Insights on Embolic Protection, Repositioning, and Stroke: A Subanalysis of the RESPOND Study

RESPOND is a prospective, single-arm study enrolling 1014 transcatheter aortic valve replacement (TAVR) patients. The objective of this analysis is to assess the impact of cerebral embolic protection (CEP) devices and prosthetic valve repositioning on the risk of neurologic complications in patients treated with the fully repositionable Lotus Valve in the RESPOND postmarket study. Valve repositioning and CEP use were at the operators’ discretion. Stroke events were adjudicated by an independent medical reviewer. This analysis assessed the baseline differences among patients according to CEP use and valve repositioning and evaluated the neurological complications at 72 hours after TAVR, hospital discharge, and 30-day follow-up. A multivariate analysis was performed to identify the potential predictors of stroke. Of the 996 patients implanted with the Lotus Valve (mean age: 80.8 years, 50.8% female, STS score 6.0 ± 6.9), 92 cases (9.2%) used CEP. The overall rate of acute stroke/transient ischemic attack (TIA) was 3.0% at 72 hours after TAVR. The 72-hour stroke/TIA rate was 1.1% in patients who had CEP and 3.2% in those who did not. Use of CEP was associated with a 2.1% absolute reduction in the risk of acute neurological events (relative risk reduction: 65.6%), although the difference was not statistically significant (p=0.51). Repositioning of the Lotus Valve occurred in 313/996 procedures (31.4%). The 72-hour rate of stroke/TIA was similar in patients who had valve repositioning (2.9%) compared with those who did not (3.1%; p=0.86). The selective use of a CEP device in the RESPOND study was associated with a nonsignificantly lower risk for stroke within 72 hours. The use of the repositioning feature of the Lotus Valve did not increase the stroke risk.

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Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Abdominal Aortic Aneurysm and Its Alterations After Treatment

Vascular and Endovascular Surgery ◽

10.1177/15385744211023281 ◽

2021 ◽

pp. 153857442110232

Author(s):

Spyridon N. Mylonas ◽

Konstantinos G. Moulakakis ◽

Nikolaos Kadoglou ◽

Constantinos Antonopoulos ◽

Thomas E. Kotsis ◽

...

Keyword(s):

Arterial Stiffness ◽

Surgical Repair ◽

Open Repair ◽

Abdominal Aortic ◽

Gender And Age ◽

Baseline Values ◽

The Difference ◽

The Impact ◽

Repair Group

Purpose: The aim of the present study was to investigate a potential difference on the arterial stiffness among aneurysm patients and non-aneurysm controls, as well as to explore potential changes between patients treated either with endovascular or open repair. Materials and Methods: A 110 patients with an infrarenal AAA were prospectively enrolled in this study. Fifty-six patients received an EVAR, whereas 54 patients received an open surgical repair. Moreover, 103 gender and age-matched subjects without AAA served as controls. The cardio-ankle vascular index (CAVI) was applied for measurement of the arterial stiffness. Results: CAVI values were statistically higher in the AAA patients when compared with control subjects. Although at 48 hours postoperatively the CAVI values were increased in both groups when compared to baseline values, the difference in CAVI had a tendency to be higher in the open group compared to the endovascular group. At 6 months of follow up the CAVI values returned to the baseline for the patients of the open repair group. However, in the endovascular group CAVI values remained higher when compared with the baseline values. Conclusion: Patients with AAAs demonstrated a higher value of CAVI compared to healthy controls. A significant increase of arterial stiffness in both groups during the immediate postoperative period was documented. The increase in arterial stiffness remained significant at 6 months in EVAR patients. Further studies are needed to elucidate the impact of a decreased aortic compliance after stentgraft implantation on the cardiac function of patients with AAA.

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The Impact of Switching from Short-Term Teriparatide Treatment to Denosumab Therapy Compared with Denosumab Alone for Patients with Osteoporotic Hip Fracture: A 1-Year Follow-up Study

10.21203/rs.3.rs-37191/v1 ◽

2020 ◽

Author(s):

Chan Ho Park ◽

Jun-Il Yoo ◽

Chang Hyun Choi ◽

You-Sung Suh

Keyword(s):

Hip Fracture ◽

Mineral Density ◽

Short Term ◽

Short Term Treatment ◽

T Score ◽

The Difference ◽

Group 2 ◽

The Impact ◽

Group 1

Abstract Background: Switching the prescription from bone-forming medication to resorptive agents is reportedly effective for patients with severe osteoporosis. The objective of this study is to determine the impact of implementing short-term teriparatide (TPTD) intervention before denosumab (DMab) therapy compared with DMab therapy alone for 1 year after hip fracture.Methods: TPTD was administered to 24 patients for an average of 12.1 weeks after which the intervention was switched to DMab therapy for 12 months (group 1). DMab alone was administered to 16 patients for 12 months (group 2). Bone mineral density (BMD) was evaluated before and after treatment at the 1-year follow-up. The improvement of BMD and T-score in hip and spine was compared with the levels of bone turnover marker.Results: The difference of hip BMD after osteoporosis treatment was -0.0081±0.03 in group 1 and 0.0074±0.04 in group 2 (p=0.180). The difference of spine BMD was 0.0819±0.04 in group 1 and 0.0145±0.03 in group 2 (p<0.001). BMD and T-score of the spine improved significantly in groups 1 and 2 (p < 0.001). There was no statistical difference in C-terminal telopeptide and osteocalcin level. Conclusion: Short-term TPTD administration followed by DMab alone was effective only in improving spine BMD. Short-term treatment with TPTD caused mild improvement in femur neck BMD compared with DMab alone. However, further research with a longer duration of TPTD treatment is warranted, as our findings lack statistical significance.

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Numerical Parametric Study of Paravalvular Leak Following a Transcatheter Aortic Valve Deployment Into a Patient-Specific Aortic Root

Journal of Biomechanical Engineering ◽

10.1115/1.4040457 ◽

2018 ◽

Vol 140 (10) ◽

Cited By ~ 13

Author(s):

Wenbin Mao ◽

Qian Wang ◽

Susheel Kodali ◽

Wei Sun

Keyword(s):

Aortic Valve ◽

Computational Model ◽

Aortic Root ◽

Paravalvular Leak ◽

Patient Specific ◽

Fe Method ◽

Transcatheter Aortic Valve ◽

Operative Planning ◽

The Difference ◽

The Impact

Paravalvular leak (PVL) is a relatively frequent complication after transcatheter aortic valve replacement (TAVR) with increased mortality. Currently, there is no effective method to pre-operatively predict and prevent PVL. In this study, we developed a computational model to predict the severity of PVL after TAVR. Nonlinear finite element (FE) method was used to simulate a self-expandable CoreValve deployment into a patient-specific aortic root, specified with human material properties of aortic tissues. Subsequently, computational fluid dynamics (CFD) simulations were performed using the post-TAVR geometries from the FE simulation, and a parametric investigation of the impact of the transcatheter aortic valve (TAV) skirt shape, TAV orientation, and deployment height on PVL was conducted. The predicted PVL was in good agreement with the echocardiography data. Due to the scallop shape of CoreValve skirt, the difference of PVL due to TAV orientation can be as large as 40%. Although the stent thickness is small compared to the aortic annulus size, we found that inappropriate modeling of it can lead to an underestimation of PVL up to 10 ml/beat. Moreover, the deployment height could significantly alter the extent and the distribution of regurgitant jets, which results in a change of leaking volume up to 70%. Further investigation in a large cohort of patients is warranted to verify the accuracy of our model. This study demonstrated that a rigorously developed patient-specific computational model can provide useful insights into underlying mechanisms causing PVL and potentially assist in pre-operative planning for TAVR to minimize PVL.

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Nonfocal Symptoms in Patients with Transient Ischemic Attack and Association with Stroke Risk

Current Neurovascular Research ◽

10.2174/1567202619666211217124919 ◽

2021 ◽

Vol 19 ◽

Author(s):

Shuxiang Yang ◽

Lu Zhao ◽

Lulu Pei ◽

Shuang Cao ◽

Yuan Gao ◽

...

Keyword(s):

Transient Ischemic Attack ◽

Stroke Risk ◽

First Year ◽

Kaplan Meier ◽

Predictive Outcome ◽

One Year ◽

Ischemic Attack ◽

Cumulative Risks

Background and Objective: Patients with transient ischemic attack（TIA）occasionally showed nonfocal symptoms, such as decreased consciousness, amnesia and non-rotatory dizziness. This study intended to evaluate the effect of nonfocal symptoms on the prognosis of patients with TIA. Methods: Data from the prospective hospital-based TIA database of the First Affiliated Hospital of Zhengzhou University were analyzed. The predictive outcome was stroke occurrence at 1 year. Cumulative risks of stroke in patients with and without nonfocal symptoms were estimated with Kaplan-Meier models. Results: We studied 1384 patients with TIA (842 men; mean age, 56±13 years), including 450 (32.5%) with nonfocal symptoms. In the ﬁrst year after TIA, stroke occurred in 168（12.1%） patients. There was no difference in the risk of stroke between patients with both focal and nonfocal symptoms and patients with focal symptoms alone (11.8% vs 12.4%, log-rank; P=0.691). Conclusions: The occurrence of nonfocal symptoms did not increase the risk of stroke at one-year follow-up compared to the occurrence of focal symptoms alone.

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Abstract P287: Sex Differences in Stroke Incidence: The REGARDS Study

Circulation ◽

10.1161/circ.125.suppl_10.ap287 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Virginia J Howard ◽

Suzanne E Judd ◽

Abraham J Letter ◽

Dawn O Kleindorfer ◽

Leslie A McClure ◽

...

Keyword(s):

Sex Differences ◽

Stroke Risk ◽

Proportional Hazards ◽

Population Based ◽

Incidence Rates ◽

National Data ◽

Stroke Incidence ◽

The Difference ◽

Regards Study

Background: There are strikingly few national data available to describe sex differences in age-specific stroke incidence. Methods: REGARDS is a national, population-based, longitudinal study of black and white participants aged > 45 years old, with oversampling of blacks and residents of the stroke belt. Between 2003 and 2007, 30,239 participants were enrolled and examined; follow-up is every 6 months by telephone for self- or proxy-reported stroke, with retrieval and adjudication of medical records by physicians. This analysis included 27,756 participants with follow up data who had no physician-diagnosed stroke at baseline. Stroke incidence rates were calculated as the number of stroke events divided by the person-years at risk with 95% confidence limits. Proportional hazards models were used to assess the race-specific association of sex with stroke risk by age strata (<65, 65–74, and 75+) after adjustment for socioeconomic factors, and Framingham stroke risk factors. Results: There were 613 incident strokes events over 135,551 person-years of follow-up. Stroke incidence rates increased with age (from 237/100,000 to 1003/100,000), and were higher in men than women in both blacks and whites (left panel of figure). After multivariable adjustment, men had higher risk than women at younger ages (<75) but for the 65–75 age group, the difference is larger for blacks than whites (right panel of figure). Discussion: These national data confirm the patterns in male/female stroke risk observed in the Greater Cincinnati/Northern Kentucky Stroke Study, with smaller sex differences at older ages, and for men, larger excess risk in whites than blacks.

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Abstract 183: Depressive Symptoms and Incident Stroke in Black and White Participants in the REGARDS Study

Stroke ◽

10.1161/str.43.suppl_1.a183 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Audrey L Austin ◽

Michael G Crowe ◽

Martha R Crowther ◽

Virginia J Howard ◽

Abraham J Letter ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Depressive Symptoms ◽

Racial Differences ◽

Stroke Risk ◽

Depression Scale ◽

Stroke Incidence ◽

Blacks And Whites ◽

The Impact

Background and Purpose: Research suggests that depression may contribute to stroke risk independent of other known risk factors. Most studies examining the impact of depression on stroke have been conducted with predominantly white cohorts, though blacks are known to have higher stroke incidence than whites. The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke in blacks and whites, and determine whether depressive symptomatology was differentially predictive of stroke among blacks and whites. Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS), is a national, population-based longitudinal study designed to examine risk factors associated with black-white and regional disparities in stroke incidence. Among 30,239 participants (42% black) accrued from 2003-2007, excluding those lacking follow-up or data on depressive symptoms, 27,557 were stroke-free at baseline. As of the January 2011 data closure, over an average follow-up of 4.6 years, 548 incident stroke cases were verified by study physicians based on medical records review. The association between baseline depressive symptoms (assessed via the Center for Epidemiological Studies Depression scale, 4-item version) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographic factors (age, race, and sex), stroke risk factors (hypertension, diabetes, smoking, atrial fibrillation, and history of heart disease), and social factors (education, income, and social network). Results: For the total sample, depressive symptoms were predictive of incident stroke. The association between depressive symptoms and stroke did not differ significantly based on race (Wald X 2 = 2.38, p = .1229). However, race-stratified analyses indicated that the association between depressive symptoms and stroke was stronger among whites and non-significant among blacks. Conclusions: Depressive symptoms were an independent risk factor for incident stroke among a national sample of blacks and whites. These findings suggest that assessment of depressive symptoms may warrant inclusion in stroke risk scales. The potential for a stronger association in whites than blacks requires further study.

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4070Clinical impact of mitral regurgitation before or following transcatheter aortic valve replacement in patients with aortic stenosis: a nationwide multivariable analysis

European Heart Journal ◽

10.1093/eurheartj/ehz745.0094 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Fauchier ◽

A Bernard ◽

A Bisson ◽

T Lacour ◽

J Herbert ◽

...

Keyword(s):

Transcatheter Aortic Valve Replacement ◽

Independent Predictor ◽

Multivariable Analysis ◽

Total Mortality ◽

Transcatheter Aortic Valve ◽

Mortality Hazard ◽

History Of ◽

The Impact ◽

Mortality Hazard Ratio

Abstract Patients undergoing transcatheter aortic valve replacement (TAVR) may have concomitant mitral regurgitation (MR). The impact of MR at baseline or after TAVR on subsequent prognosis remains to be more precisely determined. We analysed the impact of MR before or after TAVR on prognosis in the systematic analysis of patients treated with TAVR at a nationwide level. Methods Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients with aortic stenosis treated with transfemoral TAVR in France between 2008 and 2018. Cox regression was used for the analysis of predictors of events during follow-up. Results A total of 47,872 patients with transfemoral TAVR were included in the analysis (mean age 83±7 years). Moderate/severe MR was present at baseline (MRb) in 9.5% of the patients. Few patients (1.6%) revealed moderate/severe MR post-TAVR (MRpt). Mean follow-up was 1.31±1.61 years. MRb was associated with an increased cardiovascular mortality (Hazard ratio 1.29, 95% CI 1.20–1.39) and total mortality (Hazard ratio 1.15, 95% CI 1.10–1.21). However, MRb was not an independent predictor in multivariable analysis, neither for cardiovascular mortality (adjusted HR 1.06, 95% CI 0.98–1.14) nor for total mortality (adjusted HR 1.01, 95% CI 0.96–1.07). MRpt was not a predictor of cardiovascular or total mortality. Older age, male sex, history of pulmonary edema/cardiogenic shock, atrial fibrillation, myocardial infarction, diabetes, renal failure, liver disease, pulmonary disease, previous cancer and anemia at baseline independently predicted mortality during follow-up. All of them (but history of cancer) were also independent predictor of cardiovascular death. Conclusion Baseline MR was associated with increased cardiovascular and totality mortality following TAVR but was not an independent predictor of any of them. By contrast, several other predictors of cardiovascular and total mortality were identified. This suggests that MR should not be directly considered to establish the strategy for TAVR decision or for avoiding TAVR-related futility.

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087 Endovascular clot retrieval (ECR) in the elderly. For better or worse in the real world?

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-anzan.75 ◽

2019 ◽

Vol 90 (e7) ◽

pp. A28.1-A28

Author(s):

Stacey K Jankelowitz ◽

Kylie Tastula ◽

Nicola Mitchell ◽

Patrick Tang ◽

Tim Ang ◽

...

Keyword(s):

Real World ◽

Stroke Risk ◽

The Elderly ◽

Early Improvement ◽

Transcatheter Aortic Valve ◽

Real World Setting ◽

Multicentre Trials ◽

Valve Implantation ◽

Lost To Follow Up

IntroductionAcross multicentre trials ECR is safe and effective in octogenarians. Despite RCT evidence elderly patients may be denied ECR due to perceived poor risk-benefit. We examine impact of age on ECR outcomes and outcomes in transcatheter aortic valve implantation (TAVI) cases (where stroke risk is high), in a real world setting.MethodsWe analysed 311 consecutive ECR cases between 2016 and 2019 in 10 year age bands for ECR outcomes including 90 day mRS and mortality. Impact of premorbid function (mRS), NIHSS, recorded co-morbidities, and aetiology was assessed. TAVI case outcomes were examined.ResultsThirty one percent of ECR outcome cases were over 79 years of age; 90 day mortality was 34%; 25% had a 90 day mRS 0–2. Early NIHSS improvement was 5. Ninety-day mortality and mRS 0–2 for 10–19 (n=3), 20–29 (n=2), 30–39 (n=4), 40–49 (n=23), 50–59 (n=27), 60–69 (n=69), 70–79 (n=84),80–89 (n=62) and 90–99 (n=11) years were 0 and 100%, 0 and 100%, 33 and 67%, 4 and 78%, 15 and 52%, 13 and 49%, 17 and 33%, 24 and 2% and 55 and 18%, respectively. There was 9% lost to follow-up.Six TAVI cases had a NIHSS of 8–20 and pre-morbid mRS<3, four with mRS 0. Mean 24 hour NIHSS improvement was 8.ConclusionWithout age exclusions older patients had worse unadjusted outcomes. However, patients over 79 years had clinically important early improvement in NIHSS score and ninety day outcomes were comparable to favourable RCT data and TAVI patients also had early improvement.

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Transcranial Doppler in Sickle Cell Anemia Adult Patients: Brazilian Experience.

Blood ◽

10.1182/blood.v104.11.3736.3736 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3736-3736

Author(s):

Gisele S. Silva ◽

Maria S. Figueiredo ◽

Perla Vicari ◽

Airton R. Massaro ◽

Adauto Castelo Filho ◽

...

Keyword(s):

Sickle Cell ◽

Sickle Cell Anemia ◽

Transcranial Doppler ◽

Stroke Risk ◽

Arterial Disease ◽

Neurological Complications ◽

Adult Patients ◽

History Of ◽

The Mean

Abstract Sickle cell anemia (SCA) may cause a variety of neurological complications, including stroke and headaches. Stroke occurs in up to 9% of children with SCA, and transcranial Doppler (TCD) studies have demonstrated that increased velocities are related to higher stroke risk. Throbbing headache occurs in SCA but its cause, frequency, and relationship to TCD velocities have received little attention. On the other hand, there are few TCD studies in adult patients. Our aims were: 1) to describe the main features of TCD in adult SCA patients, and 2) to investigate if there were correlation between TCD features and presence of headache. TCD was performed in 56 adult SCA patients (≥ 16 years old) and in 56 healthy individuals (HI), matched by age and race. There were 6 patients with a remote history of stroke but none were on chronic transfusion. The SCA group was submitted to a neurological evaluation and specifically asked about the occurrence of headache and its characteristics. The highest flow velocity (maxFV) recorded for each artery was considered the most representative. We analyzed the frequency of FV asymmetry (side-to-side difference > 20%) and focal FV changes. The mean maxFV was significantly higher in patients (117.7 ± 21.6 cm/s) than in HI (72.45 ± 11.48 cm/s) (p<0.005). Only one patient had maxFV higher than 170 cm/s. The frequencies of asymmetry and of focal FV changes were significantly higher in SCA. Forty-one patients (73.2%) reported having headaches. Twenty-eight patients (50%) had severe (= 5 for pain intensity at a 1–10 scale) and frequent headaches (at least once a month). This group of patients presented TCD velocities significantly higher than patients without or with milder headaches (p=0.035). In conclusion, TCD maxFV was significantly higher in adult patients with SCA than HI, however, only one patient was considered at risk of stroke according to TCD criteria described in children. FV asymmetry and focal FV changes may be markers for arterial disease in adult SCA patients, and need to be further confirmed by neuroimaging and clinical follow up studies. The patients with severe headaches presented TCD velocities significantly higher than patients without or with milder headaches, but this finding needs to be confirmed by more and larger studies.

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The Impact of Aortic Valvular Calcium on Transcatheter Heart Valve Distortion

Journal of Interventional Cardiology ◽

10.1155/2021/8829906 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Akihiro Nakajima ◽

Toru Naganuma ◽

Haruhito Yuki ◽

Hirokazu Onishi ◽

Tatsuya Amano ◽

...

Keyword(s):

Aortic Valve ◽

Heart Valve ◽

Severe Aortic Stenosis ◽

Calcium Score ◽

Paravalvular Leak ◽

Transcatheter Heart Valve ◽

The Difference ◽

The Impact ◽

The Relationship

Objectives. To investigate the relationship between the eccentric calcification of aortic valve and transcatheter heart valve (THV) distortion and the impact of THV distortion on echo parameters and clinical outcomes. Background. The effects of eccentric calcification of the aortic valve on the THV distortion and the relationship between THV distortion and clinical impact were not fully understood. Methods. Patients with symptomatic severe aortic stenosis who were undergoing THV implantation were enrolled. Patients underwent preprocedural, postprocedural multislice computed tomography (MSCT), and follow-up transthoracic echocardiogram (TTE). Delta calcium score (ΔCS) is defined as the difference between the maximum and minimal calcium scores of the three cusps, while valve distortion score (VDS) is defined as the difference between the longest and shortest stent frame, as obtained using MSCT. Patients were divided into two groups according to ΔCS: “noneccentric calcification group” and “eccentric calcification group.” Results. A total of 118 patients were enrolled (59 patients in noneccentric and 59 in eccentric calcification groups). VDS was significantly lower in the noneccentric calcification group than in the eccentric calcification group (1.31 ± 0.82 mm vs. 1.73 ± 0.76 mm, p = 0.004 ). VDS was not associated with the degree of paravalvular leak (PVL) and aortic valvular mean pressure gradient (AVPG) at 30-day and 1-year follow-up TTE and the cumulative rates of all-cause death and rehospitalization at 2-year clinical follow-up. Conclusions. Eccentric valvular calcification was associated with longitudinal THV distortion. However, THV distortion was not associated with PVL, AVPG, and adverse clinical events during midterm follow-up.

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