TY - JOUR
T1 - Cerebral blood flow and cognitive functioning in patients undergoing transcatheter aortic valve implantation
AU - van Nieuwkerk, Astrid C.
AU - Hemelrijk, Kimberley I.
AU - Aarts, Hugo M.
AU - Leeuwis, Anna E.
AU - Majoie, Charles B.L.M.
AU - Daemen, Mat J.A.P.
AU - Bron, Esther E.
AU - Moonen, Justine E.F.
AU - de Sitter, Alexandra
AU - Bouma, Berto J.
AU - Harms, Alexander
AU - van der Flier, Wiesje M.
AU - Baan, Jan
AU - Piek, Jan J.
AU - Biessels, Geert Jan
AU - Delewi, Ronak
N1 - Publisher Copyright:
© 2025 The Authors
PY - 2025/3
Y1 - 2025/3
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85217951131&partnerID=8YFLogxK
U2 - 10.1016/j.eclinm.2025.103092
DO - 10.1016/j.eclinm.2025.103092
M3 - Article
AN - SCOPUS:85217951131
SN - 2589-5370
VL - 81
JO - EClinicalMedicine
JF - EClinicalMedicine
M1 - 103092
ER -