Cardiology and Therapy最新文献

{"title":"Comparative Outcomes of TAVR in Mixed Aortic Valve Disease and Aortic Stenosis: A Meta-analysis.","authors":"Justin K Ugwu, Daniel R Kandah, Jideofor K Ndulue, Okechukwu P Ebiem, Judith N Ugwu-Erugo, Russell Hamilton, Kofi Osei, Tuncay Taskesen, Daniel M Shivapour, Atul Chawla, Richard H Marcus","doi":"10.1007/s40119-022-00293-3","DOIUrl":"10.1007/s40119-022-00293-3","url":null,"abstract":"<p><strong>Introduction: </strong>Transcatheter aortic valve replacement (TAVR) has become a suitable alternative to surgical aortic valve replacement (SAVR) for the treatment of symptomatic severe aortic stenosis (AS). A high proportion of patients with AS have mixed aortic valve disease (MAVD) with mild or more concurrent aortic regurgitation (AR). Differential outcomes of TAVR among patients with AS and MAVD have not been well characterized. We compared 1-year mortalities following TAVR among patients with MAVD and AS.</p><p><strong>Methods: </strong>We conducted a meta-analysis of studies published in PubMed/Medline. The primary outcome was 1-year all-cause mortality following TAVR among patients with MAVD vs. AS. Secondary endpoints were: (1) incidence of AR within 30 days following TAVR (post TAVR AR); and (2) 1-year all-cause mortality within each group stratified according to severity of post TAVR AR.</p><p><strong>Results: </strong>Nine studies involving 9505 participants were included in the analysis. At 1 year following TAVR, mortality was lower in MAVD than in AS; HR 0.89, 95% CI 0.81-0.98. The mortality advantage increased when pre-TAVR AR was moderate or more; HR 0.84, 95% CI 0.72-0.99. The mortality advantage was attenuated after correction for publication bias. There was a higher risk of post TAVR AR in the MAVD group; OR 1.51, 95% CI 1.20-1.90 but the impact on mortality of moderate vs. mild post TAVR AR was greater among patients with AS than in patients with MAVD HR 1.67 95% CI 0.89-3.14 vs. 0.93 95% CI 0.47-1.85.</p><p><strong>Conclusions: </strong>Patients with MAVD have similar or improved survival 1 year after TAVR compared to those with AS.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 1","pages":"143-157"},"PeriodicalIF":3.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a0/20/40119_2022_Article_293.PMC9986165.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9750008","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":"Effects of Melatonin on Cardiac Injury and Inflammatory Biomarkers in Patients Undergoing Coronary Artery Bypass Graft Surgery: a Meta-analysis.","authors":"Melika Farshidianfar,&nbsp;Ali Ardekani,&nbsp;Reza Tabrizi,&nbsp;Kamran B Lankarani,&nbsp;Erfan Taherifard,&nbsp;Ashkan Abdollahi,&nbsp;Arezou Azizi,&nbsp;Maryam Akbari","doi":"10.1007/s40119-022-00287-1","DOIUrl":"https://doi.org/10.1007/s40119-022-00287-1","url":null,"abstract":"<p><strong>Introduction: </strong>The antiinflammatory and antioxidative effects of melatonin have been established in recent years. Several studies indicate that oxidative stress and inflammation are key drivers of post-coronary artery bypass graft (CABG) surgery complications. In the present study, we aimed to investigate the effects of melatonin on cardiac injury and inflammatory biomarkers in CABG candidates.</p><p><strong>Methods: </strong>Embase, Medline/PubMed, Web of Science, Scopus, and the Cochrane library were searched up to 5 June 2022. All randomized controlled trials examining cardiac injury and inflammatory biomarkers of CABG patients who received melatonin were included. The random-effects model was utilized to perform the analysis.</p><p><strong>Results: </strong>A total of 947 citations were retrieved through database searches. Finally, five articles (six trials with 342 patients) were included after the screening. Melatonin supplementation led to a significant reduction in cardiac troponin I (CTnI) [weighted mean difference(WMD): -2.28 ng/ml; 95% CI -2.87, -1.69; P < 0.01; I²: 91.25%] and high sensitivity-C reactive protein (hs-CRP) levels (WMD: -0.62 mg/L; 95% CI -0.73, -0.5; P < 0.01; I²: 99.98%) in patients undergoing CABG surgery. We found a nonsignificant decrease in creatine kinase isoenzyme muscle/brain (CK-MB) levels (WMD: -2.87 ng/ml; 95% CI -5.97, 0.23; P = 0.07; I²: 99.98%) after melatonin supplementation. No publication bias was found according to Egger's test.</p><p><strong>Conclusion: </strong>Melatonin supplementation may be useful in reducing cardiac injury and inflammatory biomarkers in CABG candidates. Future studies should investigate the clinical significance of these findings.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 1","pages":"11-20"},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/71/20/40119_2022_Article_287.PMC9986370.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9753221","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":"Pulmonary Thromboembolism Developed During Hospitalization: A Nationwide Retrospective Observational Study Using Claims Data.","authors":"Miki Imura, Tsunehisa Yamamoto, Ken-Ichi Hiasa","doi":"10.1007/s40119-022-00290-6","DOIUrl":"10.1007/s40119-022-00290-6","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence regarding the development of pulmonary thromboembolism (PE) during hospitalization is unclear. We hypothesized that the incidence of PE could vary depending on clinical department and aimed to conduct a survey on the incidence of in-hospital PE.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using claims data of in-hospital patients in Japan. We collected background information regarding patients with and without PE occurrence during hospitalization. Further, we determined the incidence of PE and implemented prophylactic procedures in patients with and without surgery according to clinical department at admission. Finally, we examined the duration of hospital stay and in-hospital mortality rates in patients with and without PE.</p><p><strong>Results: </strong>We found that 5007 (0.107%, 20.61 per 1000 person-years) patients developed PE during hospitalization and differed by clinical department at admission. Moreover, 2272 (0.095%, 19.3 per 1000 person-years) and 2735 (0.119%, 21.8 per 1000 person-years) patients with and without surgery, respectively, developed PE during hospitalization (P < 0.001). Further, 33.8% of inpatients underwent prophylactic procedures for PE; however, the implementation rate differed between patients with and without surgery (59.2% vs. 7.3%, P < 0.001). The median duration of hospital stay in patients with and without PE was 31.0 and 11.0 days, and the in-hospital mortality rates in patients with and without PE were 11.0% and 3.5%, respectively (P < 0.001).</p><p><strong>Discussion: </strong>The incidence of in-hospital PE differed according to patient characteristics, clinical departments, and presence/absence of surgery. The onset of PE during hospitalization leads to prolonged hospital stay and in-hospital death.</p><p><strong>Conclusion: </strong>It is important to conduct a proper risk assessment on admission as well as to implement proper prophylactic procedures to prevent the development of PE during hospitalization.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 1","pages":"127-141"},"PeriodicalIF":3.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6d/3c/40119_2022_Article_290.PMC9734681.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10829772","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":"Emerging PET Tracers in Cardiac Molecular Imaging.","authors":"Shashi Bhushan Singh,&nbsp;Sze Jia Ng,&nbsp;Hui Chong Lau,&nbsp;Kishor Khanal,&nbsp;Sanket Bhattarai,&nbsp;Pranita Paudyal,&nbsp;Bimash Babu Shrestha,&nbsp;Rizwan Naseer,&nbsp;Simran Sandhu,&nbsp;Saket Gokhale,&nbsp;William Y Raynor","doi":"10.1007/s40119-022-00295-1","DOIUrl":"https://doi.org/10.1007/s40119-022-00295-1","url":null,"abstract":"<p><p>¹⁸F-fluorodeoxyglucose (FDG) and ¹⁸F-sodium fluoride (NaF) represent emerging PET tracers used to assess atherosclerosis-related inflammation and molecular calcification, respectively. By localizing to sites with high glucose utilization, FDG has been used to assess myocardial viability for decades, and its role in evaluating cardiac sarcoidosis has come to represent a major application. In addition to determining late-stage changes such as loss of perfusion or viability, by targeting mechanisms present in atherosclerosis, PET-based techniques have the ability to characterize atherogenesis in the early stages to guide intervention. Although it was once thought that FDG would be a reliable indicator of ongoing plaque formation, micro-calcification as portrayed by NaF-PET/CT appears to be a superior method of monitoring disease progression. PET imaging with NaF has the additional advantage of being able to determine abnormal uptake due to coronary artery disease, which is obscured by physiologic myocardial activity on FDG-PET/CT. In this review, we discuss the evolving roles of FDG, NaF, and other PET tracers in cardiac molecular imaging.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 1","pages":"85-99"},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3c/b7/40119_2022_Article_295.PMC9986170.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10129588","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":"Anticoagulation During Pregnancy with a Mechanical Pulmonary Valve: Patient and Medical Perspective.","authors":"Lauren Ledingham,&nbsp;Amanda Thiess,&nbsp;May Ling Mah","doi":"10.1007/s40119-022-00296-0","DOIUrl":"https://doi.org/10.1007/s40119-022-00296-0","url":null,"abstract":"<p><p>This article discusses the challenges of supporting a successful pregnancy in a woman with multiple prosthetic heart valves and a complicated cardiac history, from both the patient and provider perspective. The patient is a 29-year-old female with truncus arteriosus type I with initial neonatal VSD closure and right ventricular to pulmonary artery conduit. At the age of 13, she subsequently required truncal and pulmonary valve replacements with mechanical prostheses. Standardizing an approach to anticoagulation in pregnancy in women with prosthetic heart valves is not always possible. Her story demonstrates the importance of an innovative approach to unique cases; by extrapolating what is known about pregnancy and prosthetic heart valves, cardiologists can provide the best outcomes. Simultaneously, non-directive counseling is essential throughout this period to engage the patient in shared decision-making when balancing risks and benefits of each approach to anticoagulation.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 1","pages":"1-5"},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8e/21/40119_2022_Article_296.PMC9986153.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9743418","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":"Leadless Cardiac Pacing: New Horizons.","authors":"Katarzyna Malaczynska-Rajpold, Mark Elliot, Nadeev Wijesuriya, Vishal Mehta, Tom Wong, Christopher Aldo Rinaldi, Jonathan M Behar","doi":"10.1007/s40119-022-00288-0","DOIUrl":"10.1007/s40119-022-00288-0","url":null,"abstract":"<p><p>Since the introduction of transvenous cardiac pacing leads, pacemaker system design has remained similar for several decades. Progressive miniaturisation of electronic circuitry and batteries has enabled a smaller, single pacing unit comprising the intracardiac electrodes, generator and computer. This review explores the development of leadless pacing, the clinical trials comparing leadless to transvenous pacing in addition to the future developments of multi-chamber leadless pacing.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 1","pages":"21-33"},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5a/0d/40119_2022_Article_288.PMC9986180.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9752405","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":"Colchicine in the Management of Acute Coronary Syndrome: A Meta-analysis.","authors":"Jason Nogic,&nbsp;Ojas Mehta,&nbsp;David Tong,&nbsp;Adam J Brown,&nbsp;Jamie Layland","doi":"10.1007/s40119-022-00298-y","DOIUrl":"https://doi.org/10.1007/s40119-022-00298-y","url":null,"abstract":"<p><strong>Introduction: </strong>Colchicine, thought to exert its effect via reduction of inflammation, has recently been studied in patients following acute coronary syndromes (ACS). We performed a meta-analysis of all available randomized controlled trials (RCTs) in this high-risk cohort, evaluating efficacy and safety.</p><p><strong>Methods: </strong>MEDLINE, PubMed, EMBASE, clinical trial registries, and select conference proceedings were searched for RCTs comparing colchicine to placebo in patients following ACS. The primary outcome was trial-defined major adverse cardiovascular events (MACE). Secondary endpoints included stroke, myocardial infarction (MI), all-cause and cardiovascular death, and urgent revascularization. Analysis was performed at the longest available clinical follow-up.</p><p><strong>Results: </strong>Two RCTs with a pooled sample size of 5540 patients with 2778 (50.1%) receiving colchicine and 2762 (49.9%) placebo were included. In order to maximize consistency, composite efficacy endpoints between trials were modified. Compared to placebo, patients receiving colchicine had reduction in study-defined composite endpoint (5.5% vs. 7.6%) OR 0.67 (95% CI 0.46-0.98, p = 0.04, I² = 46%). Similarly, there was a significant reduction in cerebrovascular accidents (OR 0.31, 95% CI 0.14-0.69, p = 0.004, I² = 0%) and repeat revascularization OR 0.36 (95% CI 0.14-0.90, p = 0.03, I² = 54%). There was no difference between cardiovascular death (OR 0.92, 95% CI 0.52-1.62, p = 0.78, I² = 0%), non-cardiovascular death OR 1.27 (95% CI 0.72-2.24, p = 0.41, I² = 0%), MI at longest available follow-up OR 0.89 (95% CI 0.67-1.17, p = 0.39, I² = 0%) or resuscitated cardiac arrest OR 0.88 (95% CI 0.32-2.43, p = 0.81, I² = 0%) in those receiving colchicine.</p><p><strong>Conclusions: </strong>These data suggest colchicine, in addition to guideline-directed medical therapy following acute coronary syndrome reduces MACE, cerebrovascular accidents, and rates of urgent revascularization at 2 years of follow-up.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 1","pages":"171-181"},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bf/e4/40119_2022_Article_298.PMC9986187.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9755368","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":"Hyperkalemia: Prevalence, Predictors and Emerging Treatments.","authors":"Natasha L Larivée, Jacob B Michaud, Keigan M More, Jo-Anne Wilson, Karthik K Tennankore","doi":"10.1007/s40119-022-00289-z","DOIUrl":"10.1007/s40119-022-00289-z","url":null,"abstract":"<p><p>It is well established that an elevated potassium level (hyperkalemia) is associated with a risk of adverse events including morbidity, mortality and healthcare system cost. Hyperkalemia is commonly encountered in many chronic conditions including kidney disease, diabetes and heart failure. Furthermore, hyperkalemia may result from the use of renin-angiotensin-aldosterone system inhibitors (RAASi), which are disease-modifying treatments for these conditions. Therefore, balancing the benefits of optimizing treatment with RAASi while mitigating hyperkalemia is crucial to ensure patients are optimally treated. In this review, we will briefly discuss the definition, causes, epidemiology and consequences of hyperkalemia. The majority of the review will be focused on management of hyperkalemia in the acute and chronic setting, emphasizing contemporary approaches and evolving data on the relevance of dietary restriction and the use of novel potassium binders.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 1","pages":"35-63"},"PeriodicalIF":3.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/28/74/40119_2022_Article_289.PMC9742042.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10835776","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":"Application of Single-Cell Genomics in Cardiovascular Research.","authors":"Xuejing Yu,&nbsp;Xianggui Yang,&nbsp;Jinjin Cao","doi":"10.1007/s40119-023-00303-y","DOIUrl":"https://doi.org/10.1007/s40119-023-00303-y","url":null,"abstract":"<p><p>Cardiovascular diseases (CVDs) are the leading cause of death in the global world. The emergence of single-cell technologies has greatly facilitated the research on CVDs. Currently, those single-cell technologies have been widely applied in atherosclerosis, myocardial infarction, cardiac ischemia-reperfusion injury, arrhythmia, hypertrophy cardiomyopathy, and heart failure, which are extremely helpful in elucidating the underlying mechanisms of CVDs from physiological and pathological perspectives at DNA, RNA, protein, post-transcriptional, post-translational, and metabolite levels. In this review, we would like to briefly introduce the current single-cell technologies, and will focus on the utilization of single-cell genomics in various heart diseases. Single-cell technologies have great potential in exploration of CVDs, and widespread application of single-cell genomics will promote the understanding and therapeutic treatments for CVDs.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 1","pages":"101-125"},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9c/8e/40119_2023_Article_303.PMC9986177.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9753730","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":"The Use of Midodrine as an Adjunctive Therapy to Liberate Patients from Intravenous Vasopressors: A Systematic Review and Meta-analysis of Randomized Controlled Studies.","authors":"Mohamed Hamed,&nbsp;Sheref A Elseidy,&nbsp;Ahmed Elkheshen,&nbsp;Jamal Maher,&nbsp;Adel Elmoghrabi,&nbsp;Ahmed Zaghloul,&nbsp;Andrew Panakos,&nbsp;Sidakpal Panaich,&nbsp;Marwan Saad,&nbsp;Ayman Elbadawi","doi":"10.1007/s40119-023-00301-0","DOIUrl":"https://doi.org/10.1007/s40119-023-00301-0","url":null,"abstract":"<p><strong>Background: </strong>Studies evaluating the role of midodrine as an adjunctive therapy to liberate patients with shock from intravenous (IV) vasopressors have yielded mixed results. The aim of our study was to evaluate the efficacy and safety of midodrine as an adjunctive therapy to liberate patients with shock from IV vasopressors.</p><p><strong>Methods: </strong>Electronic searches of the MEDLINE, EMBASE, and Cochrane databases through April 2022 for randomized controlled trials (RCTs) that evaluated the use of midodrine versus control in patients with shock and a low dose of IV vasopressors. The primary outcome was total IV vasopressor time, while the secondary outcomes included time-to-IV vasopressor discontinuation, IV vasopressor restart, intensive care unit (ICU) length of stay (LOS), hospital LOS, and incidence of bradycardia.</p><p><strong>Results: </strong>The final analysis included four RCTs with a total of 314 patients: 158 in the midodrine group and 156 in the control group, with a weighted mean age of 64 years (54.2% men). There was no significant difference in the total IV vasopressor time between the midodrine and control groups (standardized mean difference [SMD] - 0.53; 95% confidence interval [CI] - 1.38 to 0.32, p = 0.22; I² = 92%). Also, there were no significant differences between the two groups in the time-to-IV vasopressor discontinuation (SMD - 0.05; 95% CI - 0.57 to 0.47, p = 0.09), IV vasopressor restart (19.3 vs. 28.3%; risk ratio [RR] 0.74; 95% 0.25-2.20, p = 0.59), ICU LOS (SMD - 0.49; 95% CI - 1.30 to 0.33, p = 0.24), and hospital LOS (SMD 0.01; 95% CI - 0.27 to 0.29, p = 0.92). However, compared with the control group, the midodrine group had a higher risk of bradycardia (15.3 vs. 2.1% RR 5.56; 95% CI 1.54-20.05, p = 0.01).</p><p><strong>Conclusions: </strong>Among patients with vasopressor-dependent shock, midodrine was not associated with early liberation of vasopressor support or shorter ICU or hospital length of stay. Adding midodrine increased the risk of bradycardia. Further large RCTs are needed to better evaluate the efficacy and safety of midodrine in liberating patients from IV vasopressors.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":"12 1","pages":"185-195"},"PeriodicalIF":3.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1d/da/40119_2023_Article_301.PMC9986154.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9809384","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}