Risultati per: Il dolore neuropatico: review

Circulation, Volume 150, Issue Suppl_1, Page A4144165-A4144165, November 12, 2024. Introduction:Transcatheter mitral valve repair (TMVR) has recently emerged as a therapy option for patients with severe mitral regurgitation (MR) deemed unsuitable for traditional cardiac surgery. In contrast to surgical mitral valve replacement (SMVr), its effectiveness is uncertain. Therefore, there is a need to assess safety, mortality, and morbidity.Hypothesis:To compare the mortality and morbidity of TMVR intervention versus SMVr in patients with MR.Methods:Pubmed/Medline, EMBASE, Cochrane, Web of Science, Scopus, and grey literature were searched in May 2022. We only included studies that reported the outcomes of patients undergoing TMVR intervention compared to SMVr for MR, either secondary or primary. The primary outcome was early mortality and major adverse cardiac events (MACE). The secondary outcomes were reoperation rate, long-term survival, and complications. Statistical analysis was performed using R 4.0.3Results:Eleven studies comprising 10,627 patients (5307 TMVR and 5320 SMVr) were included in the analysis. In early mortality, the results showed TMVR has a significantly lower mortality rate than SMVr (RR: 0.84; 95% CI, 0.43-1.63; P < 0.01; I2 = 47.8%). MACE was significantly lower in TMVR than SMVr (RR: 0.52; 95% CI, 0.22-1.22; P < 0.01; I2 = 45.1%). Acute kidney injury (AKI) was significantly lower in TMVR compared to SMVr (RR: 0.76; 95% CI, 0. 34-1.67; P < 0.01; I2 = 75.1%). Although not significant, TMVR associatedwith higher rates of reoperation (RR: 2.46; 95% CI, 1.31-4.61; P = 0.53; I2 = 0%). TMVR was associated with non-significant lower rates of bleeding complications and the needs for transfusion (RR: 0.23; 95% CI, 0.20-0.28; P = 0.56; I2 = 0%). However, in long survival outcome, TMVR showed significant higher non-survival rate to SMVr (HR: 1.37; 95% CI, 0.85-2.23; P < 0.01; I2 = 26.1%).Conclusions:TMVR showed significantly lower early mortality, MACE, andAKI than SMVr. Long survival outcomes showed a negative trend for TMVR compared to SMVr in a few included studies. Therefore, TMVR can be a safe and effective approach for mitral valve regurgitation with lower early mortality and morbidity when compared to surgical management. However, there is a need for longitudinal studies on long-term outcomes.

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 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 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 A4117397-A4117397, November 12, 2024. Background:Diabetes Mellitus (DM) significantly impacts global health through cardiovascular and renal complications. SGLT2 inhibitors (SGLT2i) have emerged as beneficial for cardiovascular outcomes in Type 2 Diabetes Mellitus (T2DM). However, only few studies report outcomes related to renal function.Aim:This study aims to analyse the efficacy of SGLT2i on cardiorenal outcomes in adults with T2DM.Methods:A systematic review and meta-analysis, following PRISMA-2020 guidelines was conducted. We evaluated the efficacy of SGLT2i on cardiorenal outcomes in adults with T2DM. We included randomized controlled trials(RCT) and post hoc analyses that compared SGLT2i with placebo, focusing on cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, heart failure hospitalizations, and renal outcomes such as the progression of albuminuria and the decline of eGFR. Dichotomous outcomes were calculated using relative risk (RR) with 95% confidence interval (CI).Results:We identified 2753 studies, registered in PubMed(=788), Embase(n=538), WoS(n=369), Scopus(n=908), and Cochrane(n=150). We included 11 studies 6 RCT and 7 Post Hoc Analysis, sample size of 50.653 patients. Meta-analysis showed that SGLT2i improve cardiovascular outcomes such as reduced cardiovascular mortality (RR 0.84 [95% CI 0.73–0.97] p=0.02), heart failure hospitalizations (RR 0.65 [95%CI 0.54–0.77]p

Circulation, Volume 150, Issue Suppl_1, Page A4117438-A4117438, November 12, 2024. Introduction:Transcatheter Mitral Valve Edge to Edge Repair (TEER) is an established percutaneous treatment for patients with severe symptomatic Mitral Regurgitation (MR). The current AHA/ACC guidelines recommend TEER for inoperable patients with severe primary MR or patients with symptomatic severe secondary MR despite medical therapy. Machine learning (ML) has emerged as a tool for TEER risk stratification due to the paucity of established risk scores. To address the lack of consensus on its efficacy, we conducted a systematic review and meta-analysis of studies that utilized ML to predict the success of TEER.Methods:Electronic databases, including Embase, MEDLINE, and the Cochrane Library, were searched from inception through April 2024. We included studies that used TEER and employed at least one ML model to predict the success of TEER. The Area Under the Receiver Operating Characteristic Curve (AUC) was used to measure the accuracy of ML risk stratification algorithms.Results:102 publications were screened, with seven eventually included in this analysis. Two studies employed clustering techniques, two utilized extreme gradient boosting, and three used multiple ML algorithms to predict outcomes. Of the four studies that compared the accuracy of ML with traditional Cox regression, all four demonstrated higher accuracy with ML, and this difference was statistically significant in three of the four studies. The mean AUC of the aggregated ML data was 0.737 [95% CI: 0.717, 0.758], compared to 0.627 [95% CI: 0.600, 0.653] for the pooled traditional methods.Conclusions:To our knowledge, we conducted the first systematic review and meta-analysis of ML methods for prediction of TEER success. ML outperformed established risk scores, demonstrating promising potential. Future ML models, trained on larger patient datasets, may further improve predictive accuracy in this patient population.

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 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 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 A4138494-A4138494, November 12, 2024. Introduction/Background:Hypertension is a leading cause of morbidity and mortality. Despite treatment recommendations and encouragement of lifestyle changes, the actual rate of blood pressure control is still not at par. Remote intervention methods have been shown to achieve better rates of blood pressure control utilising lesser resources and lower healthcare costs. We conducted a systematic review by qualitatively evaluating the potential impact of remote monitoring and interventions compared to usual care in controlling Hypertension.Research Question:Are remote monitoring techniques and interventions better than usual in-person blood pressure checks for hypertension control?Methods:We did a comprehensive literature search of Pubmed/MEDLINE, Google scholar, Cochrane central Library, PLOS ONE, ScienceDirect and Clinicaltrials.gov to identify eligible randomised control trials and clinical trials published between July 2013 and May 2025. A Risk of Bias assessment was conducted using Cochrane Risk of Bias tools such as ROB-2 for randomised control trials and ROBINS-1 for cohort studies. This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results:Of the 5,185 records analysed, 10 randomised control trials, 1 cohort study and 1 implementation study satisfied our inclusion criteria. Compared to usual care, remote monitoring methods showed significant difference in systolic blood pressure control at 6-12 months in 9 out of 12 studies, while 3 studies did not show any significant difference. Quality of life, physical health, mental health and drug compliance have also shown a significant positive difference in patients. Remote self monitoring interventions were found to be more cost-effective than usual care. They also reduced the load of patients seeking appointments for hypertension control thereby improving the quality of patient care.Conclusion:The management of clinical hypertension is a challenging entity. Conventional methods of regular in-office blood pressure checks are both tedious and resource consuming. Using remote monitoring methods have shown to significantly improve blood pressure control compared to routine methods. It also eliminates white-coat hypertension during follow-up blood pressure checks which leads to more appropriate interventions. Remote monitoring and intervention for hypertension control is time-effective, cost-effective and improves quality of life.

Circulation, Volume 150, Issue Suppl_1, Page A4138152-A4138152, November 12, 2024. Background:Peripheral artery disease (PAD) is associated with worse outcomes in patients with underlying coronary artery disease (CAD). While the impact of PAD in stable CAD is well-studied, data on the impact of concomitant PAD in acute coronary syndrome (ACS) patients are limited. Our meta-analysis assesses cardiovascular and clinical outcomes in ACS patients with PAD compared to those without PAD.Methods:We conducted an extensive search using PubMed, EMBASE, and Cochrane Library for studies published prior to June 1, 2024, evaluating clinical and CV outcomes in patients diagnosed with PAD and concomitant ACS. Data were extracted and analyzed using R (v.4.3). Pooled proportions with 95% confidence intervals (95% CIs) were calculated using a random effects model. Odds ratios (ORs) with 95% confidence intervals were used as effect measures for dichotomous variables. Our outcomes of interest were all-cause mortality, major adverse cardiovascular events (MACE), recurrent CV events, and major bleeding.Results:We identified four studies, including 3,860,564 patients. Our inclusion criteria were adults (≥18 years) recently hospitalized or discharged with ACS (unstable angina, non-ST-elevation myocardial infarction, and ST-elevation myocardial infarction). PAD was defined as intermittent claudication and/or previous revascularization. The PAD group exhibited significantly higher likelihood of adverse outcomes compared to the non-PAD group. Specifically, the odds of mortality were significantly higher in the PAD group (OR: 2.79 [1.41, 5.53]; I2=99%; p=0.003), however there was substantial heterogeneity among the studies. The odds of MACE were also higher in the PAD group (OR: 2.12 [1.51, 2.96]; I2=71%; p

Circulation, Volume 150, Issue Suppl_1, Page A4114597-A4114597, November 12, 2024. Background:Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of ACS, myocardial infarction, and sudden death particularly among young women and individuals with few conventional atherosclerotic risk factors. We reveiwed possible risk factors that could predispose to SCAD.Methods:We reviewed 13 consecutive patients presenting with SCAD across three different institutions over a period of 5 yrs and determined risk fatcors associated with this disase entity.Results:13 patients presented with SCAD represented % 0.5 of the total number of patients who underwent cardiac cathaterizations for chest pain requiring admissions. 11/13 (84%) were female. 5/13 (38%) were Caucasian or Hispanic, and 3/13 (23%) were African-American. Mean age age was 49.3 + years. 8/13 (61%) had associated hyperlipidemia with LDL levels > than 110 mg/dL, 9/13 (64%) had an A1c < 5.6% and only 1/13 (0.07%) had A1c of 6.4%. HTN was present in 6/13 (46%) of patients, and family history of SCD or heart disease were only seen in 2/13 (15%). None of the patients had features suggestive of associated fibromuscular dysplasia or connecive tissue disease. D-dimer was elevated in 5/13 (38%) with average value of 1578 ng/dL. Inflammatory markers were reviewed, only 3 patient has had ESR and CRP ordered, and only 1/3 had a mildly elevated CRP 3.9 mg/dL. Only 1/13 (0.07%) required intervention which was due to further drop in her ejection fraction requiring PCI, with improvement in her symptoms. All patients were treated with dual anti-platelet therapy for 1 year, 1 was discontinued due to persitent chest pain and decision was made to treat with only aspirin. Traditionally, risks for SCAD were thought to be due to non-atheresclerotic factors, however our case series shows that more then 60% of patients had elevated LDL's and 46% with hypertension, implying that traditional atheresclerotic risk factors should not be ignored and may play a crucial role. Autoimmune diseases were not found in any of our patients.Conclusion and implications:In this series patients who had SCAD had conventional risk factors of CAD including HLD and hypertension. The variability of co morbidities makes the identification of specific risk factors very difficult and none of the patients had Fibromuscular dysplasia or any signs of inflammation. Elevated D Dimer was also seen in a majority of patients, and all but one was managed medically with a favorable outcome

Circulation, Volume 150, Issue Suppl_1, Page A4141024-A4141024, November 12, 2024. Background:Atrial fibrillation (AF) is increasingly prevalent in patients with liver cirrhosis, which is associated with both bleeding and thromboembolism. Patients with cirrhosis have been excluded from randomized controlled trials on the efficacy and safety of anticoagulants in AF. We performed a systematic review to compare direct oral anticoagulants (DOACs) with warfarin in patients with AF and concomitant cirrhosis.Methods:We systematically searched Pubmed and Embase from inception to the present. The primary outcome of interest was the hazard ratio of major bleeding. Secondary outcomes included gastrointestinal bleeding, all-cause bleeding, and ischemic stroke/systemic embolism[AN1] . Random effects models were used to calculate the weighted pooled hazard ratios for the outcomes. A two-tailed p

Circulation, Volume 150, Issue Suppl_1, Page A4145634-A4145634, November 12, 2024. Background:Catheter ablation has been increasingly used for managing atrial fibrillation (AF), to restore and maintain normal sinus rhythm. Despite its widespread use, it is unclear if there are differences in clinical outcomes, particularly in maintaining rhythm control and safety outcomes, between younger and older adults undergoing catheter ablation. The objective of this meta-analysis was to compare the outcomes following catheter ablation in younger and older adults.Methods:A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Using random effect models, mantel-Haenszel odds ratios and associated 95% confidence intervals were calculated to report the overall effect size. The primary endpoints were AF/atrial tachycardia (AT) recurrence and re-ablation requirement. Secondary outcomes included in-hospital complications such as stroke/TIA, cardiac tamponade/pericardial effusion, and vascular complications such as bleeding, hematoma, AV fistula, and femoral pseudoaneurysm. The young adult group varied between studies, ranging from under 30 years to under 45 years.Results:Data from 10 articles, with a sample size of about 126,141 AF patients, were considered. Our analysis indicated that catheter ablation for AF in the younger age group was linked to reduced odds of AF/AT reoccurrence (OR: 0.60; 95% CI: 0.44 to 0.83; p=0.002) and a decreased need for re-ablation after the index procedure (OR: 0.72; 95% CI: 0.53 to 0.97; p=0.03). Furthermore, catheter ablation in younger adults was found to be associated with a lower risk of in-hospital procedural complications like stroke/TIA (OR: 0.59; 95% CI: 0.43 to 0.80; p=0.0008) and cardiac tamponade/pericardial effusion (OR: 0.53; 95% CI: 0.42 to 0.68; p

Circulation, Volume 150, Issue Suppl_1, Page A4145387-A4145387, November 12, 2024. Background:Current therapeutic options for relieving symptoms in hypertrophic cardiomyopathy (HCM) predominantly involve invasive interventions. In contrast, cardiac myosin inhibitors (CMI), such as aficamten and mavacamten, represent a promising pharmacological alternative to alleviate left ventricular outflow tract obstruction. However, there is limited data regarding the efficacy of this therapy.Methods:We searched Pubmed, Cochrane, and Embase databases for randomized controlled trials (RCT) comparing CMI with placebo among symptomatic HCM patients. Key outcomes assessed included: (1) improvement in at least one New York Heart Association (NYHA) functional class, (2) enhancement in the Kansas City Cardiomyopathy Questionnaire – Clinical Summary Score (KCCQ-CSS), and (3) change in N-terminal pro b-type Natriuretic Peptide (NT-proBNP) levels. Statistical analyses were performed using R Studio 4.3.2.Results:Six RCTs were included, involving 826 patients, of whom 443 (53.6%) were assigned to the CMI group. The majority of participants were male (57%), with a mean age of 57.9 years and a mean follow-up duration of 21 weeks. In the pooled analysis, CMI was associated with a significant improvement of at least one NYHA functional class (RR 2.21; 95% CI 1.75, 2.80; p

Circulation, Volume 150, Issue Suppl_1, Page A4137870-A4137870, November 12, 2024. Background:Acute paroxysmal supraventricular tachycardia (PSVT) is a common arrhythmia. Etripamil, a novel calcium channel blocker via nasal spray, has shown promise for PSVT management. This meta-analysis and trial sequential analysis (TSA) evaluates the efficacy and safety of nasal Etripamil for treating PSVT.Methods:We systematically searched Pubmed, Embase, and Cochrane databases for studies assessing the efficacy and safety of Etripamil for PSVT. The main outcome was conversion to sinus rhythm(CSR) within 15 minutes. Secondary outcomes included adverse events(AE). Meta-analysis was performed using random-effects models, and TSA was employed to assess the robustness of the evidence and required information size.Results:Three randomized controlled trials (RCTs) and two extensive trials involving 1,652 participants were analyzed. Nasal Etripamil significantly increased the CSR within 15 minutes compared to placebo (RR 1.87 95% CI; 1.39-2.52, p