Risultati per: Progressi nel trattamento della psoriasi: review

Circulation, Volume 150, Issue Suppl_1, Page A4115399-A4115399, November 12, 2024. Background:Endovascular Aortic Aneurysm Repair (EVAR) has emerged as a less invasive approach to aneurysm repair. However, the optimal anesthesia modality for elective cases—general or local-regional—remains uncertain. This meta-analysis compares the outcomes of local-regional versus general anesthesia (GA) for abdominal EVAR.Methods:We searched MEDLINE, Embase, and Cochrane databases for studies comparing local-regional and general anesthesia for EVAR up to May 2024. Following the PRISMA protocol, 1,796 articles were screened. Endpoints included 30-day mortality, type I endoleaks, length of hospital stay (LHS), and Intensive Care Unit (ICU) admissions. A random-effects model with odds ratios (OR) and 95% confidence intervals (CI) was used for binary endpoints and mean difference (MD) for continuous endpoints. Heterogeneity was assessed using Q and I2 statistics. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach evaluated the quality of evidence.Results:Sixteen cohort studies, encompassing 70,654 patients treated with EVAR after excluding overlapping populations, were included. All groups had similar demographics, American Society of Anesthesiologists physical status, and aneurysm type. The mean age was 73.6 years, and 88.1% were male. Local-regional anesthesia was associated with significantly lower 30-day all-cause mortality (OR 0.74; 95% CI 0.55 to 0.99; p=0.049; I2=0, Figure A), shorter LHS (MD -0.72 days; 95% CI -1.29 to -0.15; p=0.01; I2=87%), and less ICU admissions (OR 0.53; 95% CI 0.31 to 0.93; p=0.027; I2=98%). There was no increase in endoleaks in the local-regional group (OR 0.78; 95% CI 0.55 to 1.09; p=0.143; I2=29%, Figure B). The GRADE rated this evidence as moderate certainty and high importance.Conclusion:Local-regional anesthesia may be preferable to general anesthesia for EVAR, as it reduces 30-day mortality, ICU admissions, and hospital stay length without increasing the risk of type I endoleaks.

Circulation, Volume 150, Issue Suppl_1, Page A4142117-A4142117, November 12, 2024. Introduction:The management of patients with Venous thromboembolism (VTE) receiving anticoagulant therapy is complicated by potential interactions with other medications, including antibiotics. Piperacillin-tazobactam (PTZ) has been implicated in unexpected disturbances in the coagulation cascade, which can be critical in patients concurrently using anticoagulants like rivaroxaban. This report explores the complexities of prescribing broad-spectrum antibiotics to patients with pre-existing cardiac conditions and the necessity of careful consideration of drug-drug interactions.Case Report:A 52-year-old white male with a history of deep vein thrombosis on rivaroxaban, presented with severe left leg cellulitis and subsequent gastrointestinal bleeding shortly after the initiation of piperacillin-tazobactam. His presentation was complicated by a rapid deterioration in his condition following a syncopal episode, characterized by hematochezia and hematemesis, necessitating urgent medical interventions including the cessation of all anticoagulation therapy, esophagogastroduodenoscopy and broad-spectrum antibiotics.Discussion:This case highlights the clinical challenges and potential risks of coagulopathies induced by PTZ or the interaction of PTZ with rivaroxaban, stressing the importance of multidisciplinary vigilance. The mechanisms by which PTZ may influence the coagulation pathways in patients already at risk due to their cardiac profiles underscore a significant area of concern for clinicians.

Circulation, Volume 150, Issue Suppl_1, Page A4138622-A4138622, November 12, 2024. Cardiac Rhabdomyosarcoma (CR) is a rare malignant neoplasm of the heart occurring in all age groups and genders. It can arise anywhere in the heart with varied clinical presentation. Available data on CR are mainly from case reports and series that are limited by small sizes. The purpose of this study was to characterize the epidemiology, presentation, management, hospital course, and outcomes of CR published in the English literature from 1980-2023.Methods:We reviewed and included all published case reports with a diagnosis of CR in adult patients (age >18 years) on PubMed and Google Scholar using the keywords “primary cardiac tumor” and “cardiac rhabdomyosarcoma”. Data was extracted onto an Excel spreadsheet for analysis and the outcomes of interest were demographics, clinical presentation, diagnostic modalities, management, complications, and outcomes. We used descriptive statistics to analyze the data.Results:Among a total of 97 patients from 19 countries included in this study, 54% were males and the median age was 49 years (range 18-80). The main symptoms were dyspnea (37.1%), palpitations (23.7%), chest pains (16.5%) and syncope (6.5%). Hypotension or heart failure and arrhythmias were present in 10.3% and 9.3%, respectively and 5.2% had pericardial effusion. In addition to those with metastatic tumors, 22.7% had chronic co-morbidities. The majority of the cases were primary tumors (85.6%), and the remainder were (14.4%). All patients had at least one imaging modality including echocardiography (89%) and CT/MRI (84%). The commonest sites of cardiac involvement were the left atrium (35%), right atrium (33%), right ventricle (20%), and left ventricle (12%). Approximately 68% involved a single cardiac site while 32% involved multiple sites. Among the patients, 96% underwent surgery while 33% and 25% had chemotherapy and 25% radiotherapy, respectively. The median length of hospital stay was 11 days (range, 2-68 days), and mortality was recorded in 79.3% (77/97) of the patients. The median survival time was reported in 42 patients, and it was 6 months (range, 0-36 months).Conclusion:Cardiac rhabdomyosarcoma is a rare and aggressive malignant neoplasm. Most cases are primary tumors with poor outcomes such as a very short median survival time and a very high mortality rate despite the combination of surgery, chemotherapy, and radiotherapy. This calls for further research into the early diagnosis and optimal management strategies to improve outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4139384-A4139384, November 12, 2024. Background:Recent evidence suggests a therapeutic role for ketosis in patients with heart failure (HF). However, little is known regarding the safety and effectiveness of a low carbohydrate ketogenic diet (LCKD) in patients with overweight or obesity and HF.Purpose:To examine the safety and effectiveness of a LCKD in patients with overweight or obesity and HF.Methods:A retrospective review from 2006-2024 was conducted of all patients with overweight or obesity and HF who followed a LCKD with clinical oversight for at least one year in a university health system. Changes in metabolic outcomes, echocardiographic measures, and medication use were assessed. Heart failure hospitalization (HFH) rates and rate ratios (RR) and all-cause mortality rates were calculated and stratified by HF classification.Results:A total of 125 patients met inclusion criteria, including 59 patients with HF with reduced ejection fraction (HFrEF) and 66 patients with HF with preserved ejection fraction (HFpEF). Patients lost a median (interquartile range) of 11.2 kg (-19.5, 4.4;p

Circulation, Volume 150, Issue Suppl_1, Page A4144488-A4144488, November 12, 2024. Background:Oral anticoagulants (OAC) including Vitamin K antagonists such as warfarin and direct oral anticoagulants like Apixaban, Rivaroxaban, and Edoxaban, have long been the standard treatment for stroke prevention in patients with atrial fibrillation (AF). However, they increase the risk of bleeding, making them unsuitable for certain patient populations, particularly those with a personal history of bleeding, elderly individuals prone to falls or those with high-risk occupation with safety hazards. In cases of non-valvular AF, where thrombi typically form in the left atrial appendage, mechanical left atrial appendage closure (LAAC) has come out as an alternative for selected patients. Numerous studies have shown that LAAC is comparable to OAC in preventing strokes while significantly reducing major bleeding events. This meta-analysis aims to compare the 4–5-year outcomes of these two treatment strategies in non-valvular AF.Methods:4 studies (3 randomized controlled trials and 1 observational study) comparing the 4–5-year outcomes of LAAC versus OAC in patients with AF were included in this meta-analysis. These studies were identified after a thorough search of PUBMED, COCHRANE, and MEDLINE databases from inception till May 2024. The outcomes of interest were MACE (composite of stroke, embolism, and death), ischemic stroke, major bleeding episodes, cardiovascular (CV) deaths, and all-cause death. The results were reported as Risk Ratio (RR) with 95% confidence intervals (CI), using a random effects model.Results:6,012 patients were identified from the 4 studies. After a median follow-up of 4–5 years, LAAC was associated with a clinically significant reduction in MACE (RR: 0.76, 95% CI: 0.61-0.94, p=0.01), all-cause mortality (RR: 0.77, 95% CI: 0.62-0.96, p=0.02), and CV mortality (RR: 0.64, 95% CI: 0.45-0.90, p=0.01). Additionally, a significant reduction in major bleeding episodes (RR: 0.63, 95% CI: 0.44-0.91, p=0.01) was also noted between the two treatment strategies favoring LAAC treatment group. There was no significant difference in the incidence of ischemic stroke (RR: 1.07, 95% CI: 0.62-1.85, p=0.80) between the two groups.Conclusion:Over a median follow-up of 4-5 years, LAAC was found to be as effective as OAC in preventing ischemic strokes, while also showing lower incidence of MACE, all-cause, CV mortality and major bleeding episodes. More RCTs are needed to further assess the long-term outcomes between the two strategies.

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 A4147717-A4147717, November 12, 2024. Background:SGLT2 inhibitors have demonstrated efficacy in reducing cardiovascular death and hospitalization and are recommended as first-line therapy for hear failure (HF) in adults due to acquired heart diseases. Our study aimed to assess the safety, tolerability, and outcomes of HF patients with adult congenital heart disease (ACHD) treated with SGLT2 inhibitors.Methods:We conducted a comprehensive search of three major databases—PubMed, Scopus, and Embase—and collected articles on the use of SGLT2 inhibitors for HF in ACHD patients who were already receiving angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), angiotensin receptor neprilysin inhibitors (ARNI), beta-blockers (BB), and mineralocorticoid antagonists (MRA). We excluded articles related to acute decompensated HF and HF with preserved ejection fraction. The primary outcome was the change in NYHA functional class (FC). Secondary outcomes included changes in B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) levels, as well as body weight. Additionally, we evaluated the safety and tolerability of SGLT2 inhibitors in ACHD HF patients. A pooled effect size was calculated based on mean differences (MD) or log odds ratio (LogOR).Results:Our meta-analysis included 9 studies with a total of 287 patients aged 19 to 67 (median 37.5 years) (Table). When SGLT2 inhibitors were added to combined therapies, they significantly improved NYHA FC (LogOR: 1.3, 95% CI: 0.37–2.23, p=0.01) (Figure 1A), decreased NT-proBNP (MD -0.43, 95% CI -0.70 to -0.16, p=0.00) (Figure 1B), were associated with a reduction in systolic blood pressure (MD = -0.32, 95% CI: -0.51 to 0.14, p=0.00) (Figure 1C), and led to an elevation of creatinine (Cr) levels (MD = 0.18, 95% CI -0.0 to 0.36, p=0.06) (Figure 1D). Only 4 patients experienced urinary tract infections (UTIs), and none had hypoglycemia or ketoacidosis.Conclusion:Our meta-analysis demonstrates that SGLT2 inhibitors improve NYHA FC, decrease NT-proBNP, and are well-tolerated with safety features similar to adult HF clinical trials when added to combination HF therapies including ACEI/ARB/ARNI, BB and MRA. Future prospective studies are needed to assess long-term clinical outcomes in ACHD patients with HF.

Circulation, Volume 150, Issue Suppl_1, Page A4145936-A4145936, November 12, 2024. Background:BMI is a modifiable risk factor for stroke and heart disease. However, there is limited or no data on the association of BMI with adverse outcomes and the absence of data on Black, South Asian, and Arab populations. Thus, national, and global recommendations for BMI cutoffs to prevent obesity-related complications among minority populations are debatable.Aims:This review aimed to identify a holistic estimate of the optimal BMI cutoffs at which cardiovascular adverse outcomes could be predicted amongst south Asian populations.Methods:A systematic search was conducted in PubMed, Google Scholar, and Cochrane database to identify community-based studies that reported BMI cut-off values for individuals in South Asian countries from 2004 onward. To determine ethnicity-specific BMI cut-offs for obesity equivalent to the BMI threshold for obesity in White populations (≥30 kg/m2), a random-effects meta-analysis was performed for data associated with type 2 Diabetes. The pooled estimate of cut-off points was calculated, with studies weighted by the inverse variance of their individual estimates.Results:We included 7 studies, comprising a total of 143,380 participants from South Asian countries. The pooled estimate for the BMI cutoff associated with type 2 diabetes, equivalent to a BMI of 30.0 kg/m2in White populations, was 23.3 kg/m2(95% CI: 22.0-24.6). Summary receiver operating characteristic (SROC) curves were created using a linear regression model to summarize the studies’ ROC curves. The highest Youden index indicated that the optimal BMI cut point for hypertension and dyslipidaemia among South Asian males was 23.3 kg/m2(95% CI: 22.2-24.6) and 24.3 kg/m2(95% CI: 21.2-27.4), respectively. For South Asian females, the optimal BMI cut point for hypertension was 24.0 kg/m2(95% CI: 22.9-25.2) and for dyslipidaemia was 24.7 kg/m2(95% CI: 23.0-25.9).Conclusion:Revisions to BMI cutoffs specific to different ethnicities are necessary to ensure that minority ethnic groups receive proper clinical monitoring. This will help enhance the prevention, early diagnosis, and timely management of cardiovascular risk factors.

Circulation, Volume 150, Issue Suppl_1, Page A4144819-A4144819, November 12, 2024. Background:Refractory angina severely affects patients’ quality of life around the world. Among the new treatment methods, the coronary sinus reducer (CSR) is one of the most thoroughly researched.Purpose:We aim to investigate the efficacy and safety of CSR for refractory angina.Methods:We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed, Web of Science, Scopus, Embase, and Cochrane searches until May 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using (R version 4.3).Results:With the inclusion of three RCTs, our cohort comprised a total of 180 patients. Compared to the control group, after six months, CSR was significantly associated with decreased mean change of Canadian cardiovascular society (CCS) class (MD: -0.54 with 95% CI [-0.80, -0.27], P< 0.01), an increased number of patients in the CCS class I (RR: 2.29 with 95% CI [1.14, 4.61], P= 0.02), a decreased number of patients in the CCS class III (RR: 0.53 with 95% CI [0.32, 0.87], P= 0.01), and increased exercise time (MD: 50.46 with 95% CI [9.47, 91.45], P= 0.02). However, there was no significant difference between CSR and the control group in CCS class II, class IV, across all Seattle Angina Questionnaire (SAQ) domains, the incidence of any serious adverse events (RR: 3.44 with 95% CI [0.82, 14.42], P= 0.09), stroke (RR: 2.13 with 95% CI [0.20, 22.88], P= 0.53), and all-cause mortality (RR: 1.06 with 95% CI [0.07, 16.59], P= 0.97).Conclusion:CSR has been shown to reduce angina severity by lowering CCS class scores and increasing exercise time. Large-scale RCTs are needed to confirm its effectiveness in patients with refractory angina.

Circulation, Volume 150, Issue Suppl_1, Page A4147724-A4147724, November 12, 2024. Background:ST-Elevation Myocardial Infarction (STEMI) has a huge clinical burden globally. Pre-administration of Nicorandil before primary percutaneous coronary intervention for STEMI has demonstrated efficacy in enhancing microvascular recovery and reducing reperfusion injury in RCTs. Consequently, Nicorandil exhibits potential in providing considerable cardioprotective advantage in STEMI patients.Aims:Nicorandil therapy is being extensively investigated as a treatment for reperfusion injury associated with primary percutaneous coronary intervention. This meta-analysis evaluates various studies to determine the cardioprotective effects of nicorandil, with particular emphasis on its influence on infarct size.Methods:MEDLINE (via PubMed), Scopus, Cochrane Library, and Google Scholar were systematically searched for relevant studies. Primary endpoint was infarct size. Left Ventricular End Diastolic volume, Left Ventricular End Systolic Volume, Left Ventricular Ejection Fraction (LVEF), Major Adverse Cardiovascular Events (MACE), and rehospitalizations were analysed as secondary end points. Review Manager 5.4 was used to pool mean differences (MD) and Risk Ratios (RR) along with their 95% Confidence Intervals (CI).Results:3 RCTs including a total of 438 patients were included in our review. Compared with placebo, nicorandil therapy significantly reduced infarct size with a pooled MD of -3.20 (95% CI -5.25 to -1.14). There was also significant reduction in Left Ventricular End Systolic Volume (MD= -5.63; 95% CI -11.22 to -0.05) and a nonsignificant reduction in Left Ventricular End Diastolic Volume (MD= -6.37; 95% CI -12.74 to 0.01). Nicorandil therapy caused a nonsignificant decrease in MACE (RR=0.74; 95% CI 0.37 to 1.46) and readmission rate (RR=0.73; 95% CI 0.30 to 1.77) compared to placebo. It also caused a significant increase in the Left Ventricular Ejection Fraction (LVEF) with a pooled MD of 2.53 (95% CI 0.53-4.54).Conclusion:Pre-treatment with Nicorandil in STEMI patients being treated with primary percutaneous coronary intervention is associated with significant improvement in infarct size and cardiac systolic function.

Circulation, Volume 150, Issue Suppl_1, Page A4142197-A4142197, November 12, 2024. Introduction:Few randomized clinical trials (RCTs) have evaluated the safety and efficacy of abbreviated Ticagrelor-based dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS); however, these RCTs were underpowered to detect differences in hard clinical outcomes.Research Question:What effect does abbreviated Ticagrelor-based DAPT have on risk of ischemic and bleeding events in ACS?Methods:A systematic search of MEDLINE, Cochrane, and Scopus databases was performed through 05/2024, for trials that compared abbreviated (≤ 3-months) versus standard 12-months Ticagrelor-based DAPT in ACS. The primary endpoint was all-cause mortality. Endpoints were measured at 12-months after DAPT initiation. Data were pooled using random-effects model. Heterogeneity was assessed via Chi-squared and Higgin’s I2test. RevMan 5.0 (Cochrane Collaboration, Oxford, United Kingdom) was utilized to perform statistical analysis.Results:Five trials were included in this analysis with 21,407 patients assessed. ULTIMATE-DAPT, T-PASS, and GLOBAL LEADERS-ACS assessed 1-month DAPT duration while TICO and TWILIGHT-ACS assessed 3-months DAPT duration. The average age was 62.7 years and 22.7% were women. Hypertension (61.7%), dyslipidemia (49.9%), diabetes (27.8%), and chronic kidney disease (12.7%) were the most common comorbidities. ACS presentations included NSTEMI (40.1%), unstable angina (35.2%), and STEMI (31.5%). Abbreviated Ticagrelor-based DAPT was associated with lower risk of all-cause mortality (RR 0.78; 95% CI 0.62-0.98, I2=0%) compared with standard duration DAPT. There was no differences between groups in cardiovascular death (RR 0.65; 95% CI 0.41-1.03, I2=0%), myocardial infarction (RR 1.04; 95% CI 0.85-1.27, I2=0%), stent thrombosis (RR 0.97; 95% CI 0.64-1.45, I2=0%), or ischemic stroke (RR 0.90; 95% CI 0.62-1.30, I2=0%). Abbreviated DAPT duration was associated with lower risk of major bleeding (RR 0.50; 95% CI 0.38-0.66, I2=46%).Conclusion:Our analysis includes the totality of randomized data evaluating the merits of abbreviated Ticagrelor-based DAPT after ACS. The salient study finding was the observed reduced risk of all-cause mortality with abbreviated DAPT approach, which was driven by reduced bleeding risk.

Circulation, Volume 150, Issue Suppl_1, Page A4141761-A4141761, November 12, 2024. Background:Rotational atherectomy has been performed using both radial and femoral access over the years, but there is a lack of consensus on the safety and efficacy of these access sites.Aim:To assess the safety and efficacy of radial access and femoral access.Methods:MEDLINE, Scopus, and Cochrane Library were searched until May 2024 for studies comparing radial approach with femoral approach in patients undergoing rotational atherectomy. The primary outcome was major vascular site bleeding. Secondary outcomes included short-term mortality, long-term mortality, myocardial infarction, major adverse cardiovascular events (MACE), acute stent thrombosis, procedural success, procedural time, hospital stay and radiation exposure. Effect estimates were synthesized using a random-effects model and expressed as risk ratios (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with corresponding 95% confidence intervals (CIs).Results:13 studies including 13,581 patients with mean age of 60.76 years in the radial group and 66.86 years in the femoral group, who had undergone rotational atherectomy, were included in the analysis. For the outcome of major vascular site bleeding, there was significantly lower risk (RR: 0.25; 95% CI [0.15, 0.43]; p

Circulation, Volume 150, Issue Suppl_1, Page A4144763-A4144763, November 12, 2024. Background:Anemia is frequently observed as a comorbidity in atrial fibrillation (AF) and is associated with poor clinical outcomes.Purpose:We aim to investigate the impact of anemia on clinical outcomes in AF Patients on oral anticoagulants.Methods:We comprehensively searched PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through March 2024 and conducted a prognostic systematic review and meta-analysis. All analyses were performed using R V. 4.3.1.Results:With the inclusion of 23 studies, our cohort comprised a total of 286,781 patients. Anemia was significantly associated with an 86% increase in the risk of major bleeding (HR: 1.86 with 95% CI [1.61, 2.14], P< 0.01), a 25% increase in the risk of intracranial hemorrhage (HR: 1.25 with 95% CI [1.02, 1.54], P= 0.03), a 92% increase in the risk of gastrointestinal bleeding (HR: 1.92 with 95% CI [1.68, 2.19], P< 0.01), and a 91% increase in the risk of all-cause mortality (HR: 1.91 with 95% CI [1.46, 2.51], P< 0.01). However, Anemia did not significantly affect the risk of stroke, TIA, or systemic embolism (HR: 1.07 with 95% CI [0.93, 1.22], P= 0.36).Conclusion:Anemia was significantly associated with an increased risk of major bleeding, intracerebral hemorrhage, gastrointestinal bleeding, and all-cause mortality without impacting stroke, TIA, or systemic embolism. Further research is warranted to compare the effects of DOACs and vitamin K antagonists. Clinically, it is imperative to closely monitor the anemic status of patients due to these elevated risks.

Circulation, Volume 150, Issue Suppl_1, Page A4145460-A4145460, November 12, 2024. Takotsubo syndrome (TTS) is a rare cardiovascular condition characterized by reversible ventricular dysfunction and a presentation resembling that of acute myocardial infarction. An increasing number of studies has shown physical stress as a trigger for TTS. Here, we comprehensively reviewed the literature and examined the available evidence for TTS patients triggered by sports. After searching PubMed, Embase, Web of Science and Scopus databases, two investigators independently reviewed 837 studies published through July 24, 2023. Of these studies, 21 met the inclusion criteria (n = 23 patients), including 9 patients with exercise stress test, 14 patients with daily physical activity. In Sports-trigger TTS patients, the most common TTS symptom was dyspnea (69.57%), followed by chest pain (52.17%) and diaphoresis (13.04%). The most common type of TTS was apical, accounting for 69.57% of cases, followed by the midventricular (21.74%) and basal (8.70%) types. The overall mortality rate for Sports-trigger TTS patients was 0.00%. Exercise stress test (39.13%), swimming (21.74%) and diving (21.74%) are the most frequently identified physical activity triggers of TTS. Sports is a potential etiology of TTS patients, rare but it is associated with excellent prognosis. Furthermore, the diagnosis of TTS must be considered in patients with typical symptom after sports. Future prospective studies are needed to establish appropriate guidelines for avoiding TTS during sports and the appropriate exercise prescription for Sports-trigger TTS patients to recovery.

Circulation, Volume 150, Issue Suppl_1, Page A4139264-A4139264, November 12, 2024. Introduction:Pulmonary vein isolation (PVI) is a catheter ablation (CA) technique employed as a treatment strategy for atrial fibrillation in young patients or those who do not respond to medical therapy. Techniques for PVI include radiofrequency (RFA) ablation and balloon cryoablation. The left atrial posterior wall has been recognized as a significant anatomical area involved in the onset and persistence of atrial fibrillation (AF). However, the impact of additional posterior wall isolation (PWI) during PVI remains uncertain.Research Question:What are the outcomes of pulmonary vein isolation compared to pulmonary vein isolation with adjunctive posterior wall isolation in patients with paroxysmal atrial fibrillation?Goals:To determine the efficacy of adjunctive posterior wall isolation in treating persistent AF.Methods:A systematic literature search was conducted on various databases (Pubmed/Medline, EMBASE, Google Scholar, Scopus) from inception until March 2024, to include studies comparing outcomes of patients undergoing management of paroxysmal AF with either PVI + concurrent PWI versus only PVI. Observational studies and Randomized Controlled Trials were included. Review Manager (v 5.3) was used for pooled analysis of included studies employing risk ratio (RR) as the effect measure (4).Results:We conducted a random-effects meta-analysis, pooling data from 5 studies with a total of 2,441 patients. Our analysis revealed a significant improvement in AF recurrence for the cryoablation technique with PVI+PWI (RR=0.56, 95% CI: 0.41, 0.76, I2=0%, p=0.0002) but no significant result was found for PVI+PWI in RFA (RR=1.37, 95% CI: 0.87, 2.18, I2=0%, p=0.18) for AF. For the recurrence of all arrhythmias, the risk ratios for cryoablation and RFA are 0.60 (95% CI: 0.46, 0.78, I2=0%, p=0.0001) and 1.17 (95% CI: 0.83, 1.65, I2=0%, p=0.37) respectively, significant in the case of cryoablation and non-significant for RFA.Conclusion:Concurrent PWI with PVI with the cryoablation technique in patients for the management of paroxysmal AF reduces the risk of recurrent AF. Due to the limited number of studies included, it is possible that the results were underpowered. Further prospective studies in the future are warranted.

Circulation, Volume 150, Issue Suppl_1, Page A4145264-A4145264, November 12, 2024. Background:Transcatheter aortic valve-in-valve (VIV) replacement has emerged as a valid alternative to conventional re-operation for the treatment of failed bioprosthetic surgical aortic valves. Self-expandable valves (SEV) and balloon-expandable valves (BEV) are the two major devices used. The aim of this study is to compare outcomes between SEV and BEV when used for transcatheter aortic valve replacement (TAVR) procedures in failed surgical prostheses. Methods:A comprehensive search was conducted on PubMed, Scopus, Web of Science, Cochrane Library, and Embase databases to identify studies comparing aortic valve in valve (ViV) with SEV and BEV for failed surgical aortic prostheses from inception to May 22, 2024. To estimate the effect size, dichotomous outcomes were pooled as risk ratio (RR), and continuous outcomes were pooled as mean difference (MD) with their respective 95% confidence interval (CI). Results:We included nine studies with a total of 1258 patients in the SEV group and 1079 in the BEV group. Compared to patients in the BEV group, patients in the SEV group had significantly lower one-year mortality (RR = 0.69; 95% CI: [0.49-0.98], p = 0.04). SEV group also had less incidence of severe patient protheses mismatch (RR = 0.49; 95% CI: [0.32-0.75], p