Abstract 15931: Risk of Post Procedural Atrial Fibrillation in Patients Undergoing Transcatheter Aortic Valvular Replacement - A Meta-Analysis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Waqas Qureshi ◽  
Usama b Nasir ◽  
Elsayed Z Soliman ◽  
Peter M Belford ◽  
Sanjay K Gandhi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Valve ◽  
Older Patients ◽  
Web Of Science ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Random Effects Model ◽  
Surgical Aortic Valve Replacement ◽  
Post Procedure ◽  
Valvular Replacement

Introduction: Atrial fibrillation is a common postoperative complication of surgical aortic valve replacement (SAVR). However, it is not known if the incidence of post procedure AF is impacted by performing Transcatheter Aortic Valvular Replacement (TAVR) instead of SAVR. Hypothesis: There is no difference in risk of post procedure incident AF in patients undergoing TAVR vs. SAVR. Methods: We systematically reviewed studies evaluating TAVR vs. SAVR and risk of post procedure AF. We searched MEDLINE, EMBASE, CINAHL, Web of Science, meeting abstracts, presentations and Cochrane central databases from inception through May 2015. For a study to be selected, it had to report the rates of incident AF in individuals undergoing TAVR. Data were extracted by 2 independent authors (WTQ and UBN). Forrest plot was created to show the effect sizes (Figure 1). Results: A total of 8 studies including 2483 patients (mean age 81.4 years, 70.3% male) were analyzed. There were 1293 patients that underwent TAVR and 1190 patients that underwent SAVR. The 1- year incidence of AF was 231 (17.9%) in TAVR group vs. 377 (31.6%) in SAVR group. In a random effects model, patients treated with TAVR had a 48% decreased risk of post procedural 1 year risk of AF [pooled Risk Ratio (95% confidence interval) 0.52 (0.37-0.73), p <0.001]. There was moderate heterogeneity in the results (I2 = 80%). The risk of AF was higher in studies with older patients and was lower in studies with higher proportion of patients that underwent transfemoral TAVR vs. transapical TAVR. Conclusions: In this meta-analysis, the post procedure risk of AF was lower in TAVR group as compared to SAVR group. The risk of post procedure AF should be considered while making decision for TAVR vs. SAVR.

scholarly journals Meta-analysis of right ventricular function in patients with aortic stenosis after transfemoral aortic valve replacement or surgical aortic valve replacement

2020 ◽  
Vol 11 ◽  
pp. 204062232093377
Author(s):  
Yunshan Cao ◽  
Vikas Singh ◽  
Aqian Wang ◽  
Liyan Zhang ◽  
Tingting He ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Right Ventricular ◽  
Ventricular Function ◽  
Valve Replacement ◽  
Right Ventricular Function ◽  
Meta Analysis ◽  
Surgical Aortic Valve Replacement ◽  
Post Procedure

Background: Right ventricular function (RVF) is an independent predictor of prognosis for patients undergoing aortic valve replacement: transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). The effect of transfemoral aortic valve replacement (TF-TAVR) on RVF is uncertain. We aimed to perform a meta-analysis of the effect of TF-TAVR on RVF in patients with aortic stenosis (AS) and compare the effect of TF-TAVR with SAVR. Methods: We searched relevant studies from PubMed, Embase, Cochrane Library databases, and Web of Science. Furthermore, two reviewers (Wang AQ and Cao YS) extracted all relevant data, which were then double checked by another two reviewers (Zhang M and Qi GM). We used the forest plot to present results. Tricuspid annular plane systolic excursion (TAPSE) was the primary outcome. Results: This meta-analysis included 11 studies. There were 353 patients who underwent TF-TAVR, and 358 patients who were subjected to SAVR. There was no significant difference in TAPSE at 1 week and 6 months as well as right ventricular ejection fraction (RVEF) at <2 weeks and 6 months after TF-TAVR. For the SAVR group, TAPSE at 1 week and 3 months as well as fractional area change (FAC) at 3 months post procedure were significantly aggravated, while RVEF did not change significantly. Moreover, TAPSE post-TF-TAVR was significantly improved as compared with post-SAVR. The △TAPSE, the difference between TAPSE post-procedure and TAPSE prior to procedure, was also significantly better in the TF-TAVR group than in the SAVR group. Conclusion: RVF was maintained post TF-TAVR. For SAVR, discrepancy in the measured parameters exists, as reduced TAPSE indicates compromised longitudinal RVF, while insignificant changes in RVEF implicate maintained RVF post procedure. Collectively, our study suggests that the baseline RV dysfunction and the effect of TF-TAVR versus SAVR on longitudinal RVF may influence the selection of aortic valve intervention.

scholarly journals Relationship between gestational acrylamide exposure and offspring’s growth: a systematic review and meta-analysis of cohort studies

2020 ◽  
Vol 23 (10) ◽  
pp. 1791-1799
Author(s):  
Yongle Zhan ◽  
Ying Xiao ◽  
Tianjia Guan ◽  
Shuyang Zhang ◽  
Yu Jiang
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Web Of Science ◽  
Meta Analysis ◽  
Maternal Diet ◽  
Effect Sizes ◽  
Current Evidence ◽  
Random Effects Model ◽  
Exposure Group ◽  
Dietary Strategy

AbstractObjective:To estimate the current evidence regarding the association between gestational acrylamide (AA) exposure and offspring’s growth.Design:Systematic review and meta-analysis.Setting:A systematic literature search for relevant publications was conducted using PubMed, Medline, Embase, Web of Science databases from inception to 26 April 2019. The standardised mean difference (SMD) or OR with 95 % CI was selected as the effect sizes and was calculated using a random effects model.Results:Five cohort studies including 54 728 participants were identified. Offspring’s birth weight was significantly lower in high AA exposure group than in low AA exposure group (SMD –0·05, 95 % CI –0·09, –0·02, P = 0·005). There was also an association between maternal AA exposure and small for gestational age (OR 1·14, 95 % CI 1·06, 1·23, P < 0·001). In addition, pooled ORs suggested that children had a high risk of developing overweight/obesity in the future in maternal high AA exposure group (OR 1·14, 95 % CI 1·08, 1·21, P < 0·001 at age 3; OR 1·13, 95 % CI 1·07, 1·19, P < 0·001 at age 5; OR 1·09, 95 % CI 1·02, 1·16, P = 0·020 at age 8).Conclusions:These findings have important implications for conducting health education, providing guidance on maternal diet and developing an appropriate dietary strategy for pregnant women to reduce dietary AA exposure.

scholarly journals The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies

2021 ◽  
pp. 155698452097831
Author(s):  
Vinod H. Thourani ◽  
J. James Edelman ◽  
Sari D. Holmes ◽  
Tom C. Nguyen ◽  
John Carroll ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Meta Analysis ◽  
Early Mortality ◽  
Low Risk ◽  
Perioperative Outcomes ◽  
Intermediate Risk ◽  
Surgical Aortic Valve Replacement ◽  
Risk Patients

Objective There is an increasing amount of evidence supporting use of transcatheter aortic valve replacement (TAVR) for treatment of aortic stenosis in patients at low or intermediate risk for surgical aortic valve replacement (SAVR). TAVR is now approved for use in all patient cohorts. Despite this, there remains debate about the relative efficacy of TAVR compared with SAVR in lower-risk cohorts and various subgroups of patients. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and propensity-matched trials to guide a consensus among expert cardiologists and surgeons. Methods Studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a thorough search of the major databases. Mortality, stroke, and other perioperative outcomes were assessed at 30 days and 1 year. Results Early mortality was lower in TAVR compared to SAVR in RCTs, but not propensity-matched studies in low-risk cohorts (0.66% vs 1.5%; odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20 to 0.98, I2 = 0%). No difference in mortality between TAVR and SAVR was identified in intermediate-risk patients at early or later time points. Incidence of perioperative stroke in 3 low-risk RCTs was significantly lower in TAVR (0.4%) than SAVR (1.4%; OR = 0.33, 95% CI 0.13 to 0.81, I2 = 0%). There was no difference in stroke for intermediate-risk patients between TAVR and SAVR. The expert panel of cardiologists and cardiac surgeons provided recommendations for TAVR and SAVR in various clinical scenarios. Conclusions In RCTs comparing TAVR and SAVR in low-risk patients, early mortality and stroke were lower in TAVR, but did not differ at 1 year. There was no difference in mortality and stroke in intermediate-risk patients. The Multidisciplinary Heart Team must consider individual patient characteristics and preferences when recommending TAVR or SAVR. The decision must consider the long-term management of each patient’s aortic valve disease.

Astrocyte Biomarkers in Alzheimer Disease: A Systematic Review and Meta-analysis

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012109
Author(s):  
Bruna Bellaver ◽  
João Pedro Ferrari-Souza ◽  
Lucas Uglione da Ros ◽  
Stephen F Carter ◽  
Elena Rodriguez-Vieitez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Web Of Science ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Significant Progress ◽  
Exclusion Criteria ◽  
Mao B ◽  
Positron Emission ◽  
Registration Number ◽  
Mean Differences

Objective:To perform a systematic review and meta-analysis to determine whether fluid and imaging astrocyte biomarkers are altered in Alzheimer's disease (AD).Methods:PubMed and Web of Science databases were searched for articles reporting fluid or imaging astrocyte biomarkers in AD. Pooled effect sizes were determined with mean differences (SMD) using the Hedge’s G method with random-effects to determine biomarker performance. Adapted questions from QUADAS-2 were applied for quality assessment. A protocol for this study has been previously registered in PROSPERO (registration number: CRD42020192304).Results:The initial search identified 1,425 articles. After exclusion criteria were applied, 33 articles (a total of 3,204 individuals) measuring levels of GFAP, S100B, YKL-40 and AQP4 in the blood and cerebrospinal fluid (CSF), as well as MAO-B, indexed by positron emission tomography 11C-deuterium-L-deprenyl ([11C]-DED), were included. GFAP (SMD = 0.94; 95% CI = 0.71-1.18) and YKL-40 (SMD = 0.76; CI 95% = 0.63-0.89) levels in the CSF, S100B levels in the blood (SMD = 2.91; CI 95% = 1.01-4.8) were found significantly increased in AD patients.Conclusions:Despite significant progress, applications of astrocyte biomarkers in AD remain in their early days. The meta-analysis demonstrated that astrocyte biomarkers are consistently altered in AD and supports further investigation for their inclusion in the AD clinical research framework for observational and interventional studies.

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