{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T12:45:06Z","timestamp":1767012306617,"version":"3.48.0"},"reference-count":32,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with aortic stenosis(AS)exhibit elevated covert brain injury. The association of AS\u2010related cerebral impairment with cardiac remodeling and its prognostic impact remains unclear, prompting exploration of integrated cardio\u2010cerebral assessment preliminarily.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Patients with moderate\u2010to\u2010severe aortic stenosis (AS) undergoing surgery at The First Affiliated Hospital of Guangxi Medical University (June 2021\u2013December 2024) were enrolled (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0384). Patients were stratified into a cerebral hypoperfusion\/embolism group (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0146) and an event\u2010free group (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0238) based on the presence or absence of preoperative cerebral impairment due to severe AS\u2010related 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\u2010cause death). Multivariate regression identified predictors of AS\u2010related cerebral impairment and MACE risk factors. The C\u2010index assessed the cardio\u2010cerebral integrated model's prognostic value.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u2010related cerebral impairment (all\n                      <jats:italic>p\u00a0&lt;\u00a0<\/jats:italic>\n                      0.05). Over an 18\u2010month median follow\u2010up, 79 MACE occurred. Adjusted multivariate Cox analysis confirmed AS\u2010related cerebral impairment as an independent MACE predictor (hazard ratio, 2.24 [95% CI: 2.13, 3.44];\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). The cardio\u2010cerebral integrated model (clinical\u00a0+\u00a0echo\u00a0+\u00a0ischemia) demonstrated superior MACE prediction (C\u2010index, 0.862; likelihood ratio, 62.12) vs. clinical\u2010only (C\u2010index, 0.631; likelihood ratio, 19.32; both\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) or clinical\u00a0+\u00a0echo models (C\u2010index, 0.757; likelihood ratio, 46.34; both\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AS\u2010related cerebral impairment independently correlates with cardiac remodeling and adverse outcomes. Integrated cardio\u2010cerebral assessment enhances risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/echo.70373","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T14:24:52Z","timestamp":1766499892000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrated Cardio\u2010Cerebral Assessment Predicts Adverse Outcomes in Aortic Stenosis: A Preliminary Study"],"prefix":"10.1111","volume":"42","author":[{"given":"Tongtong","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Ultrasonic Medicine the First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bingling","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Ultrasonic Medicine the First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Decai","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Ultrasonic Medicine the First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiong","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Ultrasonic Medicine the First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongzhi","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Ultrasonic Medicine the First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuai","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Ultrasonic Medicine the First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Ultrasonic Medicine the First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huiqiong","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Ultrasonic Medicine the First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liuliu","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery the First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mai","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery the First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Ultrasonic Medicine the First Affiliated Hospital of Guangxi Medical University  Nanning China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.22730"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/apha.14277"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeae285"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeaf035"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2017.10.041"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.4244\/eij\u2010d\u201019\u201000489"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/cells10040855"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jex244"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2016.01.011"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.10.003"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.035078"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2019.02.034"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2016.11.003"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.10.063"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.119.028389"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/bpa.12405"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl\u20102016\u2010310917"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeac145"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2020.05.019"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2015.05.063"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2021.09.023"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1161\/circimaging.116.006249"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00395\u2010020\u20100776\u20104"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11082078"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1577762"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12062321"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.737170"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.4103\/1673\u20105374.237124"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl\u20102021\u2010320707"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2361"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2018.11.007"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2020.07.002"}],"container-title":["Echocardiography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70373","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T12:41:41Z","timestamp":1767012101000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/echo.70373"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":32,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1111\/echo.70373"],"URL":"https:\/\/doi.org\/10.1111\/echo.70373","archive":["Portico"],"relation":{},"ISSN":["0742-2822","1540-8175"],"issn-type":[{"type":"print","value":"0742-2822"},{"type":"electronic","value":"1540-8175"}],"subject":[],"published":{"date-parts":[[2025,12]]},"assertion":[{"value":"2025-09-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70373"}}