Critical Pathways in Cardiology最新文献

{"title":"Bivalirudin Versus Heparin in Patients Undergoing Percutaneous Coronary Intervention in Acute Coronary Syndromes.","authors":"Chayakrit Krittanawong, Tania Ahuja, Zhen Wang, Yusuf Kamran Qadeer, Errol Moras, Hafeez Ul Hassan Virk, Mahboob Alam, Hani Jneid, Samin Sharma","doi":"10.1097/HPC.0000000000000372","DOIUrl":"10.1097/HPC.0000000000000372","url":null,"abstract":"<p><strong>Introduction: </strong>Data on outcomes between unfractionated heparin and bivalirudin anticoagulation during percutaneous coronary intervention (PCI) in acute coronary syndromes remain inconclusive. We aimed to systematically analyze PCI outcomes by comparing unfractionated heparin and bivalirudin.</p><p><strong>Methods: </strong>We systematically searched Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception in 1966 through January 2024 for studies evaluating PCI outcomes comparing unfractionated heparin and bivalirudin. Two investigators independently reviewed the data. Conflicts were resolved through consensus. Random-effects meta-analyses were used.</p><p><strong>Results: </strong>A total of 10 prospective trials were identified that enrolled 42,253 individuals who presented with an acute coronary syndrome. Our analysis found that heparin when compared to bivalirudin was associated with an increased risk of trial-based definition of major bleeding [relative risk (RR): 1.68, 95% confidence interval (CI): 1.29-2.20], nonaccess site complications (RR: 4.6, 95% CI: 1.75-12.09), thrombolysis in myocardial infarction major bleeding (RR: 1.70, 95% CI: 1.20-2.41), major bleeding risks (RR: 1.87, 95% CI: 1.49-2.36), cardiovascular disease death (RR: 1.26, 95% CI: 1.02-1.57), and thrombocytopenia (RR: 1.67, 95% CI: 1.07-2.62). There were no statistically significant differences between heparin and bivalirudin for all-cause mortality, major adverse cardiovascular event, stroke, reinfarction, target vessel revascularization, and acute or stent thrombosis.</p><p><strong>Conclusions: </strong>The present meta-analysis demonstrates bivalirudin reduces major bleeding when used for anticoagulation during PCI in patients with acute coronary syndromes and is not associated with an increased risk of stent thrombosis or major adverse cardiovascular event.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0372"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Department and Critical Care Use of Clevidipine for Treatment of Hypertension in Patients With Acute Stroke.","authors":"Scott S Brehaut, Angelina M Roche","doi":"10.1097/HPC.0000000000000375","DOIUrl":"10.1097/HPC.0000000000000375","url":null,"abstract":"<p><strong>Background and purpose: </strong>Clevidipine is a parenteral dihydropyridine calcium channel blocker that received Food and Drug Administration approval in 2008 for the reduction of blood pressure (BP) when oral therapy is not feasible or not desirable. Soon after approval, our institution incorporated clevidipine into protocols for the management of hypertension among acute stroke patients, based on the drug's rapid onset of action and straightforward titration to goal. A subsequent retrospective review of its use in otherwise alteplase-eligible ischemic stroke patients with BP greater than 185/110 mm Hg (n = 32, in 2014) revealed that clevidipine in that setting demonstrated the shortest median time to BP control, the shortest median door-to-alteplase administration time, and the lowest administered volume of any parenteral antihypertensive used. As a result, clinical protocols in our institution were modified to make clevidipine first-line antihypertensive in both ischemic and hemorrhagic acute stroke. In this study, we report our institution's experience with clevidipine in acute stroke, comprising the largest such report to date.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of all acute stroke patients who received clevidipine in the emergency department (ED) or intensive care unit (ICU) (n = 295) for the management of clinically significant hypertension between January 1, 2015, and December 31, 2017. Metrics analyzed included target (goal) BP for thrombolysis eligibility among patients intended for lytic therapy according to stroke management guidelines in effect at the time of care.</p><p><strong>Results: </strong>The median time for initial parenteral antihypertensive dose to goal (DTG) BP for all ischemic stroke patients (both those intended for and those not intended for lytic therapy) with complete data (n = 71 of 204) was 15 minutes; median time for door-to-IV-alteplase administration for ischemic stroke patients with complete data (n = 14 of 34 treated patients) was 59 minutes. The median time for initial parenteral antihypertensive DTG BP for all hemorrhagic stroke patients with complete data (n = 33 of 91 treated patients) was 39 minutes.</p><p><strong>Conclusions: </strong>We conclude that the salutary findings of the initial small study are valid across a larger patient sample of all acute stroke types. Based on these data, clevidipine is shown to be safe, consistent, and effective in the treatment of acute hypertension in ischemic and hemorrhagic stroke events, and is a reasonable first-line treatment option for acute hypertension in this setting.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0375"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploratory Analysis of Urine PO 2 Peri-Procedural Kinetics and CI-AKI Prognostic Abilities in Patients Undergoing PCI.","authors":"Georgios Chalikias, Dimitrios Stakos, Theodoros Kostakis, Choulia Nalmbant, Belkis Malkots, Vasilios Koutroulos, Kalliopi Theodoridou, Adina Thomaidis, Dimitrios Tziakas","doi":"10.1097/HPC.0000000000000367","DOIUrl":"10.1097/HPC.0000000000000367","url":null,"abstract":"<p><p>Novel contrast-induced acute kidney injury (CI-AKI) biomarkers are needed to detect earlier and with greater precision the pathophysiological changes in the renal medulla associated with kidney damage. We prospectively assessed the kinetics of urine oxygen tension (PO 2 ) in control healthy individuals and its prognostic ability for CI-AKI in patients undergoing percutaneous coronary intervention (PCI). We enrolled 202 consecutive patients (78% men, mean age 66 ± 10 years) treated with elective or urgent PCI. PO 2 was measured using a point-of-care (POC) standard blood gas analyzer at 3 time points (baseline, post-within 3 hours-PCI, and at 24 hours post-PCI) in urine samples. CI-AKI was defined as an increase of ≥25% or ≥0.5 mg/dl in pre-PCI serum creatinine at 48 hours post-PCI. Between baseline and post-PCI measurements, patients without CI-AKI showed a decrease of -37 (36) mm Hg in PO 2 urine levels, whereas patients with CI-AKI showed a decrease of only -23 (38) mm Hg. ( P = 0.014). Using receiver operating characteristic curve analysis, percentage change in urine PO 2 immediately after PCI relative to baseline levels significantly predicted CI-AKI (area under the curve 0.804; 95% confidence interval, 0.717-0.892). A significant drop in urine PO 2 appears as a normal response of the kidney medulla to an acute insult (contrast media) immediately post-PCI with recovery to baseline levels 24 hours later. The absence or attenuation of this drop in urine PO 2 could predict CI-AKI earlier and more precisely.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0367"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the association of clinical cardiovascular parameters and metabolic indices with levels of cystatin C in early middle age.","authors":"Laith Ashour, Zeid Jarrar, Ghada Alzoubi, Samar Hamdan, Rima Heramas, Dima Alakhdar, Julie Abu Jeries, Areen Mishleb, Maher Marar, Layan Ayesh, Lina A Abu Sirhan","doi":"10.1097/HPC.0000000000000386","DOIUrl":"10.1097/HPC.0000000000000386","url":null,"abstract":"<p><strong>Background: </strong>The pathophysiology of renal dysfunction requires population-based study. It is debatable in the literature whether cardiovascular metrics have an impact on cystatin C levels.</p><p><strong>Methods: </strong>using public-use biomarkers data of The National Longitudinal Study of Adolescent to Adult Health (Add Health) Wave 5 data, we tested, after adjusting for age (range: 32-42), anthropometrics (Body Mass Index (BMI), waist circumference, and arm circumference), HbA1C, Low-Density Lipoprotein (LDL), triglyceride, smoking, and sex, the association of five clinical cardiovascular measures (systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse pressure, and pulse rate) with cystatin C levels. Multiple linear regression analysis with a design-based approach was employed for data analysis after log-transformation of cystatin C levels.</p><p><strong>Results: </strong>Our findings showed that there was no significant association between cystatin C levels and any of the previously mentioned cardiovascular parameters in this age group (P > 0.05). However, there was a significant association between cystatin C levels and age (Exponentiated estimate (EE) (percent increase per unit) =1.21; 95% CI=[0.97, 1.103], P < 0.0001), BMI and waist circumference (EE= 0.702; 95% CI=[0.7, 0.705], P < 0.0001), triglycerides level (EE=0.02; 95% CI=[0.0199, 0.0201], P = 0.01), smoking status (EE (compared to nonsmokers)=8.98, 95% CI=[8.95, 9.01], P < 0.0001), and female sex (EE (compared to males)= -5.92; 95% CI=[-5.94, -5.89], P < 0.0001).</p><p><strong>Conclusions: </strong>Our findings clarify the impact of confounding factors, particularly age, on cystatin C levels. They also demonstrate how the significant correlation between cardiovascular parameters and cystatin C levels that seen in earlier studies is largely affected by the age. Anthropometrics, age, lipid indices, and smoking should all be considered in clinical practice as possible reasons for increased cystatin C levels in otherwise healthy middle-aged individuals.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of some cardiovascular risk factors: obesity, hypertension, and smoking among medical students.","authors":"Asayil A Alrasheed, Norah I Alabdullatif, Aljawhara W AlOmair, Atheer K Almutairi, Abdulaziz H Moria, Zainab Amjad, Eman Elsheikh","doi":"10.1097/HPC.0000000000000380","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000380","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiovascular diseases (CVDs) are the principal cause of worldwide mortality, with 17.9 million deaths reported in 2019. In Saudi Arabia, CVDs account for 42% of all deaths, occurring on average 10 years earlier than in Western populations. Medical students are particularly susceptible to Cardiovascular disease CVD risk factors due to demanding academic schedules and lifestyle changes. This study aims to identify cardiovascular risk factors (CVRF) among medical students at King Faisal University, highlighting the need for preventive measures and curriculum modifications.</p><p><strong>Methods: </strong>This prospective cross-sectional study was conducted from February to April 2024 at King Faisal University, focusing on undergraduate medical students. Participants not enrolled in the College of Medicine, those who declined to complete the survey, or those who submitted incomplete responses were excluded. A total of 313 students participated in the study. Data collection involved physical evaluations and a validated questionnaire covering demographics, medical history, lifestyle, and diet. Measurements included waist circumference, weight, height, blood pressure, and pulse. Data was analyzed using IBM SPSS Statistics version 19.</p><p><strong>Results: </strong>Among participants, 52.4% had a normal body mass index BMI, while 19.5% were overweight and 11.2% obese. Blood pressure measurements showed 45.7% had normal BP, but 44.4% were prehypertensive. A family history of CVDs was reported by 55.6% of students, with hypertension (HTN) and diabetes being the most common. Smoking was infrequent, with only 5.1% reporting regular habits. Dietary analysis showed moderate consumption of unhealthy foods, with 80% maintaining a moderately healthy diet. Physical activity assessment indicated significant portions engaged in light or moderate activities, but only a minority met recommended levels for vigorous activities. Significant associations were found between physical activity levels and academic year, personal history of diseases, and smoking behavior.</p><p><strong>Conclusion: </strong>Most students had normal body weight, but many were overweight or pre-hypertensive. Family histories of CVDs, particularly (HTN) and diabetes, were common. Smoking was rare, but diets included frequent unhealthy foods. These findings underscore the need for targeted health programs to reduce cardiovascular risks in this population.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Risk Factors and Echocardiographic Findings in a Predominantly Black Population With Rheumatoid Arthritis and Heart Failure.","authors":"Abida Hasan, Seyed M Zaidi, Sahil Zaveri, Nicholas Taklalsingh, Seyedeh L Zonnoor, Joseph Casillas-Gonzalez, Harshith Chandrakumar, Ashkan Tadayoni, Sara Sharif, Courtney Connelly, Aron Soleiman, Thiagarajan Sezhian, Karthik Sreedhara, Cindy L Tsui, Yelyzaveta Prysyazhnyuk, Diana Gruenstein, Adiell Melamed, Filip Oleszak, Rachel Axman, Daniel Beltre, Anan Kazi, Fahmida Patwari, Andrew Tsai, Michael Freilich, Anny Corominas, Kristaq Koci, Omar Siddique, Ryan Marder, Raphael Kirou, Isabel M McFarlane","doi":"10.1097/HPC.0000000000000365","DOIUrl":"10.1097/HPC.0000000000000365","url":null,"abstract":"<p><p>Among white rheumatoid arthritis (RA) cohorts, heart failure with preserved ejection fraction is the most prevalent type of heart failure (HF). We aimed to assess the type of HF affecting Black RA patients. A total of 64 patients with RA-HF were compared with age-, sex-, and race-matched RA patients without HF. Left ventricular ejection fraction, wall motion abnormalities, left ventricle (LV) mass, and wall thickness were reviewed. About 87.3% were Black and 84.4% were women, with a mean age of 69.6 ± 1.38 (± SEM) and body mass index (kg/m 2 ) of 29.6 ± 1.07. RA-HF patients had higher rates of hypertension (HTN), chronic kidney disease, and atrial fibrillation. However, 66.7% had ≥3 cardiovascular risk factors compared with RA patients without HF. 2D echocardiograms of RA-HF revealed that 62.3% had left ventricular ejection fraction ≥50%, 37% had diastolic dysfunction, and 43.1% had wall motion abnormalities. LV mass and relative wall thickness measurements indicated LV eccentric remodeling. The odds ratio for HF was 4.7 (CI, 1.5-14.53), P < 0.01, among the RA-HTN group and 3.5 (CI, 1.091-11.7) P < 0.01 among smokers. In our predominantly Black RA-HF patients, heart failure with preserved ejection fraction was the most common type of HF. HTN was associated with the highest OR for HF. Eccentric hypertrophic remodeling, a known poor prognostic indicator for cardiovascular events, was found. Further studies are required to confirm our findings.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"183-188"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141284968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Power Long-Duration Versus High-Power Short-Duration Radiofrequency Ablation of the Atrioventricular Node.","authors":"Sahil Zaveri, Mahmoud Alsaiqali, Howard Yu, Rafsan Ahmed, Ahmad Jallad, Adam S Budzikowski","doi":"10.1097/HPC.0000000000000369","DOIUrl":"10.1097/HPC.0000000000000369","url":null,"abstract":"<p><strong>Background: </strong>Atrioventricular node (AVN) radiofrequency (RF) ablation is a highly effective treatment of atrial tachyarrhythmias that are resistant to other management modalities. To date, there is limited research that compares the properties of different RF ablation catheters. The current study aims to compare the effectiveness of several types of RF catheters in AVN ablation.</p><p><strong>Methods: </strong>A total of 66 patients, with a mean age of 73.27 years, underwent AVN RF ablation. The catheters used were categorized as unirrigated (UI), externally irrigated, and contact force sensing with 10 to 20 g of force. Externally-irrigated catheters were divided into 2 different settings: low-power long-duration (LPLD) (30 W, 45°C, and 60 seconds) and high-power short-duration (HPSD) (50 W, 43°C, and 12 seconds). We compared the success rate of the different RF catheters using logistic regression and lesion times using linear regression.</p><p><strong>Results: </strong>The distribution of the types of catheters used is UI in 48%, LPLD in 16%, and HPSD in 36% of patients. All ablation procedures were successful, with no immediate postprocedure complications. HPSD had a significantly shorter lesion time than UI catheters by 403.42 seconds (-631.67 to -175.17).</p><p><strong>Conclusions: </strong>UI catheters, LPLD, and HPSD were equally safe and effective in ablation procedures. The HPSD catheter had a significantly shorter lesion time and, thus, overall decreased procedure time.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"199-201"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Trends, Mortality and Outcomes in Intravascular Imaging-Guided Versus Angiography-Guided Percutaneous Coronary Intervention in the United States.","authors":"Chayakrit Krittanawong, Song Peng Ang, Yusuf Kamran Qadeer, Zhen Wang, Mahboob Alam, Hani Jneid, Samin Sharma","doi":"10.1097/HPC.0000000000000363","DOIUrl":"10.1097/HPC.0000000000000363","url":null,"abstract":"<p><p>Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have become increasingly utilized in patients undergoing percutaneous coronary intervention (PCI). Despite these purported advantages, prior reports regarding the use of IVUS and OCT have indicated that contemporary use of intravascular imaging remains low with significant regional variation. Here, we present the findings of an updated contemporary analysis regarding the use of IVUS/OCT-guided PCI versus angiography-guided PCI in the United States. We also evaluated in-hospital mortality and clinical outcomes between IVUS/OCT-guided PCI versus angiography-guided PCI-only over million patients in the United States. There has been a significant decrease in the number of PCIs performed, while there has been increasing in the trend of IVUS/OCT-guided PCI over this period. Most importantly, we found that IVUS/OCT-guided PCI was associated with better clinical outcomes in terms of in-hospital mortality, compared with angiography-guided PCI.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"202-206"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141071699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TNF alpha Inhibitors in Cardiac Sarcoidosis: A Systematic Review and Meta-Analysis.","authors":"Asma Mahmood, Mahnoor Farooq Raja, Habiba Imran, Bushra Zahoor, Mohammad Sadiq Khan Khakwani, Nikhil Duseja, Ihtisham Rahman, Aiman Murtaza, Hafiz Muhammad Faizan Abid, Muhammad Sohail Sattar, Neha Bajaj, Saneha Bajaj, Laiqa Tariq, Aimen Shafiq","doi":"10.1097/HPC.0000000000000364","DOIUrl":"10.1097/HPC.0000000000000364","url":null,"abstract":"<p><strong>Background: </strong>Recent studies have focused on treating cardiac sarcoidosis (CS) with corticosteroids primarily mitigating symptoms and reducing the risk of mortality and other cardiovascular complications. A promising new treatment approach involves tumor necrosis factor (TNF) alpha inhibitors.</p><p><strong>Methodology: </strong>A systematic search was conducted on PubMed, the Cochrane Library, and Elsevier's Science Direct databases to identify studies comparing TNF alpha inhibitors with other drugs in CS patients who had heart failure. The analyses were conducted using the random-effects model.</p><p><strong>Results: </strong>The study's primary outcome is an increase in ejection fraction (EF), secondary outcomes include a reduction in the dose of prednisone at 6 and 12 months, maximum standardized uptake value by cardiac tissue, and fluorodeoxyglucose uptake by cardiac myocytes on positron emission tomography scan. The total number of pooled participants was 154 out of which 140 met the Heart Rhythm Society criteria for CS. The pooled analysis showed that treatment with the TNF alpha inhibitors was associated with a significant increase in EF [weighted mean difference (WMD), 46.272; 95% confidence interval (CI), 40.60-51.94, P < 0.001; I2, 75.74%], reduction in the dose of prednisone at 6 months (WMD, 9.20; 95% CI, 7.65-10.75; P < 0.001; I2, 13.33%) and at 12 months (WMD, 6.40; 95% CI, 4.74-8.07; P < 0.001; I2, 9.37%); decrease in myocardial maximum standardized uptake value (WMD, 1.99; 95% CI, 0.91-3.06; P < 0.001; I2: 97%) and reduction in fluorodeoxyglucose uptake by cardiac myocytes (WMD, 1.55; 95% CI, 1.09-2.00; P < 0.001; I2, 32.29) on positron emission tomography scans.</p><p><strong>Conclusions: </strong>The research findings suggest that TNF alpha inhibitors improve EF, reduce required steroid dosage, and improve clinical outcomes. Nonetheless, further high-quality randomized controlled trials with large sample sizes are needed to assess other impacts of this therapy on patients with CS.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":"23 4","pages":"218-223"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-triggered Events Poorly Predict the Presence of Atrial Tachyarrhythmia on Ambulatory Electrocardiogram Monitors in Patients With Heart Failure.","authors":"Maranda Herner, Zameer Abedin, Michael Torre, Yue Zhang, Cody Orton, Ann Lyons, Benjamin A Steinberg","doi":"10.1097/HPC.0000000000000366","DOIUrl":"10.1097/HPC.0000000000000366","url":null,"abstract":"<p><strong>Background: </strong>Ambulatory electrocardiogram (AECG) monitoring is an attractive method for objectively identifying atrial fibrillation (AF) symptoms by documenting simultaneous arrhythmia with symptomatic episodes. However, no study yet has evaluated this simultaneous symptom-rhythm correlation in patients with heart failure (HF). We aimed to measure the correlation between symptoms and atrial arrhythmia (ATAF) episodes among patients with HF and known AF using prolonged AECG monitoring.</p><p><strong>Methods: </strong>We analyzed ATAF events and patient-triggered symptomatic events (PTSEs) on AECG monitors in adults with a history of AF and HF.</p><p><strong>Results: </strong>Among 959 monitors, we identified a total of 26,634 events, including 15,787 ATAF events and 4950 PTSE. The mean age was 70 years, 48% were female, and 91% were Caucasian. Among 4950 PTSEs, only 1116 demonstrated ATAF (23%). PTSE showed a low correlation with ATAF, with a moderate inverse tetrachoric correlation of -0.62 (bootstrapped 95% confidence interval: -0.61 to -0.63). The mean heart rate (HR) of symptomatic ATAF events was 115 bpm (SD: 33), compared with asymptomatic ATAF (107 bpm, SD: 33, P < 0.001). The mean HR of all symptomatic events was 92 bpm (SD: 28) and of asymptomatic events was 99 bpm (SD: 30), P < 0.001.</p><p><strong>Conclusions: </strong>Our study found that symptomatic events on AECG monitors poorly predict ATAF episodes, ATAF episodes are rarely noted as symptomatic, and poor HR control fails to fully explain AF symptoms in patients with known AF and HF. Our study encourages further research into other symptom assessments, such as patient-reported outcomes and a more comprehensive approach to AF treatment in HF rather than primarily symptom based.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"196-198"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11582081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}