Risultati per: Il dolore neuropatico: review

Circulation, Volume 150, Issue Suppl_1, Page A4144404-A4144404, November 12, 2024. Introduction:Mavacamten, a cardiac myosin inhibitor, distinguishes from other pharmacological interventions by addressing not only symptomatic treatment but also targeting the underlying pathophysiological mechanisms in Hypertrophic Cardiomyopathy (HCM). Therefore, we aimed in our meta-analysis to evaluate the impact of mavacamten on echocardiographic parameters and cardiac biomarkers in HCM patients.Methods:We searched different databases such as PubMed, SCOPUS, WOS, and Cochrane from inception until February 20, 2023, for any randomized controlled trials (RCTs) that compare mavacamten to placebo in HCM patients and report the echocardiographic parameters. Our outcomes of interest were diastolic function parameters [lateral and septal early diastolic mitral annular velocity (lateral e’ and septal e’), lateral and septal ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity of the septum (E/e’ lateral and septal ratio)], left ventricular parameters [left ventricular ejection fraction (LVEF) and left ventricular outflow tract (LVOT) valsalva gradient ], as well as cardiac biomarkers [NT-proBNP and troponin]. We used the mean difference (MD) for continuous outcomes with the corresponding 95% confidence interval (CI).Results:Four RCTs with a total of 503 patients were included. Mavacamten led to a significant improvement in lateral e’ and septal e’, (MD=1.43, 95% CI [1.06, 1.79]), (MD=0.78, 95% CI [0.51, 1.05]) respectively compared to placebo. Furthermore, mavacamten was superior to placebo in reducing E/e’ lateral ratio, (MD=-3.05, 95% CI [-5.05, -1.05]) E/e’ septal ratio (MD=-3.38, 95% CI [-4.50, -2.25]), LVEF, and LVOT valsalva gradient, (MD=-3.52, 95% CI [-4.76, -2.27]), (MD=-51.02, 95% CI [-69.66, -32.38]), respectively. Regarding to cardiac biomarkers, mavacamten demonstrated substantial efficacy in reducing NT-proBNP (MD=-557.14, 95% CI [-685.59, -428.68]), and troponin (MD=-8.47, 95% CI [-12.73, -4.21]).Conclusion:Our meta-analysis reveals that mavacamten significantly enhanced echocardiographic outcomes for diastolic function and left ventricular parameters. Also, mavacamten led to a significant reduction in cardiac biomarkers.

Circulation, Volume 150, Issue Suppl_1, Page A4136009-A4136009, November 12, 2024. Introduction:Since individual adherence/persistence studies for heart failure (HF) guideline-directed medical therapy (GDMT) have mainly focused on single classes or had limited sample sizes, providing inconclusive estimates, a comprehensive analysis is needed to understand the magnitude of the problem.Hypothesis:Adherence and persistence to HF GDMT are suboptimal and are associated with increased risks of HF admission and mortality.Aims:To generate estimates of real-world HF medication adherence and persistence and associated clinical outcomes.Methods:We conducted a systematic review and meta-analysis, searching PubMed, EMBASE, and CINAHL for observational studies on adherence and persistence in HF GDMT from inception to 9/25/23. We evaluated bias using the Newcastle-Ottawa Scale. Primary outcomes were adherence and persistence rates using a restricted maximum-likelihood model. Adherence was summarized as the mean proportion of days covered (PDC) and medication possession ratio (MPR), proportion of patients with good adherence (PDC/MPR≥80%), and persistence. Secondary outcomes were all-cause mortality and HF readmission with summary hazard ratios (HRs) and 95% confidence intervals (CI) estimated. Heterogeneity and publication bias were assessed using Cochran’s Q, I squared statistics, funnel plots, and Egger’s tests, while subgroup analyses explored variations across studies.Results:The 48 studies included comprised 1,614,985 patients (mean age 71; 57% men). The overall mean PDC/MPR was 76%, with good adherence of 54%, and persistence rates of 60%. Renin-angiotensin-aldosterone system inhibitors had the highest mean PDC/MPR of 78%, good adherence of 56%, and persistence of 64%, while mineralocorticoid receptor antagonists (MRAs) had the lowest at 71%, 47%, and 49% respectively. Nonadherence/nonpersistence to GDMT was associated with a higher rate of mortality (HR 1.27 [95% CI 1.19–1.35]) and HF admission (HR 1.25 [95% CI 1.14-1.37]).Conclusions:Suboptimal adherence/persistence to HF GDMT is common, with only half of patients showing good adherence. Given the association with worse clinical outcomes, clinicians should prioritize identifying barriers to and addressing nonadherence/nonpersistence to HF GDMT, particularly with MRAs.

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

Circulation, Volume 150, Issue Suppl_1, Page A4145057-A4145057, November 12, 2024. Introduction:Cardiovascular Implantable Electronic Device (CIED) infection is class I indication for complete transvenous lead removal (LR). The reimplantation strategies post-LR, especially in pacemaker-dependent patients or those necessitating cardiac resynchronization therapy (CRT) and/or implantable defibrillators, remain complex. Considering the limitations and risks associated with traditional approaches, the exploration of alternative devices such as leadless pacemakers (LP) have garnered attention due to their purported lower infection risk.Methods:We meticulously reviewed literature sources including PubMed, Scopus, and Embase utilizing a combination of search terms. The inclusion criterion was LP implantation post-LR of infected CIED, while the exclusion criterion was LR for noninfectious indications. Study endpoints encompassed patients’ outcomes during follow-up.Results:Our literature review yielded 818 articles, of which 21 met the inclusion criteria, encompassing a cohort of 612 patients who underwent LR followed by LP implantation (Table 1). A total of 250 (40.8%) patients underwent concurrent LP implantation during the LR procedure. The rest underwent staged procedures and the overall duration between LR of infected CIED and LP implantation was 4.32 ± 3.9 days. In our cohort, 172 (28.1%) patients had systemic CIED infections, whereas 130 (21.2%) had isolated pocket infections, with Staphylococcus aureus as the predominant causative organism in 96 (39.3%) cases. Procedural complications were scarce. Over a mean follow-up period of 13.2 ± 8.1 months, pacemaker syndrome was observed in 3 (0.67%) patients, while 1 (0.16%) patient had a re-infection related to LP.Conclusion:The remarkably low incidence of complications and re-infections following LP implantation underscores its potential utility as a viable implantation option after LR, particularly in pacing-dependent patients at higher risk of CIED infections.

Circulation, Volume 150, Issue Suppl_1, Page A4117690-A4117690, November 12, 2024. Background:Takotsubo syndrome is a reversible cause of heart failure; however, a low percentage of patients can develop serious complications, including cardiac rupture.Aims:Analyze case reports or case series of cardiac rupture in patients with Takotsubo syndrome, detailing patient characteristics to uncover risk factors and prognosis for this severe complication.Methods:We conducted a systematic search of MEDLINE and Embase databases to identify case reports or case series of patients with Takotsubo syndrome complicated by cardiac rupture, from inception to October 2023.Results:We identified 39 reported cases, including 44 subjects (40 females; 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity. An emotional trigger was present in 15 (34%) subjects and common admission symptoms were chest pain (35 [80%]) and dyspnea (14 [32%]). ST-segment elevation was present in 39 (93%) of 42 cases, with the anterior myocardial segments (37 [88%]) being the most compromised, followed by lateral (26 [62%]) and inferior (14 [33%]) segments. The mean left ventricular ejection fraction was 40±13% and an apical ballooning pattern was observed in all (100%) ventriculographies. The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery treatment was attempted in 16 (36%) cases, and 28 (64%) patients did not survive (Figure).Conclusions:Cardiac rupture as a complication of Takotsubo syndrome is a rare clinical condition associated with high mortality. Elderly females, especially from White/Caucasian or East Asian/Japanese descent, presenting with ST-segment elevation in the anterior or lateral leads, and an apical ballooning pattern, are disproportionally affected. Additional studies with prospective collection of patient-level data are needed to better identify those at increased risk for cardiac rupture associated with Takotsubo syndrome and to address ways to improve mortality rates in this population.

Circulation, Volume 150, Issue Suppl_1, Page A4144790-A4144790, November 12, 2024. Background:A prolonged PR interval has been demonstrated as a predictor of increased risk for incident atrial fibrillation (AF), coronary artery disease, heart failure, and pacemaker implantation.Purpose:We aim to investigate the impact of prolonged PR interval > 200 ms on AF recurrence after catheter ablation.Methods:We comprehensively searched PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through May 2024. We conducted a pair-wise and prognostic systematic review and meta-analysis with a reconstructed time-to-event data meta-analysis. All analyses were performed using R V. 4.3.1.Results:With the inclusion of four studies, our cohort comprised a total of 2,790 patients. Regarding pair-wise meta-analysis, PR interval > 200 ms was significantly associated with an increased incidence of AF recurrence compared to PR interval ≤ 200 ms (RR: 1.50 with 95% CI [1.33, 1.70], P< 0.01). Regarding adjusted prognostic meta-analysis, PR interval > 200 ms was significantly associated with a 92% increase in the risk of AF recurrence compared to PR interval ≤ 200 ms (HR: 1.92 with 95% CI [1.61, 2.30], P< 0.01). Our reconstructed Kaplan Meier showed that a PR interval > 200 ms was significantly associated with a 65% increase in the risk of AF recurrence compared to a PR interval ≤ 200 ms (HR: 1.65 with 95% CI [1.42, 1.92], P< 0.00001) over 120 months follow-up.Conclusion:Our meta-analysis concluded that a prolonged PR interval greater than 200 ms is a significant predictor of AF recurrence after catheter ablation, reflecting atrial remodeling, and since the PR interval can be easily measured by a surface 12-lead ECG, patients with a prolonged PR interval may require additional treatment strategies.

Circulation, Volume 150, Issue Suppl_1, Page A4114970-A4114970, November 12, 2024. Background:Pulsed field ablation (PFA) and high-power short-duration radiofrequency ablation (HPSD) are emerging techniques for treating atrial fibrillation (AF), offering promising results compared to cryoballoon ablation (CBA). This network meta-analysis aims to evaluates the efficacy and safety of PFA, HPSD, and CBA.Method:PubMed, Embase, Cochrane Central Register of Controlled Trials, and EBSCO Information Services were systematically searched for relevant studies until April 2024. The primary outcome is freedom from atrial arrhythmia. A random-effects model was used for data synthesis, and P-scores were employed for outcome ranking. Point estimation (odd ratios) was calculated for comparisons.Results:Fifteen studies were included in our network meta-analysis, involving 5,093 atrial fibrillation patients: 812 (16%), 2,659 (52%), and 1,622 (32%) patients underwent PFA, CBA, and HPSD, respectively. PFA demonstrated the highest efficacy (P-scores 99.3%). Point estimation between PFA and HPSD, and PFA and CBA, were 1.394 (95% CI: 1.047-1.858) and 1.479 (95% CI: 1.134–1.929), respectively. PFA had higher complications compared to HPSD (OR=4.44, 95% CI: 1.405-14.031) and CBA (OR=2.581, 95% CI: 0.992–6.720). HPSD had the shortest fluoroscopic time (P-scores 100%), while CBA had the longest (P-scores 0%). PFA had the shortest procedural time compared to CBA and HPSD with P-scores of 100% 50% and 0%, respectively.Conclusion:PFA showed higher efficacy but higher complication risk than HPSD and CBA. HPSD and CBA demonstrated similar efficacy and safety.

Circulation, Volume 150, Issue Suppl_1, Page A4142116-A4142116, November 12, 2024. Introduction:The measurement of Urinary Sodium Concentration (UNa) is a pivotal biomarker in managing Acute Heart Failure (AHF), offering a non-invasive and readily accessible means to evaluate diuretic response. This systematic review and meta-analysis is designed to investigate the correlation between UNa levels and patient-centric outcomes in AHF, aiming to validate the evidence base and refine clinical practice.Methods:This systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. We systematically searched PubMed, Cochrane Central, Scopus, Google Scholar, and ClinicalTrials.gov from their inception to May 2024. Our search included randomized controlled trials (RCTs) and observational studies comparing outcomes between acute heart failure (AHF) patients with high urinary sodium concentration (UNa) and those with low UNa.Results:The analysis included 12 studies comprising 5 RCTs and 7 observational studies, incorporating a total of 8,743 AHF patients. In the high UNa group, pooled data demonstrated significantly higher urinary output (MD 534.49 ml, 95% CI 348.48 to 720.49; P < 0.00001) and increased weight loss (MD 1.15 kg, 95% CI 0.45 to 1.85; P < 0.001). Additionally, there was a lower risk of renal function decline (OR 0.48, 95% CI 0.24 to 0.97; P < 0.04). Patients with high urinary sodium had a shorter mean hospital stay of 7.6 days compared to 8.8 days for those with low UNa, with an overall reduction in length of stay (MD -1.38 days, 95% CI -2.44 to -0.32; P < 0.01). Mortality was also lower in the high UNa group, particularly over longer follow-up periods: at 1-month follow-up (OR 0.40, 95% CI 0.21 to 0.78; P = 0.007), at 6-month follow-up (OR 0.45, 95% CI 0.29 to 0.72; P = 0.0007), and at 12-month follow-up (OR 0.16, 95% CI 0.16 to 0.26; P < 0.00001). Furthermore, the high UNa group exhibited a lower risk of worsening heart failure requiring inotropes (OR 0.40, 95% CI 0.23 to 0.70; P = 0.002) and a reduced incidence of heart failure rehospitalization (OR 0.42, 95% CI 0.20 to 0.89; P = 0.02).Conclusion:High urinary sodium concentration is strongly associated with improved clinical outcomes in acute heart failure, including greater urinary output, increased weight loss, shorter hospital stays, and reduced risks of renal function decline, mortality, worsening heart failure, and rehospitalization.

Circulation, Volume 150, Issue Suppl_1, Page A4140276-A4140276, November 12, 2024. Background:The potential benefits and risks of combination sodium-glucose co-transporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) therapy versus (vs.) monotherapy, remain a subject of debate to reduce metabolic and cardiovascular outcomes in patients with diabetes mellitus. This study aims to systematically review and meta-analyze the available evidence from randomized controlled trials (RCTs).Methods:A comprehensive search identified relevant RCTs comparing combination therapy with SGLT-2i and GLP-1RA to monotherapy or placebo. The primary outcome was the incidence of major adverse cardiovascular events (MACE) (all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, and hospitalization for heart failure (hHF)). Secondary outcomes included changes in metabolic parameters and adverse events. Random-effects meta-analysis estimated risk ratios, mean difference, and 95% confidence intervals (CI).Results:The meta-analysis included 11 RCTs with 42,851 participants, of which 2,870 on combination therapy, and the rest on SGLT-2i (37.1%), GLP-1RA (20.1%) monotherapies or placebo (42.8%). Combination therapy had a significantly lower risk of MACE vs. GLP-1RA monotherapy (RR=0.81, 95% CI 0.65;1.00) and placebo (RR=0.73, 95% CI 0.61;0.88). Combination therapy also had a lower risk of hHF vs. GLP-1RA, SGLT-2, and placebo monotherapies (RR=0.37, 95% CI 0.22;0.65), (RR=0.37, 95% CI 0.19;0.75), and (RR=0.43, 95% CI 0.24;0.75), respectively. Combination therapy was showed greater weight loss and HbA1c reduction vs. SGLT-2i monotherapy (MD=-2.03, 95% CI -2.85;-1.21 and MD=-0.74, 95% CI -1.21;-0.27), respectively, while no difference vs. GLP-1RA monotherapy. Incidence of nausea and diarrhea was higher with combination therapy vs. SGLT-2i monotherapy (MD=3.34, 95% CI 1.74;6.43 and MD=1.75, 95% CI 1.10;2.77), respectively.Conclusion:Combination SGLT-2i and GLP-1RA therapy may provide superior cardiovascular, weight, and HbA1c outcomes vs. monotherapy, despite higher gastrointestinal adverse events. These results impact the management of patients with metabolic and cardiovascular diseases, and highlighting the need for further research to optimize combination therapy.

Circulation, Volume 150, Issue Suppl_1, Page A4145439-A4145439, November 12, 2024. Introduction:Thyrotoxicosis is a systemic condition caused by the effects of elevated levels of thyroid hormones. The cardiovascular manifestations of thyrotoxicosis range from sinus tachycardia and atrial fibrillation to heart failure. The incidence of malignant arrhythmias and cardiac arrest associated with thyrotoxicosis is not well known, and much of the current literature regarding this is limited to case reports. This study conducts a systematic review of the literature to identify patient demographics and outcomes where thyrotoxicosis manifests as cardiac arrest.Methodology:A systematic literature review was conducted by searching three different databases, Embase, PubMed, and Scopus from inception to January 5th, 2024, to identify and review case reports regarding patients with thyrotoxicosis who had a cardiac arrest.Results:We identified 98 patients with thyrotoxicosis manifested as cardiac arrest. The mean age was 40 ±15 years, and 62% were female. Most were previously healthy and had no history of a thyroid disorder (60%). Of the patients with preexisting hyperthyroidism, around 50% had Graves’ disease. Notably, around 90% of these patients had no history of heart disease. The overall mortality was 23.5% (table 1).Conclusion:Thyrotoxicosis should be considered when an otherwise healthy patient presents with a cardiac arrest in the third or fourth decade of life. The outcome in these patients seems to be favorable, with more than three-quarters of patients in our study having survived the event.

Circulation, Volume 150, Issue Suppl_1, Page A4141367-A4141367, November 12, 2024. Background:Heart failure (HF) is a chronic condition with high morbidity and mortality rates, and is known to pose a significant burden on the healthcare system. Telemonitoring, an innovative approach using remote monitoring of patients’ health data, has emerged as a potential solution to enhance HF management and improve patient outcomes.Research Question:This systematic review investigates whether telemonitoring interventions improve heart failure outcomes compared to standard care.Aim:We aim to synthesize the current evidence on the impact of telemonitoring on all-cause mortality, cardiovascular mortality, heart failure-related hospitalization, and health-related quality of life in patients with heart failure.Methods:We conducted a thorough search of electronic databases, including PubMed, Cochrane Library, Google Scholar, and PLOS Medicine, to identify relevant randomized controlled trials (RCTs) and systematic reviews/meta-analyses (SRs/MAs) evaluating telemonitoring interventions in heart failure. Studies were selected based on pre-defined criteria. A review of the literature and risk of bias assessment was performed independently by four reviewers.Results:Out of 16,778 articles reviewed, eight were chosen for this study, comprising 3 SRs/MAs and 5 RCTs. The findings suggest that using telemonitoring interventions, such as structured telephone support, mobile health interventions, and medication support, significantly reduces deaths and hospitalizations in heart failure patients compared to standard care. Longer telemonitoring duration (≥12 months) significantly lowered hospitalization rates.Conclusions:This systematic review suggests that telemonitoring may be associated with improved heart failure outcomes, including reduced mortality and hospitalization rates. However, further research is needed to explore telemonitoring interventions’ long-term effects and cost-effectiveness in heart failure management.

Circulation, Volume 150, Issue Suppl_1, Page A4131488-A4131488, November 12, 2024. Background:Diagnosis of cardiac amyloidosis (CA) is often delayed due to variability in clinical presentation. The electrocardiogram (ECG) is one of the most common and widely available tools for assessing cardiovascular diseases. Artificial intelligence (AI) models analyzing ECG have recently been developed to detect CA, but their pooled accuracy is yet to be evaluated.Aim:To meta-analyze the accuracy of AI-enhanced ECG in diagnosing CA.Methods:We searched the Scopus, MEDLINE, and Cochrane CENTRAL databases up until April 2024 for studies assessing AI-enhanced ECG diagnosis of CA. Studies reporting findings from derivation and validation cohorts were included. Studies combining other diagnostic modalities such as echocardiography were excluded. The outcome of interest was the area under the receiver operating characteristic curve (AUC) for overall CA and subtypes transthyretin amyloidosis (ATTR) and light chain amyloidosis (AL). Analysis was done using RevMan 5.4.1 general inverse variance random effects model, pooling data for AUC and 95% confidence intervals (CI).Results:5 studies comprising 7 cohorts met the eligibility criteria. The total derivation and validation cohorts were 8,639 and 3,843 respectively. The AUC were 0.89 (95% CI, 0.86-0.91) for cardiac amyloidosis, 0.90 (95% CI, 0.86-0.95) for ATTR amyloidosis and 0.80 (95% CI, 0.80-0.93) for AL amyloidosis. The forest plots can be found in the Figure 1.Conclusion:AI-enhanced ECG models effectively detect CA and may provide a useful tool for the early detection and intervention of this disease.

Circulation, Volume 150, Issue Suppl_1, Page A4144446-A4144446, November 12, 2024. Introduction:Empagliflozin, a sodium–glucose co-transporter-2 (SGLT-2) inhibitor, improves cardiovascular outcomes in patients with heart failure (HF) with or without diabetes mellitus. However, limited data is available regarding its impact after acute myocardial infarction (AMI). Therefore, we aimed in our meta-analysis to evaluate the safety and efficacy of empagliflozin after AMI.Methods:We searched PubMed, Scopus, Cochrane Library, and Web of Science from inception to April 19th, 2024, to identify any Randomized Controlled trials (RCTs) that compare empagliflozin to placebo after AMI. The safety outcomes were presented as short term cardiovascular mortality, all-cause mortality, hospitalization for heart failure (HF), and any adverse events. The efficacy outcomes were reported as NT-proBNP, systolic blood pressure (SBP), diastolic blood pressure (DBP), and LDL-c. Dichotomous outcomes were pooled in the form of risk ratio (RR), and continuous outcomes in form of mean difference (MD), with the corresponding 95% confidence intervals (CI).Results:Ten RCTs with a total of 10,697 patients were included. Empagliflozin was associated with significant lower risk of cardiovascular mortality (RR = 0.57, 95% CI [0.46, 0.71]), all cause mortality, and hospitalization for heart failure, (RR=0.64, 95% CI [0.53, 0.79]), (RR = 0.67, 95% CI [0.58, 0.79]), respectively. Furthermore, empagliflozin demonstrated a significant reduction in both NT-proBNP (MD = -161.26, 95% CI [-294.58, -27.93]) and SBP (MD= -8.59, 95% CI [-13.26, -3.93]). However, there is no difference between the two groups in terms of any adverse events, diastolic blood pressure, and LDL-c, (RR=0.98, 95% CI [0.95, 1.02]), (MD = -2.55, 95% CI [-5.31,0.20]), (MD=1.67, 95% CI [-6.11, 9.46]), respectively.Conclusion:Our meta analysis reveals that empagliflozin significantly reduce all major cardiovascular outcomes after AMI such as cardiovascular mortality and hospitalization due to heart failure. Moreover, empagliflozin effectively lowers NT-proBNP levels and SBP with no superiority in terms of adverse events, diastolic blood pressure and LDL-c.

Circulation, Volume 150, Issue Suppl_1, Page A4145107-A4145107, November 12, 2024. Background:Kounis syndrome (KS), also known as allergic myocardial infarction, is a rare but potentially life-threatening condition characterized by acute coronary syndrome in the setting of allergic reactions triggered by drugs, foods, vaccines, or environmental exposure. Our study provides an updated comprehensive insight into this patient cohort on a large scale.Methods:We conducted a systemic literature search in PubMed, EMBASE, and Google Scholar between 2018 and 2024, using MeSH terms and keywords for “Kounis syndrome”, “drug”, and allergy to identify the cases of drug-induced KS. Initial search yielded 325 articles. After excluding duplicates, review articles and irrelevant studies, we included only 51 articles reporting drug-induced KS.Results:Our study identified 51 patients of KS with a median age of 56 ± 14 years. Of those, 56.86% were female. The most frequently implicated drugs in KS were antimicrobials (37.25%), followed by iodinated contrast media (19.60%), NSAIDs (15.68%), and antineoplastics (9.80%). Of those, 64.70% of patients were diagnosed with KS-I, 13.72% with KS-II, and 21.56% with KS-III. Chest pain (94.1%), dyspnea (90.1%), and palpitations (60.78%) were predominant initial manifestations, and most cases (78.43%) were presented within 1st hour of drug ingestion. ST-segment changes (100%) were common ECG findings, and 64.70% of patients had elevated cardiac troponin. All patients had reduced left ventricular ejection fraction (LVEF) (

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 A4131100-A4131100, November 12, 2024. Background:Previous literature shows that metabolic surgery effectively decreases the risk of cardiovascular disease (CVD) events in patients with obesity. The use of metabolic surgery has, however, been limited in people with obesity and pre-existing CVD due to concerns of poor post-operative cardiovascular outcomes. This study aims to determine the effectiveness and safety of metabolic surgery in patients with pre-existing CVD.Methods:A search of electronic databases, PubMed, Cochrane Central and SCOPUS was conducted from their inception till May 2024. The study was conducted adhering to the PRISMA guidelines. Outcomes of interest were risk of all-cause mortality, major adverse cardiovascular events (MACE), risk of myocardial infarction (MI), and cerebrovascular events in patients with and without prior CVD undergoing bariatric surgery. Data was pooled as generic inverse variance using a random effects model, and presented as hazard ratios (HR) with their 95% confidence intervals (CI).Results:We included four studies in our analysis (n = 5,244). Our pooled analysis shows that metabolic surgery leads to significant reduction in risk of all-cause mortality (HR = 0.51, 95% CI: [0.42, 0.61]; p