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.
Vasovagal syncope (VVS) refers to a heterogeneous group of conditions whereby the cardiovascular reflexes normally controlling the circulation are interrupted irregularly in response to a trigger, resulting in vasodilation, bradycardia, or both. VVS affects one-third of the population at least once in their lifetime or by the age of 60, reduces the quality of life, and may cause disability affecting certain routines. It poses a considerable economic burden on society, and, despite its prevalence, there is currently no proven pharmacological treatment for preventing VVS. The novel procedure of ganglionated plexus (GP) ablation has emerged rapidly in the past two decades, and has been proven successful in treating syncope. Several parameters influence the success rate of GP ablation, including specific ablation sites, localization and surgical techniques, method of access, and the integration of other interventions. This review aims to provide an overview of the existing literature on the physiological aspects and clinical effectiveness of GP ablation in the treatment of VVS. Specifically, we explore the association between GPs and VVS and examine the impact of GP ablation procedures as reported in human clinical trials. Our objective is to shed light on the therapeutic significance of GP ablation in eliminating VVS and restoring normal sinus rhythm, particularly among young adults affected by this condition.
Ablation Techniques , Syncope, Vasovagal , Young Adult , Animals , Humans , Syncope, Vasovagal/surgery , Quality of Life , Anura , Bradycardia
As permanent pacemaker implantation is increasingly becoming a common practice, it is important to understand potential complications associated with the procedure. We present a 78-year-old Caucasian female who developed contralateral pneumomediastinum, pneumothorax, and pneumopericardium after undergoing implantation of a dual-chamber pacemaker.
Urea kinetic modeling suggests that significant time reductions may be realized in hemodialysis patients with residual renal urea clearance (K(r)t/V urea). However, the actual impact of a strategy that integrates such function into the dialysis prescription is not clear, because of both uncertainty regarding the rate of decay of K(r)t/V urea, as well as potential clinical constraints upon dose reduction. To examine this issue, we retrospectively reviewed data from 51 patients with K(r)t/N urea after initiation of maintenance hemodialysis. In 31 cases, there were no clinical barriers to adjustment of the dialysis prescriptions. Regression analysis revealed that each 0.10 increment in K(r)t/V urea yielded an actual dialysis time reduction of 12 minutes per week with average cumulative reduction of 80 minutes per week per patient. At approximately 1 year after initiation of dialysis, there were still 10 patients whose dialysis prescriptions were being adjusted on the basis of K(r)t/V urea. In conclusion, our results suggest that the incorporation of K(r)t/V urea in the hemodialysis prescription allows for substantial and enduring reductions in dialysis time in a significant minority of patients. Larger prospective studies are needed to evaluate the long-term safety of this strategy in modifying the dose of hemodialysis.
Kidney/metabolism , Renal Dialysis , Urea/metabolism , Humans , Metabolic Clearance Rate , Time Factors
Left ventricular (LV) shape has hitherto received little attention from echocardiographers; systematic quantitative observations on LV shape, apart from LV volume, wall thickness or function, have been attempted only recently. In this article, we focus on assessment of normal LV shape and changes in overall LV chamber configuration in cardiomyopathic and other dysfunctional left ventricles. The topic of LV shape of hypertrophic LV chambers is also addressed. LV shape descriptors comprise ratios of various LV measurements to each other; their values in normal and abnormal LV chambers, as set forth in recent work from our laboratory and others, are summarized. Cardiologists, including echocardiographers, are not generally aware of the various geometric approaches to quantifying chamber shapes. These are briefly described, with comments on their relative suitability for application to LV shape evaluation.
Although echocardiography has been used for diagnosing pericardial effusions since 1965, the grading of such effusions for size, and also the diagnosis of tamponade have depended almost entirely on qualitative observations or "signs." The categorization of pericardial effusions into small, moderate, or large according to the width of pericardial space is very roughly semiquantitative. Diagnostic criteria for tamponade are based on altered ventricular or atrial wall contour, and on phasic respiratory fluctuations of ventricular size and flow velocities. We review a new approach to pericardial effusion volume estimation, based on assessing the pericardial sac volume as well as cardiac volume by the ellipsoid formula. A new quantitative criteria for tamponade (i.e., biatrial width to cardiac width) (annular level) ratio may be useful, a ratio < 0.85 indicating tamponade, reflecting late diastolic biatrial collapse. The echo diagnosis of pericardial constriction depends on pericardial thickening combined with various abnormalities of septal and ventricular wall motion, some of them subtle. We review a new two-dimensional echo "sign" present in some cases of pericardial constriction: abnormal posterior displacement of the left atrial posterior wall, and reduced angle (<150 degrees ) between it and left ventricular wall in long-axis view. Measurements reflecting the fluctuation of certain Doppler parameters can also be useful in diagnosis of this entity.
