research magnet Research Magnet news Medical News

View research about

Essential mixed cryoglobulinemia Dentist Paediatric Cardiology Autoimmune dysautonomia Pain Medicine Fitness Inclusion body myositis (IBM) Juvenile myositis (JM) Pathology Sarcoma Colorectal Cancer Alopecia areata Pemphigus Vascular Surgery Cleft Lip Gall Bladder Cancer Dementia Dermatomyositis Progesterone dermatitis Transverse myelitis Sports Medicine Medical Charity ADHD Foot & Ankle Orthopaedics Cosmetic Surgery Interstitial cystitis (IC) Brain Tumor Primary Biliary Cholangitis Endocrinology Subacute bacterial endocarditis (SBE) Leukodystrophy Procedural Dermatology Molecular Genetic Pathology Autoimmune retinopathy Heart Failure Coronary Artery Disease Narcolepsy Peripheral neuropathy Malignant Hypertension Implantology Angina Paediatric Dentistry Transplant Heamatology Pure red cell aplasia (PRCA) Castleman disease (CD) Nephrology Autoimmune encephalomyelitis Chronic Lymphocytic Leukaemia Orthopaedic Surgery Bile Duct Cancer Undifferentiated connective tissue disease (UCTD) Dressler’s syndrome Dermatology Hyperlipidaemia Cold agglutinin disease Musculoskeletal Oncology Cardiothoracic Surgery Doctor Optic neuritis Epilepsy Parkinson’s Disease Surgical Oncology Ocular cicatricial pemphigoid Overactive Bladder Devic’s disease (neuromyelitis optica) Anti-GBM/Anti-TBM nephritis Autoimmune myocarditis Polymyalgia rheumatica Lower GI Guillain Barre Syndrome Temporal arteritis/Giant cell arteritis Low Back Pain Lung Cancer Hand Surgery Paediatric Surgery Hypertriglyceridemia Perivenous encephalomyelitis Neuroendocrine Tumors Antiphospholipid syndrome Spinal Cord Injury Upper GI Biochemical Genetics Microbiology Reflex sympathetic dystrophy COVID-19 Henoch-Schonlein purpura (HSP) Chronic inflammatory demyelinating polyneuropathy (CIDP) Polyglandular syndromes type I, II, III Paediatric ICU Maternal & Fetal Medicine Cancer Hypogammalglobulinemia Endovascular surgery Discoid lupus Hip & Knee Osteoarthritis Asthma Rheumatic fever Parry Romberg syndrome Pediatrics Obesity & Bariatrics Pancreatic Cancer Prediabetes Syncope & Collapse Microscopic polyangiitis (MPA) Hospice And Palliative Medicine Urology Behcet’s disease General Medicine / Internal Medicine Granulomatosis with Polyangiitis Spina Bifida Thoracic Surgery Neonatal & Perinatal Medicine Bladder Cancer Hepatology Ophthalmology Podiatrist Traumatic Brain Injury Coronavirus Transplant Hepatology Clinical Pharmacology Autoimmune orchitis Specialist In Training Chronic recurrent multifocal osteomyelitis (CRMO) Occupational & Environmental Medicine Liver Cancer Vaginal Cancer Clinic Ankylosing spondylitis Neurosurgery Schmidt syndrome General Surgery Hidradenitis Suppurativa (HS) (Acne Inversa) Evans syndrome Obstetrics And Gynecology Chiropractor Dermatological Immunology Pulmonology Stem Cell Research Pyoderma gangrenosum Psychiatry Immunology & Allergy Amyloidosis Critical Care Ulcerative colitis (UC) Retroperitoneal fibrosis Autoimmune inner ear disease (AIED) Peripheral Vascular Disease Depression Undersea & Hyperbaric Medicine Mona Vale ED Acute Myeloid Leukaemia Thyroid eye disease (TED) Herpes gestationis or pemphigoid gestationis (PG) Psoriasis Lupus Macular Degeneration Pernicious anemia (PA) Head & Neck Surgery Geriatric Psychiatry Cardiology Pharmacy Reactive Arthritis Melanoma Psychosomatic Medicine Linear IgA disease (LAD) Chronic Kidney Disease Palliative Medicine Bullous pemphigoid Clinical Cytogenetics Mitochondrial Myopathies Chronic Ischaemic Heart Disease Audiologist Congenital heart block Tropical Medicine Adolescent Medicine Otology Neurotology Dermatitis herpetiformis Juvenile diabetes (Type 1 diabetes) Muscular Dystrophy Clinical Paediatric Genetics Moya Moya Disease Prostate Cancer Myelin Oligodendrocyte Glycoprotein Antibody Disorder Churg-Strauss Syndrome Restless legs syndrome (RLS) ENT Paediatric Physician Pregnancy Reproductive Endocrinology & Infertility Vulval Cancer Giant cell myocarditis Alzheimers Autoimmune oophoritis Sympathetic ophthalmia (SO) Benign Hypertension Aerospace Medicine Speech Pathologist Medical Administration Palindromic rheumatism (PR) Atrial Fibrillation Transplant Nuclear Medicine Women's Health Breast Fibromyalgia Meningitis CREST syndrome Takayasu’s arteritis Osteopathy Relapsing polychondritis Kawasaki disease Ligneous conjunctivitis Huntingtons Disease Goodpasture’s syndrome COPD Bowel Cancer Skin Cancer Mooren’s ulcer Pars planitis (peripheral uveitis) Inflammatory Arthritis Primary sclerosing cholangitis Haematology Rural & Remote Agammaglobulinemia Organ Donation Raynaud’s phenomenon Addiction Psychiatry Histopathology Vogt-Koyanagi-Harada Disease Hashimoto’s thyroiditis Radiation Oncology Paediatric Respiratory Baló disease Craniofacial Surgery Anal Cancer Medical Organisation Chiropractice Infectious Disease Clinical Researcher Laboratory Immunology Sexual Health Medicine Addison’s disease Achalasia Vitiligo Scleroderma Eosinophilic esophagitis (EoE) Parsonage-Turner syndrome Rare Disease Craniofacial Microsomia Immune thrombocytopenic purpura (ITP) Lambert-Eaton syndrome Rare Diseases Coeliac disease Neurodevelopmental Disabilities Sleep Medicine Lichen planus Mircobiology Diabetes & Metabolism Burns Cystic Fibrosis Optometry Spinal Surgery Clinical Cardiac Electrophysiology Complementary Medicine Delirium Physiotherapy Emergency Medicine Brain Injury Medicine Hospital Geriatric Medicine Polymyositis Insulin Resistance Fibrosing alveolitis Anesthesiology Neuro Ophthalmology Axonal & neuronal neuropathy (AMAN) MedicalDirector software Testicular Cancer Schizophrenia Mucha-Habermann disease Rheumatology Womb Cancer Clinical Genetics Adult Reconstructive Orthopaedics Gynecologic Oncology Neonatal Lupus Chronic Myeloid Leukaemia Gynaecology Pediatric Allergy & Immunology Paediatric Emergency Medicine Uveitis & Ocular Immunology Hemolytic anemia Internal Medicine Oesophaegal Cancer Forensic Psychiatry Physiotherapist Paediatric Orthopaedics Oncology Cerebral Atherosclerosis Myeloma cleft palate Provider Postpericardiotomy syndrome Penile Cancer Neurology Queer Health Occupational Therapy Cardiothoracic Intensive Care Chinese Medical Practitioner Cerebrovascular & Skull Base Surgery Disaster Medicine Chagas disease Intensive Care Medicine International Health Sleep Apnoea Glomerulonephritis Psychologist Nutrition Graves’ disease TIA Interventional Radiology Acute Lymphoblastic Leukaemia Thyroid Cancer Dietician Crohn’s disease Sports & Exercise Medicine Scleritis Advanced Heart Failure & Transplant Cardiology Orthodontics Adult Still's disease Dentistry Myelodysplasia Cicatricial pemphigoid Paramedicine Cosmetic Medicine Lichen sclerosus Radiology Multiple Sclerosis Neuro Oncology Child And Adolescent Psychiatry Geriatric Wellness Polyarteritis nodosa Phonetics Hypercholesterolaemia Neurodegenerative Disorders Myocardial infarction Kidney Cancer Stiff person syndrome (SPS) Cataracts Neuro Intensive Care Susac’s syndrome Neuromuscular Medicine Leukocytoclastic vasculitis POEMS syndrome Eosinophilic fasciitis Cogan’s syndrome Thrombocytopenic purpura (TTP) Meniere’s disease Ophthalmic Pathology Endovascular Surgical Neuroradiology Optometrist Audiology Sperm & testicular autoimmunity Carotid Artery occlusion Adult Cardiothoracic Anesthesiology Gastroenterology Giant cell arteritis (temporal arteritis) Simulation Medicine Sjögren’s syndrome Stroke Multifocal Motor Neuropathy (MMN) Autoimmune urticaria HIV / AIDS Female Pelvic Medicine & Reconstructive Surgery Respiratory Medicine IgG4-related sclerosing disease Tolosa-Hunt syndrome (THS) Nurse Juvenile arthritis Celiac disease Diabetes Mellitus Mouth, Head and Neck Cancer Pharmacist Sarcoidosis Autoimmune pancreatitis Oral Health Dermatopathology Laryngeal Cancer Lyme disease chronic Autoimmune hepatitis Paraneoplastic cerebellar degeneration (PCD) Interventional Cardiology Technology Podiatry Endoscopy Stomach Cancer Patient Paroxysmal nocturnal hemoglobinuria (PNH) Psychology Benign mucosal pemphigoid Psoriatic arthritis Endometriosis Obstetric Anesthesiology Healthcare Otolaryngology Bariatric Surgery Coxsackie myocarditis Breast Cancer Nuclear Radiology Applied Dermatology Metabolic Syndrome Cervical Cancer Uterine Cancer Eye Cancer Diagnostic Laboratory Immunology Transplant Pulmonology IgA Nephropathy Public Health Rehabilitation Medicine Erythema nodosum Mesothelioma Robotic Surgery Inflammatory Bowel Disease Clinical Immunology General Practice (Family Medicine) Toxicology ATSI Health Practitioner Non Hodgkin Lymphoma Transplant Nephrology Wheel Travel Medicine Neutropenia Public Health Medicine Musculoskeletal Radiology Retrieval Medicine Blood Cancer Ovarian Cancer Addiction Medicine Plastic Surgery Conference Organiser Osteopath Oral & Maxillofacial Surgery Motor Neuron Disease Occupational Therapist Trauma Cerebral Palsy Autoimmune angioedema

The latest medical research on Cardiology

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about cardiology gathered by our medical AI research bot.

The selection below is filtered by medical specialty. Registered users get access to the Plexa Intelligent Filtering System that personalises your dashboard to display only content that is relevant to you.

Want more personalised results?

Request Access

Aortic remodelling based on false lumen communications in patients undergoing acute type I dissection repair with AMDS hybrid prosthesis: a substudy of the DARTS trial.

Cardiothoracic Surgery

The Dissected Aorta Repair Through Stent Implantation trial demonstrated positive proximal aortic remodelling following aortic dissection repair with the AMDS Hybrid Prosthesis. In this study, we look to identify predictors of aortic remodelling following aortic dissection repair with AMDS including whether communications between branch vessels and the false lumen predict aortic growth.

The Dissected Aorta Repair Through Stent Implantation trial included patients who underwent Acute DeBakey type I aortic dissection repair with the AMDS from March 2017-January 2019. Anatomic measurements were collected from original computerized tomography scans. Measurements were taken at zones 2, 3, 6, and 9. Patients were grouped based on the number of false lumen communications with the supra-aortic branch vessels or visceral branch vessels.

Forty-seven patients were included in the original Dissected Aorta Repair Through Stent Implantation trial. Patients with false lumen communications with the supra-aortic branch vessels tended to have significant growth at zone 3(p = 0.02-0.0018), while greater numbers of visceral false lumen communications tended to predict aortic growth at zones 3 (p = 0.003), 6(p = 0.017-0.0087), and 9(p = 0.0016-0.0003).

Aortic remodelling following Acute DeBakey type I aortic dissection repair using the AMDS may be predicted by local false lumen communications with branch vessels. Patients undergoing Acute DeBakey type I aortic dissection repair were more likely to experience significant aortic growth in zone 3 with more head vessel communications and in zones 3, 6, and 9 with more visceral false lumen communications. Predictors of aortic remodelling may help to guide initial surgical management for aortic dissection patients.

Cardiorenal Syndrome: An Evolutionary Appraisal.

Circulation. Heart failure

A recent American Heart Association Scientific Statement and Presidential Advisory recognized a new syndrome, the cardiovascular-kidney-metabolic s...

Self-reported dyspnoea and shortness of breathing deterioration in long-term survivors after segmentectomy or lobectomy for early-stage lung cancer.

Cardiothoracic Surgery

To assess the self-reported current dyspnoea and perioperative changes of dyspnoea in long term survivors after minimally invasive segmentectomy or lobectomy for early-stage lung cancer.

Cross-sectional telephonic survey of patients alive and disease-free as of March 2023, with pathologic stage IA1-2, non-small cell lung cancer, assessed 1 to 5 years after minimally invasive segmentectomy or lobectomy (performed from January 2018 to January 2022). Current dyspnoea level: Baseline Dyspnoea Index score < 10. Perioperative changes of dyspnoea were assessed using the Transition Dyspnoea Index. A negative Transition Dyspnoea Index focal score indicates perioperative deterioration in dyspnoea.Mixed effect models were used to examine demographic, medical, and health-related correlates of current dyspnoea and changes of dyspnoea level.

152 of 236 eligible patients consented or were available to respond to the telephonic interview(67% response rate):90 lobectomies and 62 segmentectomies.The Baseline Dyspnoea Index score was lower (greater dyspnoea) in lobectomy patients (median 7, IQR 6-10) compared to segmentectomy (median 9, IQR 6-11), p = 0.034. 70% of lobectomy patients declared to have a current dyspnoea vs 53% after segmentectomy, p = 0.035.82% of patients after lobectomy reported a perioperative deterioration in their dyspnoea compared to 57% after segmentectomy, p = 0.002.Mixed effect logistic regression analysis adjusting for patient related factors and time elapsed from operation showed that segmentectomy was associated with a reduced risk of perioperative dyspnoea deterioration (as opposed to lobectomy) (OR 0.31, p = 0.004).

Our findings may be valuable to inform the shared decision-making process by complementing objective data on perioperative changes of pulmonary function.

Antegrade cerebral perfusion via the right subclavian artery during open distal arch or proximal descending aortic repair from left thoracotomy.

Cardiothoracic Surgery

In the current endovascular era, open surgery through left posterolateral thoracotomy (PLT) with moderate to deep hypothermic circulatory arrest (D...

Uncovering Unrecognized Heart Failure With Preserved Ejection Fraction Among Individuals With Obesity and Dyspnea.

Circulation. Heart failure

Although heart failure with preserved ejection fraction (HFpEF) has become the predominant heart failure subtype, it remains clinically under-recognized. HFpEF diagnosis is particularly challenging in the setting of obesity given the limitations of natriuretic peptides and resting echocardiography. We examined invasive and noninvasive HFpEF diagnostic criteria among individuals with obesity and dyspnea without known cardiovascular disease to determine the prevalence of hemodynamic HFpEF in the community.

Research volunteers with dyspnea and obesity underwent resting echocardiography; participants with possible pulmonary hypertension qualified for invasive cardiopulmonary exercise testing. HFpEF was defined using rest or exercise pulmonary capillary wedge pressure criteria (≥15 mm Hg or Δpulmonary capillary wedge pressure/Δcardiac output slope, >2.0 mm Hg·L-1·min-1).

Among n=78 participants (age, 53±13 years; 65% women; body mass index, 37.3±6.8 kg/m2), 40 (51%) met echocardiographic criteria to undergo invasive cardiopulmonary exercise testing. In total, 24 participants (60% among the cardiopulmonary exercise testing group, 31% among the total sample) were diagnosed with HFpEF by rest or exercise pulmonary capillary wedge pressure (n=12) or exercise criteria (n=12). There were no differences in NT-proBNP (N-terminal pro-B-type natriuretic peptide; 79 [62-104] versus 73 [57-121] pg/mL) or resting echocardiography (mitral E/e' ratio, 9.1±3.1 versus 8.0±2.7) among those with versus without HFpEF (P>0.05 for all). Distributions of HFpEF diagnostic scores were similar, with the majority classified as intermediate risk (100% versus 93.75% [H2FPEF] and 87.5% versus 68.75% [HFA-PEFF (Heart Failure Association Pretest assessment, echocardiography and natriuretic peptide, functional testing, and final etiology)] in those with versus without HFpEF).

Among adults with obesity and dyspnea without known cardiovascular disease, at least a third had clinically unrecognized HFpEF uncovered on invasive cardiopulmonary exercise testing. Clinical, biomarker, resting echocardiography, and diagnostic scores were similar among those with and without HFpEF. These results suggest clinical underdiagnosis of HFpEF among individuals with obesity and dyspnea and highlight limitations of noninvasive testing in the identification of HFpEF.

Generalizable Approach to Quantifying Guideline-Directed Medical Therapy.

Circulation. Heart failure

Quantifying guideline-directed medical therapy (GDMT) intensity is foundational for improving heart failure (HF) care. Existing measures discount dose intensity or use inconsistent weighting.

The Kansas City Medical Optimization (KCMO) score is the average of total daily to target dose percentages for eligible GDMT, reflecting the percentage of optimal GDMT prescribed (range, 0-100). In Change the Management of Patients With HF, we computed KCMO, HF collaboratory (0-7), and modified HF Collaboratory (0-100) scores for each patient at baseline and for 1-year change in established GDMT at the time (mineralocorticoid receptor antagonist, β-blocker, ACE [angiotensin-converting enzyme] inhibitor/angiotensin receptor blocker/angiotensin receptor neprilysin inhibitor). We compared baseline and 1-year change distributions and the coefficient of variation (SD/mean) across scores.

Among 4532 patients at baseline, mean KCMO, HF collaboratory, and modified HF Collaboratory scores were 38.8 (SD, 25.7), 3.4 (1.7), and 42.2 (22.2), respectively. The mean 1-year change (n=4061) for KCMO was -1.94 (17.8); HF collaborator, -0.11 (1.32); and modified HF Collaboratory, -1.35 (19.8). KCMO had the highest coefficient of variation (0.66), indicating greater variability around the mean than the HF collaboratory (0.49) and modified HF Collaboratory (0.53) scores, reflecting higher resolution of the variability in GDMT intensity across patients.

KCMO measures GDMT intensity by incorporating dosing and treatment eligibility, provides more granularity than existing methods, is easily interpretable (percentage of ideal GDMT), and can be adapted as performance measures evolve. Further study of its association with outcomes and its usefulness for quality assessment and improvement is needed.

Risk Factors and Outcomes Associated With Heart Failure With Preserved and Reduced Ejection Fraction in People With Chronic Kidney Disease.

Circulation. Heart failure

Heart failure (HF) is associated with poor outcomes in people with chronic kidney disease, yet it is unknown whether outcomes differ by HF subtype. This study aimed to examine associations of incident HF with preserved ejection fraction (HFpEF) versus HF with reduced ejection fraction (HFrEF) with progression to end-stage kidney disease (ESKD) and mortality.

We studied individuals with chronic kidney disease in the CRIC study (Chronic Renal Insufficiency Cohort) who were free of HF at cohort entry. Incident HF hospitalizations were adjudicated and classified into HFpEF (ejection fraction, ≥50%) or HFrEF (ejection fraction, <50%) based on echocardiograms performed during the hospitalization or at a research study visit. ESKD was defined as need for chronic dialysis or kidney transplant. Cox proportional hazards were used to evaluate the association of time-updated HF subtype with risk of ESKD and mortality, adjusting for demographics, comorbidities, and medication use.

Among the 3557 study participants without HF at cohort entry, mean age was 57 years and mean estimated glomerular filtration rate was 45 mL/min per 1.73 m2. A total of 682 participants had incident HF. Incidence rates for HFpEF and HFrEF were 0.9 (95% CI, 0.8-1.0) and 0.7 (95% CI, 0.6-0.8) per 100 person-years, respectively (Pdifference=0.005). Associations of incident HF with progression to ESKD were not statistically different for HFpEF (hazard ratio, 2.06 [95% CI, 1.66-2.56]) and HFrEF (hazard ratio, 1.80 [95% CI, 1.36-2.38]; P=0.42). The associations with mortality were stronger for HFrEF (hazard ratio, 2.73 [95% CI, 2.24-3.33]) compared with HFpEF (hazard ratio, 1.99 [95% CI, 1.65-2.40]; P=0.0002).

In a chronic kidney disease population, the rates of HFpEF hospitalizations were greater than that of HFrEF. Risk of ESKD was high but not statically different across HF subtypes. There was a stronger association of HFrEF with mortality. Prevention and treatment of both HFpEF and HFrEF should be central priorities to improve outcomes in chronic kidney disease.

Portal Vein Doppler tracks volume status in patients with severe tricuspid regurgitation: A Proof-of-Concept Study.

European Heart Journal: Acute Cardio Care

Renal and liver congestion are associated with adverse outcomes in patients with tricuspid regurgitation (TR). Currently, there are no valid sonographic indicators of fluid status in this population. Intra-renal venous Doppler (IRVD) is a novel method for quantifying renal congestion but its interpretation can be challenging in severe TR due to altered hemodynamics. This study explores the potential of portal vein Doppler (PVD) as an alternative marker for decongestion during volume removal in patients with severe TR.

42 patients with severe TR undergoing decongestive therapy were prospectively enrolled. Inferior vena cava diameter (IVCd), PVD and IRVD were sequentially assessed during volume removal. Improvement criteria were Portal Vein Pulsatility Fraction (PVPF) < 70% and Renal Venous Stasis Index (RVSI) < 0.5 for partial improvement, and PVPF <30% and RVSI <0.2 for complete improvement.

After volume removal, PVPF significantly improved from 130 ± 39% to 47 ± 44% (p < 0.001), while IRVD improved from 0.72 ± 0.08 to 0.54 ± 0.22 (p < 0.001). A higher proportion of patients displayed improvement in PVD compared to IRVD (partial: 38% vs. 29%, complete: 41% vs. 7%) (p < 0.001). IRVD only improved in patients with concomitant improvement in severe TR. PVD was the only predictor of achieving ≥5 litres of negative fluid balance (AUC 0.83 p = 0.001).

This proof-of-concept study suggests that PVD is the only sonographic marker that can track volume removal in severe TR, offering a potential indicator for decongestion in this population. Further intervention trials are warranted to determine if PVD-guided decongestion improves patient outcomes in severe TR.

Cardiovascular Benefits of GLP-1 Receptor Agonists in Patients Living with Obesity or Overweight: A Meta-analysis of Randomized Controlled Trials.

Cardiovascular Drugs

PROSPERO identifier number CRD42023475226.

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing GLP-1 RAs versus placebo in patients with obesity or overweight. We searched PubMed, Cochrane, and Embase databases. A random-effects model was used to calculate risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CIs).

A total of 13 RCTs were included, with 30,512 patients. Compared with placebo, GLP-1 RAs reduced systolic blood pressure (MD - 4.76 mmHg; 95% CI - 6.03, - 3.50; p < 0.001; I2 = 100%) and diastolic blood pressure (MD - 1.41 mmHg; 95% CI - 2.64, - 0.17; p = 0.03; I2 = 100%). GLP-1 RA significantly reduced the occurrence of myocardial infarction (RR 0.72; 95% CI 0.61, 0.85; p < 0.001; I2 = 0%). There were no significant differences between groups in unstable angina (UA; RR 0.84; 95% CI 0.65, 1.07; p = 0.16; I2 = 0%), stroke (RR 0.91; 95% CI 0.74, 1.12; p = 0.38; I2 = 0%), atrial fibrillation (AF; RR 0.49; 95% CI 0.17, 1.43; p = 0.19; I2 = 22%), and deep vein thrombosis (RR 0.30; 95% CI 0.06, 1.40; p = 0.13; I2 = 0%).

In patients living with obesity or overweight, GLP-1 RA reduced systolic and diastolic blood pressure and the occurrence of myocardial infarction, with a neutral effect on the occurrence of UA, stroke, AF, and deep vein thrombosis.

Features and outcomes of focal intimal disruption in acute type B intramural hematoma.

Cardiothoracic Surgery

Focal intimal disruption is a risk factor for adverse aorta-related events in acute type B intramural haematoma patients. This study evaluated the impact of focal intimal disruption on overall survival with a selective intervention strategy for large or growing focal intimal disruptions. Additionally, this study evaluated the risk factors associated with the growth of focal intimal disruption.

This retrospective study included all consecutive patients admitted for acute type B intramural haematoma between November 2004 and April 2021. The primary outcome was overall survival. The secondary outcome was cumulative incidence of composite aortic events and the growth of focal intimal disruption. The latter was calculated on centerline-reconstructed computed tomography images.

A total of 105 patients were included. A total of 106 focal intimal disruptions were identified in 73 patients (73/105, 69.5%). The 1- and 5-year cumulative incidence rates of composite aortic events were 36.2% and 39.2%, respectively. The 1- and 5-year overall survival were 93.3% and 81.5%, respectively. Initial maximal aortic diameter and large focal intimal disruption during acute phase were significant risk factors for composite aortic event, but not risk factors for overall survival. Early appearance interval of focal intimal disruption was a significant risk factor for growth of focal intimal disruption.

With a selective intervention strategy for large or growing focal intimal disruptions, the presence of large focal intimal disruption during acute phase does not affect overall survival. Early appearance interval was associated with the growth of focal intimal disruption.

Same evidence different recommendations: a methodological assessment of transatlantic guidelines for the management of valvular heart disease.

Cardiothoracic Surgery

To identify methodological variations leading to varied recommendations between the American College of Cardiology (ACC)/American Heart Association (AHA) and the European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) valvular heart disease (VHD) Guidelines, and to suggest foundational steps towards standardizing guideline development.

An in-depth analysis was conducted to evaluate the methodologies used in developing the Transatlantic Guidelines for managing VHD. The evaluation was benchmarked against the standards proposed by the Institute of Medicine.

Substantial discrepancies were noted in the methodologies utilized in development processes, including writing committee composition, evidence evaluation, conflict of interest management, and voting processes. Furthermore, despite their mutual differences, both methodologies also demonstrate notable deviations from the IOM standards in several essential areas, including literature review and evidence grading. These dual variances likely influenced divergent treatment recommendations. For example, the ESC/EACTS recommends transcatheter edge-to-edge repair (TEER) for patients ineligible for mitral valve surgery, while the ACC/AHA recommends TEER based on anatomy, regardless of surgical risk. ESC/EACTS guidelines recommend a mechanical aortic prosthesis for patients under 60, while ACC/AHA guidelines recommend it for patients under 50. Notably, the ACC/AHA and ESC/EACTS guidelines have differing age cut-offs for surgical over transcatheter aortic valve replacement (<65 and <75 years, respectively).

Variations in methodologies for developing CPGs have resulted in different treatment recommendations that may significantly impact global practice patterns. Standardization of essential processes is vital to increase the uniformity and credibility of CPGs, ultimately improving healthcare quality, reducing variability and enhancing trust in modern medicine.

Multicentric experience of antegrade thoracic endovascular aortic repair for the treatment of thoracic aortic diseases.

Cardiothoracic Surgery

Aim of this multicentre retrospective cohort study is to evaluate technical success, early and late outcomes of thoracic endovascular repair (TEVAR) with grafts deployed upside-down through antegrade access, to treat thoracic aortic diseases.

Antegrade TEVAR performed between January 2010 and December 2021 have been collected and analyzed. Both elective and urgent procedures were included. Exclusion criteria were endografts deployed into previous or concomitant surgical or endovascular repairs.

Fourteen patients were enrolled; 13 males (94%) with mean age of 71 years (IQR 62; 78). Five patients underwent urgent procedures (2 ruptured aortas and 3 symptomatic patients). Indication to treatment were 8 (57%) aneurysms/pseudoaneurysms, 3 (21%) dissections and 3 (21%) penetrating aortic ulcers. Technical success was achieved in all procedures. Early mortality occurred in 4 (28%) cases, all urgent procedures. Median follow-up was 13 months (IQR 1; 44). Late death occurred in 2 (20%) patients, both operated in elective setting. The first died at 19 months due to aortic-related reintervention, the second died at 34 months for a not aortic-related cause. Two patients (14%) underwent aortic-related reintervention for late type I endoleak. Survival rate in elective procedures was 100%, 84% and 67% at 12, 24 and 36 months respectively. Freedom from reintervention was 92%, 56% and 56% at 12, 24 and 36 months respectively.

Antegrade TEVAR can seldomly be considered an alternative when traditional retrograde approach is not feasible. Despite good technical success and low access-site complications, this study demonstrates high rates of late type I endoleak and aortic-related reinterventions.