Risultati per: Infezione da Helicobacter pylori: review

Circulation, Volume 150, Issue Suppl_1, Page A4141750-A4141750, November 12, 2024. Background:The latest guidelines advocate for catheter ablation (CA) over standard medical therapy (SMT) for managing atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). However, significant knowledge gaps exist regarding the effectiveness of CA vs. SMT in patients with heart failure with preserved ejection fraction (HFpEF).Methods:PubMed, Scopus, and Embase until February 2024 were systematically searched. Given the limited number of randomized studies, propensity score-matched observational studies comparing CA with SMT in AF patients with HFpEF were also included. The primary outcome was a composite endpoint of all-cause mortality and HF hospitalization.Results:Eight studies that enrolled 17,717 SMT and 2537 CA patients were included. CA was associated with a significantly lower risk of the composite endpoint of all-cause mortality and HF hospitalization (HR 0.69, 95% CI: 0.40-0.98). The risk of HF hospitalization (HR 0.48, 95% CI: 0.17-0.80), cardiovascular mortality (HR 0.27, 95% CI: -0.06-0.61), and AF recurrence (HR 0.53, 95% CI: 0.37-0.70) were also lower in the CA group.Conclusion:CA demonstrated significant cardiovascular morbidity and mortality benefits when compared to SMT in the HFpEF population.

Circulation, Volume 150, Issue Suppl_1, Page A4136033-A4136033, November 12, 2024. Background:Folic acid, a B vitamin, is essential for DNA synthesis and repair, and its role in reducing homocysteine levels has been linked to cardiovascular health. Elevated homocysteine is a risk factor for cardiovascular diseases, including acute myocardial infarction (MI) and coronary artery disease (CAD). Despite evidence suggesting that folic acid supplementation may lower homocysteine levels, its clinical benefits in reducing cardiovascular events remain unclear.Methods:A comprehensive literature search was conducted in PubMed/Medline, Google Scholar, and Cochrane Library databases for studies published from 2000 to 2024 using MeSH terms related to “folic acid,” “B vitamin,” “acute myocardial infarction,” “cardiac arrest,” “heart attack,” and “coronary heart disease.” Only randomized controlled trials (RCTs) and observational studies in English involving adult patients with acute MI or CAD were included. Exclusion criteria were applied to poor-quality studies, irrelevant outcomes, overlapping populations, and non-English texts. Data on study characteristics and patient demographics were extracted, and study quality was assessed using the RoB2 tool. Outcomes were pooled using RevMan 5.3.4 software.Results:Fourteen studies on all-cause mortality showed a risk ratio (RR) of 0.99 [95% CI: 0.94-1.04], indicating no significant difference between folic acid and control groups. Eight studies on cardiovascular mortality yielded a RR of 0.90 [95% CI: 0.82-0.99], suggesting a significant reduction in cardiovascular deaths with folic acid supplementation. Analyses of sudden death, coronary artery bypass graft (CABG) events, revascularization procedures, stroke, and recurrent MI found no significant associations with folic acid supplementation.Conclusions:High-dose folic acid supplementation appears to reduce cardiovascular mortality in post-MI patients but shows no significant impact on other clinical outcomes. This meta-analysis’s limitations include potential publication bias, heterogeneity among included studies, and variability in folic acid dosages and treatment durations. Furthermore, the lack of comprehensive homocysteine level data constrained the analysis. Future large-scale RCTs are needed to fully ascertain the therapeutic potential of folic acid supplementation in secondary prevention of cardiovascular events.

Circulation, Volume 150, Issue Suppl_1, Page A4139209-A4139209, November 12, 2024. Background:There has been growing awareness and recognition of discrepant health outcomes based on ethnic and racial background in patients undergoing cardiovascular procedures. Transcatheter aortic valve procedures has become the primary treatment for aortic stenosis and is currently the standard of care. Despite widespread adoption of TAVR, African Americans (AA) have continued to remain underrepresented and typically suffer poorer outcomes. Thus, we conducted a systematic review and meta-analysis to compare TAVR outcomes between AA and non-AA populations.Methodology:We systematically searched all electronic databases (PubMed, EMBASE, Scopus, Web of science) from inception until May 25th, 2024. A pooled analysis of data from observational studies and randomized controlled trials reporting post-TAVR outcomes based on racial background were included. The key endpoints evaluated were in-hospital mortality, post-procedure myocardial infarction (MI), pacemaker placement, in-hospital stroke, vascular complications, major bleeding, acute kidney injury (AKI). We used the I2 statistic to assess heterogeneity among studies using the Random-Effects model, with significance set at I2 > 50%. All analysis was carried out using R version 4.3.2.Results:The meta-analysis of eleven observational studies, involving 953,892 TAVR patients [912,301 (95.64%) Caucasians and 41,591 (4.36%) AAs], showed a statistically significant higher risk of post-procedure pacemaker placement (OR 1.08, 95% CI: 0.77-1.51, p=

Circulation, Volume 150, Issue Suppl_1, Page A4145460-A4145460, November 12, 2024. Takotsubo syndrome (TTS) is a rare cardiovascular condition characterized by reversible ventricular dysfunction and a presentation resembling that of acute myocardial infarction. An increasing number of studies has shown physical stress as a trigger for TTS. Here, we comprehensively reviewed the literature and examined the available evidence for TTS patients triggered by sports. After searching PubMed, Embase, Web of Science and Scopus databases, two investigators independently reviewed 837 studies published through July 24, 2023. Of these studies, 21 met the inclusion criteria (n = 23 patients), including 9 patients with exercise stress test, 14 patients with daily physical activity. In Sports-trigger TTS patients, the most common TTS symptom was dyspnea (69.57%), followed by chest pain (52.17%) and diaphoresis (13.04%). The most common type of TTS was apical, accounting for 69.57% of cases, followed by the midventricular (21.74%) and basal (8.70%) types. The overall mortality rate for Sports-trigger TTS patients was 0.00%. Exercise stress test (39.13%), swimming (21.74%) and diving (21.74%) are the most frequently identified physical activity triggers of TTS. Sports is a potential etiology of TTS patients, rare but it is associated with excellent prognosis. Furthermore, the diagnosis of TTS must be considered in patients with typical symptom after sports. Future prospective studies are needed to establish appropriate guidelines for avoiding TTS during sports and the appropriate exercise prescription for Sports-trigger TTS patients to recovery.

Circulation, Volume 150, Issue Suppl_1, Page A4138074-A4138074, November 12, 2024. Background:Various durations and de-escalation strategies of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention for patients presenting with acute coronary syndromes (ACS) have been reported in randomized controlled trials (RCTs). However, it remains uncertain whether the effect of these DAPT strategies is influenced by sex.Methods:PubMed and EMBASE were searched in May 2024. We included RCTs which investigated DAPT strategies for ACS patients comparing any de-escalation strategies such as short-term DAPT (≤6 months) followed by P2Y12inhibitor or aspirin monotherapy, unguided de-escalation from potent P2Y12inhibitors to low-dose potent P2Y12inhibitors or clopidogrel at one month, and guided de-escalation with platelet function tests, compared with standard duration DAPT (6-12 months). We conducted a systematic review and meta-analysis. The efficacy and safety of each DAPT strategy was compared between sexes, and relative hazard ratios (RHR) were calculated. The primary outcome was net adverse clinical events (NACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, and major bleeding (BARC 3 or 5).Results:Eleven RCTs that enrolled 27,033 patients with ACS were included. De-escalation of antiplatelet therapy had a lower risk of NACE than standard duration DAPT for both female (HR, 0.73; 95% CI, 0.55-0.96;I2=32%) and male (HR, 0.85; 95% CI, 0.74-0.97;I2=23%). There were no significant differences in NACE between female and male patients randomized to de-escalation vs. standard duration DAPT (RHR, 0.84; 95% CI, 0.65-1.09 ;I2=0%) (Figure). Similarly, no significant differences were observed between female and male patients with respect to major adverse cardiovascular events (RHR, 0.75; 95% CI, 0.52-1.08;I2=0%) or major bleeding (RHR, 1.37; 95% CI, 0.85-2.21 ;I2=0%).Conclusion:In patients with ACS, de-escalation of antiplatelet therapy is safe and effective irrespective of sex.

Circulation, Volume 150, Issue Suppl_1, Page A4139425-A4139425, November 12, 2024. Introduction:Although prior reports suggest that percutaneous coronary intervention (PCI) of non-infarct-related artery (NIRA) in patients with acute myocardial infarction (AMI) and multivessel disease improves clinical outcomes, the optimal timing for NIRA-PCI remains debated.Research Questions:When is the preferred timing to perform NIRA-PCI after infarct-related-artery (IRA)- PCI?Aims:We aimed to compare the clinical outcomes based on PCI strategies classified by the timing of NIRA-PCI in AMI patients with multivessel disease.Methods:We performed a systematic review and network meta-analysis of randomized controlled trials (RCTs) evaluating clinical outcomes to compare PCI strategies for multivessel disease in AMI patients until September 2023. The primary outcome measure was all-cause death, while the secondary outcomes included myocardial infarction, stroke, coronary revascularization, and bleeding.Results:We included 22 RCTs (N=13,093) comparing the IRA only-PCI and NIRA-PCI strategies. Immediate NIRA-PCI strategy was defined as performing NIRA-PCI after IRA-PCI without delay. Staged NIRA-PCI strategies were categorized into three groups based on the protocol-defined or treated timing for NIRA-PCI from the IRA-PCI: within one week (Staged_Within1W), one week to one month (Staged_1Wto1M), and after one month (Staged_After1M). Compared with IRA-only PCI, Staged_Within1W had significantly lower risks for all-cause death, myocardial infarction, and coronary revascularization. The immediate PCI strategy relative to IRA-only PCI favored for myocardial infarction and coronary revascularization; however, there was no significant difference for all-cause death. Although Staged_1Wto1M or Staged_After1M showed trends similar to Staged_Within1W, all outcome measures had no significant difference. The risk for bleeding or stroke was comparable among the four strategies.Conclusions:This meta-analysis demonstrated a consistent benefit of the NIRA-PCI strategies relative to IRA-only PCI strategy in patients with AMI and multivessel disease. Among the NIRA-PCI strategies, NIRA-PCI within one week appeared the most preferred strategy in patients with AMI and multivessel disease.

Circulation, Volume 150, Issue Suppl_1, Page A4146232-A4146232, November 12, 2024. Background:Kidney transplant is the most common transplanted organ in the world. However, the efficacy of transplants from deceased donors with acute kidney injury (AKI) before transplantation is a matter of debate. For this reason, we performed a meta-analysis to assess the outcomes of kidney transplants from deceased donors with AKI when compared to non-AKI deceased donors.Methods:We systematically searched MedLine, Embase, and Cochrane databases for studies comparing kidney transplants from deceased donors with AKI compared to those without AKI. The endpoints were Acute Rejection (AR), Delayed Graft Function (DGF), and Graft Failure (GF). We calculated event prevalence with risk ratios for binary outcomes, along with 95% confidence intervals (CI). Statistical analysis was performed using R version 4.3.2. A random-effects model was used for all outcomes, and heterogeneity was assessed with Cochrane’s Q and I2 statistics.Results:We included 10 retrospective cohort studies, that comprised 68,619 patients, where 33,623 (49%) were females after we disposed of major overlapping populations. We found that the overall risk of AR, DGF, and GF to be respectively (RR 0.93; 95% CI: 0.88 to 0.98; p

Circulation, Volume 150, Issue Suppl_1, Page A4143622-A4143622, November 12, 2024. Introduction:Obesity-related heart failure in patients is often associated with high symptom burden. However, no treatments have been proven to specifically target obesity-related heart failure with preserved ejection fraction (HfpEF).Objective:The objective of this study is to evaluate the efficacy of semaglutide in patients with obesity and HfpEF.Methods:The study was by the PRISMA guidelines. Studies reporting endpoints of semaglutide in patients with obesity and HfpEF were included. The outcomes included percentage weight change and adjudicated heart failure events. Both random and common effects models were used for the data analysis. The random intercept logistic regression model was used to compute the proportions, and the Peto method was used to compute the odds ratios. A p-value ≤ 0.05 was considered significant.Results:In total, three studies with 1463 patients with obesity and HfpEF were included in the study. The mean age of the patients was 68.8 ± 3.47 years. 50.7% of the patients were females. Patients who received Semaglutide had statistically higher odds of 10% weight reduction (OR 6.35; 1.54-26.21; p

Circulation, Volume 150, Issue Suppl_1, Page A4143621-A4143621, November 12, 2024. Introduction:As per current guidelines, low molecular weight heparin (LMWH) has been commonly used as prophylaxis for venous thromboembolism in cancer patients. Directly acting anticoagulants (DOACs) having ease of administration, oral availability despite renal dysfunction, and possibly higher adherence, are also being used as an alternative to prevent venous thromboembolism Events (VTE) recently. In addition, rivaroxaban is among the first DOACs used in the prophylaxis for VTE.Hypothesis:This study intends to compare the efficacy and safety of rivaroxaban and LMWH (enoxaparin, dalteparin, and nadroparin) in preventing VTE in cancer patients.Methods:A comprehensive literature search was performed on PubMed, Embase, Scopus, and Cochrane libraries from inception until March 2024, with suitable Mesh terms. The random effects model was used to calculate the pooled Odds Ratio (OR) with their corresponding 95% confidence intervals (CI). A p-value of

Circulation, Volume 150, Issue Suppl_1, Page A4119611-A4119611, November 12, 2024. Background:Catheter ablation has emerged as an effective treatment option for atrial fibrillation (AF) in the general population. However, limited data exist on the outcomes of catheter ablation in patients infected with the Human Immunodeficiency Virus (HIV+) with concomitant AF.Objectives:This systematic review and single arm meta-analysis aims to comprehensively evaluate the literature on catheter ablation approach and outcome in HIV+ patients with AF.Methods:A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted following PRISMA guidelines.Studies meeting the intervention of catheter ablation for AF in HIV+ patients, using radiofrequency, cryoballoon, or pulsed field ablation techniques, were included and data were collected and synthesized using proportion meta-analysis techniques. Statistical analysis was carried out using R software.Results:Three studies met the inclusion criteria, involving 89 HIV+ patients, with an average age of 51.5 years, of whom 83.1% were men, undergoing catheter ablation. Two studies performed received isolation of the pulmonary vein (PV) + posterior wall and superior vena cava. And one study evaluated only the isolation of the pulmonary veins. Of these patients, 43.8% had paroxysmal AF and 56.1% had persistent AF. In two studies reporting freedom from atrial arrhythmias, all patients (62) experienced recurrence of atrial arrhythmias within 5 years of follow-up. Freedom from repeat ablation was 6.26% (Figure 1A). The rate of Pulmonary Vein Trigger was 31.28% (Figure 1B), while the rate of Non-Pulmonary Vein Trigger (non-PV) was 76.64% (Figure 1C).Conclusion:In this systematic review and meta-analysis assessing outcomes of ablation in HIV patients with AF, we observed a similar prevalence of paroxysmal and persistent AF. Furthermore, contrary to the non-HIV+ patients, a high incidence of non-pulmonary vein triggers of AF was noted in this population.

Circulation, Volume 150, Issue Suppl_1, Page A4139264-A4139264, November 12, 2024. Introduction:Pulmonary vein isolation (PVI) is a catheter ablation (CA) technique employed as a treatment strategy for atrial fibrillation in young patients or those who do not respond to medical therapy. Techniques for PVI include radiofrequency (RFA) ablation and balloon cryoablation. The left atrial posterior wall has been recognized as a significant anatomical area involved in the onset and persistence of atrial fibrillation (AF). However, the impact of additional posterior wall isolation (PWI) during PVI remains uncertain.Research Question:What are the outcomes of pulmonary vein isolation compared to pulmonary vein isolation with adjunctive posterior wall isolation in patients with paroxysmal atrial fibrillation?Goals:To determine the efficacy of adjunctive posterior wall isolation in treating persistent AF.Methods:A systematic literature search was conducted on various databases (Pubmed/Medline, EMBASE, Google Scholar, Scopus) from inception until March 2024, to include studies comparing outcomes of patients undergoing management of paroxysmal AF with either PVI + concurrent PWI versus only PVI. Observational studies and Randomized Controlled Trials were included. Review Manager (v 5.3) was used for pooled analysis of included studies employing risk ratio (RR) as the effect measure (4).Results:We conducted a random-effects meta-analysis, pooling data from 5 studies with a total of 2,441 patients. Our analysis revealed a significant improvement in AF recurrence for the cryoablation technique with PVI+PWI (RR=0.56, 95% CI: 0.41, 0.76, I2=0%, p=0.0002) but no significant result was found for PVI+PWI in RFA (RR=1.37, 95% CI: 0.87, 2.18, I2=0%, p=0.18) for AF. For the recurrence of all arrhythmias, the risk ratios for cryoablation and RFA are 0.60 (95% CI: 0.46, 0.78, I2=0%, p=0.0001) and 1.17 (95% CI: 0.83, 1.65, I2=0%, p=0.37) respectively, significant in the case of cryoablation and non-significant for RFA.Conclusion:Concurrent PWI with PVI with the cryoablation technique in patients for the management of paroxysmal AF reduces the risk of recurrent AF. Due to the limited number of studies included, it is possible that the results were underpowered. Further prospective studies in the future are warranted.

Circulation, Volume 150, Issue Suppl_1, Page A4145264-A4145264, November 12, 2024. Background:Transcatheter aortic valve-in-valve (VIV) replacement has emerged as a valid alternative to conventional re-operation for the treatment of failed bioprosthetic surgical aortic valves. Self-expandable valves (SEV) and balloon-expandable valves (BEV) are the two major devices used. The aim of this study is to compare outcomes between SEV and BEV when used for transcatheter aortic valve replacement (TAVR) procedures in failed surgical prostheses. Methods:A comprehensive search was conducted on PubMed, Scopus, Web of Science, Cochrane Library, and Embase databases to identify studies comparing aortic valve in valve (ViV) with SEV and BEV for failed surgical aortic prostheses from inception to May 22, 2024. To estimate the effect size, dichotomous outcomes were pooled as risk ratio (RR), and continuous outcomes were pooled as mean difference (MD) with their respective 95% confidence interval (CI). Results:We included nine studies with a total of 1258 patients in the SEV group and 1079 in the BEV group. Compared to patients in the BEV group, patients in the SEV group had significantly lower one-year mortality (RR = 0.69; 95% CI: [0.49-0.98], p = 0.04). SEV group also had less incidence of severe patient protheses mismatch (RR = 0.49; 95% CI: [0.32-0.75], p

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 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 A4141761-A4141761, November 12, 2024. Background:Rotational atherectomy has been performed using both radial and femoral access over the years, but there is a lack of consensus on the safety and efficacy of these access sites.Aim:To assess the safety and efficacy of radial access and femoral access.Methods:MEDLINE, Scopus, and Cochrane Library were searched until May 2024 for studies comparing radial approach with femoral approach in patients undergoing rotational atherectomy. The primary outcome was major vascular site bleeding. Secondary outcomes included short-term mortality, long-term mortality, myocardial infarction, major adverse cardiovascular events (MACE), acute stent thrombosis, procedural success, procedural time, hospital stay and radiation exposure. Effect estimates were synthesized using a random-effects model and expressed as risk ratios (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with corresponding 95% confidence intervals (CIs).Results:13 studies including 13,581 patients with mean age of 60.76 years in the radial group and 66.86 years in the femoral group, who had undergone rotational atherectomy, were included in the analysis. For the outcome of major vascular site bleeding, there was significantly lower risk (RR: 0.25; 95% CI [0.15, 0.43]; p

Circulation, Volume 150, Issue Suppl_1, Page ASu504-ASu504, November 12, 2024. Background:Rapid defibrillation by the public with automated external defibrillators (AEDs) is critical to improving out-of-hospital cardiac arrest (OHCA) survival. Concerns about theft, vandalism, and misuse of AEDs have led to the implementation of security measures, including the use of locked cabinets to house these devices in public areas.Aim:This scoping review aims to systematically explore the existing literature on the impact of locked cabinets for AEDs during emergencies.Methods:A search of Medline, Embase, Cochrane, CINAHL and Google Scholar (20 pages) was performed on May 25th 2024. Studies of any design (e.g., experimental, observational, qualitative) that evaluated the impact of locked cabinets on AED accessibility and effectiveness during emergencies. Data were charting was iterative, and after reading included studies the studies were grouped by the outcomes studied.Results:We screened 2,096 titles and found 10 relevant studies: 8 observational studies and 2 OHCA simulation studies. Four papers were only published as conference abstract and no studies reported on patient outcomes. Data were reported on varying numbers of AEDS (ranging from 39 to 31,938) which were located inside buildings and public spaces. Overall theft and vandalism rates were very low, with the majority of studies reporting rates of