BACKGROUND AND PURPOSE:Clot extent, location, and collateral integrity are important determinants of outcome in acute stroke. We hypothesized that a novel clot burden score (CBS) and collateral score (CS) are important determinants of clinical and radiologic outcomes and serve as useful additional stroke outcome predictors.

Background Insertable cardiac monitors (ICMs) are small subcutaneously implanted devices that detect changes in R-wave amplitudes (RWAs), effective in arrhythmia-monitoring. Although ICMs have proven to be immensely successful, electrical artefacts are frequent and can lead to misdiagnosis. Thus, there is a growing need to sustain and increase efficacy in detection rates by gaining insight into various patient-specific factors such as body postures and activities. Methods RWAs were measured in 15 separate postures, including supine, lying on the right-side (RS) or left-side (LS) and sitting, and two separate ICM orientations, immediately after implantation of Confirm Rx™ ICM in 99 patients. Results The patients (53 females and 46 males, mean ages 66.62 ± 14.7 and 66.40 ± 12.25 years, respectively) had attenuated RWAs in RS, LS and sitting by ~ 26.4%, ~ 27.8% and ~ 21.2% respectively, compared to supine. Gender-based analysis indicated RWAs in RS (0.32 mV (0.09–1.03 mV), p < 0.0001) and LS (0.37 mV (0.11–1.03 mV), p = 0.004) to be significantly attenuated compared to supine (0.52 mV (0.20–1.03 mV) for female participants. Similar attenuation was not evident for male participants. Further, parasternally oriented ICMs (n = 44), attenuated RWAs in RS (0.37 mV(0.09–1.03 mV), p = 0.05) and LS (0.34 mV (0.11–1.03 mV), p = 0.02) compared to supine (0.48 mV (0.09–1.03 mV). Similar differences were not observed in participants with ICMs in the 45°-relative-to-sternum (n = 46) orientation. When assessing the combined effect of gender and ICM orientation, female participants demonstrated plausible attenuation in RWAs for RS and LS postures compared to supine, an effect not observed in male participants. Conclusion This is the first known study depicting the effects on RWA due to body postures and activities immediately post-implantation with an overt impact by gender and orientation of ICM. Future work assessing the cause of gender-based differences in RWAs may be critical. Trial registration: Clinical Trials, NCT03803969. Registered 15 January 2019 – Retrospectively registered, https://clinicaltrials.gov/NCT03803969

Background: Insertable cardiac monitors (ICMs) are small subcutaneously implanted devices that detect changes in R-wave amplitudes (RWAs), effective in arrhythmia-monitoring. Although ICMs have proven to be immensely successful, there is a growing need to sustain and increase efficacy in detection rates irrespective of changes in body postures and activities. Methods: RWAs were measured in 15 separate postures, including supine, lying on the right-side (RS) or left-side (LS) and sitting, immediately after implantation of Confirm Rx™ ICM in 99 patients. Results: The patients (53 females and 46 males, mean ages 66.62±14.7 and 66.40±12.25 years, respectively) had attenuated RWAs in RS, LS and sitting by ~26.4%, ~27.8% and ~21.2% respectively, compared to supine. Gender-based analysis indicated RWAs in RS (0.32mV (0.09-1.03mV), p<0.0001) and LS (0.37mV (0.11-1.03mV), p=0.004) to be significantly attenuated compared to supine (0.52mV(0.20-1.03mV) for female participants. Similar attenuation was not evident for male participants. Further, parasternally oriented ICMs (n=44), attenuated RWAs in RS (0.37mV(0.09-1.03mV), p=0.05) and LS (0.34mV (0.11-1.03mV), p=0.02) compared to supine (0.48mV (0.09-1.03mV). Similar differences were not observed in participants with ICMs in the 45°-relative-to-sternum (n=46) orientation. When assessing the combined effect of gender and ICM orientation, female participants demonstrated plausible attenuation in RWAs for RS and LS postures compared to supine, an effect not observed in male participants.Conclusion: This is the first known study to evaluate effects of body postures and activities on RWAs immediately post-implantation with an ICM. Future work assessing the cause of gender-based differences in RWAs may be critical.Trial registration: Clinical Trials, NCT03803969. Registered 15 January 2019 – Retrospectively registered, https://clinicaltrials.gov/NCT03803969

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Background: Frailty in TAVI patients correlates with poorer clinical outcomes. Sarcopenia as assessed on routine pre-TAVI CT imaging may provide a surrogate measure of frailty.Methods: Retrospective analysis of patients who underwent pre-TAVI CT imaging at a major tertiary hospital between 2009-2019. Skeletal muscle area was calculated on CT by 2 measures: overall cross-sectional skeletal muscle mass standardised for height (SMI) and psoas muscle area standardised for body surface (PMA) at L3 level. Sarcopenia cutoff on SMI was defined as ,52.4 cm 2 /m 2 in males and ,38.5 cm 2 /m 2 in females. We evaluated outcomes of mortality and composite endpoint of serious post-procedural complications being vascular complications, stroke, pulmonary embolus, new arrhythmia and acute kidney injury. Stepwise logistic regression was used to determine association between CT skeletal muscles measures and outcomes.Outcomes: In 258 patients who underwent TAVI, 191(74%) had assessable SMI and 221(80%) had assessable PMA. Mean SMI was 43.7 cm 2 /m 2 for males and 37.7 cm 2 / m 2 for females, with 138/191(72%) being sarcopenic. Sarcopenic patients were more likely to be male (p,0.001), nonobese (p,0.001), smokers (p=0.045), have CKD (p=0.01) and pulmonary hypertension (p=0.04). Sarcopenia defined by SMI independently predicted risk of post-procedural complications (OR 3.38, p=0.04) however did not predict mortality. PMA was inversely associated with all-cause mortality (OR 0.83, p=0.04) and risk of serious post-procedural complications (OR 0.79, p,0.001).Conclusion: Pre-procedural CT-defined measures of skeletal muscle indicative of sarcopenia predicts both serious post-procedural complications and all-cause mortality in patients undergoing TAVI. Further studies are warranted to compare clinical frailty markers with CT-defined measures of sarcopenia.

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