Risultati per: Infezione da Helicobacter pylori: review

Circulation, Volume 150, Issue Suppl_1, Page A4144752-A4144752, November 12, 2024. Background:Adults with congenital heart disease (ACHD) are lifelong at high risk for premature cardiovascular events and life-threatening complications, suggestive of early or accelerated cardiovascular disease. Endothelial and microvascular dysfunction as well as arterial stiffness play a key role in the emergence and progression of cardiovascular complications. As vascular dysfunction may precede the occurrence of adverse events, early identification of endothelial damage markers in ACHD is crucial.Aim:This is the first systematic review and meta-analysis of studies investigating the endothelial and microvascular function in ACHD patients versus healthy controls.Methods:We systematically searched four major electronic databases (PubMed, CENTRAL, Scopus, Web of Science), ClinicalTrials.gov and grey literature. We included studies evaluating endothelial and microvascular function with any semi- or non-invasive method in adult patients with and without ACHD. Studies exploring arterial stiffness indices were also investigated.Results:In total, 31 studies (1118 ACHD patients, 794 controls) were included in this systematic review. Branchial arterial endothelium-dependent (assessed via flow-mediated dilatation, FMD) and -independent vasodilation (assessed via nitroglycerine-mediated dilatation, NMD) were impaired in ACHD patients versus controls (mean difference [MD] -2.5, 95% confidence intervals [CI] -3.7; -1.3 and MD -3.9, 95%CI -6.8; -1.0, respectively). Microvascular dysfunction was also evident; significantly lower reactive hyperemia index and peripheral arterial tonometry (PAT) ratio were found in ACHD patients compared with controls (MD −0.26, 95%CI −0.48; −0.04 and MD −0.26, 95%CI −0.5; −0.4, respectively). Regarding arterial stiffness, pooled analysis revealed non-significant differences in pulse wave velocity between the study groups (standardized MD 0.2, 95%CI -0.2; 0.6). However, augmentation index was significantly higher in ACHD (standardized MD 1.6, 95%CI 0.8; 2.4).Conclusions:ACHD patients have impaired endothelial and microvascular function and increased arterial stiffness, factors that may be responsible for the increased adverse cardiovascular events in this population.

Circulation, Volume 150, Issue Suppl_1, Page A4147899-A4147899, November 12, 2024. Background:Despite the advancement in management, pulmonary embolism has challenges in its early diagnosis and initiation of the therapies. To counter this situation, the concept of a Pulmonary Embolism Response Team (PERT), a multidisciplinary team comprised of different healthcare providers, emerged in 2012 as an initiative to optimize care for pulmonary embolism patients. This approach shown to be effective in improving the early and effective management of PE patients, thus improving the clinical recovery in some studies yet remain inclusive in other studies. Given the trending PERT acceptance situation in PE management, we performed this systematic review and meta-analysis to analyze the clinical impact of the PERT approach on PE patient management.Methods:We conducted a systematic review and meta-analysis from pertinent studies published until May 2024 using PubMed, Embase, and Scopus databases comparing PERT vs standard approach for PE management. This study is registered with PROSPERO and data analysis was performed using the RevMan Web.Results:In this analysis, 15,621 PE patients who managed via the PERT or standard approach were included in 23 studies. The use of PERT was associated with significantly lower odds of short-term mortality (OR: 0.76, CI 0.59 to 0.99), and higher odds of utilization of advanced treatment strategy (OR: 3.45, CI 1.95 to 6.09). Additionally, PERT was associated with favorably lower odds of major bleeding (OR: 0.60, CI 0.34 to 1.05) and early achievement of therapeutic anticoagulation (MD: -1.39, CI -5.32 to 2.54). Despite higher odds of ICU admission, the length of stay in ICU was significantly lower in the PERT group (MD: -0.67, CI -1.28 to -0.05).Conclusion:Based on this meta-analysis, the PERT approach for PE management significantly increases the chances of utilization of advanced PE management strategies, thus shortening the ICU stays, and reducing mortality risk. Additionally, it could potentially reduce the major bleeding risk. PERT should be in the focus as one of the standards of care for area PE management.

Circulation, Volume 150, Issue Suppl_1, Page A4144970-A4144970, November 12, 2024. Introduction:Chronic total coronary occlusion (CTO) management remains a challenge. Several studies have reported the benefits of percutaneous coronary intervention (PCI) in CTO. However, the outcomes of PCI vs optimal medical therapy (OMT) are still controversial. We conducted an extensive review and meta-analysis to compare the clinical outcomes between PCI and OMT in CTO.Methods:We comprehensively searched the databases of MEDLINE and EMBASE from inception to May 2024. Included studies were published cohort (prospective or retrospective) with propensity score matching analysis and randomized trials that reported all-cause death, cardiac death, and myocardial infarction (MI) with PCI and OMT in CTO patients. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate odd ratios and 95% confidence intervals.Results:Sixteen studies, 6 randomized controlled trials (RCTs) and 11 observational studies with propensity score with matching (PSMs), were included in this meta-analysis involving 8,316 CTO patients (4,332 underwent PCI and 4,084 received OMT). In the overall analysis, all-cause death, cardiac death, and MI were significantly reduced in PCI compared to OMT group, respectively ([OR] 0.65, 95% CI 0.55-0.76, I2=0.0%, p

Circulation, Volume 150, Issue Suppl_1, Page A4143622-A4143622, November 12, 2024. Introduction:Obesity-related heart failure in patients is often associated with high symptom burden. However, no treatments have been proven to specifically target obesity-related heart failure with preserved ejection fraction (HfpEF).Objective:The objective of this study is to evaluate the efficacy of semaglutide in patients with obesity and HfpEF.Methods:The study was by the PRISMA guidelines. Studies reporting endpoints of semaglutide in patients with obesity and HfpEF were included. The outcomes included percentage weight change and adjudicated heart failure events. Both random and common effects models were used for the data analysis. The random intercept logistic regression model was used to compute the proportions, and the Peto method was used to compute the odds ratios. A p-value ≤ 0.05 was considered significant.Results:In total, three studies with 1463 patients with obesity and HfpEF were included in the study. The mean age of the patients was 68.8 ± 3.47 years. 50.7% of the patients were females. Patients who received Semaglutide had statistically higher odds of 10% weight reduction (OR 6.35; 1.54-26.21; p

Circulation, Volume 150, Issue Suppl_1, Page A4144705-A4144705, November 12, 2024. Background:Giant cell arteritis (GCA) is a chronic inflammatory condition associated with a significantly increased risk of various cardiovascular and thromboembolic events. Existing studies show that there may be an increased risk of cardiovascular disease in GCA, but the results are inconsistent. This meta-analysis aims to quantify the association between GCA and the risk of various cardiovascular outcomes, providing a comprehensive evaluation of the cardiovascular burden in patients with GCA.Methods:A comprehensive literature search was carried out using several databases. Studies were included based on predefined eligibility criteria. Using random effect models, Mantel-Haenszel odds ratios and associated 95% confidence intervals were produced to report the overall effect size. Funnel plots, Egger regression tests, and Begg-Mazumdar’s rank correlation test were used to assess publication bias. The endpoint included any cardiovascular events, myocardial infarction (MI), coronary artery disease (CAD), aortic aneurysm/dissection, peripheral artery disease (PAD), stroke, and venous thromboembolism.Results:The meta-analysis included 14 studies with a combined sample size of 609,954 patients, where the mean age was 73.8 years and 72.2% were female. Patients with GCA had significantly higher odds of experiencing any cardiovascular event (OR = 1.81, 95% CI = 1.55 to 2.15), MI (OR = 1.63, 95% CI = 1.34 to 1.97), CAD (OR = 1.51, 95% CI = 1.09 to 2.08), aortic aneurysm/dissection (OR = 1.95, 95% CI = 1.55 to 2.46), PAD (OR = 2.02, 95% CI = 1.69 to 2.41), stroke (OR = 1.52, 95% CI = 1.25 to 1.84), venous thromboembolism (OR = 1.92, 95% CI = 1.73 to 2.12), deep vein thrombosis (OR = 2.09, 95% CI = 1.50 to 2.91) and pulmonary embolism (OR = 2.45, 95% CI = 1.38 to 4.36). The heterogeneity of the outcomes ranged from low to high across different analyses. No publication bias was evident in the analysis.Conclusion:The meta-analysis highlights the critical need for vigilant cardiovascular monitoring and proactive management strategies in GCA patients. Further research is needed to identify specific factors that contribute to cardiovascular complications in these patients.

Circulation, Volume 150, Issue Suppl_1, Page A4116692-A4116692, November 12, 2024. Background and Aims:The increasing use of assisted reproductive technology (ART) has raised concerns regarding its long-term cardiovascular safety due to potential hormonal imbalances and pro-thrombotic states. This study aimed to assess the long-term cardiovascular risk associated with fertility treatments in women.Methods:Following PRISMA guidelines, a systematic review and meta-analysis was conducted via MEDLINE (Pubmed) from inception to January 2024. Randomized, cohort or case-control studies were included if fulfilling the following criteria: the association between fertility therapy and the subsequent cardiovascular outcome was reported and conditioned on confounding factors (at least age); the presence of a control group; minimum one-year follow-up. Effect size (ES) estimates of the association between fertility therapy and subsequent cardiovascular disease were pooled using the DerSimonian and Laird random-effects model. Heterogeneity was assessed with the I2index. This study is registered with PROSPERO (CRD42024505605).Results:Of 7,298 articles screened, eleven studies were included, encompassing 606,912 women undergoing ART and 70,562,486 controls. The analysis found no increase in the long-term risk of major adverse cardiovascular events (ES=0.97, 95% CI=0.81-1.16, I2=89.55%, p=0.73), coronary heart disease (ES=0.88, 95% CI=0.71-1.10, I2=24.36%, p=0.26), stroke (ES=1.20, 95% CI=0.96-1.49, I2=48.33%, p=0.11), heart failure (ES=0.74, 95% CI=0.60-0.94, I2=0.00%, p=0.01), venous thromboembolism (ES=1.03, 95% CI=0.78-1.34, I2=54.41%, p=0.85), hypertension (ES=1.08, 95% CI=0.88-1.326, I2=94.63%, p=0.46), or diabetes (ES=1.03, 95% CI=0.86-1.22, I2=78.44%, p=0.77).Conclusions:ART does not increase the long-term risk of cardiovascular diseases in women. These results support the cardiovascular safety of fertility treatments, though further research into specific ART techniques and extended follow-up is recommended.

Circulation, Volume 150, Issue Suppl_1, Page A4145010-A4145010, November 12, 2024. Introduction:Coronary heart disease(CHD) and myocardial infarction(MI) cost American healthcare $99 billion annually. In the US, 20.5 million adults over 20 years of age suffer from CHD, and 9.3 million from MI. MI causes cardiac myocyte death and scarring, leading to ischemic cardiomyopathy (ICMY), heart failure(HF), and arrhythmia. Current treatments improve perfusion and prevent remodeling but cannot reverse scarring. Stem cell therapy(SCT) aims to replace scarred myocardium with viable tissue, preventing complications like ICMY and HF.Aims:Evaluating the efficacy of SCT, in treating MI and preventing ICMY and HF. Efficacy was measured after 6 months, 1 year, and the long term.Methods:We followed the PRISMA protocol and guidelines to identify all human clinical trials on PubMed since 2010 that used SCT in adults with MI. Observational, non-human studies and isolated case reports were excluded. Our population of interest: adults with MI and SCT were compared to the control group of standard therapy alone(ST). Cardio sphere-derived autologous stem cells, Autologous Bone Marrow Stem Cell Therapy, Bone marrow-derived mononuclear cells via anterograde intra-arterial coronary delivery, Intracoronary infusion of autologous CD34 (+) cell, and Mesenchymal Stem/Stromal Cells were utilized in these trials. The primary outcome measured was efficacy: defined as an increase in Left Ventricular Ejection Fraction(LVEF) by >10%.Results:More than 3000 articles were reviewed, and after applying rigorous inclusion and exclusion criteria, we narrowed down to 32 articles with 2613 patients for qualitative and quantitative analysis. We found an increase in LVEF of >10% with optimal treatment after 12 months of management in the SCT (P

Circulation, Volume 150, Issue Suppl_1, Page A4146753-A4146753, November 12, 2024. Background:The role of digital health interventions (DHI) in addition to usual care (UC) in patients discharged after an acute coronary syndrome (ACS) remains uncertain.Hypothesis:DHI improves medication adherence, and systolic blood pressure (BP) control and reduces mortality in patients after an ACS.Purpose:To ascertain the efficacy of adding DHI to UC in patients discharged after an ACS through a systematic review and meta-analysis.Methods:We systematically searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs) comparing DHI plus UC versus UC alone in patients discharged after an ACS. We pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for binary and continuous outcomes, respectively. Our outcomes of interest were medication adherence (as per the studies’ definitions), all-cause mortality, and systolic BP. Statistical analyses were performed using R software version 4.4.0.Results:We included 22 RCTs comprising 20,587 patients, of whom 14,079 (68.4%) were randomized to DHI + UC. The mean age was 59.5 years and 58.5% were male. About 15% had diabetes mellitus at baseline while 54% had hypertension. In the pooled analysis, DHI plus UC significantly increased medication adherence (RR 1.06; 95% CI 1.01 to 1.13; p=0.03; Fig. 1) and reduced systolic BP (MD -3.16 mmHg; 95% CI -5.53 to -0.79; p

Circulation, Volume 150, Issue Suppl_1, Page A4146268-A4146268, November 12, 2024. Background:Low cholesterol efflux is associated with increased cardiovascular (CV) event risk. CSL112 is a reconstituted, infusible human plasma-derived apolipoprotein A-I that enhances cholesterol efflux, but its efficacy in reducing CV events is unclear. We aim to conduct a systematic review and meta-analysis comparing CSL112 infusions with placebo in acute myocardial infarction patients.Methods:We searched Cochrane, Embase and Pubmed databases for randomized controlled trials (RCT). The outcomes of interest were: (1) all-cause mortality; (2) emergent serious adverse events (SAE); and (3) major adverse cardiovascular events (MACE). Heterogeneity was examined with I2 statistics.We pooled risk ratios (RR) with 95% confidence intervals (CI) using a random effects model. Statistical analysis was done using R Studio 4.3.2.Results:Three RCTs were included, encompassing 19,557 patients, of whom 10,004 (51%) were in the CSL112 group. Most of the participants were male (74.5%), with a mean age of 65.1 years and a mean follow-up of 11.6 months. In the pooled analysis, there was no significant statistical difference in all-cause mortality (RR 1.06; 95% CI 0.57, 1.97; p=0.86; I2=19%; Fig 1), SAE (RR 1.01; 95% CI 0.84, 1.22; p=0.90; I2=48%; Fig 2A), and MACE (RR 0.94; 95% CI 0.83, 1.06; p=0.32; I2=0%; Fig 2B).Conclusion:Our findings suggest that the administration of CSL112 was not associated with a reduction in mortality, SAE or MACE in patients with acute myocardial infarction.

Circulation, Volume 150, Issue Suppl_1, Page A4140060-A4140060, November 12, 2024. Introduction:Type 2 diabetes mellitus (T2DM) is a major risk factor for coronary artery disease (CAD). SGLT2 inhibitors (SGLT2i) are effective in reducing cardiovascular mortality in T2DM patients, but their benefits for those with both CAD and T2DM are uncertain.Objective:The primary outcome was to evaluate the efficacy of SGLT2i compared to other hypoglycemic agents or placebo in reducing the risk of all-cause mortality in patients with T2DM and CAD. Secondary outcomes included cardiovascular death, fatal or non-fatal stroke, and fatal or non-fatal myocardial infarction. We hypothesize that SGLT2i are more effective in mortality risk reduction in patients with T2DM and concomitant CAD.Methods:A systematic review following PRISMA-2020 guidelines was conducted across four databases to evaluate the efficacy of SGLT2i in reducing mortality risk in diabetic patients with CAD. Quantitative analysis using Stata v18 employed a random-effects model (Restricted Maximum Likelihood) with Hazard Ratios (HR) as the measure of association.Results:Out of 853 studies identified, 5 publications were included in the final quantitative analysis, which included 5225 patients. The Newcastle-Ottawa Quality Assessment Form showed all included cohort studies had a low risk of bias. Those patients taking SGLT2i had a significant reduction in 38% the risk of all-cause mortality (HR 0.62 [0.47, 0.80]), this same effect was observed when compared with each subgroup vs. other hypoglycemic agents, HR 0.52 [0.29, 0.93]; vs. placebo, HR 0.64 [0.46, 0.90]. Results show very low heterogeneity. In overall cardiovascular death analysis, a significantly greater reduction was observed with SGLT2i (HR 0.61 [0.46, 0.81]), as well as when compared with placebo (HR 0.64 [0.47, 0.86]). In contrast, when compared with other hypoglycemic agents, there was a reduction, but this was not significant (HR 0.45 [0.19, 1.03]). No statistically significant decrease in the risk of fatal or non-fatal stroke and myocardial infarction was found with SGLT2i.Conclusion:SGLT2i demonstrates a greater significant benefit in reducing all-cause and cardiovascular mortality in patients with T2DM and CAD.

Circulation, Volume 150, Issue Suppl_1, Page A4113561-A4113561, November 12, 2024. Background:Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have demonstrated mortality benefits in patients with heart failure (HF). Since acute coronary syndrome (ACS) is an increasingly prevalent cardiovascular condition that often leads to HF, SGLT2i might play a role in reducing mortality in these patients. Previous randomized controlled trials (RCTs) have demonstrated inconsistent efficacy of Empagliflozin, an SGLT2i, in patients with ACS.Methods:A comprehensive systematic literature search was conducted spanning the major bibliographic databases to retrieve RCTs comparing Empagliflozin to placebo in patients with ACS. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals were pooled using the DerSimonian and Laird random-effects model with statistical significance set at p

Circulation, Volume 150, Issue Suppl_1, Page A4141513-A4141513, November 12, 2024. Background:The beneficial effect of SGLT-2 inhibitors in managing type 2 diabetes mellitus and heart failure with reduced ejection fraction has already been established. However, the outcomes of dapagliflozin on cardiovascular events in patients with acute myocardial infarction are not well studied.Hypothesis:Our study aims to investigate the effect of dapagliflozin in reducing cardiovascular events among patients with acute myocardial infarction.Methods:A systematic search was conducted using multiple electronic databases from inception until March 2024 using the appropriate Mesh terms, “ dapagliflozin,” “SGLT 2 inhibitors,” “acute myocardial infarction,” “heart failure,” “major cardiovascular events,” “all-cause mortality.” We used the random effect model to calculate the pooled relative risk and their corresponding confidence interval. A p-value of

Circulation, Volume 150, Issue Suppl_1, Page A4145225-A4145225, November 12, 2024. Background:Sodium-glucose co-transporter two inhibitors (SGLT2i) have recently been included in heart failure (HF) guidelines due to their benefits in reducing mortality and hospitalization rates. However, the benefits of SGLT2i in patients with post-acute myocardial infarction (MI) remain controversial. Therefore, we aim to perform an updated systematic review and meta-analysis comparing SGLT2i with placebo in patients after an acute MI.Methods:We performed a systematic review and meta-analysis to determine the impact of SLGT2i in patients with post-acute MI with or without diabetes type II (DM II). We systematically searched Pubmed, Cochrane, and Embase for randomized controlled trials (RCTs) comparing SGLT2i and placebo in patients following an acute MI. The primary outcome assessed was (1) HF hospitalization. In this analysis, we also included the following secondary outcomes:(2) cardiovascular (CV) mortality and (3) MI recurrence. Risk Ratios(RRs) with 95% confidence interval (CI) were pooled across studies using a random effect model.Results:Our meta-analysis included ten RCTs comprising 25908 patients, of whom 14098 (54.4%) received SGLT2i therapy and 15078 (58.2%) had type II diabetes. The mean age was 62 years, and the mean follow-up was 21.2 months. In the pooled analysis, HF hospitalization was significantly lower in the SGLT2is group (RR 0.76; 95%CI 0.68,0.84; p

Circulation, Volume 150, Issue Suppl_1, Page A4147872-A4147872, November 12, 2024. Introduction:Both self-expanding (SEV) and balloon-expandable (BEV) valves are used in transcatheter aortic valve implantation (TAVI) for patients with severe aortic stenosis (AS) and small aortic annulus (SAA). This updated meta-analysis compares the efficacy and safety of SEV versus BEV in TAVI for these patients.Hypothesis:This study investigates whether SEV valves are hemodynamically and clinically superior to BEV valves in patients with small aortic annulus.Methods:PubMed, SCOPUS, and Cochrane Central databases were systematically searched for randomized and observational studies comparing SEV and BEV in TAVI for SAA patients. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model for clinical outcomes (all-cause mortality, stroke, permanent pacemaker implantation [PPI]) and hemodynamic parameters (mean gradient [MG], indexed effective orifice area [iEOA], moderate to severe prosthesis-patient mismatch [PPM], and paravalvular leak [PVL]).Results:A total of 21 studies involving 6,515 patients (58.4% treated with SEV) were included. SEV valves were associated with lower all-cause mortality (OR 0.75; 95% CI 0.60-0.95; p=0.014), lower MG (OR -4.44; 95% CI -5.48-3.39; p

Circulation, Volume 150, Issue Suppl_1, Page A4124370-A4124370, November 12, 2024. Background:Dual antiplatelet therapy (DAPT) is well established as standard of care following percutaneous coronary intervention (PCI). Recent trials have shown a potential benefit in the reduction of hemorrhagic events with a shorter course of DAPT. However, the optimal duration of DAPT following PCI remains unclear.Question:Is 1 month of DAPT followed by P2Y12 inhibitor monotherapy superior to the standard 12-month DAPT regimen in terms of cardiovascular outcomes in patients post-PCI?Methods:Medline, PubMed, and Cochrane Central Register of Controlled Trials databases were searched for randomized clinical trials (RCTs) comparing 1-month vs. 12-months of DAPT followed by P2Y12 inhibitor monotherapy post-PCI. The outcomes of interest were cardiovascular death, myocardial infarction, and major bleeding. We used R version 4.1.2 (The R Foundation, 2021) to pool the data using a random-effects model. Heterogeneity was assessed with I2.Results:We included three RCTs reporting data from 22,413 patients, of whom 11,180 (49.8%) were treated with 1-month of DAPT, followed by P2Y12 inhibitor monotherapy. Follow-up ranged from 12 months to 24 months. The incidence of all-cause death (RR 1.20; 95% CI 0.95-1.51; p=0.12) and myocardial infarction (RR 0.86; 95% CI 0.71-1.05; p=0.14) were not significantly different between the groups. However, major bleeding (RR 0.51; 95% CI 0.26-0.99; p=0.048) was significantly reduced with a short course of DAPT followed by P2Y12 inhibitor monotherapy, as compared with standard 12 months of DAPT.Conclusion:Following PCI, a transition from DAPT to P2Y12 inhibitor monotherapy at 1-month is associated with a significant reduction in major bleeding as compared with standard DAPT for 12-months, with no significant change in the incidence of all-cause mortality or myocardial infarction.

Circulation, Volume 150, Issue Suppl_1, Page A4137467-A4137467, November 12, 2024. Background:Intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) allows better visualization of atherosclerotic plaques than angiography alone. We conducted a systematic review and meta-analysis to comprehensively synthesize the available evidence regarding the efficacy of IVUS-guidance compared to angiography-guided PCI. Moreover, we conducted a sensitivity analysis to determine the applicability of IVUS guidance in complex PCI.Methods:We conducted a comprehensive literature search of major bibliographic databases from inception until May 2024 to identify randomized controlled trials (RCTs) comparing IVUS-guided versus angiography-guided PCI. Risk ratios (RR) with their corresponding 95% confidence intervals (CI) were pooled using the random-effects model, with a p-value