Abnormalities of brain imaging in patients after left ventricular assist device support following explantation

Murase, Sho; Okazaki, Shuhei; Yoshioka, D.; Watanabe, Kotaro; Gon, Yasufumi; Todo, Kenichi; Sasaki, Tsutomu; Sakaguchi, Manabu; Misumi, Yusuke; Toda, Köichi; Sawa, Yoshiki; Mochizuki, Hideki

doi:10.1016/j.healun.2019.11.019

Cited by 18 publications

(13 citation statements)

References 35 publications

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“…For instance, two MRI studies from Japan found cerebral microbleeds and cortical superficial siderosis, which are imaging markers of small vessel disease, in over 97 and 31% of LVAD patients, respectively. 101,131 Aforementioned bimodal temporal distribution of stroke after LVAD implantation 9,37,52-54 will certainly further impact long-term cognitive outcomes.…”

Section: Outcome Of Lvad-associated Strokementioning

confidence: 99%

A Comprehensive Review of Risk Factor, Mechanism, and Management of Left Ventricular Assist Device–Associated Stroke

et al. 2021

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The use of left ventricular assist devices (LVADs) has been increasing in the last decade, along with the number of patients with advanced heart failure refractory to medical therapy. Ischemic stroke and intracranial hemorrhage remain the leading causes of morbidity and mortality in LVAD patients. Despite the common occurrence and the significant outcome impact, underlying mechanisms and management strategies of stroke in LVAD patients are controversial. In this article, we review our current knowledge on pathophysiology and risk factors of LVAD-associated stroke, outline the diagnostic approach, and discuss treatment strategies.

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Section: Outcome Of Lvad-associated Strokementioning

confidence: 99%

A Comprehensive Review of Risk Factor, Mechanism, and Management of Left Ventricular Assist Device–Associated Stroke

et al. 2021

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“…31 A retrospective review of LVAD patients dem-onstrated that there was a higher percentage of microbleeds and brain hemosiderin deposition compared with healthy controls, as well as those with congestive heart failure but without LVAD devices. 32 It is worth noting that cerebral microbleeds are a common occurrence in cerebral amyloid angiopathy (CAA). CAA is associated with dementia, stroke, and encephalopathies, 33 but there is little evidence that the sporadic amyloid β-protein deposits in the brain in these patients are at all related to either the systemic light chain amyloidosis that can affect the heart, or the wild-type TTR amyloidosis related cardiomyopathy.…”

Section: Hemorrhagementioning

confidence: 99%

Cerebrovascular Disease and Cognitive Outcome in Patients with Cardiac Disease

Johansen

Gottesman

2021

Semin Neurol

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The pace of understanding cognitive decline and dementia has rapidly accelerated over the past decade, with constantly evolving insights into the vascular contributions to cognitive impairment and dementia (VCID). Notably, more overlap has been discovered in the pathophysiology between what was previously understood to be Alzheimer's disease and VCID, leading to a heightened emphasis on disease prevention through early and aggressive control of vascular risk factors. One particularly vulnerable population may be those with cardiac disease, as they are at risk for cerebrovascular disease, which itself can lead to dementia, and increasing evidence supports cognitive impairment in disease processes such as heart failure and atrial fibrillation, independent of ischemic stroke, suggesting other potential mechanisms. In this article, we review the evidence supporting the relationship between cardiac disease, cerebrovascular disease, and cognitive decline and discuss the ongoing and future research efforts aimed at defining the important relationship between these entities.

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“…CAA typically occurs among patients aged >60 years, however, the average age of LVAD patients in the Murase study 7 was 41, which begs the question of whether LVADs place patients at higher risk for the development of CAA. Though the authors have suggested that the antithrombotic therapy that LVAD patients are exposed to may cause some of the reported MRI findings, it is not clear if these drugs cause the underlying vasculopathy or simply contribute to higher bleeding rates in the context of pre-existing CAA.…”

mentioning

confidence: 94%

“…al. 7 expand upon their previous work 6 and conduct a retrospective review of 49 post-explant LVAD patients (37% of whom had symptomatic stroke; half of which were hemorrhagic stroke) and compare brain MRI scans to 49 age and sex-matched healthy controls and 45 control patients with congestive heart failure (CHF). The use of these control groups strengths the causal link between mechanical circulatory support and MRI abnormalities, particularly since CHF patients have many of the same co-morbidities and antithrombotic regimens as LVAD patients.…”

mentioning

confidence: 99%

This is your brain on LVAD

Frontera

2020

The Journal of Heart and Lung Transplantation

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Abnormalities of brain imaging in patients after left ventricular assist device support following explantation

Cited by 18 publications

References 35 publications

A Comprehensive Review of Risk Factor, Mechanism, and Management of Left Ventricular Assist Device–Associated Stroke

A Comprehensive Review of Risk Factor, Mechanism, and Management of Left Ventricular Assist Device–Associated Stroke

Cerebrovascular Disease and Cognitive Outcome in Patients with Cardiac Disease

This is your brain on LVAD

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