Risultati per: Il dolore neuropatico: review

Circulation, Volume 150, Issue Suppl_1, Page A4145439-A4145439, November 12, 2024. Introduction:Thyrotoxicosis is a systemic condition caused by the effects of elevated levels of thyroid hormones. The cardiovascular manifestations of thyrotoxicosis range from sinus tachycardia and atrial fibrillation to heart failure. The incidence of malignant arrhythmias and cardiac arrest associated with thyrotoxicosis is not well known, and much of the current literature regarding this is limited to case reports. This study conducts a systematic review of the literature to identify patient demographics and outcomes where thyrotoxicosis manifests as cardiac arrest.Methodology:A systematic literature review was conducted by searching three different databases, Embase, PubMed, and Scopus from inception to January 5th, 2024, to identify and review case reports regarding patients with thyrotoxicosis who had a cardiac arrest.Results:We identified 98 patients with thyrotoxicosis manifested as cardiac arrest. The mean age was 40 ±15 years, and 62% were female. Most were previously healthy and had no history of a thyroid disorder (60%). Of the patients with preexisting hyperthyroidism, around 50% had Graves’ disease. Notably, around 90% of these patients had no history of heart disease. The overall mortality was 23.5% (table 1).Conclusion:Thyrotoxicosis should be considered when an otherwise healthy patient presents with a cardiac arrest in the third or fourth decade of life. The outcome in these patients seems to be favorable, with more than three-quarters of patients in our study having survived the event.

Circulation, Volume 150, Issue Suppl_1, Page A4145107-A4145107, November 12, 2024. Background:Kounis syndrome (KS), also known as allergic myocardial infarction, is a rare but potentially life-threatening condition characterized by acute coronary syndrome in the setting of allergic reactions triggered by drugs, foods, vaccines, or environmental exposure. Our study provides an updated comprehensive insight into this patient cohort on a large scale.Methods:We conducted a systemic literature search in PubMed, EMBASE, and Google Scholar between 2018 and 2024, using MeSH terms and keywords for “Kounis syndrome”, “drug”, and allergy to identify the cases of drug-induced KS. Initial search yielded 325 articles. After excluding duplicates, review articles and irrelevant studies, we included only 51 articles reporting drug-induced KS.Results:Our study identified 51 patients of KS with a median age of 56 ± 14 years. Of those, 56.86% were female. The most frequently implicated drugs in KS were antimicrobials (37.25%), followed by iodinated contrast media (19.60%), NSAIDs (15.68%), and antineoplastics (9.80%). Of those, 64.70% of patients were diagnosed with KS-I, 13.72% with KS-II, and 21.56% with KS-III. Chest pain (94.1%), dyspnea (90.1%), and palpitations (60.78%) were predominant initial manifestations, and most cases (78.43%) were presented within 1st hour of drug ingestion. ST-segment changes (100%) were common ECG findings, and 64.70% of patients had elevated cardiac troponin. All patients had reduced left ventricular ejection fraction (LVEF) (

Circulation, Volume 150, Issue Suppl_1, Page A4145162-A4145162, November 12, 2024. Background:Acute coronary syndrome (ACS) poses a significant global health burden despite advancements in its management. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, primarily used in type 2 diabetes mellitus (T2DM), have gained recent consideration as potential agents for ACS management due to their cardiovascular benefits beyond glycemic control. This study aimed to assess the effects of empagliflozin on left cardiac parameters in ACS patients.Methods:PubMed, Cochrane, Scopus, and Web of Science were searched thoroughly to identify relevant randomized controlled trials (RCTs) until June 1st, 2024. Continuous data were pooled using mean difference (MD) with a 95% confidence interval (CI) using R (Version 4.3).Results:Four RCTs involving 701 patients were included. Compared to placebo, empagliflozin significantly reduced left ventricular end-systolic volume index (LVESVi) (MD: -2.38, 95% CI: -3.95 to -0.80, p = 0.0032), left ventricular mass index (LVMi) (MD: -2.76, 95% CI: -4.95 to -0.56, p = 0.0137), and left ventricular filling pressure (E/e’) (MD: -0.59, 95% CI: -1.07 to -0.10, p = 0.0189). However, empagliflozin treatment did not yield a statistically significant change in left ventricular ejection fraction (LVEF) (MD: 1.21, 95% CI: -0.05 to 2.48, p = 0.0603), nor a significant change in left ventricular end-diastolic volume (LVEDV) (MD: -4.49, 95% CI: -14.24 to 5.26, p = 0.37), left ventricular end-systolic volume (LVESV) (MD: -5.19, 95% CI: -10.77 to 0.39, p = 0.0682), and left ventricular end-diastolic volume index (LVEDVi) (MD: -2.20, 95% CI: -4.59 to 0.19, p = 0.0718).Conclusion:Empagliflozin provides favorable effects on left cardiac structural parameters in ACS patients, as it was associated with reduced LVESVi, LVMi, and E/e’. This suggests a potential role for SGLT2 inhibitors as adjunctive therapy in ACS management, warranting further investigation into their mechanisms and long-term clinical outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4144790-A4144790, November 12, 2024. Background:A prolonged PR interval has been demonstrated as a predictor of increased risk for incident atrial fibrillation (AF), coronary artery disease, heart failure, and pacemaker implantation.Purpose:We aim to investigate the impact of prolonged PR interval > 200 ms on AF recurrence after catheter ablation.Methods:We comprehensively searched PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through May 2024. We conducted a pair-wise and prognostic systematic review and meta-analysis with a reconstructed time-to-event data meta-analysis. All analyses were performed using R V. 4.3.1.Results:With the inclusion of four studies, our cohort comprised a total of 2,790 patients. Regarding pair-wise meta-analysis, PR interval > 200 ms was significantly associated with an increased incidence of AF recurrence compared to PR interval ≤ 200 ms (RR: 1.50 with 95% CI [1.33, 1.70], P< 0.01). Regarding adjusted prognostic meta-analysis, PR interval > 200 ms was significantly associated with a 92% increase in the risk of AF recurrence compared to PR interval ≤ 200 ms (HR: 1.92 with 95% CI [1.61, 2.30], P< 0.01). Our reconstructed Kaplan Meier showed that a PR interval > 200 ms was significantly associated with a 65% increase in the risk of AF recurrence compared to a PR interval ≤ 200 ms (HR: 1.65 with 95% CI [1.42, 1.92], P< 0.00001) over 120 months follow-up.Conclusion:Our meta-analysis concluded that a prolonged PR interval greater than 200 ms is a significant predictor of AF recurrence after catheter ablation, reflecting atrial remodeling, and since the PR interval can be easily measured by a surface 12-lead ECG, patients with a prolonged PR interval may require additional treatment strategies.

Circulation, Volume 150, Issue Suppl_1, Page A4131488-A4131488, November 12, 2024. Background:Diagnosis of cardiac amyloidosis (CA) is often delayed due to variability in clinical presentation. The electrocardiogram (ECG) is one of the most common and widely available tools for assessing cardiovascular diseases. Artificial intelligence (AI) models analyzing ECG have recently been developed to detect CA, but their pooled accuracy is yet to be evaluated.Aim:To meta-analyze the accuracy of AI-enhanced ECG in diagnosing CA.Methods:We searched the Scopus, MEDLINE, and Cochrane CENTRAL databases up until April 2024 for studies assessing AI-enhanced ECG diagnosis of CA. Studies reporting findings from derivation and validation cohorts were included. Studies combining other diagnostic modalities such as echocardiography were excluded. The outcome of interest was the area under the receiver operating characteristic curve (AUC) for overall CA and subtypes transthyretin amyloidosis (ATTR) and light chain amyloidosis (AL). Analysis was done using RevMan 5.4.1 general inverse variance random effects model, pooling data for AUC and 95% confidence intervals (CI).Results:5 studies comprising 7 cohorts met the eligibility criteria. The total derivation and validation cohorts were 8,639 and 3,843 respectively. The AUC were 0.89 (95% CI, 0.86-0.91) for cardiac amyloidosis, 0.90 (95% CI, 0.86-0.95) for ATTR amyloidosis and 0.80 (95% CI, 0.80-0.93) for AL amyloidosis. The forest plots can be found in the Figure 1.Conclusion:AI-enhanced ECG models effectively detect CA and may provide a useful tool for the early detection and intervention of this disease.

Circulation, Volume 150, Issue Suppl_1, Page A4142988-A4142988, November 12, 2024. Introduction:The latest expert consensus on catheter-based Left Atrial Appendage Occlusion (LAAO) suggests considering either transesophageal echocardiography (TEE) alone or the addition of Cardiac Computed Tomography Angiography (CCTA) for pre-procedural planning. However, evidence comparing the effectiveness of adding CCTA to regular TEE planning on procedural success is limited.Methods:We aimed to perform a systematic review and meta-analysis to determine the impact of adding CCTA to regular TEE for pre-procedural planning in patients undergoing LAAO. We systematically searched Cochrane, Embase, and Medline for observational studies and randomized controlled trials (RCTs) comparing TEE alone to TEE with the addition of CCTA. The primary endpoint was procedural success. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled across studies using a random-effects model.Results:Four studies were included in our meta-analysis, three of which were RCTs and one observational study, comprising a total of 824 patients, of whom 496 (60.2%) underwent additional CCTA. In the pooled analysis, procedural success was higher in the group with added CCTA (RR 1.10; 95% CI 1.01 – 1.19; p=0.022; I2=52%). A subgroup analysis of RCTs alone confirmed these findings, with a slightly higher magnitude of effect in benefit of the addition of CCTA, and with lower heterogeneity (RR 1.15; 95% CI: 1.06 – 1.25; I2 = 0%).Conclusions:In this meta-analysis comparing TEE alone vs TEE with the addition of CCTA for preprocedural planning of LAAO, the addition of CCTA was associated with a higher procedural success rate, and this finding was confirmed in a subgroup analysis of randomized data.

Circulation, Volume 150, Issue Suppl_1, Page A4113561-A4113561, November 12, 2024. Background:Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have demonstrated mortality benefits in patients with heart failure (HF). Since acute coronary syndrome (ACS) is an increasingly prevalent cardiovascular condition that often leads to HF, SGLT2i might play a role in reducing mortality in these patients. Previous randomized controlled trials (RCTs) have demonstrated inconsistent efficacy of Empagliflozin, an SGLT2i, in patients with ACS.Methods:A comprehensive systematic literature search was conducted spanning the major bibliographic databases to retrieve RCTs comparing Empagliflozin to placebo in patients with ACS. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals were pooled using the DerSimonian and Laird random-effects model with statistical significance set at p

Circulation, Volume 150, Issue Suppl_1, Page A4141513-A4141513, November 12, 2024. Background:The beneficial effect of SGLT-2 inhibitors in managing type 2 diabetes mellitus and heart failure with reduced ejection fraction has already been established. However, the outcomes of dapagliflozin on cardiovascular events in patients with acute myocardial infarction are not well studied.Hypothesis:Our study aims to investigate the effect of dapagliflozin in reducing cardiovascular events among patients with acute myocardial infarction.Methods:A systematic search was conducted using multiple electronic databases from inception until March 2024 using the appropriate Mesh terms, “ dapagliflozin,” “SGLT 2 inhibitors,” “acute myocardial infarction,” “heart failure,” “major cardiovascular events,” “all-cause mortality.” We used the random effect model to calculate the pooled relative risk and their corresponding confidence interval. A p-value of

Circulation, Volume 150, Issue Suppl_1, Page A4145225-A4145225, November 12, 2024. Background:Sodium-glucose co-transporter two inhibitors (SGLT2i) have recently been included in heart failure (HF) guidelines due to their benefits in reducing mortality and hospitalization rates. However, the benefits of SGLT2i in patients with post-acute myocardial infarction (MI) remain controversial. Therefore, we aim to perform an updated systematic review and meta-analysis comparing SGLT2i with placebo in patients after an acute MI.Methods:We performed a systematic review and meta-analysis to determine the impact of SLGT2i in patients with post-acute MI with or without diabetes type II (DM II). We systematically searched Pubmed, Cochrane, and Embase for randomized controlled trials (RCTs) comparing SGLT2i and placebo in patients following an acute MI. The primary outcome assessed was (1) HF hospitalization. In this analysis, we also included the following secondary outcomes:(2) cardiovascular (CV) mortality and (3) MI recurrence. Risk Ratios(RRs) with 95% confidence interval (CI) were pooled across studies using a random effect model.Results:Our meta-analysis included ten RCTs comprising 25908 patients, of whom 14098 (54.4%) received SGLT2i therapy and 15078 (58.2%) had type II diabetes. The mean age was 62 years, and the mean follow-up was 21.2 months. In the pooled analysis, HF hospitalization was significantly lower in the SGLT2is group (RR 0.76; 95%CI 0.68,0.84; p

Circulation, Volume 150, Issue Suppl_1, Page A4131100-A4131100, November 12, 2024. Background:Previous literature shows that metabolic surgery effectively decreases the risk of cardiovascular disease (CVD) events in patients with obesity. The use of metabolic surgery has, however, been limited in people with obesity and pre-existing CVD due to concerns of poor post-operative cardiovascular outcomes. This study aims to determine the effectiveness and safety of metabolic surgery in patients with pre-existing CVD.Methods:A search of electronic databases, PubMed, Cochrane Central and SCOPUS was conducted from their inception till May 2024. The study was conducted adhering to the PRISMA guidelines. Outcomes of interest were risk of all-cause mortality, major adverse cardiovascular events (MACE), risk of myocardial infarction (MI), and cerebrovascular events in patients with and without prior CVD undergoing bariatric surgery. Data was pooled as generic inverse variance using a random effects model, and presented as hazard ratios (HR) with their 95% confidence intervals (CI).Results:We included four studies in our analysis (n = 5,244). Our pooled analysis shows that metabolic surgery leads to significant reduction in risk of all-cause mortality (HR = 0.51, 95% CI: [0.42, 0.61]; p

Circulation, Volume 150, Issue Suppl_1, Page A4117690-A4117690, November 12, 2024. Background:Takotsubo syndrome is a reversible cause of heart failure; however, a low percentage of patients can develop serious complications, including cardiac rupture.Aims:Analyze case reports or case series of cardiac rupture in patients with Takotsubo syndrome, detailing patient characteristics to uncover risk factors and prognosis for this severe complication.Methods:We conducted a systematic search of MEDLINE and Embase databases to identify case reports or case series of patients with Takotsubo syndrome complicated by cardiac rupture, from inception to October 2023.Results:We identified 39 reported cases, including 44 subjects (40 females; 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity. An emotional trigger was present in 15 (34%) subjects and common admission symptoms were chest pain (35 [80%]) and dyspnea (14 [32%]). ST-segment elevation was present in 39 (93%) of 42 cases, with the anterior myocardial segments (37 [88%]) being the most compromised, followed by lateral (26 [62%]) and inferior (14 [33%]) segments. The mean left ventricular ejection fraction was 40±13% and an apical ballooning pattern was observed in all (100%) ventriculographies. The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery treatment was attempted in 16 (36%) cases, and 28 (64%) patients did not survive (Figure).Conclusions:Cardiac rupture as a complication of Takotsubo syndrome is a rare clinical condition associated with high mortality. Elderly females, especially from White/Caucasian or East Asian/Japanese descent, presenting with ST-segment elevation in the anterior or lateral leads, and an apical ballooning pattern, are disproportionally affected. Additional studies with prospective collection of patient-level data are needed to better identify those at increased risk for cardiac rupture associated with Takotsubo syndrome and to address ways to improve mortality rates in this population.

Circulation, Volume 150, Issue Suppl_1, Page A4134589-A4134589, November 12, 2024. Background:Risk stratification for embolism in cardiac myxomas remains poorly explored.Goals:By this meta-analysis we studied the risk factors assicated with embolism among patients with cardiac myxoma.Methods:A comprehensive search was conducted across PubMed, Embase, Cochrane Library, and Google Scholar from their inception until January 2024. Statistical analyses were performed using Cochrane’s RevMan 5.4 software. For each risk factor, the pooled odds ratio or mean difference was calculated along with the corresponding 95% confidence interval.Results:We included 18 studies in our analysis with a total population of 2601 out of which 525 patients (20.1%) had at least one episode of embolism. The pooled analyses showed that hypertension (p = 0.001), New York Heart Association I/II (p = 0.03), irregular tumor surface (p

Circulation, Volume 150, Issue Suppl_1, Page A4148117-A4148117, November 12, 2024. Background:Tricuspid regurgitation (TR) is a prevalent disease in the population and is usually progressive. Most patients are treated with conservative management due to the risk involving transcatheter tricuspid valve replacement (TTVR) and surgical tricuspid valve replacement (STVR). The TRI-SCORE was developed to evaluate the severity of patients with TR and their risk of undergoing a correction procedure. However, there is still controversy regarding the cutoff value of the score. Therefore, we aim to perform a systematic review and meta-analysis comparing the cutoffs ≥6 with =6 with

Circulation, Volume 150, Issue Suppl_1, Page A4148181-A4148181, November 12, 2024. Background:Following an ischemic stroke, a serious complication known as hemorrhagic transformation (HT) might jeopardize patient outcomes. Inflammatory indicators, such as the neutrophil-to-leukocyte ratio (NRR), and lipid markers, such as the low-density lipoprotein (LDL) to high-density lipoprotein (HDL) ratio, have been investigated as HT predictors. Recent research has delved further into the predictive significance of these biomarkers for ischemic stroke outcomes.Objectives:To systematically review the literature on the predictive value of NLR and LDL to HDL ratios for HT in ischemic stroke patients, incorporating recent findings that enhance our understanding of these biomarkers.Methods:A detailed search of electronic databases was conducted to gather studies focusing on NLR and LDL to HDL ratios as predictors for HT in ischemic stroke. The selection process followed strict inclusion criteria, and the quality of studies was rigorously assessed.Results:The paper discusses new findings that emphasize the impact LDL and NLR play in influencing HDL ratios and, hence, HT prediction. Following an ischemic stroke, an increased incidence of HT, especially parenchymal hematoma (PH), has been associated with greater NLR. A high neutrophil-to-HDL ratio (NHR) has also been identified as a possible predictor of poor prognosis in ischemic stroke, underscoring its significance in predicting HT. Furthermore, the LDL-to-HDL ratio has been connected to long-term clinical outcomes like death and recurrent myocardial infarction, which may be associated with HT risk.Conclusions:In individuals with ischemic stroke, NLR and LDL-to-HDL ratios are potential HT indicators. The addition of current data underscores the potential of these ratios not just as HT indicators but also as markers for broader stroke-related effects. More studies are needed to validate these results and provide consistent recommendations for their use in clinical practice.

Circulation, Volume 150, Issue Suppl_1, Page A4139998-A4139998, November 12, 2024. Background:Post coronary artery bypass surgery atrial fibrillation (Post-CABG AF) was reported to have variable incidence ranging from 10 to 40% and also noted to have a significant risk of stroke and all-cause mortality. This systematic review evaluated the incidence and adverse outcomes of post-CABG AF.Methods:The search period was from 1 January 2010 to September 30, 2023. We conducted a literature search in PubMed of English language, peer-reviewed manuscripts. We included observational and experimental studies among patients who underwent CABG and developed new-onset atrial fibrillation. We analyzed the overall incidence of new-onset AF, 30-day mortality, and adverse outcomes, including cerebrovascular accidents.Results:Thirty-two manuscripts, including findings from two randomized controlled trials conducted among patients with post-CABG new onset atrial fibrillation were reviewed, comprising of 150,788 patients. Of these, 39,327 (26%) developed new-onset post-CABG AF. The median age of patients with new onset post-CABG is 67.5 (IQR 66-69) years, with 52.5% males. The average incidence of cerebrovascular accidents calculated from four manuscripts was 6.26% and 3.38% among patients with and without new-onset AF post-CABG, respectively, with RR 1.92 (95% CI 1.69 – 2.18). Four studies described 30 days of mortality risk, which averaged at 3.05% and 1.46% among patients with and without new-onset AF post-CABG, respectively, with RR 2.08 (95% CI 1.77,2.45).Conclusion:This systematic analysis shows a higher incidence of post-CABG new-onset AF, along with a significant increase in 30-day mortality risk and incidence of cerebrovascular accident when compared to patients who did not develop new-onset AF postoperatively. We propose further studies on determining solutions for post-CABG AF.

Circulation, Volume 150, Issue Suppl_1, Page A4142117-A4142117, November 12, 2024. Introduction:The management of patients with Venous thromboembolism (VTE) receiving anticoagulant therapy is complicated by potential interactions with other medications, including antibiotics. Piperacillin-tazobactam (PTZ) has been implicated in unexpected disturbances in the coagulation cascade, which can be critical in patients concurrently using anticoagulants like rivaroxaban. This report explores the complexities of prescribing broad-spectrum antibiotics to patients with pre-existing cardiac conditions and the necessity of careful consideration of drug-drug interactions.Case Report:A 52-year-old white male with a history of deep vein thrombosis on rivaroxaban, presented with severe left leg cellulitis and subsequent gastrointestinal bleeding shortly after the initiation of piperacillin-tazobactam. His presentation was complicated by a rapid deterioration in his condition following a syncopal episode, characterized by hematochezia and hematemesis, necessitating urgent medical interventions including the cessation of all anticoagulation therapy, esophagogastroduodenoscopy and broad-spectrum antibiotics.Discussion:This case highlights the clinical challenges and potential risks of coagulopathies induced by PTZ or the interaction of PTZ with rivaroxaban, stressing the importance of multidisciplinary vigilance. The mechanisms by which PTZ may influence the coagulation pathways in patients already at risk due to their cardiac profiles underscore a significant area of concern for clinicians.