Risultati per: Il dolore neuropatico: review

Circulation, Volume 150, Issue Suppl_1, Page ASu1104-ASu1104, November 12, 2024. Background:Individuals experiencing unsheltered homelessness (those living in encampments) are at greater risk of experiencing health issues, including consequences of cardiovascular disease and opioid abuse, compared to sheltered individuals. They also face more significant barriers to care, one of which may be access to emergency medical care. Many individuals in homeless encampments are concealed within urban areas, often making it challenging for Emergency Medical Services (EMS) to precisely pinpoint their location. Furthermore, the lack of phone access and delays in bystanders notifying EMS can lead to delayed response times and inadequate medical attention.Objective:We aimed to categorize EMS calls and analyze EMS unit arrival times for homeless individuals on the street versus those in shelters, focusing on events requiring life-saving skills amenable to bystander intervention.Methods:The study is a retrospective review of EMS records for incidents in Allegheny County, PA, from January to July 2023. Cases were included that had documented evidence of a homeless patient treated by EMS, occurring near or in homeless encampments, as well as cases with homeless patients occurring at known homeless shelters as defined by EMS charting. The primary outcome was the response time of 911-initiated EMS (time of dispatch to arrival). Case characteristics and chief complaints were summarized and stratified by sheltered and unsheltered homeless status.Results:1204 cases were reviewed, with 424 (35.2%) involving unsheltered and sheltered homeless patients. Unsheltered individuals experienced more traumatic injuries and were disproportionately involved in drug overdose and intoxication incidents, with a mean overdose/intoxication of 20 with 95% CI ( 16.5, 24) compared to the mean of 10.7 with 95% CI (8.1, 14) for sheltered individuals. The mean EMS response time did not significantly differ between unsheltered and sheltered individuals, averaging 7.95 and 8.15 minutes, with a p-value of 0.79 for both groups respectively.Conclusion:In Allegheny County, although unsheltered individuals have equal timely access to EMS services, they exhibit higher rates of trauma and drug overdoses, which require timely intervention, and can benefit from trained lay people assisting prior to EMS arrival. Future training in these skills may be of benefit to this population.

Circulation, Volume 150, Issue Suppl_1, Page A4137278-A4137278, November 12, 2024. Background:Limited single-center and observational studies suggest that left atrial appendage occlusion (LAAO) may be a safe alternative in selected elderly patients with AFib.Hypothesis:We hypothesize that patients aged over 80 will have similar rates of complications and the same level of efficacy in stroke prevention as young patients.Aims:This review aims to establish the safety and efficacy of LAAO in octogenarians and nonagenarian patients with AFib.Methods:A systematic search of PubMed, Science Direct, and CENTRAL was performed for studies that reported outcomes comparing octogenarian and nonagenarian patients who underwent LAAo with their younger counterparts. The Review Manager 5.4 software was utilized to conduct a meta-analysis of the outcomes.Results:Seven observational studies consisting of 6,126 patients were included, of whom 1,879 (31%) were ≥80 years old and 4247 (69%)

Circulation, Volume 150, Issue Suppl_1, Page A4140600-A4140600, November 12, 2024. Background:Patients with nonvalvular atrial fibrillation (AF) and a history of intracranial bleeding while on anticoagulant therapy commonly undergo left atrial appendage occlusion (LAAO) to prevent thromboembolic events. Despite being suitable candidates for LAAO, treatment for this patient population is underrepresented in clinical trials.Methods:PubMed, Cochrane, and Embase databases were systematically searched for studies reporting clinical outcomes after LAAO in patients with prior intracranial bleeding. Pooled incidence data were presented as mean percentages with 95% confidence intervals (CI) using a random-effects model.Results:A total of 20 observational studies were included comprising 1,945 patients with nonvalvular AF and prior intracranial bleeding receiving LAAO. The mean age was 73.2 years, 35.2% were women, 49.8% received Watchman device. The mean CHA2DS2-VASc was 4.48 and the mean HAS-BLED was 3.74. In patients with prior intracranial bleeding, the LAAO procedure was associated with an all-cause mortality pooled incidence rate of 4.42% (95% CI 2.40-8.02; I2=81%, Figure 1A), major bleeding rate of 3.93% (95% CI 2.43-6.30; I2=54%, Figure 1B), device-related thrombosis rate of 1.46% (95% CI 0.83-2.66; I2=0%), peri device leak rate of 4.70% (95% CI 1.61-12.97; I2=86%), and stroke rate of 3.48% (95% CI 2.14-5.63; I2=47%).Conclusion:This meta-analysis of 20 studies found that, in patients with history of intracranial bleeding receiving LAAO, the incidence of clinical outcomes is comparable to the overall population undergoing LAAO.

Circulation, Volume 150, Issue Suppl_1, Page A4142243-A4142243, November 12, 2024. Background:The cumulative exposure to X-ray radiation during cardiac intervention can indeed pose various health risks. This meta-analysis aims to compare radiation protective shields (drapes and X-ray shields) versus conventional safety measures (lead apron) on the operator’s procedural radiation exposure during cardiac interventions.Methods:A systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed, Embase Cochrane, Scopus, and WOS until February 2024. We used the random-effects model to report continuous outcomes using mean difference (MD) with a 95% confidence interval (CI).Results:We included 16 RCTs with 3370 patients. Radiation shields were significantly associated with low total operator radiation dose (MD: -7.3, 95%CI [-11.9, -2.7], P< 0.01) with no significant difference between both arms regarding chest radiation dose (MD: -20.7, 95%CI [-48.9, 7.6], P= 0.15) and thyroid radiation dose (MD: -15.4, 95%CI [-32.4, 1.7], P= 0.08).Also, shields were significantly associated with low air kerma (MD: -46.4, 95%CI [-87.3, -5.5], P= 0.03) and low fluoroscopy duration (MD: -0.3, 95%CI [-0.6, -0.04], P= 0.02). However, there was no difference between both arms regarding the total procedure time (MD: -0.7, 95%CI [-3.1, 1.6], P= 0.54), contrast volume (MD: -3.2, 95%CI [-10.2, 3.7], P= 0.36), and dose area product (MD: 628.4, 95% CI [-3466.9, 4723.8], P= 0.76). Also, we found no differences between drape and shields subgroups in all outcomes.Conclusion:Radiation protection shields significantly reduced the total radiation dose exposure and air kerma. Also, shields are associated with lower fluoroscopy duration, insignificant lower procedure time, and contrast volume.

Circulation, Volume 150, Issue Suppl_1, Page A4125729-A4125729, November 12, 2024. Background:Transcatheter edge-to-edge mitral valve repair (TEER) is an established procedure in patients with severe mitral regurgitation (MR) and elevated surgical risk on optimal medical therapy. However, there remains considerable mortality in this patient population. Some studies have shown that serum brain natriuretic peptide (BNP) and N-terminal pro b-type natriuretic peptide (NT-proBNP) predict all-cause mortality after TEER, whereas other studies have shown mortality to be independent of these markers. To address this gap in knowledge, we sought to examine the existing literature to determine whether there is an association between pre-procedural serum natriuretic peptides and mortality after TEER.Hypothesis:Among patients undergoing TEER, elevated pre-procedural BNP and NT-proBNP are associated with increased all-cause mortality.Methods:Databases including MEDLINE, Embase, and Cochrane Library were searched from inception through September 2023 for studies assessing pre-procedural serum natriuretic peptide levels and mortality among patients undergoing TEER. Pooled hazard ratios (HR) and standardized mean differences (SMD) were calculated using a random-effects model estimated by restricted maximum likelihood with the Hartung-Knapp modification.Results:A total of 30 studies comprising 10259 patients undergoing TEER met inclusion criteria. 25 studies measured NT-proBNP and 5 studies measured BNP. Elevated pre-procedural NT-proBNP ( >5000 or >10000 pg/mL) was associated with increased all-cause mortality in both adjusted (HR = 2.94; 95% CI = 1.75 – 4.95; I2 = 46.8%) and unadjusted (HR = 5.16; 95% CI = 1.85 – 14.40; I2 = 0.0%) analyses (Figures 1 and 2). Pre-procedural BNP and NT-proBNP were also significantly lower among survivors at 12 months compared to non-survivors (SMD = 0.82; 95% CI = 0.37 – 1.27; I2 = 78.3%) (Figure 3). This association was demonstrated in patients with primary or secondary MR.Conclusions:Pre-procedural BNP and NT-proBNP levels are significant predictors of all-cause mortality in patients undergoing TEER for primary or secondary MR. This supports the inclusion of BNP or NT-proBNP in pre-procedural assessments to help inform patient discussions and guide post-procedural follow-up and monitoring.

Circulation, Volume 150, Issue Suppl_1, Page A4116340-A4116340, November 12, 2024. Background:Transcatheter aortic valve replacement (TAVR) stands as a notable alternative to surgery for severe aortic stenosis (AS). Despite the established benefits of statins in cardiovascular pathologies, their specific impact in patients with severe AS undergoing TAVR remains uncertain. Our study aims to assess whether perioperative statin use improves survival and outcomes post-TAVR.Methods:A search was conducted across various databases to retrieve studies comparing perioperative statin use versus no statin use in patients undergoing TAVR. The primary outcome of interest was all-cause mortality (ACM). Secondary outcomes included stroke, acute kidney injury (AKI), 30-day mortality, myocardial infarction (MI), cardiovascular complications, and in-hospital mortality. Comprehensive Meta-Analysis Software (v. 3) was used to pool odds ratio (OR) under a random-effects model, with statistical significance set at p < 0.05.Results:Our analysis encompassing 20663 patients from 15 observational studies found that perioperative statin use was associated with a significant reduction in ACM (OR= 0.71, 95% CI: 0.61-0.83,I2= 50.3%, p

Circulation, Volume 150, Issue Suppl_1, Page A4138159-A4138159, November 12, 2024. Background:It is uncertain whether the efficacy and safety of dual antiplatelet therapy (DAPT) in patients with high bleeding risk (HBR) vary according to DAPT duration and stent type (e.g., durable polymer drug-eluting stents (DP-DESs), biodegradable polymer DESs (BP-DESs), or polymer-free drug-coated stents (PF-DCSs)).Objectives:We aimed to study the stent type and DAPT duration appropriate for patients with HBR.Methods:PubMed and EMBASE were searched until October 2023. Randomized controlled trials (RCTs) involving patients with HBR that compared standard DAPT (6-12 months) with DP- or BP-DES versus short DAPT (≤3 months) with DP- or BP-DES or PF-DCS or bare-metal stent (BMS) were identified (Figure). The primary efficacy outcome was major adverse cardiovascular events (MACEs), defined as cardiovascular death, myocardial infarction (MI), and stroke. The primary safety outcome was major bleeding. Secondary outcomes included MI and stent thrombosis (ST). We performed a network meta-analysis using a random effects model.Results:Thirteen RCTs with a total of 19,418 patients with HBR were included. Compared to standard DAPT with DP-DES, short DAPT with BMS was associated with a higher risk of MACE and MI. For major bleeding, short DAPT strategies were associated with a lower risk than standard DAPT strategies (e.g. short DAPT with DP-DES versus standard DAPT with DP-DES; HR[95% CI]: 0.48[0.28-0.82]). Interestingly, the use of BP-DES was associated with a higher risk of ST than DP-DES (e.g. standard DAPT with BP-DES versus short DAPT with DP-DES; HR[95% CI]: 2.65[1.03-6.79]).Conclusions:In patients with HBR who underwent PCI, a short DAPT strategy with DP-DES should be used since it offers the best combination of efficacy and safety.

Circulation, Volume 150, Issue Suppl_1, Page A4146837-A4146837, November 12, 2024. Background:Bruton Tyrosine Kinase inhibitors (BTKi) are targeted therapies that have demonstrated promising results in the treatment of hematological malignancies; however, they are associated with adverse cardiac events. Direct comparisons of the cardiotoxic profile between old-generation and new-generation BTKi are limited.Research Question:Are novel BTKi associated with a lower incidence of cardiac adverse events compared with ibrutinib?Aims:We aimed to perform a systematic review and meta-analysis of cardiac events from studies comparing new-generation BTKi versus ibrutinib in patients with hematological malignancies.Methods:We searched PubMed, Embase, and Cochrane Library for studies comparing any new-generation BTKi with ibrutinib in patients with hematological malignancies. Outcomes included 1) risk of cardiac events; 2) atrial fibrillation (AF); 3) rate of treatment discontinuations due to AF; and 4) hypertension. We pooled risk ratios (RR) with 95% confidence intervals (CI). Statistical analysis was performed using R software 4.3.1, under a random-effects model. Heterogeneity was assessed using I2statistics.Results:We included four randomized controlled trials with 1905 patients, of whom 957 (50%) received new-generation BTKi. Age ranged from 28 to 90 years, with 1337 (70%) male patients. Prior lines of systemic therapy ranged from none to 12. Overall cardiac events were significantly lower in patients who received novel BTKi compared with those who received ibrutinib (RR 0.75; 95% CI 0.63 to 0.90; p=0.002; I2=0%; Fig.1A). New-generation BTKis were associated with a statistically significant reduction in the risk of AF (RR 0.48; 95% 0.35 to 0.64; p

Circulation, Volume 150, Issue Suppl_1, Page A4144394-A4144394, November 12, 2024. Introduction:Cardiac resynchronization therapy (CRT) reduces mortality in patients with moderate to severe heart failure (HF) and reduced ejection fraction. However, outcomes associated with CRT in CCC patients are still controversial. We conducted a meta-analysis to quantify total mortality in patients with chronic Chagas cardiomyopathy compared to HF of other etiologies (Non-Chagas).Objectives:To perform a meta-analysis of studies to measure all-cause mortality in CCC patients compared to patients of other etiologies (Non-Chagas) when undergoing CRT.Methods:A literature search was conducted in PubMed, Cochrane, Embase, Scielo for English, Portuguese, and Spanish comparing all-cause mortality in patients undergoing CRT in CCC and other etiologies (Non-Chagas). The Non-Chagas group included patients with HF of ischemic, dilated, or idiopathic etiology. Statistical analysis was performed in RevMan 5.18. Heterogeneity was assessed by I2 statistics.Results:577 patients from 3 studies were included, with 170 patients having Chronic Chagas Cardiomyopathy. Follow-up time ranged from 12 to 41 months. Mean age was 61.7 +/- 11.6 years and 61.5% were male. Mean ejection fraction across studies was 25.8% +/- 6.4.All-cause mortality (OR: 2.41; 95% CI: 1.65-3.53; p < 0.00001, I2 = 0%) was significantly higher in patients with Chronic Chagas Cardiomyopathy compared to the Non-Chagas group.Conclusion:Patients with CCC had higher all-cause mortality compared to Non-Chagas patients when undergoing CRT. These results highlight the importance of prospective controlled studies comparing Cardiac Resynchronization Therapy with other treatments to define the optimal therapy for patients with heart failure with reduced ejection fraction due to Chagas disease.

Circulation, Volume 150, Issue Suppl_1, Page A4137188-A4137188, November 12, 2024. Background:Atrial fibrillation (AF) is the most prevalent arrhythmia globally, with an escalating incidence in the United States. It is known that racial and ethnic disparities exist in the management of AF. Although current guidelines recommend catheter ablation (CA) as one of the most effective rhythm control strategies, recent data suggest that minority populations, including Black, Hispanic, and Asian individuals with AF, are less likely to undergo CA, and aggregate data are lacking in this area.Aims/Hypothesis:To determine differences in CA rates and the likelihood of undergoing CA for AF in racial/ethnic minority populations compared to Caucasians. We hypothesized that minorities are less likely to undergo CA for AF than their non-minority counterparts.Methods:A systematic search of PubMed, EMBASE, and Cochrane Library, based on an a priori registered protocol (PROSPERO Registration CRD42024496174), from January 1st, 2010, to January 2nd, 2024, was conducted to identify studies with ≥ 500 participants assessing CA use in AF in at least two racial/ethnic groups. Data were combined using a random-effects model meta-analysis.Results:A total of 431 non-duplicate records were identified. After independent screening based on inclusion/exclusion criteria, 19 studies comprising 12,598,109 patients were included. Among them, 9,577,652 (76.0%) were White, 789,954 (6.3%) were Black, 476,216 (3.8%) were Hispanic, 113,005 (0.9%) were Asian, while 1,641,282 (13.0%) were classified as other or were missing race/ethnicity data. The proportion of White subjects who underwent CA for AF was 4% (95% CI 3-5%). In contrast, the proportion of Black, Hispanic, and Asian individuals with AF who underwent CA was 2% (95% CI 1-3%), respectively, for each group. Pooled odds ratios (OR) of having CA for AF compared to Whites were 0.68 (95% CI 0.56 – 0.83), 0.72 (95% CI 0.63 – 0.82), 0.64 (95% CI 0.48 – 0.86) for Blacks, Hispanics, and Asians, respectively.Conclusions:The use of CA among the total AF population was low across all ethnic groups. Moreover, racial/ethnic minority groups were significantly less likely to undergo CA compared to White patients.

Circulation, Volume 150, Issue Suppl_1, Page A4145588-A4145588, November 12, 2024. Background:Cancer therapies, including anthracyclines and tyrosine kinase inhibitors, can induce cardiotoxic effects, increasing the incidence of heart failure (HF). With improvements in cancer survival rates, the focus has shifted towards minimizing non-cancer-related morbidities and improving overall quality of life. SGLT2 inhibitors (SGLT2i) have demonstrated efficacy in reducing cardiovascular events, particularly HF, in patients with and without diabetes. Given their dual cardioprotective and anticancer properties, these drugs present a promising therapeutic option in the cardio-oncology field. Preclinical studies have shown that SGLT2i, especially canagliflozin, can impede tumor growth in various cancer models.Methods:We conducted a systematic review and meta-analysis following PRISMA guidelines. Four studies were identified from three databases up to May 2024: MEDLINE/PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. The SGLT2i used in these studies included canagliflozin, dapagliflozin, and empagliflozin. The total sample size was 10,775 patients, with 1,649 in the SGLT2i group and 9,126 in the control group. Outcomes analyzed were hospitalizations for HF, total adverse events, and all-cause mortality using R/R Studio.Results:SGLT2i significantly reduced the risk of hospitalizations for HF compared to control (OR: 0.50; 95% CI: 0.38–0.66, p < 0.01), with significant heterogeneity observed (I2= 71%, p = 0.02). The incidence of total adverse events was lower in the SGLT2i group (OR: 0.99; 95% CI: 0.84–1.16, p < 0.01), with high heterogeneity noted (I2= 98%, p < 0.01). SGLT2i showed a trend towards reduced all-cause mortality but was not statistically significant (OR: 1.01; 95% CI: 0.87–1.18, p < 0.01), and high heterogeneity was present (I2= 98%, p < 0.01).Conclusions:SGLT2i use in cancer patients is associated with a significant reduction in hospitalizations for HF. While there is a trend towards reduced all-cause mortality and total adverse events, the results are not statistically significant. The high heterogeneity in the analyzed studies suggests variability in patient populations and study designs, indicating a need for further research to confirm these findings.

Circulation, Volume 150, Issue Suppl_1, Page A4140895-A4140895, November 12, 2024. Background:Red cell distribution width (RDW) is a measurement of variability in erythrocyte size and volume, routinely reported as part of a complete blood count. Recently, it has gained popularity as a novel prognostic biomarker for cardiovascular disease outcomes. Our study investigates the predictive value of pre-procedural RDW for all-cause mortality (ACM) within one year for patients undergoing transcatheter aortic valve implantation (TAVI).Methods:We comprehensively reviewed databases like PubMed, Google Scholar, Embase, and Scopus until May 2024, looking for studies reporting an association between pre-procedural RDW and outcomes in TAVI. A binary random effects model was used to calculate the pooled adjusted odds ratio (aOR), and subgroup analysis was performed. I2 statistics were used to determine the heterogeneity of studies, further enhancing the robustness of our research.Results:Our systematic review and meta-analysis included five studies (three retrospective, two prospective) encompassing 2,565 patients with a mean age of 81.32 years. Our study showed a slight female predominance (52%). The mean follow-up period was one year. Comorbidities like coronary artery disease, diabetes melitus, atrial fibrillation, prior myocardial infarction were commonly reported among the study population. Higher pre-procedural RDW was associated with increased odds of ACM at the end of one year with an unadjusted pooled OR 1.86 (95% CI: 1.30-2.67, p

Circulation, Volume 150, Issue Suppl_1, Page A4145344-A4145344, November 12, 2024. Background:The prevalence of atrial fibrillation (AF) increases with age. However, limited data are available regarding the prognostic implications of rhythm versus rate control strategies for AF in the elderly. We have conducted this systematic review and meta-analysis to explore the effects of early rhythm control strategy in elderly (age >65 years) AF patients.Methods:A literature search was conducted for relevant studies using MEDLINE (PubMed), EMBASE, Scopus, Cochrane CENTRAL, Conference Abstracts, and ClinicalTrials.com through March 19th, 2024. The primary outcome was all-cause mortality. Meta-analysis was performed using the random-effects Mantel-Haenszel method, and pooled risk ratios (RRs) along with 95% confidence intervals (CIs) were calculated using RevMan 5.4.Results:Six studies with 39,181 patients (rhythm control 11,446; rate control 27,735) were included. The mean age was 79 years in the rhythm control and 81 years in the rate control cohort. Females were 52% in rhythm control and 55% in the rate control group. The rhythm control strategy was associated with a lower risk of stroke (RR 0.73, 95%CI 0.66-0.81, p

Circulation, Volume 150, Issue Suppl_1, Page A4125026-A4125026, November 12, 2024. Introduction:Primary percutaneous coronary intervention (pPCI) is the treatment of choice for patients with ST-segment elevation myocardial infarction (STEMI). Nevertheless, pPCI is still associated with poorer outcomes particularly left ventricular dysfunction. Pressure-controlled intermittent coronary sinus occlusion (PiCSO) is a novel therapeutic approach proposed to improve myocardial perfusion and its function in patients with STEMI. Therefore, we performed this meta-analysis to evaluate the effects of PiCSO on left ventricular function in STEMI patients.Methods:We performed a comprehensive search on PubMed, Scopus, and Web of Science. Our primary endpoints were left ventricular ejection fraction (LVEF%), left ventricular end diastolic volume (LVEDV), and left ventricular end systolic volume (LVESV). The secondary endpoint was infarct size. We performed Trial Squential Analysis (TSA), and we pooled our continuous data as mean difference (MD) and 95% confidence interval (CI) in the fixed effects model.Results:A total of four studies, with 335 patients, were included in the analysis. Our pooled analysis showed that PiCSO significantly increased LVEF% compared to pPCI (MD = 3.52, 95% CI [1.05, 6.00], P= 0.005). However, there was no significant difference between the two groups in terms of LVESV and LVEDV (MD = -1.1, 95% CI [-9.28, 7.08], P= 0.79; MD = -1.69, 95% CI [-9.14, 5.76], P= 0.66, respectively). With regard to infarct size, a significant reduction was observed in PiCSO group compared to pPCI (MD = -4.26, 95% CI [-7.39, -1.14], P= 0.007). The TSA curve crossed the conventional boundary for statistical significance, indicating that the available evidence reach the predetermined threshold.Conclusions:Our meta-analysis revealed that PiCSO could mitigate left ventricular dysfunction in STEMI patients by improving LVEF% and reducing infarct size. Nevertheless, PiCSO failed to show a positive impact on LVESV and LVEDV. Further large-scale studies are warranted to draw a definitive conclusion.

Circulation, Volume 150, Issue Suppl_1, Page A4139688-A4139688, November 12, 2024. Background:Historically, patients with type 2 diabetes mellitus (T2DM) and concurrent cardiovascular disease (CVD) have been managed through multifactorial interventions, including lifestyle modifications. Recently, empagliflozin, a potent sodium-glucose cotransporter 2 inhibitor (SGLT2i), has emerged as a novel antidiabetic agent demonstrating significant improvements in cardiovascular outcomes.Aim:To conduct a meta-analysis comparing empagliflozin with placebo in patients with T2DM and concomitant CVD.Methods:We performed a thorough literature search of PubMed, EMBASE, and the Cochrane Library up to May 2024 to identify studies comparing empagliflozin with placebo in patients with T2DM and concomitant CVD. Effect estimates were pooled using a random-effects model and reported as risk ratios (RR) for dichotomous outcomes and standard mean difference (SMD) or mean differences (MD) for continuous outcomes, each accompanied by 95% confidence intervals (CIs). Due to varying units of measurement for HbA1c that were not interconvertible, SMD was employed. Conversely, MD was used for the analysis of other continuous outcomes.Results:16 studies fulfilled the inclusion criteria. Empagliflozin significantly reduced HbA1c (SMD: -1.33 [-2.28, -0.38]; p=0.006;Figure) and cardiac mortality (RR= 0.62 [0.50, 0.78]; p

Circulation, Volume 150, Issue Suppl_1, Page A4141828-A4141828, November 12, 2024. Background:The combination of ibrutinib and venetoclax has emerged as a promising therapeutic option for patients with chronic lymphocytic leukemia (CLL), demonstrating significant advantages compared to traditional chemotherapy-based approaches. However, the potential adverse cardiovascular effects, especially in patients who have not previously undergone treatment, have not been fully elucidated.Hypothesis:The use of ibrutinib and venetoclax is associated with a higher incidence of cardiovascular adverse events.Aims:This study aims to analyze the incidence of cardiovascular adverse effects in patients treated with ibrutinib and venetoclax for CLL, who were previously naïve to treatment.Methods:PubMed, Embase, and Cochrane Central databases were systematically searched in April 2024 for randomized controlled trials (RCTs) that compared ibrutinib plus venetoclax to standard care therapies (ST) (chlorambucil-obinutuzumab; ibrutinib only and fludarabine-cyclophosphamide-rituximab) in untreated patients with CLL and reported the outcomes of (1) atrial fibrillation; (2) hypertension and (3) sudden death. We performed a systematic review and meta-analysis using RStudio version 2024.04.0. Heterogeneity was examined with the Cochran Q test and I2 statistics.Results:We included 4 RCTs in the final analysis, with a total of 885 participants, of whom 450 (50.8%) were on ibrutinib plus venetoclax. Ibrutinib plus venetoclax was associated with a significant increase in the incidence of atrial fibrillation compared with standard care therapy (OR 7.04; 95% CI 3.11-15.92; p