Key result
Increased post-TAVI cardiac output is linked to ~8% higher cerebral blood flow per additional liter.
Why the study?
To test the hypothesis that improved cardiac output after TAVI is associated with an increase in cerebral blood flow in patients with severe aortic valve stenosis.
Does transcatheter aortic valve implantation improve cardiac output and cerebral blood flow in patients with severe symptomatic aortic valve stenosis?
Cohort (n=31)
Does transcatheter aortic valve implantation improve cardiac output and cerebral blood flow in patients with severe symptomatic aortic valve stenosis?
Effect estimate: 8.2% increase in cerebral blood flow per 1 L/min increase in cardiac output
p-value: p=.003
In patients with severe aortic stenosis, TAVI significantly increases cardiac output, which is directly associated with an increase in cerebral blood flow at 3 months.
Cardiac output gains after TAVI were associated with increased cerebral blood flow; leaves open whether TAVI enhances cerebral perfusion.
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a minimally invasive, life-saving treatment for patients with severe aortic valve stenosis that improves quality of life. We examined cardiac output and cerebral blood flow in patients undergoing TAVI to test the hypothesis that improved cardiac output after TAVI is associated with an increase in cerebral blood flow. DESIGN: Prospective cohort study. SETTING: European high-volume tertiary multidisciplinary cardiac care. PARTICIPANTS: Thirty-one patients (78.3 ± 4.6 years; 61% female) with severe symptomatic aortic valve stenosis. MEASUREMENTS: Noninvasive prospective assessment of cardiac output (L/min) by inert gas rebreathing and cerebral blood flow of the total gray matter (mL/100 g per min) using arterial spin labeling magnetic resonance imaging in resting state less than 24 hours before TAVI and at 3-month follow-up. Cerebral blood flow change was defined as the difference relative to baseline. RESULTS: On average, cardiac output in patients with severe aortic valve stenosis increased from 4.0 ± 1.1 to 5.4 ± 2.4 L/min after TAVI (P = .003). The increase in cerebral blood flow after TAVI strongly varied between patients (7% ± 24%; P = .41) and related to the increase in cardiac output, with an 8.2% (standard error = 2.3%; P = .003) increase in cerebral blood flow per every additional liter of cardiac output following the TAVI procedure. CONCLUSION: Following TAVI, there was an association of increase in cardiac output with increase in cerebral blood flow. These findings encourage future larger studies to determine the influence of TAVI on cerebral blood flow and cognitive function.
No takes yet. Share an insight, caveat, or question.
Vlastra et al. (2020) conducted a cohort in Severe symptomatic aortic valve stenosis (n=31). Transcatheter aortic valve implantation (TAVI) vs. Baseline (pre-TAVI) was evaluated on Change in cardiac output and cerebral blood flow (8.2% increase in cerebral blood flow per 1 L/min increase in cardiac output, p=.003). Following TAVI, an increase in cardiac output was associated with an 8.2% increase in cerebral blood flow per every additional liter of cardiac output (P=0.003).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: