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The American Journal of Cardiology Feb 2023Myocardial bridging (MB) is a congenital variant in which a segment of a coronary artery follows an atypical intramural course under a "bridge" of myocardium and is... (Meta-Analysis)
Meta-Analysis
Myocardial bridging (MB) is a congenital variant in which a segment of a coronary artery follows an atypical intramural course under a "bridge" of myocardium and is notably common in hypertrophic cardiomyopathy (HCM). This systematic review and meta-analysis explored the clinical consequences of MB in patients with HCM. A total of 3 outcome domains were investigated: cardiovascular mortality, nonfatal adverse cardiac events, and investigative indicators of myocardial ischemia. A meta-analysis was performed on 10 observational studies comparing outcomes in patients with HCM with and without MB. Studies were identified through a systematic search of 4 databases (PubMed, Scopus, Medline Complete, and Web of Science). The quality of the studies was assessed using a modified version of the Downs and Black tool, from which studies could score a maximum of 23 points. The mean score was 17.5 ± 1.3 (good). The meta-analysis showed that MB was not associated with cardiovascular mortality (odds ratio [OR] 1.70, 95% confidence interval [CI] 0.56 to 5.15, p = 0.35) or nonfatal adverse cardiac events (OR 1.80, 95% CI 0.98 to 3.28, p = 0.06) but was associated with myocardial ischemia (OR 1.89, 95% CI 1.03 to 3.44, p = 0.04). In conclusion, the potential prognostic implications of MB in HCM, especially in those with hemodynamically significant bridges and/or severe underlying disease, should not be ignored. The focus of future studies should be to establish functional and morphologic thresholds, by which MB may adversely influence prognosis by corroborating imaging findings with clinical outcome data.
Topics: Humans; Myocardial Bridging; Cardiomyopathy, Hypertrophic; Myocardium; Myocardial Ischemia
PubMed: 36512852
DOI: 10.1016/j.amjcard.2022.10.059 -
The International Journal of... Mar 2023Some studies have indicated that the use of 2D-Speckle tracking echocardiography (2DSTE) aids in predicting recovery of myocardial contractile function after... (Meta-Analysis)
Meta-Analysis
Some studies have indicated that the use of 2D-Speckle tracking echocardiography (2DSTE) aids in predicting recovery of myocardial contractile function after revascularization in patients with chronic ischemic left ventricular (LV) dysfunction or acute myocardial infarction (MI). The purpose of this meta-analysis was to evaluate the diagnostic accuracy of 2DSTE strain in the detection of myocardial viability at rest and during low-dose dobutamine (LDD) stress. A systematic review for all prospective trials using 2DSTE to assess myocardial viability until January 2019 was done. Using a standard approach of meta-analysis for diagnostic tests. Overall, nine studies including 525 patients with either chronic ischemic heart disease or acute MI fulfilled the inclusion criteria. Seven studies used longitudinal strain (LS) at rest, nine studies used circumferential strain (CS) at rest, four studies used LS during LDD stress, and four studies used CS during LDD stress. LS and CS during LDD stress showed equally high sensitivity (81.5% and 81.5% respectively) and specificity (81.3% and 81.4% respectively) for detecting reversible dysfunction. At rest, LS and CS showed equally lower sensitivity (67.1%, p < 0.0001 vs. LDD stress and 68.7%, p < 0.0001, vs. LDD stress, respectively) and specificity (64%, p < 0.0001 vs. LDD stress and 65.7%, p = 0.0008 vs. LDD stress, respectively) as compared with LDD stress. LS and CS by 2DSTE during LDD stress accurately identify reversible ischemic myocardial dysfunction in patients with chronic ischemic LV dysfunction or after MI. The use of LDD stress can be recommended over resting strain measures in this setting.
Topics: Humans; Prospective Studies; Predictive Value of Tests; Echocardiography; Myocardium; Myocardial Ischemia; Ventricular Dysfunction, Left; Myocardial Infarction
PubMed: 36369588
DOI: 10.1007/s10554-022-02753-2 -
Medicina (Kaunas, Lithuania) Oct 2022According to recent guidelines, myocardial contrast echocardiography (MCE) is recommended for detecting residual myocardial viability (MV). However, the long-term... (Meta-Analysis)
Meta-Analysis Review
Long-Term Prognostic Value of Myocardial Viability by Myocardial Contrast Echocardiography in Patients after Acute Myocardial Infarction: A Systematic Review and Meta-Analysis.
According to recent guidelines, myocardial contrast echocardiography (MCE) is recommended for detecting residual myocardial viability (MV). However, the long-term prognostic value of MV as assessed by MCE in identifying major adverse cardiac events (MACE) after acute myocardial infarction (AMI) remains undefined. We searched multiple databases, including PubMed, EMBASE, and Web of Science for studies on the prognostic value of MCE for clinical outcomes in AMI patients. The primary endpoints were MACEs during follow-up. Six studies that evaluated a total of 536 patients with a mean follow-up of 36.8 months were reviewed. The pooled sensitivity and specificity of MCE for predicting MACEs were 0.80 and 0.78, respectively, and the summary operating receiver characteristics achieved an area under the curve of 0.84. The pooled relative risks demonstrated that the MV evaluated by MCE after AMI was correlated with a high risk for total cardiac events (pooled relative risk: 2.07; 95% confidence interval: 1.28-3.37) and cardiac death (pooled relative risk: 2.48; 95% confidence interval: 1.03-5.96). MV evaluated by MCE was a highly independent predictor of total cardiac events (pooled hazard ratio: 2.09, 95% confidence interval: 1.14-3.81) in patients after AMI. Residual MV evaluated by MCE may be an effective long-term prognostic tool for predicting MACE in patients after AMI that can provide moderate predictive accuracy. The assessment of MV by MCE may become an alternative technique with the potential to rapidly provide important information for improving long-term risk stratification in patients after AMI, at the bedside in clinical practice, especially for patients who cannot tolerate prolonged examinations. The PROSPERO registration number is CRD42020167565.
Topics: Humans; Prognosis; Echocardiography; Myocardial Infarction; Myocardium; Heart; Predictive Value of Tests
PubMed: 36295589
DOI: 10.3390/medicina58101429 -
Cardiovascular Revascularization... Feb 2023Myocardial viability assessment is used to select patients who will derive the greatest benefit from revascularization. It remains controversial whether... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Myocardial viability assessment is used to select patients who will derive the greatest benefit from revascularization. It remains controversial whether revascularization only benefits patients with ischemic cardiomyopathy who have viable myocardium. The objective of this meta-analysis was to compare mortality between patients with ischemic cardiomyopathy and non-viable myocardium who underwent revascularization and those who underwent medical therapy alone.
METHODS
The MEDLINE database was searched using PubMed to retrieve studies published up to December 2021. Inclusion criteria were 1. studies that evaluated the impact of revascularization (revascularization group) versus medical therapy alone (control group) following myocardial viability assessment; 2. patients who had coronary artery disease that was amenable to coronary artery bypass grafting or percutaneous coronary intervention; and 3. patients who had non-viable myocardium. The main outcome measure was all-cause mortality.
RESULTS
A total of 12 studies were included, evaluating 1363 patients with non-viable myocardium, of whom 501 patients underwent revascularization and 862 patients received medical therapy alone. There was a significant reduction in all-cause mortality (RR 0.76, 95 % CI: 0.62-0.93, I = 0) in the revascularization group compared to the control group. There was no association between the type of viability imaging modality and the risk of all-cause mortality (P-interaction = 0.58).
CONCLUSIONS
The findings of this meta-analysis suggest a benefit from revascularization compared to medical therapy in patients with ischemic cardiomyopathy despite the lack of myocardial viability.
Topics: Humans; Stroke Volume; Myocardial Ischemia; Myocardium; Coronary Artery Disease; Cardiomyopathies; Myocardial Revascularization
PubMed: 36055939
DOI: 10.1016/j.carrev.2022.08.032 -
Clinical Cardiology Oct 2022This meta-analysis aims to look at the impact of early intravenous Metoprolol in ST-segment elevation myocardial infarction (STEMI) before percutaneous coronary... (Meta-Analysis)
Meta-Analysis Review
Effect of early metoprolol before PCI in ST-segment elevation myocardial infarction on infarct size and left ventricular ejection fraction. A systematic review and meta-analysis of clinical trials.
AIM
This meta-analysis aims to look at the impact of early intravenous Metoprolol in ST-segment elevation myocardial infarction (STEMI) before percutaneous coronary intervention (PCI) on infarct size, as measured by cardio magnetic resonance (CMR) and left ventricular ejection fraction.
METHODS
We searched the following databases: PubMed, Scopus, Cochrane library, and Web of Science. We included only randomized control trials that reported the use of early intravenous Metoprolol in STEMI before PCI on infarct size, as measured by CMR and left ventricular ejection fraction. RevMan software 5.4 was used for performing the analysis.
RESULTS
Following a literature search, 340 publications were found. Finally, 18 studies were included for the systematic review, and 8 clinical trials were included in the meta-analysis after the full-text screening. At 6 months, the pooled effect revealed a statistically significant association between Metoprolol and increased left ventricular ejection fraction (LVEF) (%) compared to controls (mean difference [MD] = 3.57, [95% confidence interval [CI] = 2.22-4.92], p < .00001), as well as decreased infarcted myocardium(g) compared to controls (MD = -3.84, [95% [CI] = -5.75 to -1.93], p < .0001). At 1 week, the pooled effect revealed a statistically significant association between Metoprolol and increased LVEF (%) compared to controls (MD = 2.98, [95% CI = 1.26-4.69], p = .0007), as well as decreased infarcted myocardium(%) compared to controls (MD = -3.21, [95% CI = -5.24 to -1.18], p = .002).
CONCLUSION
A significant decrease in myocardial infarction and increase in LVEF (%) was linked to receiving Metoprolol at 1 week and 6-month follow-up.
Topics: Humans; Metoprolol; Myocardial Infarction; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction; Stroke Volume; Ventricular Function, Left
PubMed: 36040709
DOI: 10.1002/clc.23894 -
Frontiers in Endocrinology 2022The aim of the study was to evaluate the effect of empagliflozin on diffuse myocardial fibrosis by cardiac magnetic resonance (CMR) T1 mapping. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of the study was to evaluate the effect of empagliflozin on diffuse myocardial fibrosis by cardiac magnetic resonance (CMR) T1 mapping.
RESEARCH METHODS AND PROCEDURES
Databases including PubMed, Cochrane library, Embase, and Sinomed for clinical studies of empagliflozin on myocardial fibrosis were searched. Two authors extracted the data and evaluated study quality independently. Weighted mean difference (WMD) and 95% confidence intervals (CI) were used for continuous variables. Review Manager 5.3 was used to performed the analysis.
RESULTS
Six studies were included in this meta-analysis. One of the six studies was assessed as poor quality by the assessment of methodological quality; however, the remaining five studies were considered good. The WMD value of △extracellular volume (ECV) was merged by the fixed-effect model, and the pooled effect size was -1.48 (95% CI -1.76 to -1.21, < 0.00001), which means in favor of empagliflozin. Heterogeneity analysis did not find any heterogeneity (chi = 0.39, = 0.82, = 0%). In addition, empagliflozin had a tendency to reduce ECV compared to treatment before with no statistical significance (WMD = -0.29, 95% CI -1.26 to 0.67, = 0.55; heterozygosity test, chi = 2.66, = 0.45, = 0%). The WMD value of △native T1 was also merged by the fixed-effect model, but the pooled effect size showed neither statistical difference between empagliflozin and placebo treatment (WMD = -5.40, 95% CI -21.63 to 10.83, = 0.51) nor heterogeneity (chi = 0.05, = 0.83, = 0%).
CONCLUSIONS
Empagliflozin has cardiovascular benefits by reducing diffuse myocardial fibrosis. ECV could act as a non-invasive imaging tool to assess diffuse myocardial fibrosis and monitor disease progression.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=324804, identifier: CRD42022324804.
Topics: Benzhydryl Compounds; Cardiomyopathies; Fibrosis; Glucosides; Humans; Myocardium
PubMed: 36034443
DOI: 10.3389/fendo.2022.917761 -
Pathogens (Basel, Switzerland) Jul 2022Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global health concern responsible for the ongoing pandemic. Histopathological pieces of evidence on... (Review)
Review
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global health concern responsible for the ongoing pandemic. Histopathological pieces of evidence on COVID-19 are not fully investigated. This review aims to provide, through microscopy investigations, a histopathological overview of COVID-19 structural and ultrastructural alterations in different organs and tissues, excluding the respiratory system. The authors systematically reviewed the literature over the period February 2020-July 2022. Selected databases were PubMed, Scopus, and Google Scholar. The search strategy included the following terms: "COVID-19" or SARS-CoV-2 and "histopathology" or "pathology"; and "microscopy" and "liver", "myocardium"," spleen", "testis", and "placenta". Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Thirty-one articles included in this systematic review demonstrated, at a histopathological level, that COVID-19 exerts detrimental effects on tissues, often promoting degenerative processes. Even if COVID-19 shows a histopathological tropism for the respiratory system, other tissues, from cardiovascular to reproductive, are affected by COVID-19. Therefore, this paper provides an up-to-date view of histopathological observations of the structural and ultrastructural alterations associated with COVID-19 and may contribute to a better knowledge of the physiopathological bases of this disease.
PubMed: 36014988
DOI: 10.3390/pathogens11080867 -
Frontiers in Cardiovascular Medicine 2022There has been a rapid increase in the number of Artificial Intelligence (AI) studies of cardiac MRI (CMR) segmentation aiming to automate image analysis. However,...
BACKGROUND
There has been a rapid increase in the number of Artificial Intelligence (AI) studies of cardiac MRI (CMR) segmentation aiming to automate image analysis. However, advancement and clinical translation in this field depend on researchers presenting their work in a transparent and reproducible manner. This systematic review aimed to evaluate the quality of reporting in AI studies involving CMR segmentation.
METHODS
MEDLINE and EMBASE were searched for AI CMR segmentation studies in April 2022. Any fully automated AI method for segmentation of cardiac chambers, myocardium or scar on CMR was considered for inclusion. For each study, compliance with the Checklist for Artificial Intelligence in Medical Imaging (CLAIM) was assessed. The CLAIM criteria were grouped into study, dataset, model and performance description domains.
RESULTS
209 studies published between 2012 and 2022 were included in the analysis. Studies were mainly published in technical journals (58%), with the majority (57%) published since 2019. Studies were from 37 different countries, with most from China (26%), the United States (18%) and the United Kingdom (11%). Short axis CMR images were most frequently used (70%), with the left ventricle the most commonly segmented cardiac structure (49%). Median compliance of studies with CLAIM was 67% (IQR 59-73%). Median compliance was highest for the model description domain (100%, IQR 80-100%) and lower for the study (71%, IQR 63-86%), dataset (63%, IQR 50-67%) and performance (60%, IQR 50-70%) description domains.
CONCLUSION
This systematic review highlights important gaps in the literature of CMR studies using AI. We identified key items missing-most strikingly poor description of patients included in the training and validation of AI models and inadequate model failure analysis-that limit the transparency, reproducibility and hence validity of published AI studies. This review may support closer adherence to established frameworks for reporting standards and presents recommendations for improving the quality of reporting in this field.
SYSTEMATIC REVIEW REGISTRATION
[www.crd.york.ac.uk/prospero/], identifier [CRD42022279214].
PubMed: 35911553
DOI: 10.3389/fcvm.2022.956811 -
Clinical Research in Cardiology :... Oct 2022Coronavirus Disease-2019 (COVID-19) vaccination has been associated with the development of carditis, especially in children and adolescent males. However, the rates of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Coronavirus Disease-2019 (COVID-19) vaccination has been associated with the development of carditis, especially in children and adolescent males. However, the rates of these events in the global setting have not been explored in a systematic manner. The aim of this systematic review and meta-analysis is to investigate the rates of carditis in children and adolescents receiving COVID-19 vaccines.
METHODS
PubMed, Embase and several Latin American databases were searched for studies. The number of events, and where available, at-risk populations were extracted. Rate ratios were calculated and expressed as a rate per million doses received. Subgroup analysis based on the dose administered was performed. Subjects ≤ 19 years old who developed pericarditis or myocarditis following COVID-19 vaccination were included.
RESULTS
A total of 369 entries were retrieved. After screening, 39 articles were included. Our meta-analysis found that 343 patients developed carditis after the administration of 12,602,625 COVID-19 vaccination doses (pooled rate per million: 37.76; 95% confidence interval [CI] 23.57, 59.19). The rate of carditis was higher amongst male patients (pooled rate ratio: 5.04; 95% CI 1.40, 18.19) and after the second vaccination dose (pooled rate ratio: 5.60; 95% CI 1.97, 15.89). In 301 cases of carditis (281 male; mean age: 15.90 (standard deviation [SD] 1.52) years old) reported amongst the case series/reports, 261 patients were reported to have received treatment. 97.34% of the patients presented with chest pain. The common findings include ST elevation and T wave abnormalities on electrocardiography. Oedema and late gadolinium enhancement in the myocardium were frequently observed in cardiac magnetic resonance imaging (CMR). The mean length of hospital stay was 3.91 days (SD 1.75). In 298 out of 299 patients (99.67%) the carditis resolved with or without treatment.
CONCLUSIONS
Carditis is a rare complication after COVID-19 vaccination across the globe, but the vast majority of episodes are self-limiting with rapid resolution of symptoms within days. Central illustration. Balancing the benefits of vaccines on COVID-19-caused carditis and post-vaccination carditis.
Topics: Adolescent; Adult; COVID-19; COVID-19 Vaccines; Child; Contrast Media; Gadolinium; Humans; Infant; Male; Myocarditis; Vaccination; Vaccines; Young Adult
PubMed: 35906423
DOI: 10.1007/s00392-022-02070-7 -
Heart Failure Reviews Nov 2022Left ventricular non-compaction cardiomyopathy (LVNC) is a congenital heart disease with autosomal dominant inheritance. This review aims to summarize the existing data... (Review)
Review
Left ventricular non-compaction cardiomyopathy (LVNC) is a congenital heart disease with autosomal dominant inheritance. This review aims to summarize the existing data about the predictors of fatal arrhythmias in patients with LVNC. Medline and Cochrane library databases were searched from inception to November 2021 for articles on LVNC. The reference lists of the relevant research studies as well as the relevant review studies and meta-analyses were also searched. Clinical symptoms and electrocardiogram findings such as left bundle branch block are significantly associated with ventricular arrhythmias. Other non-invasive tools such as Holter monitoring, echocardiography, and cardiac magnetic resonance (CMR) can provide additional value for risk stratification. CMR-derived left and right ventricular ejection fraction, left ventricular end-diastolic diameter, late gadolinium enhancement, and non-compacted to compacted myocardium ratio are predictive of ventricular arrhythmias. An electrophysiological study can provide additional prognostic data in patients with LVNC who are at moderate risk of ventricular arrhythmias. Risk stratification of LVNC patients with no prior history of a fatal arrhythmic event remains challenging. Symptoms assessment, electrocardiogram, Holter monitoring, and cardiac imaging should be performed on every patient, while an electrophysiological study should be performed for moderate-risk patients. Large cohort studies are needed for the construction of score models for arrhythmic risk stratification purposes.
Topics: Cardiomyopathies; Contrast Media; Gadolinium; Humans; Predictive Value of Tests; Stroke Volume; Ventricular Function, Left; Ventricular Function, Right
PubMed: 35776368
DOI: 10.1007/s10741-022-10257-3