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Abstract：
BACKGROUND: There is a scarcity of data on the prevalence and clinical impact of cerebrovascular disease detected on preprocedural computed tomography (CT) before aortic valve replacement (AVR) in patients with severe aortic stenosis.
RESULTS: Among patients with severe aortic stenosis undergoing AVR, the authors compared clinical outcomes between patients with and without cerebrovascular disease detected on preprocedural CT, which was defined as chronic brain infarction or hemorrhage. The primary outcome measure in this study was a composite of all-cause death or stroke. Among 567 study patients, 200 patients (35.3%) had cerebrovascular disease on preprocedural CT. Among 200 patients with cerebrovascular disease on preprocedural CT, only 28.5% of patients had a clinical history of symptomatic stroke. The cumulative 3-year incidence of death or stroke was higher in patients with cerebrovascular disease on preprocedural CT than in those without cerebrovascular disease on preprocedural CT (40.7% versus 24.1%, log-rank P<0.001). After adjusting for confounders, the higher risk of patients with cerebrovascular disease on preprocedural CT relative to those without remained significant for death or stroke (hazard ratio [HR], 1.42 [95% CI, 1.02-1.98]; P=0.04). Among 200 patients with cerebrovascular disease on preprocedural CT, patients with prior symptomatic stroke compared with those without were not associated with higher adjusted risk for death or stroke (HR, 1.18 [95% CI, 0.72-1.94]; P=0.52).
CONCLUSIONS: Among patients with severe aortic stenosis undergoing AVR, a substantial proportion had cerebrovascular disease on preprocedural CT, with a clinical history of symptomatic stroke in one-fourth of patients. Regardless of history of symptomatic stroke, patients with cerebrovascular disease on preprocedural CT had worse clinical outcomes compared with those without cerebrovascular disease on preprocedural CT.
RESULTS: Among patients with severe aortic stenosis undergoing AVR, the authors compared clinical outcomes between patients with and without cerebrovascular disease detected on preprocedural CT, which was defined as chronic brain infarction or hemorrhage. The primary outcome measure in this study was a composite of all-cause death or stroke. Among 567 study patients, 200 patients (35.3%) had cerebrovascular disease on preprocedural CT. Among 200 patients with cerebrovascular disease on preprocedural CT, only 28.5% of patients had a clinical history of symptomatic stroke. The cumulative 3-year incidence of death or stroke was higher in patients with cerebrovascular disease on preprocedural CT than in those without cerebrovascular disease on preprocedural CT (40.7% versus 24.1%, log-rank P<0.001). After adjusting for confounders, the higher risk of patients with cerebrovascular disease on preprocedural CT relative to those without remained significant for death or stroke (hazard ratio [HR], 1.42 [95% CI, 1.02-1.98]; P=0.04). Among 200 patients with cerebrovascular disease on preprocedural CT, patients with prior symptomatic stroke compared with those without were not associated with higher adjusted risk for death or stroke (HR, 1.18 [95% CI, 0.72-1.94]; P=0.52).
CONCLUSIONS: Among patients with severe aortic stenosis undergoing AVR, a substantial proportion had cerebrovascular disease on preprocedural CT, with a clinical history of symptomatic stroke in one-fourth of patients. Regardless of history of symptomatic stroke, patients with cerebrovascular disease on preprocedural CT had worse clinical outcomes compared with those without cerebrovascular disease on preprocedural CT.
摘要：
背景：关于严重主动脉瓣狭窄患者在主动脉瓣置换术（AVR）前的术前计算机断层扫描（CT）检测到的脑血管疾病的患病率和临床影响的数据很少。
结果：在接受AVR的重度主动脉瓣狭窄患者中，作者比较了术前CT检测到的有和无脑血管疾病患者的临床结果，定义为慢性脑梗塞或出血。这项研究的主要结局指标是全因死亡或卒中的综合结果。在567名研究患者中，200例（35.3%）患者术前CT有脑血管疾病。200例脑血管病患者术前CT检查,只有28.5%的患者有症状性卒中的临床病史.术前CT诊断为脑血管疾病的患者3年死亡或卒中的累积发生率高于术前CT诊断为无脑血管疾病的患者(40.7%对24.1%,对数秩P<0.001)。在调整了混杂因素后，术前CT检查脑血管疾病患者的死亡或卒中风险高于无患者(风险比[HR],1.42[95%CI，1.02-1.98]；P=0.04）。200例脑血管病患者术前CT检查,既往有症状卒中的患者与没有卒中的患者相比，其死亡或卒中的校正风险较高(HR,1.18[95%CI，0.72-1.94]；P=0.52）。
结论：在接受AVR的重度主动脉瓣狭窄患者中，相当比例的人在术前CT上有脑血管疾病，四分之一的患者有症状性卒中的临床病史。不管有症状的中风史，与术前CT无脑血管疾病患者相比,术前CT有脑血管疾病患者的临床结局更差.
结果：在接受AVR的重度主动脉瓣狭窄患者中，作者比较了术前CT检测到的有和无脑血管疾病患者的临床结果，定义为慢性脑梗塞或出血。这项研究的主要结局指标是全因死亡或卒中的综合结果。在567名研究患者中，200例（35.3%）患者术前CT有脑血管疾病。200例脑血管病患者术前CT检查,只有28.5%的患者有症状性卒中的临床病史.术前CT诊断为脑血管疾病的患者3年死亡或卒中的累积发生率高于术前CT诊断为无脑血管疾病的患者(40.7%对24.1%,对数秩P<0.001)。在调整了混杂因素后，术前CT检查脑血管疾病患者的死亡或卒中风险高于无患者(风险比[HR],1.42[95%CI，1.02-1.98]；P=0.04）。200例脑血管病患者术前CT检查,既往有症状卒中的患者与没有卒中的患者相比，其死亡或卒中的校正风险较高(HR,1.18[95%CI，0.72-1.94]；P=0.52）。
结论：在接受AVR的重度主动脉瓣狭窄患者中，相当比例的人在术前CT上有脑血管疾病，四分之一的患者有症状性卒中的临床病史。不管有症状的中风史，与术前CT无脑血管疾病患者相比,术前CT有脑血管疾病患者的临床结局更差.
