Risultati per: Colite ulcerosa negli adulti: review

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 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 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 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 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 A13413-A13413, November 8, 2022. Background:Right ventricular systolic dysfunction (RVSD) is a known predictor of survival in patients with heart failure with reduced ejection fraction. However, the association between RVSD and heart failure with preserved ejection fraction (HFpEF) remains unclear.Objectives:We, therefore, conducted a systematic review and meta-analysis to assess the association between RVSD and HFpEF.Method:Two investigators independently searched the databases of MEDLINE and EMBASE from inception to April 28, 2022 to identify the study that reported outcomes of interest in HFpEF with or without RVSD. Primary outcome was a composite outcome of death and heart failure rehospitalization. Secondary outcome was all-cause mortality. RVSD was defined as right ventricular ejection fraction < 50% by echocardiography or cardiovascular magnetic resonance. Data from each study were combined using the random-effects model to calculate pooled hazard ratio (HR) and 95% confidence interval (CI).Results:Five observational studies involving 1,181 patients with HFpEF from December 2014 to May 2021 were included in our meta-analysis. The presence of RV systolic dysfunction in HFpEF patients was associated with a significantly higher risk of composite outcome of death and heart failure rehospitalization (HR 3.29; 95% CI 1.92-5.65; I2 = 52%) and all-cause mortality (HR 1.72; 95% CI 1.16-2.53; I2 = 68%) compared to those without RV systolic dysfunction.Conclusions:Our meta-analysis demonstrates that HFpEF patients with RVSD is associated with a worse outcome compared to those without RVSD.

Circulation, Volume 146, Issue Suppl_1, Page A10114-A10114, November 8, 2022. Introduction:The most common 4th-line treatment for resistant hypertension (RHTN) is the addition of a mineralocorticoid receptor antagonist (MRA). Renal denervation (RD) has also been investigated as a treatment option for RHTN. A lack of data on the comparative effectiveness of these two therapies poses challenges in choosing optimal treatment strategies for patients with RHTN.Methods:Placebo-controlled and sham-controlled randomized clinical trials testing spironolactone or RD as treatments for RHTN were included in this analysis. Prespecified subgroup analyses comparing the efficacy of MRA and RD were conducted for the outcomes of 24-hour blood pressure (BP) and office BP.Results:Fourteen studies (8 MRA and 6 RD) were identified that included 2,306 participants (1,414 MRA and 892 RD). Cochran risk of bias assessment showed 84% of the domains to be low risk of bias for the MRA studies and 88% of the domains to be low risk of bias for the RD studies. The raw mean difference (RMD) between MRA and placebo control was statistically significant for 24-hour systolic (SBP) (-10.59 mmHg; 95% confidence interval (CI) -12.88 to -8.31), 24-hour diastolic (DBP) (-5.03 mmHg; 95% CI -6.75 to -3.32), office SBP (-10.43 mmHg; 95% CI -12.23 to -8.63), and office DBP (-4.10 mmHg; 95% CI -5.18 to -3.02). The RMD between RD and sham control was not statistically significant for 24-hour SBP (-1.85 mmHg; 95% CI -3.88 to 0.18), 24-hour DBP (-0.67 mmHg; 95% CI -1.84 to 0.51), office SBP (-1.93 mmHg; 95% CI -5.17 to 1.31), and office DBP (-1.55 mmHg; 95% CI -3.43 to 0.33). The interaction between the subgroups was statistically significant for all analyses.Discussion:MRAs had a greater reduction in 24-hour ambulatory and office BP compared to RD among patients with RHTN. This data may help physicians s counsel their patients regarding optimal treatment options for RHTN.

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 A12680-A12680, November 8, 2022. Introduction:Whether alcohol consumption increases the risk of atrial fibrillation (AF) recurrence following catheter ablation for AF remains unclear. We aimed to systematically review the medical literature to assess the impact of alcohol consumption on the recurrence of AF following AFHypothesis:Elevated levels of alcohol consumption are associated with increased rates of AF recurrence following AF ablation.Methods:A structured electronic database search (MEDLINE, EMBASE, CONTROL; inception – December 2021) of the scientific literature was performed for studies reporting rates of AF recurrence following catheter ablation stratified by patients’ level of alcohol consumption. Alcohol use was dichotomized into categories which represented moderate-heavy alcohol use or those that represented abstention or rare alcohol use. Study specific odds rations (ORs) were meta-analyzed using a random effects model. Risk of bias was evaluated using the ROBINS-I tool.Results:A total of nine observational studies were identified, which included 5436 patients undergoing catheter ablation. There was substantial variation in the categories used to stratify alcohol consumption. Compared to patients consuming little to no alcohol, patients consuming moderate to high amounts of alcohol had a greater odds of AF recurrence (OR 1.45 [95% CI: 1.06-1.99, p = 0.02]; I2= 79%). This relationship remained significant after exclusion of studies with < 100 participants (OR 1.40, 95% CI 1.03-1.90, p = 0.03) and when abstract-only publications were excluded (OR 1.84, 95% CI 1.21-2.80, p = 0.004). All included studies were found to be at serious risk of bias, mainly due to confounding. There was no evidence of publication bias.Conclusions:Increased alcohol consumption is associated with increased rates of AF recurrence following catheter ablation for AF. Reduction of alcohol consumption post ablation may reduce AF recurrence.

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 A10071-A10071, November 8, 2022. Introduction:COVID-19 infection and vaccines are associated with acute myocarditis. However, the relative risk of myocarditis is not fully characterized. The aim of this study is to compare the risk ratio (RR) of myocarditis in COVID-19 vaccines and SARS-CoV-2 infection groups and to delineate the effect modifiers.Hypothesis:Risk ratio of myocarditis is higher in the infection group than in the vaccinated group, and this risk is modified by age and sex.Methods:Multiple electronic databases and trial registries were searched to April 2022, for randomized controlled trials and observational cohort studies reporting the risk of myocarditis associated with the COVID-19 vaccines and the risk associated with SARS-CoV-2 infection. We estimated the effect of COVID-19 infection and vaccines on rates of myocarditis by random-effects meta-analyses using the generic inverse variance method. Meta-regression analyses were conducted to assess the effect of sex and age on the incidence of myocarditis.Results:22 eligible studies consisting of 55.5 million in the vaccinated cohort and 2.5 million in the infection cohort were included. Median age was 49 years (interquartile range (IQR): 38-56), and 49% (IQR: 43% to 52%) were male. Of patients diagnosed with myocarditis, 3.48% were hospitalized and 0.05% died. The RR for myocarditis in the infection group was15 (95% CI: 11.09 – 19.81) and 2.0 (95% CI: 1.44-2.65) in the vaccine group. Of patients who developed myocarditis after receiving the vaccine or having the infection, 61% (IQR: 39% -87%) were male. Meta-regression analysis indicated that male sex and young age were associated with myocarditis. Risk of bias assessment was moderate.Conclusions:In this systematic review and meta-analysis, we found that the risk of incident myocarditis is about 7 times higher in persons who were infected with SARS-CoV-2 virus than in those who received the vaccine.

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 A12187-A12187, November 8, 2022. Objective:This meta-analysis aimed to evaluate outcomes of transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) versus surgical aortic valve replacement (SAVR) with coronary artery bypass grafting (CABG).Methods:MEDLINE and EMBASE were searched through November 2021 to identify studies comparing TAVR+PCI and SAVR+CABG for severe aortic stenosis with concurrent coronary artery disease. Outcomes of interest were long-term all-cause mortality, repeat coronary intervention, rehospitalization, myocardial infarction, and stroke during follow-up, and 30-day periprocedural outcomes.Results:Two randomized controlled trials and six observational studies including a total of 104,220 patients (TAVR+PCI, n = 5,004; SAVR+CABG, n = 99,226) were included. Median follow-up periods ranged from one to three years. TAVR+PCI was associated with higher all-cause mortality and coronary reintervention during follow-up period (Hazard Ratio [HR], 1.35; 95% confidence interval [CI], 1.11-1.65; p = 0.003, HR, 4.14; 95% CI, 1.74-9.86; p = 0.001, respectively), 30-day permanent pacemaker implantation rate (Odds Ratio [OR], 3.79; 95% CI, 1.61-8.95; p = 0.002), and periprocedural vascular complications (OR 6.97; 95% CI, 1.85-26.30; p = 0.004). In contrast, TAVR+PCI was associated with a lower rate of 30-day acute kidney injury (OR, 0.32; 95% CI, 0.20-0.50; p = 0.0001). Rehospitalization, myocardial infarction, stroke during follow-up, and other periprocedural outcomes including 30-day mortality were similar in both groups.Conclusions:In patients with severe aortic stenosis and coronary artery disease, TAVR+PCI was associated with higher all-cause mortality at follow-up compared with SAVR+CABG. Heart team approach to assess TAVR candidacy remains imperative.

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 A12167-A12167, November 8, 2022. Background:Raised BNP/NT-pro BNP has been reported as a poor prognostic indicator in hypertrophic cardiomyopathy (HCM) patients. However, the unavailability of pooled data utilizing BNP/NT-proBNP as a prognostic biomarker led us to perform this systematic review and meta-analysis.Methods:Using relevant keywords, PubMed/Medline, Scopus, and EMBASE were systematically reviewed to evaluate studies reporting all-cause mortality or sudden death with BNP/NT-pro BNP through May 2022. Random effects models and I2statistics were used for pooled hazard ratios (HR) and heterogeneity assessment using Review Manager (RevMan) [Computer program]. Version 5.4, The Cochrane Collaboration, 2020.Results:Our systematic review included sample size of 6691 from 12 studies [Table 1]. Four publications were from China, 2 from Japan and Turkey each and 1 from USA, UK, Italy and France each. Age ranged from 46-55 years with a follow up time from 3-8 years. High NT-proBNP was associated with significantly high risk of all-cause mortality in both unadjusted (HR 1.69, 95%CI: 1.30-2.20, p

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