BACKGROUND: Anemia is prevalent in patients undergoing transcatheter aortic valve replacement(TAVR) and has been linked to impaired outcomes after the procedure. Few studies have evaluated the impact of anemia and new...BACKGROUND: Anemia is prevalent in patients undergoing transcatheter aortic valve replacement(TAVR) and has been linked to impaired outcomes after the procedure. Few studies have evaluated the impact of anemia and new ischemic lesions post TAVR.METHODS: We prospectively enrolled 158 patients who received TAVR in our center. Anemia was defined according to the World Health Organization criteria as hemoglobin <12 g/dL in women and <13 g/dL in men. All patients underwent diffusion-weighted magnetic resonance imaging(DW-MRI) procedure before and within 4–7 days after TAVR. RESULTS: Anemia was present in 85(53.8%) patients who underwent TAVR, and 126(79.7%) patients had 718 new DW-MRI positive lesions with a mean of 4.54±5.26 lesions per patient. The incidence of new ischemic lesions was 81.2% in patients with anemia versus 78.1% in patients without anemia(P=0.629). Moreover, anemic patients had bigger total volume/lesions in the anterior cerebral artery/middle cerebral artery(ACA/MCA) and MCA regions compared to the non-anemic patients(31.89±55.78 mm^(3) vs. 17.08±37.39 mm^(3), P=0.049;and 54.54±74.72 mm^(3) vs. 33.75±46.03 mm^(3), P=0.034). Anemia was independently associated with the volume/lesion in the ACA/MCA(β=16.796, 95% confidence interval [95% CI] 2.001 to 31.591, P=0.026) and in the MCA zone(β=0.020, 95% CI 0.001 to 0.040, P=0.041). CONCLUSIONS: Patients with pre-procedural anemia may have bigger total volume/lesions in the ACA/MCA and MCA regions compared to the non-anemic patients. Whether the consequences of bigger total volume/lesions impact neurological and cognitive outcomes remains to be investigated.展开更多
Dear editor,Transcatheter aortic valve replacement(TAVR)is a safe and effective first-line therapeutic management for patients with severe aortic stenosis.The evidence of multiple randomized clinical trials proves the...Dear editor,Transcatheter aortic valve replacement(TAVR)is a safe and effective first-line therapeutic management for patients with severe aortic stenosis.The evidence of multiple randomized clinical trials proves the safety and efficacy of TAVR in patients.[1-2]However,new-onset conduction disorders,atrial fi brillation,and acute coronary syndrome are still common complications after TAVR procedures.Acute life-threatening complications such as myocardial infarction may result in fatal clinical outcomes.The COVID-19 pandemic makes periodic and timely follow-ups for patients after TAVR more diffi cult.An ambulatory electrocardiogram(AECG)monitoring system by a smart wearable device has recently emerged as a tool to monitor cardiac events before and after TAVR.[3]Smartwatches can monitor and record multiple biometric parameters,like heart rate,step counts,sleep cycles,oxygen saturation,and analyze QRS complexes and P waves after triggering incidences。展开更多
基金funded by Zhejiang Province Science and Technology Department Key R&D Program(2018C03084,2021C03097).
文摘BACKGROUND: Anemia is prevalent in patients undergoing transcatheter aortic valve replacement(TAVR) and has been linked to impaired outcomes after the procedure. Few studies have evaluated the impact of anemia and new ischemic lesions post TAVR.METHODS: We prospectively enrolled 158 patients who received TAVR in our center. Anemia was defined according to the World Health Organization criteria as hemoglobin <12 g/dL in women and <13 g/dL in men. All patients underwent diffusion-weighted magnetic resonance imaging(DW-MRI) procedure before and within 4–7 days after TAVR. RESULTS: Anemia was present in 85(53.8%) patients who underwent TAVR, and 126(79.7%) patients had 718 new DW-MRI positive lesions with a mean of 4.54±5.26 lesions per patient. The incidence of new ischemic lesions was 81.2% in patients with anemia versus 78.1% in patients without anemia(P=0.629). Moreover, anemic patients had bigger total volume/lesions in the anterior cerebral artery/middle cerebral artery(ACA/MCA) and MCA regions compared to the non-anemic patients(31.89±55.78 mm^(3) vs. 17.08±37.39 mm^(3), P=0.049;and 54.54±74.72 mm^(3) vs. 33.75±46.03 mm^(3), P=0.034). Anemia was independently associated with the volume/lesion in the ACA/MCA(β=16.796, 95% confidence interval [95% CI] 2.001 to 31.591, P=0.026) and in the MCA zone(β=0.020, 95% CI 0.001 to 0.040, P=0.041). CONCLUSIONS: Patients with pre-procedural anemia may have bigger total volume/lesions in the ACA/MCA and MCA regions compared to the non-anemic patients. Whether the consequences of bigger total volume/lesions impact neurological and cognitive outcomes remains to be investigated.
文摘Dear editor,Transcatheter aortic valve replacement(TAVR)is a safe and effective first-line therapeutic management for patients with severe aortic stenosis.The evidence of multiple randomized clinical trials proves the safety and efficacy of TAVR in patients.[1-2]However,new-onset conduction disorders,atrial fi brillation,and acute coronary syndrome are still common complications after TAVR procedures.Acute life-threatening complications such as myocardial infarction may result in fatal clinical outcomes.The COVID-19 pandemic makes periodic and timely follow-ups for patients after TAVR more diffi cult.An ambulatory electrocardiogram(AECG)monitoring system by a smart wearable device has recently emerged as a tool to monitor cardiac events before and after TAVR.[3]Smartwatches can monitor and record multiple biometric parameters,like heart rate,step counts,sleep cycles,oxygen saturation,and analyze QRS complexes and P waves after triggering incidences。
