Minerva cardiology and angiology最新文献

{"title":"Percutaneous closure of patent foramen ovale in patients with platypnea-orthodeoxia syndrome: an Italian multicenter experience.","authors":"Francesca M DI Muro, Miriam Compagnone, Giuseppe Santoro, Giacomo G Boccuzzi, Alfonso Ielasi, Orazio Viola, Pietro Martinucci, Antonio Della Valle, Giulia Nardi, Maria F Crociani, Niccolò Ciardetti, Miroslava Stolcova, Francesca Ristalli, Alessio Mattesini, Carlo DI Mario, Francesco Meucci","doi":"10.23736/S2724-5683.25.06841-3","DOIUrl":"https://doi.org/10.23736/S2724-5683.25.06841-3","url":null,"abstract":"<p><strong>Background: </strong>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 (SO<inf>2</inf>) while supine. The preferred treatment is percutaneous closure of the interatrial shunt, although surgery may be necessary in complex cases.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 SO<inf>2</inf>, with an average increase of +8.65% from baseline, along with marked symptom resolution that persisted at 6-month follow-up.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":18668,"journal":{"name":"Minerva cardiology and angiology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmet needs in cardiovascular disease care: an umbrella review of challenges, innovations, and systemic barriers.","authors":"Yashendra Sethi, Giuseppe Biondi-Zoccai","doi":"10.23736/S2724-5683.25.06853-X","DOIUrl":"https://doi.org/10.23736/S2724-5683.25.06853-X","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Evidence acquisition: </strong>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.</p><p><strong>Evidence synthesis: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":18668,"journal":{"name":"Minerva cardiology and angiology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional and immune-inflammatory indexes in risk stratification of heart failure with preserved ejection fraction.","authors":"Alexander E Berezin","doi":"10.23736/S2724-5683.25.06938-8","DOIUrl":"https://doi.org/10.23736/S2724-5683.25.06938-8","url":null,"abstract":"","PeriodicalId":18668,"journal":{"name":"Minerva cardiology and angiology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144506812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carotid ultrasound: is it the best way to evaluate subclinical atherosclerosis?","authors":"Andrea Boccatonda, Lorenzo Andreetto, Alice Brighenti, Damiano D'Ardes, Giulio Cocco, Francesco Cipollone, Francesca Santilli, Carla Serra","doi":"10.23736/S2724-5683.25.06721-3","DOIUrl":"https://doi.org/10.23736/S2724-5683.25.06721-3","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":18668,"journal":{"name":"Minerva cardiology and angiology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144506811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive role of nutritional and immune-inflammatory indexes in the diagnostic work-up and risk stratification of heart failure with preserved ejection fraction.","authors":"Yunus E Yavuz, Sefa Tatar, Ahmet T Şahin, Muzaffer Aslan","doi":"10.23736/S2724-5683.25.06817-6","DOIUrl":"https://doi.org/10.23736/S2724-5683.25.06817-6","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with preserved ejection fraction (HFpEF) is a significant public health concern with high morbidity. This study evaluates the prognostic significance of Prognostic Nutritional Index (PNI) and Pan-Immune-Inflammation Value (PIV) in HFpEF, aiming to enhance understanding of its inflammatory and nutritional aspects and identify markers for better diagnosis and risk stratification.</p><p><strong>Methods: </strong>This retrospective cohort study included 71 patients diagnosed with HFpEF using the HFA-PEFF algorithm and 81 control subjects without heart failure. The PIV, and PNI indices were calculated. A 6-month follow-up of the HFpEF group was conducted to assess rehospitalization rates.</p><p><strong>Results: </strong>The study found that patients with HFpEF had significantly higher PIV and PNI rates than the control group (P=0.016, P<0.001). A negative correlation (r=-0.328, P<0.001) was observed between the PNI and HFA-PEFF scores. The ROC analysis demonstrated that PIV (AUC: 0.92) had the strongest predictive ability for rehospitalization, followed by Systemic Immune-Inflammatory Index (SII, AUC: 0.87) and PNI (AUC: 0.78), while BMI showed the weakest performance (AUC: 0.59). The multivariate logistic regression analysis demonstrated that both PNI (OR: 0.783, 95% CI: 0.627-0.977, P=0.031) and PIV (OR: 1.012, 95% CI: 1.003-1.021, P=0.008) were significant predictors of rehospitalization in HFpEF patients.</p><p><strong>Conclusions: </strong>PIV and PNI are important parameters that play a predictive role in diagnosing HFpEF and independently predicting rehospitalization. In the multivariate analyses for rehospitalization, that PIV stands out more than SII, and PNI stands out more than BMI, was current and valuable information.</p>","PeriodicalId":18668,"journal":{"name":"Minerva cardiology and angiology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144506813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial cardiomyopathy: new pathophysiological and clinical aspects.","authors":"Nicola Pierucci, Marco V Mariani, Giovanni Iannetti, Ludovico Maffei, Andrea Coluccio, Domenico Laviola, Marta Palombi, Sara Trivigno, Luigi Spadafora, Emmanouela Chourda, Luca Barca, Giuseppe Mascia, Vincenzo M LA Fazia, Andrea D'Amato, Paolo Severino, Cristina Chimenti, Fabio Miraldi, Carlo Lavalle","doi":"10.23736/S2724-5683.25.06725-0","DOIUrl":"https://doi.org/10.23736/S2724-5683.25.06725-0","url":null,"abstract":"<p><p>Atrial cardiomyopathy (ACM) is increasingly recognized as a key contributor to the development and perpetuation of atrial fibrillation (AF), a prevalent cardiac arrhythmia with significant clinical implications. ACM involves complex structural, electrical, and functional remodeling of the atrial myocardium, driven by various pathological conditions such as hypertension, heart failure, and obesity. Key mechanisms include atrial fibrosis, inflammation, and oxidative stress, which collectively contribute to the pro-arrhythmic and pro-thrombotic state associated with AF. Recent studies highlight the role of epicardial adipose tissue in promoting atrial fibrosis and the importance of genetic predispositions in ACM development. Advanced imaging techniques, including left atrial strain and cardiac magnetic resonance, are emerging as valuable tools for assessing atrial remodeling and guiding therapeutic decisions. Understanding the intricate relationship between ACM and AF may enable earlier identification and targeted interventions, potentially improving outcomes in affected patients. Despite advances, gaps remain in identifying early markers of ACM and developing specific therapeutic strategies. This review focuses on the analysis of ACM as a contributor to AF and its pathophysiological and clinical implications. Future research should focus on refining diagnostic criteria and exploring novel treatment approaches to manage ACM and its associated risks more effectively.</p>","PeriodicalId":18668,"journal":{"name":"Minerva cardiology and angiology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment strategies in Fabry disease: insights from a multinational scoping review.","authors":"Agustina Sabino, Magali Margaria, Roberto Margaria-Fernandez, Brenda Gouvea-Feres, Enzzo Barrozo-Marrazzo, Sofia Wagemaker-Viana, Daniel Fernandez-Guzman, Natalia S Morales, Mary Magdi-Michiel-Mina, Carlos Quispe-Vicuña, Letícia Nunes-Campos, Federico Fernandez-Zelcer, Carlos Stegmann, Carina F Argüelle S, Juan M Politei, Gaston A Rodriguez-Granillo, Jorgelina Stegmann","doi":"10.23736/S2724-5683.25.06787-0","DOIUrl":"https://doi.org/10.23736/S2724-5683.25.06787-0","url":null,"abstract":"<p><strong>Introduction: </strong>Fabry disease (FD) is a rare X-linked lysosomal disorder caused by deficient α-galactosidase A (α-Gal A) activity. This scoping review synthesizes evidence on screening, diagnostic, and follow-up methods for FD.</p><p><strong>Evidence acquisition: </strong>We searched six databases for English and Spanish articles published from 2017 until April 2023. Eligible studies included human research on clinical manifestations and methods for screening, diagnosing, and monitoring FD, such as experimental and quasi-experimental studies, observational research, reviews, and guidelines. We followed PRISMA-ScR guidelines for screening and data extraction. We analyzed data with descriptive statistics and qualitative synthesis.</p><p><strong>Evidence synthesis: </strong>We included 383 studies, with cross-sectional designs being the most common (N:=155, 41%). Most studies were from high-income countries, and 199 (52%) did not report patients' phenotypes. Screening methods often combined clinical presentation, laboratory results, and imaging findings. Specifically, 14 studies (4%) focused on newborn screening. Clinical symptoms were described in 315 studies (82%) and were instrumental in diagnostic investigation. While hallmark manifestations were prevalent, less-recognized symptoms like tinnitus, early stroke, cerebrovascular dolichoectasia, conduction disorders, aortic root dilatation, and parapelvic cysts, were highlighted as important in clinical suspicion. Laboratory, particularly α-Gal A measurement (N.=183, 48%), and genetic sequencing were fundamental to diagnosis confirmation. Follow-up assessments concentrated on cardiovascular, genitourinary, and nervous systems, employing imaging and electrophysiological studies, along with various scales and questionnaires.</p><p><strong>Conclusions: </strong>This review provides a comprehensive overview of screening, diagnostic, and monitoring strategies for FD, offering evidence-based insights to improve the clinical management of FD patients.</p>","PeriodicalId":18668,"journal":{"name":"Minerva cardiology and angiology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac amyloidosis in severe aortic stenosis patients: an updated review unraveling their complex interplay.","authors":"Marc G Fakhoury, Upamanyu L Chanda, Hasim Reza, Kanika Tayal, Sushmitha Rameshbabu, Zaib Nisa, Hajera A Raheem, Nikitha Gudapati, Phillip D Ebanks, Jatin Motwani","doi":"10.23736/S2724-5683.25.06736-5","DOIUrl":"https://doi.org/10.23736/S2724-5683.25.06736-5","url":null,"abstract":"<p><p>Aortic stenosis (AS) and cardiac amyloidosis (CA) often coexist in elderly patients, complicating diagnosis and treatment. AS is characterized by the narrowing of the aortic valve, leading to left ventricular outflow obstruction, primarily due to age-related calcification and congenital defects. CA, the most common cause of restrictive cardiomyopathy, results from amyloid protein deposits in the myocardium, causing diastolic dysfunction. Accurate diagnosis of CA in AS patients is challenging due to overlapping symptoms and the need for advanced imaging and biomarkers. Aortic valve replacement (AVR), through surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) methods, is the primary treatment for severe AS. However, the presence of CA significantly impacts perioperative risk and long-term outcomes, with increased rates of heart failure, pacemaker placement, and mortality. Despite conflicting study results, CA in AS patients is associated with poorer long-term survival and more complications. Future research should enhance AI-based diagnostics, explore novel biomarkers, and clarify AS-CA interactions. Gene-silencing therapies and optimizing perioperative management and enhancing patient education are also crucial. Addressing these challenges will improve the prognosis and quality of life for patients with concurrent AS and CA, facilitating better clinical management of this complex dual pathology.</p>","PeriodicalId":18668,"journal":{"name":"Minerva cardiology and angiology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ankle-Brachial Index in patients with acute myocardial infarction.","authors":"Monica Verdoia, Fabiana Patti, Barbara Conti, Claudio Castagno, Michele Aronici, Enzo Forliti, Andrea Rognoni","doi":"10.23736/S2724-5683.25.06763-8","DOIUrl":"https://doi.org/10.23736/S2724-5683.25.06763-8","url":null,"abstract":"<p><strong>Background: </strong>Ankle-Brachial Index (ABI) has been validated for the diagnosis and risk stratification of vascular disease in the healthy population. The prognostic role and predictors of ABI in patients with established coronary artery disease still remain debated, and especially among patients with acute myocardial infarction (AMI) and represented therefore the aim of the present study.</p><p><strong>Methods: </strong>We included patients undergoing coronary angiography and PCI for AMI in a single center from May 2022 to November 2024 and with no established history of peripheral arterial disease. ABI was measured before discharge in a phase of hemodynamic stability. Peripheral Arterial Disease (PAD) was defined for ABI ≤0.90.</p><p><strong>Results: </strong>Overall, 130 patients with AMI were included, of whom 28 (21.5%) had impaired ABI values. No clinical or demographic difference was observed according to ABI, but for lower platelet count (216.7±52.9 vs. 264.8±86.9, P=0.006), that emerged as the only independent predictor of impaired ABI (OR=0.989 [95% CI: 0.982-0.997], P=0.007). Patients with higher platelet count (III tertile, >267.6×10³/µL, N.=44) displayed significantly higher white blood cells count (P<0.001) and lower use of acetylsalicylic acid (P=0.06). At multivariable regression analysis, we confirmed the independent association between higher platelet tertiles values and impaired ABI (adjusted OR=0.147 [95% CI: 0.037-0.576], P=0.006).</p><p><strong>Conclusions: </strong>Among patients with acute myocardial infarction, abnormal values of ABI are common, although similarly distributed across major established cardiovascular risk factors. In fact, platelet count emerged as the only independent predictor of impaired ABI and the inverse association between higher platelet count and ABI values was confirmed in different higher-risk subsets of patients. Future dedicated large-scale studies could provide the prognostic implications and more insightful understanding of our findings.</p>","PeriodicalId":18668,"journal":{"name":"Minerva cardiology and angiology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of N-acetylcysteine in reducing the risk of postoperative atrial fibrillation in cardiothoracic surgery: a systematic review and meta-analysis of randomized controlled trials.","authors":"Atef A Hassan, Noha R Ismail, Abdelmoumen E Rezk, Hanady M Elfeky, Abdelrahman M Mady, Ahmed G Allam, Kirellos S Abbas","doi":"10.23736/S2724-5683.24.06482-2","DOIUrl":"10.23736/S2724-5683.24.06482-2","url":null,"abstract":"<p><strong>Introduction: </strong>New-onset postoperative atrial fibrillation (POAF) is a common complication following cardiac surgeries. N-acetylcysteine (NAC) showed a significant reduction in the incidence of POAF. This review aimed to systematically summarize and Meta-analyze data from previously published Randomized Controlled Trials (RCTs).</p><p><strong>Evidence acquisition: </strong>Electronic databases: PubMed, Cochrane, Embase, Scopus, and Web of Science were searched. Data was extracted and the quality of the included studies was assessed. A random-effects DerSimonian Laird model was employed for meta-analysis.</p><p><strong>Evidence synthesis: </strong>Fifteen RCTs were included in this study (NAC, N.=940; control, N.=935). In the NAC group, 16.38% developed POAF compared with 23.53% in the control group. NAC supplementation was associated with a decreased incidence of POAF in patients undergoing cardiothoracic surgery (RR 0.69; 95% CI 0.52, 0.91; P=0.008). Meta-regression of randomized trial data showed that the incidence of POAF was not related to the NAC dose (P=0.439). A subgroup analysis in terms of the time of NAC administration revealed that preoperative and postoperative NAC administration was the only subgroup that demonstrated a statistically significant difference (RR 0.48, 95% CI 0.32, 0.71; P=0.0003) compared with placebo and showed no heterogeneity.</p><p><strong>Conclusions: </strong>Atrial fibrillation is a significant postoperative complication, particularly in cardiothoracic surgery. This study highlights the need for further research on optimal NAC dosing and timing, with evidence suggesting that preoperative and postoperative NAC administration may significantly decrease postoperative atrial fibrillation in cardiothoracic surgery patients, although limitations and variability in study designs need to be considered.</p>","PeriodicalId":18668,"journal":{"name":"Minerva cardiology and angiology","volume":" ","pages":"387-396"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}