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Introduction: Post-stroke depression (PSD) is a common neuropsychiatric complication of stroke with a high incidence of 31% and that is associated with poor functional outcomes and increased mortality. Its pathophysiology is poorly understood, however, evidence suggests that neuroinflammation in reaction to the stroke could play a role in the development of PSD. Hypothesis: To compare C-reactive protein (CRP), and homocysteine (Hcy) levels in post-stroke patients with and without depression. Methods: We systematically searched all electronic databases from inception until May 30th 2022 comparing baseline CRP and Hcy. Results: A total of 12 studies with 3,154 Patients were included in this analysis. The mean age of the overall cohort was 64.8 years with PSD patients appearing to be older than non-PSD patients (mean 67.3 years vs 63.8 years). In terms of gender distribution, there were more females in the PSD group compared with non-PSD groups (48.9% vs 40.7%). PSD patients were more likely to be widowed (18% vs 7.25%) and had a family history of psychiatric disorder (10.4% vs 4.4%) compared to non-PSD patients. Patients with PSD had higher levels of baseline CRP [SMD 0.86, (95% CI 0.65 to 1.08), p<0.001; I2=87%] and Hcy PSD [SMD 1.12, (95% CI 0.57 to 1.67), p<0.001; I2=96%] compared to patients without PSD. Meta-regression was performed using covariates including age, female gender, hypertension, diabetes mellitus, CAD, NIHSS, widowhood and family history of psychiatric disorder. Diabetes mellitus appeared to be the only significant effect modifier (coefficient 0.23, p=0.01) for the association between baseline CRP and PSD. Conclusions: Elevated baseline levels of CRP and Hcy were significantly higher in patients that developed PSD, suggesting that both could play a role in the pathophysiology of PSD and as a potential biomarker for diagnosing risk of depression

Introduction: Aortic stenosis (AS) is one of the most prevalent valvular heart diseases globally. As many as 16% of AS patients have underlying cardiac amyloidosis (CA). To date, there is a paucity of data on outcomes among AS with concomitant CA patients post-TAVR. Hypothesis: This study aimed to evaluate the clinical outcomes post TAVR among patients with CA. Methods: We performed a systematic literature search of databases for relevant articles from inception until June 01, 2022. Unadjusted odds ratios (OR) were pooled using a random-effect model, and a p-value of <0.05 was considered statistically significant. Results: 5 studies with 1,488 patients were involved in the final analysis. The mean age of patients among CA+AS and AS alone was (85 vs 80) years. The number of males affected with dual pathology was higher compared to AS alone (71% vs 59%). 29% of patients were having a right bundle branch block in the CA+AS group, while 12% were among AS alone. Mean IV Septal Thickness (1.53 vs 1.33), mean relative wall thickness (0.60 vs 0.40) and mean LA dimensions (5.19 vs 4.8) were higher among the CA+AS group compared with AS alone. At the mean follow up of 12 months the odds of in-hospital mortality (OR, 2.09(95% CI: 0.77-5.63), P = 0.15), stroke (OR, 0.46(95%CI: 0.06-3.60), P = 0.46), and vascular complication (OR, 0.19(95% CI: 0.01-3.40), P = 0.26) were comparable between both group. In contrast, the incidence of acute kidney injury (OR, 3.09(95% CI: 2.02-4.71), P<0.001), and major bleeding (OR, 1.74(95% CI: 1.02-2.98), P = 0.04) were significantly higher among CA+AS group compared to AS group following TAVR. Conclusions: TAVR appeared to be a safe procedure among patients diagnosed with amyloidosis in aortic stenosis with a similar mortality rate between both groups of patients. Further studies should aim at determining the optimal valve replacement strategy in AS patients with concomitant CA.

Introduction: Unlike type 1 myocardial infarction (T1MI) which is caused by plaque rupture and erosion, type 2 myocardial infarction (T2MI) is due to the mismatch between supply-demand of oxygen. To date, there were limited studies available and consequently, the outcomes of patients with T1MI compared to T2MI remained inconclusive. Hypothesis: We aimed to compare the outcomes of T1MI and T2MI patients in terms of mortality and adverse cardiovascular outcomes. Methods: We performed a systematic literature search of databases for relevant articles from inception until March 20, 2022. Results: 340,802 patients had T1MI while the remaining 52,855 patients had T2MI. Mean age was similar between both groups (T1MI: 69.4 years, T2MI: 71.8 years) while proportion of female was found to be more higher in T2MI (61% vs 38%). Our analysis revealed that patients with T1MI had a significantly lower odds of all-cause mortality (OR 0.44, 95%CI 0.34 to 0.56, p<0.001), in-hospital mortality (OR 0.63, 95%CI 0.46 to 0.86, p<0.001), 1-year mortality(OR 0.35, 95% CI 0.25 to 0.47, p<0.001) and MACE (OR 0.59, 95% CI 0.39 to 0.91, p=0.02). There was no significant difference in terms of 30-day mortality (OR 0.58, 95% CI 0.25 to 1.36, p=0.21), CV mortality (OR 0.95, 95% CI 0.68 to 1.32, p=0.74), all-cause readmission (OR 0.84, 95% CI 0.62 to 1.14, p=0.26) and readmission due to MI (OR 1.22, 95% CI 0.66 to 2.27, p=0.53) between both groups. Conclusions: Patients with T1MI had favourable outcomes in terms of mortality and MACE compared to that with T2MI patients. Further studies should aim at determining the optimal management strategy for these high-risk patients for better patient outcomes.

Introduction: With the increasing prevalence of asymptomatic severe AS and its progression to the symptomatic stage the early surgical aortic valve repair is emerging as a popular option but with limited evidence of its efficacy and safety. Objective: We aimed to conduct a meta-analysis to evaluate the efficacy and safety to early surgical aortic valve repair as compared to conservative management. Methods: A systematic literature search was performed in PubMed, Scopus, Embase and Cochrane databases for studies comparing the early surgery versus conservative management among asymptomatic aortic stenosis patients. The primary outcome was all-cause mortality. Secondary endpoints were cardiovascular mortality (CVM), sudden cardiac death (SCD), hospitalisation due to heart failure, the composite of mortality and MACCE, Clinical thromboembolic events, major bleeding, myocardial infarction (MI), and stroke. Results: A total of 5 articles (3 observational studies and 2 randomized controlled trials) were included. We found that there were significantly lower odds of all-cause mortality [OR, 0.33; (95%CI:0.25-0.42); p<0.000001], cardiovascular mortality [OR, 0.34 (95%CI:0.25-0.47); p<0.00001] and composite of mortality and MACE (OR:0.32(95%CI:0.24,0.42;p<0.00001), sudden cardiac death (OR:0.32; CI: 0.16-0.64; p=0.001) and hospitalization due to heart failure (OR:0.27, CI: 0.16-0.44; p<0.00001) with early surgical aortic valve repair compared to conservative management. There was no significant difference between the incidence of major bleeding, clinical thromboembolic events, stroke and myocardial infarction between the conservative care groups and early surgery. We also found a reduced risk of Conclusion: Among asymptomatic patients with AS, SAVR shows better outcomes in reducing mortality and other complications compared with the conservative management approach.