Cerebral blood flow and cognitive functioning in patients undergoing transcatheter aortic valve implantation.

Abstract

Background: Approximately one-third of patients with symptomatic severe aortic valve stenosis scheduled for transcatheter aortic valve implantation (TAVI) have some degree of cognitive impairment. The effect of TAVI on cardiac output, cerebral blood flow (CBF), and cognitive functioning has not been systematically studied.

Methods: CAPITA (NCT05481008) is a prospective longitudinal study assessing cerebral and cognitive outcomes in patients that underwent TAVI between August 2020 and October 2022. At baseline (<24 h before TAVI) and three-month follow-up, patients underwent echocardiography, brain magnetic resonance imaging (MRI), and multidomain neuropsychological assessment. Primary outcome measures were change in CBF (Δml/100 g/min on arterial spin labelling MRI) and change in global cognitive functioning (Δz-scores). Secondary outcomes included cardiac output (L/min), and white matter hyperintensities (mL, number). Differences were tested with paired t-test and associations were tested with linear mixed models.

Findings: A total of 148 patients (80.5 ± 5.7 years, 43% female) underwent TAVI. Three months after TAVI, cardiac output increased from 5.9 ± 1.4 L/min to 6.3 ± 1.4 L/min (mean difference 0.37, 95% CI 0.12-0.62, p = 0.004). CBF increased from 52.2 ± 14.5 mL/100 g/min to 55.9 ± 17.7 mL/100 g/min (mean difference 3.8, 95% CI 1.15-6.36, p = 0.005). Global cognitive functioning also increased from 0.02 ± 0.52 to 0.15 ± 0.49 (mean difference 0.13, 95% CI 0.06-0.20, p < 0.001) with most prominent increase in patients with worst baseline cognitive functioning. Patients with cognitive decline (22%), had a higher volume of new in white matter hyperintensities than patients with stable or improved cognition (78%): 1.26 ± 2.96, vs 0.29 ± 0.45, vs 0.31 ± 0.91 mL (p = 0.06).

Interpretation: In patients with severe symptomatic aortic valve stenosis undergoing TAVI, cardiac output, CBF, and cognitive functioning improved after three months.

Funding: The Heart-Brain Connection crossroad consortium of the Dutch Cardiovascular Alliance. The Netherlands CardioVascular Research Initiative: Dutch Heart Foundation (CVON 2018-28 & 2012-06 Heart Brain Connection).