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Background Sodium‒glucose cotransporter 2 (SGLT2) inhibitors have been included in heart failure (HF) guidelines because of their benefits in reducing mortality and hospitalization rates. However, the timing and benefits of initiating SGLT2 inhibitors in patients after myocardial infarction (MI) remain controversial. Therefore, we aimed to perform a systematic review and meta-analysis comparing SGLT2 inhibitors with placebo in patients with MI. Methods We performed a systematic review and meta-analysis to determine the impact of SGLT2 inhibitors in patients with recent or previous MI. We systematically searched PubMed, Cochrane, and Embase for RCTs comparing SGLT2 inhibitors versus placebo in patients with MI. The primary outcome was (1) HF hospitalization. In this analysis, we also included the following secondary outcomes: (2) major adverse cardiovascular events (MACE) defined as a composite of cardiovascular (CV) death, MI or stroke; and (3) all-cause mortality. A subgroup analysis was conducted for the primary outcome, comparing patients who had experienced an MI more than 8 weeks prior to study enrolment (previous MI) versus those who had experienced an MI within the preceding 8 weeks (acute MI). Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled with a random effects model. Results Our meta-analysis included 10 RCTs comprising 22,266 patients, of whom 11,339 (51.2%) had type 2 diabetes. The mean age was 62 years, and the median follow-up was 21 months. According to the pooled analysis, HF hospitalization rates were lower in patients on SGLT2 inhibitors compared with placebo (RR 0.77; 95% CI 0.69, 0.85; p  < 0.001)). Differences in MACE were also observed in favor of SGLT2 inhibitors versus placebo (RR 0.88; 95% CI 0.79, 0.97; p  = 0.012). There was no statistically significant difference in all-cause mortality between the groups (RR 0.88; 95% CI 0.78, 1.00; p  = 0.058). Benefits of SGLT2 inhibitors for the primary outcome were consistent regardless of the timing of last MI, with no treatment by subgroup interaction (p for interaction = 0.56). Conclusion In this meta-analysis of patients who experienced MI, the administration of SGLT2 inhibitors was associated with lower rates of hospitalization for HF. In addition, the treatment effect of SGLT2 inhibitors was consistent regardless of whether they were started in the recent versus previous MI setting.

BackgroundSurgical ablation (SA) is a key treatment for atrial fibrillation (AF) patients undergoing heart surgery. However, direct comparisons between SA and non-mitral valve (non-MV) surgery alone are lacking. We performed a systematic review and meta-analysis comparing concomitant SA to isolated non-MV surgery in AF patients.MethodsMEDLINE, Embase and Cochrane were searched. Outcomes of interest were: (1) postoperative AF (POAF); (2) early all-cause mortality; (3) postoperative pacemaker implantation and (4) stroke. Additionally, a subgroup analysis comparing randomised controlled trials (RCTs) and propensity score-matched studies (PSM) was conducted. Risk ratios (RRs) and their respective 95% CI were calculated using a random effects model.ResultsAfter screening 6423 citations, we included 2 RCTs and 5 PSM studies encompassing 39 348 AF patients undergoing non-MV surgery, of whom 18 394 (46.7%) underwent SA. Compared with isolated non-MV surgery, SA was associated with significant POAF reduction (RR: 0.73; 95% CI: 0.67 to 0.79; I2=0%) and higher risk of postoperative pacemaker implantation (RR: 1.34; 95% CI: 1.14 to 1.57, I2=0%) compared with surgery alone. No differences were found in early all-cause mortality (RR: 0.96; 95% CI: 0.76 to 1.22; I2=65%) and postoperative stroke (RR: 1.06; 95% CI: 0.89 to 1.26; I2=0%). The subgroup analysis comparing RCTs and PSM showed significant consistency among the different designs.ConclusionsIn this meta-analysis, SA was associated with POAF reduction in non-MV surgery. In terms of safety, it was suggested that although no difference in early mortality and postoperative stroke was observed, SA had a higher risk of pacemaker implantation than isolated non-MV surgery.

The goal of this study was to identify factors associated with pain sensitivity, procedural discomfort, and referral for surgical hysteroscopy, aiming to improve office hysteroscopy success rates. This was an observational prospective cross-sectional study that analyzed data from women who underwent outpatient hysteroscopy between October 2022 and October 2023. Epidemiological, clinical, and procedural data were collected from medical records. Pain levels were assessed using a visual analog scale (VAS), categorized as acceptable (0–6) or severe (7–10). Statistical analyses were performed to explore associations between patient characteristics and pain levels, with p-values < 0.05 considered significant. This study evaluated 1662 women. The mean age was 54.0 (±12.4) years, and 59.1% were postmenopausal. Nulliparity, menopause, lower body mass index (BMI), and fewer vaginal deliveries were associated with higher pain levels (p < 0.05). Cervical stenosis significantly increased procedural pain: 20.8% and 27.6% of patients with stenosis resolved during the procedure, respectively, reported severe pain. In the multivariate logistic regression analysis, protective factors against severe pain included having ≥2 vaginal deliveries (OR 0.53, 95% CI 0.39–0.72), patent internal (OR 0.53, 95% CI 0.38–0.75) and external cervical orifices (OR 0.47, 95% CI 0.30–0.72), presence of myomas (OR 0.53, 95% CI 0.34–0.83), and biopsy performance (OR 0.55, 95% CI 0.41–0.74). Severe pain, uterine lesions, and stenosis were the main reasons for surgical referral. Lower BMI, nulliparity, menopause, and cervical stenosis were significant predictors of increased pain during outpatient hysteroscopy. These findings may help identify patients at higher risk for procedural discomfort and support strategies to improve success of office hysteroscopy.

Background Remdesivir has been established as a safe treatment for patients with COVID-19. However, given the SARS-CoV-2 random mutations, 3CL protease inhibitors have been studied in recent randomized controlled trials. Therefore, this meta-analysis aims to compare 3CL protease inhibitors versus placebo in patients with mild to moderate COVID-19. Methods We systematically searched PubMed, Embase, and Cochrane Central for RCTs comparing the treatment regimens in patients with mild to moderate COVID-19. Outcomes of interest were the number of patients with symptomatic resolution, recovery rates, viral load change from baseline, alleviation rates, any adverse events, and serious/severe adverse events. Risk ratios (RRs) and hazard ratios (HRs) with 95% CI were calculated for binary outcomes, and standardized mean differences (SMDs) were calculated for continuous outcomes. R version 4.3.2 was used for statistical analysis with the random effects model. Results Ten studies were included, comprising 8,511 patients, of whom 4,654 (55.97%) received 3CL protease inhibitors. Follow-up ranged from 21 to 29 months. In our time-to-event analysis, 3CL protease inhibitors significantly increased the rate of alleviation (HR 1.17; 95% CI [1.09;1.25]; p  < 0.01), and recovery rates (HR 1.18; 95% CI [1.11;1.26]; p  < 0.01) in patients with mild to moderate COVID-19. However, 3CL protease inhibitors significantly reduced viral load at 72 h (SMD − 0.95; 95% CI [-1.23; -0.66]; p  < 0.01) compared with placebo in these patients. There was no significant difference between groups in symptomatic resolution (RR 1.01; 95% CI [1.00;1.03]; p  = 0.147). Conclusion 3CL protease inhibitors significantly reduced the change in the viral load and increased the rate of symptom alleviation and recovery, underscoring their importance as a potential therapeutic option.

Background Transthyretin (TTR) Cardiomyopathy (ATTR-CM) is characterized by the deposition of misfolded TTR monomers in the heart, leading to progressive heart failure. TTR-specific therapies offer a pharmacological approach to slow disease progression. However, there remains limited data on the efficacy, comparative effectiveness, and safety of these therapies. Therefore, we aim to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TTR-specific therapies with placebo in patients with ATTR-CM. Methods We searched through Pubmed, Cochrane, and Embase databases. Our primary outcome was: (1) All Cause Mortality. We also performed a subgroup analysis comparing TTR stabilizers versus TTR knock-down therapies (RNA inhibitors and antisense oligonucleotides). Results Nine RCTs were included, involving 2,713 patients, of whom 1,160 (59.34%) were assigned to the TTR-specific therapies group. In the pooled analysis, TTR-specific therapies were associated with a significant reduction in all-cause mortality (RR 0.70; 95% CI 0.60, 0.83; p  < 0.01; I² = 0%), with both TTR stabilizers and knock-down therapies showing equally effective reductions ( p  = 0.97). Additionally, TTR-specific therapies improved LV longitudinal strain (SMD − 0.22; 95% CI -0.34, -0.10; p  < 0.01; I² = 17%) and reduced LV mass (SMD − 9.11 g; 95% CI -16.4 g, -1.82 g; p  = 0.01; I² = 0%). Conclusion This meta-analysis highlights the potential of TTR-targeting therapies as an effective option for managing ATTR-CM, with significant improvements in survival. No efficacy differences were found between TTR stabilizers and knock-down therapies.

Background Natriuretic peptides (NP) are widely used to diagnose heart failure (HF), but their role in guiding treatment remains uncertain. We performed a randomized trial meta‐analysis comparing NP‐guided therapy to usual care in acute decompensated HF. Methods We searched PubMed, Embase, and Cochrane for RCTs comparing NP‐guided therapy to usual care in acute decompensated HF. Outcomes included all‐cause mortality, cardiovascular death, and a composite of mortality and HF hospitalizations (reported as RR and 95% CI). Heterogeneity was assessed using I2, and a random‐effects model was applied when appropriate. Analyses were performed in R Studio 4.3.2. Results We included 9 RCTs with 3992 patients, of whom 2007 (50.3%) underwent NP‐guided treatment. The median follow‐up was 12 months. All‐cause mortality (RR: 0.84; 95% CI: 0.69–1.01; p = 0.069; I2 = 41%), cardiovascular death (RR: 0.91; 95% CI: 0.78–1.08; p = 0.287; I2 = 0%), and the composite outcome of HF hospitalization or cardiovascular death (RR: 0.91; 95% CI: 0.77–1.09; p = 0.308; I2 = 56%) were not significantly different between groups. The time to event analysis of all‐cause mortality had a slightly significant advantage in favor of NP‐guided therapy (HR: 0.81; 95% CI: 0.69–0.95; p = 0.01; I2 = 0%). Conclusion Although NP‐guided therapy showed a statistically significant benefit in time to all‐cause mortality, this was not consistently reflected across other endpoints, and its overall clinical impact remains uncertain. Natriuretic peptides can help diagnose acute heart failure, but their role in treatment remains unclear. A meta‐analysis of 9 RCTs (N = 3992) found NP‐guided therapy slightly reduced time to all‐cause mortality but did not significantly impact overall mortality, cardiovascular death, or hospitalizations, suggesting limited benefit in clinical outcomes.

The Norwood operation has transformed the approach to hypoplastic left heart syndrome and its variants. Given the complexity of this procedure, postoperative residual injuries are prevalent. To evaluate the impact of significant residual injuries on clinical outcomes and mortality in Norwood procedure patients at a high-volume tertiary center in a developing nation using the technical performance score (TPS). This single-center, retrospective study included patients who underwent the Norwood procedure between December 2018 and February 2023. Data on demographics, echocardiograms, complications, intensive care unit stay, and mortality were collected. Logistic regression and linear analyses assessed the impact of TPS on outcomes. Of 69 patients, nine (13%) were excluded due to incomplete echocardiographic data, leaving 60 (87%) for TPS classification. Among them, 28 (47%) were male. TPS classification was as follows: 40 (66%) in class 1 (excellent), five (8.3%) in class 2 (adequate), and 15 (25%) in class 3 (inadequate), indicating significant residual lesions or need for reintervention. The 30-day mortality rate was 21.6%, increasing to 41.6% before the next stage. In TPS class 3, 30-day mortality was 33% vs. 17% in classes 1 and 2 (P = 0.27). Interstage mortality was 60% in class 3 compared to 35% in other groups (P = 0.13). Major complications were significantly higher in TPS class 3 (93% vs. 55.5%, P = 0.04). TPS effectively predicts major complications post-Norwood and serves as a valuable tool for improving patient outcomes.