The impact of concomitant chronic total occlusion on clinical outcomes in patients undergoing transcatheter aortic valve replacement: a large single-center analysis

BackgroundCoronary artery disease (CAD) is a common finding in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). However, the impact on prognosis of chronic total occlusions (CTOs), a drastic expression of CAD, remains unclear.Methods and resultsWe retrospectively reviewed 1,487 consecutive TAVR cases performed at a single tertiary care medical center. Pre-TAVR angiograms were analyzed for the presence of a CTO. At the time of TAVR, 11.2% (n = 167) patients had a CTO. There was no significant association between the presence of a CTO and in-hospital or 30-day mortality. There was also no difference in long-term survival. LV ejection fraction and mean aortic gradients were lower in the CTO group.ConclusionsOur analysis suggests that concomitant CTO lesions in patients undergoing TAVR differ in their risk profile and clinical findings to patients without CTO. CTO lesion per se were not associated with increased mortality, nevertheless CTOs which supply non-viable myocardium in TAVR population were associated with increased risk of death. Additional research is needed to evaluate the prognostic significance of CTO lesions in TAVR patients

Homocysteine as a predictive factor for hip fracture in older persons

To the Editor: In their study of homocysteine as a predictive factor for hip fracture in older persons, McLean et al. (May 13 issue) do not thoroughly discuss the role of physical activity, which may influence the association between homocysteine levels and the risk of fracture. Several previous studies and systematic reviews suggested that exercise increases bone mineral density and reduces or prevents bone loss in patients with osteoporosis. Physical activity is also effective in preventing falls. [...]<br/

The impact of chronic total occlusions in patients undergoing transcatheter aortic valve replacement: A systematic review and meta‐analysis

Coronary artery disease (CAD) is frequently encountered in patients evaluated for transcatheter aortic valve replacement (TAVR) due to severe aortic stenosis. The prognostic relevance of chronic total occlusions (CTOs) in this setting is poorly understood. We conducted a search of MEDLINE and EMBASE to identify studies evaluating patients who underwent TAVR and evaluated outcomes depending on the presence of coronary CTOs. Pooled analysis was performed to estimate the rate and risk ratio for mortality. Four studies involving 25,432 patients fulfilled the inclusion criteria. The follow up ranged from in-hospital outcomes to 8-years follow-up. Coronary artery disease was present in 67.8% to 75.5% of patients in 3 studies which reported this variable. The prevalence of CTOs varied between 2% and 12.6% in this cohort. The presence of CTOs was associated with increase in length of stay (8.1 ± 8.2 vs. 5.9 ± 6.5, p < 0.01), cardiogenic shock (5.1% vs. 1.7%, p < 0.01), acute myocardial infarction (5.8% vs. 2.8%, p = 0.02) and acute kidney injury (18.6% vs. 13.9%, p = 0.048). The pooled 1-year death rate revealed 41 deaths in 165 patients in the CTO group and 396 deaths in 1663 patients with no CTO ((24.8%) vs. (23.8%)). The meta-analysis of death with CTO versus no CTO showed a nonsignificant trend toward increased mortality with CTOs (risk ratio 1.11 95% CI 0.90–1.40, I2 = 0%). Our analysis suggests that concomitant CTO lesions in patients undergoing TAVR are common, and its presence was associated with increased in-hospital complications. However, CTO presence by itself was not associated with increased long-term mortality, only a nonsignificant trend toward an increased risk of death in patients with CTO was found. Further studies are warranted to assess the prognostic relevance of CTO lesion in TAVR patients

Mother-Infant Interactions at Home and in a Laboratory Setting: A Comparative Analysis in Two Cultural Contexts

Lamm B, Gudi H, Freitag C, et al. Mother-Infant Interactions at Home and in a Laboratory Setting: A Comparative Analysis in Two Cultural Contexts. Journal of Cross-Cultural Psychology. 2014;45(6):843-852.This study addresses the question how the setting of assessment influences maternal playing behavior with their 3-month-old infants across cultures. Mother-infant interactions of 338 dyads from two cultural communities (German middle-class and rural Cameroonian Nso) were videotaped either in their home or in a laboratory setting. Results indicate that both settings of assessment are appropriate to observe cultural differences in maternal interactional behavior. As expected, rural Nso mothers show more proximal interactional behavior than German middle-class mothers, who focus more on distal behavioral strategies. The laboratory setting amplifies cultural differences by culture-specific effects on the playing behavior. Whereas rural Nso mothers show increased activities in the lab, German middle-class mothers' behavior seems to be inhibited

African Versus Caucasian Faces in a Visual Expectation Paradigm: A Longitudinal Study With German and Cameroonian Infants

Faßbender I, Lohaus A, Thomas H, et al. African Versus Caucasian Faces in a Visual Expectation Paradigm: A Longitudinal Study With German and Cameroonian Infants. Journal of Cross-Cultural Psychology. 2014;45(8):1273-1287.This article focuses on sequence learning on the Visual Expectation Paradigm (VExP) using human faces as stimulus material. For a sample of 133 Caucasian German infants assessed longitudinally at 3 and 6 months of age, a previous study has shown that the response latency of 6-month-old infants was shorter when the infants solved the task with Caucasian own-race faces in contrast to African other-race faces. The advantage for own-race faces occurs at the same age the Other-Race-Effect (ORE) has been reported to emerge. As studies on ORE development have shown the phenomenon in infants from various cultural backgrounds, the follow-up question to be answered here is whether the performance differences on the VExP can also be found in other than Caucasian infants. As a complement to the German sample, 30 African infants from Cameroon were assessed longitudinally with the same VExP task at ages 3 and 6 months. Our results indicate that perception differences between own-race and other-race faces influence performance on the VExP in both samples. As expected, the Cameroonian infants improved performance on the VExP from 3 to 6 months only in their own-race African faces condition

Differential Development of Motor Abilities in Western Middle-Class and Cameroonian Nso Infants

Kolling T, Lamm B, Vierhaus M, et al. Differential Development of Motor Abilities in Western Middle-Class and Cameroonian Nso Infants. Journal of Cross-Cultural Psychology. 2014;45(9):1502-1508.The present longitudinal study repeatedly tested motor development in 345 infants at ages 3, 6, and 9 months in two eco-cultural contexts (German middle-class and Cameroonian Nso). To analyze differential motor developments and its co-determinants (parental education and growth in weight), person-centered analyses (hierarchical cluster analyses) were applied. Results indicate that cluster analyses of fine motor development scores led to two culture-mixed cluster groups. Four cluster groups were extracted in the gross motor domain showing differential growth curves. Differential growth curves were partly explained by education of mother and weight trajectories. Besides considering methodological aspects, inter-individual differences of intra-individual change within and across eco-cultural contexts are discussed

Experience with headwear influences the other-race effect in 4-year-old children

Suhrke J, Freitag C, Lamm B, et al. Experience with headwear influences the other-race effect in 4-year-old children. Journal of Experimental Child Psychology. 2015;137:156-163.The other-race effect (ORE) implies the better recognition of faces of one's own race compared with faces of a different race. It demonstrates that face recognition is shaped by daily experience with human faces. Such experience mainly includes structural information of own-race faces and also information on the way faces are usually seen, as a whole or partly covered by scarves or other headwear. In two experiments, we investigated how this mode of presentation is related to the occurrence of the ORE during childhood. In Experiment 1, 4-year-old German children (N= 104), accustomed to seeing faces without headwear in daily life, were asked to recognize female Caucasian or African faces, presented either as a whole or wearing a woolen hat, in a forced choice paradigm. In Experiment 2, 4-year-olds from rural Cameroon (N = 70), accustomed to seeing faces with and without headwear in daily life, participated in the same task. In both groups, the ORE was present in the familiar mode of presentation, that is, in whole faces in German children and in whole and partly covered faces in Cameroonian children. The results are discussed in relation to the role of experience for face recognition processes. (c) 2015 Elsevier Inc. All rights reserved

Rural Nso and German Middle-Class Mothers' Interaction With Their 3-and 6-Month-Old Infants: A Longitudinal Cross-Cultural Analysis

Lamm B, Gudi H, Faßbender I, et al. Rural Nso and German Middle-Class Mothers' Interaction With Their 3-and 6-Month-Old Infants: A Longitudinal Cross-Cultural Analysis. Journal of Family Psychology. 2015;29(4):649-655.This study aims to analyze culture-specific development of maternal interactional behavior longitudinally. Rural Cameroonian Nso mothers (n = 72) and German middle-class mothers (n = 106) were observed in free-play interactions with their 3- and 6-month-old infants. Results reveal the expected shift from a social to a nonsocial focus only in the German middle-class mothers' play interactions but not the rural Nso mothers' play. Nso mothers continue their proximal interactional style with a focus on body contact and body stimulation, whereas German middle-class mothers prefer a distal style of interaction with increasing object-centeredness. These cultural differences are in line with broader cultural models and become more accentuated as the infants grow older