ObjectiveTo investigate the sex-specific impact of baseline myocardial injury on cardiac reverse remodeling after transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis (AS). MethodsThis retrospective cohort study consecutively enrolled patients with symptomatic severe AS who underwent TAVR between May 2021 and January 2024 at the Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University. According to the "Fourth Universal Definition of Myocardial Infarction (2018)", patients were classified into preprocedural myocardial injury-positive [hs-cTnI(+)] and -negative [hs-cTnI(?)] groups based on high-sensitivity cardiac troponin I (hs-cTnI) levels. Echocardiographic parameters were collected at baseline and at 1, 6, and 12 months after TAVR. Left ventricular mass index (LVMi) was used to evaluate the degree of cardiac reverse remodeling. Stratified by sex, the trends of LVMi at each postoperative timepoint were compared between sexes, and the impact of baseline myocardial injury on cardiac reverse remodeling within 12 months after TAVR was analyzed. ResultsA total of 408 patients were enrolled, with a median age of 72 (67, 77) years, including 227 (55.6%) males and 181 (44.4%) females. Preprocedural severe cardiac remodeling was observed in 81 patients, including 48 (21.1%, 48/227) male and 33 (18.2%, 33/181) female patients. Cardiac reverse remodeling in male patients occurred predominantly within the first 6 months after TAVR and subsequently plateaued between 6 and 12 months (P=0.528), whereas female patients showed continuous improvement in LVMi at each follow-up timepoint throughout the 12-month follow-up (P<0.05). There were 118 (52.0%) male and 100 (55.2%) female patients in the hs-cTnI (+) group. In both male and female subgroups, LVMi in the hs-cTnI (+) group was significantly higher than that in the hs-cTnI (?) group at baseline and each follow-up timepoint (P<0.05). ConclusionThe impact of baseline myocardial injury on post-TAVR cardiac reverse remodeling exhibits sex differences. Male patients in the hs-cTnI (+) group show poorer improvement in cardiac reverse remodeling, with a plateau phase at 6 months postoperatively, while female patients demonstrate sustained improvement in reverse remodeling within 12 months after TAVR.
ObjectiveTo investigate the clinical characteristics of deep branch of the ulnar nerve injuries at the wrist and hand and to summarize the classification criteria. MethodsA retrospective analysis was conducted on 12 patients with deep branch of the ulnar nerve injuries at the wrist and hand admitted between November 2016 and September 2025, including 7 males and 5 females with an average age of 42.2 years (range, 17-69 years). The duration of injury ranged from 0.3 to 4.0 months (mean, 1.85 months). Two point discrimination (2-PD) of the little finger was 12 (4, 15) mm. The muscle strength of little finger abduction was rated as grade 3 in 1 case, grade 4? in 6 cases, and grade 5 in 5 cases. Pinch strength between the thumb and index finger was (2.88±0.49) kg. Wartenberg sign was positive in 10 cases and negative in 2 cases. The index-middle finger crossing test was positive and claw-hand deformity was present in all patients. Ten patients underwent surgical treatment, whereas 2 patients received conservative treatment. ResultsBased on the anatomical characteristics of the deep branch of the ulnar nerve, clinical manifestations, and intraoperative exploration findings, injuries to the deep branch of the ulnar nerve at the wrist and hand were classified into three types. Type Ⅰ injuries were located proximal to the pisohamate hiatus; type Ⅱ injuries were located between the pisohamate hiatus and a point 17 mm distal to the hook of the hamate; and type Ⅲ injuries were located distal to a point 17 mm distal to the hook of the hamate. Among the 12 patients, 7 were rated as type Ⅰ injuries, 3 as type Ⅱ injuries, and 2 as type Ⅲ injuries. All patients were followed up 6-108 months after treatment (median, 15.5 months). At last follow-up, 2-PD of the little finger improved to 6 (4, 6) mm; the muscle strength of little finger abduction improved to grade 5? in 3 patients and grade 5 in 9 patients; and pinch strength between the thumb and index finger increased to (6.53±1.12) kg. All differences between pre- and post-treatment were significant (P<0.05). Wartenberg sign, the index-middle finger crossing test, and claw-hand deformity were all negative. The all outcome indicators in the 7 patients with type Ⅰ injuries significantly improved when compared with those before treatment (P<0.05). Conclusion Based on the clinical characteristics and injury location, injuries to the deep branch of the ulnar nerve at the wrist and hand can be classified into three types. The pisohamate hiatus and the point 17 mm distal to the hook of the hamate on the palmar aspect are key anatomical landmarks for this classification. This classification system may facilitate accurate localization of deep ulnar nerve branch injuries and provide guidance for surgical planning.
Aortic stenosis (AS) is the most common primary valve lesion requiring surgery or transcatheter intervention in modern era. Its prevalence is rising rapidly as a consequence of the aging population. Transcatheter aortic valve replacement (TAVR) as a therapy option for older high-risk symptomatic severe AS patients has emerged and is currently extending its indications towards surgery intermediate- and low-risk subjects. Considering the common characteristics of frailty and high comorbidity among AS patients, cardiac rehabilitation (CR) has been proven to improve not only survival but also quality of life in previous reports. CR as a classⅠ recommendation in guidelines for the prevention and treatment of cardiovascular disease has been widely used in clinical practice. The purpose of this article is to sort out the current CR programs for TAVR patients in global medical management, and explore the CR optimization program fit for China medical model in post COVID-19 pandemic era.