Integrated Cardio-Cerebral Assessment Predicts Adverse Outcomes in Aortic Stenosis: A Preliminary Study.

BACKGROUND

Patients with aortic stenosis(AS)exhibit elevated covert brain injury. The association of AS-related cerebral impairment with cardiac remodeling and its prognostic impact remains unclear, prompting exploration of integrated cardio-cerebral assessment preliminarily.

METHODS

Patients with moderate-to-severe aortic stenosis (AS) undergoing surgery at The First Affiliated Hospital of Guangxi Medical University (June 2021-December 2024) were enrolled (n = 384). Patients were stratified into a cerebral hypoperfusion/embolism group (n = 146) and an event-free group (n = 238) based on the presence or absence of preoperative cerebral impairment due to severe AS-related hemodynamic compromise or embolic events. Preoperative clinical/echocardiographic and surgical data were collected. The composite primary endpoint was major adverse cardiac events (MACE) (malignant arrhythmia, heart failure rehospitalization, or all-cause death). Multivariate regression identified predictors of AS-related cerebral impairment and MACE risk factors. The C-index assessed the cardio-cerebral integrated model's prognostic value.

RESULTS

The cerebral hypoperfusion/embolism group showed more pronounced left atrial (LA) and left ventricular (LV) remodeling. Multivariate logistic regression linked enlarged ascending aorta, left heart remodeling (increased LA size, elevated E/e' ratio, decreased LV global longitudinal strain and LA reservoir strain), reduced cardiac output (CO), and pulmonary artery systolic pressure to AS-related cerebral impairment (all p < 0.05). Over an 18-month median follow-up, 79 MACE occurred. Adjusted multivariate Cox analysis confirmed AS-related cerebral impairment as an independent MACE predictor (hazard ratio, 2.24 [95% CI: 2.13, 3.44]; p < 0.001). The cardio-cerebral integrated model (clinical + echo + ischemia) demonstrated superior MACE prediction (C-index, 0.862; likelihood ratio, 62.12) vs. clinical-only (C-index, 0.631; likelihood ratio, 19.32; both p < 0.001) or clinical + echo models (C-index, 0.757; likelihood ratio, 46.34; both p < 0.001).

CONCLUSIONS

AS-related cerebral impairment independently correlates with cardiac remodeling and adverse outcomes. Integrated cardio-cerebral assessment enhances risk stratification.