The efficacy of colchicine in preventing atrial fibrillation recurrence and pericarditis post-catheter ablation for atrial fibrillation - A systematic review and meta-analysis of prospective studies.

Introduction: Catheter ablation (CA) initiates a proinflammatory process responsible for atrial fibrillation (AF) recurrence (25-40%) and pericarditis (0.8%). Due to its anti-inflammatory properties, colchicine, a microtubule inhibitor, is explored for the prevention of early AF recurrence and pericarditis after pulmonary vein isolation. We performed a pooled analysis to determine the rates of AF recurrence and pericarditis after CA in patients receiving colchicine. Methods: A comprehensive literature review was conducted on PubMed and SCOPUS from inception to December 2023 using medical subject headings and keywords, followed by a citation and reference search. We identified prospective studies reporting recurrent AF and pericarditis outcomes after catheter ablation in patients taking colchicine versus placebo. A binary random effects model was used to estimate pooled odds ratios and 95% confidence intervals. Sensitivity analysis was conducted using the leave-one-out method, and heterogeneity was assessed using the I2 statistic. Results: Of the 958 identified studies, 4 met our inclusion criteria. A total of 1,619 patients were analyzed; 743 received colchicine, and 875 were in the placebo group. Recurrent AF after CA occurred in 192 (29.0 %) of the colchicine group and 318 (39.5 %) of the placebo group. Post-ablation pericarditis occurred in 34 (5.3 %) of the colchicine group and 128 (16.5 %) of the placebo group. Pooled analysis of prospective studies showed that colchicine decreased the odds of recurrent AF [OR: 0.63 (95 % CI: 0.50-0.78), p < 0.01, I2  = 8 %] and post-ablation pericarditis [OR: 0.34 (95 % CI: 0.16-0.75), p < 0.01, I2  = 57 %]. Odds of GI disturbance were increased with colchicine use in our analysis [OR: 2.77 (95 % CI: 1.17-6.56), p = 0.02, I2  = 84 %]. Conclusion: Colchicine use is associated with decreased odds of recurrent AF and pericarditis post-CA from the analysis of prospective studies. These results underscore the potential for colchicine therapy for future exploration with randomized and controlled research with different dosages.

Elevated Triglyceride-Glucose Index as a Predictor of Carotid Plaque Incidence: Insights from a Comprehensive Meta-Analysis.

BACKGROUND: Early detection of carotid plaque (CP) can help reduce the burden of ASCVD in the general population. CP and triglyceride-glucose index (TyGi) are associated with insulin resistance. OBJECTIVES: We performed a meta-analysis exploring the association of TyGi levels with the incidence of CP. METHODS: A systematic search of PubMed, Scopus, and Google Scholar till September 2023 reporting TyGi and CP identified 67 studies, of which 13 met our study criteria. TyGi was assessed both categorically and continuously. Binary random-effects models used for pooled odds ratios (OR) with 95% confidence intervals (CI) and I2 statistic for heterogeneity. RESULTS: Analyzed data from 163,792 patients with a mean age of 53 ± 8.9 years, primarily female (51.5%). Common comorbidities were hypertension (42.4%) followed by dyslipidemia (24.3%). Multivariable analysis showed that high vs. low TyGi quartile was associated with a higher risk of CP with unadjusted OR (1.82, 95% CI [1.5 - 2.21], p < 0.01; I²â€¯= 95.77, p < 0.01) and adjusted OR (1.3, 95% CI [1.16 - 1.46], p < 0.01; I²â€¯= 79.71, p < 0.01). Increasing TyGi also had a higher risk of CP with unadjusted OR (1.53, 95% CI [1.15 - 2.03], p< 0.01; I²â€¯= 98.48, p < 0.01) and adjusted OR (1.23, 95% CI [1.11 - 1.35], p < 0.01; I²â€¯= 89.82, p< 0.01). The association was validated by sensitivity analysis. CONCLUSION: Our study indicates a higher risk of CP in patients with higher TyGi scores, underscoring its significance as a predictor for carotid atherosclerosis.

Meta-analysis of renin angiotensin aldosterone modulators mitigating Atrial Fibrillation risk in hypertensive patients.

INTRODUCTION: Hypertension is associated with left ventricular hypertrophy/enlargement/fibrosis and atrial ectopic rhythm, leading to an increased risk of Atrial Fibrillation (AF). We aimed to stratify the effect of Angiotensin Converting Enzyme Inhibitors (ACEi) and Angiotensin Receptor Blockers (ARB) on the risk of AF. METHODS: PubMed, Scopus, and Google Scholar databases were screened, and cross-citation was conducted for studies reporting AF in hypertensive patients on ACEi and ARB. Of 145 studies found till May 2023, 19 were included in this study. Binary random-effects models estimated the pooled odds ratios, I2 statistics assessed heterogeneity and sensitivity analysis was assessed using the leave-one-out method. RESULTS: 153,559 hypertensive patients met the inclusion criteria. For incidental AF, ACEi and ARB showed a significant decrease in both unadjusted (OR 0.75, 95% CI [0.66-0.85], I² = 20.79%, p=0.29) and adjusted risks (OR 0.76, 95% CI [0.62-0.93], I² = 88.41%, p<0.01). In recurrent AF, the unadjusted analysis showed no significant effect (OR 0.89, 95% CI [0.55-1.42], I² = 78.44%, p<0.01), while the adjusted analysis indicated a reduced risk (OR 0.62, 95% CI [0.50-0.76], I² = 65.71%, p<0.01). Leave-one-out sensitivity analysis confirmed these results. CONCLUSIONS: ACEi and ARB considerably decrease the risk of incidental and recurrent AF in hypertensive patients, emphasizing the importance of treating clinical hypertension with these drugs.

Acute ischemic stroke in young adults: comparative analysis of outcomes and mortality in metabolically healthy obese or overweight vs. non-obese or overweight hospitalizations, 2016-2019 cohort.

INTRODUCTION: Rising obesity rates and the increasing prevalence of stroke in the metabolically healthy obese and overweight (MHOO) necessitate examining its association in younger (18-44 year) populations and analyzing acute ischemic stroke (AIS) trends and outcomes in MHOO vs. metabolically healthy non-obese or overweight (MHnOO). METHODS: Data from the United States National Inpatient Sample (2016-2019) was analyzed to identify young MHOO and MHnOO AIS patients using ICD-10-CM codes. Metabolically healthy status was defined by excluding hospitalization records with diagnostic codes for hypertension, diabetes, and dyslipidemia. Demographics, trends, and outcomes were compared using appropriate statistical approaches. RESULTS: Of 26,949,310 young metabolically healthy hospitalizations between 2016 and 2019, 47,795 had AIS, of which 4,985 were MHOO and 42,810 were MHnOO. The median age of AIS hospitalization was 35 years, and primarily female and white. From 2016 to 2019, AIS incidence rose slightly, which was significant only for the MHnOO cohort. The in-hospital mortality rate was significantly lower in the MHOO cohort (6.0 % vs. 8.6 %, p < 0.001). Hospitalization length and cost did not differ substantially between groups. Adjusted multivariable analysis revealed no significant difference in AIS hospitalization risk between MHOO and MHnOO (aOR: 1.02, p=0.701), with subgroup analysis in males (aOR: 0.88, p=0.161) or females (aOR: 1.06, p=0.363). However, all-cause in-hospital mortality (ACIHM) in AIS had lower odds in the MHOO vs. MHnOO cohorts (aOR: 0.60, p=0.021). CONCLUSION: Our study finds a rising trend of AIS hospitalizations in young metabolically healthy adults, with obesity or overweight status not being associated with AIS hospitalization. We identify an "obesity paradox" of lower odds for ACIHM for AIS hospitalizations in the MHOO cohort.

Serum direct bilirubin as a prognostic marker for short-term ischemic stroke morbidity and mortality: Pooled analysis of cohort studies.

OBJECTIVES: Recent research on serum bilirubin's impact on stroke outcomes presents conflicting evidence. Higher bilirubin levels have been associated with both protective effects against ischemic stroke and increased risk of poor neurological recovery and higher mortality. MATERIALS AND METHODS: Systematic searching of the PubMed and SCOPUS databases from inception till April 2024 yielded 139 studies of which four were included for analysis. Adhering to MOOSE guidelines, we specifically assessed the association between high versus low direct bilirubin (DBIL) levels and poor neurological recovery using a narrowly defined criterion of the Modified Rankin Scale (mRS) score from 2 to 6. RESULTS: The pooled analysis from four studies analyzed data, encompassed 12,632 acute ischemic stroke hospitalizations, indicates a significant association between high serum DBIL and increased risk of poor neurological recovery (OR: 1.89, 95% CI: [1.28-2.77], p < 0.01), with moderate study heterogeneity (I2 = 58%, p = 0.07). Publication bias was mild, with an LFK index of - 1.81. CONCLUSION: Our findings suggest a potential association between elevated DBIL and a higher risk of post-stroke morbidity and mortality, indicating the need for further research to explore DBIL as a potential predictor of post-stroke neurological recovery and to understand its role in ischemic stroke pathophysiology better.

A Comparative Analysis of Positive and Negative Stimuli for Takotsubo Cardiomyopathy: A Pooled Analysis of Two Studies and a Systematic Review.

Takotsubo cardiomyopathy (TTC) is characterized by transient myocardial dysfunction triggered by both negative and positive emotional experiences, known respectively as broken heart syndrome (BHS) and happy heart syndrome (HHS). Despite the scarcity of comparative analyses between HHS and BHS in the literature, our pooled analysis, incorporating two retrospective registry analyses of 1395 TTC patients (57 HHS and 1338 BHS), reveals that while BHS is more prevalent, both conditions exhibit similar clinical presentations and outcomes. Statistical analyses, utilizing binary random effects models, indicate that diabetes mellitus is less common in HHS patients and serves as a predictor for BHS. Furthermore, there are differences in cardiac imaging between the two groups; individuals with HHS have higher odds of experiencing midventricular ballooning, whereas those with BHS are more likely to have apical ballooning. These findings highlight the similarities in clinical features and outcomes between HHS and BHS, while also illustrating distinct imaging profiles. The study emphasizes the need for future prospective studies to delve deeper into the implications of these TTC subtypes, offering valuable insights into their comparative aspects and underlying mechanisms.

Nutritional Risk Screening in Hospitalized Adults Using the Malnutrition Universal Screening Tool at a Tertiary Care Hospital in South India.

Background and objectives Malnutrition is still widely prevalent in India. Various nutritional screening tools have been developed to screen for nutritional risk status but no one tool is considered the best. The Malnutrition Universal Screening Tool (MUST) is accepted by the European Society for Clinical Nutrition and Metabolism and validated for use in hospitalized adults. Hence, it was used in this study to estimate the prevalence of malnutrition in hospitalized adults and its association with socioeconomic inequality. Methods A sample of randomly selected 358 ambulatory hospitalized patients above 18 years of age was used in the study. Data pertaining to demography, socioeconomic status, medical history, and MUST were collected using a structured questionnaire. The height and weight of the patients were measured, and their BMI was determined. The patients were classified into five socioeconomic classes and their MUST scores were determined. Results Statistically significant (P < 0.05) increasing trend was observed in the height, weight, and BMI of patients with increasing socioeconomic status. Diabetes mellitus (39%) followed by hypertension (30%) were the predominant comorbid conditions. According to MUST, the overall prevalence of medium and high risk of malnutrition was 11% and 24%, respectively, and the socioeconomic class that was most impacted was Class 4 (1,130-2,259 INR per capita monthly income). Interpretation and conclusions Socioeconomic status influences the prevalence of malnutrition, comorbid conditions, and the anthropometric measurements of admitted patients. The prevalence of nutritional risk status irrespective of sex was found to be 34.91% (24.3% in males and 10.61% in women) in the study.