Valvular & structural heart diseaseCohort study
Clinical Significance of Diffusion-Weighted Brain MRI Lesions After Transcatheter Aortic Valve Replacement (TAVR)
- Pooled patient-level analysis of prospective studies
- 4 prospective TAVR embolic protection studies
- core laboratory analysis
Authors' conclusion
Our study confirms that the number, size, and total volume of acute brain infarction defined by DW-MRI are each associated with clinical ischemic strokes, disabling strokes, and worse stroke recovery in patients undergoing TAVR
Study context
- Population
- Patients undergoing TAVR with predischarge diffusion-weighted magnetic resonance imaging (DW-MRI)495 completed DW-MRI
- Participants
- 603 patients
- Exposure
- Total lesion volume (TLV) >500 mm3 vs TLV ≤500 mm3 on predischarge DW-MRI
- Outcome
- Association of DW-MRI lesion number, individual and total lesion volume with clinical ischemic stroke (C-statistic)
- Follow-up
- 30 days
Main finding
As reported in the abstract
Ischemic stroke
P < 0.0001
- C-statistic for TLV predicting ischemic stroke
- 0.84
- C-statistic for number of lesions
- 0.81
- C-statistic for maximum individual lesion volume (ILV)
- 0.82
Observational data: associations, not effects.
Further findings
| Outcome | Values | P value |
|---|---|---|
| Disabling stroke · 30 days | TLV >500 mm3 8.8% · TLV ≤500 mm3 0.9% | P < 0.0001 |
| Complete stroke recovery · 30 days | TLV >500 mm3 44% · TLV ≤500 mm3 62.5% | P = 0.001 |
Clinical ischemic stroke (all patients) · 30 days
- Rate of clinical ischemic stroke
- 6.9%
Acute ischemic brain injury on DW-MRI
- Patients with acute ischemic brain injury
- 85%
- Discrete lesions per patient (mean ± SD)
- 5.5 ± 7.3
- Mean ILV
- 78.2 ± 257.1 mm3
- Mean TLV
- 555 ± 1,039 mm3
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Clinical Significance of Diffusion-Weighted Brain MRI Lesions After TAVR. J Am Coll Cardiol. Published 20 August 2024. doi:10.1016/j.jacc.2024.05.055
Summarised from the published abstract; every number is checked against it