independently correlated with the occurrence of all-cause death or admission for heart failure after adjusting for other prognostic predictors (hazard ratio 4.016, 95 % confidence interval 1.572-10.259, P = 0.007).
Conclusion:
The presence of CMBs predicts the incidence of all-cause death or admission for heart failure in patients undergoing TAVR. Evaluating CMBs could provide useful information for post-TAVR management.
Insights
Cerebral microbleeds (CMBs) detected before transcatheter aortic valve replacement (TAVR) predict higher risks of death or heart failure hospitalization. Pre-TAVR CMB evaluation may improve patient management and outcomes.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Prognostic significance of cerebral microbleeds (CMBs) after transcatheter aortic valve replacement (TAVR) remains unclear.
- CMBs are small, often asymptomatic, brain lesions detected via MRI.
Purpose of the Study:
- To investigate the association between pre-TAVR CMBs and adverse clinical outcomes.
- To determine if CMBs predict stroke, death, or heart failure admission post-TAVR.
Main Methods:
- Single-center retrospective study of 124 patients undergoing TAVR.
- Brain MRI performed before TAVR to identify CMBs.
- Outcomes assessed: stroke, all-cause death, heart failure admission.
Main Results:
- CMBs present in 32.2% of patients.
- No significant difference in stroke incidence between groups.
- Significantly higher incidence of all-cause death or heart failure admission in patients with CMBs (P=0.010).
- CMBs independently predicted adverse outcomes (HR 4.016, P=0.007).
Conclusions:
- Pre-TAVR CMBs are a significant predictor of all-cause death or heart failure admission.
- CMB assessment can enhance risk stratification and guide post-TAVR management strategies.
