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Stachel G, Jentzsch M, Oehring M, Antoniadis M, Schwind S, Noack T, Platzbecker U, Borger M, Laufs U, Lenk K. Red blood cell distribution width (RDW) is associated with unfavorable functional outcome after transfemoral transcatheter aortic valve implantation. IJC HEART & VASCULATURE 2024; 51:101383. [PMID: 38496258 PMCID: PMC10940133 DOI: 10.1016/j.ijcha.2024.101383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/07/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
Background Red blood cell distribution width (RDW) is calculated in every blood count test and reflects variability in erythrocyte size. High levels mirror dysregulated erythrocyte homeostasis and have been associated with clonal hematopoiesis as well as higher mortality in several conditions.We aimed to determine the impact of preprocedural RDW levels on functional outcomes after transcatheter aortic valve implantation (TAVI). Methods In this single-center retrospective study, we analyzed 176 consecutive patients receiving TAVI between 2017 and 2021. RDW upper limit of normal was < 15 %. Patients were stratified according to preprocedural RDW as having normal or elevated values. We assessed all-cause-mortality and a composite endpoint comprising cardiovascular/ valve-related mortality and cardiovascular, valve-related and heart failure hospitalization at 1 year. Results 43 patients (24.4 %) had RDW ≥ 15 %. There were significant baseline differences between groups (Society of Thoracic Surgeons - Predicted Risk of Mortality score 3.18 %[interquartile range 1.87-5.47] vs. 6.63 %[4.12-10.54] p < 0.001; hemoglobin 13.2 g/dL[11.8-14.1] vs. 10.4 g/dL[9.8-12.2], p < 0.001, RDW-normal vs. RDW-high, respectively). Age was not distinct (80.2 years [77.5-84.1] vs 81.2[71.3-84.7], p = 0.78). 1-year-all-cause mortality was not different (7.9 % vs. 9.4 %, p = 0.79). The RDW-high group showed markedly higher NT-proBNP levels after 1 year (647 ng/ml[283-1265] vs. 1893 ng/ml[744-5109], p = 0.005), and experienced more clinical endpoints (hazard ratio 2.57[1.28-5.16] for the composite endpoint, p = 0.006). RDW remained an independent predictor of the composite endpoint when accounting for all baseline differences in multivariable regression. Conclusion Elevated preprocedural RDW identifies patients at risk for impaired functional outcome after TAVI and may represent a useful low-cost parameter to guide intensity of outpatient surveillance strategies.
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Affiliation(s)
- Georg Stachel
- Medical Clinic and Policlinic IV - Cardiology, University of Leipzig Medical Center, Leipzig, Germany
| | - Madlen Jentzsch
- Medical Clinic and Policlinic I - Hematology, Cell Therapy and Hemostaseology, University of Leipzig Medical Center, Leipzig, Germany
| | - Michelle Oehring
- Medical Clinic and Policlinic IV - Cardiology, University of Leipzig Medical Center, Leipzig, Germany
| | - Marios Antoniadis
- Medical Clinic and Policlinic IV - Cardiology, University of Leipzig Medical Center, Leipzig, Germany
| | - Sebastian Schwind
- Medical Clinic and Policlinic I - Hematology, Cell Therapy and Hemostaseology, University of Leipzig Medical Center, Leipzig, Germany
| | - Thilo Noack
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I - Hematology, Cell Therapy and Hemostaseology, University of Leipzig Medical Center, Leipzig, Germany
| | - Michael Borger
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Ulrich Laufs
- Medical Clinic and Policlinic IV - Cardiology, University of Leipzig Medical Center, Leipzig, Germany
| | - Karsten Lenk
- Medical Clinic and Policlinic IV - Cardiology, University of Leipzig Medical Center, Leipzig, Germany
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Jiménez-Xarrié E, Asmarats L, Roqué-Figuls M, Millán X, Li CHP, Fernández-Peregrina E, Sánchez-Ceña J, Massó van Roessel A, Maestre Hittinger ML, Paniagua P, Arzamendi D. Impact of Baseline Anemia in Patients Undergoing Transcatheter Aortic Valve Replacement: A Prognostic Systematic Review and Meta-Analysis. J Clin Med 2023; 12:6025. [PMID: 37762965 PMCID: PMC10531747 DOI: 10.3390/jcm12186025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/01/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is currently the treatment of choice for patients aged ≥75 years with severe aortic stenosis. Preoperative anemia is present in a large proportion of patients and may increase the risk of post-procedural complications. The purpose of this prognostic systematic review was to analyze the impact of baseline anemia on short- and mid-term outcomes following TAVR. A computerized search was performed on PubMed and Web of Science databases for studies published between January 2013 and December 2022. Primary outcomes were 30-day need for transfusion, acute renal failure, 30-day and mid-term mortality, and readmission during the first year post-TAVR. Data were analyzed via random effects model using inverse variance method with 95% confidence intervals. Eleven observational studies met our eligibility criteria and included a total of 12,588 patients. The prevalence of baseline anemia ranged between 39% and 72%, with no relevant sex differences. Patients with preprocedural anemia received more blood transfusions [OR: 2.95 (2.13-4.09)]), and exhibited increased rates of acute kidney injury [OR:1.74 (1.45-2.10)], short-term mortality [OR: 1.47 (1.07-2.01], and mid-term [OR: 1.89 (1.58-2.25)] mortality following TAVR compared with those without anemia. Baseline anemia determined an increased risk for blood transfusion, acute kidney injury, and short/mid-term mortality among TAVR recipients.
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Affiliation(s)
- Elena Jiménez-Xarrié
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - Lluis Asmarats
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - Marta Roqué-Figuls
- Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | - Xavier Millán
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - Chi Hion Pedro Li
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - Estefanía Fernández-Peregrina
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - Juan Sánchez-Ceña
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - Albert Massó van Roessel
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - M. Luz Maestre Hittinger
- Anesthesiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - Pilar Paniagua
- Anesthesiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - Dabit Arzamendi
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
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Murthi M, Velagapudi S, Sharma B, Ezegwu O, Akuna E, Park DY, Atluri R, Vardar U. Comparison of In-Hospital Mortality and Clinical Outcomes Between Patients Aged More Than and Less Than 80 Years Undergoing Transcatheter Aortic Valve Replacement. Cureus 2022; 14:e24534. [PMID: 35497082 PMCID: PMC9045730 DOI: 10.7759/cureus.24534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background The transcatheter aortic valve replacement (TAVR) procedure has been increasingly utilized in the management of aortic stenosis among the elderly. In this study, we sought to assess the hospital outcomes and major adverse events (MAEs) associated with TAVR in patients aged ≥80 years compared to those aged <80 years. Methodology We performed a retrospective observational study using the National Inpatient Sample in 2018. We divided TAVR patients into two cohorts based on age, namely, ≥80 years old and <80 years old. The primary outcomes included the comparison of in-hospital mortality and MAEs in the two cohorts. Results We identified 63,630 patients who underwent TAVR from January 1 to December 31, 2018. Among them, 35,115 (55%) were ≥80 years and 28,515 (45%) were <80 years of age. There was a higher rate of post-procedural in-hospital mortality in patients ≥80 years old (1.6% vs. 1.1%, adjusted odds ratio (aOR) = 1.56, [confidence interval (CI) = 1.13-2.16], p = 0.006). They also had higher rates of pacemaker insertion compared to those <80 years old (7.4% vs. 6.5%, aOR = 1.17 [CI = 1-1.35], p = 0.03). On subgroup analysis, the rates of MAEs were not different between the two cohorts (23.8% vs. 23.4%, p = 0.09); however, patients aged ≥80 years who experienced MAEs had higher in-hospital mortality (5.7% vs. 4.3%, aOR = 1.58 [CI = 1.08-2.32], p = 0.01) and shorter length of hospital stay (7.2 vs. 8.7 days, p = 0.03) compared to those aged <80 years. Anemia, liver disease, chronic kidney disease, and previous stroke were associated with higher odds of in-hospital MAEs in both groups. Conclusions The results of our study show that patients older than 80 years of age undergoing TAVR had higher rates of in-hospital mortality and pacemaker insertion compared to those less than 80 years of age. The rates of MAEs were not significantly different between the two groups.
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Affiliation(s)
- Mukunthan Murthi
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Sujitha Velagapudi
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Bharosa Sharma
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Olisa Ezegwu
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Emmanuel Akuna
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Dae Yong Park
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Ramtej Atluri
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Ufuk Vardar
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
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Analysis of Red Blood Cell Parameters in Dogs with Various Stages of Degenerative Mitral Valve Disease. J Vet Res 2020; 64:325-332. [PMID: 32587922 PMCID: PMC7305654 DOI: 10.2478/jvetres-2020-0043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 06/02/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction Although peripheral blood analysis has become increasingly automated, microscopy is the only available method for the diagnosis of anisocytosis and poikilocytosis. The aims of the study were to compare RBC volume data obtained with two different analysers and by manual assessment of smears and to compare this data between dogs in various stages of heart failure secondary to degenerative mitral valvular (DMV) disease. The impact of diuretic administration on RBC morphology was also assessed. Material and Methods Sixty-eight dogs, 56 in different stages of DMV disease and 12 as healthy controls, were studied. Impedance and flow cytometry haematological analyses were performed for each animal. Additionally, two smears were prepared for manual analysis. RBC structure, staining, and size differences were recorded. Results There were no significant differences between the blood morphological parameters assessed using haematological analysers nor between dogs receiving diuretic treatment and those not treated. Based on the manual smear, significantly higher erythrocyte anisocytosis was observed in the dogs with symptomatic DMV disease than in the control group. Conclusion Haematological analysers based on impedance and flow cytometry provide reliable and comparable morphological results in dogs with heart failure. However, microscopic assessment of blood smears is a more reliable tool to detect erythrocyte anisocytosis.
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De Larochellière H, Puri R, Eikelboom JW, Rodés-Cabau J. Blood Disorders in Patients Undergoing Transcatheter Aortic Valve Replacement: A Review. JACC Cardiovasc Interv 2019; 12:1-11. [PMID: 30621965 DOI: 10.1016/j.jcin.2018.09.041] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/17/2018] [Accepted: 09/25/2018] [Indexed: 02/08/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is well established for treating patients with severe aortic stenosis considered at intermediate to high surgical risk. Blood disorders such as anemia, thrombocytopenia, and acquired type 2A von Willebrand disease are relatively frequent in TAVR candidates, and multiple studies to date have highlighted their potential clinical association with mortality and/or bleeding complications post-TAVR. The present review provides an overview of various blood disorders observed pre- and post-TAVR, with special focus on their incidence, etiology, clinical association, and management.
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Affiliation(s)
- Hugo De Larochellière
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Rishi Puri
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - John W Eikelboom
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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Kanjanahattakij N, Rattanawong P, Krishnamoorthy P, Sirinvaravong N, Chongsathidkiet P, Lapumnuaypol K, George JC, Witzke C, Figueredo VM. Anaemia and mortality in patients with transcatheter aortic valve replacement: a systematic review and meta-analysis. Acta Cardiol 2019; 74:386-392. [PMID: 30328768 DOI: 10.1080/00015385.2018.1510802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective: This study was done to determine the relationship between pre-procedural anaemia and mortality post transcatheter aortic valve replacement (TAVR). Introduction: TAVR is now a treatment option for patients with severe aortic stenosis (AS) with high surgical risk. Anaemia is a common comorbidity in the TAVR population. Small studies have suggested that anaemia is associated with worse short-term and long-term mortality in patients who underwent TAVR. However, there are no meta-analyses to further assess this association. Method: Studies were systematically searched from electronic databases (EMBASE and MEDLINE). Inclusion criteria were adult population with aortic stenosis who underwent TAVR, and number of patients with pre-procedural anaemia reported. Outcomes were short-term mortality or long-term mortality. Pooled effect size was calculated with a random-effect model, weighted for the inverse of variance. Heterogeneity was assessed with I2. Results: Six studies were included in the final analysis. Of these, pooled analysis of four studies examining association between anaemia and 30-day mortality did not show a statistically significant relationship. A pooled analysis of four studies examining the association of anaemia and long-term mortality after TAVR showed pooled adjusted risk ratio (RR) of 1.43, 95% CI 1.22-1.67 with low heterogeneity (I2 = 33%). Subgroup analysis after exclusion of one smaller study showed that the association remained significant (RR 1.41, 95% CI 1.27-1.56) with decreased heterogeneity (I2 = 0%). Conclusion: This systematic review and meta-analysis found an association between pre-procedural anaemia and increased long-term but not short-term mortality after TAVR. Further study of the pathophysiology underlying this association is needed.
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Affiliation(s)
| | | | | | | | | | | | - Jon C. George
- Division of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Christian Witzke
- Division of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Vincent M. Figueredo
- Division of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
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Lv Z, Zhou B, Yang C, Wang H. Preoperative Anemia and Postoperative Mortality in Patients with Aortic Stenosis Treated with Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review and Meta-Analysis. Med Sci Monit 2019; 25:7251-7257. [PMID: 31559972 PMCID: PMC6778413 DOI: 10.12659/msm.916185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with severe aortic stenosis who have comorbidities that prevent general anesthesia and open cardiothoracic surgery are candidates for transcatheter aortic valve implantation (TAVI). However, TAVI can result in patient mortality following the procedure. This systematic review of the literature and meta-analysis aimed to determine the relationship between preoperative anemia and postoperative mortality in patients following TAVI. MATERIAL AND METHODS PubMed, EMBASE, the Cochrane Library, and the Web of Science were systematically searched from their inception to February 2019 for relevant published studies that included patients with bicuspid aortic valve stenosis and tricuspid aortic valve stenosis who underwent TAVI and who had preoperative data on hemoglobin levels. The pooled odds ratios (OR) and 95% confidence interval (CI) were calculated using a random-effects generic inverse variance method. RESULTS Six published studies that involved 6,406 patients with aortic stenosis were included in the meta-analysis. There was no significant difference observed for the final pooled result for patients with and without anemia for the short-term 30-day postoperative mortality (OR, 1.34; 95% CI, 0.77-2.35). However, long-term mortality rates were significantly worse in patients with preoperative anemia compared with those without anemia (OR, 1.77; 95% CI, 1.34-2.35). CONCLUSIONS Systematic review of the literature and meta-analysis showed that pre-procedural anemia reduced long-term mortality following TAVI. This finding supports the need to correct preoperative anemia in patients with aortic stenosis to improve patient outcome following TAVI.
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Affiliation(s)
- Zhenqian Lv
- Department of Cardiovascular Surgery, Qingdao Fuwai Hospital, Qingdao, Shandong, China (mainland)
| | - Baoguo Zhou
- Department of Cardiovascular Surgery, Qingdao Fuwai Hospital, Qingdao, Shandong, China (mainland)
| | - Chunyue Yang
- Department of Cardiovascular Medicine, Qingdao Fuwai Hospital, Qingdao, Shandong, China (mainland)
| | - Haiping Wang
- Department of Cardiovascular Surgery, Qingdao Fuwai Hospital, Qingdao, Shandong, China (mainland)
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Szekely Y, Finkelstein A, Bazan S, Halkin A, Abbas Younis M, Erez J, Keren G, Banai S, Arbel Y. Red blood cell distribution width as a prognostic factor in patients undergoing transcatheter aortic valve implantation. J Cardiol 2019; 74:212-216. [PMID: 31060955 DOI: 10.1016/j.jjcc.2019.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/12/2019] [Accepted: 04/09/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Red blood cell distribution width (RDW), which is routinely reported in complete blood counts, is a measure of the variability in size of circulating erythrocytes. RDW is an independent predictor of prognosis in patients with cardiovascular diseases. We evaluated the short- and long-term prognostic value of RDW in a large cohort of transcatheter aortic valve implantation (TAVI) patients. METHODS The impact of RDW on outcome was determined prospectively in 1029 consecutive patients with severe aortic stenosis (AS) undergoing transfemoral TAVI. The cohort was divided into 2 groups according to RDW above and below 15.5%. Collected data included patient characteristics, medical background, left ventricle ejection fraction (LVEF), frailty score, Society of Thoracic Surgeons (STS) score, periprocedural laboratory results, and long-term (up to 7.5 years) clinical outcomes. RESULTS The mean age (±SD) was 83.1±6.3 years, mean STS score was 4.2±3.1% and mean estimated LVEF was 55.7±8.4%. Mean pre-TAVI RDW levels were 15.3±3.2%. Patients with RDW≤15.5% (n=683) and RDW>15.5% (n=346) had a 1-year mortality rate of 6% and 17%, respectively (p=0.001) and a 5-year mortality rate of 20% and 38%, respectively (p<0.001). Baseline RDW>15.5% was independently associated with all-cause mortality (hazard ratio 1.83, 95% confidence interval 1.44-2.32, p<0.001). CONCLUSIONS Elevated RDW is a strong independent marker and predictor of short- and long-term mortality following TAVI, that might present a relevant future supplement to current preprocedural risk scores. Additional research is needed to clarify the mechanisms responsible for this finding.
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Affiliation(s)
- Yishay Szekely
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel.
| | - Ariel Finkelstein
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel
| | - Samuel Bazan
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel
| | - Amir Halkin
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel
| | - Maria Abbas Younis
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel
| | - Johnathan Erez
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel
| | - Gad Keren
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel
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Takagi H, Hari Y, Kawai N, Ando T. Meta-Analysis of Impact of Anemia and Hemoglobin Level on Survival After Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 123:306-314. [PMID: 30401487 DOI: 10.1016/j.amjcard.2018.09.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 12/12/2022]
Abstract
To establish evidence whether baseline anemia and decreases in baseline hemoglobin levels affect survival after transcatheter aortic valve implantation (TAVI), we performed a meta-analysis of available studies. Studies considered for inclusion met the following criteria: the design was a comparative study of patients with baseline anemia versus those without baseline anemia or a cohort study investigating baseline anemia (as a dichotomous variable) or baseline hemoglobin levels (as a continuous variable) as one of prognostic factors of mortality; the study population was patients who underwent TAVI; and main outcomes included early (30-day or in-hospital) or late (including early) all-cause mortality. Study-specific estimates were combined in the random-effects model. Our search identified 15 eligible studies including a total of 11,657 TAVI patients. Pooled analysis demonstrated that baseline anemia was associated with a statistically significant increase in early (p = 0.003) and midterm mortality (p < 0.0001) and that incremental decreases in baseline hemoglobin levels were associated with a statistically significant increase in midterm mortality (p < 0.00001). Pooled analysis of only adjusted estimates indicated that anemia was independently associated with a statistically significant increase in early (p = 0.02) and midterm mortality (p < 0.0001) and that incremental decreases in baseline hemoglobin levels were independently associated with a statistically significant increase in midterm mortality (p < 0.00001). In conclusion, baseline anemia and lower baseline hemoglobin levels may be associated with increased early and midterm mortality after TAVI.
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Yosuke Hari
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Norikazu Kawai
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Tomo Ando
- Department of Cardiology, Detroit Medical Center, Detroit, MI
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Evaluation of frequency and intensity of asymptomatic anisocytosis in the Japanese dog breeds Shiba, Akita, and Hokkaido. ACTA VET BRNO 2018. [DOI: 10.2754/avb201786040385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Microcytosis is observed in healthy Japanese breed dogs. The aim of the study was to evaluate the frequency and intensity of asymptomatic anisocytosis using a three-grade scale in Japanese dog breeds with special emphasis on the following indices: mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration, and red blood cell distribution width. The retrospective study included analyses of blood morphology and blood smear for clinically healthy Japanese dog breeds Shiba, Akita, and Hokkaido aged from 6 months to 14 years, performed as a part of preventative care. A total of 74 dogs of both sexes were qualified for the study. The group included both neutered and non-neutered animals (Akita – 17 females, 12 males, Shiba – 24 females, 18 males, Hokkaido – 2 females, 1 male). The blood smear revealed significant anisocytosis in 60.8% and mild anisocytosis in 28.4% of the tested dogs – 89.2% in total. Microcytosis was reported for 25.7% of the tested Japanese breed dogs. Reduced mean cell haemoglobin and mean cell haemoglobin concentration were diagnosed in 75.7% and 40.5% of dogs, respectively. Red blood cell distribution width as an anisocytosis indicator exceeded the norm in 12% of the tested dogs. Compared to mixed breed dogs, the Japanese breeds had a reduced mean cell volume, mean cell haemoglobin concentration and significant anisocytosis in the blood smear as well as a higher red blood cell distribution width indicator. Veterinarians should consider these differences when interpreting the results of morphological blood tests.
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