Cardiac output, cerebral perfusion and cognition in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation.

Cardiovascular disease and cognitive diseases are closely related. Cognitive
impairment is common (21-39%) among patients with severe aortic valve stenosis.
The proof-of-concept CP-TAVI study showed increased cardiac output following
transcatheter aortic valve implantation (TAVI) was associated with increased
cerebral blood flow. We hypothesize increased cerebral blood flow (CBF)
subsequently leads to improved cognitive functioning. Additionally, silent
micro emboli caused by crushing of the calcified native valve during TAVI may
cause cognitive deterioration. If it could be predicted which patients are at
risk for TAVI induced cerebral micro emboli, these patients could benefit from
cerebral protection devices, preventing cognitive decline.

the objectives of the CP-TAVI II study are 1A) to identify whether an increase
in cardiac output after TAVI is associated with an increase of global CBF; 1B)
explore regional differences in CBF after TAVI; 1C) determine whether (global
or regional) increased CBF is associated with improved cognitive functioning;
1D) identify patient and procedural characteristics associated with increased
cardiac output, CBF and cognitive functioning; 2A) identify the incidence and
volume of new white matter hyperintensities after (WMH) TAVI; 2B) evaluate
patient and procedural predictors for the increase in WMH volume, including
baseline aortic valve calcification volume, measured with computed tomography;
2C) if aortic valve calcification volume predicts new white matter
hyperintensities, define a cut-off value for high-risk patients; 2D) assess
whether the increase in white matter hyperintensity volume is associated with
deterioration of cognitive scores.

Prospective observational study, measuring cardiac output (routine
echocardiography), cerebral blood flow (arterial spin labelling magnetic
resonance imaging) and cognitive functioning (neuropsychologist) prior to TAVI
(<24 hours) and at 3 month follow-up

In addition to usual treatment, patients will undergo an MRI scan (30 minutes),
and multiple cognitive tests (90 minutes). The first set of these three tests
will be done during standard admission 24 hours prior to TAVI and the second
set will be done during routine follow-up outpatient appointment. Additional
hospital visits are not needed.