Risultati per: AGA: linee guida sulla de-prescrizione degli inibitori della pompa protonica

Circulation, Volume 146, Issue Suppl_1, Page A13012-A13012, November 8, 2022. Introduction:Atrial fibrillation (AF) symptom relief is a primary indication for catheter ablation, but the impact of ablation on AF symptoms is not well characterized. The objective of this study was to describe AF symptom documentation in electronic health records (EHRs) pre- and post-ablation and identify correlates of post-ablation symptoms.Methods:We evaluated EHRs of AF patients (n=1293) in a large, urban health system from 2010-2020 who underwent ablation and had at least one encounter note within 30 days of the ablation. We extracted structured data about patient demographics, medications, diagnoses, and encounters, and symptom data from unstructured clinical notes using natural language processing. We used Cochran’s Q tests with post-hoc McNemar’s tests to determine whether the prevalence of symptoms differed significantly pre- and 3, 6, 9, and 12 months post-ablation. We used bivariate logistic regression models to estimate the unadjusted odds of symptom prevalence by personal or clinical characteristics at 6 and 12 months post-ablation.Results:Compared to pre-ablation, the prevalence of any AF symptom decreased but anxiety and weakness increased post-ablation (Table 1). The unadjusted odds of any symptoms 12 months post-ablation were associated with Black/African-American (odds ratio [OR]=0.35; 95% confidence interval [CI]=0.14-0.92) or another race (OR=0.39, 95% CI=0.16-0.95) versus Asian race, Hispanic/Latino ethnicity (OR=2.40, 95% CI=1.28-4.39) versus non-Hispanic/Latino, antiarrhythmic medication (OR=0.62, 95% CI=0.46-0.80) versus no medication, smoking history (OR=0.70, 95% CI=0.53-0.94) versus no history, and heart failure (OR=0.73, 95% CI=0.55-0.97) versus no heart failure.Conclusion:Symptom patterns post-ablation are heterogeneous. Findings warrant confirmation with larger, more representative datasets, which may be informative for patients whose primary goal for undergoing an ablation is symptom relief.

Circulation, Volume 146, Issue Suppl_1, Page A15535-A15535, November 8, 2022. Estrogen is known to produce changes in cardiac electrophysiology specifically in premenopausal women, increasing the risk of arrhythmias. We report a case of Torsades de Pointes (TdP) in a young premenopausal female.A 25-year-old female with a history of anxiety presented to the emergency room (ED) with several days of vomiting. While in the ED, she had an unwitnessed syncopal event, and was found to be in pulseless ventricular fibrillation (V-Fib) . She required one defibrillation to obtain return of spontaneous circulation (ROSC). Initial work up showed calcium 7.6 mg/dl, phosphorous 1.1 mg/dl, magnesium 2.4 mg/dl, potassium 4.0 mg/dl. Remainder of electrolytes were normal. Toxicology screen was positive for cannabinoids. Post ROSC EKG showed sinus tachycardia at a rate of 103bpm with a prolonged QTc of 531ms. Patient was not on any medications outpatient. On further discussion, patient reported no prior history of syncopal episodes, palpitations, and denied any family history of sudden cardiac death. She did report she was presently on her menses. Shortly after admission, she had recurrent polymorphic ventricular tachycardia which degenerated to TdP. She was loaded with magnesium. Echocardiogram showed an ejection fraction (EF) of 35-39% and global hypokinesis. Diagnostic left heart catheterization was performed revealing clean coronaries. Cardiac MRI revealed EF of 43% without any late gadolinium enhancement. Her QTc remained prolonged even with electrolyte normalization. She underwent successful ICD placement and remained event free during the remainder of the hospital course. She will undergo genetic work up for long QT syndrome.Female sex hormones, specifically estrogen, have been described in literature as pro-arrhythmic given its effects on QT prolongation and ion gated channels. Prior cases of menstruation dependent arrhythmias have speculated that the abrupt reduction in estradiol prior to menstruation is associated with increased cyclic adenosine monophosphate dependent arrhythmogenicity. This case highlights the multifactorial etiology of sudden V-Fib arrest in a young female, and the importance of understanding the role that sex hormones play in the underlying pathogenesis.

Circulation, Volume 146, Issue Suppl_1, Page A11099-A11099, November 8, 2022. Introduction:Potent antiplatelet therapy has a high bleeding risk after acute myocardial infarction, so de-escalation from ticagrelor to clopidogrel has recently been introduced. But, optimal de-escalation strategy according to BMI is unclear.MethodIn TALOS-AMI trial, patients with acute myocardial infarction receiving aspirin and ticagrelor after index percutaneous coronary intervention (PCI) were investigated. This post hoc study determined the efficacy and safety of de-escalation (clopidogrel plus aspirin) compared with active control (ticagrelor plus aspirin) across a range of patient BMIs.ResultsAmong 2,686 randomized patients, 1,558 (58.0%) had 18.5 ≤BMI

Circulation, Volume 146, Issue Suppl_1, Page A13963-A13963, November 8, 2022. Introduction:Torsade de Pointe (TdP) is defined as a polymorphic VT (pVT) typically associated with QTc prolongation. However, not all pVT occur in the presence of QTc prolongation and respond to different forms of therapy. Hence defining their etiology is important.Case:A 48-yo Female with H/O resolved peripartum cardiomyopathy, hypertension & obesity presented to the hospital following a syncopal episode. Her BP was 207/125 mmHg, and ECG showed sinus rhythm with a QTc of 436. No history of heart disease or SCD in her family. Physical exam was unremarkable, labs showing K-3.2 without troponin elevation. On day 2, she developed a pVT requiring defibrillation and amiodarone. Telemetry revealed a PVC causing R on T phenomenon with a coupling interval of 260 msec prior to initiation of SVT with QTc 484 and K-2.8. On day 3, despite electrolyte correction, she had multiple non-sustained pVTs with QTc 482. Amiodarone was switched to lidocaine and QTc normalized to 447. TTE and LHC were unremarkable with a small LV aneurysm on cMRI. On day 4, the patient continued to have incessant runs of pulseless pVT requiring defibrillation and started on verapamil. A 12 lead ECG during VT demonstrated left bundle branch mimicry with a left axis consistent with a VT exit site along the RV moderator band. The patient underwent emergent ablation with targets along the right anterolateral papillary muscle. AICD was placed prior to discharge.Discussion:The critical timing of PVC falling on the peak of the preceding T wave differentiates ‘Short-coupled TdP’ from other malignant VTs with normal QTc. These PVCs typically originate from distal ramifications of Purkinje fibers in both ventricles. PVC morphology with LBBB pattern, left axis and late precordial R-S transition points to the moderator band as the source of idiopathic VT. Contrasting with typical TdP, medical management with Quinidine and Verapamil may be efficacious. Catheter ablation is curative in most cases.

Circulation, Volume 146, Issue Suppl_1, Page A12595-A12595, November 8, 2022. Introduction:Post-transplant lymphoproliferative disorder (PTLD) is an important cause of morbidity and mortality in heart transplant (HTx) recipients. However, clinical characteristics and predictors of PTLD in the real world have not been well studied.MethodsWe retrospectively analyzed clinical characteristics, predictors, and outcomes of PTLD, in 28,136 recipients of heart alone transplants between January 2000 and June 2015 from the International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry.ResultsTen-year incidence of PTLD after successful discharge from HTx during 2000-2007 was 3.8%. The adjusted overall risk of mortality was significantly higher in patients diagnosed with PTLD within 3 years after HTx compared to those without PTLD (HR 2.22, 95% CI 1.86-2.65, p

Circulation, Volume 146, Issue Suppl_1, Page A14285-A14285, November 8, 2022. Introduction:Contemporary literature reveals a range of cardiac complications in patients who receive the percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).Hypothesis:This study compared the adverse cardiac outcomes and procedural/technical success rates between the patients groups of in-stent (IS) CTO PCI and de novo CTO PCI.Methods:This systematic review and meta-analysis compared odds for primary (all-cause mortality, MACE, cardiac death post PCI, stroke) and secondary (bleeding requiring blood transfusion, ischemia-driven target-vessel revascularization, PCI procedural success, PCI technical success, and target-vessel MI) endpoints between 2,734 patients who received PCI for IS CTO and 17,808 for de novo CTO. Odds ratios for outcome variables were calculated within 95% confidence intervals (CIs) via the Mantel-Haenszel method. The pooled analysis was undertaken for observational (retrospective/prospective) single- and multi-centered studies published between January 2005 and December 2021.Results:We found 57% higher, 166% higher, 129% higher, and 57% lower odds for MACE (OR: 1.57, 95% CI 1.31, 1.89,p

Circulation, Volume 146, Issue Suppl_1, Page A14042-A14042, November 8, 2022. Introduction:Patients with cardiac resynchronization therapy (CRT) upgrades with right ventricular pacing (RVP) dependence may have a different prognosis after CRT and require a distinct implementation strategy.Hypothesis:Left ventricular (LV) size/function, optimal AHA segments for LV pacing, and survival post-CRT is different for patients with RV pacing undergoing CRT upgrade procedures.Methods:Cardiac magnetic resonance (CMR) with cine imaging, DENSE strain mechanical activation mapping, and scar imaging was performed prior to implants of CRT systems that were “de novo” (Group 1) or upgraded from pre-existing pacemakers or ICDs with RVP (Group 2) and without RVP (Group 3). Optimal LV pacing sites were identified based on latest activation. Patients were followed for clinical outcomes.Results:In 92 patients (23.5% female, 65.8 ± 10.7 years old), the baseline LVEDVI by CMR was significantly smaller in RVP upgrade (Group 2) patients (101.8 +/- 34.3 cc/m2) compared with de novo (Group 1; 140.5 +/- 38.2 cc/m2); p=0.001) and non-RVP upgrade patients (Group 3; 153.6 +/- 46.4 cc/m2; p=0.001) (Figure 1). RVP upgrade patients also had the widest baseline QRS (178.2 +/- 26.6 ms v. 159.7 +/- 18.5 ms in Group 1 v. 154.5 +/- 20.1 ms in Group 3; p = 0.001) and were more likely to have latest mechanical activation in an anterior LV segment (50%) versus Group 1 (10%) and Group 3 (35%) patients (p = 0.0007). As shown in Figure 2, RVP upgrade patients had the worst survival (p = 0.007).Conclusion:Patients with RVP dependence undergoing CRT upgrades are more likely to have smaller baseline LV volumes by CMR, greater QRS durations, optimal pacing sites in anterior segments, and unfavorable survival.

Circulation, Volume 146, Issue Suppl_1, Page A14836-A14836, November 8, 2022. Background:Pre-stent era witnessed the presence of abnormal vasomotion at balloon-injured coronary segments, leading to fatal vasospasm. Drug-coated balloon (DCB) angioplasty is fundamentally the same procedure that was performed in the pre-stent era, except for antiproliferative drug being delivered. We evaluated whetherde novonative coronary lesions treated using DCB are prone to vasospasm and how they respond to ergonovine and nitrate.Methods and Results:Among 132 DCB angioplasty recipients, 89 patients underwent ergonovine provocation test at 6-9 months follow-up. Within-subject ergonovine- and nitrate-induced diameter changes were compared among the three different sites: DCB-treated vs. angiographically normal vs. segment showing prominent vasoreactivity (spastic). None of 132 patient experienced clinically refractory vasospastic angina during follow-up. Ergonovine induced vasospasm in seven patients; all cases were multifocal spasms either involving(n=2) or sparing DCB-treated segments(n=5). No patient showed focal spasms that exclusively involved DCB-treated lesions. Among patients with vasospastic features, DCB-treated segments showed less vasoconstriction than did the spastic counterparts (p

Circulation, Volume 146, Issue Suppl_1, Page A11289-A11289, November 8, 2022. Aims:Proliferation of vascular smooth muscle cells (VSMCs) is a hallmark of pulmonary hypertension (PH). Proliferative cells utilize purine bases from thede novopurine synthesis (DNPS) pathways for nucleotide synthesis, however, it is unclear whether DNPS plays a critical role in VSMC proliferation during development of PH. The last two steps of DNPS are catalyzed by the enzyme 5-aminoimidazole-4-carboxamide ribonucleotide formyltransferase/inosine monophosphate cyclohydrolase (ATIC). We investigated whether ATIC-driven DNPS affects the proliferation of pulmonary artery smooth muscle cells (PASMCs) and the development of PH.Methods and Results:Metabolites of DNPS in proliferative PASMCs were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). ATIC mRNA and protein expression was assessed in platelet-derived growth factor (PDGF)-treated PASMCs and in the lungs of PH rodents and patients with pulmonary artery hypertension (PAH). Mice with global and VSMC-specific knockout ofAticwere utilized to investigate the role of ATIC in hypoxia-induced PH. ATIC-mediated DNPS at the mRNA, protein and enzymatic activity levels were increased in PDGF-treated PASMCs or PASMCs from PH rodents and patients with PAH. In cultured PASMCs,ATICknockdown decreased DNPB, nucleic acid DNA/RNA synthesis and reduced cell proliferation. Global or VSMC-specific knockout ofAticattenuated vascular remodeling and inhibited the development and progression of hypoxia-induced PH in mice.Conclusion:Targeting ATIC-mediated DNPS compromises the availability of purine nucleotides for incorporation into DNA/RNA, reducing PASMC proliferation and pulmonary vascular remodeling and ameliorating the development and progression of PH.

Report Iss, cresce uso cinture e casco ma Sud resta indietro

Pharmacological management of obesity improves outcomes and decreases the risk of obesity-related complications. This American Gastroenterological Association guideline is intended to support practitioners in decisions about pharmacological interventions for overweight and obesity.

Circulation, Volume 146, Issue 15, Page e204-e204, October 11, 2022.