Showing papers by "Marco Zuin published in 2023"
TL;DR: In this paper , the authors performed a systematic review and meta-analysis to assess the risk of acute pulmonary embolism (PE) and DVT in COVID-19 recovered subject.
Abstract: Data regarding the occurrence of venous thromboembolic events (VTE), including acute pulmonary embolism (PE) and deep vein thrombosis (DVT) in recovered COVID-19 patients are scant. We performed a systematic review and meta-analysis to assess the risk of acute PE and DVT in COVID-19 recovered subject. Following the PRIMSA guidelines, we searched Medline and Scopus to locate all articles published up to September 1st, 2022, reporting the risk of acute PE and/or DVT in patients recovered from COVID-19 infection compared to non-infected patients who developed VTE over the same follow-up period. PE and DVT risk were evaluated using the Mantel-Haenszel random effects models with Hazard ratio (HR) as the effect measure with 95% confidence interval (CI) while heterogeneity was assessed using Higgins I2 statistic. Overall, 29.078.950 patients (mean age 50.2 years, 63.9% males), of which 2.060.496 had COVID-19 infection, were included. Over a mean follow-up of 8.5 months, the cumulative incidence of PE and DVT in COVID-19 recovered patients were 1.2% (95% CI:0.9-1.4, I2: 99.8%) and 2.3% (95% CI:1.7-3.0, I2: 99.7%), respectively. Recovered COVID-19 patients presented a higher risk of incident PE (HR: 3.16, 95% CI: 2.63-3.79, I2 = 90.1%) and DVT (HR: 2.55, 95% CI: 2.09-3.11, I2: 92.6%) compared to non-infected patients from the general population over the same follow-up period. Meta-regression showed a higher risk of PE and DVT with age and with female gender, and lower risk with longer follow-up. Recovered COVID-19 patients have a higher risk of VTE events, which increase with aging and among females.
5 citations
TL;DR: In this paper , a systematic review and meta-analysis of the available data was conducted to assess the risk of new-onset hypertension in COVID-19 survivors within one year from the index infection.
Abstract: Arterial Hypertension (HT) has been described as a common comorbidity and independent risk factor of short-term outcome in COVID-19 patients. However, data regarding the risk of new-onset HT during the post-acute phase of COVID-19 are scant. We assess the risk of new-onset HT in COVID-19 survivors within one year from the index infection by a systematic review and meta-analysis of the available data. Data were obtained searching MEDLINE and Scopus for all studies published at any time up to February 11, 2023, and reporting the long-term risk of new-onset HT in COVID-19 survivors. Risk data were pooled using the Mantel–Haenszel random effects models with Hazard ratio (HR) as the effect measure with 95% confidence interval (CI). Heterogeneity among studies was assessed using I2 statistic. Overall, 19,293,346 patients (mean age 54.6 years, 54.6% males) were included in this analysis. Of them, 758,698 survived to COVID-19 infection. Over a mean follow-up of 6.8 months, new-onset HT occurred to 12.7 [95% CI 11.4–13.5] out of 1000 patients survived to COVID-19 infection compared to 8.17 [95% CI 7.34–8.53] out of 1000 control subjects. Pooled analysis revealed that recovered COVID-19 patients presented an increased risk of new-onset HT (HR 1.70, 95% CI 1.46–1.97, p < 0.0001, I2 = 78.9%) within seven months. This risk was directly influenced by age (p = 0.001), female sex (p = 0.03) and cancer (p < 0.0001) while an indirect association was observed using the follow-up length as moderator (p < 0.0001). Our findings suggest that new-onset HT represents an important post-acute COVID-19 sequelae.
1 citations
TL;DR: In this paper , a protocol has been proposed for the appropriate management of LDL-C levels in post-ACS patients both in terms of therapeutic choice and timing of treatment use.
Abstract: Current guidelines on the management of dyslipidemias of the European Society of Cardiology/European Atherosclerosis Society recommend reducing low-density lipoprotein cholesterol (LDL-C) in patients after an acute coronary syndrome (ACS) by ≥50% compared to baseline values with a LDL-C level below 1.4 mmol/l (55 mg/dl) (class I recommendation, level of evidence A). However, in the real world, a low proportion of patients is treated according to the recommended lipid-lowering therapies and, as a consequence, very few people reach these targets. We analyzed seven recent studies reporting data on lipid control in 36 354 patients who were at very high risk because of a previous ACS in Europe. Overall, only 12.1% (95% confidence interval 9.8-13.5) of the patients achieved the recommended LDL-C levels, highlighting the gap between guidelines and current clinical practice. Indeed, the so-called stepwise strategy, although effective from a theoretical point of view, seems hardly applicable in the real world, underlying the need for new therapeutic strategies and algorithms. Based on these observations, a protocol has been proposed for the appropriate management of LDL-C levels in post-ACS patients both in terms of therapeutic choice and timing of treatment use.
1 citations
1 citations
TL;DR: In this article , the authors review the evidence supporting the potential benefit of earlier administration of reperfusion in hemodynamically unstable pulmonary embolism patients and suggest some potential strategies to further explore this issue.
Abstract: High-risk pulmonary embolism (PE) is associated with significant morbidity and mortality. Systemic thrombolysis (ST) remains the most evidenced-based treatment for hemodynamically unstable PE but, in daily clinical practice, it remains largely underused. In addition, unlike acute myocardial infarction or stroke, a clear time window for reperfusion therapy, including fibrinolysis, for high-risk PE has not been defined either for fibrinolysis, or for the more recently incorporated options of catheter-based thrombolysis or thrombectomy. The aim of the present article is to review the current evidence supporting the potential benefit of earlier administration of reperfusion in hemodynamically unstable PE patients and suggest some potential strategies to further explore this issue.
TL;DR: In this paper , the authors present and discuss recent advancements in device design and composition from both technical and clinical perspectives, as well as the advent of new bioabsorbable materials, is promising to make percutaneous PFO closure devices safer.
Abstract: ABSTRACT Introduction Over the last 5 years, the armamentarium of the interventional cardiologist dealing with percutaneous closure of patent foramen ovale (PFO) has been enriched by some novel devices and further improvements of existing ones that have or promise to increase the safety and effective closure rate of PFO patients. Areas covered This review presents and discusses recent advancements in device design and composition from both technical and clinical perspectives. Expert opinion Device technology is continuously evolving. The recent modification of delivery system, device hooking, and composition, as well as the advent of new bioabsorbable materials, is promising to make percutaneous PFO closure devices safer. The search for more effectiveness with possibly less metal behind is still ongoing.
TL;DR: In this article , the authors assess the sex and age-specific trends in acute myocardial infarction (AMI) mortality in the modern European Union (EU-27) member states between years 2012 and 2020.
Abstract: AIMS
To assess the sex- and age- specific trends in acute myocardial infarction (AMI) mortality in the modern European Union (EU-27) member states between years 2012 and 2020.
METHODS AND RESULTS
Data on cause-specific deaths and population numbers by sex for each country of the EU-27 were retrieved through publicly available European Statistical Office (EUROSTAT) dataset for the years 2012 to 2020. AMI-related deaths were ascertained when codes for AMI (ICD-10 codes I21.0-I22.0) were listed as the underlying cause of death in the medical death certificate. Deaths occurring before the age of 65 years were defined as premature deaths. To calculate annual trends, we assessed the average (AAPC) annual percent change with relative 95% confidence intervals (CIs) using Joinpoint regression. During the study period, 1,793,314 deaths (1,048,044 males and 745,270 females) occurred in the EU-27 due to of AMI. The proportion of AMI-related deaths per 1,000 total deaths decline from 5.0% to 3.5% both in the entire population (p for trend <0.001) and in males or females, separately. Joinpoint regression analysis revealed a continuous linear decrease in age-adjusted AMI-related mortality from 2012 to 2020 among EU-27 members [AAPC: -4.6% (95% CI: -5.1 to -4.0), p < 0.001]. The age-adjusted mortality rate showed a plateau in some Eastern European countries and was more pronounced in EU-27 females and in subjects aged ≥ 65 years old.
CONCLUSIONS
Over the last decade, the age-adjusted AMI-related mortality has been continuously declining in most of the in EU-27 Member States. However, some disparities still exist between western and eastern European countries.
TL;DR: In this paper , the key tips for performing US-guided access using the distal radial artery (dRA) in patients undergoing percutaneous cardiac procedures are provided. But, due to the presence of different muscular-skeletal structures, as well as to the small diameter of the dRA, an ultrasound-guided cannulation would be preferred since a blind puncture increases the risk of tendon damage and/or the irritation of the underlying periosteum.
Abstract: Over the latest years, the use of distal radial access (dTRA), also called “snuffbox,” has become more and more popular for cardiac catheterization. Indeed, dTRA has several advantages compared to the traditional proximal radial approach, such as a lower risk of hand ischemia, radial artery occlusion (RAO) and faster post‐procedural hemostasis. However, due to the presence of different muscular‐skeletal structures, as well as to the small diameter of the distal radial artery (dRA), an ultrasound‐guided cannulation would be preferred since a blind puncture increases the risk of tendon damage and/or the irritation of the underlying periosteum. The present article is aimed to provide the key tips for performing US‐guided access using the dRA in patients undergoing percutaneous cardiac procedures.
TL;DR: The authors performed a systematic review and meta-analysis to establish the pooled prevalence and the in-hospital outcomes of chronic thrombocytopenia (cTCP) in patients after TAVR.
Abstract:
Thrombocytopenia represents an important issue in patients undergoing Transcatheter aortic valve replacement (TAVR) due to severe aortic stenosis. We performed a systematic review and meta–analysis to establish the pooled prevalence and the in–hospital outcomes of Chronic thrombocytopenia (cTCP) in patients after TAVR.
PubMed and Scopus databases were systematically searched for articles, published in any language, from inception through September 15, 2022, reporting the prevalence of cTCP in patients who underwent TAVR and providing data on the hospital outcomes. The pooled prevalence and the outcomes were evaluated pooling the adjusted odds ratio (OR) with the related 95% confidence interval (CI) using a random– effect models. Statistical heterogeneity between groups was measured using the Higgins I2 statistic
Overall, 1,402,431 patients (mean age 87.2 years, 45.1% females) where hospitalized for TAVR. Among them, cTCP was observed in 7.0% of cases (95% CI: 1.7–24.5%, p<0.0001, I2:84.5%). No significant differences were observed for in–hospital mortality and stroke comparing patients with cTCP to those without (OR: 1.07, 95% CI: 0.62–1.82, p=0.802, I2: 79.6% and OR: 0.90, 95% CI: 0.67–1.21, p=0.48, I2: 0%, respectively). Conversely, cTCP subjects showed a significant higher risk of vascular complications (OR: 1.72, 95% ci 1.37–2.16, p<0.0001, I2:0%), acute kidney injury (OR: 1.60, 95% CI: 1.16–2.20, p=0.004, I2:81.4%) and cardiac tamponade (OR: 3.31, 95% ci: 1.85–5.94, p<0.0001, I2: 0%) (Figure 1).
cTCP is present in about 7% of patients underoing TAVR and was results associated with an increased risk of vascular complications and cardiac tamponade during the periprocedural period.
TL;DR: In this article , a meta-analysis of existing data comparing the PON1 arylesterase activity in AD and healthy subjects from the general population was performed, which revealed that PON 1 activity was significantly lower in the AD group compared to controls, exhibiting low level of heterogeneity.
TL;DR: In this article , the authors assessed the trends in patients with acute myocardial infarction (AMI) with cardiogenic shock (CS) related mortality in United States (US) subjects over the latest 21 years.
Abstract: Data on mortality trends in patients with acute myocardial infarction (AMI) with cardiogenic shock (CS) are scant. This study aimed to assess the trends in CS-AMI-related mortality in United States (US) subjects over the latest 21 years. Mortality data of US subjects with AMI listed as the underlying cause of death and CS as contributing cause were obtained from the Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiologic Research) dataset from January 1999 to December 2019. CS-AMI-related age-adjusted mortality rates (AAMRs) per 100,000 US population were stratified by gender, race and ethnicity, geographic areas, and urbanicity. Nationwide annual trends were assessed as annual percent change (APC) and average APC with relative 95% confidence intervals (CIs). Between 1999 and 2019, CS-AMI was listed as the underlying cause of death in 209,642 patients, (AAMR of 3.01 per 100,000 people [95% CI 2.99 to 3.02]). AAMR from CS-AMI remained stable from 1999 to 2007 (APC -0.2%, [95% CI -2.0 to 0.5], p = 0.22) and then significantly increased (APC 3.1% [95% CI 2.6 to 3.6], p <0.0001), especially in male patients. Starting in 2009, the AAMR increase was more pronounced in those <65 years, Black Americans, and residents of rural areas. The higher AAMRs were clustered in the South (average APC 4.5%, [95% CI 4.4 to 4.6]) of the country. In conclusion, CS-AMI-related mortality in US patients increased from 2009 to 2019. Targeted health policy measures are needed to address the rising burden of CS-AMI in US subjects.
TL;DR: In this paper , the authors assess current trends in US mortality related to high-risk pulmonary embolism (PE) over the past 21 years and determine differences by sex, race, ethnicity, age and census region.
TL;DR: In this article , the authors assessed the prognostic role of different patterns of dyspnoea onset regarding in-hospital mortality, clinical deterioration and the composite of the outcomes in PE patients, according to their haemodynamic status at admission.
Abstract: Aims Dyspnoea is a well known symptom of acute pulmonary embolism (PE). We assess the prognostic role of different patterns of dyspnoea onset regarding in-hospital mortality, clinical deterioration and the composite of the outcomes in PE patients, according to their haemodynamic status at admission. Methods Patients from the prospective Italian Pulmonary Embolism Registry (IPER) were included in the study. At admission, patients were stratified, according to their haemodynamic status, as high- (haemodynamically unstable) and non-high-risk (haemodynamically stable) patients. Results Overall, 1623 consecutive patients (mean age 70.2 ± 15.2 years, 696 males), with confirmed acute PE, were evaluated for the features of dyspnoea. Among these, 1353 (83.3%) experienced dyspnoea at admission. No significant differences were observed regarding in-hospital mortality and the composite outcome of in-hospital mortality and clinical deterioration between patients with and without dyspnoea. However, in non-high-risk patients, clinical deterioration was more frequently observed when dyspnoea was present compared with absence of dyspnoea (P = 0.002). Multivariate Cox regression analyses showed that non-high-risk patients had an increased risk of clinical deterioration when experiencing dyspnoea within 24 h [hazard ratio (HR): 1.57, 95% confidence interval (CI): 1.49–1.65, P < 0.0001] and between 25 h and 7 days before admission (HR: 1.66, 95% CI: 1.58–1.77, P < 0.0001), independently of age, sex, right ventricular dysfunction, positive cardiac troponin and thrombolysis. Conclusions Non-high-risk PE patients experiencing dyspnoea within 7 days before hospitalization had a higher risk of clinical deterioration compared with those without and, therefore, they may require more aggressive management.
TL;DR: In this article , the authors assessed the atrial fibrillation/flutter (AF/AFL) mortality rates and relative trends among the Italian population between 2003 and 2017 using joinpoint regression analysis.
Abstract: AIMS
We sought to assess the atrial fibrillation/flutter (AF/AFL) mortality rates and relative trends among the Italian population between 2003 and 2017.
METHODS
Data regarding the cause-specific mortality and population size by sex in 5-year age groups were extracted from the World Health Organization (WHO) global mortality database. Decedents reporting the codes I48 were extracted accordingly to the International Classification of Disease-10 (ICD-10) coding system. The age-adjusted mortality rates (AAMRs), with relative 95% confidence intervals (CIs), also stratified by sex, were determined using the direct method. Joinpoint regression analyses were used to identify periods with statistically distinct log linear trends in AF/AFL-related death rates. To calculate nationwide annual trends in AF/AFL-related mortality, we assessed the average annual percentage change (AAPC) and relative 95% CIs.
RESULTS
Over the study period, 90 623 (57 109 females) AF-related deaths were recorded. The AF/AFL AAMR increased from 8.1 (95% CI: 7.8-8.2) deaths per 100 000 to 18.7 (16.9-20.0) deaths per 100 000 population. Joinpoint regression analysis revealed a linear increase in age-standardized AF/AFL-related mortality [AAPC: +3.6 (95% CI: 3.0-4.3, P < 0.0001)] in the entire Italian population. Moreover, the mortality rate increased with age, showing a seemingly exponential distribution with a similar trend between males and females. Although the increase was more pronounced among women [AAPC: +3.7 (95% CI: 3.1-4.3, P < 0.0001)] compared with men [AAPC: +3.4 (95% CI: 2.8-4.0, P < 0.0001)], the difference did not reach statistical significance (P = 0.16).
CONCLUSIONS
In Italy, the AF/AFL-related mortality rates linearly increased from 2003 to 2017.
TL;DR: In this paper , the authors used the free publicly available EUROSTAT death certificate database to examine premature age-adjusted IHD mortality rates (per 100.000) and relative average annual percentage change (AAPC) in Italy from 2011 to 2017 using ICD-codes I20-I25.
TL;DR: In this paper , a meta-analysis of data from cohort studies was performed to estimate the association between weekend admission and short-term mortality in atrial fibrillation (AF) patients.
Abstract: Background Previous investigations have analysed the relationship between weekend (WE) admission and early death in patients with atrial fibrillation (AF) patients without reaching univocal results. We systematically reviewed the available literature and performed a meta-analysis of data from cohort studies to estimate the association between WE admission and short-term mortality in AF patients.Methods This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. We searched relevant publications using MEDLINE and Scopus from inception until 15 November 2022. Studies reporting the mortality risk as an adjusted odds ratio (OR), with relative 95% confidence interval (CI) comparing early (in‐hospital or 30‐day) mortality between patients admitted during the WE (Friday to Sunday) versus weekdays (WD) and having confirmed AF were included into the analysis. Data were pooled using a random-effects models with OR and related 95% CI.Results Overall, 5.164.986 AF patients (mean age 69.7 years old, 47.6% males) enrolled in five retrospective investigations were considered for the analysis. A random-effect model evidenced that AF patients admitted during the WE had a higher risk of 30-day or in-hospital death (adjusted OR: 1.57; 95% CI, 1.05–1.27, p = .003, I2 = 64.7%). Sensitivity analysis confirmed yielded results. A meta-regression analysis showed a relationship between mortality and the mean age of the studies included (p = .001) while no associations were identified using sex as moderating variables (p = .15).Conclusions Patients admitted during WE for AF are characterised by an approximately 58% excess in the risk of early death.
TL;DR: In this article , the authors evaluated the temporal trend of the atherosclerosis-related discharges and the relative LOS among Italian subjects aged >20 years, between the years 2010 and 2019.
Abstract: Introduction Atherosclerosis remains the top cause of mortality and morbidity among the Italian population. The increasing life-expectancy represents a key determinant of cardiovascular disease (CVD) epidemiology in Italy, considering that older age is one of the major determinants of cardiovascular health. However, data regarding the trend of the atherosclerosis-related hospitalizations and the relative length of stay (LOS) among the Italian population has remained scant. The aim of the present study is to evaluate the temporal trend of the atherosclerosis-related discharges and the relative LOS among Italian subjects aged >20 years, between the years 2010 and 2019.
TL;DR: In this article , the authors used joinpoint regression analysis to identify periods with statistically distinct log linear trends in PH-related death rates and calculated nationwide annual trends in DCM-related mortality, to calculate the average annual percentage change (AAPC) and relative 95% CIs.
Abstract: Aims Data regarding the pulmonary hypertension (PH)-related mortality and relative trends in the Italian population remain scant. We sought to assess the PH mortality rates and relative trends among the Italian population between 2005 and 2017. Methods Data regarding the cause-specific mortality and population size by sex in 5-year age groups were extracted from the WHO global mortality database. The age-standardized mortality rates, with relative 95% confidence intervals (CIs), also stratified by sex, were using the direct method. Joinpoint regression analyses were used to identify periods with statistically distinct log linear trends in PH-related death rates. To calculate nationwide annual trends in DCM-related mortality, we assessed the average annual percentage change (AAPC) and relative 95% CIs. Results In Italy, the PH age-standardized annual mortality rate decreased from 2.34 (95% CI: 2.32–2.36) deaths per 100 000 to 1.51 (95% CI: 1.48–1.53) deaths per 100 000 population. Over the entire period, men had higher PH-related mortality rates than women. Moreover, the PH-related mortality trend rose with a seemingly exponential distribution with a similar trend among male and female individuals. Joinpoint regression analysis revealed a linear significant decrease in age-standardized PH-related mortality from 2005 to 2017 [AAPC: −3.1% (95% CI: −3.8 to −2.5), P < 0.001] in the entire Italian population. However, the decline was more pronounced among men [AAPC: −5.0 (95% CI: −6.1 to −3.9), P < 0.001] compared with women [AAPC: −1.5 (95% CI: −2.3 to −0.7), P = 0.001]. Conclusion In Italy, the PH-related mortality rates linearly declined from 2005 to 2017.
TL;DR: In this paper , the authors systematically reviewed and analyzed all studies published from 2008 to 2022 that evaluated the optimal therapeutic window for systemic thrombolysis in high-risk acute pulmonary embolism (PE) patients.
Abstract: Current guidelines on the management of acute pulmonary embolism (PE) of the European Society of Cardiology recommend the administration of systemic thrombolysis in hemodynamically unstable patients (defined as high risk - class I, level of evidence A). However, in the real world, systemic thrombolysis remains underused in hemodynamically unstable PE patients. We systematically reviewed and analyzed all studies published from 2008 to 2022 that evaluated the optimal therapeutic window for systemic thrombolysis in high-risk PE patients, also reporting potential thrombolysis-related adverse events. We identified only two studies enrolling 532 patients (mean age 65.5 years, 251 male). These studies suggested that early administration of systemic thrombolysis was associated with reduced short-term mortality and lower rates of major bleeding events and subsequent clinical deterioration. The identification of a less wide therapeutic window for the administration of systemic thrombolysis may improve the short-term mortality of high-risk PE patients and reduce the incidence of thrombolysis-related adverse events encouraging the use of systemic fibrinolysis, where appropriate.
TL;DR: In this paper , the authors used joinpoint regression analysis to identify periods with statistically distinct log linear trends in dilated cardiomyopathy-related death rates in the Italian population between 2005 and 2017.
Abstract: Aims Data regarding the dilated cardiomyopathy (DCM)-related mortality and relative time trends in the Italian population remain scant. We sought to assess the DCM mortality rates and relative trends among the Italian population between 2005 and 2017. Methods Annual death rates by sex and 5-year age group were extracted from the WHO global mortality database. The age-standardized mortality rates, with relative 95% confidence intervals (95% CIs), also stratified by sex, were calculated using the direct method. Joinpoint regression analyses were used to identify periods with statistically distinct log linear trends in DCM-related death rates. To calculate nationwide annual trends in DCM-related mortality, we assessed the average annual percentage change (AAPC) and relative 95% CIs. Results In Italy, the DCM age-standardized annual mortality rate decreased from 4.99 (95% CI: 4.97–5.02) deaths per 100 000 to 2.51 (95% CI: 2.49–2.52) deaths per 100 000 population. Over the entire period, men had a higher DCM-related mortality rates than women. Moreover, the mortality rate increased with age, with a seemingly exponential distribution and showing a similar trend among men and women. Joinpoint regression analysis revealed a linear decrease in age-standardized DCM-related mortality from 2005 to 2017 [AAPC: −5.1% (95% CI: −5.9 to −4.3, P < 0.001)] in the entire Italian population. However, the decline was more pronounced among women [AAPC: −5.6 (95% CI: −6.4 to −4.8, P < 0.001)] compared with men [AAPC: −4.9 (95% CI: −5.8 to −4.1, P < 0.001)]. Conclusion In Italy, the DCM-related mortality rates linearly declined from 2005 to 2017.
TL;DR: In this paper , the trends of ventricular fibrillation and flutter (VF/VFL)related mortality in the United States (US) population have not yet been investigated.
Abstract: The Ventricular fibrillation and flutter (VF/VFL)‐related mortality trends in the United States (US) population have not yet been investigated. We aimed to assess the trends of VT/VFL‐related mortality from 1999 to 2019 among subjects aged more than 15 years old in the US.
TL;DR: In this article , the authors analyzed the death records provided in the publicly available Multiple Cause of Death Dataset of the Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiological Research).
Abstract: Data regarding the mortality rate in patients with mitral valve prolapse (MVP) experiencing sudden cardiac death (SCD) remains scant. To further elucidate this issue in the US population, we analyzed the death records provided in the publicly available Multiple Cause of Death Dataset of the Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiological Research) between 1999 and 2020. In this cohort study, 824 US subjects with MVP died from SCD between 1999 and 2020, representing about the 0.3% of all SCDs. The higher mortality rate was observed among women aged <44 years, of White ethnicity, living in urban areas. In conclusion, although the mortality rate of SCD in patients with MVP remains low among the general population, the identification of demographic features and risk factors for SCD may enable strategies for the risk stratification of MVP.
TL;DR: In this paper , the authors summarize the current available data regarding the pathophysiological role of secondary flows in coronary artery bifurcation, providing an interpretation of these findings from an interventional perspective.
TL;DR: In this paper , a review of the available literature to highlight the clinical and diagnostic elements that could contribute to suspicion of myocarditis as an adverse event of SARS-CoV-2 immunization was performed.
Abstract: The occurrence of acute myocarditis following the administration of mRNA vaccines against SARS-CoV-2 remains relatively rare, and it is associated with a very low mortality rate. The incidence varied by vaccine type, sex, and age and after the first, second, or third vaccination dose. However, the diagnosis of this condition often remains challenging. To further elucidate the relationship between myocarditis and SARS-CoV-2 mRNA vaccines, starting with two cases observed at the Cardiology Unit of the West Vicenza General Hospital located in the Veneto Region, which was among the first Italian areas hit by the COVID-19 pandemic, we performed a review of the available literature to highlight the clinical and diagnostic elements that could contribute to suspicion of myocarditis as an adverse event of SARS-CoV-2 immunization.
TL;DR: Recently, growing evidence has shown that high levels of lipoprotein (a) and chronic inflammation may be responsible for the residual risk of cardiovascular events in patients managed with an optimal evidence-based approach as discussed by the authors .
Abstract: Growing evidence has shown that high levels of lipoprotein (a) (Lp(a)) and chronic inflammation may be responsible for the residual risk of cardiovascular events in patients managed with an optimal evidence-based approach. Clinical studies have demonstrated a correlation between higher Lp(a) levels and several atherosclerotic diseases including ischemic heart disease, stroke, and degenerative calcific aortic stenosis. The threshold value of Lp(a) serum concentrations associated with a significantly increased cardiovascular risk is >125 nmol/L (50 mg/dL). Current available lipid-lowering drugs have modest-to-no impact on Lp(a) levels. Chronic inflammation is a further condition potentially implicated in residual cardiovascular risk. Consistent evidence has shown an increased risk of cardiovascular events in patients with high sensitivity C reactive protein (>2 mg/dL), an inflammation biomarker. A number of anti-inflammatory drugs have been investigated in patients with or at risk of cardiovascular disease. Of these, canakinumab and colchicine have been found to be associated with cardiovascular risk reduction. Ongoing research aimed at improving risk stratification on the basis of Lp(a) and vessel inflammation assessment may help refine patient management. Furthermore, the identification of these conditions as cardiovascular risk factors has led to increased investigation into diagnostic and therapeutic strategies targeting them in order to reduce atherosclerotic cardiovascular disease burden.