Search

We aimed to explore whether interventional closure of patent foramen ovale (PFO) results in reduction of composite outcome [stroke/transitory ischemic attack (TIA), death, and thrombolysis in myocardial infarction—TIMI bleeding], stroke and stroke/TIA compared to medical treatment in patients with cryptogenic stroke. Searching the PUBMED and Cochrane library database, we performed meta-analysis from all randomized controlled studies that compared effects of interventional PFO closure with medical treatment on stroke prevention. 3560 patients from six randomized trials were included. Interventional PFO closure reduced composite outcome (RR of 0.47, 0.26–0.85, p = 0.01), stroke (RR of 0.38, 0.18–0.82, p = 0.01) and stroke/TIA (RR of 0.56, 0.43–0.74, p

Use of protective angiotensin-converting enzyme inhibitors (ACE-I) in patients with cardiovascular disease (CVD) is sometimes limited by incident coughing. In clinical trials, cough occurred also on placebo. We performed a meta-analysis including randomized, placebo-controlled trials reporting cough on ACE-I in patients with CVD. We evaluated the attributable fraction of cough on ACE-I accounting rate on placebo: placebo-adjusted ACE-I (%) = (ACE-I (%) - Placebo (%)) / ACE-I (%). In total, 65,054 patients from 22 included studies were analyzed. Placebo-adjusted ACE-I cough was 37% of 13.5% reported cases on ACE-I, while 8.5% reported cases on placebo were equivalent to 63% of cases on ACE-I, indicating potential other factors for cough than ACE-I in a substantial number of cough cases on ACE-I. Placebo-adjusted ACE-I cough had the highest rates of arterial hypertension (85%) and the lowest of heart failure (29%). Therefore, other causes of cough, particularly in heart failure, should be excluded before ACE-I withdrawal.

Zusammenfassung. Die Myokarditis ist eine entzündliche Erkrankung des Herzmuskels mit verschiedenster Ätiopathogenese. In Europa sind Virusinfektionen die häufigste Ursache für eine Herzmuskelentzündung. Die Diagnostik der Myokarditis ist auch aufgrund des breiten Spektrums ihres klinischen Erscheinungsbildes schwierig. Die Zusammenschau von klinischen Symptomen mit den Ergebnissen nichtinvasiver Untersuchungen kann den Verdacht einer bestehenden Herzmuskelentzündung erhärten. Die Endomyokardbiopsie gilt weiterhin als Goldstandard in der Diagnostik der entzündlichen Herzerkrankung. Die histopathologische, immunhistologische und molekularbiologische Aufarbeitung der Biopsien erlaubt eine ätiologische Abklärung und ggf. auch eine Therapieeinleitung wie z. B. eine immunsuppressive Therapie bei Sarkoidose, Riesenzellmyokarditis oder eosinophiler Myokarditis. Eine spezifische evidenzbasierte Therapie der Virusmyokarditis gibt es bisher nicht; jedoch kann bei Patienten mit bioptisch gesicherter virusnegativer lymphozytärer Myokarditis ebenfalls eine immunsuppressive Therapie diskutiert werden.

Heart rate (HR) is associated with cardiovascular outcomes in all the stages of the cardiovascular continuum as well as in patients with pulmonary, cerebrovascular, and renal disease, sepsis, cancer, and erectile dysfunction. In patients with cardiovascular disease, but also in the general population, increased HR represents an important indicator of mortality with each acceleration of HR over 70 b.p.m. increasing the risk. In patients in sinus rhythm with chronic heart failure with reduced ejection fraction (HFrEF), a HR70 b.p.m. increased the risk of hospitalization, and75 b.p.m. the risk of cardiovascular death as shown in the Systolic Heart Failure Treatment with the I