Anemia and risk of periprocedural cerebral injury detected by diffusion-weighted magnetic resonance imaging in patients undergoing transcatheter aortic valve replacement.

BACKGROUND: Anemia is prevalent in patients undergoing transcatheter aortic valve replacement (TAVR) and has been linked to impaired outcomes after the procedure. Few studies have evaluated the impact of anemia and new ischemic lesions post TAVR. METHODS: We prospectively enrolled 158 patients who received TAVR in our center. Anemia was defined according to the World Health Organization criteria as hemoglobin <12 g/dL in women and <13 g/dL in men. All patients underwent diffusion-weighted magnetic resonance imaging (DW-MRI) procedure before and within 4-7 days after TAVR. RESULTS: Anemia was present in 85 (53.8%) patients who underwent TAVR, and 126 (79.7%) patients had 718 new DW-MRI positive lesions with a mean of 4.54±5.26 lesions per patient. The incidence of new ischemic lesions was 81.2% in patients with anemia versus 78.1% in patients without anemia (P=0.629). Moreover, anemic patients had bigger total volume/lesions in the anterior cerebral artery/middle cerebral artery (ACA/MCA) and MCA regions compared to the non-anemic patients (31.89±55.78 mm3 vs. 17.08±37.39 mm3, P=0.049; and 54.54±74.72 mm3 vs. 33.75±46.03 mm3, P=0.034). Anemia was independently associated with the volume/lesion in the ACA/MCA (ß=16.796, 95% confidence interval [95% CI] 2.001 to 31.591, P=0.026) and in the MCA zone (ß=0.020, 95% CI 0.001 to 0.040, P=0.041). CONCLUSIONS: Patients with pre-procedural anemia may have bigger total volume/lesions in the ACA/MCA and MCA regions compared to the non-anemic patients. Whether the consequences of bigger total volume/lesions impact neurological and cognitive outcomes remains to be investigated.

(Z)-5-(4-Fluoro-benzyl-idene)-1,3-thia-zolidine-2,4-dione.

In the title compound, C(10)H(6)FNO(2)S, the benzene and thia-zolidine rings make a dihedral angle of 7.52 (3)°. Intra-molecular C-H⋯O and C-H⋯S hydrogen bonds result in the formation of nearly planar five- and six-membered rings; the adjacent rings are nearly coplanar. In the crystal structure, inter-molecular N-H⋯O hydrogen bonds link the mol-ecules.

Methyl 4-(4-fluoro-phen-yl)-6-isopropyl-2-[N-methyl-N-(methylsulfonyl)amino]-pyrimidine-5-carboxyl-ate.

In the mol-ecule of the title compound, C(17)H(20)FN(3)O(4)S, the pyrimidine and benzene rings are oriented at a dihedral angle of 35.59 (3)°. Intra-molecular C-H⋯N and C-H⋯O hydrogen bonds result in the formation of one five- and two six-membered non-planar rings. One of the six-membered rings adopts a chair conformation, while the other six-membered ring and the five-membered ring exhibit envelope conformations with O and N atoms displaced by 0.837 (3) and 0.152 (3) Å, respectively from the planes of the other ring atoms. In the crystal structure, inter-molecular C-H⋯F hydrogen bonds link the mol-ecules into infinite chains.

Methyl 4-chloro-3-nitro-benzoate.

In the title compound, C(8)H(6)ClNO(4), the mol-ecules are linked by C-H⋯O inter-actions to form a chain parallel to the a axis. The chains are further connected by slipped π-π stacking between symmetry-related benzene rings, with a centroid-to-centroid distance of 3.646 (2) Šand an inter-planar distance of 3.474 Å, resulting in an offset of 1.106 Å.

Ethyl 4-chloro-3-nitro-benzoate.

In the mol-ecule of the title compound, C(9)H(8)ClNO(4), an intra-molecular C-H⋯O hydrogen bond results in the formation of a planar five-membered ring, which is nearly coplanar with the adjacent six-membered ring, the rings being oriented at a dihedral angle of 4.40 (3)°. In the crystal structure, inter-molecular C-H⋯O hydrogen bonds link the mol-ecules.

5-Bromo-2-methyl-pyridine N-oxide.

In the mol-ecule of the title compound, C(6)H(6)BrNO, the methyl C and oxide O atoms lie in the pyridine ring plane, while the Br atom is displaced by 0.103 (3) Å. In the crystal structure, inter-molecular C-H⋯O hydrogen bonds link the mol-ecules into centrosymmetric dimers.