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BACKGROUND: Atherosclerosis is a multi-factorial disease, and low-density lipoprotein cholesterol (LDL-C) is a critical risk factor in developing atherosclerotic cardiovascular disease (ASCVD). Cholesteryl-ester transfer-protein (CETP), synthesized by the liver, regulates LDL-C and high-density lipoprotein cholesterol (HDL-C) through the bidirectional transfer of lipids. The novelty of CETP inhibitors (CETPis) has granted new focus towards increasing HDL-C, besides lowering LDL-C strategies. To date, five CETPis that are projected to improve lipid profiles, torcetrapib, dalcetrapib, evacetrapib, anacetrapib, and obicetrapib, have reached late-stage clinical development for ASCVD risk reduction. Early trials failed to reduce atherosclerotic cardiovascular occurrences. Given the advent of some recent large-scale clinical trials (ACCELERATE, HPS3/TIMI55-REVEAL Collaborative Group), conducting a meta-analysis is essential to investigate CETPis' efficacy. METHODS: We conducted a thorough search of randomized controlled trials (RCTs) that commenced between 2003 and 2023; CETPi versus placebo studies with a ≥6-month follow-up and defined outcomes were eligible. PRIMARY OUTCOMES: major adverse cardiovascular events (MACEs), cardiovascular disease (CVD)-related mortality, all-cause mortality. SECONDARY OUTCOMES: stroke, revascularization, hospitalization due to acute coronary syndrome, myocardial infarction (MI). RESULTS: Nine RCTs revealed that the use of a CETPi significantly reduced CVD-related mortality (RR = 0.89; 95% CI: 0.81-0.98; p = 0.02; I2 = 0%); the same studies also reduced the risk of MI (RR = 0.92; 95% CI: 0.86-0.98; p = 0.01; I2 = 0%), which was primarily attributed to anacetrapib. The use of a CETPi did not reduce the likelihood any other outcomes. CONCLUSIONS: Our meta-analysis shows, for the first time, that CETPis are associated with reduced CVD-related mortality and MI.
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Mechanical circulatory support devices are used to support the heart in cardiogenic shock. We present a case of demonstrating the feasible use of left ventricular assistive device with reverse configuration to support severe right ventricular failure in a patient with recent tricuspid annuloplasty ring.
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Although it is no longer in production, the Starr-Edwards valve has successfully replaced hundreds of thousands of heart valves in the past 50 years of its use. We report on the case of a valve in the aortic position still functioning 49 years after implantation without replacement, showcasing the valve's durability.
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Cardiac tamponade is a life-threatening complication during left atrial appendage (LAA) closure. We report a 77-year-old woman who underwent a transseptal puncture for LAA closure with the Watchman device that was complicated by tamponade. This was successfully treated with the deployment of a Cardioform 25-mm septal occluder device. (Level of Difficulty: Intermediate.).
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The frequency of 18q- is estimated to be approximately 1/40 000 live births and is more commonly associated with certain clinical features including short stature, intellectual disability and malformations of many major organ systems. Congenital cardiac abnormalities are present in 24-36% of cases and screening can prove difficult. A 28-year-old Caucasian female with a history of long arm chromosome 18q deletion was evaluated for persistent dyspnea and decreased activity level. Multiple hospitalizations failed to identify the etiology of her symptoms. Initial transthoracic echocardiogram failed to show any underlying cardiac etiology of her symptoms. Multiple recurrent hospitalizations with the same chief complaint. A transesophageal echo (TEE) showed large secundum atrial septal defect (ASD). Successful surgical closure of her large secundum ASD provided significant symptoms relief. The threshold of obtaining TEE should be low in patients with 18q- which permits early recognition and treatment of underlying structural heart disease.
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PURPOSE OF REVIEW: The need for liver transplant due to the progression of hepatitis C virus (HCV) infection necessitates the consideration of antiviral treatment. Host genomic variations affect response to HCV treatment and predict the rates of adverse effects. Recently, multiple genomic polymorphisms were found to be critical in predicting treatment response as well as the rate of neuropsychiatric adverse effects in patients infected with HCV who are receiving antiviral treatments. RECENT FINDINGS: The use of antiviral treatments (pegylated IFN-alpha and ribavirin) to clear HCV infection is associated with poor response in HCV genotype 1 and with the development of depression. Polymorphisms in the promoter region of the IFN-alpha/beta receptor 1 (IFNAR1) can influence the risk of developing depression. Similar polymorphisms in the IL28B gene encoding for IFN-λ-3 are associated with a two- to three-fold improvement in response to treatment. SUMMARY: In patients with HCV infection receiving antiviral treatments, genomic variations in two genes can help predict the increased risk of developing depression and the likelihood of achieving virus clearance. This can identify patients who are at an increased likelihood of virus clearance and who should be targeted to receive prophylactic approaches (antidepressants, psychotropics) to prevent the development of depression during HCV antiviral treatment.