Integrated Cardio-Cerebral Assessment Predicts Adverse Outcomes in Aortic Stenosis: A Preliminary Study

Area of Science:

• Cardiology
• Neurology
• Medical Imaging

Background:

• Aortic stenosis (AS) is associated with increased covert brain injury.
• The link between AS-related cerebral impairment, cardiac remodeling, and prognosis is not fully understood.

Purpose of the Study:

• To investigate the association between AS-related cerebral impairment and cardiac remodeling.
• To evaluate the prognostic impact of AS-related cerebral impairment on major adverse cardiac events (MACE).
• To assess the value of an integrated cardio-cerebral assessment model for risk stratification.

Main Methods:

• 384 patients with moderate-to-severe AS were stratified into cerebral hypoperfusion/embolism (n=146) and event-free (n=238) groups.
• Clinical, echocardiographic, and surgical data were collected; MACE (arrhythmia, heart failure, death) was the primary endpoint.
• Multivariate regression and Cox analysis identified predictors of cerebral impairment and MACE; a cardio-cerebral integrated model was evaluated using the C-index.

Main Results:

• The cerebral impairment group exhibited more pronounced left atrial and left ventricular remodeling.
• Enlarged ascending aorta, left heart remodeling, reduced cardiac output, and elevated pulmonary artery systolic pressure were linked to cerebral impairment (p < 0.05).
• AS-related cerebral impairment independently predicted MACE (HR, 2.24; p < 0.001); the integrated model showed superior prediction (C-index, 0.862).

Conclusions:

• AS-related cerebral impairment is independently associated with cardiac remodeling and adverse cardiovascular outcomes.
• Integrated cardio-cerebral assessment significantly improves risk stratification for patients with AS.