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Fissata la data del concorso MMG 2022/25. Fimmg: Basta ritardi, necessario avviare da subito iter per bando 2023/26 e recuperare annualità persa
Fissata la data del concorso MMG 2022/25. Fimmg: Basta ritardi, necessario avviare da subito iter per bando 2023/26 e recuperare annualità persa
Circulation, Ahead of Print. This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
Circulation, Ahead of Print. Aim:The “2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease” provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes).Methods:A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate.Structure:Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
Circulation, Ahead of Print.
Circulation, Volume 146, Issue Suppl_1, Page A13174-A13174, November 8, 2022. Introduction:Heart failure with preserved ejection fraction (HFpEF, EF >50%) syndrome is often associated with hypertension, hyperlipidemia, obesity, and diabetes. Morbidity and mortality in patients with HFpEF are similar to those with heart failure with reduced ejection fraction, however therapies are scarce. Mouse models used to understand sarcomere dysfunction in HFpEF and to identify new targets are needed. In this study we challenged young mice with volume overload and metabolic perturbations induced by high fat diet (HFD) to harbor the conditions of HFpEF.Methods:C57BL/6N 16-weeks old female and male mice were treated with subcutaneous pellets of controlled released DOCA (Deoxycorticosterone Acetate, 0.71 mg/d), drinking water with 1% saline and HFD for a period of 3 weeks to induce obesity and mild hypertension. Cardiac function was evaluated at baseline (before treatment) and 2 and 3 weeks after treatment. Body weight, % fat mass, %lean mass, glucose tolerance test, and lipid profile were also evaluated at baseline and 3 weeks after treatment.Results (Table): Treatment induced diastolic dysfunction measurable by echocardiography at 3 weeks with slower peak myocardial relaxation velocity (e’), increased peak blood inflow velocity at early diastolic filling E/e’ ratio, increased E/A ratio, and increased isovolumetric relaxation time (IVRT). Meanwhile ejection fraction is preserved. As expected HFD feeding elicited body weight increase with increased fat mass accumulation associated with decreased lean mass, glucose intolerance and hypercholesterolemia.Conclusions:This study describes a mouse model of HFpEF that only requires 3 weeks of treatment with DOCA, 1% saline drinking water and HFD. This model reproduces the most common comorbidities of HFpEF such as diastolic dysfunction, obesity, glucose intolerance, and hypercholesterolemia, and may be used to understand the molecular pathophysiology of HFpEF.
Circulation, Volume 146, Issue Suppl_1, Page A14442-A14442, November 8, 2022. Introduction:The longitudinal trends of cardio-oncology healthcare disparities is unknown.Methods:We performed the first nationally representative longitudinal analysis using Machine Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) and the 2016-2018 National Inpatient Sample (NIS), the United States’ largest all-payer inpatient dataset.Results:Among 101,521,656 hospitalizations from 2016-2018, 3,233,249 (3.18%) were female with active cancer, 18,310 (0.57%) had STEMI, 4,670 (0.14%) received LHC, 3,360 (0.10%) received PCI, and 160 (0.005%) received percutaneous heart pump (Impella). The most common active primary malignancies significantly differed for females (lung [15.19%], breast [14.10%], uterus [10.60%], leukemia [8.88%], and non-Hodgkin lymphoma [NHL] [6.92%]) versus males (prostate [15.56%], lung [15.21%], leukemia [10.05%], NHL [8.50%], and colon [6.57%]) (p
Circulation, Volume 146, Issue Suppl_1, Page A14520-A14520, November 8, 2022. Introduction:While implicated in both cardiac and renal dysfunction, it remains unclear if myeloperoxidase (MPO) plays a role in the development of acute cardiorenal syndrome (CRS). We developed an assay to quantify MPO inhibitory capacity (MIC) to assess a plasma sample’s capacity to inhibit MPO activity.Hypothesis:We hypothesized that unopposed MPO activity (less inhibition) contributes to development of acute CRS and greater MPO inhibition leads to improved clinical outcomes.Methods:90 paired samples of acute heart failure (AHF) patients were collected at enrollment and between 24-96 hours follow-up. Diluted samples were supplemented with 100 ng/mL exogenous MPO and allowed to equilibrate for 1 hour at room temperature. Equal parts sample and Amplex UltraRed Reagent were incubated for 30 minutes, and fluorescence was read. 59 patients had long-term follow-up data for time to readmission survival analysis, censored for loss to follow up, death, or transplantation.Results:Patients with CRS have higher rather than lower MIC compared to that in uncomplicated patients (50% vs 34%, p=0.048). Serial MIC measurements during hospitalization revealed that patients with persistently low MIC experienced better outcomes (median time to readmission 575 days vs 104 days, p=0.023, Figure).Conclusions:Contrary to our original hypothesis, we observed acute CRS patients had higher rather than lower MIC, and that persistently low MIC experienced better long-term outcomes. These results imply that in patients experiencing acute CRS, there is a circulating MPO inhibitory component that has not been previously accounted for, and that unopposed MPO activity was not associated with CRS or poor outcomes.
Circulation, Volume 146, Issue Suppl_1, Page A15063-A15063, November 8, 2022. Genome-wide association studies (GWAS) have identified hundreds of risk loci for cardiometabolic and lipid-related traits. GWAS loci are enriched in tissue-specific transcriptional regulatory elements that affect target gene expression driving physiological changes. Most GWAS variants are located in non-coding regions, which makes identifying functional variants and target genes challenging. Previously, we identified GWAS signals colocalized with molecular quantitative trait loci for liver gene expression (eQTL) and liver accessible chromatin (caQTL) to predict regulatory variants for lipid and cardiometabolic traits. These caQTLs are rs13395911, rs11644920, rs34003091 and rs9556404 associated with liver enzymes, LDL-cholesterol, and triglycerides. To evaluate the predicted mechanisms, we tested these variants with surrounding regulatory elements for allelic effects on transcriptional reporter activity and for effects on target gene expression in HepG2 cell line. Along with the two previously reported intronic caQTL variants, rs13395911 and rs11644920,we observed significant (P
Circulation, Volume 146, Issue Suppl_1, Page A12164-A12164, November 8, 2022. Introduction:Atrial fibrillation (AF) is associated with a high risk of adverse outcomes. Social determinants of health (SDOH) are gendered (unevenly distributed between females and males) and associated with outcomes in cardiovascular diseases. Little is known about their impact in AF. We evaluated the association between gendered SDOH and adverse outcomes in AF patients.Methods:Data came from the ESC-EHRA EORP-AF General Long-Term Registry, a European AF prospective registry. Gendered SDOH included: education, living alone vs not, smoking, alcohol use, gender inequality index (GII), physical activity and quality of life measures. Study outcome was a composite of major adverse cardiovascular events and all-cause death. SDOH main effect was tested in multivariate logistic regressions and for a sex/GII interaction.Results:We studied 11,096 patients (mean (SD) age 69.2 (11.4) years; 40.7% females, median [IQR] CHA2DS2-VASc score 3 [2-4]). Most had secondary education, did not live alone, did not smoke or use alcohol, were physically inactive, had moderate quality of life, and lived in countries with gender equity. Multivariate analyses showed that gendered SDOH together with traditional risk factors were associated with the outcome (Figure 1). Higher education level and quality of life were associated with lower risk of adverse outcomes. Conversely, living alone and higher GII (larger gender inequity) were associated with worse outcomes. Females were found at lower risk, however this protective effect was reversed in countries with higher GII (sex-GII p-interaction0.048).Conclusions:Gendered SDOH are associated with adverse outcomes in AF. Notably, gender inequity confers poorer outcomes in females with AF.
Circulation, Volume 146, Issue Suppl_1, Page A13986-A13986, November 8, 2022. Background.Cangrelor is an intravenous P2Y12 inhibitor with an immediate onset of action and a short half-life. Its use seems especially attractive in patients who cannot swallow oral drugs, e.g. after CPR or in cardiogenic shock.Purpose.To determine the efficacy and safety of the intravenous P2Y12 inhibitor cangrelor undergoing PCI after prehospital cardiopulmonary resuscitation (CPR) and/or cardiogenic shock (CS) in real life.Methods:The CAN-SHOCK registry included patients undergoing PCI for acute myocardial infarction after CPR. Baseline characteristics, procedural features, and in-hospital outcomes were centrally collected and analysed. The primary endpoint was the incidence of stent thrombosis and/or myocardial reinfarction until 48 hours after PCI.Results.A total of 303 patients were included in 10 centers in Austria and Germany. The inclusion criteria were CPR before PCI (n=169, 55.8 %), cardiogenic shock (n=68, 22.4 %) and CPR and cardiogenic shock (n=59, 19.5 %). The baseline characteristics, in-hospital procedures and outcomes are listed in the table.Conclusions.In this large multicentre registry cangrelor in patients undergoing PCI after CPR and/or CS cangrelor was effective in preventing stent thrombosis and re-infarction and associated with an acceptable bleeding rate.
Circulation, Volume 146, Issue Suppl_1, Page A11823-A11823, November 8, 2022. Background:Besides hard medical outcomes in patients with inherited cardiac conditions (ICC). it is crucial to focus on the patient-reported outcomes (PRO) as well. These patients may have a disease-specific need due to ICC-related distress concerning family members and reproductive choices. We evaluated which PRO scales are currently used in cardiogenetics.Methods:From three datasets (PubMed, PsychINFO, and Web of Science), eligible studies published between 2008-2022 were selected as described in the review protocol (PROSPERO 2021 CRD42021271384). The quality of studies was assessed (https://pubmed.ncbi.nlm.nih.gov/27082055 ) and analyzed for the primary outcome variable of patient-reported outcomes.Results:Eighteen out of 232 articles were selected for data extraction; 9 studies used a cross-sectional design, and population characteristics and outcome measures varied. The risk of bias was high or unclear in 77% of the studies. All studies mainly used two questionnaires in combination or alone: the short form of medical outcomes survey (SF-36), a generic PROM that reports on health status and the Hospital Anxiety and Depression Scale (HADS), a standard measure of psychological well-being. Thirteen studies using SF-36 showed lower scores on the mental health component in patients with ICC versus population norms. Ten studies using HADS showed a prevalence of clinically significant anxiety (17-47%) and depression (8.3% to 28%) which are higher than the population norm (8.3% and 6.3%).Conclusion:Our results from only a few published studies indicate that although psychological morbidity in ICC patients is high, measurements are non-specific, variable, and generic and address overall health, instead of addressing factors specific to ICC, such as heritability. We propose to develop a disease-specific PROM for cardiogenetics to evaluate the heritability factor in patients with ICC to implement in the care pathway and optimize patient-centred care.
Circulation, Volume 146, Issue Suppl_1, Page A11152-A11152, November 8, 2022. Introduction:Transesophageal echocardiograms (TEEs) performed during structural cardiac interventions may have higher complications than those performed in the non-operative setting. However, there is limited data on complications associated with TEE in these procedures. The objective of this study was to evaluate the prevalence of major complications among these patients in the United States (US).Methods:A retrospective cohort study was conducted using an electronic health record database from large academic medical centers across the US for patients undergoing TEE during structural interventions from January 2012 to January 2022. Using the American Society of Echocardiography endorsed ICD-10 codes, patients undergoing TEE during a structural cardiac intervention, including transaortic, mitral or tricuspid valve repair, left atrial appendage occlusion, and paravalvular leak replacement were identified. The primary outcome was major complications within 72 hours of the procedure (composite of bleeding, esophageal and upper respiratory tract injury).Results:A total of 9,482 adult patients undergoing TEE for transcatheter structural cardiac interventions were identified. The median age was 71 years (IQR: 61 – 80 years), including 43% females and 19% non-white individuals. Of those, 7,158 (75%) of patients were on anticoagulation, and 6,272 (66%) were on antiplatelet therapy. In the study cohort, 246 (2.6%) patients had a major complication. Complication rates were higher in patients on anticoagulation or antiplatelet therapy compared to those who were not (2.9% vs. 0.84%, p
Circulation, Volume 146, Issue Suppl_1, Page A325-A325, November 8, 2022. Background:In nonshockable cardiac arrest (CA) patients, the 2020 cardiopulmonary resuscitation (CPR) guidelines have stressed that high-quality CPR improves survival from CA, as with the 2015 CPR guidelines. However, it is unknown whether the 2015 guidelines contributed to the favorable neurological outcomes in adult CA patients. The present study aimed to clarify the effects of the 2015 guidelines on adult CA patients using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital CA (OHCA).Methods:From the data of this registry, between 2011 and 2020, we included adult witnessed OHCA patients due to cardiac etiology who had non-shockable rhythm as an initial rhythm. We excluded patients who received prehospital care in 2011, 2015, 2016, and 2020 because it was difficult to distinguish prehospital care based on either 2010 CPR guidelines, 2015, or 2020. We also excluded patients who received bystander CPR by citizens because we cannot assess the quality of bystander CPR. Study patients were divided into two groups based on the different CPR guidelines; the era of the 2010 guidelines (2010G) and the era of the 2015 guidelines (2015G). The endpoint was the favorable neurological outcome at 30 days after OHCA. Potential confounding factors based on biological plausibility and previous studies were included in the multivariable logistic regression analysis. These variables included the age, sex (male, female), advanced airway or not, the administration of adrenaline or not, the administration of saline or not, and time interval from call EMS to the scene.Results:Of the 1,259,960 patients registered in the All-Japan Utstein Registry, the data of 54,219 patients were included in this analysis. The 2015G was significantly higher in the 30-day favorable neurological outcome than the 2010G (2010G vs. 2015G = 1.5% vs. 1.8%: p=0.008). In the multivariate analysis, the adjusted odds ratio for 30-day favorable neurological outcome in OHCA patients in the 2015G compared to in the 2010G was 1.37 (95%CI 1.19-1.58, p
Circulation, Volume 146, Issue Suppl_1, Page A15477-A15477, November 8, 2022. Introduction:Approximately 8-40% of ST-elevation Myocardial Infarction (STEMI) present later than 12 hours after symptom onset. Current ACC/AHA guidelines recommend primary percutaneous coronary intervention (PCI) for STEMI after 12 hours of symptom onset only in the setting of cardiogenic shock or severe acute heart failure, (Class Ia, LOE B) or persistent ischemic symptoms (Class IIa, LOE B). There are limited data comparing long-term outcomes among patients with a late STEMI presentation managed with PCI versus medical therapy (MT).Objective:To compare long-term outcomes among patients treated with PCI versus MT who have late presentation of STEMIMethods:We followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to extract data from PubMed/Medline, Cochrane, Embase, and Clinicaltrials.gov databases by using the search terms “late” or “delayed” or “ >12 hours” presentation with STEMI from 01/2012 through 12/2022. Included studies reported at least one of the following outcomes: all-cause mortality, reinfarction, heart failure, major adverse cardiac events (MACE), and stroke. Studies reporting delays in PCI due to COVID-19 positive status or COVID-19 enforced protocols were excluded to prevent the impact of pragmatic barriers on treatment. Relative risk (RR) was calculated using random effects model if heterogeneity was >50%, otherwise, fixed effects model was usedResults:Seven studies (n=11,576, delayed PCI n=6,248, and medical therapy n=5,319) were included in our analysis. The median follow-up was 12 months (1-60 months). Overall, among patients with STEMI and PCI >12 hour after presentation had lower incidence of MACE (27% vs. 30%, RR 0.85, 95% CI 0.76-0.69, I2=30%, p=0.007) compared to MT alone, which was driven by a significantly reduced all-cause mortality with PCI (4.4% vs. 17%, RR 0.38, 95% CI 0.17-0.85, I2=95%, p=0.01). No significant differences were observed in the incidence of recurrent MI and heart failure hospitalizations.Conclusion:Our study suggests favorable outcomes of PCI in STEMI with presentation >12 hours compared with medical therapy. Further prospective studies are needed to validate our findings.
Circulation, Volume 146, Issue Suppl_1, Page A13094-A13094, November 8, 2022. Extracellular vesicles (EVs) are emerging as promising biomarkers for cardiovascular disease (CVD) and contributors to CVD pathogenesis. Plasma EVs access the endothelium from various vascular beds allowing them to impact endothelial function and inform on the global particulate secretome produced by parenchymal, vascular and immune cells. In this study we examined associations between plasma EVs and biochemical and physiological parameters in a cohort of African American (AA) women at risk for CVD. We also examined EV effect on coronary endothelial function. This study will serve as baseline data for a longitudinal study aimed to determine the effects of exercise on EVs and endothelial function in a similar cohort.A cohort of 24 AA women between 22-71 yrs, with BMI between 26-47 kg/m2and ASCVD risk scores between 2.3-22.1 were included in the study. EVs were isolated from fasted heparinized plasma using size exclusion chromatography. EV size and numbers were determined using nanoparticle tracking analysis. Lipids, inflammatory cytokines, and metabolic panels were measured at the time of blood draw. Human coronary endothelial cells were treated with EVs from participants and endothelial barrier function and migration were measured using ECIS technology. Associations were determined using multivariable linear regression analysis, adjusted for BMI and ASCVD risk.We found a negative association (beta=-0.712, p
