Aims and objectives
Chronic cerebral hypoperfusion due to severe aortic valve stenosis impairs neuralfunction,potentially causing alterations in white matter (WM) integrity,that can be measuredusing diffusion tensor imaging (DTI).These patients can be treated with transcatheter aortic valve implantation (TAVI) and,
in this study,
we hypothesized thatWM microstructural integrity improves significantly after TAVI,
together withcognitive function.
DTI provides information on the anisotropic diffusion of water molecules.
By measuring the fractional anisotropy (FA) and apparent diffusion coefficient (ADC),
it is possible to detect changes at the level of cellular microarchitecture,
as...
Methods and materials
Study population
Following IRB approval,
we selected all TAVI patients from the prospective arm of the Rule out Transcatheter Aortic Valve Thrombosis with Post-implantation Computed Tomography (RETORIC) study (NCT02826200) with complete imaging data. The study was performed in accordance with institutional guidelinesand allpatients signed a written informed consent before participation in the examination.
MRI protocol
All patients underwent MRI-DTI one week and 6-9 months after TAVI (discharge and follow up).All examinations wereperformed on a 1.5-T MR scanner (Achieva1.5,
Philips Medical Systems,
Best,
The Netherlands) using...
Results
Out of 77 consecutive patients of the RETORIC study,
we included 23 subjects (8 males,
age 77±7 years,
range 63-91 years) in our analysis.
Theremaining 54 patients had:
missing baseline DTI (n=5)
not yet/not performed follow up DTI (n=44)
poor DTI image quality (n=5)
We found improved directionality and coherence of water diffusion in the NAWM of all fiber tracts,
reflected by increased FA and decreased ADC.
Apart from the left middle cerebellar peduncle and right arcuate fascicle (AF),
all other fiber tracts showed significant...
Conclusion
Ourpreliminary datashow microstructural improvement after TAVI in the measured WM tracts of patients with aortic valve stenosis.Furthermore we found improvement in some cognitive function domains.
The RETORIC study might reveal important implications regarding the effect of TAVI on neural function.
References
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Glineur D,
Kefer J et al (2011) Magnetic resonance imaging evaluation of cerebral embolization during percutaneous aortic valve implantation: comparison of transfemoral and trans-apical approaches using Edwards Sapiens valve.
Eur J Cardiothorac Surg 40:475-479
2 Kahlert P,
Knipp SC,
Schlamann M et al (2010) Silent and apparent cerebral ischemia after percutaneous transfemoral aortic valve implantation: a diffusion-weighted magnetic resonance imaging study.
Circulation 121:870-878
3 Samim M,
Hendrikse J,
van der Worp HB et al (2015) Silent ischemic brain lesions after transcatheter aortic...