Minerva cardiology and angiology最新文献

Introduction: The current meta-analysis aimed to determine the efficacy of propolis supplementation on hypertension.

Evidence acquisition: the systematic review and meta-analysis were undertaken on five online databases to find clinical trials assessing the effects of propolis on systolic blood pressure (SBP) and diastolic blood pressure (DBP) markers up to October 2023. The pooled estimation of the weighted mean difference (WMD) and the corresponding 95% confidence intervals (CI) were calculated using a fixed-effect model. Egger's regression test was used to assess publication bias.

Evidence synthesis: A significant decrease was observed in SBP levels following propolis supplementation (WMD=-5.58 mmHg, 95% CI: -7.74, -3.42; I²=42.99%, P=0.08). However, no significant change was found in the levels of DBP (WMD=-1.34 mmHg, 95% CI: -6.10, 3.41; I²=75.94%, P<0.01). Moreover, studies with an experimental design (-5.53, 95% CI: -13.24, 2.18) and trials with <30 individuals (-3.96, 95% CI: -7.98, 0.06) did not demonstrate a significant impact of propolis on SBP levels. In trials with an experimental design, a substantial decrease in DBP levels was seen in subgroup analyses after propolis supplementation (-9.29, 95% CI: -12.50, -6.08).

Conclusions: The results of the study revealed the positive effects of propolis supplementation in the context of hypertension, as evidenced by a reduction in SBP levels.

Introduction: This meta-analysis seeks to evaluate the efficacy of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKA) in individuals with chronic kidney disease (CKD), end-stage renal disease (ESRD), and undergoing hemodialysis (HD) who also have atrial fibrillation (AF).

Evidence acquisition: A comprehensive search of MEDLINE, clinicaltrials.gov, EMBASE, and Cochrane Database for relevant studies reporting the usefulness of OAC therapy for CKD, ESRD, and HD patients with AF was conducted from its inception until 1^st May 2023. The studies that reported OR, RR, or HR for adult AF patients to investigate the efficacy of OAC in CKD, ESRD, and HD were included. Statistical analysis was completed using a generic inverse variance and random-effects model to calculate the combined HR and their corresponding 95% CIs for all outcomes.

Evidence synthesis: The meta-analysis included 33 studies with 178,956 patients. The analysis revealed that the DOACs, when compared to VKA, significantly lowered the risk of stroke or systemic embolism (HR: 0.81 [95% CI: 0.70, 0.93]; P=0.002; I²=62%), bleeding (HR: 0.77, [95% CI: 0.67, 0.89]; P=0.0003; I²=83%), and intracranial hemorrhage (HR: 0.56, [95% CI 0.47, 0.66]; P<0.00001; I²=0%). Similarly, the risks of cardiovascular death (HR: 0.88, [95% CI 0.78, 1.00]; P=0.05; I²=0%), all-cause mortality (HR: 0.88, [95% CI 0.70, 1.10]; P=0.25; I²=96%), and myocardial infarction (HR: 0.80, [95% CI 0.54, 1.17]; P= 0.25; I²= 0%) were lowered by DOAC, but the result was insignificant. No significant difference was seen in the risk of gastrointestinal bleeding between DOAC and VKA as well (HR: 0.95, [95% CI 0.75, 1.20]; P=0.65; I²=83%).

Conclusions: Our meta-analysis confirms that DOACs are effective for managing AF in patients with kidney disease, with potential clinical implications for AF and CKD management. Further research should explore DOACs' reno-protective effects.

Background: The aim of this study is to investigate the effect of hyperuricemia on prognosis of drug-eluting stent implantation for coronary bifurcated lesions and the value of uric acid levels in predicting the prognosis.

Methods: Patients with coronary bifurcation lesions treated with drug-eluting stent implantation were retrospectively enrolled. The clinical, interventional and follow-up data were analyzed.

Results: Totally, 308 patients were enrolled and were divided into three groups according to the uric acid levels: group Q1 (N.=105), Q2 (N.=101), and Q3 (N.=102). Before PCI, the stenosis rate was 0.85 (0.80, 0.90) for the main coronary artery and 0.50 (0.50, 0.50) for the branch artery. After PCI and stent deployment, the arterial stenosis rate was 0.20 (0.20, 0.20) for the main coronary artery and 0.50 (0.50, 0.50) for the branch artery. At 36-month follow-up, seven patients died of different reasons, with five patients in group Q1, one in group Q2, and one in group Q3, 96 patients were readmitted for treatment of angina pectoris, with 18 in Q1 group, 29 in Q2 group, and 49 in Q3 group. Twenty-seven patients experienced revascularization because of deterioration of the condition, including six patients in group Q1, seven in group Q2, and 14 in group Q3. After correction of the confounding factors, the readmission rate of angina pectoris was significantly (P<0.001) increased with the increase of the uric acid level: Q3 vs. Q1 (220.47/1000 vs. 66.69/1000 person years, HR 3.65, 95% CI 1.92-6.96) and Q2 vs. Q1 (113.76/1000 vs. 66.69/1000 person years, HR 2.20,95% CI 1.16-4.18).

Conclusions: Increased uric acid level is an independent risk factor for cardiogenic readmission rather than for all-cause mortality and revascularization after drug-eluting stent implantation for patients with coronary bifurcation lesions.

Background: Cardiovascular (CV) disease is a significant risk even among seemingly healthier populations like master athletes, who face unique CV challenges due to their advanced age and high-intensity physical activities. Exercise stress echocardiography (ESE) has emerged as a valuable diagnostic tool to detect exercise-induced coronary artery disease (CAD), offering advantages over traditional exercise stress testing (EST) by integrating echocardiographic imaging. This article aimed to assess the diagnostic value and efficacy of ESE for detecting CAD in master athletes who exhibit exercise-induced alterations during pre-participation screening (PPS) EST.

Methods: This retrospective study analyzed 521 master athletes (aged 35 years and older) who underwent annual CV assessments including EST as part of their PPS at Noale Hospital, Venice, Italy, from September 2020 to August 2023. Participants who showed exercise-induced alterations suspicious for CAD on EST were further evaluated using ESE.

Results: Of the 521 athletes screened, 58 (11.1%) exhibited suspicious alterations for CAD during EST. ESE further identified 13 athletes with wall motion abnormalities (WMA), of whom 10 were subsequently diagnosed with critical CAD and received appropriate interventions. The positive predictive value of ESE was 0.77. Comparatively, athletes with WMA had significantly higher CV risk scores. No major adverse CV events (MACE) were reported during the 43.9-month follow-up.

Conclusions: ESE is an effective third-line diagnostic tool in master athletes, demonstrating a high diagnostic yield for identifying significant CAD. Its integration into routine CV screening for master athletes can enhance the detection of underlying pathologies, potentially leading to timely and life-saving interventions.

Background: Spontaneous coronary artery dissection (SCAD) is an emerging cause of acute coronary syndrome (ACS), disproportionately affecting women. Data on the management and outcomes of these patients remain limited, especially regarding the overall risk of major adverse cardiovascular events (MACE) and arrhythmic complications. This study aimed to investigate the incidence and independent predictors of MACE in SCAD patients.

Methods: In this single-center, prospective observational study, 76 patients with SCAD were enrolled. Clinical follow-up (mean duration: 4.03±3.4 years) was conducted through in-hospital visits and electronic database monitoring. The primary composite endpoint included MACE, defined as cardiovascular (CV) rehospitalization and death, the secondary endpoint included supraventricular and ventricular arrhythmias.

Results: All the patients enrolled were characterized by their clinical presentation, underlying risk factors, and triggers for SCAD. Of the 76 patients, 45 (59.2%) received medical therapy alone, 27 (35.5%) underwent percutaneous coronary intervention (PCI), and four (5.2%) had coronary artery bypass grafting (CABG). During the follow-up period, the primary endpoint occurred in 34 patients (44.7%), with CV rehospitalization as the main cause of MACE (31 patients, 40.8%). Coronary revascularization emerged as the only independent predictor of MACE (HR=1.92, 95% CI 1.13-3.21, P=0.035). The secondary endpoint occurred in 13 patients (17.1%).

Conclusions: Although SCAD is often considered a rare and relatively benign cause of ACS, our findings reveal a high rate of CV rehospitalization and mortality. Furthermore, mid-term follow-up indicates that SCAD is associated with supraventricular and non-sustained ventricular arrhythmias, with limited impact on prognosis and generally requiring pharmacological optimization.

Introduction: Whilst aortic stenosis remains the most prevalent valvular abnormality, the management of asymptomatic severe aortic stenosis remains a clinical challenge. Recently, two randomised-controlled trials (RCTs) - EVOLVED (Early Intervention in Patients With Asymptomatic Severe Aortic Stenosis and Myocardial Fibrosis) and Early TAVR (Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis) - have been published, alongside an extended follow-up from the AVATAR (Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis) study.

Evidence acquisition: In response, we conducted a systematic review of PubMed, Ovid, and Cochrane databases, identifying RCTs up to October 29, 2024, that compared early intervention with conventional management.

Evidence synthesis: Four studies met the inclusion criteria, with a combined total of 1427 patients across the trials. Meta-analysis of the primary endpoints across these studies demonstrated a benefit with early intervention (HR=0.50, 95% CI: 0.35-0.73). However, we did not find mortality and cardiac mortality to show significant reductions (HR=0.68, 95% CI: 0.40-1.18 and HR=0.66, 95% CI: 0.33-1.29, respectively). Crucially, stroke outcomes were improved with early intervention (HR=0.60, 95% CI: 0.38-0.95), as were unplanned hospitalizations (HR=0.40, 95% CI: 0.30-0.53).

Conclusions: These findings confirm the safety of early intervention and suggest a reduction in stroke incidence, although no significant benefits were observed in overall or cardiac mortality; results which can help to guide shared decision-making with patients and prevent adverse health outcomes.