Minerva cardiology and angiology最新文献

Introduction: Transcatheter aortic valve replacement (TAVR) is increasingly performed nowadays, bleeding and vascular complications are not uncommon. Current recommendations for the use of protamine in the post-TAVR setting remain uncertain. This study aimed to evaluate the efficacy and safety of protamine in this setting.

Evidence acquisition: A systematic search using four databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, was conducted from inception to October 17^th, 2024, without language restrictions. The inclusion criteria were studies that compared the efficacy or safety of protamine vs control in post-TAVR patients.

Evidence synthesis: There were six studies (two randomized and four non-randomized) included in this meta-analysis, involving 3897 participants. We used a random-effects model for this meta-analysis. Protamine was associated with a lower risk of major bleeding compared to the control group, with an odds ratio (OR) of 0.47 (95% CI 0.30 to 0.74, P<0.01). Additionally, protamine was associated with a lower risk of major vascular complications compared to the control, with an OR of 0.45 (95% CI 0.31 to 0.65, P<0.01). Protamine also reduced the risk of minor bleeding and life-threatening bleeding compared to the control. For the safety outcome, the administration of protamine did not increase the risk of stroke and myocardial infarction.

Conclusions: The administration of protamine demonstrated efficacy in reducing bleeding and vascular complications without increasing the risk of thromboembolic complications in the post-TAVR setting.

Background: Coronary chronic total occlusions (CTO) are associated with an increased chance of untreatable symptoms and worse prognosis. However, limited data are available about the interaction between treatment strategy, potential ischemia burden reduction and quality of life (QoL) improvement.

Methods: Our prospective registry aims to assess the potentially different impacts of treatment strategies (coronary artery bypass grafting vs. percutaneous coronary intervention vs. optimal medical therapy) on clinical outcomes and QoL domains. This article specifically focuses on describing the registry's rationale, design, and baseline characteristics of the enrolled patients.

Results: A total of 157 patients were enrolled. Every patient was evaluated for baseline symptoms, ischemic burden and QoL and allocated to a treatment arm. In 112 patients (71.3%) ischemia baseline assessment was performed and for 116 (73.9%) Seattle Angina Questionnaire (SAQ) was available. At baseline, a significant functional limitation was evident, especially in terms of angina stability (mean score 69±31%) and disease perception (mean score 69±27%). In 49.1% of patients, ischemia testing was positive. Patients with documented ischemia were generally more symptomatic (CCS class 1 36.4% vs. 57.9%, P=0.023) and a significant inverse correlation between CCS class and SAQ domains was found. No association between ischemia burden and self-reported QoL scores was found.

Conclusions: The PETS-CTO registry is the first prospective registry investigating the impact of different treatment strategies on QoL and ischemia burden in patients with CTOs. At baseline, the severity of symptoms was directly associated with ischemia burden and inversely associated with self-reported QoL evaluation.

In clinical practice, ventricular ejection fraction (EF) and global longitudinal strain (GLS) are the most often used parameters for evaluating left ventricular systolic function, despite the impact that variable loading conditions have. Alternatively, the myocardial efficiency (ME) of the heart, encompassing cardiac energy formation and dissipation, along with myocardial oxygen consumption (MVO2), is a useful surrogate for assessing myocardial work (MW), a parameter correlated with the pressure-strain loop (PSL), arterial pressure, and cardiac output (CO). This refinement proves especially practical in defining cardiac work across various clinical contexts, including arterial hypertension and heart failure (HF), the primary conditions associated with cardiovascular mortality. In this review, we explore how many invasive and non-invasive studies have shown that MW and consequently ME are correlated with the state of cardiovascular wellbeing and myocardial performance, allowing it to be integrated with other parameters present in clinical practice.

Atrial fibrillation (AF) is a prevalent and significant health concern, imposing a substantial economic burden on healthcare systems worldwide. The condition is associated with an increased risk of stroke, heart failure and other comorbidities, contributing to heightened morbidity and mortality rates amongst those affected. Healthcare resource utilization and costs associated with the treatment and management of AF have become a pressing concern, particularly in the context of recurrent episodes. Catheter ablation (CA) has been demonstrated to have positive effects on relieving the economic burden of AF. The aim of this review is to evaluate the economic burden of AF and analyze the cost-efficiency of CA compared to pharmacological treatments, particularly in patients with drug-refractory AF. This narrative review is focused on manuscripts, derived from the NCBI (PubMed) online database, which deal with the economic burden of AF through the analysis of direct and indirect costs and benefits of various therapeutic options, concentrating on CA compared to drug management alone. The economic burden of AF varies widely across healthcare systems, with direct costs ranging from $ 2000 to $ 60,000 per patient per year. The review confirms that CA, despite its higher initial costs ($ 27,000-38,000 per procedure in the USA), provides long-term financial benefits. Across the analyzed studies, CA led to a 20-40% reduction in hospitalization rates, a 15-30% decrease in emergency department visits, and a significant reduction in medication use, particularly in antiarrhythmic drugs and anticoagulants. Cost-utility analyses indicate that CA is cost-effective, with incremental cost-effectiveness ratios (ICER) ranging from $ 6000 to $ 60,000 per quality-adjusted life year (QALY). Furthermore, studies demonstrate a 10-20% improvement in quality-of-life scores for patients undergoing CA compared to those on pharmacological therapy alone. CA is a cost-efficient strategy for managing AF, especially in patients with symptomatic, drug-refractory AF. The procedure provides both long-term economic benefits by reducing healthcare resource utilization and favorable socio-economic effects by improving quality of life. Future studies should continue to explore the broader economic impact of AF management, including indirect costs such as lost productivity and caregiver burden.

Background: Patent foramen ovale (PFO)-associated platypnea-orthodeoxia syndrome (POS) is a rare and often underdiagnosed condition characterized by hypoxemia refractory to oxygen therapy and paroxysmal dyspnea in the upright position, with normal arterial oxygen saturation (SO2) while supine. The preferred treatment is percutaneous closure of the interatrial shunt, although surgery may be necessary in complex cases.

Methods: This retrospective multicenter study included patients diagnosed with POS undergoing percutaneous PFO closure between 2020 and 2024 across eight tertiary Italian hospitals. We analyzed clinical characteristics, septal morphology, procedural details, as well as in-hospital and short-term clinical outcomes.

Results: A total of 48 patients (56.3% female; mean age 75.4±9.8 years) were included. Pre-procedural echocardiography revealed complex interatrial septal (IAS) anatomy, with a significant proportion of patients presenting with IAS aneurysms and relatively large PFOs. The most frequently selected devices were the Amplatzer PFO and Cardia Ultrasept PFO Occluder (31.3% and 37.5%, respectively), followed by the GORE GSO device (16.7%), achieving a 100% procedural success rate. Postprocedure, all patients demonstrated significant improvement in orthostatic SO2, with an average increase of +8.65% from baseline, along with marked symptom resolution that persisted at 6-month follow-up.

Conclusions: In conclusion, PFO-related POS is often associated with complex IAS anatomy, including septal aneurysms and wider PFO tunnels. In such cases, larger and more flexible devices should be preferred for better adaptation to the unique septal structures and to obtain immediate and sustained improvements in oxygenation and symptoms. These findings emphasize the critical role of individualized device selection and procedural planning in optimizing outcomes for this challenging patient population.

Introduction: Cardiovascular disease (CVD) remains a leading global health challenge, accounting for 32% of global deaths, with significant disparities in access to care and outcomes, particularly in low- and middle-income countries (LMICs). Despite advancements in prevention, diagnosis, and treatment, unmet needs persist across clinical management, technological integration, and health system barriers. This umbrella review synthesizes evidence on these unmet needs to provide a comprehensive framework for future research and policy interventions.

Evidence acquisition: A systematic search was conducted across PubMed, Scopus, Google Scholar, and the Cochrane Library from 2010 to 2023, using keywords such as "unmet needs," "cardiovascular disease," and "health system barriers." Fifty systematic reviews, encompassing 580 studies, were included. Data extraction and quality assessment were performed using the Joanna Briggs Institute checklist, with findings categorized into clinical, technological, socioeconomic, and population-specific domains.

Evidence synthesis: The review identified critical gaps in cardiovascular care, including limited access to specialized services, suboptimal adherence to clinical guidelines, and disparities in technological integration, particularly in LMICs. Socioeconomic factors, such as income inequality and gender disparities, significantly impact access to care and outcomes. Technological advancements, including telemedicine, wearable devices, and AI, show promise but face barriers to widespread adoption. Patient education and mental health integration emerged as essential components of comprehensive care models. Precision public policy was highlighted as a key strategy to address these disparities through targeted, data-driven interventions.

Conclusions: This review highlights the urgent need for multifaceted strategies to address unmet needs in cardiovascular care. Enhancing access to care, improving guideline adherence, integrating technology, and addressing socioeconomic disparities are critical to reducing the global burden of CVD. Collaborative efforts among policymakers, healthcare providers, and researchers are essential to develop equitable, patient-centered solutions. Precision public policy, tailored to the unique needs of diverse populations, offers a promising pathway to achieving these goals and improving cardiovascular health outcomes worldwide.

Carotid artery ultrasound is a simple, safe, non-invasive and cost-effective method to assess the presence or absence of carotid plaques and measure their extent. Measurement of intimal medial thickness (IMT) is the most widely used marker to quantify the burden of atherosclerotic disease at that level. All guidelines published to date are against routine population screening. Most guidelines recommend screening patients with multiple risk factors including diabetes, age > 65 years, smoking, or hypercholesterolemia. IMT measurements are extremely heterogeneous due to interindividual variability and some technical measurement concerns. Furthermore, increased IMT is also the result of non-atherosclerotic processes, such as smooth muscle cell hyperplasia and fibrocellular hypertrophy leading to medial hypertrophy and compensatory arterial remodeling. Nowadays, other ultrasound measurements such as the highest maximal wall thickness or the average maximal wall thickness have been studied and used to predict atherosclerotic burden other than IMT. This narrative review aims to examine the role of carotid ultrasound in the evaluation of patients with sub-clinical atherosclerosis and cardiovascular disease primary prevention.