-
Current Problems in Cardiology Jul 2023Accumulation of epicardial adipose tissue (EAT) and Subclinical hypothyroidism (SH) are associated with increased cardio-metabolic risk. The objective of this study was... (Meta-Analysis)
Meta-Analysis Review
Accumulation of epicardial adipose tissue (EAT) and Subclinical hypothyroidism (SH) are associated with increased cardio-metabolic risk. The objective of this study was to quantitatively compare EAT thickening between patients with SH and healthy controls. Therefore, after searching the PubMed/MEDLINE, Embase, Science Direct, Scopus, Google Scholar, and Cochrane databases; we analyzed a group of observational studies who compare the EAT changes between SH vs control groups. A total of 9 studies were included in the final analysis, for a total of 424 patients with SH and 330 controls. Random or fixed effects models were used. Pooled analysis revealed that HS increased EAT (MD: 1.0 mm [0.40; 1.50]; P < 0.01). This meta-analysis suggests that the amount of EAT is significantly increased in SH patients. EAT might be a marker of cardiovascular risk in patients with SH.
Topics: Humans; Hypothyroidism; Obesity; Pericardium; Adipose Tissue; Heart Disease Risk Factors; Risk Factors
PubMed: 36841317
DOI: 10.1016/j.cpcardiol.2023.101674 -
Herz Aug 2016Several studies have suggested that epicardial adipose tissue (EAT) volume may be associated with the risk of atrial fibrillation (AF). However, these studies have... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several studies have suggested that epicardial adipose tissue (EAT) volume may be associated with the risk of atrial fibrillation (AF). However, these studies have reported conflicting results. We therefore aimed to investigate the relationship between EAT volume and AF.
METHODS
We systematically retrieved the relevant studies reporting on the relationship between EAT volume and AF using the Cochrane Library, PubMed, Medline, EBSCO, and Embase databases. Data were extracted from applicable articles, and mean differences were pooled using the RevMan 5.3 software.
RESULTS
Ten case-control studies were identified. With regard to the relationship between EAT volume and AF, both total-EAT volume (24.23 ml, 95 % CI: 19.40-29.06, p < 0.00001) and EAT volume surrounding the left atrium (LA-EAT; 16.35 ml, 95 %CI: 12.73-19.98, p < 0.00001) were significantly increased in patients with AF. With regard to the relationship between the different types of AF and EAT volume, there was a significant difference in the total-EAT volume subgroup (19.38 ml, 95 % CI: 11.45-27.31, p < 0.0001) and in the LA-EAT volume subgroup (17.91 ml, 95 % CI: 15.13-20.69, p < 0.00001) between patients with persistent AF (PeAF) and paroxysmal AF (PAF). However, there was no significant difference between the total-EAT and LA-EAT volume subgroups (χ (2) = 0.12, p = 0.70).
CONCLUSION
EAT volume may be associated with an increased risk of AF. Additionally, the EAT volume in patients with PeAF was larger than that in PAF patients, independent of the location of EAT.
Topics: Adipose Tissue; Adiposity; Atrial Fibrillation; Female; Humans; Imaging, Three-Dimensional; Incidence; Male; Multidetector Computed Tomography; Organ Size; Pericardium; Reproducibility of Results; Risk Assessment; Sensitivity and Specificity; Statistics as Topic
PubMed: 26659845
DOI: 10.1007/s00059-015-4387-z -
Cureus Oct 2022Inflammation of the pericardium is referred to as pericarditis, which can cause sharp chest pain and has a high chance of recurrence even after treatment. This review... (Review)
Review
Inflammation of the pericardium is referred to as pericarditis, which can cause sharp chest pain and has a high chance of recurrence even after treatment. This review will explore anakinra, which is an interleukin-1 receptor antagonist, as a potential new treatment for pericarditis. The systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by searching PubMed and GoogleScholar from the years 2012 to 2022. After applying inclusion and exclusion criteria, thorough screening, and quality appraisal, a total of eleven studies were included in the review; eight case reports and three clinical trials. All studies showed that 100 mg/day of anakinra caused a remarkable improvement in patient outcomes. In addition, the pericarditis resolved quicker and had a lower chance of recurrence in comparison to conventional therapy.
PubMed: 36212270
DOI: 10.7759/cureus.29862 -
European Journal of Cardio-thoracic... Oct 2015There is a growing trend to perform off-bypass surgical ablation for atrial fibrillation (AF) because it is perceived to be safer and more effective than the Cox-Maze... (Comparative Study)
Comparative Study Meta-Analysis Review
A systematic review of minimally invasive surgical treatment for atrial fibrillation: a comparison of the Cox-Maze procedure, beating-heart epicardial ablation, and the hybrid procedure on safety and efficacy.
There is a growing trend to perform off-bypass surgical ablation for atrial fibrillation (AF) because it is perceived to be safer and more effective than the Cox-Maze procedure with cardiopulmonary bypass (CPB) support. In this systematic review, we compared three minimally invasive stand-alone surgical ablation procedures for AF: the endocardial Cox-Maze procedure, epicardial surgical ablation and a hybrid epicardial surgical and catheter-based endocardial ablation procedure (hybrid procedure). Relevant studies were identified in MEDLINE and the Cochrane Database of Systematic Reviews according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From 565 initial studies, 37 were included in this review. The total number of patients across all studies was 1877 (range 10-139). Two studies reported on endocardial Cox-Maze procedures (n = 145), 26 reported on epicardial surgical ablation (n = 1382) and 9 reported on hybrid surgical ablation (n = 350). For minimally invasive Cox-Maze, epicardial and hybrid groups, operative mortality rates were 0, 0.5 and 0.9%, perioperative permanent pacemaker insertion rates were 3.5, 2.7 and 1.5%, incidence of conversion to median sternotomy was 0, 2.4 and 2.5%, and reoperation for bleeding was 1.0, 1.5 and 2.2%, with mean length of stay (days) of 5.4, 6.0 and 4.6, respectively. At 12 months, rates of sinus rhythm restoration were 93, 80 and 70%, and sinus restoration without anti-arrhythmic medications was 87, 72 and 71%, for Cox-Maze, epicardial and hybrid procedures, respectively. Of the three procedures, the minimally invasive Cox-Maze procedure with CPB support was most effective for the treatment of stand-alone AF and had important safety advantages in conversion to sternotomy and major bleeding. The minimally invasive Cox-Maze procedure with CPB support also demonstrated the potential for a higher success rate 12 months following the procedure.
Topics: Atrial Fibrillation; Cardiopulmonary Bypass; Catheter Ablation; Electrocardiography; Female; Humans; Length of Stay; Male; Minimally Invasive Surgical Procedures; Operative Time; Patient Safety; Pericardium; Prognosis; Risk Assessment; Severity of Illness Index; Survival Rate; Treatment Outcome
PubMed: 25567961
DOI: 10.1093/ejcts/ezu536 -
Annals of Vascular Surgery May 2024Infected aortic grafts and mycotic aneurysms represent one of the most complex challenges faced by vascular surgeons. Treatment has progressed from extra-anatomical... (Meta-Analysis)
Meta-Analysis Review
Outcomes Following Use of Bovine Pericardium (Xenoprosthetic) Grafts for Reconstruction of Mycotic Aortic Aneurysms and Infected Aortic Grafts: A Systematic Review and Meta-Analysis.
BACKGROUND
Infected aortic grafts and mycotic aneurysms represent one of the most complex challenges faced by vascular surgeons. Treatment has progressed from extra-anatomical bypass to in situ reconstruction. Additionally, bovine pericardium reconstruction (BPR) has increased, due to accessibility and reduced lower limb morbidity. There remains, however, limited evidence for its use. The aim is to pool all known data to understand outcomes following BPR of mycotic aneurysms or infected vascular grafts.
METHODS
A systematic review was conducted in November 2021 with subsequent computerized meta-analysis of the pooled results and a final search in March 2022. Three databases, Excerpta Medica dataBASE (EMBASE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), and National Institutes of Health PubMed (PubMed), were searched for the search term "(bovine OR xenoprosthetic) AND (aneurysm)", according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS
From 9 studies, there were 133 patients: 67% graft infections and 33% mycotic aneurysms. Fifty-seven percent of reconstructions were in the abdominal aorta and 33% were in the thoracic aorta. One hundred fifty-eight pathogens were identified, including Staphylococcus aureus (23%), Candida albicans (13%), and Escherichia coli (13%). In 12%, no microorganisms were identified. Thirty-day mortality was 19.14% (CI 10.83-28.71), late mortality was 19.08% (confidence interval [CI] 7.76-32.83), and overall mortality was 40.20% (CI 29.82-50.97). One patient died intraoperatively. There were a total of 151 in-hospital complications after 30 days postoperation. Common complications were acute renal failure (17%), pneumonia (14%), delirium (12%), respiratory insufficiency (11%) and renal insufficiency (7%). Lower limb ischemia was low, occurring in 5.66% (CI 0.54-13.82) of patients. Loss of graft patency leading to reintervention occurred in 1.20% (CI 0.00-7.71) of the grafts. Reinfection rate was 0.00% (CI 0.00-1.21).
CONCLUSIONS
This meta-analysis highlights low reinfection and high graft patency using BPR with medium-length follow-up; however, there remain limited long-term and comparative data regarding options for aortic reconstruction. As expected in this complex cohort, the complication rate and 30-day mortality remain high.
Topics: Humans; Cattle; Animals; Aneurysm, Infected; Reinfection; Treatment Outcome; Blood Vessel Prosthesis; Aorta, Abdominal; Blood Vessel Prosthesis Implantation; Aortic Aneurysm; Pericardium; Retrospective Studies; Risk Factors
PubMed: 38307226
DOI: 10.1016/j.avsg.2023.11.037 -
Lipids in Health and Disease May 2016Several studies have been performed to investigate the relationship between psoriasis and epicardial fat tissue (EFT). However, the number of patients of every single... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several studies have been performed to investigate the relationship between psoriasis and epicardial fat tissue (EFT). However, the number of patients of every single study is relatively small.
OBJECTIVES
We carried out a meta-analysis to evaluate whether EFT is associated with psoriasis.
METHODS
A search of PubMed, Ovid Embase, Ovid Medline, the Cochrane Library and Chinese BioMedical Literature Database (CBM) for controlled trials was done from inception to January 20th, 2016. Published trials that included a psoriasis group and a control group without psoriasis with data for at least epicardial fat tissue (EFT) were included. All statistical analyses were conducted using the Stata 12.0 (Stata Corporation, College Station, TX, USA).
RESULTS
There were 5 trials involving 731 patients. Patients with psoriasis showed significantly higher EFT than control group (SMD: 0.86, 95 % CI: 0.27-1.46, P = 0.004).
CONCLUSIONS
Patients with psoriasis have higher EFT compared to control subjects without psoriasis.
Topics: Adipose Tissue; Adult; Cardiovascular Diseases; Clinical Trials as Topic; Echocardiography; Female; Humans; Male; Middle Aged; Pericardium; Psoriasis; Risk Factors; Tomography, X-Ray Computed
PubMed: 27245937
DOI: 10.1186/s12944-016-0271-y -
European Journal of Cancer (Oxford,... Jun 2020An amassing body of evidence exists to support an association between the use of immune checkpoint inhibitors (ICIs) and the development of tuberculosis (TB).
BACKGROUND
An amassing body of evidence exists to support an association between the use of immune checkpoint inhibitors (ICIs) and the development of tuberculosis (TB).
METHODS
We performed a systematic review of the literature to assess the nature of this relationship using PubMed, EMBASE and meeting proceedings.
RESULTS
We have identified 16 patients who developed active TB during immunotherapy. Median age was 61 (range: 49-87). Twelve (75%) were male and 4 (25%) were female. Lung cancer was the most common type of cancer (n = 8), followed by melanoma (n = 3) and head and neck cancer (n = 3). Median time to TB reactivation after initiation of ICI therapy was 6.3 months (range: 1-24 months). Two (13%) patients died of complications of TB (spinal cord compression, GI perforation). TB reactivation in organs (pericardium, bone, liver, and GI track; one each) other than the lungs has been documented. We did not find any cases of TB reactivation that occurred during anti-CTLA-4 therapy.
CONCLUSION
Findings from our systematic review indicate that PD-(L)1 inhibitors are linked to TB reactivation. TB activation can occur in various organs and TB-related fatalities have been reported. TB screening before starting immunotherapy should be considered in high-risk patient populations. Further research, including prospective studies with patients whose baseline TB status is known, is necessary to better understand the incidence of TB reactivation during ICI therapy and how best to manage TB that develops during immunotherapy.
Topics: Aged; Aged, 80 and over; Antineoplastic Agents, Immunological; Female; Humans; Male; Middle Aged; Neoplasms; Prognosis; Survival Rate; Tuberculosis
PubMed: 32375103
DOI: 10.1016/j.ejca.2020.03.015 -
International Journal of Cardiology Jan 2018Pericardial effusion is the abnormal accumulation of fluid in the pericardial space. The complications of pericardial effusion can either be acute (e.g., cardiac... (Review)
Review
Pericardial effusion is the abnormal accumulation of fluid in the pericardial space. The complications of pericardial effusion can either be acute (e.g., cardiac tamponade) or chronic (e.g., constrictive pericarditis). We have conducted a systematic review of the scientific literature to evaluate the efficacy and safety of intrapericardial fibrinolysis in preventing complications of pericardial effusion. We searched for both published and unpublished studies. 29 studies, with a total of 109 patients were included in this review; 17 case reports, 11 case series, and one randomised controlled trial (RCT). All included studies had a high risk of bias. The most common causes of pericardial effusion were Staphylococcus aureus (12 studies with 23 cases) and Mycobacterium tuberculosis (2 studies with 19 cases). The most common fibrinolytic agents used were streptokinase (15 studies) and urokinase (5 studies). Intrapericardial fibrinolysis prevented complications in 94 (86.2%) patients. Non-fatal procedure-related complications were reported 21 (19.2%) patients. No patient died following intrapericardial fibrinolysis. There is very low certainty of the efficiency and safety of intrapericardial fibrinolysis in preventing the complications of pericardial effusion. High quality RCTs are required to address this question.
Topics: Fibrinolysis; Fibrinolytic Agents; Humans; Pericardial Effusion; Pericarditis; Pericardium; Randomized Controlled Trials as Topic; Streptokinase; Treatment Outcome
PubMed: 29107356
DOI: 10.1016/j.ijcard.2017.10.049 -
Immunotherapy May 2022The advent of PD-1/L1 inhibitors has changed the landscape for patients with non-small-cell lung cancer (NSCLC). Meanwhile, the adverse events of PD-1/L1... (Meta-Analysis)
Meta-Analysis Review
The advent of PD-1/L1 inhibitors has changed the landscape for patients with non-small-cell lung cancer (NSCLC). Meanwhile, the adverse events of PD-1/L1 inhibitors have been focused. The Cochrane Central Register of Controlled Trials, PubMed and Embase databases and ClinicalTrials.gov were searched from inception to February 2021. 18 studies involving 11,394 patients with NSCLC were included. PD-1/L1 inhibitor monotherapy was associated (relative risk, 95% confidence interval) with an increased risk of pericardial effusion (2.72 [1.45-5.12]; p = 0.002) and cardiac tamponade (2.76 [1.15-6.62]; p = 0.023), whereas PD-1/L1 inhibitors combined with chemotherapy did not increase the risk of pericardial effusion and cardiac tamponade (3.08 [0.93-10.21]; p = 0.066 and 3.27 [0.37-28.94]; p = 0.288, respectively). For patients with NSCLC, treatment with PD-1/L1 inhibitor monotherapy increases the risk of pericardial effusion and cardiac tamponade, but PD-1/L1 inhibitors combined with chemotherapy do not.
Topics: B7-H1 Antigen; Carcinoma, Non-Small-Cell Lung; Cardiac Tamponade; Humans; Immune Checkpoint Inhibitors; Lung Neoplasms; Pericardial Effusion; Programmed Cell Death 1 Receptor
PubMed: 35373580
DOI: 10.2217/imt-2021-0223 -
Journal of the Intensive Care Society Aug 2021Non-valvular cardiac aspergillosis is a rare infection of the pericardium, myocardium or endocardium and is associated with a high mortality. There is a paucity of... (Review)
Review
INTRODUCTION
Non-valvular cardiac aspergillosis is a rare infection of the pericardium, myocardium or endocardium and is associated with a high mortality. There is a paucity of reports of non-valvular cardiac aspergillosis in critically ill and solid organ transplant (SOT) patients. The majority of cases have been reported in haemato-oncology patients, some of whom have undergone a bone marrow transplant.
OBJECTIVES
We describe four cases affected by non-valvular cardiac aspergillosis in the intensive care setting including a systematic review of this extremely rare infection which is associated with high mortality.
RESULTS
All four-patients died but presented with varying clinical, radiological and microbiological evidence of the disease. Three patients presented following complications after solid organ transplantation, two in the context of acute liver failure and emergency liver transplant and one several years after a double lung transplant. The last patient presented with necrotising gall stone pancreatitis, multi-organ failure and subsequently a prolonged intensive care unit (ICU) stay. On review of the literature, January 1955 to July 2019, 45 cases were identified, with different risk factors, clinical and radiological manifestations, treatment regimen and outcome.
CONCLUSION
Antemortem diagnosis of cardiac aspergillosis is difficult and rare, with no cases reporting positive blood culture results. Galactomannan serology has poor sensitivity in solid organ transplant patients, further reduced by prophylactic antimicrobial treatment, which is common in the ICU setting especially post-transplant patients. Due to the scarcity of cases, treatment is extrapolated from invasive aspergillosis management, with emphasis on early treatment with combination therapy.
PubMed: 34422107
DOI: 10.1177/1751143720936821