Risultati per: Il dolore neuropatico: review

Circulation, Volume 150, Issue Suppl_1, Page A4142193-A4142193, November 12, 2024. INTRODUCTION:Many anti-cancer agents, including alkylating, anthracycline-based, and anti-HER2 chemotherapies, have a high risk of causing clinically significant cardiac toxicity, manifesting as heart failure (HF). The efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i’s) in HFrEF and HFpEF is well-established; their role, however, in managing chemotherapy-related cardiac dysfunction (CTRCD) remains unclear.AIMS:To analyze available data on the efficacy of SGLT2i’s in CTRCD.Methods:Pubmed, Embase and Web of Science databases were queried to find relevant clinical studies on the use of SGLT2i’s in CTRCD. Primary outcomes included HF incidence, HF exacerbations, and all-cause mortality. Using a random effects model, relative risk ratios (RRs) with 95% confidence intervals were computed for all outcomes.Results:Out of 807 retrieved citations, 4 observational studies with 6576 participants were included in the analysis. In SGLT2i’s and non-SGLT2i’s groups, the number of subjects, mean age, and proportion of males were 1551 vs. 5025, 67.6 vs. 68.9 years, and 42% (648) vs. 40% (2000) with median follow-up range of 1.5-3.4 years. Only one study enrolled patients with prior HF, while diabetes was common among all. Anthracyclines were the most common chemotherapy agents used and the majority of patients had a hematological malignany. Onset of HF in the SGLT2i’s group, as reported by two studies, was 6/31 and 94/930 in the non-SGLT2is group. The pooled HF incidence rate was similar between the two groups, with an RR of 0.54 (0.25-1.16, p=0.11). SGLT2i’s users had a significantly lower rate of HF exacerbations and all-cause mortality compared with those who did not receive SGLT2i’s with RR of 0.54 (0.33-0.91, p=0.02) and 0.48 (0.32-0.73, p=0.0006), respectively. Additionally, SGLT2i’s were associated with a significantly lower rate of arrhythmias [ RR 0.40 (0.22-0.70, p=0.001)]. The mortality effect was beleived to be influenced by the antitumor effects of SGLT2i’s as well. Moreover, the rates of adverse events secondary to SGLT2i’s, such as euglycemic ketoacidosis, hypoglycemia, and infections, were reported to be lower.Conclusion:The observational data on the efficacy of SGLT2i’s in CTRCD are promising. These drugs were found to have favorable effects on HF exacerbations, all-cause mortality, and arrhythmias onset associated with CTRCD. Large-scale randomized clinical trials are needed to validate these findings.

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 A4135791-A4135791, November 12, 2024. Background:While non-vitamin K antagonist oral anticoagulants (NOACs) are more effective than single antiplatelets (mostly low-dose aspirin) at reducing stroke risk in patients with atrial fibrillation (AF), differences in bleeding risk between NOACs and single-dose antiplatelets across various populations remain unclear.Aim:We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing bleeding outcomes of NOACs versus single antiplatelet therapy.Methods:We searched MEDLINE, EMBASE, and CENTRAL to June 2024 for RCTs that compared NOAC (therapeutic doses used for stroke prevention in AF patients) versus single antiplatelet therapy for a treatment duration of ≥3 months. For the meta-analyses, we used fixed-effects models and reported results as summary risk ratios (RRs). We used Risk of Bias 2 and GRADE to assess the quality and certainty of the evidence.Results:Eight RCTs with 26,194 participants were included. Mean follow-up time was 18 (±13) months. NOACs included in the studies were apixaban (4 studies), rivaroxaban (2 studies), and dabigatran (2 studies). All studies used low-dose aspirin as the comparator. When compared to aspirin, NOACs had a higher risk of major bleeding (326/13107 [2.5%] vs. 239/13087 [1.8%] events; RR 1.36 95% CI 1.15-1.60, I2=52%, 8 trials; high certainty) (Figure A), gastrointestinal bleeding (104/8803 [1.2%] vs. 74/8788 [0.8%] events; RR 1.39; 95%CI, 1.04-1.87; I2=0%; 5 trials; high certainty), and clinically relevant non-major bleeding (318/10397 [3.1%] vs. 230/10395 [2.2%] events; RR 1.38; 95%CI, 1.17-1.63; I2=16%; 5 trials; high certainty). There was no difference in the risk of intracranial hemorrhage (88/13107 [0.7%] vs. 84/13087 [0.6%] events; RR 1.04, 95%CI 0.78-1.41; I2=48%; 9 trials; high certainty) (Figure B) nor fatal bleeding (22/12412 [0.2%] vs. 28/12392 [0.2%] events; RR 0.78; 95%CI, 0.45-1.36; I2=8%; 6 trials; high certainty).Conclusion:When compared to aspirin, NOACs are associated with an increased risk of major bleeding and clinically relevant non-major bleeding, but not intracranial hemorrhage. These data are important to inform patients about the risks of antithrombotic treatment.

Circulation, Volume 150, Issue Suppl_1, Page A4136346-A4136346, November 12, 2024. Introduction:Thermal injury following atrial fibrillation catheter ablation is a rare but fatal complication. We aim to assess the safety profile of different forms of esophageal cooling methods versus standards of care.Methods:We searched PubMed, Cochrane Library, Scopus, and Web of Science databases for randomized controlled trials and cohort studies comparing esophageal cooling to Luminal esophageal temperature (LET) monitoring regarding esophageal thermal lesions (ETL) post atrial fibrillation ablation. Case reports, case series, reviews, conference abstracts and animal studies were excluded. Review manager software (version 5.4) was used to perform the meta-analysis.Results:We included 10 studies with 25662 patients in total: 14515 patients in the esophageal cooling group and 11147 patients in the LET group. Overall esophageal lesion analysis demonstrated no statistically significant difference between the esophageal cooling group and LET (RR = 0.72, 95% CI = 0.35 to 1.49, p-value = 0.38). Subgroup analysis showed no statistically significant difference for mild/moderate lesions (RR = 1.52, 95% CI = 0.80 to 2.90, p-value = 0.20). However, the subgroup analysis showed a statistically significant association between esophageal cooling and decreased severity of esophageal lesions compared with LET (RR = 0.29, 95% CI = 0.12 to 0.71, p-value = 0.007). Regarding AF recurrence, the pooled analysis showed no statistically significant difference between esophageal cooling group and LET (RR = 1.24, 95% CI = 0.95 to 1.61, p-value = 0.11).Conclusion:In patients undergoing AF catheter ablation, the implementation of esophageal cooling showed statistical significance in decreasing the severity of esophageal lesions compared to the LET group. Also, esophageal cooling demonstrated non-inferiority in AF recurrence compared to LET. Future research should focus on assessing the long-term effects of esophageal cooling during AF catheter ablation.

Circulation, Volume 150, Issue Suppl_1, Page A4135723-A4135723, November 12, 2024. Background:Dual antiplatelet therapy (DAPT) consisting of ticagrelor, a P2Y12inhibitor, and aspirin, is the recommended treatment of acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI). However, recently ticagrelor monotherapy has been shown to preserve ischemic protection while reducing bleeding risk in ACS patients. We aimed to compare the clinical outcomes of DAPT and ticagrelor monotherapy in ACS patients undergoing PCI.Methods:MEDLINE, Scopus, and EMBASE were queried up to May 2024 for randomized controlled trials (RCTs) comparing ticagrelor monotherapy after 1 to 3 months of DAPT versus continued DAPT for 12 months in ACS patients. The primary outcomes were all-cause death, net adverse clinical events (NACE) and Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding. Key secondary endpoints included BARC 3 or 5 bleeding, myocardial infarction (MI), hemorrhagic and ischemic stroke, and target vessel revascularization (TVR). A random-effects meta-analysis was performed to derive risk ratios (RR) and corresponding 95% confidence intervals (CI).Results:Six RCTs including 28,526 patients, with a mean age of 63.5 years, were included. DAPT was associated with a significantly higher risk of all-cause death (RR: 1.32, 95% CI: 1.05-1.64, P=0.02), NACE (RR: 1.20, 95% CI: 1.01-1.42, P=0.04), and BARC 2, 3, or 5 bleeding (RR: 1.96, 95% CI: 1.71-2.26, P

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 A4131381-A4131381, November 12, 2024. Background:Dietary interventions play a crucial role in weight management and reducing cardiovascular risk factors. Our study aims to compare the effectiveness of four dietary macronutrient interventions on weight loss and cardiovascular (CV) risk factor reduction through a systematic review and network meta-analysis.Methods:We conducted a comprehensive literature search on PubMed, Scopus, Embase, and Cochrane Library up till May 2024 to identify randomized controlled trials (RCTs) comparing four macronutrient dietary interventions including Mediterranean Diet (MD), Keto, Dietary Approaches to Stop Hypertension (DASH), and Intermittent Fasting (IF) with study period ≥ 6 months or 24 weeks. The primary outcomes of interest were weight loss, systolic blood pressure (SBP), Diastolic blood pressure (DBP), Body Mass Index (BMI), High density lipoprotein (HDL), Low density Lipoprotein (LDL), cholesterol levels and C-reactive protein (CRP) levels. Outcomes were reported as standard mean difference (SMD).Results:Our analysis identified 50 studies enrolling 5368 patients (MD=3554; DASH=838; Keto=206; IF=770). Regarding BP outcome, MD and DASH had significant reduction in SBP and DBP respectively (MD [SBP]: -0.76 mmHg vs DASH [DBP]: -1.92 mmHg) respectively. In contrast, IF showed a significant rise in SBP (0.87). MD participants also had significant weight loss (-1.06 kg) and a moderate decrease in BMI (-0.79) when compared with other diets. Furthermore, IF, keto, and MD showed moderate increase in HDL levels (0.61, 0.77 and 0.33) respectively. In contrast, DASH resulted in a moderate decline in HDL levels (-0.92). IF and MD resulted in modest decline in LDL levels (-0.45 and -0.42) respectively. In contrast, Keto demonstrated non-significant rise in LDL (0.35). DASH showed a significant decrease in triglycerides (-3.02). Lastly, MD demonstrated a significant reduction in CRP (-0.89).Conclusions:MD and DASH were superior to other dietary interventions in terms of weight loss and CV risk factors. Further research is required to tailor specific types of dietary interventions and assess their long-term efficacy on weight loss and CV risk reduction.

Circulation, Volume 150, Issue Suppl_1, Page A4147545-A4147545, November 12, 2024. Introduction:Pulsed field ablation (PFA) is an adaptation of direct current ablation first used for catheter ablation in the 1980s. Expectations of a reduced risk profile led to the current resurgence in investment and interest in the technology as a potential alternative energy source for ablations to treat atrial fibrillation (AF). However, reports of adverse events, including new risks, are increasing.Research Question:How many adverse effects are reported with the use of newly available PFA systems?Aims:Quantify and describe the adverse events from PFA reported to date in the Food and Drug Administration’s (FDA) Manufacturer and User Facility Device Experience (MAUDE) database.Methods:We searched the U.S. FDA’s MAUDE database for all reports filed with the code “QZI”, which is the product code for PFA systems created with the first FDA approvals in February 2024. All reports from inception through April 2024 (a total of 3 months) were included in this review. Per manufacturer presentation in May 2024, approximately 1000 cases utilizing PFA had been captured in a post-market registry of the predominant commercially used technology, but the exact number of cases can not be determined from MAUDE data.Results:A total of 217 adverse events were reported over the first 3 months of US approval, with 91 of these considered patient injuries. These injuries included 10 cases of cardiac tamponade, 7 reports of postoperative arrhythmia, 6 instances of device-related tissue entrapment, 5 cases of hemolysis with impaired renal function, 5 cases of stroke or TIA, including both embolic and hemorrhagic, 3 cases of intraoperative heart block, 2 coronary spasms, and 2 cases of intraoperative ST elevation.(Figure)Of the 91 reported patient safety events, 46 required hospitalization, 13 cases required temporary pacing, 11 required pericardiocentesis, 4 required dialysis, 4 required cardiothoracic surgery, and 2 required cardioversion.Conclusions:A number of adverse events have been reported to the MAUDE database in the first 3 months of FDA approval of PFA. The cardiac electrophysiology community should remain vigilant to ensure that the benefit-risk profile remains acceptable for patient safety.

Circulation, Volume 150, Issue Suppl_1, Page A4145216-A4145216, November 12, 2024. Background:The neutrophil-lymphocyte ratio (NLR) has been proposed as a potential prognostic marker for mortality outcomes in various conditions, yet its association with chronic hemodialysis (HD) remains underexplored. We aim to study its utility by conducting a meta-analysis of this specific population.Methods:We conducted a comprehensive systematic search from PubMed, Google Scholar, and Scopus to identify studies showing the association between NLR and mortality outcomes in patients with chronic HD. Random-effects model with 95% confidence intervals (CI) were employed to pool adjusted hazard ratios (aHRs) and odds ratios (OR), I2statistics for evaluating heterogeneity for all-cause mortality (ACM) and cardiovascular mortality (CVM) outcomes. Leave-one-out sensitivity analysis and meta-regression analyses assessed changes in overall effects and identified confounders, respectively. The Joanna Briggs Institute (JBI) tool was used to assess the quality of the studies.Results:Out of 180 articles analyzed, nineteen studies comprising 9,047 patients with a mean age of 59.5 ± 5.86 years and a mean follow-up duration of 46.7 months were included in our meta-analysis. The majority of the sample had a smoking history, hypertension, diabetes, and cerebrovascular diseases. Our meta-analysis revealed a significant association between higher NLR ( >2.5) and increased risks of both ACM (aHR: 1.24, 95% CI: 1.13-1.36, P < 0.0001) (Figure 1a) and CVM (aHR: 1.23, 95% CI: 1.02-1.49, P = 0.03). (Figure 1b) Studies reporting outcomes in OR also reported similar findings for ACM (OR: 4.58, 95% CI: 1.73 - 12.1, p = 0.002) (Figure 1c) and CVM (OR: 1.11, 95% CI: 1.01 - 1.23, p = 0.03). Sensitivity analysis revealed no variations. The pooled AUC was 0.711 (95% CI: 0.63 - 0.80, p < 0.0001). JBI tool revealed higher scores indicating higher quality studies. Meta-regression analysis did not identify significant associations between NLR and confounding variables such as age. (Figure 1d)Conclusion:This meta-analysis strongly concludes that NLR ( >2.5) is significantly associated with ACM and CVM in patients with chronic HD and can be useful in planning for the prevention of mortality-related strategies.

Circulation, Volume 150, Issue Suppl_1, Page A4145162-A4145162, November 12, 2024. Background:Acute coronary syndrome (ACS) poses a significant global health burden despite advancements in its management. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, primarily used in type 2 diabetes mellitus (T2DM), have gained recent consideration as potential agents for ACS management due to their cardiovascular benefits beyond glycemic control. This study aimed to assess the effects of empagliflozin on left cardiac parameters in ACS patients.Methods:PubMed, Cochrane, Scopus, and Web of Science were searched thoroughly to identify relevant randomized controlled trials (RCTs) until June 1st, 2024. Continuous data were pooled using mean difference (MD) with a 95% confidence interval (CI) using R (Version 4.3).Results:Four RCTs involving 701 patients were included. Compared to placebo, empagliflozin significantly reduced left ventricular end-systolic volume index (LVESVi) (MD: -2.38, 95% CI: -3.95 to -0.80, p = 0.0032), left ventricular mass index (LVMi) (MD: -2.76, 95% CI: -4.95 to -0.56, p = 0.0137), and left ventricular filling pressure (E/e’) (MD: -0.59, 95% CI: -1.07 to -0.10, p = 0.0189). However, empagliflozin treatment did not yield a statistically significant change in left ventricular ejection fraction (LVEF) (MD: 1.21, 95% CI: -0.05 to 2.48, p = 0.0603), nor a significant change in left ventricular end-diastolic volume (LVEDV) (MD: -4.49, 95% CI: -14.24 to 5.26, p = 0.37), left ventricular end-systolic volume (LVESV) (MD: -5.19, 95% CI: -10.77 to 0.39, p = 0.0682), and left ventricular end-diastolic volume index (LVEDVi) (MD: -2.20, 95% CI: -4.59 to 0.19, p = 0.0718).Conclusion:Empagliflozin provides favorable effects on left cardiac structural parameters in ACS patients, as it was associated with reduced LVESVi, LVMi, and E/e’. This suggests a potential role for SGLT2 inhibitors as adjunctive therapy in ACS management, warranting further investigation into their mechanisms and long-term clinical outcomes.

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 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 A4128519-A4128519, November 12, 2024. Background:The integration of large language models (LLMs) such as ChatGPT into healthcare can have significant implications for patient education and clinical decision-making.Aims:This systematic review and pooled analysis aim to evaluate the accuracy of ChatGPT 3.5 and 4 in answering simple queries across cardiovascular (CV) medicine disciplines.Methods:Literature searches were conducted in PubMed, Embase, and Cochrane Central in May 2024. Keywords included “ChatGPT”, “LLMs”, and “Chat-based artificial intelligence models”. Cross-sectional, peer-reviewed studies published in 2023 and 2024 investigating ChatGPT’s performance in CV medicine-related queries (Table/Figure) were extracted and included. All queries were evaluated by expert physicians in the corresponding fields within each study (and not by our readjudication), and a standardized grading system was employed for pooled analysis using an “accurate” and “inaccurate” grading scale for each answer.Results:Out of 127 identified and screened peer-reviewed studies, fourteen studies involving 542 CV-related queries were included. Pooled analysis revealed an overall accuracy of 84.5% (458/542) (95% CI [81.5, 87.6]). Stratification by model (ChatGPT-4 vs. ChatGPT-3.5) did not show a significant difference in accuracy (p=0.32). Furthermore, no significant differences in accuracies were seen between answers in 2023 and 2024 (p=0.07). The accuracies across the various topics were statistically comparable, except in the field of cardio-oncology, which showed significantly lower accuracy at 68% (p=0.02). Detailed performances per topic are included in the table and figure.Conclusion:ChatGPT demonstrated consistently high accuracy in answering CV-related queries with no significant differences across model versions or years. These results support the potential use of online-chat based LLMs as an informational tool in cardiology.

Circulation, Volume 150, Issue Suppl_1, Page A4141749-A4141749, November 12, 2024. Background:Mineralocorticoid receptor antagonists namely, Spironolactone and Eplerenone, have been cornerstone therapies for reducing morbidity and mortality in patients with heart failure. However, the comparative efficacy and safety profiles of Spironolactone and Eplerenone in patients with heart failure and reduced ejection fraction have been largely unknown.Hypothesis:We hypothesize that Eplerenone is more efficacious and safer than Spironolactone in treating patients with heart failure and reduced ejection fraction.Methods:We conducted a comprehensive literature search in electronic databases such as PubMed, GoogleScholar, ScienceDirect, Cochrane library, PLOSONE and Clinicaltrial.gov, including studies published within the last 10 years.We used RevMan 5.4.1 version to make statistical calculations and random effects model to calculate the pooled mean difference(MD) and relative risk(RR) values with their corresponding 95% confidence intervals(CI). A p-value of