ObjectiveTo explore the preoperative evaluation result of multidetector computed tomography (MDCT) in aortic stenosis (AS) patients with bicuspid aortic valve (BAV) undergoing transcatheter aortic valve replacement (TAVR) in order to summarize relevant experience.MethodsA total of 33 consecutive AS patients who underwent TAVR in Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University from March 2016 to June 2020 were enrolled, and the preoperative evaluation characteristics of MDCT were compared between tricuspid aortic valve (TAV) and BAV.ResultsIn the 33 patients, whose mean age was (74±6) years, 22 were male and 11 were female, 17 were with BAV and 16 were with TAV. The medium (lower quartile, upper quartile) of calcification score was 360 (192, 1 034) mm3. There were 12 cases of artificial valve model to be speculated Downsize, including 9 calcific BAV cases (75%).ConclusionThe calcific BAV has a higher ratio of Downsize in the TAVR procedure.
Stroke is one feared complication after transcatheter aortic valve replacement (TAVR). It affects the prognosis of TAVR, leading to a decline in the survival rate and quality of life of patients, while increasing the economic burden of patients. In recent years, a variety of cerebral embolic protection devices have been used to reduce the incidence of stroke during TAVR and improve the prognosis, some of which have been approved for clinical use. However, there are many controversies about their safety and effectiveness. This article reviews the definitions, short-term and long-term incidences, and risk factors of TAVR-related stroke, and elaborates on recent large-scale studies of different cerebral embolic protection devices.
Objective To investigate the association of central obesity (Waist-to-Hip Ratio) and carotid intima-media thickness (IMT) in Han, Uygur and Kazak female adults in Xinjiang. Methods Four-stage stratified cluster random sampling was used to select adult samples aged over 35 years in different districts in Xinjiang, and then a study was conducted using a questionnaire, physical exams (including blood pressure, height, weight, waist length, and hip length) and lab biochemical tests, while IMT was measured by ultrasound. According to WHR, the people were divided into two groups (WHR≥0.9 group and WHRlt;0.9 group). Results 14 618 cases had been surveyed, including 7 294 female adults (Han: 2 793 cases; Uygur: 2 490 cases; and Kazak: 2 011 cases). Among the same nationality, the WHR≥0.9 group had higher levels of systolic pressure, diastolic pressure, urea nitrogen, fasting blood-glucose, triglyceride and total cholesterol than the WHRlt;0.9 group, with significant differences (P=0.000). The two groups were the same in creatinine, high-density lipoprotein cholesterol and low density lipoprotein with no significant differences (Pgt;0.05). Among all people, the WHR≥0.9 group had slightly thicker IMT than the WHRlt;0.9 group (P=0.17). Among the Han nationality, the two groups were the same in IMT (P=0.23). Uygur’s IMT and Kazak’s IMT in the WHR≥0.9 group were thicker than that in the WHRlt;0.9 group (P=0.00). Among different populations, in the WHR≥0.9 group, Kazak’s IMT was the thickest, while Uygur’s IMT was the thinner, with significant differences (P=0.00). Within the WHR≥0.9 group, in different age groups, Kazak’s IMT was the thickest; except in the group of aged over 75 years, there were significant differences among other subgroups, the Han group, and the Uygur group (all Plt;0.05). The result of logistic regression showed that, WHR≥0.9 was an independent risk factor of IMT thickening among the three groups. Conclusion WHR increase is positively associated with IMT among the three nationalities. Also, WHR≥0.9 was an independent risk factor of IMT in all the three nationalities.
Severe symptomatic native aortic regurgitation (AR) is associated with poor prognosis. Surgical aortic valve replacement is presently the main choice of treatment according to current guidelines. The data of safety and efficacy of transcatheter aortic valve replacement (TAVR) for patients with pure native AR were limited. In this paper, a case of AR patient with heart failure was reported. After preoperative CT evaluation and operation plan, the postoperative symptoms improved significantly. Bundle branch block and retroperitoneal hematoma appeared during hospitalization. After the treatment, the patient’s condition improved. Before the discharge, cardiac ultrasound indicated that the reflux was significantly improved, no perivalvular leakage was observed, and cardiac function was improved. AR remains a challenging pathology for TAVR. TAVR is a feasible and reasonable option for carefully selected patients with pure AR.
It has been 20 years since the first transcatheter aortic valve replacement (TAVR) was performed internationally in 2002, and the development of TAVR technology in China has also been more than 10 years. The reliability of TAVR has been clinically proven, and it has also brought good benefits to patients with aortic stenosis. With the gradual progress of technology, TAVR has a trend to surpass surgical aortic valve replacement and become the mainstream surgery for patients with aortic stenosis. This article will review the relevant issues in the development of TAVR technology in recent years, based on existing research, and provide certain clinical references for the future development of TAVR technology.
Objective To investigate the correlation between CYP2C19 gene polymorphisms and the incidence and prognosis of heart failure. Methods 1 368 patients who underwent parallel genomic testing and visited the Department of Cardiology at the People’s Hospital of Xinjiang Uygur Autonomous Region between June 2021 and December 2022 were selected. After quality control of genotype data, the patients were divided into a heart failure group and a control group based on diagnostic criteria. Genotyping of 31 genes and 62 single nucleotide polymorphism (SNPs) was performed using TaqMan-SNP genotyping technology. Differences in allele distribution and clinical indicators between the two groups were compared, and the incidence of cardiovascular adverse events in the heart failure group was followed up and calculated. Results A total of 1 352 patients were included. Among them, there were 169 cases in the heart failure group and 1 183 cases in the control group. At the rs12769205 locus of the CYP2C19 gene, the risk of disease for patients carrying the G allele was lower than those carrying the A allele (odds ratio=0.733, P=0.023). In addition to age, coronary heart disease, BMI, and the type of allele was also an independent influencing factor for heart failure (P＜0.05). Moreover, the level of cardiac troponin T in carriers of two mutant alleles was significantly higher than in carriers of one mutant allele (P =0.044) and in carriers of the wild-type allele (P=0.028). During the follow-up period, no significant differences were observed in the cumulative incidence of major cardiovascular adverse events among the three genotypes at the rs12769205 locus. Conclusion The polymorphic locus rs12769205 of the CYP2C19 gene is associated with the occurrence of heart failure, which may provide a theoretical basis for the diagnosis and treatment of heart failure.
Objective To evaluate the effectiveness of nicorandil for reperfusion of acute myocardial infarction (AMI), so as to provide high quality evidence for formulating the rational AMI therapy. Methods Databases including The Cochrane Library (Issue 3, 2012), PubMed, EMbase, HighWire, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) on nicorandil in AMI reperfusion published before March 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and evaluated the methodological quality of the included studies. Then the meta-analysis was conducted using RevMan5.1 software. Results A total of 11 trials involving 1 027 patients were included. The results of meta-analyses showed that: for AMI reperfusion, nicorandil could decrease the non-reflow or slow flow rate (RR=0.34, 95%CI 0.19 to 0.61, P=0.000 3), improve the left ventricular ejection fraction (MD=5.49, 95%CI 4.51 to 6.47, Plt;0.000 01), reduce the left ventricular end-diastolic volume (MD=–14.38, 95%CI –17.31 to –11.45, Plt;0.000 01), and decrease the incidence of cardiac adverse events (RR=0.34, 95%CI 0.25 to 0.46, Plt;0.000 01), readmission rate (RR=0.33, 95%CI 0.17 to 0.63, P=0.000 8) and mortality rate (RR=0.40, 95%CI 0.16 to 0.97, P=0.04). Conclusion Current evidence shows that nicorandil used as an adjuvant for AMI reperfusion can increase coronary microcirculation, improve prognosis, and decrease the incidence of cardiac adverse events, readmission and mortality rate. Due to the limited quality and quantity of the included studies, this conclusion still needs to be further proved by performing more large-scale and high quality RCTs, so we suggest clinician should adopt rational therapies based on patient’s conditions.
Objective To assess the effectiveness and safety of different dual antiplatelet therapies in patients undergoing percutaneous coronary intervention. Methods Such databases as The Cochrane Library, MEDLINE, EMbase, CBM, CNKI and WanFang Data were searched to collect the randomized controlled trials (RCTs) and observational studies on the effectiveness and safety of dual antiplatelet therapies both short-duration (≤6 months) and long-duration (gt;6 months) after percutaneous coronary intervention. The literature was screened according to the inclusive and exclusive criteria by two reviewers independently, the quality was evaluated, the data were extracted, and meta-analyses were performed by using RevMan 5.1 software. Results Eight trials were included, of which 3 were RCTs involving 7 475 patients, and 5 were observational studies involving 12 744 patients. Meta-analyses on RCTs showed that the incidence of death or myocardial infarction in the long-duration treatment group was lower than that of the short-duration treatment group (OR=0.74, 95%CI 0.56 to 0.98, Plt;0.000 1), while meta-analyses on observation studies showed the similar result (OR=0.7, 95%CI 0.45 to 1.08, P=0.11). With the variables of published year and follow-up time, the heterogeneity of cohort studies was discussed through meta-regression (Z=3.61, P=0.000) which indicated that both published year and follow-up time might be the source of heterogeneity due to their contribution. For RCTs, the incidence of severe bleeding events in the short-duration treatment group was lower than that in the long-duration treatment group (OR=1.29, 95%CI 0.99 to 1.69, P=0.06). For observational studies, the incidence of late stent thrombosis in the long-duration treatment group was lower than that in the short-duration treatment group (OR=0.40, 95%CI 0.15 to 1.07, P=0.07). Conclusion The long duration (gt;6months) of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention can reduce the incidence of death or myocardial infarction and decrease the tendency of late stent thrombosis, but cannot obviously increase the incidence rate of severe bleeding events. The current evidence shows no marked superiority in longer duration (gt;12months) of dual antiplatelet therapy.
Objective To determine the benefits of an invasive compared to a conservative strategy for treating unstable anguba (UA)/ non-ST-elevation myocardial infarction (NSTEMI). Methods We searched The Cochrane Library (Issue 4, 2009), MEDLINE (1996 to September 2009), EMbase (1974 to September 2009), CBM (1989 to 2009), CNKI (1997 to 2009), and VIP (1989 to 2009). The quality of the included studies was critically evaluated. Data analyses were performed using the Cochrane Collaboration’s RevMan 5.0 software. Results Seven randomized controlled trials involving 11 394 patients met the inclusion criteria. The results meta-analyses showed the incidence of all-cause mortality at six months follow-up was lower in the early invasive group compared with the conservative group (RR=0.75, 95%CI 0.61 to 0.92, P=0.007); the relative risk of myocardial infarction was significantly decreased in the early invasive group (RR=0.74, 95%CI 0.63 to 0.87); there was a reduction in rehospitalization for unstable angina in the invasive group (RR=0.66, 95%CI 0.61 to 0.73, Plt;0.000 01); the invasive strategy was associated with a two-fold increase in the relative risk of PCI-related myocardial infarction (as variably defined). There was not a significant increase in bleeding by an invasive strategy at six months follow-up, but, a routine invasive strategy was associated with a significantly higher bleeding rate at 1-year follow-up (RR=2.22, 95%CI 1.55 to 3.17, Plt;0.000 1). Patients with elevated cardiac biomarker levels at baseline benefited more from routine intervention, with no significant benefit observed in patients with negative baseline marker levels. Conclusion An early invasive strategy is preferable to a conservative strategy in the treatment of UA/NSTEMI, especially higher-risk patients with elevated cardiac biomarker benefit more from invasive strategy. In addition, complications such as procedure-MI and bleeding must be paid great attention to.
Objective To systematically review the efficacy and safety of different duration of dual antiplatelet therapies in patients undergoing new-generation drug-eluting stents implantation. Methods Such databases as MEDLINE, The Cochrane Library (Issue 2, 2015), EMbase, CBM, CNKI and WanFang Data were searched to collect studies on the different duration of dual antiplatelet therapies in patients undergoing new-generation drug-eluting stents implantation from inception to April 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results Six trials were included. The results of meta-analysis showed: compared with 12 months dual antiplatelet therapy group, the incidence of bleeding in the 6 months dual antiplatelet therapy group was lower (OR=0.48, 95%CI 0.26 to 0.89, P=0.02). There were no significant differences in incidence of myocardial infarction, all cause mortality, stroke and stent thrombosis between two groups. Compared with 24 months dual antiplatelet therapy group, the incidence of stent thrombosis in the 12 months dual antiplatelet therapy group was higher (OR=2.50, 95%CI 1.13 to 5.61, P=0.02), but the incidence of bleeding in 12 months dual antiplatelet therapy group was lower (OR=0.25, 95%CI 0.07 to 0.89, P=0.03). No significant differences were found in the incidence of myocardial infarction, all cause mortality and stroke between 12 months dual antiplatelet therapy group and 24 months dual antiplatelet therapy group. Conclusions 6 months dual antiplatelet therapy following new-generation drug-eluting stent implantation is relatively more safe and efficacy. There is significant increase of incidence of bleeding in 12 or 24 months dual antiplatelet therapy. Due to the limited quantity and quality of included studies, the above results are needed to be validated by more high quality studies.