Risultati per: Colite ulcerosa negli adulti: review

Circulation, Volume 146, Issue Suppl_1, Page A13292-A13292, November 8, 2022. Introduction:Studies indicate that living in a rural area may be associated with worse health outcomes. However, it is unclear whether rurality is associated with mortality in patients with acute myocardial infarction (AMI) and heart failure (HF). This systematic review and meta-analysis aimed to evaluate rural-urban differences in mortality rate after AMI or HF.Methods:A systematic search was conducted for studies published till May 1, 2022 in PubMed, Embase and CENTRAL. Included studies compared mortality rates after hospital admission for AMI or HF in rural versus urban areas. Follow up ranged between 30 days and 3 years. Adjusted Odds ratios (aORs) were pooled with a random-effects model.Results:Six cohort studies were identified, which included 785,156 patients (128,990 in rural vs. 656,166 in urban) with AMI and 1,159,000 patients (192,749 in rural vs. 966,251 in urban) with HF. Compared with urban, patients admitted with AMI in rural areas had higher mortality rates (16% vs 14%, aOR 1.12, 95% Confidence Interval (CI) 1.05-1.20;p=0.0003,I2=75%). Compared with urban, patients admitted with HF in rural areas had higher mortality rates (21% vs 18%, aOR 1.19, 95% CI 1.03-1.38;p=0.02,I2=90%). (Figure)Conclusions:Among patients with AMI or HF, living in rural areas is associated with an increased risk of mortality. Clinical and policy efforts are needed in order to reduce disparities in rural health.

Circulation, Volume 146, Issue Suppl_1, Page A11497-A11497, November 8, 2022. Introduction:Medical therapies to prevent atrial fibrillation (AF) episodes and to reduce heart failure (HF) or cardiovascular (CV) death in patients with AF are limited. The role of mineralocorticoid receptor antagonists (MRAs) in this population is unclear.Objectives:We aimed to assess whether the effect of MRAs (e.g. spironolactone, eplerenone, finerenone) in reducing cardiovascular events differs in patients with and without AF, and to evaluate the efficacy of MRAs in reducing AF events.Methods:We searched MEDLINE, Embase, and CENTRAL to March 2022 for randomized controlled trials (RCT) comparing an MRA to placebo or usual care in patients with established cardiovascular disease or risk factors. Pairs of reviewers systematically screened the eligible studies and used random-effects models to combine data.Results:We identified 6 RCTs including 7,245 participants (1,791 with AF and 5,454 without AF) that assessed the effect of MRAs on a composite of HF hospitalization or CV death (Figure). MRAs had similar efficacy for reducing HF hospitalization/CV death in patients with a history of AF (HR 0.86, 95% CI: 0.52-1.42; I2=71%) as compared to those without a history of AF (HR 0.77, 95% CI: 0.62-0.96; I2=58%) – P for subgroup differences=0.69. There was no evidence of difference in the efficacy of MRAs in reducing HF hospitalization (P for subgroup differences=0.93) and CV death (P for subgroup differences=0.41) in patients with and without AF. We identified 21 RCTs including 22,126 participants that reported on the occurrence of AF events. MRAs significantly reduced AF events (RR 0.78, 95% CI: 0.71-0.87; I2=0%). This effect was similar for reducing both new-onset AF (RR 0.81, 95% CI: 0.64-1.01; I2=32%) and recurrent AF episodes (RR 0.77, 95% CI: 0.67-0.88; I2=0%) – P for subgroup differences=0.71.Conclusions:MRAs reduce HF hospitalization or CV death to a similar extent in patients with and without AF. In addition, MRAs may prevent new-onset and recurrent AF events.

Circulation, Volume 146, Issue Suppl_1, Page A12936-A12936, November 8, 2022. Introduction:Aortic stenosis (AS) patients admitted for elective transcatheter aortic valve replacement (TAVR) frequently present significant coronary artery disease (CAD). Despite the increasing number of TAVR procedures, it remains unclear if the strategy of performing percutaneous coronary intervention (PCI) and TAVR during the same hospitalization differs from isolated TAVR.Methods:We performed a systematic review and meta-analysis of observational studies in patients with AS and significant CAD (lesions ≥50%). The aim of the study was to compare TAVR and PCI on same hospitalization (with no regard for whether in the same procedure) to TAVR and deferred PCI. In-hospital mortality, acute kidney injury and major bleeding were our outcomes of interest.Results:We included 4 studies with 2917 patients, 665 treated with TAVR+PCI and 2252 treated with TAVR alone. TAVR+PCI was associated with higher in-hospital mortality (OR 1.66; 95% CI 1.21 – 2.27; p=0.002; Fig. 1). However, there was no difference in acute kidney injury (OR 0.59; 95% CI 0.26 – 1.32; p=0.20; Fig. 2A). Furthermore, TAVR+PCI seemed to lower the rate of major bleeding (OR 0.65; 95% CI 0.46 – 0.93; p=0.02 Fig. 2B).Conclusions:In this meta-analysis of retrospective studies, TAVR and PCI on same hospital admission was associated with higher in-hospital mortality when compared to isolated TAVR.

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.

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 A15112-A15112, November 8, 2022. Introduction:Subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative to transvenous implantable cardioverter-defibrillator (T-ICD) in select patients with complex anatomy, high infection risk and venous access issues. T-ICD is known to cause perioperative and long-term complications. Considering expanding indications for S-ICD, ongoing uncertainty in efficacy and unknown utility in low-risk patients, we performed this updated meta-analysis to study device related complications in both the systems.Methods:We performed a meta-analysis using electronic literature search to retrieve studies that compared S-ICD to T-ICD. Outcomes of interest were efficacy and device-related complications. Outcomes were pooled under random-effects and reported as risk ratios (RRs) and 95% CIs. 15 studies (observational, case-control and RCTs), median follow up 31.1 months, with variable heterogeneity for different outcomes (Fig-1), were included to capture real-world data.Results:A total of 21628 patients (S-ICD group n=3594, male 72.6%, mean age 50.1±10y and T-ICD group n=18034, male =72.6%, mean age 53.3±10.6y) were recruited. Lead-related complications were significantly lower in S-ICD, RR {0.21 [0.13, 0.34], P=

Circulation, Volume 146, Issue Suppl_1, Page A14604-A14604, November 8, 2022. Background:Current guidelines cite complete heart block as a complication of invasive hemodynamic monitoring. This was described to be higher in those with existing intraventricular conduction delays. The objective of this meta-analysis was to evaluate the true risk of arrhythmias and pacemaker implantation rates in patients undergoing right-heart catheterization or with pulmonary artery catheter use.Methods:A literature search was performed from inception until May 2022. Studies that reported incidence rates of arrhythmias in those undergoing right-heart catherization or with pulmonary catheter use, including right- (RBBB) and left-bundle branch (LBBB), were included. Some studies described the development of complete heart block (CHB) and need for pacing.Results:Six single-center studies were included in our analysis with a total of 8, 077 right-heart catheter insertions. All patients had continuous ECG monitoring. Most frequently reported arrhythmia was premature ventricular ectopy (56.4%). No fatal ventricular arrhythmias were described and when noted, RBBB was transient in nature (0.2%, n=12/7577). The risk of CHB was 12.8% (n=24) in those with pre-existing LBBB (n=187). Pacing needs were infrequently described, but when reported was 6.3% (n=10) of concordant CHB and LBBB (n=160), and this was 0.2% of all described LBBB patients (n=6292) (Figure).Conclusion:Most arrhythmias were benign and transient in nature. The risk of CHB requiring pacing needs was only 0.2%. This begs the question of true burden of the theoretical complication of CHB with invasive hemodynamic monitoring, and most evidence is from decades ago.

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 A11383-A11383, November 8, 2022. Introduction:Left ventricular thrombus (LVT) is a well-established risk for ischemic stroke. Nevertheless, it remains uncertain if percutaneous coronary intervention (PCI) in the setting of LVT further augments the risk of stroke. Therefore, in this study, we evaluated the risk of stroke among patients with LVT undergoing PCI.Methods:This retrospective observational cohort study included the patients admitted with LVT to Heart Hospital in Qatar between April 1, 2015 and March 31, 2020. The study population was divided into two groups: (1) patients with LVT who underwent PCI; (2) patients with LVT who did not undergo PCI. The primary outcome evaluated was stroke during the index admission, and the secondary outcomes were in-hospital mortality, all-cause mortality, and stroke at 12 months post discharge. Logistic regression was used to determine the risk of stroke associated with PCI among patients with LVT. A p

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 A14772-A14772, November 8, 2022. Introduction:Vascular closure devices have shown marked improvement in patient comfort and time to ambulation after undergoing atrial fibrillation (AF) and atrial flutter (AFL) radiofrequency ablation. They have been proven superior to manual closure and Figure of 8 suture in terms of pain control and time to ambulate. However, data comparing different vascular closure devices is sparse.Hypothesis:To compare the efficacy of venous closure devicesMethods:We retrospectively reviewed 100 patients at our institution who underwent AF and AFL radiofrequency ablation. We aimed to assess the difference in time to ambulation, device failure, pain control and vascular complication rate between the two commonly used venous closure devices (VASCADE and PERCLOSE).Results:A total of 100 patients (50 in each arm) were included in the study. The mean age was 67.6+9.3 years and 73% patients were men. The two groups were well balanced with respect to baseline demographics and clinical characteristics except for coronary artery disease (24%VASCADE vs. 14% PERCLOSE, p

Circulation, Volume 146, Issue Suppl_1, Page A11462-A11462, November 8, 2022. Introduction:Surgical Myectomy (SM) is the gold standard treatment for hypertrophic obstructive cardiomyopathy (HOCM). However, alcohol septal ablation (ASA) has emerged as an alternative option for selected patients. Nonetheless, the long-term efficacy and safety of ASA have been debated in recent years. The aim of this metanalysis is to evaluate the long-term outcomes of ASA vs SM in HOCM patients.Hypothesis:ASA is a safe and effective alternative to SM in HOCM.Methods:: Unrestricted searches of the PubMed, EMBASE, and Cochrane databases from inception till June 1, 2022, for studies comparing long-term outcomes of ASA with SM in HOCM patients. Relevant data were extracted and analyzed using Revman 5.3 software. Odds Ratio (OR) and 95% Confidence interval (CI) were calculated using the random-effects model.Results:: A total of 12 retrospective studies were included examining 7,599 HOCM patients (2,010 ASA vs 5,589 SM). After a mean follow-up of 5.04 years, all-cause mortality was similar between the two groups (OR 1.18; 95% CI 0.60-2.29). However, ASA was associated with high rates of reinterventions (OR 15.68; 95% CI 6.71-36.61), and pacemaker insertion (OR 2.74; 95% CI 1.39-5.41).Conclusions:Although there was no difference in mortality between ASA and SM, ASA was associated with higher rates of reinterventions and pacemaker insertion in long-term follow-up. Therefore, the selection of septal reduction therapy in HOCM should be individualized and should be performed in a comprehensive center after detailed risk and benefits discussions with an experienced team.

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 A11771-A11771, November 8, 2022. Background:Obesity is usually associated with worse cardiovascular outcomes. However, fewer studies have evaluated its impact on long-term major adverse cardiovascular events (MACE) following CTO PCI. We conducted a meta-analysis to assess the same.Methods:PUBMED, Scopus, and EMBASE were systematically searched for studies reporting long-term (at least >1 year) outcomes with obesity vs no obesity in patients with CTO PCI. MACE events [all-cause mortality, cardiac mortality, revascularization, restenosis/reocclusion, recurrent angina pectoris (RAP), target-vessel myocardial infarction (MI), heart failure, cardiac death, or ischemia-driven target-vessel revascularization (TVR) were the primary endpoint. Pooled odds ratios (OR) and heterogeneity were assessed with random-effects models and I2 statistics respectively. Subgroup analysis was performed to assess the risk by age group and follow-up duration. The leave-one-study-out method was used for sensitivity analysis.Results:After an initial electronic search of thirty-two studies, five studies were selected, and between 2016 to 2021 selected were included in the final analysis. The sample size consisted of 5022 patients with a median age of 63. No significant impact of higher BMI/obesity was seen overall on a median duration of 2.6 yrs [OR(95% CI)= 0.95 (0.82-1.11), p=0.53, I2= 90.86%)](Fig 1).However, on a subgroup analysis, the geriatric age group (≥65 yrs) demonstrated an “Obesity Paradox” effect on MACE after CTO PCI, [OR (95%CI)=0.64 (0.47-0.88), I2=42.13, p

Circulation, Volume 146, Issue Suppl_1, Page A12107-A12107, November 8, 2022. Background:Short-term (

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.