Risultati per: Il dolore neuropatico: review

Circulation, Volume 150, Issue Suppl_1, Page A4134877-A4134877, November 12, 2024. Background:Cardiovascular disease (CVD) remains a leading cause of death globally, yet disparities in CVD outcomes among sexual minorities compared to heterosexual adults are under-researched. Sexual minorities face unique stressors, discrimination, and barriers to healthcare, which may contribute to higher CVD risk. This meta-analysis synthesizes evidence on health disparities between sexual minorities and heterosexual adults.Methods:We searched MEDLINE, Cochrane, and Embase databases for studies published between 2002 to 2024 that compared cardiovascular health disparities between sexual minorities and their heterosexual counterparts. Outcomes were CVD, Diabetes, Hypertension, and Obesity. We pooled odds ratios (OR) for binary endpoints with 95% confidence intervals (CI) using a random-effects model. Statistical analyses were performed using R software version 4.3.2.Results:We included 9 Cross-sectional studies after minimizing population overlap, comprising 1,938,814 patients with a mean age of 47 years. There were no significant differences in the odds of CVD (OR 1.10; 95% CI 0.87 to 1.39; Figure 1 A), Diabetes (OR 0.88; 95% CI 0.74 to 1.04; Figure 1 B), hypertension (OR 1.07; 95% CI 0.97 to 1.19; Figure 2 A) and Obesity (OR 1.01; 95% CI 0.76 to 1.35; Figure 2 B) between groups. In subgroup analysis, there were higher odds of obesity in the sexual minority population when compared to their heterosexual counterparts (OR 1.29; 95 % CI 1.15 to 1.45) and higher hypertension odds in sexual minority men (OR 1.35; 95% CI 1.12 to 1.63).Conclusion:In this meta-analysis, we found no statistically significant difference in the prevalence of CVD, diabetes, and obesity between sexual minorities and heterosexuals, meaning that more studies are necessary to assess this difference. Subgroup analyses revealed sexual minority men had higher odds of hypertension and sexual minority women for obesity.

Circulation, Volume 150, Issue Suppl_1, Page A4143963-A4143963, November 12, 2024. Background:Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are known to have cardioprotective effects in diabetes mellitus and heart failure patients. Anthracyclines, chemotherapeutic agents used in the treatment of various malignancies, carry a high risk of cardiotoxicity and heart failure. The use of SGLT2i to prevent cardiotoxicity and adverse cardiovascular outcomes in cancer patients undergoing anthracycline therapy is not well established.Hypothesis:This meta-analysis aims to evaluate the relationship between the use of SGLT2i for the reduction of adverse cardiovascular outcomes in patients undergoing anthracycline therapy.Methods:We systematically searched for relevant articles published until March 2024 on PubMed, Cochrane, and Embase. The hazard ratio (HR) was pooled using the random-effects model and a p-value of

Circulation, Volume 150, Issue Suppl_1, Page A4147438-A4147438, November 12, 2024. Introduction/Background:Right ventricular failure (RVF) is the inability of the RV to adequately perfuse pulmonary circulation and sufficiently fill the LV; it increases morbidity, mortality, and length of hospital stay. In critically ill patients, three main etiologies of RV failure are excessive preload, excessive afterload, and insufficient myocardial contractility. In addition to medical management, some patients at risk for refractory cardiogenic shock may require temporary mechanical circulatory support (TMCS).Research Questions/Hypotheses:The Impella RP flex (Abiomed, Danvers, MA) has provided an option for percutaneous RV support through the internal jugular vein and allows for early rehabilitation of complex cardiac patients.Methods/Approach:Consecutive cases at our center using the Impella RP flex were evaluated for hemodynamics and quality measures.Research/Data:Thirteen patients received RP flex support: 3 patients with pulmonary hypertension during mitral valve repair or replacement, 4 patients for prophylactic placement pre-LVAD, 3 patients with intraoperative placement during CABG, 2 patients with acute myocardial infarction, and 1 patient for salvage therapy. The average length of stay for our patients was 30.23 days; average duration of Impella support was 4.46 days.Twelve patients required inotropic support with milrinone and 91.7% received epinephrine. Of the 12 patients who required vasodilators, 100% received inhaled nitric oxide and 50% received sildenafil. Four patients required sildenafil at the time of discharge (36.4%).Internal jugular vein cannulation and intracorporeal support allows capable patients to participate in physical therapy early in the recovery process. Of our cohort, 30.77% of patients were successfully assisted out of bed to chair and 15.38% ambulated with assistance. All patients had pre- and post-creatinine levels collected, with an average pre-implantation creatinine level of 1.48 and post-explantation level of 1.76. The average pre-implantation lactic acid level was 4.75; only 11 patients had post-explantation lactic acid measurements collected, which averaged 3. Eleven patients were successfully discharged and no patients required home inotropes.Conclusions:The RP flex allows for RV unloading for patients requiring TMCS; it is best used early or prophylactically for patients who are otherwise high-risk for complications or who may require high-dose pressors and prolonged ICU level of care.

Circulation, Volume 150, Issue Suppl_1, Page A4141922-A4141922, November 12, 2024. Advances in modeling methodology and increased democratization of software led to rapid increase in novel prediction models. In clinical research, these models proclaim novel predictors, promise superior accuracy and meaningful improvements in patient outcomes. Developing an accurate prediction model requires rigorous methodology with great attention to study design and conduct. Failure to adhere leads to prediction bias and may result in harmful decisions.We conducted a systematic review of research articles in heart failure listed in PubMed 2018 – 2023 and presented by their authors as developing prediction models, either diagnostic or prognostic. The study variables were selected based on PROBAST and TRIPOD (Table 1). These were summarized and the study conducts were evaluated against the gold standard of prediction modeling per PROBAST and TRIPOD. For each study, we calculated the optimal sample size, i.e. the minimal size required for at least 5% prediction accuracy and 90% shrinkage in parameters. Sentiment analysis was performed to estimate the prevalence of promotional language in the abstract corpus.From 6,429 studies, 212 studies were presented as developing prediction models. Of those, 83 (39%) were truly about developing prediction models (TPM) and the rest were impostors, i.e. inferential models misrepresented as predictive.Mostly, TPMs were prognostic, modeled binary outcomes, and employed machine-learning methods (Table 1). Commonly, essential data volume summaries were lacking and handling of missing data was inadequate. The deficit in the number of samples in model training was 1499 (-316, 3866) samples with 52(71%) studies below the optimal size.Model validation or testing was not performed in 30% of the studies. Discrimination statistics were reported often in testing but not in validation. The calibration was rarely assessed at either phase. Thirty (36%) studies had enough information to implement risk score calculations. The sentiment analysis showed increased use of hype words in both TPMs and impostors relative to 2020-rates in Millar et al (2022).Most TPM studies exhibit poor design, insufficient sample size, mishandling of missing data, and inadequate model evaluation. These deficiencies result in biased risk estimates, degrade the performance in external data limiting generalizability and clinical utility of the developed models. Excessive use of hype can be misleading and may impede objective evaluation by the readers.

Circulation, Volume 150, Issue Suppl_1, Page A4139484-A4139484, November 12, 2024. Background:Cardiac sarcoidosis (CS) is a rare condition marked by conduction disturbances, and ventricular tachycardia (VT) resulting from reentrant pathways. VT ablation is typically considered for patients with refractory VT. This systematic review aims to synthesize reported outcomes and identify potential predictors for the success of VT ablation in CS patients.Methods:A systematic literature review was conducted following the PRISMA guidelines, searching PubMed, Cochrane, Embase, and Scopus databases up to May 2024. A random-effects model was used to evaluate electrophysiologic and procedural variables and compare outcomes to identify potential predictors of success.Results:After excluding duplicates, 473 titles and abstracts were screened. Twenty-five studies were fully reviewed, and 9 studies comprising data from 311 CS patients who underwent VT ablation were included. The mean age of patients was 50.5 years, with 30% being female. Epicardial mapping was performed in 29% (CI 22-36%; 72/251) of cases, and 96% (CI 77-100%; 65/72) of those underwent epicardial ablation. The prevalence of VT storm before the procedure was 28% (CI 16-42%; 89/259), with a suppression success rate of 84% (CI 73-93%; 64/76). The acute complete success rate defined as lack of inducibility was 58% (CI 49-66%; 174/307). During follow-up, which ranged from 19 to 58 months, 34% (CI 21-48%; 113/271) of patients survived free from the composite outcome of death, transplantation, or VT recurrence. Patients with acute success had fewer inducible VTs (MD –1.1; CI: -1.8 to -0.5; p < 0.001). No other variables were significantly associated with acute success. However, patients with acute success tended to be older than those with partial or unsuccessful outcomes (MD 7.5; CI: -0.2 to 15.1; p = 0.055).Conclusion:VT ablation in patients with CS shows acceptable acute success rates. Patients presenting with VT storm have a high rate of arrhythmia acute suppression. A lower number of inducible VTs is associated with higher acute success rates. Despite these results, the prognosis remains poor, with a significant proportion of patients experiencing disease recurrence, death, or requiring heart transplantation.

Circulation, Volume 150, Issue Suppl_1, Page A4144167-A4144167, November 12, 2024. Background:Myocardial ischemia remains a significant global health concern for cardiovascular morbidity and mortality. In addition to the traditional treatment modalities, stem cell transplantation is emerging as a promising therapeutic intervention for cardiac regeneration and functional recovery. Our study evaluated the efficacy and clinical impact of SCT by reducing infarct scar size and improving cardiac function. The secondary objectives are to compare stem cell types, identify optimal transplantation strategies, and address safety and feasibility.Method:Randomized controlled trials from January 2000 to July 2023 were collected from PubMed, Cochrane, Google Scholar, and Elsevier. Based on criteria and evidence quality, screening and selection were done. A RevMan analysis was done. Infarct size, LVEF, LVESV, LVEDV, and mortality were measured. Comparator variables included placebo, medical therapy, CABG, and other types of stem cells. Randomization, allocation concealment, blinding, and therapeutic interventions differed among trials. Heterogeneity and publication bias were assessed using random-effects model and funnel plots. Sensitivity analysis and meta-regression identified outcome variability.Results:Seventeen studies (n = 1022 patients) met the inclusion criteria, encompassing various cell types, doses, and administration routes. Compared to controls, SCT greatly enhanced LVEF (MD: 3.39, 95% CI: 1.05 to 5.73, p = 0.005) and reduced infarct size (MD: 14.23, 95% CI: 7.12 to 21.35, p

Circulation, Volume 150, Issue Suppl_1, Page A4147488-A4147488, November 12, 2024. Background:Previous studies have shown that influenza vaccination (IV) may reduce the incidence of cardiovascular events in patients with cardiovascular disease. In this meta-analysis, we aimed to clarify the effects of IV in patients with myocardial ischemia (MI) and heart failure (HF).Hypothesis:The influenza vaccine reduces the incidence of major adverse cardiovascular events among patients with MI and HF.Methods:A comprehensive search was performed in PubMed, Cochrane Library, and Embase databases from inception up to march 2024. We included randomized clinical trials (RCTs) that assessed the effects of IV in patients with HF and MI, and reported outcomes of major adverse cardiovascular events (MACE), cardiovascular death, and all-cause death. Analyses were conducted using R software. Heterogeneity was assessed using the I2 statistic. A random-effects model was applied to calculate pooled Relative Risk (RR). A stratified analysis was performed to investigate ST-segment elevation myocardial infarction (STEMI) and non-STEMI subgroups. Sensitivity analysis was performed to explore heterogeneity. Confidence Interval (CI) was set at 95%.Results:We identified six RCTs comprising a total population of 9229 participants. Of these, 4100 were patients with MI, and 5129 were HF patients. Overall, MACE (RR 0.65; 95%CI 0.47-0.89; p=0.007; I2=75%) (Figure 1A) and cardiovascular death (RR 0.60; 95%CI 0.37-0.96; p=0.035; I2=62%) (Figure 1B) were significantly lower in group receiving IV compared to placebo/no treatment. No statistically significant difference was observed for all-cause death. In sensitivity analysis, after excluding HF patients, IV significantly decreased the risk of MACE (RR 0.57; 95%CI 0.43-0.76; p

Circulation, Volume 150, Issue Suppl_1, Page A4124677-A4124677, November 12, 2024. Introduction:Chagas disease is a significant cause of tropical disease-related mortality. It presents in acute, indeterminate, and chronic phases, with chronic cardiomyopathy being the most severe form, leading to heart failure, arrhythmias, and sudden cardiac death. Conventional echocardiography often fails to detect early subclinical dysfunction, whereas Global longitudinal strain (GLS) may provide earlier detection of myocardial strain abnormalities. Left ventricular dysfunction is an independent predictor of mortality and GLS is an emerging modality that may aid early detection of cardiac involvement.Objective:This study aims to compare left ventricular function using multiple echocardiographic parameters between patients with indeterminate and chronic forms of Chagas disease and to perform a systematic literature review.Methods:The observational study involved 11 patients (mean age 76.36 years) from a tertiary hospital in Brazil, classified as indeterminate (45%) or chronic (55%). Serological confirmation and detailed echocardiographic evaluations, including GLS, were performed. A systematic literature review was also conducted on GLS in Chagas cardiomyopathy.Results:Patients with chronic Chagas disease showed significantly lower LVEF and GLS compared to those with the indeterminate form. Segmental strain analysis revealed consistent contractility reductions across specific ventricular segments in both groups.Discussion:Chagas cardiomyopathy often leads to dilated cardiomyopathy with significant arrhythmias and heart failure. GLS can detect early myocardial changes even before a significant drop in LVEF, indicating its potential for early diagnosis and better management of Chagas cardiomyopathy. Literature review supports the use of GLS for detecting early cardiac involvement and predicting adverse outcomes.Conclusion:Incorporating GLS with conventional echocardiography offers enhanced early detection of myocardial changes in Chagas disease. While promising, further research is needed to establish the clinical significance and impact of these techniques in routine practice.

Circulation, Volume 150, Issue Suppl_1, Page A4140486-A4140486, November 12, 2024. Introduction:Reperfusion injury, defined as the injury to tissue upon restoring blood flow after a period of ischemia, remains a concern in many clinical scenarios such as myocardial infarction and coronary artery bypass surgery. Among several mechanisms of action, metformin, a commonly used antidiabetic medication, has received attention recently for its potential protective effects against reperfusion injury.Hypothesis:Metformin ameliorates reperfusion injury due to a reduction in myocardial injury markers and improvement in endothelial function across diverse clinical settings.Methods:A systematic literature search of PubMed, Embase, and Cochrane Library databases up to January 2022 was performed. Metformin’s effects on reperfusion injury were identified by searching myocardial injury and endothelial dysfunction. The study included eight articles on metformin and reperfusion injury. Animal studies, expert opinions, and reviews were excluded.Results:Treatment with metformin significantly lowered myocardial injury markers, with reduced troponin levels: pooled SMD -0.61, 95% CI -0.87 to -0.36, and infarct size by a pooled mean difference of -5.25%, 95% CI -8.96 to -1.53. Additionally, metformin had beneficial effects on the endpoints of endothelial function, including flow-mediated dilation (pooled SMD 0.68, 95% CI 0.38 to 0.97) and markers of oxidative stress and inflammation. Subgroup analysis showed a consistent effect of metformin across different patient populations and different clinical settings. The sensitivity analysis did not indicate the presence of a single study that affected the stability of the result.Conclusion:This meta-analysis supports the protective effect of metformin against reperfusion injury in various clinical settings. Metformin appears to reduce myocardial injury and promote improvement in endothelial function, which may translate into reducing the risk of adverse cardiovascular events among patient populations at high risk for them. Further research is warranted to investigate the mechanisms for its cardioprotective effect.

Circulation, Volume 150, Issue Suppl_1, Page A4135270-A4135270, November 12, 2024. Introduction:A growing body of evidence from randomized controlled trials (RCTs) has demonstrated the superiority of transcatheter aortic valve replacement (TAVR) over surgical aortic valve replacement (SAVR) irrespective of surgical risk in patients with severe aortic stenosis (SAS). Given the rise in TAVR procedures, analyzing trends in outcomes over time is critical to aid clinical decision-making. Hence, we pooled RCT data for a robust assessment of clinical and procedural outcomes in SAS patients undergoing TAVR and SAVR.Methods:PUBMED and SCOPUS were queried until April 2024. Trials were classified into high and low-risk groups based on surgical risk. The outcomes were analyzed at 30 days (short-term), 1 year (mid-term), and 5 years (long-term). Estimates were calculated as random effects risk ratios (RRs) with 95% confidence intervals (CI).Results:10 RCTs with a total of 10,252 patients were included. There was no significant association between TAVR and SAVR in reducing all-cause mortality at 30 days (RR: 0.84 [0.64, 1.10]; Figure 1a). While TAVR was associated with a significantly lower all-cause mortality at 1 year (RR: 0.82 [0.68-0.97]; Figure 1b), it was linked with a significantly higher all-cause mortality at 5 years (RR: 1.14 [1.07-1.21]; Figure 1c). Myocardial infarction and stroke were similar in both groups up to 5 years. TAVR was associated with a lower risk of acute kidney injury for up to 1 year and atrial fibrillation for up to 5 years but a higher risk of new permanent pacemaker implantation and aortic valve re-intervention for up to 5 years. In low-risk patients, TAVR showed no significant differences from SAVR for all-cause mortality at 30 days and 5 years, but it was significant at 1 year. In high-surgical-risk patients, all-cause mortality was comparable between TAVR AND SAVR at 30 days and 1 year, with a higher rate observed with TAVR at 5 years.Conclusion:Compared with SAVR, TAVR was superior in reducing all-cause mortality at 1 year in low-risk patients and inferior in reducing all-cause mortality at 5 years in high-risk patients. A thorough evaluation of anatomical, clinical, and procedural factors is crucial to tailor the optimal intervention for each patient.

Circulation, Volume 150, Issue Suppl_1, Page A4146871-A4146871, November 12, 2024. Background:Transcatheter mitral valve replacement (TMVR) has emerged as a promising alternative to conventional redo-surgical intervention in patients presenting with mitral valve prosthesis failure. We conducted a meta-analysis to delineate efficacy and safety of transcatheter mitral valve replacement (TMVR), encompassing both valve-in-valve (ViV) and valve-in-ring (ViR) procedures, compared to redo-surgical mitral valve replacement (SMVR).Aim:The primary aim of our meta-analysis was to investigate the early clinical outcomes following either ViV/ViR TMVR or SMVR.Methods:PubMed/MEDLINE, Cochrane Library, and clinicaltrials.gov were systematically searched according to predefined inclusion and exclusion criteria. Several efficacy and safety outcomes were pooled and reported as risk ratios (RRs) with 95% confidence intervals (CIs).Results:Fourteen retrospective cohort studies (patients=18,519) were evaluated in this analysis. Compared with redo-SMVR for mitral valve prosthesis failure, TMVR exhibited lower in-hospital mortality (OR=0.69; 95% CI 0.56–0.86; p

Circulation, Volume 150, Issue Suppl_1, Page A4146032-A4146032, November 12, 2024. Background:Stress testing is a well-established non-invasive method commonly used in clinical practice for patients with angina. However, its benefit in diabetic patients after coronary intervention remains unclear. This systematic review aims to address this knowledge gap by evaluating the impact of routine stress testing in this specific patient population.Research Question:Does routine stress testing improve outcomes in diabetic patients with prior revascularization?Goals:We aimed to perform a systematic review and meta-analysis of studies that evaluated death, MACE and repeated revascularization episodes in diabetic patients who have prior coronary intervention.Methods:We searched PubMed, Embase and Cochrane databases for randomized controlled trials (RCT) and cohort studies evaluating diabetic patients who underwent cardiac revascularization and reporting the following outcomes: (1) Myocardial Infarction (MI) and Cardiovascular Death; (2) Ischemia; and (3) Repeat Revascularization. Statistical analysis was performed using Open Meta and heterogeneity was assessed with I2statistical.Results:We included 16924 patients from 16 studies, of which 15 were observational cohort studies and 1 was a RCT. All patients were diabetics and had a history of revascularization. Follow-up ranged from 1 to 5.2 years. The mean patient age was 60.8±9.5 years and 75% were male. MI and cardiovascular death was found in 9.8% (95% CI; range 6.8-12.8%; p

Circulation, Volume 150, Issue Suppl_1, Page A4139802-A4139802, November 12, 2024. Background:SGLT2 inhibitors improve cardiovascular outcomes in patients with heart failure and chronic kidney disease. However, the evidence on their efficacy in patients who have had acute myocardial infarction is still lacking. This systematic review and meta-analysis aimed to assess the safety and efficacy of SGLT2 inhibitors on cardiovascular outcomes in patients with a recent acute myocardial infarction.Methods:We searched various electronic databases including MEDLINE (via PubMed), Embase, the Cochrane Library, and Clincaltrials.gov to retrieve randomized controlled trials comparing SGLT2 inhibitors to placebo in patients with acute myocardial infarction. We performed statistical analysis on RevMan 5.4 using the random effect model. We reported dichotomous outcomes as relative risk (RR) along with 95% confidence intervals (CI) and continuous outcomes as mean difference (MD) along with 95% CI.Results:Our meta-analysis included 6 RCTs involving 11,256 patients. SGLT2i significantly decreased the rate of hospitalization for heart failure (RR 0.73, 95% CI: 0.61-0.88, I2=0%) with no significant change in mortality (RR 1.05, 95% CI: 0.78-1.40, I2=25%). There was no significant change between the two groups when assessing the rate of all-cause hospitalization (RR 1.00, 95% CI: 0.84-1.17, I2=%), cardiovascular death (RR 1.03, 95% CI: 0.83-1.28, I2=%), hepatic injury (RR 1.99, 95% CI: 0.54-7.40, I2=%), ketoacidosis (RR 2.00, 95% CI: 0.18-22.01, I2=%), hypoglycemia (RR 0.80, 95% CI: 0.21-2.97, I2=%), or lower limb amputation (RR 1.80, 95% CI: 0.60-5.36, I2=%). The mean change in NT-pro BNP (MD -0.28 95% CI: -0.61-0.05, I2=0%] and LVEF at follow-up (MD 0.62, 95% CI -0.73-1.97, I2=0%] were also comparable between the two groups.Conclusion:SGLT2i reduces the rate of hospitalization for heart failure with no change in mortality or other cardiovascular outcomes. Further high-quality and large-scale RCTs are required to confirm or refute our findings and provide more reliable results.

Circulation, Volume 150, Issue Suppl_1, Page A4118611-A4118611, November 12, 2024. Background:Ultrasound Renal Denervation (uRDN) has emerged as an innovative therapeutic modality for resistant hypertension. However, there is uncertainty regarding the effectiveness of this procedure compared to other renal denervation techniques. We aimed to evaluate the effectiveness of uRDN especially on ambulatory and daytime blood pressure.Objectives:given the need for clarity in treatment approaches, our study aimed to evaluate the impact of ultrasound renal denervation particularly on ambulatory and daytime blood pressure in patients with hypertension.Methods:we conducted a systematic search of Embase, PubMed, and Cochrane Library databases up to March 2024 to identify randomized controlled trials (RCT) evaluating the effectiveness of uRDN. Statistical analyses were performed using RevMan 6.3 software, utilizing the mean and standard deviation method to calculate mean differences (MD) with a 95% confidence interval (CI).Results:four studies were included in the final analysis, involving 648 patients. Ultrasound renal denervation reduced daytime ambulatory SBP (5.12 mmHg; 95% CI -6.07 to -4.16, p = < 0.00001), 24 hours SBP (-4.87 mmHg; 95% CI 6.53 to -3.20, p = < 0.00001), office SBP (-5.03 mmHg; 95% CI -6.27 to -3.79, p = < 0.00001) at 2 months after the procedure and showed a decrease in patient medication at 6 months after the procedure.Conclusions:the use of uRND decreases the blood pressure among patients within 2-3 months following the procedure. However, after 6-months of procedure, there is no further significant reduction in blood pressure, although there is a notable decrease in medication. With this data, it is reassuring to conclude that endovascular uRDN using upgraded catheter technologies with the refinement of contemporary procedural techniques has improved the BP-lowering efficacy and safety of RDN during a 3 to 6-month follow-up, with decrease short-term need in medications. The impact of uRDN on the long term deserves further investigation.

Circulation, Volume 150, Issue Suppl_1, Page A4120924-A4120924, November 12, 2024. Background:Colchicine, in multiple ways, has beneficial as well as adverse effects on patients with myocardial infarction.Objective:Our current study aims to study the efficacy as well as harmful effects of colchicine on patients with myocardial infarction.Methods:A comprehensive search was conducted on PubMed, the Cochrane Library, Scopus, Google Scholar, and Clinical trials till May 2024, and Randomized controlled trials were searched investigating the effect of Colchicine on patients with Myocardial Infarction. The quality of trials was assessed with the Cochrane risk of bias tool. Our primary Outcomes include adverse cardiovascular events while secondary outcomes include All-cause Mortality, adverse gastrointestinal effects, levels of hs-CRP, incidence of stroke, cardiac arrest, and hospitalization urgency. Risk ratios and mean differences were pooled under the Random-effect Model.Results:Statistical analysis shows that colchicine did not impact all-cause Mortality (RR =1.00, 95% CI=0.72-1.39, P=0.98, I2=0%), cardiac arrest (RR=0.81, 95% CI=0.33-1.95, P=0.63, I2=0), incidence of stroke(RR=0.45, 95% CI= 0.17-1.19, P=0.11, I2=36%) recurrent myocardial infarction (RR=0.78, 95%CI=0.57-1.06, P=0.11, I2=11%) and levels of hs-CRP (MD= -0.87, 95% CI=-1.80-0.06, P=0.07, I2=67%). However, colchicine shows statistically significant reduction in cardiovascular events(RR=0.75, 95%CI=0.60-0.94 , P=0.01, I2= 48%) , hospitalization urgency(RR=0.46, 95% CI=0.31-0.68, P=0.0001, I2=0%) and statistically significant increase adverse gastrointestinal events (RR=1.86, CI=1.14-3.02, P=0.01, I2=79%).Conclusion:Hence, we conclude that colchicine reduces adverse cardiovascular events, hospitalization urgency and increases adverse gastrointestinal events especially diarrhea in patients with myocardial infarction. However, colchicine did not reduce all-cause deaths, cardiac arrest, stroke incidence, the incidence of recurrent myocardial infarction, and hs-CRP; we still believe that the effect of colchicine on myocardial infarction needs further investigation and encourages the researcher to conduct more trials, especially with long-term follow-up.

Circulation, Volume 150, Issue Suppl_1, Page A4146173-A4146173, November 12, 2024. Background:Recurrent atrial fibrillation (AF) occurs in approximately 20 to 40% of patients following catheter ablation. SGLT2 inhibitors (SGLT2i), known for their cardiovascular benefits beyond glycemic control in type 2 diabetes, exhibit multiple pleiotropic effects. These effects offer glucose-independent and direct cardiac protection, potentially enhancing atrial remodeling. Studies suggest that SGLT2 inhibitors may also reduce atrial tachyarrhythmia and lower the risk of recurrence after the initial ablation procedure.Methods:We conducted a systematic review and meta-analysis following PRISMA guidelines. Studies were identified from three databases up to May 2024: MEDLINE/PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. Primary outcomes included AF recurrence with secondary outcomes of left ventricular ejection fraction (LVEF) improvement, hospitalizations and adverse events. Data was extracted and analyzed using R/R Studio. Random effects model was utilized to calculate odds ratios (OR) and 95% confidence intervals (CI).Results:Six studies were included with 5,456 participants (2,514 in SGLT2i group, 2,942 in control group). SGLT2i significantly reduced AF recurrence (OR = 0.44, 95% CI: 0.29-0.67, I2= 65%, p = 0.01). Four studies with 1,044 participants showed a non-significant trend towards LVEF improvement with SGLT2i (OR = 1.99, 95% CI: 0.99-3.99, I2= 0%, p = 0.88). Hospitalization rates from five studies (5,184 participants) showed no significant difference between groups (OR = 1.07, 95% CI: 0.63-1.82, I2= 46%, p = 0.12). Adverse events in four studies (734 participants) were not significantly higher in the SGLT2i group (OR = 1.19, 95% CI: 0.56-2.52, I2= 0%, p = 0.53).Conclusions:The results suggest that SGLT2i use significantly reduces AF recurrence following catheter ablation, with a trend toward LVEF improvement, though not statistically significant. Hospitalization rates and adverse events did not significantly differ between the SGLT2i and control groups, indicating a favorable safety profile. These findings support the potential benefit of SGLT2i in post-ablation management. Further large-scale randomized controlled trials are needed to confirm these results.