Astrid C van Nieuwkerk, Kimberley I Hemelrijk, Hugo M Aarts, Anna E Leeuwis, Charles B L M Majoie, Mat J A P Daemen, Esther E Bron, Justine E F Moonen, Alexandra de Sitter, Berto J Bouma, Alexander Harms, Wiesje M van der Flier, Jan Baan, Jan J Piek, Geert Jan Biessels, Ronak Delewi
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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.</p><p><strong>Findings: </strong>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). 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引用次数: 0
摘要
背景：大约三分之一的有症状的严重主动脉瓣狭窄患者计划进行经导管主动脉瓣植入术（TAVI），有一定程度的认知障碍。TAVI对心输出量、脑血流量（CBF）和认知功能的影响尚未系统研究。方法：CAPITA （NCT05481008）是一项前瞻性纵向研究，评估2020年8月至2022年10月期间接受TAVI的患者的大脑和认知结果。基线时(结果：共有148例患者（80.5±5.7岁，43%为女性）接受了TAVI。TAVI术后3个月，心输出量由5.9±1.4 L/min增加至6.3±1.4 L/min（平均差值0.37,95% CI 0.12-0.62, p = 0.004）。CBF从52.2±14.5 mL/100 g/min增加到55.9±17.7 mL/100 g/min（平均差值3.8,95% CI 1.15 ~ 6.36, p = 0.005）。总体认知功能也从0.02±0.52增加到0.15±0.49（平均差值0.13,95% CI 0.06-0.20, p）。解释：重度症状性主动脉瓣狭窄患者行TAVI后，心输出量、CBF和认知功能在3个月后得到改善。资助：荷兰心血管联盟的心脑连接十字路口联盟。荷兰心血管研究计划：荷兰心脏基金会（CVON 2018-28和2012-06心脑连接）。
Cerebral blood flow and cognitive functioning in patients undergoing transcatheter aortic valve implantation.
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).
期刊介绍：
eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.
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