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Circulation, Volume 146, Issue Suppl_1, Page A12107-A12107, November 8, 2022. Background:Short-term (
Circulation, Volume 146, Issue Suppl_1, Page A14647-A14647, November 8, 2022. Introduction:Mobile-based healthcare is considered a strategy that can overcome time and space constraints and increase the participation rate of a heart health program; however, a review of the elements of exercise prescription, such as frequency, intensity, time, and type (FITT), has been insufficient. Therefore, a systematic review and meta-analysis were performed to identify the FITT elements of an app-based exercise heart health intervention that was effective in improving the exercise capacity of patients with Acute Coronary Syndrome (ACS).Methods:A literature search was conducted for papers published up to November 2021. We searched for randomized controlled trials (RCTs) evaluating the effectiveness of an exercise-based heart health program using a smartphone app for adult inpatients initially diagnosed with ACS, who received primary percutaneous coronary intervention or medication treatment. With the help of our librarians, we searched MEDLINE, EMBASE, and Cochrane CENTRAL. Literature selection, bias evaluation, and data collection were independently performed by two researchers. Cochrane Risk of Bias 2 was used to evaluate the quality of literature; the level of evidence was evaluated using GRADE, and CMA Version 3.0 was used for the meta-analysis. Effect size for exercise capacity was calculated using standardized mean difference.Results:Seven RCTs were identified. The study results suggested that using an app-based exercise heart health program was effective in improving the exercise capacity of patients in Phase III of cardiac rehabilitation post-ACS. As a confirmed exercise prescription factor, the app was found to be effective in improving exercise capacity when aerobic exercise was performed for approximately 30 minutes at least three to five times a week. The effect size for exercise capacity was 0.42 (95% CI, 0.24-0.60; I2, 45.00;p
Circulation, Volume 146, Issue Suppl_1, Page A15236-A15236, November 8, 2022. Introduction:The term ‘survivorship’ describes the therapeutic, functional, psychosocial, and financial experience of living with a chronic condition.This term acknowledges the fact that a patient’s life can be radically altered overnight because of their disease and treatment, but also designates patients as ‘survivors’, having overcome the acute phase (‘acute survivorship’) and now needing to live with, through and beyond their condition (‘extended survivorship’ and ‘permanent survivorship’). The aim of this systematic review was to identify the most frequently used quality of life (QOL) assessment tools and to determine how closely these align to the concept of ‘survivorship’.Methods:A systematic literature review was conducted according to PRISMA guidelines. Embase, Medline and the Cochrane Library were electronically searched till January 2022 for studies reporting on QOL in aortic dissection patients. Observational studies and case series studies were included. Due to the degree of heterogeneity existing between the studies, a meta-analysis was not conduced. Study quality was assessed using the Agency for Healthcare Research and Quality (ARHQ) methodology checklist.Results:A total of 27 studies were included, encompassing 32 QOL tools. The most common QOL tool utilised was the SF-36, across 11 studies. Only one qualitative study investigated patient perspectives of living with aortic dissection. Overall, QOL was found to be poor in aortic dissection survivors. All identified QOL tools demonstrated a poor alignment with the survivorship domains. Included studies displayed a moderate to high risk of bias, having small sample sizes and an insufficient follow-up period.Conclusion:This review highlights the absence of an aortic dissection specific QOL tool. All QOL tools identified failed to encompass the breadth of survivorship domains, with a lack of studies focusing on the patients’ perspective. Further research is urgently required to gain an insight into the quality of life of patients who have survived an aortic dissection, and to develop an aortic dissection specific QOL tool, underpinned by the survivorship domains.
Circulation, Volume 146, Issue Suppl_1, Page A10070-A10070, November 8, 2022. Introduction:Data on comparative outcomes between valve in valve transcatheter mitral valve replacement (ViV-TMVR) versus redo-surgical mitral valve replacement (SMVR) for degenerated bioprosthetic valves remain limited.Hypothesis:ViV TMVR is associated with lower in-hospital mortality and complication rates compared with redo SMVR.Methods:The MEDLINE (PubMed, Ovid) and Cochrane databases were queried with various combinations of medical subject headings (MeSH) to identify relevant articles. Eight studies evaluating comparative outcomes (ViV TMVR vs Redo SMVR) for patients with degenerated bioprosthetic valves were included in the analysis.Results:A total of 5,161 patients with degenerated prosthetic mitral valves underwent ViV TMVR (n = 1163) and redo SMVR (n = 3998) were included in the study. The mean age of patients was 76 versus 66 years for ViV TMVR versus the redo SMVR group, respectively (p
Circulation, Volume 146, Issue Suppl_1, Page A11428-A11428, November 8, 2022. Introduction:Endothelin-1 causes vasoconstriction by activation of calcium flux in smooth muscle cells. Use of endothelin receptor antagonists (ERAs) has remained controversial. Renal denervation (RD) has also been investigated as a treatment option for resistant hypertension (RHTN). The efficacy of these two novel treatment strategies was compared.Methods:Placebo-controlled and sham-controlled randomized clinical trials testing ERA or RD as treatments for RHTN were selected. Prespecified subgroup analyses comparing the efficacy of ERA and RD were conducted for outcomes of 24-hour (hr) blood pressure (BP) and office BP.Results:Nine studies (3 ERA and 6 RD) were identified that included 1,708 participants (816 ERA and 892 RD). Cochran risk of bias assessment showed 72% of the domains to be low risk of bias for the ERA studies and 88% of the domains to be low risk of bias for the RD studies. The raw mean difference (RMD) between ERA and placebo control was statistically significant for 24-hr systolic (SBP) (-8.34 mmHg; 95% CI -11.51 to -5.81, 24-hr diastolic (DBP) (-6.77 mmHg; 95% CI -8.90 to -4.63), office SBP (-4.50 mmHg; 95% CI -6.92 to -2.08), and office DBP (-2.01 mmHg; 95% CI -2.13 to -1.88). The RMD between RD and sham control was not statistically significant for 24-hr SBP (-1.85 mmHg; 95% CI -3.88 to 0.18), 24-hr DBP (-0.67 mmHg; 95% CI -1.84 to 0.51), office SBP (-1.93 mmHg; 95% CI -5.17 to 1.31), and office DBP (-1.55 mmHg; 95% CI -3.43 to 0.33). The interaction between the treatment subgroups was statistically significant for 24-hr SBP and DBP, but not for office SBP and DBP.Discussion:ERAs had greater reduction in 24-hr and office BP compared to RD among patients with RHTN. Despite efficacy in reducing BP in RHTN, use of ERAs remains controversial given the cost and side effect profile. RD does not reduce BP among patients with RHTN. Medications are the optimal treatment for RHTN and sham controlled data showing efficacy is needed prior to widespread use and adoption of RD in RHTN.
Circulation, Volume 146, Issue Suppl_1, Page A10977-A10977, November 8, 2022. Introduction:Exercise restriction following the identification of a cardiovascular condition can profoundly impact the identity, career, and well-being of athletes. Shared decision-making (SDM) is emerging as the standard of care to guide recommendations for athletes at risk of cardiovascular events. This scoping review summarizes existing approaches, barriers, and facilitators to SDM in sports cardiology.Methods:A literature search of the MEDLINE, Embase, Cochrane Library, PubMed, CINAHL, SPORTDiscus, and PsycInfo databases was conducted in January 2022. Abstract screening and full-text review were completed in duplicate by independent reviewers. The PCC (Participants, Concepts, Context) framework was used to assess study eligibility. Included articles discussed the use of SDM (C/C) following the diagnosis of a cardiovascular condition in an athlete (P).Results:A total of 6,049 records were screened, of which 38 were included in this review. Article classifications included theoretical papers (31), such as editorials and guidelines, and research studies (7). Main findings of the research studies are shown in Table 1. All selected articles defined SDM as an open dialogue between the athlete, healthcare team, and other stakeholders (e.g., parents, coaches). The benefits and risks of management strategies, treatment options, and return-to-play were the focus of this dialogue. Common themes among SDM approaches emerged, such as emphasizing patient values, considering non-physical factors (e.g., emotional, psychological, financial), and informed consent. Barriers to SDM included pressure from institutions and liability of healthcare providers in the case of adverse events.Conclusions:SDM is the recommended paradigm for providing care to athletes diagnosed with cardiovascular conditions. Further education for healthcare providers regarding the SDM approach, as well as future research assessing SDM in a clinical setting, is needed.
Circulation, Volume 146, Issue Suppl_1, Page A11658-A11658, November 8, 2022. Arthropod and insect bites/stings have been associated with the development of Acute Coronary Syndrome (ACS) in prior case reports. In this systematic analysis, we review 57 reported cases of ACS in patients that were exposed to arthropods, bee stings or insect bites, and provide a summary of these findings in Table 1. We then discuss Kounis Syndrome Type 1 or Type 2 as the proposed mechanism by which myocardial ischemia develops in this subset of patients, and the implications of this diagnosis on management. Kounis Syndrome Type 1 develops due to mast cell activation and histamine release provoking vasospasms and inducing myocardia injury in the absence of underlying coronary artery disease, as demonstrated in Figure 1A. Kounis Syndrome Type 2 develops due to inflammation induced plaque rupture and subsequent thrombus formation, as demonstrated in Figure 1B. In general, Kounis Syndrome should be suspected in patient’s presenting with the appropriate exposure, an allergic or anaphylactic response and/or unremarkable coronary angiogram (specific to Type 1). Once suspected, the use of coronary artery vasodilators, antihistamines, steroids and possibly Epinephrine should be considered in management. In this review, it was discovered that approximately 50% of cases received management consistent with Kounis Syndrome (targeted to allergic/anaphylactic symptoms) with appropriate clinical response, yet only 12% received the formal diagnosis, indicating this condition is underdiagnosed. Furthermore, 40% of patients that underwent coronary angiogram did not have CAD, indicating a possible Type 1 (vasospastic) etiology of ACS that may benefit from more targeted therapy.
Circulation, Volume 146, Issue Suppl_1, Page A9692-A9692, November 8, 2022. Background:Randomized controlled trials (RCTs) of sodium-glucose transporter-2 inhibitors (SGLT-2is) have proven to be effective in decreasing major adverse cardiovascular events (MACE) in patients with heart failure. A recently published meta-analysis showed that the use of SGLT-2i among women with diabetes resulted in less reduction in MACE vs. men. This study aims to determine sex differences in MACE in patients with chronic heart failure.Methods:We systematically searched the medical database until April 30, 2022, and retrieved all the RCTs using SGLT-2is with specified CV outcomes. We used PRISMA, Preferred Reporting Items for a Review and Meta-analysis. We pooled the hazard ratio (HR) of MACE in both sexes, did a meta-analysis, and analyzed the odds ratio (OR) of MACE based on sex. Statistical analysis was completed with the use of Cochrane Review Manager (RevMan) version 5.4. Results of the pooled hazard ratio (HR) and the 95% confidence interval (CI) were made based on intention-to-treat analysis.Results:Figure 1 shows the results of the meta-analysis of 4 RCTs conducted with SGLT-2is (n=20725) vs. placebo. MACE was significantly lower in males and females taking SGLT-2is (men – HR 0.76; 95% CI 0.69 to 0.83; p=0.00001; women – HR 0.72; 95% CI 0.63 to 0.83; p=0.00001). Pooled data from three of the RCTs (n=7233) revealed a greater reduction in MACE in females vs. males (OR 1.32; 95% CI 1.14 to 1.53; p=0.0002).Conclusion:SGLT-2is reduce the risk of MACE in patients with heart failure, regardless of sex. However, the benefits were more pronounced in females, contrary to the meta-analysis of SGLT-2is in patients with diabetes. This finding may reflect an actual sex difference due to physiologic or behavioral factors or can be due to inadequate statistical power. More sex-based RCTs may help establish these sex differences in cardiovascular outcomes.
Circulation, Volume 146, Issue Suppl_1, Page A10114-A10114, November 8, 2022. Introduction:The most common 4th-line treatment for resistant hypertension (RHTN) is the addition of a mineralocorticoid receptor antagonist (MRA). Renal denervation (RD) has also been investigated as a treatment option for RHTN. A lack of data on the comparative effectiveness of these two therapies poses challenges in choosing optimal treatment strategies for patients with RHTN.Methods:Placebo-controlled and sham-controlled randomized clinical trials testing spironolactone or RD as treatments for RHTN were included in this analysis. Prespecified subgroup analyses comparing the efficacy of MRA and RD were conducted for the outcomes of 24-hour blood pressure (BP) and office BP.Results:Fourteen studies (8 MRA and 6 RD) were identified that included 2,306 participants (1,414 MRA and 892 RD). Cochran risk of bias assessment showed 84% of the domains to be low risk of bias for the MRA studies and 88% of the domains to be low risk of bias for the RD studies. The raw mean difference (RMD) between MRA and placebo control was statistically significant for 24-hour systolic (SBP) (-10.59 mmHg; 95% confidence interval (CI) -12.88 to -8.31), 24-hour diastolic (DBP) (-5.03 mmHg; 95% CI -6.75 to -3.32), office SBP (-10.43 mmHg; 95% CI -12.23 to -8.63), and office DBP (-4.10 mmHg; 95% CI -5.18 to -3.02). The RMD between RD and sham control was not statistically significant for 24-hour SBP (-1.85 mmHg; 95% CI -3.88 to 0.18), 24-hour DBP (-0.67 mmHg; 95% CI -1.84 to 0.51), office SBP (-1.93 mmHg; 95% CI -5.17 to 1.31), and office DBP (-1.55 mmHg; 95% CI -3.43 to 0.33). The interaction between the subgroups was statistically significant for all analyses.Discussion:MRAs had a greater reduction in 24-hour ambulatory and office BP compared to RD among patients with RHTN. This data may help physicians s counsel their patients regarding optimal treatment options for RHTN.
Circulation, Volume 146, Issue Suppl_1, Page A14282-A14282, November 8, 2022. Introduction:While kidney transplant recipients (KTR) are high risk candidates for valve replacements, the safety of transcatheter aortic valve replacement (TAVR) is limited among this population as they are excluded from major trials. We aimed to compare the outcomes between TAVR and surgical aortic valve replacement (SAVR) among KTR by a systematic review and meta-analysis.Methods:We comprehensively searched PubMed, Embase, and Cochrane Library from its inception until April 20, 2022 for relevant studies. Outcomes were pooled using the DerSimonian and Laird random-effects model and reported as odd ratios (OR) or standardized mean difference (SMD) and 95% confidence intervals (CI).Results:6 studies involving 5,452 patients (1,956 TAVR, 3,496 SAVR) were included in the analysis. TAVR patients were older (69.4 years vs 62.8 years), were less likely to be male (66.7% vs 67.9%) and had a higher prevalence of most comorbidities including coronary artery diseases (78% vs 58%), heart failure (71% vs 42%) and diabetes mellitus (52% vs 45%). Compared with SAVR, KTR undergoing TAVR had significantly lower risk of in-hospital all-cause mortality (OR 0.51, 95% CI: 0.39 to 0.67, p
Circulation, Volume 146, Issue Suppl_1, Page A15477-A15477, November 8, 2022. Introduction:Approximately 8-40% of ST-elevation Myocardial Infarction (STEMI) present later than 12 hours after symptom onset. Current ACC/AHA guidelines recommend primary percutaneous coronary intervention (PCI) for STEMI after 12 hours of symptom onset only in the setting of cardiogenic shock or severe acute heart failure, (Class Ia, LOE B) or persistent ischemic symptoms (Class IIa, LOE B). There are limited data comparing long-term outcomes among patients with a late STEMI presentation managed with PCI versus medical therapy (MT).Objective:To compare long-term outcomes among patients treated with PCI versus MT who have late presentation of STEMIMethods:We followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to extract data from PubMed/Medline, Cochrane, Embase, and Clinicaltrials.gov databases by using the search terms “late” or “delayed” or “ >12 hours” presentation with STEMI from 01/2012 through 12/2022. Included studies reported at least one of the following outcomes: all-cause mortality, reinfarction, heart failure, major adverse cardiac events (MACE), and stroke. Studies reporting delays in PCI due to COVID-19 positive status or COVID-19 enforced protocols were excluded to prevent the impact of pragmatic barriers on treatment. Relative risk (RR) was calculated using random effects model if heterogeneity was >50%, otherwise, fixed effects model was usedResults:Seven studies (n=11,576, delayed PCI n=6,248, and medical therapy n=5,319) were included in our analysis. The median follow-up was 12 months (1-60 months). Overall, among patients with STEMI and PCI >12 hour after presentation had lower incidence of MACE (27% vs. 30%, RR 0.85, 95% CI 0.76-0.69, I2=30%, p=0.007) compared to MT alone, which was driven by a significantly reduced all-cause mortality with PCI (4.4% vs. 17%, RR 0.38, 95% CI 0.17-0.85, I2=95%, p=0.01). No significant differences were observed in the incidence of recurrent MI and heart failure hospitalizations.Conclusion:Our study suggests favorable outcomes of PCI in STEMI with presentation >12 hours compared with medical therapy. Further prospective studies are needed to validate our findings.
Circulation, Volume 146, Issue Suppl_1, Page A11096-A11096, November 8, 2022. Introduction:Many randomized controlled trials (RCTs) compared rate control vs rhythm control therapy in patients with atrial fibrillation (AF). In this study, we systematically reviewed these RCTs and performed a meta-analysis of the outcomes comparing the two therapies.Methods:We searched PubMed, Medline, EMBASE, and SCOPUS databases until April 30, 2022 for all RCTs investigating AF rate vs rhythm control. We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) for constructing and reporting this review. We assigned I2 >50% as an indicator of statistical heterogeneity among the RCTs. We analyzed all-cause mortality, stroke rate, heart failure (HF) hospitalization, and total hospitalization between the two groups. We estimated the risk ratios (RR) with a random-effects model using the Mantel-Haenszel technique and calculated the 95% confidence intervals (CI). A P-value
Circulation, Volume 146, Issue Suppl_1, Page A11186-A11186, November 8, 2022. Introduction:The association of the COVID-19 vaccination with myocarditis has been reported in adolescents. However, evidence of myocarditis after COVID-19 vaccination among adolescents is scarce compared to adults. We aimed to investigate the clinical features and outcomes of COVID-19 mRNA vaccination-related myocarditis in adolescents.Methods:PubMed and EMBASE were searched through April 2022 to investigate the characteristics of vaccine-associated myocarditis in adolescent patients (aged 12-20 years) through observational studies, case series, and correspondence according to PRISMA guidelines. Data regarding patient characteristics, the type, and dose of the vaccine, laboratory data, imaging studies, mortality, and treatments were extracted from each article. One-group meta-analysis in a random-effects model was performed.Results:22 observational studies were identified, including 861 cases of vaccine-associated myocarditis. The mean age was 16.0 (95%CI, 15.5-16.5), and the male was predominant at 90.8%. Three-quarters of myocarditis occurred after the second dose (78.2%, 95% CI, 62.4- 94.0). The incident rate was higher after the second dose (12.7 -118.7 per million persons) than the first dose (0.6-10.0 per million persons). Chest pain (85.2%) was the common presenting symptom. Although 16.0% of patients (51/302) had left ventricular (LV) systolic dysfunction (LV ejection fraction [EF] < 55%), most of the cases (40/289) were mildly reduced LVEF as 45-54% (12.0% of total patients). Interestingly, cardiac magnetic resonance imaging revealed late gadolinium enhancement in 80.5% (95% CI, 65.7-95.2) of the cases. Overall, 92.8% of patients required hospitalization, and 14.7% required intensive care unit admission. However, no in-hospital mortality was observed (0/230), and the length of stay at the hospital was less than 5 days.Conclusions:This systematic review and meta-analysis demonstrate a low incident rate and largely favorable outcomes of COVID-19 vaccine-associated myocarditis in adolescents. Our findings would help better understand myocarditis following COVID-19 mRNA vaccination among adolescents and decision-making for parents with vaccine hesitancy.
Circulation, Volume 146, Issue Suppl_1, Page A14060-A14060, November 8, 2022. Background:RCTs studying the effect of sodium-glucose co-transporter 2 inhibitors (SGLT2i) on cardiovascular (CV) risk factors and outcomes have been underpowered to assess patients with overweight or obesity, thus presenting the need for a meta-analysis.Methods:Electronic databases were queried up till February 2022 for RCTs comparing SGLT2i with placebo in patients with overweight (BMI ≥25 kg/m2) or obesity (BMI ≥30 kg/m2) – irrespective of diabetes status – with a follow-up of ≥24 weeks. Meta-analyses were performed using the generic inverse variance technique and a random-effects model. Results are presented as weighted mean differences (WMD) for continuous outcomes, and hazard ratios (HR) for dichotomous outcomes. Outcomes studied were: (i) weight; (ii) systolic BP; (iii) diastolic BP; (iv) heart rate; (v) HDL-C; (vi) LDL-C; (vii) major adverse cardiac events (MACE), i.e., composite of CV death, non-fatal myocardial infarction (MI) and non-fatal stroke; (viii) composite of heart failure hospitalization and CV death (HFH/CV death); (ix) mortality; (x) MI; and (xi) stroke.Results:Seventeen RCTs (47,649 patients) were included. Compared with placebo, SGLT2i significantly reduced weight (WMD: -2.32 kg [-2.77, -1.88]), HbA1c (WMD: -0.79 % [-0.98, – 0.61]) and systolic BP (WMD: -2.15 mm Hg [-3.08, – 1.22]). SGLT2i did not have a significant effect on diastolic BP (WMD: -0.55 mmHg [-1.51, 0.41]), heart rate (WMD: 0.08 bpm. [-0.21, 0.37]), HDL-C (WMD: 1.62 mmol l-1[-0.21, 3.45]) or LDL-C (WMD: 0.53 mmol l-1[-0.88, 1.94]). Amongst CV outcomes, SGLT2i reduced the risk of MACE (HR: 0.90 [0.81, 0.99]), HFH/CV death (HR: 0.82 [0.75, 0.90]), and mortality (HR: 0.85 [0.77, 0.94]). No effect was noted on stroke (HR: 0.99 [0.85, 1.26]) or MI (HR: 0.89 [0.77, 1.02]).Conclusions:In patients with overweight or obesity, SGLT2i produce a modest but significant reduction in weight, systolic BP and HbA1c. SGLT2i may also reduce the risk of MACE, HFH/CV death, and mortality.
Circulation, Volume 146, Issue Suppl_1, Page A15314-A15314, November 8, 2022. Introduction:Mycobacterium chimaera is an emerging pathogen, recognized to cause prosthetic valve infective endocarditis (PVIE) and disseminated infection following open-chest cardiac surgery with certain contaminated heater-cooler systems. Diagnosis is challenging and requires a very high index of suspicion. Data regarding the optimal cardiac imaging evaluation of this condition is limited.Methods:Scopus, PubMed, EMBASE, Ovid and Cochrane were searched for published articles through October 2021, using keywords “Mycobacterium chimaera”, “Prosthetic valve” and “Endocarditis”. 169 articles were found and reviewed for study eligibility. Articles were included if they consisted of Mycobacterium chimaera causing IE, with imaging modalities used to establish diagnosisResults:Thirty-three articles were included, yielding twenty-two cases of Mycobacterium chimaera PVIE. The disease manifested on average thirty months after surgery, with an average patient age of 59 years (90% male). Imaging modalities to establish the diagnosis of prosthetic valve infective endocarditis included: transthoracic echocardiogram in 5 cases, transesophageal echocardiogram (TEE) in nine cases, 18F-FDG-PET/CT in seven cases. A combination of imaging modalities with TEE and 18F-FDG-PET/CT was reported once; TTE, TEE and 18F-FDG-PET/CT was also noted in one case. Lastly there was one instance each of combined use of TTE, TEE, and one of the following: CTA, Cardiac MRI, or standard CT. Nine cases did not specify the imaging modality used to achieve diagnosis. Ten patients died.Conclusions:PVIE due to Mycobacterium chimaera infection is a rare and challenging diagnosis, which requires a high index of suspicion. Accurate diagnosis should be aided by multimodality cardiac imaging, with 18F-FDG-PET/CT being a powerful adjunct imaging modality.
Circulation, Volume 146, Issue Suppl_1, Page A12367-A12367, November 8, 2022. Introduction:In recent years, the “obesity paradox” has been shown in studies demonstrating better outcomes in overweight and obese patients undergoing percutaneous or surgical cardiovascular procedures. This study compares the effect of body-mass index (BMI) on outcomes in patients undergoing transcatheter aortic valve replacement (TAVR).Methods:A comprehensive systematic search was conducted in PubMed, Web of Science, and Cochrane library for relevant studies. Studies were included if they had categories for BMI (normal-weight, overweight, and obese) and reported the outcomes of TAVR in each group. Random-effects using STATA was performed for the meta-analysis.Results:34 studies with 96,093 patients were included in our study. Overweight and obese patients had a significantly lower rate of 1-year all-cause mortality, long-term all-cause mortality and moderate to severe aortic regurgitation compared to normal-weight patients (Figure 1). Incidence of 30-day myocardial infarction was lower in overweight patients, and 1-year stroke incidence was significantly lower in obese patients compared with normal cases. In contrast, permanent pacemaker implantation was more observed in overweight and obese patients. There was no significant difference in outcomes in underweight patients compared to normal-weight ones except for a higher rate of major vascular complications in underweight cases.Conclusions:Our analysis showed improved outcomes in terms of all-cause mortality and aortic regurgitation in overweight and obese patients undergoing TAVR compared to normal-weight patients.
