Microstructural alterations measured by diffusion tensor imaging following transcatheter aortic valve replacement and their association with cerebral ischemic injury and cognitive function - a prospective study

Abstract

Purpose: We assessed diffusion tensor imaging (DTI) metric changes of the corpus callosum and cingulum correlated to postprocedural ischemic lesion load (ILL) and cognitive performance in transcatheter aortic valve replacement (TAVR).

Methods: TAVR subjects had DTI post-TAVR (≤ 8 days) and at 6 months (78 participants, males 56%, age 78.8 years ± 6.3) and four neurocognitive tests (pre-TAVR, post-TAVR, 6 months, 1 year). DTI metrics (fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD)) were calculated for 7 regions: corpus callosum (genu, body, splenium) and cingulum (cingulate gyrus, parahippocampal cingulum bilaterally). DTI metrics post-TAVR and at 6 months were compared with Student's t-test (p < 0.0071) and ANOVA covarying for sex, ILL (p < 0.05) with post hoc analysis of ILL groups (p < 0.0167). Repeated-measures linear mixed-effect model (p < 0.05) was performed to investigate the effect of time and ILL on cognition.

Results: At 6 months, significant decrease of the following DTI metrics was detected: AD (genu, body, splenium, right parahippocampal cingulum: p ≤ 0.0046); MD (body, both cingulate gyri: p ≤ 0.0050); RD (left cingulate gyrus: p = 0.0021); FA (splenium: p < 0.0001). ANOVA confirmed significant effect of female sex on AD + MD reduction (body, right cingulate gyrus) and AD reduction (left cingulate gyrus) (p ≤ 0.0254). Significant negative effect of ILL on some DTI metric changes was found (AD + MD-body: p ≤ 0.0050; MD-left cingulate gyrus: p = 0.0087). Cognitive performance remained stable with significant negative correlation of ILL and retrograde memory and visual scores (p ≤ 0.0483).

Conclusion: Significant effect of TAVR on cerebral microstructural integrity was found with reduced diffusivities opposite to the trends reported in various neurodegenerative conditions/ageing, notably in women and lower ILL, and with preserved/improved cognition.

Trial registration number: NCT02826200 at ClinicalTrials.gov; date of registration: 07. July 2016.

Keywords: Cognitive function; DTI (diffusion tensor imaging); MRI; TAVR (transcatheter aortic valve replacement).

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Fig. 1

Flowchart of study design, diffusion tensor imaging and cognitive study cohorts

Fig. 2

a 3D left anterior–posterior view; b 3D right posterior-anterior view of one study subject’s regions of interest projected over the fused colour coded fractional anisotropy and T1 weighted images. Red = genu of corpus callosum, orange = body of corpus callosum, yellow = splenium of corpus callosum, emerald green = right cingulate gyrus, jade green = left cingulate gyrus, dark blue = right parahippocampal cingulum, light blue = left parahippocampal cingulum

Fig. 3

Box plots of significant associations of change in diffusion tensor imaging metrics with sex. Top row: change of axial diffusivity (left) and mean diffusivity (right) from post-TAVR to 6 months in the body of corpus callosum in females versus males. Bottom row: change of axial diffusivity (left) and mean diffusivity (middle) from baseline to 6 months in the right cingulate gyrus; change of axial diffusivity from baseline to 6 months in the left cingulate gyrus (right) in females versus males. (Red line = median; top of box = 25th percentile; bottom of box = 75th percentile; plotted whisker = the most extreme data value that is not an outlier; red cross = outlier)

Fig. 4

Box plots of association of change in diffusion tensior imaging metrics with ischemic lesion load (ILL). Top row (from left to right): change of fractional anisotropy, axial diffusivity, mean diffusivity and radial diffusivity from baseline to 6 months in the body of corpus callosum in ILL groups I, II and III. Bottom row (from left to right): change of fractional anisotropy and mean diffusivity from baseline to 6 months in the left cingulate gyrus; change of axial diffusivity and mean diffusivity from baseline to 6 months in the splenium of the corpus callosum in ILL groups I, II and III. (Red line = median; top of box = 25th percentile; bottom of box = 75th percentile; plotted whisker = the most extreme data value that is not an outlier; red cross = outlier). *p-values from repeated measures analysis of variance across ILL groups. ¥p-value from post hoc analysis indicating significant between-group difference

Fig. 5

Box plots of cognitive scores pre-TAVR, post-TAVR, at 6 months and 1 year. Red line = median; top of box = 25th percentile; bottom of box = 75th percentile; plotted whisker = the most extreme data value that is not an outlier; red cross = outlier