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

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. Therefore we assess 1A) whether an increase in cardiac output after TAVI is associated with an increase of global CBF; 1B) regional differences in CBF after TAVI; 1C) whether (global or regional) increased CBF is associated with improved cognitive functioning; 1D) patient and procedural characteristics associated with increased cardiac output, CBF and cognitive functioning; 2A) the incidence and volume of new white matter hyperintensities (WMH) after TAVI; 2B) 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. In a prospective observational cohort of 142 patients undergoing TAVI, we measure cardiac output using inert gas rebreathing; cerebral blood flow using arterial spin labelling MRI; and cognitive functioning using a neuropsychological test battery, prior to TAVI (<24 hours) and at 3 months follow-up.

After TAVI, cardiac output will increase, which leads to increased cerebral blood flow (CBF) and subsequently to improved cognitive functioning. 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.

Baseline (<24 hours before TAVI) and follow-up 3 months after TAVI

Transcatheter aortic valve implantation (TAVI)