Valvular & structural heart disease
Clinical Significance of Diffusion-Weighted Brain MRI Lesions After Transcatheter Aortic Valve Replacement (TAVR): Results of a Patient-Level Pooled 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
Methodological details4 prospective TAVR embolic protection studies, core laboratory analysis
- 4 prospective TAVR embolic protection studies
- Core laboratory analysis
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
Disabling stroke · 30 days
P < 0.0001
Complete stroke recovery · 30 days
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: Results of a Patient-Level Pooled Analysis. J Am Coll Cardiol. Published 20 August 2024. doi:10.
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