PMID- 36168113
OWN - NLM
STAT- MEDLINE
DCOM- 20221121
LR  - 20221206
IS  - 2047-2412 (Electronic)
IS  - 2047-2404 (Linking)
VI  - 23
IP  - 12
DP  - 2022 Nov 17
TI  - Subclinical leaflet thrombosis after transcatheter aortic valve implantation is 
      associated with silent brain injury on brain magnetic resonance imaging.
PG  - 1584-1595
LID - 10.1093/ehjci/jeac191 [doi]
AB  - AIMS: Whether hypoattenuated leaflet thickening (HALT) following transcatheter 
      aortic valve implantation (TAVI) carries a risk of subclinical brain injury (SBI) 
      is unknown. We investigated whether HALT is associated with SBI detected on 
      magnetic resonance imaging (MRI), and whether post-TAVI SBI impacts the patients' 
      cognition and outcome. METHODS AND RESULTS: We prospectively enrolled 153 
      patients (age: 78.1 +/- 6.3 years; female 44%) who underwent TAVI. Brain MRI was 
      performed shortly post-TAVI and 6 months later to assess the occurrence of acute 
      silent cerebral ischaemic lesions (SCIL) and chronic white matter 
      hyperintensities (WMH). HALT was screened by cardiac computed tomography (CT) 
      angiography (CTA) 6 months post-TAVI. Neurocognitive evaluation was performed 
      before, shortly after and 6 months following TAVI. At 6 months, 115 patients had 
      diagnostic CTA and 10 had HALT. HALT status, baseline, and follow-up MRIs were 
      available in 91 cases. At 6 months, new SCIL was evident in 16%, new WMH in 66%. 
      New WMH was more frequent (100 vs. 62%; P = 0.047) with higher median volume (319 
      vs. 50 mm3; P = 0.039) among HALT-patients. In uni- and multivariate analysis, 
      HALT was associated with new WMH volume (beta: 0.72; 95%CI: 0.2-1.39; P = 0.009). 
      The patients' cognitive trajectory from pre-TAVI to 6 months showed significant 
      association with the 6-month SCIL volume (beta: -4.69; 95%CI: -9.13 to 0.27; P = 
      0.038), but was not related to the presence or volume of new WMH. During a 
      3.1-year follow-up, neither HALT [hazard ratio (HR): 0.86; 95%CI: 0.202-3.687; P 
      = 0.84], nor the related WMH burden (HR: 1.09; 95%CI: 0.701-1.680; P = 0.71) was 
      related with increased mortality. CONCLUSIONS: At 6 months post-TAVI, HALT was 
      linked with greater WMH burden, but did not carry an increased risk of cognitive 
      decline or mortality over a 3.1-year follow-up (NCT02826200).
CI  - (c) The Author(s) 2022. Published by Oxford University Press on behalf of the 
      European Society of Cardiology. All rights reserved. For permissions, please 
      email: journals.permissions@oup.com.
FAU - Apor, Astrid
AU  - Apor A
AD  - Heart and Vascular Center, Semmelweis University, 68, Varosmajor Street, 1122 
      Budapest, Hungary.
FAU - Bartykowszki, Andrea
AU  - Bartykowszki A
AD  - Heart and Vascular Center, Semmelweis University, 68, Varosmajor Street, 1122 
      Budapest, Hungary.
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 1122 Budapest, Hungary.
FAU - Szilveszter, Balint
AU  - Szilveszter B
AD  - Heart and Vascular Center, Semmelweis University, 68, Varosmajor Street, 1122 
      Budapest, Hungary.
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 1122 Budapest, Hungary.
FAU - Varga, Andrea
AU  - Varga A
AD  - Heart and Vascular Center, Semmelweis University, 68, Varosmajor Street, 1122 
      Budapest, Hungary.
FAU - Suhai, Ferenc I
AU  - Suhai FI
AD  - Heart and Vascular Center, Semmelweis University, 68, Varosmajor Street, 1122 
      Budapest, Hungary.
FAU - Manouras, Aristomenis
AU  - Manouras A
AD  - Department of Medicine, Karolinska Institute, 14186 Stockholm, Sweden.
AD  - Heart and Vascular Theme, Karolinska University Hospital, 17164 Stockholm, 
      Sweden.
FAU - Molnar, Levente
AU  - Molnar L
AUID- ORCID: 0000-0003-0861-1247
AD  - Heart and Vascular Center, Semmelweis University, 68, Varosmajor Street, 1122 
      Budapest, Hungary.
FAU - Jermendy, Adam L
AU  - Jermendy AL
AD  - Heart and Vascular Center, Semmelweis University, 68, Varosmajor Street, 1122 
      Budapest, Hungary.
FAU - Panajotu, Alexisz
AU  - Panajotu A
AD  - Heart and Vascular Center, Semmelweis University, 68, Varosmajor Street, 1122 
      Budapest, Hungary.
FAU - Turani, Mirjam Franciska
AU  - Turani MF
AD  - Department of Cardiology, Medical Center - Hungarian Defense Forces, 1134 
      Budapest, Hungary.
FAU - Papp, Roland
AU  - Papp R
AD  - Heart and Vascular Center, Semmelweis University, 68, Varosmajor Street, 1122 
      Budapest, Hungary.
FAU - Karady, Julia
AU  - Karady J
AUID- ORCID: 0000-0002-6640-6260
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 1122 Budapest, Hungary.
FAU - Kolossvary, Marton
AU  - Kolossvary M
AUID- ORCID: 0000-0002-5570-991X
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 1122 Budapest, Hungary.
FAU - Kovats, Timea
AU  - Kovats T
AD  - Heart and Vascular Center, Semmelweis University, 68, Varosmajor Street, 1122 
      Budapest, Hungary.
FAU - Maurovich-Horvat, Pal
AU  - Maurovich-Horvat P
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 1122 Budapest, Hungary.
AD  - Medical Imaging Center, Semmelweis University, 1082 Budapest, Hungary.
FAU - Merkely, Bela
AU  - Merkely B
AD  - Heart and Vascular Center, Semmelweis University, 68, Varosmajor Street, 1122 
      Budapest, Hungary.
FAU - Nagy, Aniko Ilona
AU  - Nagy AI
AUID- ORCID: 0000-0002-0519-5172
AD  - Heart and Vascular Center, Semmelweis University, 68, Varosmajor Street, 1122 
      Budapest, Hungary.
AD  - Department of Medicine, Karolinska Institute, 14186 Stockholm, Sweden.
LA  - eng
SI  - ClinicalTrials.gov/NCT02826200
PT  - Journal Article
PL  - England
TA  - Eur Heart J Cardiovasc Imaging
JT  - European heart journal. Cardiovascular Imaging
JID - 101573788
SB  - IM
CIN - Eur Heart J Cardiovasc Imaging. 2022 Nov 17;23(12):1596-1597. PMID: 36168131
MH  - Humans
MH  - Female
MH  - Aged
MH  - Aged, 80 and over
MH  - *Transcatheter Aortic Valve Replacement/adverse effects
MH  - *Aortic Valve Stenosis/diagnostic imaging/surgery/etiology
MH  - Treatment Outcome
MH  - *Thrombosis/etiology
MH  - Magnetic Resonance Imaging
MH  - Brain
MH  - *Brain Injuries/etiology
MH  - Aortic Valve/surgery
MH  - *Heart Valve Prosthesis
MH  - Risk Factors
OTO - NOTNLM
OT  - HALT (hypoattenuated leaflet thickening)
OT  - TAVI (transcatheter aortic valve implantation)
OT  - WMH (white matter hyperintensities)
OT  - brain MRI (magnetic resonance imaging)
OT  - cognition
COIS- Conflict of interest: P.M.-H. is shareholder of Neumann Medical Ltd.; B.M. 
      received institutional grants from Boston Scientific and Medtronic, speakers fees 
      from Boehringer Ingelheim, Astra Zeneca, Biotronic, Abbott, Novartis, and is 
      advisory board member at Boehringer Ingelheim, Astra Zeneca, and Novartis.
EDAT- 2022/09/29 06:00
MHDA- 2022/11/22 06:00
CRDT- 2022/09/28 00:15
PHST- 2022/03/25 00:00 [received]
PHST- 2022/08/10 00:00 [revised]
PHST- 2022/08/25 00:00 [accepted]
PHST- 2022/09/29 06:00 [pubmed]
PHST- 2022/11/22 06:00 [medline]
PHST- 2022/09/28 00:15 [entrez]
AID - 6724473 [pii]
AID - 10.1093/ehjci/jeac191 [doi]
PST - ppublish
SO  - Eur Heart J Cardiovasc Imaging. 2022 Nov 17;23(12):1584-1595. doi: 
      10.1093/ehjci/jeac191.