Risultati per: Colite ulcerosa negli adulti: review

Circulation, Volume 146, Issue Suppl_1, Page A11658-A11658, November 8, 2022. Arthropod and insect bites/stings have been associated with the development of Acute Coronary Syndrome (ACS) in prior case reports. In this systematic analysis, we review 57 reported cases of ACS in patients that were exposed to arthropods, bee stings or insect bites, and provide a summary of these findings in Table 1. We then discuss Kounis Syndrome Type 1 or Type 2 as the proposed mechanism by which myocardial ischemia develops in this subset of patients, and the implications of this diagnosis on management. Kounis Syndrome Type 1 develops due to mast cell activation and histamine release provoking vasospasms and inducing myocardia injury in the absence of underlying coronary artery disease, as demonstrated in Figure 1A. Kounis Syndrome Type 2 develops due to inflammation induced plaque rupture and subsequent thrombus formation, as demonstrated in Figure 1B. In general, Kounis Syndrome should be suspected in patient’s presenting with the appropriate exposure, an allergic or anaphylactic response and/or unremarkable coronary angiogram (specific to Type 1). Once suspected, the use of coronary artery vasodilators, antihistamines, steroids and possibly Epinephrine should be considered in management. In this review, it was discovered that approximately 50% of cases received management consistent with Kounis Syndrome (targeted to allergic/anaphylactic symptoms) with appropriate clinical response, yet only 12% received the formal diagnosis, indicating this condition is underdiagnosed. Furthermore, 40% of patients that underwent coronary angiogram did not have CAD, indicating a possible Type 1 (vasospastic) etiology of ACS that may benefit from more targeted therapy.

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 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 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 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 A11655-A11655, November 8, 2022. Objective:Low molecular weight heparin (LMWH) has been established for the treatment of cancer-associated thromboembolism (CAT). Recent guidelines suggest Direct Oral Anti-Coagulants (DOACs) may have a role in the management of CAT, however these recommendations were conditional. This study aims to compare DOACs with LMWH and Vitamin K Antagonists (VKAs) in CAT.Methods:We conducted a meta-analysis of studies through a systematic search of four electronic databases (PubMed, Scopus, Web of Science, and Cochrane) published before January 25, 2022. Our criteria included studies in patients with all cancer types who received DOACs, VKAs, or LMWH for prevention or treatment of CAT. We analyzed outcomes including recurrent venous thromboembolism, major bleeding, clinically relevant non-major bleeding (CRNMB), and all-cause mortality. The quality 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 network meta-analysis was performed using the netmeta package in R software.Results:A total of 55 studies were included; 18 RCTs, and 37 cohort studies. DOACs (RR= 0.72, 95% CI [0.63; 0.83]) and LMWH (RR= 0.78, 95% CI [0.64; 0.94]) had a significantly lower risk of major bleeding than VKAs. There was also a significantly decreased risk of clinically relevant non-major bleeding (CRNMB) with LMWH than DOACs (RR= 0.63, 95% CI [0.55; 0.73]) and DOACs compared to VKA (RR= 0.83, 95% CI [0.72; 0.95]). With regards to recurrent venous thromboembolism risk (VTE), DOACs showed a significantly lower risk compared with either LMWH (RR=0.70, 95% CI [0.59; 0.83]) or VKA (RR=0.66, 95% CI [0.54; 0.80]).Conclusion:We conclude that DOACs are more effective in the management of CAT when compared to LMWH and VKA. DOACs and LMWH have significantly lower risk of major bleeding when compared to VKA. More research is needed to determine the best anticoagulation strategy for distinct types of cancers.

Circulation, Volume 146, Issue Suppl_1, Page A15236-A15236, November 8, 2022. Introduction:The term ‘survivorship’ describes the therapeutic, functional, psychosocial, and financial experience of living with a chronic condition.This term acknowledges the fact that a patient’s life can be radically altered overnight because of their disease and treatment, but also designates patients as ‘survivors’, having overcome the acute phase (‘acute survivorship’) and now needing to live with, through and beyond their condition (‘extended survivorship’ and ‘permanent survivorship’). The aim of this systematic review was to identify the most frequently used quality of life (QOL) assessment tools and to determine how closely these align to the concept of ‘survivorship’.Methods:A systematic literature review was conducted according to PRISMA guidelines. Embase, Medline and the Cochrane Library were electronically searched till January 2022 for studies reporting on QOL in aortic dissection patients. Observational studies and case series studies were included. Due to the degree of heterogeneity existing between the studies, a meta-analysis was not conduced. Study quality was assessed using the Agency for Healthcare Research and Quality (ARHQ) methodology checklist.Results:A total of 27 studies were included, encompassing 32 QOL tools. The most common QOL tool utilised was the SF-36, across 11 studies. Only one qualitative study investigated patient perspectives of living with aortic dissection. Overall, QOL was found to be poor in aortic dissection survivors. All identified QOL tools demonstrated a poor alignment with the survivorship domains. Included studies displayed a moderate to high risk of bias, having small sample sizes and an insufficient follow-up period.Conclusion:This review highlights the absence of an aortic dissection specific QOL tool. All QOL tools identified failed to encompass the breadth of survivorship domains, with a lack of studies focusing on the patients’ perspective. Further research is urgently required to gain an insight into the quality of life of patients who have survived an aortic dissection, and to develop an aortic dissection specific QOL tool, underpinned by the survivorship domains.

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 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 A13405-A13405, November 8, 2022. Background:Despite previous studies exploring female reproductive factors, early menarche and its impact on stroke risk remains under-reported. This systematic review seeks to further explore this correlation.Methods:PubMed, SCOPUS and EMBASE databases were systematically reviewed for studies reporting long-term incidence and odds of stroke in patients who had menarche at an early age vs. menarche at a normal age. Random effects models were used for the meta-analysis and subgroup analysis. I2 statistics were used to identify substantial ( >75%) heterogeneity. A sensitivity analysis was performed using the leave-one-out method.Results:Ten prospective studies with a total of 1,971,454 patients were included and the odds of stroke were evaluated for patients with early menarche vs controls. Overall unadjusted odds for stroke with early menarche was 1.14 (95%CI 1.08 -1.20, p

Circulation, Volume 146, Issue Suppl_1, Page A11630-A11630, November 8, 2022. Introduction:Wearable cardiac defibrillators (WCD) have been shown to be effective for detection and treatment of ventricular tachyarrhythmias. However, their efficacy in improving survival or decreasing mortality in patients with newly diagnosed cardiomyopathy (CM) is uncertain. This study reviews the current available evidence.Method:We searched databases since inception to April 2022, without language and year of publication restriction for randomized trials and cohort studies that examined the difference between WCD use and non-use in mortality and survival among patients with ischemic and non-ischemic CM. Two independent investigators screened the abstracts and full texts and extracted the data. Data was analyzed using random effect model.Results:From 603 records identified by a librarian, only 4 randomized trials on WCD use in ischemic CM met the inclusion criteria. One of them was an abstract without any full text published. The total participants were 18,779 of which 2,408 were in the WCD group (mean age 65.12±11.5, 20.7% female) and the rest in control group (mean age 65.45±11.36, 28% female). The adjusted all-cause mortality at 3 months follow up was significantly lower in WCD group (RR 0.32, CI [0.11-0.97], including three studies, 2,360 patients in WCD group and 4,954 in control group) (heterogeneity score I2=86%)(figure). Adjusted all-cause mortality at 12 months was also significantly lower in WCD group (RR 0.43, CI [0.25-0.71], two studies, 857 patients in WCD group and 15,566 in control group) (heterogeneity score, I2=49%). Only one study reported adjusted risk for arrhythmic death, myocardial infarction, arrhythmia (atrial or ventricular), stroke and hospitalization. In addition, one study reported the difference in cost and healthcare use between the two groups.Conclusion:Our meta-analysis confirms significant reduction in all-cause mortality associated with WCD use in patients with newly diagnosed ischemic cardiomyopathy.

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 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 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 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