Long-term impact of transcatheter closure interatrial shunts on disabling migraine.

BACKGROUNDS: Effectiveness of patent foramen ovale (PFO) closure on relief of migraine, is still unclear. We sought to analyse the long-term (>10 years) effects of interatrial septal shunt repair on disabling migraine performing a retrospective non-randomised study. METHODS: Clinical records of patients with disabling, medication-refractory migraine and PFO or significant ASD referred to our centre for closure from 2006 to 2018, were analysed. RESULTS: Forty -six patients (38 female, mean age 40.0 ± 3.7 years) with PFO and 32 patients with significant ASD (28 female, mean age 38.0 ± 4.1 years) submitted to transcatheter closure had a pre-existing disabling migraine with mean Migraine Disability Assessment Score (MIDAS) of 35.8 ± 4.7. After a mean follow-up of 118.2 ± 19.1 months (range 96 to 144), 72 out of 78 patients were still followed-up: in all subjects, aura was abolished, and migraine improved also in patients without aura. The mean MIDAS significantly decreased from baseline value (p < 0.01). Complete migraine resolution was associated in PFO patients with a shorter history of migraine, a more severe thrombophilic profile, a more severe Right-to-Left Shunt (RLS) and larger left atrial diameter and volume, and in ASD patients with bidirectional shunt. CONCLUSIONS: Device-based repair of PFO/ASD in patients with migraine was associated with abolition of aura and symptoms reduction in the long-term period.

Risk of incident heart failure after COVID-19 recovery: a systematic review and meta-analysis.

Patients recovered from COVID-19 have an increased incidence of cardiovascular disease and heart structural changes. The aim of the present manuscript is to assess the risk of incident heart failure (HF) after COVID-19 infection. Data were obtained searching MEDLINE and Scopus for all studies published at any time up to September 1, 2022 reporting the risk of incident HF in COVID-19 recovered patients. The cumulative post-COVID-19 incidence and risk of incident HF were pooled using a random effects model and presented with the corresponding 95% confidence interval (CI). Statistical heterogeneity was measured using the Higgins I2 statistic. Overall, 21,463,173 patients (mean age 54.5 years, 58.7% males) were analyzed. Among them, 1,628,424 had confirmed COVID-19 infection while the remaining 19,834,749 represented the controls. The mean length of follow-up was 9.2 months. A random effect model revealed a pooled incidence of post COVID-19 HF in 1.1% of cases (95% CI: 0.7-1.6, I2: 99.8%). Moreover, recovered COVID-19 patients showed an increased risk of incident HF (HR: 1.90, 95% CI: 1.54-3.24, p < 0.0001, I2 = 96.5%) in the same follow-up period. Meta-regression showed a direct relationship for the risk of incident HF using age (p = 0.001) and hypertension (HT) (p = 0.02) as moderators, while an inverse association was observed when the follow-up length was adopted as moderating variable (p = 0.01). COVID-19 survivors had an additional 90% risk of developing HF after COVID-19 infection in the long-term period. This risk was directly related with age and previous history of HT especially in the early post-acute phase of the infection.

[Thrombolysis in hemodynamically unstable patients with acute pulmonary embolism: searching for the optimal therapeutic temporal window]. / Trombolisi nei pazienti con embolia polmonare emodinamicamente instabile: alla ricerca della finestra terapeutica temporale ottimale.

Current guidelines on the management of acute pulmonary embolism (PE) of the European Society of Cardiology recommend the administration of systemic thrombolysis in hemodynamically unstable patients (defined as high risk - class I, level of evidence A). However, in the real world, systemic thrombolysis remains underused in hemodynamically unstable PE patients. We systematically reviewed and analyzed all studies published from 2008 to 2022 that evaluated the optimal therapeutic window for systemic thrombolysis in high-risk PE patients, also reporting potential thrombolysis-related adverse events. We identified only two studies enrolling 532 patients (mean age 65.5 years, 251 male). These studies suggested that early administration of systemic thrombolysis was associated with reduced short-term mortality and lower rates of major bleeding events and subsequent clinical deterioration. The identification of a less wide therapeutic window for the administration of systemic thrombolysis may improve the short-term mortality of high-risk PE patients and reduce the incidence of thrombolysis-related adverse events encouraging the use of systemic fibrinolysis, where appropriate.