Key result
Preoperative AS-related cerebral impairment linked to ~124% higher MACE risk.
Why the study?
The association of aortic stenosis-related cerebral impairment with cardiac remodeling and its prognostic impact remained unclear.
Does preoperative AS-related cerebral impairment predict major adverse cardiac events in patients with moderate-to-severe aortic stenosis undergoing surgery?
Cohort (n=384)
No
Does preoperative AS-related cerebral impairment predict major adverse cardiac events in patients with moderate-to-severe aortic stenosis undergoing surgery?
Effect estimate: HR 2.24 (95% CI 2.13-3.44)
p-value: p=<0.001
Preoperative AS-related cerebral impairment is an independent predictor of adverse outcomes, and an integrated cardio-cerebral assessment improves risk stratification in patients undergoing surgery for aortic stenosis.
Should not yet change perioperative risk models; leaves open whether cardio-cerebral integration improves outcomes in prospective studies.
Background Patients with aortic stenosis(AS)exhibit elevated covert brain injury. The association of AS‐related cerebral impairment with cardiac remodeling and its prognostic impact remains unclear, prompting exploration of integrated cardio‐cerebral assessment preliminarily. Methods Patients with moderate‐to‐severe aortic stenosis (AS) undergoing surgery at The First Affiliated Hospital of Guangxi Medical University (June 2021–December 2024) were enrolled ( n = 384). Patients were stratified into a cerebral hypoperfusion/embolism group ( n = 146) and an event‐free group ( n = 238) based on the presence or absence of preoperative cerebral impairment due to severe AS‐related hemodynamic compromise or embolic events. Preoperative clinical/echocardiographic and surgical data were collected. The composite primary endpoint was major adverse cardiac events (MACE) (malignant arrhythmia, heart failure rehospitalization, or all‐cause death). Multivariate regression identified predictors of AS‐related cerebral impairment and MACE risk factors. The C‐index assessed the cardio‐cerebral integrated model's prognostic value. Results The cerebral hypoperfusion/embolism group showed more pronounced left atrial (LA) and left ventricular (LV) remodeling. Multivariate logistic regression linked enlarged ascending aorta, left heart remodeling (increased LA size, elevated E/e' ratio, decreased LV global longitudinal strain and LA reservoir strain), reduced cardiac output (CO), and pulmonary artery systolic pressure to AS‐related cerebral impairment (all p < 0.05). Over an 18‐month median follow‐up, 79 MACE occurred. Adjusted multivariate Cox analysis confirmed AS‐related cerebral impairment as an independent MACE predictor (hazard ratio, 2.24 [95% CI: 2.13, 3.44]; p < 0.001). The cardio‐cerebral integrated model (clinical + echo + ischemia) demonstrated superior MACE prediction (C‐index, 0.862; likelihood ratio, 62.12) vs. clinical‐only (C‐index, 0.631; likelihood ratio, 19.32; both p < 0.001) or clinical + echo models (C‐index, 0.757; likelihood ratio, 46.34; both p < 0.001). Conclusions AS‐related cerebral impairment independently correlates with cardiac remodeling and adverse outcomes. Integrated cardio‐cerebral assessment enhances risk stratification.
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Huang et al. (2025) conducted a cohort in Moderate-to-severe aortic stenosis (n=384). Preoperative AS-related cerebral impairment vs. No preoperative cerebral impairment was evaluated on Major adverse cardiac events (MACE) (malignant arrhythmia, heart failure rehospitalization, or all-cause death) (HR 2.24, 95% CI 2.13-3.44, p=<0.001). Preoperative AS-related cerebral impairment independently predicted major adverse cardiac events (HR 2.24; 95% CI 2.13-3.44; p<0.001), and an integrated cardio-cerebral model enhanced risk prediction.
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