Risultati per: Colite ulcerosa negli adulti: review

Circulation, Volume 146, Issue Suppl_1, Page A13056-A13056, November 8, 2022. Introduction:There has been growing evidence comparing Coronary Computed Tomography Angiography (CCTA) versus the standard of care(SOC) in patients with suspected stable coronary artery disease (CAD). We aimed to perform a systematic review and meta-analysis to compare CCTA versus SOC in patients with stable CAD.Methods:We searched multiple databases for randomized controlled trials (RCTs) comparing CCTA with SOC with various functional testing approaches for the evaluation of stable CAD. We used a random-effects model to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Outcomes included all-cause mortality, myocardial infarction (MI), hospitalization for unstable angina (UA), invasive angiography, revascularization, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG).Results:We identified 6 RCTs with a total of 19,881 patients with stable CAD, of which 9,995 underwent CCTA and 9,886 underwent UC. There were no significant differences between CCTA and SOC in terms of all-cause mortality (RR: 0.91; 95% CI: 0.70-1.19; p=0.64), MI (RR: 0.78; 95% CI: 0.58-1.05; p=0.70), hospitalizations for UA (RR: 1.20; 95% CI: 0.95-1.51;p=0.64), invasive angiography (RR: 0.11; 95% CI: 0.32-1.61; p

Circulation, Volume 146, Issue Suppl_1, Page A14060-A14060, November 8, 2022. Background:RCTs studying the effect of sodium-glucose co-transporter 2 inhibitors (SGLT2i) on cardiovascular (CV) risk factors and outcomes have been underpowered to assess patients with overweight or obesity, thus presenting the need for a meta-analysis.Methods:Electronic databases were queried up till February 2022 for RCTs comparing SGLT2i with placebo in patients with overweight (BMI ≥25 kg/m2) or obesity (BMI ≥30 kg/m2) – irrespective of diabetes status – with a follow-up of ≥24 weeks. Meta-analyses were performed using the generic inverse variance technique and a random-effects model. Results are presented as weighted mean differences (WMD) for continuous outcomes, and hazard ratios (HR) for dichotomous outcomes. Outcomes studied were: (i) weight; (ii) systolic BP; (iii) diastolic BP; (iv) heart rate; (v) HDL-C; (vi) LDL-C; (vii) major adverse cardiac events (MACE), i.e., composite of CV death, non-fatal myocardial infarction (MI) and non-fatal stroke; (viii) composite of heart failure hospitalization and CV death (HFH/CV death); (ix) mortality; (x) MI; and (xi) stroke.Results:Seventeen RCTs (47,649 patients) were included. Compared with placebo, SGLT2i significantly reduced weight (WMD: -2.32 kg [-2.77, -1.88]), HbA1c (WMD: -0.79 % [-0.98, – 0.61]) and systolic BP (WMD: -2.15 mm Hg [-3.08, – 1.22]). SGLT2i did not have a significant effect on diastolic BP (WMD: -0.55 mmHg [-1.51, 0.41]), heart rate (WMD: 0.08 bpm. [-0.21, 0.37]), HDL-C (WMD: 1.62 mmol l-1[-0.21, 3.45]) or LDL-C (WMD: 0.53 mmol l-1[-0.88, 1.94]). Amongst CV outcomes, SGLT2i reduced the risk of MACE (HR: 0.90 [0.81, 0.99]), HFH/CV death (HR: 0.82 [0.75, 0.90]), and mortality (HR: 0.85 [0.77, 0.94]). No effect was noted on stroke (HR: 0.99 [0.85, 1.26]) or MI (HR: 0.89 [0.77, 1.02]).Conclusions:In patients with overweight or obesity, SGLT2i produce a modest but significant reduction in weight, systolic BP and HbA1c. SGLT2i may also reduce the risk of MACE, HFH/CV death, and mortality.

Circulation, Volume 146, Issue Suppl_1, Page A13046-A13046, November 8, 2022. Introduction:Pocket hematoma is a feared complication of cardiac implantable electronic device (CIED) placement. About half the patients undergoing the procedure are on anticoagulation with consequent increased frequency of device-pocket hematoma. The risk of hematoma is variable based on the type of anticoagulation therapy. The purpose of this study was to compare the risk of device-hematoma in patients oninterruptednovel oral anticoagulants (NOAC) versusuninterruptedvitamin K antagonists (VKA) during the peri-operative period.Methods:We performed a meta-analysis using electronic literature search to retrieve studies with CIED surgery on uninterrupted VKA versus interrupted NOAC (range 12-96 hours). Primary outcome of interest was pocket-hematoma. Outcomes were pooled under random-effects meta-analyses and reported as risk ratios (RRs) and 95% CIs. 5 studies with low heterogeneity (I2=14%), 4 observational and 1post-hocanalysis of a randomized trial, were included. 1002 patients NOAC group=376 and VKA group=626 were followed for 4-6 weeks.Results:Baseline characteristics were similar, mean age 71 years and 71% male across both groups. There was no significant difference in endpoints: pocket hematoma (major and minor) {RR 0.74 (0.43-1.29), P=0.29}; major hematoma {RR 0.53 (0.24-1.19), P=0.13}; hematomas with new implants {RR 0.82 (0.46-1.48), P=0.51}; hematomas with generator changes {RR 1.90 (0.84-4.31), P=0.12}; hematomas with device-upgrade {RR 0.41 (0.15-1.07), P=0.07}; major bleed {RR 0.18 (0.03-1.09), P=0.06}; pericardial effusion {RR 1.01 (0.13-8.19), P=0.67}(Fig 1). One study reported peri-implantation infection (n=4/311 NOAC, n=2/467 VKA). One patient out of all 5 studies had systemic thromboembolism in each group (1/837 NOAC, 1/1000 VKA).Conclusion:Interrupted NOAC use is not associated with a higher risk of pocket hematoma compared to uninterrupted VKA after CIED placement.

Circulation, Volume 146, Issue Suppl_1, Page A15459-A15459, November 8, 2022. Introduction:Heart failure with preserved ejection fraction (HFpEF) is a common condition with one of its characteristics being exercise intolerance, which contributes to poor quality of life and clinical outcomes. High-intensity interval training (HIIT) is an innovative training approach, but its impact on patients with HFpEF is uncertain. We pooled data from all relevant studies reporting results of HIIT versus moderate continuous training (MCT) on cardiopulmonary exercise outcomes in patients with HFpEF.Methods:PubMed and SCOPUS were queried until February, 2022 for all randomized controlled trials (RCT) comparing the effects of HIIT versus MCT on outcomes such as peak oxygen consumption (peak VO2), respiratory exchange ratio (RER), and minute ventilation / carbon dioxide production (VE/CO2) > slope. A random-effects model was used and weighted mean differences (WMDs) were reported with 95% confidence intervals (CI). Heterogeneity across studies was evaluated using the HigginsI2statistic.Results:Three RCTs (n = 150) were included in our analysis. The mean training duration was 23 weeks (range: 4 – 52 weeks). Pooled analysis demonstrated that HIIT significantly improved peak VO2(WMD = 1.46 mL.kg-1.min-1(0.88, 2.05);p

Circulation, Volume 146, Issue Suppl_1, Page A13952-A13952, November 8, 2022. Introduction:Studies evaluating trends in the incidence and mortality for in-hospital cardiac arrest (IHCA) in children with cardiac disease admitted to the intensive care unit (ICU) are rare. Additionally, there is limited information on factors associated with IHCA and mortality.Hypothesis:We hypothesized that the incidence of IHCA and the mortality rate in cardiac children admitted to the ICU has significantly decreased over time.Methods:We conducted a systematic review of PubMed, Web of Science, EMBASE, and CINAHL from inception to Sept 2021. Random effects meta-analysis was used to compute pooled-proportions and pooled-ORs. Meta-regression adjusted for type of study (registry vs cohort) and diagnostic category (surgical vs general cardiac) was used to evaluate trends in incidence and mortality.Results:Of the 2,574 studies identified, 25 were included in the systematic review (126,087 patients), 18 in the meta-analysis. Five percent (95% CI: 4-7%) of ICU children experienced IHCA and 35% (95% CI: 27-44%) did not achieve ROSC. In centers with ECMO, 21% (95% CI: 15-28%) underwent ECPR. The pooled in-hospital mortality was 54% (95% CI: 47-62%). Both incidence of IHCA and in-hospital mortality decreased significantly in the last 20 y (p

Circulation, Volume 146, Issue Suppl_1, Page A10535-A10535, November 8, 2022. Introduction:The association of combined low-risk lifestyle behaviors (LRLBs) with cardiovascular disease (CVD) and all-cause mortality has not been systematically quantified.Objective:We undertook a systematic review and dose-response meta-analysis to assess the association of combined LRLBs with CVD and all-cause mortality.Methods:MEDLINE, EMBASE and Cochrane were searched up to December 29, 2021. Prospective cohort studies reporting the association between a minimum of 3 combined LRLBs (including healthy diet) with CVD, coronary heart disease (CHD) and stroke incidence and mortality were included. Independent reviewers extracted data and assessed study quality. Highest vs. lowest LRLB score was pooled using random effects. Heterogeneity was assessed (Cochran Q) and quantified (I2). Global dose response meta-analysis (DRM) for maximum adherence was estimated using one-stage linear mixed model. The certainty of the evidence was assessed using GRADE.Results:116 cohort comparisons (n=9,775,191) involving 382,922 cases were included. Comparing highest with lowest adherence LRLBs were associated with lower risk of CHD incidence (RR, 0.29 [95% CI, 0.21, 0.42]), stroke incidence (0.56 [0.50, 0.62]), CVD incidence (0.47 [0.37, 0.58]), CHD mortality (0.32 [0.25, 0.41]), stroke mortality (0.37 [0.30, 0.46]), CVD mortality (0.41 [0.34, 0.49]) and all-cause mortality (0.46 [0.41 to 0.52]). DRM analysis showed a linear association between LRLBs and all outcomes reaching a global DRM between 59-76% protection. LRLBs were defined with variable ranges as a healthy body weight (body mass index median), regular physical activity (1/week to >30 minutes/day), smoking cessation (never smoked or smoking cessation), light alcohol intake (≤30g/day) and adequate sleep (5.5-9 hours). The certainty of the evidence was graded as moderate to high owing to downgrades for inconsistency and/or upgrades for a large magnitude of effect and significant dose-response gradient.Conclusions:Pooled analyses show that the combination of LRLBs was associated with a substantial lower risk of CVD outcomes and all-cause mortality. The available evidence provides a very good indication of the benefit of combined LRLBs.

Circulation, Volume 146, Issue Suppl_1, Page A15645-A15645, November 8, 2022. Introduction:Posterior mediastinal hematoma (PMH) is a rare complication of anti-coagulation (AC) use. We present a complex case of a patient with a sub-massive pulmonary embolism (PE) whose care was complicated by PMH causing airway obstruction following thrombectomy.Case:A 60-year-old male with a history of prostate cancer in remission presented after a syncopal event. On admission, he was afebrile, mildly tachycardic (100bpm), normotensive (135/91), with no oxygen requirement. Laboratory data showed high sensitivity troponin 244 ng/L and BNP 82 pg/ml. CTPA revealed a saddle PE with right heart strain (PESI score 100). He was initiated on anticoagulation and underwent successful mechanical thrombectomy using a Penumbra aspiration catheter. He had acute respiratory failure later that evening, necessitating intubation. Repeat CTPA showed increased clot burden and new onset PMH (Figure 1). Of note, his AC was continued due to clot burden. A repeat thrombectomy was performed using the FlowTriever System Device (Inari Medical, Irvine, CA). Despite this intervention, he continued to struggle with extubation, and a new stridor was noted. Bronchoscopy revealed external compression of proximal trachea correlating with the PMH location. He was deemed too high risk for evacuation of the PMH. Therefore, he underwent tracheostomy to bypass the area of compression. This subsequently allowed for successful extubation.Discussion:While thrombectomy can cause iatrogenic bleeding, no bleeding was seen on the post-procedure angiogram in our patient. Thus, these findings are attributed to PMH. PMH has been reported 6 times in literature (table 1), one associated with PE. Management options include hematoma evacuation or holding AC and performing serial follow up imaging. Our patient did not undergo evacuation of hematoma, and a tracheostomy was used instead to bypass the obstruction. This highlights the need to individualize management of these complex patients.

Circulation, Volume 146, Issue Suppl_1, Page A14883-A14883, November 8, 2022. Introduction:Postprocedural anticoagulation is indicated for at least 45 days in patients who undergo percutaneous left atrial appendage occlusion with the Watchman device. The relative efficacy and safety of non-vitamin K oral anticoagulants (NOACs) to warfarin for postprocedure anticoagulation in this setting is not well known.Methods:We conducted a systematic review and meta-analysis to compare NOACs with warfarin in patients who underwent left atrial appendage occlusion with Watchman. PubMed, Cochrane, and EMBASE were systematically searched. We included randomized and observational studies with at least 45 days of follow-up following Watchman implantation comparing anticoagulation with NOACs vs. warfarin for thrombotic and hemorrhagic outcomes.Results:We included 11 studies with 2,325 patients who underwent Watchman device implantation and were anticoagulated with NOACs (n=1,194; 51.35%) or warfarin (n=1,131; 48.65%). NOACs were associated with a lower incidence of major bleeding (OR 0.49; 95% CI 0.28-0.89; p=0.02; Fig. 1A) and device-related thrombosis (OR 0.44; 95% CI 0.21-0.93; p=0.03; Fig. 1B). There was no significant difference between NOACs and warfarin with regards to stroke or transient ischemic attack (OR 0.43; 95% CI 0.15-1.28; p=0.13; Fig. 2).Conclusions:In this meta-analysis, NOACs were associated with lower risks of device-related thrombosis and major bleeding relative to warfarin in patients who undergo Watchman implantation.

Circulation, Volume 146, Issue Suppl_1, Page A11804-A11804, November 8, 2022. Background:Research on fast-track recovery protocols postulate epidural anaesthesia (TEA) in cardiac surgery contribute to improved postoperative outcomes. However, concerns about TEA’s safety and current equivocal evidence, hinder its widespread usage. We conducted a systematic review and meta-analysis to assess the effects of TEA in cardiac surgery.Methods:We searched four databases for randomised controlled trials (RCTs) assessing the use of TEA against only GA in adults undergoing cardiac surgery, up till 4 June 2022. We conducted random effects meta-analyses (DerSimonian and Laird), evaluated risk of bias using the Cochrane Risk-of-Bias 2 tool, and rated certainty of evidence via the GRADE approach. Primary outcomes were ICU and Hospital length of stay, with other outcomes including postoperative complications. Trial sequential analysis (TSA) was conducted on all outcomes to elicit statistical and clinical benefit.Results:Our meta-analysis included 39 RCTs (1941 TEA patients, 2047 GA patients). TEA significantly reduced ICU LOS (Figure 1: -6.8 hours, 95%-CI: -10.8 to -2.8, p=0.0009), hospital LOS (-0.7 days, 95%-CI: -1.2 to -0.2, p=0.0051), and extubation time (-2.8 hours, 95%-CI: -3.8 to -1.8, p=0.0001). However, there was no significant reduction in mortality. TSA found that the cumulative Z-curve passed the TSA-adjusted boundary for ICU LOS (see below), hospital LOS, and ET, suggesting a clinical benefit. TEA also significantly reduced transfusion requirements, pain scores, delirium, arrhythmia, and pooled pulmonary complications, without additional complications such as epidural hematomas.Conclusions:TEA reduces ICU and hospital lengths of stay, and postoperative complications in patients undergoing cardiac surgery with minimal reported complications. These findings favour the use of TEA in cardiac surgery, and warrants consideration for use in cardiac surgeries worldwide.

Circulation, Volume 146, Issue Suppl_1, Page A14282-A14282, November 8, 2022. Introduction:While kidney transplant recipients (KTR) are high risk candidates for valve replacements, the safety of transcatheter aortic valve replacement (TAVR) is limited among this population as they are excluded from major trials. We aimed to compare the outcomes between TAVR and surgical aortic valve replacement (SAVR) among KTR by a systematic review and meta-analysis.Methods:We comprehensively searched PubMed, Embase, and Cochrane Library from its inception until April 20, 2022 for relevant studies. Outcomes were pooled using the DerSimonian and Laird random-effects model and reported as odd ratios (OR) or standardized mean difference (SMD) and 95% confidence intervals (CI).Results:6 studies involving 5,452 patients (1,956 TAVR, 3,496 SAVR) were included in the analysis. TAVR patients were older (69.4 years vs 62.8 years), were less likely to be male (66.7% vs 67.9%) and had a higher prevalence of most comorbidities including coronary artery diseases (78% vs 58%), heart failure (71% vs 42%) and diabetes mellitus (52% vs 45%). Compared with SAVR, KTR undergoing TAVR had significantly lower risk of in-hospital all-cause mortality (OR 0.51, 95% CI: 0.39 to 0.67, p

Circulation, Volume 146, Issue Suppl_1, Page A13752-A13752, November 8, 2022. Introduction:Treating individuals with stable multivessel coronary artery disease (CAD) and retained ventricular function is still debatable. Percutaneous coronary intervention (PCI) and coronary bypass grafting (CABG) are all options for treatment, and they are all employed in tandem with rigorous secondary prevention. One technique’s significant long-term mortality benefit over the other is still debatable for multivessel disease management.Hypothesis:To compare the long-term mortality and complications of coronary artery bypass graft (CABG) versus Percutaneous Coronary Intervention (PCI) among patients with multivessel disease.Methods:Pubmed/Medline, EMBASE, Cochrane, Web of Science, Scopus, and grey literature were searched in March 2022. We only included randomized clinical trials (RCTs) that reported the outcome differences between CABG and PCI. The primary outcome was long-term all-cause mortality. The secondary outcomes were re-intervention rate and major adverse cardiac events (MACE). The statistical analysis was performed using Comprehensive Meta-analysis software version 3.Results:A total of 6 Randomized Control Trails (RCTs) studies were included in the analysis comprising 7,126 patients (3558 PCI and 3568 CABG). The median follow up period was 6.33 years. Long-term mortality from any cause (after 2 years follow up or more) was significantly higher in PCI group compared to CABG group (HR: 1.44; 95% CI, 1.25-1.67; P < 0.01; I2= 18.78%). This trend was consistent among diabetic patients (HR: 1.39; 95% CI, 1.14-1.69; P < 0.01; I2= 23.73%). CABG procedure was associated with lower rate of additional or repeat intervention (RR: 0.25; 95% CI, 0.17-0.37; P < 0.01; I2= 74.4%). Cardiovascular-specific mortality and MACE were lower among CABG group compared to PCI (RR: 0.77; 95% CI, 0.58-0.95; P < 0.01; I2= 0%), (RR: 0.77; 95% CI, 0.64-0.93; P < 0.01; I2= 0%), respectively.Conclusions:The study shows that CABG provides lower long-term mortality rates, including diabetic patients, a lower rate of repeat intervention, and lower major adverse cardiac events. Therefore, CABG is an effective and safe approach for patients with multivessel diseases compared to PCI, especially in the long term.

Circulation, Volume 146, Issue Suppl_1, Page A14100-A14100, November 8, 2022. Background:Treatment with various sodium-glucose cotransporter 2 inhibitors (SGLT-2Is) has decreased cardiovascular events in patients with heart failure (HF). Therefore, we conducted a network meta-analysis to investigate which SGLT-2Is are more effective in patients with HF.Methods:PubMed, Web of Science, Scopus, and Embase, were systematically searched from inception to February 2022. We included randomized controlled trials (RCTs) that investigated the use of SGLT-2Is vs. placebo in HF patients. The main outcomes were all-cause, cardiovascular mortality, serious adverse events, and hospitalizations due to HF. The random-effects method model and inverse variance statistics were used to calculate the odds ratio (OR) with a 95% confidence interval (CI).Results:Our study included 12 RCTs with a total number of 69,024 patients (37,923 in the SGLT2 inhibitors group and 31,101 in the placebo group). Five RCTs used empagliflozin, 4 used dapagliflozin, 1 used canagliflozin, 1 used ertugliflozin, and 1 used sotagliflozin. Our analysis showed that empagliflozin has a statistically significant lowest odds for both cardiovascular mortality and serious adverse effects (OR: 0.80 with 95% CI [0.67-0.96]) and (OR: 0.84 with 95% CI [0.76-0.93]), respectively compared to other SGLT-2Is. All SGLT-2Is have been associated with the same lower odds without preferences for one over the others regarding all-cause mortality. Furthermore, the hospitalization rate due to HF showed a statistically significant decrease with all the SGLT-2Is except for canagliflozin, which showed insignificant results with (OR: 0.63 with 95% CI [0.39-1.01]).Conclusion:No differences between the SGLT-2Is included in this analysis were observed in terms of all-cause mortality. Empagliflozin had the lowest odds of cardiovascular mortality and serious adverse effects. Canagliflozin was the only SGLT-2Is that showed no significant results in odds of hospitalization for HF.

Circulation, Volume 146, Issue Suppl_1, Page A12357-A12357, November 8, 2022. Introduction:The prevalence of obesity among patients with AF and its impact on catheter ablation outcomes remain controversial. We aimed to examine the proportion of obese participants enrolled in current AF ablation RCTs and outcomes of ablation among patients with obesity.Methods:We systematically searched PUBMED for RCTs examining catheter ablation for treatment of AF published between 01/2019 to 03/2022. When mean and standard deviation (SD) were available, normal distribution was assumed and a z-score was used to estimate the proportion of obese participants. A trial was classified as group A and B when conducted in countries where obesity is defined as BMI ≥30 and ≥25 kg/m2, respectively.Results:Of 26 RCTs comprising 1,582 participants, 19 (73.1%) trials reported the BMI of study participants, but only 2 (7.7%) specified the proportion of obesity (15.5% and 39.0%). Two trials excluded participants with BMI >35 kg/m2. In group A (N1=17), the mean BMI was 28.8±1.4 kg/m2with estimated obese participants of 39.7% (IQR 38-45 kg/m2). The mean BMI in group B (N2=9) was 24.9±1.1 kg/m2with estimated obese participants of 47.1% (IQR 37-50 kg/m2), Figure. Subgroup analysis examining the effect of catheter ablation according to the BMI status was not reported in any RCTs. Bivariate or multivariate analysis evaluating the effect of BMI or body weight were used in only 4 (15.4%) RCTs. The results suggested that BMI or body weight did not affect their main findings with risk ratio of 0.97-1.00.Conclusion:Current AF ablation RCTs underreport the actual proportion of participants with obesity. However, using the available mean BMI of the study subjects, concomitant obesity among AF patients was highly prevalent and identified in 40-50%. The impact of obesity on the main findings is not fully reported; thus, efficacy of AF ablation among obese patients could not be concluded.

Circulation, Volume 146, Issue Suppl_1, Page A310-A310, November 8, 2022. Purpose:Often emphasized as a best practice in prehospital airway management, first-pass intubation success (FPS) depends upon paramedic self-reports. We sought to determine the accuracy of paramedic reports of FPS in prehospital airway management.Methods:We analyzed adult (age >=18 years) prehospital airway management data from a ground EMS agency, including cases from 5/1/2020 to 2/28/2022. Paramedics performed all adult prehospital endotracheal intubations (ETI) using standard video laryngoscopy (Airtraq, Mountain View CA) with a hyperangulated blade. Paramedics did not use neuromuscular blocking agents for ETI. Real time video images were recorded for all cases. We excluded cases where the video was missing, data was not captured, or the video was of insufficient quality. Each video was reviewed by a single independent rater using the same objective definition of FPS as the paramedic. The primary outcome was FPS, defined as correct intratracheal placement on the first video laryngoscopy. We evaluated agreement between paramedic and reviewer-reported FPS using Cohen’s Kappa statistic.Results:There were a total of 514 ETI cases, including cardiac arrest, trauma, and non-arrest medical. Paramedic and reviewer reported FPS agreed in 429/514 (83.5%) and disagreed in 85 (16.5%). Of the discordant cases, the paramedic reported FPS but the reviewer disagreed in 78 (92%). Interrater agreement was strong; kappa 0.659 (95%CI 0.595 – 0.722). FPS discordance was not associated with patient age, sex, cardiac arrest status.Conclusions:Despite the computed Kappa statistic showing strong interrater reliability, the objective nature of the rating leaves very little room for discordance. The expected result would have been near compete agreement, however 15% of cases resulted in disagreement. Additionally, when there was disagreement, it overwhelmingly favored the clinician reporting FPS when the reviewer disagreed. Paramedics incorrectly reported FPS in 1 of 6 ETI. Independent review is essential in the assessment of prehospital ETI performance. Further study is needed to determine the reasons for the discordance that may include confusion about the FPS definition or incentivization (real or perceived) of reporting outcomes in a particular way.

Circulation, Volume 146, Issue Suppl_1, Page A12263-A12263, November 8, 2022. Introduction:Aortic stenosis (AS) is characterized by highly variable progression rates. Differential rates of AS progression have been proposed to explain apparent disparities in the treatment of severe AS. However, the evidence supporting this claim is uncertain.Methods:We conducted a systematic review of MEDLINE and EMBASE from 1989 to 2022 to identify prospective cohort studies of AS hemodynamic progression. We evaluated the pooled patient demographics, AS severity, baseline and mean annual changes in echocardiographic markers, and prognostic factors.Results:We identified 32 prospective cohort studies. Overall, 11,432 patients were followed for 27 +/- 15 months on average. The average age was 67 +/- 8 years. The average percent female was 36 +/- 14%. Race was reported in only 4 (13%) cohorts; the average proportion of white patients was 93.9 +/- 6.1%. The average baseline hemodynamic severity was consistent with aortic sclerosis, mild AS, moderate AS, and severe AS in 3 (9.4%), 8 (25.0%), 19 (59.3%), and 2 (6.3%) studies, respectively. Overall, average baseline and annual changes in echocardiographic values were: peak aortic jet velocity (Vmax) 3.21 +/- 0.61 m/s (0.20 +/- 0.09 m/s/yr); aortic valve area (AVA) 1.23 +/- 0.31 cm2 (-0.09 +/- 0.05 cm2/yr); and mean aortic valve gradient (MG) 26.2 +/- 7.6 mmHg (3.9 +/- 1.6 mmHg/yr). Age, sex, coronary artery disease, hypertension, diabetes, hyperlipidemia, and smoking were not associated with AS progression in >75% cohorts. Baseline Vmax and MG were associated with greater AS progression in 6 cohorts (75%). Baseline aortic valve calcification (AVC) and AVA were consistently associated with greater AS progression in 9 cohorts (100%). One cohort found that women have a greater ΔMG for a given level of AVC. A univariate analysis of race in one cohort showed that African American ethnicity was associated with lower risk of progression from normal aortic valves to incident AS.Conclusion:There is limited representation of women and ethnic minorities in prospective AS progression cohorts. Active recruitment of diverse populations in these cohorts is needed. The available clinical evidence provides limited support for claims of differential progression as the cause of racial disparities in AS treatment.

Circulation, Volume 146, Issue Suppl_1, Page A15314-A15314, November 8, 2022. Introduction:Mycobacterium chimaera is an emerging pathogen, recognized to cause prosthetic valve infective endocarditis (PVIE) and disseminated infection following open-chest cardiac surgery with certain contaminated heater-cooler systems. Diagnosis is challenging and requires a very high index of suspicion. Data regarding the optimal cardiac imaging evaluation of this condition is limited.Methods:Scopus, PubMed, EMBASE, Ovid and Cochrane were searched for published articles through October 2021, using keywords “Mycobacterium chimaera”, “Prosthetic valve” and “Endocarditis”. 169 articles were found and reviewed for study eligibility. Articles were included if they consisted of Mycobacterium chimaera causing IE, with imaging modalities used to establish diagnosisResults:Thirty-three articles were included, yielding twenty-two cases of Mycobacterium chimaera PVIE. The disease manifested on average thirty months after surgery, with an average patient age of 59 years (90% male). Imaging modalities to establish the diagnosis of prosthetic valve infective endocarditis included: transthoracic echocardiogram in 5 cases, transesophageal echocardiogram (TEE) in nine cases, 18F-FDG-PET/CT in seven cases. A combination of imaging modalities with TEE and 18F-FDG-PET/CT was reported once; TTE, TEE and 18F-FDG-PET/CT was also noted in one case. Lastly there was one instance each of combined use of TTE, TEE, and one of the following: CTA, Cardiac MRI, or standard CT. Nine cases did not specify the imaging modality used to achieve diagnosis. Ten patients died.Conclusions:PVIE due to Mycobacterium chimaera infection is a rare and challenging diagnosis, which requires a high index of suspicion. Accurate diagnosis should be aided by multimodality cardiac imaging, with 18F-FDG-PET/CT being a powerful adjunct imaging modality.