Risultati per: Colite ulcerosa negli adulti: review

Circulation, Volume 146, Issue Suppl_1, Page A11472-A11472, November 8, 2022. Background:Recent randomized controlled trials (RCTs) have demonstrated the superiority of treating patients with acute coronary syndrome (ACS) with dual antiplatelet therapy (DAPT) uniform de-escalation strategy (i.e., switching from potent P2Y12inhibitors to clopidogrel one month after the event). However, it remains unclear if this strategy would be effective in elderly patients. We aimed to assess the efficacy of the available DAPT strategies, including the uniform de-escalation strategy, in ACS patients older than 65.Methods:We searched the PubMed, EMBASE, and Cochrane CENTRAL databases up to December 2021 for RCTs or subgroup analyses investigating DAPT strategies for elderly ACS patients (age ≥65 years) and conducted a network meta-analysis. The endpoint was net clinical benefit outcome, defined as a composite of major adverse cardiovascular events and bleeding. The P-score was used to rank the treatments.Results:Seven RCTs with 5,079 patients were included. The uniform de-escalation strategy was associated with a better net clinical benefit outcome (hazard ratio: 0.62; 95% confidence interval [0.41-0.92]) compared with DAPT using potent P2Y12inhibitors, and it was similarly effective compared with other DAPT strategies. There was no significant heterogeneity (I2=0%;p=0.82) or inconsistency (p=0.40). The uniform de-escalation strategy was ranked as the most effective strategy (by P score) superior to DAPT using clopidogrel or low-dose prasugrel.Conclusions:The uniform de-escalation strategy was an effective strategy for older ACS patients. Compared with conventional DAPT using potent P2Y12inhibitors, this strategy decreased the composite of major adverse cardiovascular events and bleeding events.

Circulation, Volume 146, Issue Suppl_1, Page A9551-A9551, November 8, 2022. Introduction:In the wake of the COVID-19 pandemic, extracorporeal membrane oxygenation (ECMO) has been widely used to treat severe acute respiratory distress syndrome (ARDS) in adults. However, the indications, complications, and outcomes of ECMO in children with COVID-19 remain unelucidated. We conducted a systematic review and meta-analysis to investigate the characteristics and outcomes of ECMO use in children with COVID-19.Methods:PubMed and EMBASE databases were searched in March 2022 without language restrictions, and studies involving children (aged≤18) with COVID-19 who received ECMO were included. Two investigators extracted data and assessed the risk of bias independently. Mortality, successful weaning rate, and complications related to ECMO were synthesized by a one-group meta-analysis using a random-effect model.Results:We included 18 observational studies, 4 case series, and 22 case reports encompassing 110 children with COVID-19 requiring ECMO. The median age was 8 years (range: 10 days to 18 years), and the median body mass index was 21.4 kg/m2(range: 12.3-56.0). The most common comorbidities were obesity (11% [7/63]) and congenital heart diseases (11% [7/63]), while 48% (30/63) were previously healthy. The major indications were multisystem inflammatory syndrome in children (52% [47/90]) and ARDS (40% [36/90]). Seventy-one percent (56/79) received venoarterial-ECMO. The median ECMO runtime was 7 days (range: 3-71). The mortality rate was 26.6% (95% confidence interval [CI] 15.9-40.9), and the successful weaning rate was 77.0% (95% CI 55.4-90.1). ECMO-related complications, including stroke, acute kidney injury, pulmonary edema, and thromboembolism, were seen in 37.0% (95% CI 23.1-53.5).Conclusions:This meta-analysis demonstrated relatively favorable outcomes of ECMO for COVID-19 in children. Our findings will contribute to establishing the evidence of ECMO and serve as a guide to managing children with severe COVID-19.

Circulation, Volume 146, Issue Suppl_1, Page A11351-A11351, November 8, 2022. Background:Surgical myectomy (SM) and Alcohol septal ablation (ASA) are two known therapies recommended for symptomatic hypertrophic cardiomyopathy patients. Although, their results are contradictory between the outcomes of these two procedures to this day.Hypothesis:This meta-analysis evaluates and compares the two procedure-related clinical outcomes.Method:We performed a systematic literature search on PubMed, Embase and Cochrane for relevant articles from inception until May 20, 2022. Unadjusted odds ratios (OR) were pooled using a random-effect model, and a p-value of

Circulation, Volume 146, Issue Suppl_1, Page A13426-A13426, November 8, 2022. Objective:Randomized control trials (RCT) conducted on myocardial infarction (MI) patients regarding the efficacy of therapeutic hypothermia (TH) as an adjunct to percutaneous coronary intervention (PCI) have shown inconsistent results. This study aims to compare the use of TH in patients with MI undergoing PCI with control groups.Methods:We systematically searched four databases; PubMed, Scopus, Web of Science, and Cochrane for studies conducted until March 2022. The inclusion criteria were any study design that compared TH in patients with MI undergoing PCI with a control group. Infarct size percentage and recurrent MI were primary efficacy outcomes. Mortality, major adverse cardiovascular events (MACE), and overall bleeding complications were primary safety outcomes. The risk of bias assessment of the included RCTs was conducted through Cochrane tool, while the quality of the included cohort studies was assessed by the NIH tool. The meta-analysis was performed on RevMan.Results:A total of 19 studies were included; 15 RCTs, one case-control, and three cohort studies. Infarct size percentage was significantly reduced in TH group as compared to control (MD= -1.76, 95% CI [-3.04, -0.47), p=0.007), but the TH group had a higher incidence of bleeding complications (OR= 1.88, 95% CI [1.11, 3.18), p=0.02). There were no significant differences between TH and control groups in mortality (OR= 1.06, 95% CI [0.75, 1.50), p=0.73) or recurrent MI (OR= 1.21, 95% CI [0.64, 2.30), p=0.56).Conclusion:In patients with MI, TH reduces infarct size while increasing bleeding complications. Mortality and recurrent MI outcomes are not significantly reduced.

Circulation, Volume 146, Issue Suppl_1, Page A12960-A12960, November 8, 2022. Background:Iron deficiency in patients with systolic heart failure (HF) was found to be associated with poorer exercise capacity and quality of life. We conducted this systematic review and meta-analysis to assess whether iron supplementation in patients with systolic HF can improve exercise capacity and quality of life.Methods:We searched MEDLINE, and Embase databases from inception to May 2022 to identify the studies that reported the impact of iron therapy including oral and intravenous (IV) iron forms in systolic HF patients with iron deficiency. Outcomes of interest included 1) six minute walk test (6MWT) and 2) Quality of life (QoL) assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ). Data from each study were combined using the random-effects model to calculate weight mean difference (WMD) and 95% confidence interval (CI)Results:Five studies (4 randomized controlled trials and 1 nonrandomized open-label study) with a total of 1,075 patients (610 in the intervention group and 465 in the control group) were included. In the intervention group, 474 patients received IV iron and 136 patients received oral iron therapy. Iron therapy was associated with significant improvement of 6MWT (WMD =22.81, 95% CI 0.47-45.14, p < 0.001) and KCCQ (WMD =4.68, 95%CI 0.43-8.93, p< 0.001). Interestingly, subgroup analysis showed that the main results were driven by IV iron therapy in both 6MWT (WMD =34.68, 95%CI 25.13-44.24, p< 0.001) and KCCQ (WMD =6.78, 95%CI 3.81-9.75, p< 0.001) as there was no significant improvement after oral iron therapy in 6MWT (WMD =0.15, 95% CI -23.86-24.16, p =0.99) and KCCQ (WMD =2.71, 95% CI-1.35-6.78, p =0.19). As shown in Figure 1.Conclusions:Intravenous iron therapy, but not oral iron therapy is associated with improved exercise capacity and QoL in patients with systolic HF.

Circulation, Volume 146, Issue Suppl_1, Page A10416-A10416, November 8, 2022. Introduction:Trials evaluating the efficacy of influenza vaccine in secondary prevention among patients with prior coronary artery disease (CAD) have yielded mixed results. We sought to evaluate the efficacy of influenza vaccine in reducing cardiovascular events among patients with prior CAD.Methods:MEDLINE, EMBASE, and Cochrane databases were searched without restrictions through March 2022 for Randomized Controlled Trials (RCTs) that evaluated the outcomes of influenza vaccine versus control in patients with prior CAD. We conducted a pairwise meta-analysis comparing outcomes among the influenza vaccine. The primary outcome was all-cause mortality.Results:The final analysis included 5 trials with a total of 4,187 patients and the weighted median follow-up duration was 12 months. The influenza vaccine group was associated with 46% relative risk [RR] reduction in all-cause mortality compared with control group. (2.8% vs. 5.1%; RR 0.56; 95% confidence interval [CI] 0.41-0.76; I2=0%). The influenza vaccine group was also associated with lower composite of MACE (6.3% vs. 9.9%; RR 0.63; 95% CI 0.52-0.78), and cardiovascular mortality (2.5% vs. 4.7%; RR 0.54; 95% CI 0.39-0.74). There was no significant difference among both groups in acute myocardial infarction (MI) (RR 0.77; 95% CI 0.53-1.13), ischemia—driven revascularization (RR 0.89; 95% CI 0.52-1.53) and hospitalization for heart failure (RR 0.91; 95% CI 0.91 0.21-4.00).Conclusion:a meta-analysis of RCTs showed that influenza vaccine was associated with lower major adverse cardiac events (MACE), all-cause mortality, and cardiovascular mortality in patients with prior CAD. Further efforts are warranted to improve influenza vaccination rate in patients with CAD.

Circulation, Volume 146, Issue Suppl_1, Page A10977-A10977, November 8, 2022. Introduction:Exercise restriction following the identification of a cardiovascular condition can profoundly impact the identity, career, and well-being of athletes. Shared decision-making (SDM) is emerging as the standard of care to guide recommendations for athletes at risk of cardiovascular events. This scoping review summarizes existing approaches, barriers, and facilitators to SDM in sports cardiology.Methods:A literature search of the MEDLINE, Embase, Cochrane Library, PubMed, CINAHL, SPORTDiscus, and PsycInfo databases was conducted in January 2022. Abstract screening and full-text review were completed in duplicate by independent reviewers. The PCC (Participants, Concepts, Context) framework was used to assess study eligibility. Included articles discussed the use of SDM (C/C) following the diagnosis of a cardiovascular condition in an athlete (P).Results:A total of 6,049 records were screened, of which 38 were included in this review. Article classifications included theoretical papers (31), such as editorials and guidelines, and research studies (7). Main findings of the research studies are shown in Table 1. All selected articles defined SDM as an open dialogue between the athlete, healthcare team, and other stakeholders (e.g., parents, coaches). The benefits and risks of management strategies, treatment options, and return-to-play were the focus of this dialogue. Common themes among SDM approaches emerged, such as emphasizing patient values, considering non-physical factors (e.g., emotional, psychological, financial), and informed consent. Barriers to SDM included pressure from institutions and liability of healthcare providers in the case of adverse events.Conclusions:SDM is the recommended paradigm for providing care to athletes diagnosed with cardiovascular conditions. Further education for healthcare providers regarding the SDM approach, as well as future research assessing SDM in a clinical setting, is needed.

Circulation, Volume 146, Issue Suppl_1, Page A12898-A12898, November 8, 2022. Introduction:Disparities in blood pressure (BP) control persist in underserved communities. Although mobile health (mHealth) technologies have increased access to routine care for HTN, few studies have analyzed the effectiveness of mHealth interventions in populations experiencing HTN disparities.Methods:We conducted a systematic review of studies in seven databases published up to November 2021. The search used controlled vocabulary and keywords for HTN, mHealth interventions, and social determinants of health. We included papers that focused on mHealth interventions to manage HTN in underserved populations based on racial, ethnic, and socioeconomic factors. The primary outcome was change in systolic BP (SBP) and diastolic BP (DBP), and we assessed variations in the primary outcome by each study’s relative sociodemographic representation.Results:Among 2,644 unique studies identified, 24 studies (evaluating 7,960 participants in total) met our inclusion criteria. Demographic characteristics were similar between intervention and control groups (intervention: mean age 57.7 [SD 6.2] years; 59.8% women; 40.4% Black; 22.2% Hispanic). Among 18 studies that reported 6-month BP changes, reductions in SBP and DBP values in the intervention group were -7.03 mmHg (control: -2.71 mmHg) and -3.65 mmHg (control: -1.63 mmHg), respectively. Subgroup analysis showed that studies with a higher representation of Hispanic, low-income, and low-education level participants had less pronounced BP improvements than studies with a lower representation of these subgroups.Conclusion:This review provides evidence for the effectiveness of mHealth interventions for HTN management. Future studies and community-based initiatives are needed to further increase individuals’ access to these interventions and to ensure their effectiveness across all populations disproportionately impacted by HTN.

Circulation, Volume 146, Issue Suppl_1, Page A11762-A11762, November 8, 2022. Background:Considering a paucity of pooled data on the influence of Body Mass Index (BMI) on long-term cardiac outcomes in individuals with Hypertrophic Obstructive Cardiomyopathy(HOCM), we conducted this systematic review.Methods:PUBMED, Scopus, EMBASE and Google Scholar were used to screen studies reporting Mortality/Major Adverse Cardiac Events (MACE) and Sudden Cardiac Death(SCD) among obese vs nonobese HOCM patients. Pooled odds ratios(OR) and heterogeneity were assessed with random-effects models and I2statistics. Subgroup analysis was performed to assess the risk by study type, sample size, country and procedure. The leave-one-study-out method was used for sensitivity analysis.Results:Of the 178 titles screened, we included 13 studies published between 2016-2022 with a total of 2,409,397 HOCM patients followed for a median of 6 years (1.8-8.2 year range). The sample had a higher proportion of males (61.33%) with a mean age of 56.3 years (37-78 year range). The unadjusted [OR=1.55(1.09-2.21), I2=96%] and adjusted [OR=1.28 (1.06-1.54), I2=82.7%] pooled odds of all-cause mortality were significantly higher with increased BMI. On subgroup analyses, prospective studies showed higher odds [n=3, 1.79 (1.23-2.6), p=1000:OR=1.39(1.24-1.57)] but lower sample sizes from other countries [n

Circulation, Volume 146, Issue Suppl_1, Page A12125-A12125, November 8, 2022. Background:In the past year, an implantable pulmonary artery pressure (PAP) sensor with CardioMEMS was approved by the FDA for heart failure (HF) patients with New York Heart Association (NYHA) class III or those with HF-related hospitalization (HFH). However, recent guidelines have not strongly recommended adding the PAP sensor to the standard of care in chronic HF patients.Objectives:We conducted this systematic review and meta-analysis to evaluate whether remote PAP-guided therapy can improve outcomes in chronic HF patients.Methods:We searched MEDLINE and Embase databases from inception to May 2022 to identify studies that compared outcomes of interest, including HFH and all-cause mortality in patients with HF who received remote PAP sensors in addition to the standard of care and those with the standard of care alone. Data from each study were combined using the random-effects model.Results:Four studies (2 randomized controlled trials and 2 matched cohort studies) with 7,505 patients (3,693 in the PAP sensor group and 3,812 in the control group) were included. The use of implantable PAP sensors in patients with chronic HF was associated with significantly lower HFH (hazard ratio (HR) = 0.76, 95% conference interval (CI) 0.68-0.84, p

Circulation, Volume 146, Issue Suppl_1, Page A11364-A11364, November 8, 2022. Introduction:Mitral valve prolapse (MVP) is a common valvular disorder affecting approximately 3% of the population. Several risk factors in patients with MVP for malignant arrythmias, including ventricular tachycardia (VT), fibrillation (VF), and sudden cardiac death (SCD), have been proposed. We performed systematic review and meta-analysis to evaluate risk factors for malignant arrhythmias in patients with MVP.Methods:We comprehensively searched the databases of MEDLINE from inception to May 2022. Included studies were published cohorts comparing patients with MVP and malignant arrhythmias or SCD versus MVP without those events. Data from each study were combined using the random-effects model. Pooled odd ratios (OR) and 95% confidence intervals (CI) were calculated.Results:Five studies from 1985 to 2021 were included involving 769 patients with MVP [100 patients with SCD, VF, VT, and/or implantable cardioverter defibrillator (ICD) shocks]. We found that T-wave inversion (pooled OR=3.14, 95%CI: 2.18-4.5, p

Circulation, Volume 146, Issue Suppl_1, Page A13268-A13268, November 8, 2022. Introduction: Plant-based dietary patternsthat emphasize foods derived from plant sources and limit consumption of animal products have the potential to prevent and manage major chronic diseases. We aim to assess the existing prospective observational evidence on associations between adherence to plant-based dietary patterns and risk of developing type 2 diabetes (T2D), cardiovascular disease (CVD), cancer, and mortality.Methods: A systematic review and meta-analysis on prospective observational studies of plant-based dietary patterns and outcomes of T2D, CVD, cancer, and mortality was conducted. We searched PubMed and MEDLINE, Embase, and Web of Science, and screened references.Results:A total of 67 studies were identified, including 3,826,137 participants with 40,885 cases of incident T2D, 145,187 CVD cases, 25,510 cancer cases, and 75,412 deaths. An inverse association was observed between higher adherence to a plant-based dietary pattern and lower risks of T2D (RR, 0.80 [95% CI: 0.74-0.85]), CVD (0.89 [0.84-0.94]), and all-cause mortality (0.85 [0.76-0.95]) with a modest heterogeneity across studies (I2ranged: 62.8%-96.2%), whereas a non-significant inverse association was observed for cancer risk (0.94 [0.87-1.01];I2=49.2%). The inverse association with cancer was strengthened and became significant when healthy plant-based foods, such as vegetables, fruits, whole grains, and legumes, were included in the definition of plant-based dietary patterns (0.90 [95% CI: 0.81-0.99;I2=41.0%]). Among seven studies with measurements of changes in dietary patterns, increased adherence to a plant-based dietary pattern was significantly associated with lower risks of T2D (0.82 [0.71-0.95];I2=72.2%) and mortality (0.95 [0.91-1.00];I2=0%).Conclusions:Higher adherence to a plant-based dietary patterns, especially from healthy resources, may be beneficial for the primary prevention of T2D, CVD, cancer, and mortality.

Circulation, Volume 146, Issue Suppl_1, Page A10177-A10177, November 8, 2022. Introduction:Pacing-induced cardiomyopathy (PiCM) is a potential adverse sequela of right ventricular pacing. Definition varies between studies and the optimal management approach is uncertain. We aimed to characterize definition, incidence, risk factors and treatment strategies of PiCM.Methods:We performed a systematic review and meta-analysis of human studies that evaluated PiCM following pacemaker implantation identified through a literature search of PubMed and EMBASE up to March 2022. Included studies had fifty or more participants. We collected data regarding study definition of PiCM and calculated pooled prevalence across studies. Meta-analysis with random-effects modelling was used to assess association between risk factors and PiCM, reported as odds ratio (OR) with 95% confidence interval (CI).Results:Twenty-six studies (six prospective studies) with a total of 57993 patients (mean/median age 51-78 years, female 45%) were included in final analysis. Fifteen unique definitions of PiCM were reported; the most common definition was left ventricular ejection fraction (LVEF)

Circulation, Volume 146, Issue Suppl_1, Page A15154-A15154, November 8, 2022. Background:Social isolation (SI) or loneliness affects overall morbidity, but its influence as a cerebrovascular risk factor is understudied. This review aims to assess the long-term impact of social isolation on stroke risk.Methods:PUBMED, Scopus, and EMBASE were systematically searched for prospective studies reporting stroke/cerebrovascular outcomes of lack of social contact/network or SI. A stroke/systemic embolic event was the primary endpoint. Pooled relative risk and heterogeneity were assessed with random-effects models and I2statistics, respectively. Subgroup analysis was performed based on follow-up duration and mean/median age of patients. Leave one out sensitivity analysis was performed. A funnel plot was used for visual assessment of publication bias. A p

Circulation, Volume 146, Issue Suppl_1, Page A12706-A12706, November 8, 2022. INTRODUCTION:Prolonged cardiac monitoring is frequently used to detect atrial fibrillation (AF) in high-risk populations, with the goal of preventing thromboembolic events. We sought to determine the impact of prolonged cardiac monitoring on the incidence of stroke and systemic embolism (SSE) or transient ischemic attack (TIA)METHODS:We performed a systematic review and meta-analysis of randomized trials evaluating prolonged monitoring versus usual care (PROSPERO #CRD42021277611). Studies were identified through CENTRAL, MEDLINE, and Embase. We included studies with ≥100 participants and ≥30 days follow-up. The primary outcome was a composite of SSE/TIA, as reported in the original trials. Secondary outcomes included AF detection, oral anticoagulation (OAC) initiation, and major bleeding. Sensitivity analysis examining the impact of monitoring device, and indication for monitoring were performed. Meta-analyses were performed with R using a random-effects model.RESULTS:From 1411 records, we included 9 RCTs (n = 10,205). Mean age was 70 years, 40% were female, and mean CHADS2 score was 4.0. Studies used implantable cardiac monitors (n = 4), external cardiac monitors (n = 3), or handheld ECG devices (n = 2). Study populations included post-stroke (n = 5), high risk for AF or stroke (n = 2), and post-cardiac surgery (n = 1). Mean follow-up was 16 months (range 3-65). Extended monitoring did not significantly reduce the primary outcome (Figure, random effects risk ratio [RR] 0.87, 95% confidence interval [CI] 0.72-1.06, I2 = 0%) or its individual components. Extended monitoring increased AF detection (RR 4.56, 95% CI 3.01-6.92, I2 = 65%) and OAC usage (RR 2.25, 95% CI 2.01-2.53, I2 = 0%), but did not impact major bleeding (RR 1.23, 95% CI 0.84-1.82, I2 = 0%).CONCLUSION:Prolonged monitoring was associated with increased AF detection and OAC use, without significantly reducing the occurrence of thromboembolic events.

Circulation, Volume 146, Issue Suppl_1, Page A11548-A11548, November 8, 2022. Background:Evidence demonstrated gender disparities after transcatheter aortic valve replacement (TAVR) with early generation transcatheter heart valves (THV)s. However, it is unclear whether gender-related differences persist with the newer generation THVs. We conducted this meta-analysis and systematic review to assess gender disparities after TAVR with newer generation THVsMethods:We searched MEDLINE, and Embase databases from inception to May 2022 to identify studies that reported gender-specific outcomes after TAVR with newer generation THVs (Sapien 3, Corevalve Evolut R, and Evolut Pro). Outcomes of interests included 30-day mortality, 1-year mortality and vascular complications. Data were pooled using random-effects models to calculate pooled odds ratio (OR) and 95% conference interval (CI).Results:Four studies with a total of 47,933 patients (21,073 in females and 26,860 in males) were included. Ninety-six percent received TAVR via transfemoral approach. Females had higher 30-day mortality (OR = 1.53, 95%CI 1.31-1.79, p-value (p) < 0.001) and vascular complications (OR=1.43, 95%CI 1.23-1.65, p< 0.001). However, 1-year mortality was similar between 2 groups (OR=0.83, 95%CI 0.67-1.04, p=0.33).Conclusions:Higher 30-day mortality after TAVR in females may be attributed from higher vascular complications. Further research is needed to explore potential causes of increased mortality. While vascular complications may be an etiology, other patient characteristics or procedure-related issues should be evaluated.