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- Archilletti, Federico, et al.
(författare)
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Timing of mechanical circulatory support during primary angioplasty in acute myocardial infarction and cardiogenic shock : Systematic review and meta-analysis
- 2022
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Ingår i: Catheterization and Cardiovascular Interventions. - : Wiley. - 1522-1946 .- 1522-726X. ; 99:4, s. 998-1005
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: We aim to define whether the timing of microaxial left ventricular assist device (IMLVAD) implantation might impact on mortality in acute myocardial infarction (AMI) cardiogenic shock (CS) patients who underwent primary percutaneous coronary intervention (PPCI). Background: Despite the widespread use of PPCI, mortality in patients with AMI and CS remains high. Mechanical circulatory support is a promising bridge to recovery strategy, but evidence on its benefit is still inconclusive and the optimal timing of its utilization remains poorly explored. Methods: We compared clinical outcomes of upstream IMLVAD use before PPCI versus bailout use after PPCI in patients with AMI CS. A systematic review and meta-analysis of studies comparing the two strategies were performed. Effect size was reported as odds ratio (OR) using bailout as reference group and a random effect model was used. Study-level risk estimates were pooled through the generic inverse variance method (random effect model). Results: A total of 11 observational studies were identified, including a pooled population of 6759 AMI-CS patients. Compared with a bailout approach, upstream IMLVAD was associated with significant reduction of 30-day (OR = 0.65; 95% confidence interval [CI] = 0.51–0.82; I2 = 43%, adjusted OR = 0.54; 95% CI = 0.37–0.59; I2 = 3%, test for subgroup difference p = 0.30), 6-month (OR = 0.51; 95% CI = 0.27–0.96; I2 = 66%), and 1-year (OR = 0.56; 95% CI = 0.39–0.79; I2 = 0%) all-cause mortality. Incidence of access-related bleeding, acute limb ischemia and transfusion outcomes were similar between the two strategies. Conclusion: In patients with AMI-CS undergoing PPCI, upstream IMLVAD was associated with reduced early and midterm all-cause mortality when compared with a bailout strategy.
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| 2. |
- Bisogno, Marco, et al.
(författare)
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Standardizing local governments’ audit reports : for better or for worse?
- 2022
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Ingår i: Public Money and Management. - : Taylor and Francis Ltd.. - 0954-0962 .- 1467-9302. ; 42:7, s. 482-490
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Tidskriftsartikel (refereegranskat)abstract
- IMPACT: This article contributes to the policy debate on whether to standardize audit reports in public sector organizations. It offers useful insights that national regulators and standard-setters can consider when introducing new rules and standards in the audit regulatory space. Regulators and standard-setters interested in teasing out the professional support that auditors can offer should be aware of the need for a balance between standardization and freedom in preparing annual audit reports. ABSTRACT: The article investigates audit reports in Italian local governments using the theoretical lens of standardization theory. By means of a content analysis on 90 audit reports for the financial year 2018, the effectiveness of a standardized audit model for the audit report is discussed. The findings reveal that standardization seems to lead to a rigid approach in producing the audit reports of local governments. The study offers insights into rethinking the audit regulatory space in public sector organizations.
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| 3. |
- Ricci, Fabrizio, et al.
(författare)
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Exercise-induced myocardial edema in master triathletes : Insights from cardiovascular magnetic resonance imaging
- 2022
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Ingår i: Frontiers in Cardiovascular Medicine. - : Frontiers Media SA. - 2297-055X. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Strenuous exercise has been associated with functional and structural cardiac changes due to local and systemic inflammatory responses, reflecting oxidative, metabolic, hormonal, and thermal stress, even in healthy individuals. We aimed to assess changes in myocardial structure and function using cardiovascular magnetic resonance (CMR) imaging in master triathletes early after a full-distance Ironman Triathlon race. Materials and methods: Ten master triathletes (age 45 ± 8 years) underwent CMR within 3 h after a full-distance Ironman Triathlon race (3.8 km swimming, 180 km cycling, and 42.2 km running) completed with a mean time of 12 ± 1 h. All the triathletes had a 30-day follow-up CMR. Cine balanced steady-state free precession, T2-short tau inversion recovery (STIR), tagging, and late gadolinium enhancement (LGE) imaging sequences were performed on a 1.5-T MR scanner. Myocardial edema was defined as a region with increased T2 signal intensity (SI) of at least two SDs above the mean of the normal myocardium. The extent of myocardial edema was expressed as the percentage of left ventricular (LV) mass. Analysis of LV strain and torsion by tissue tagging included the assessment of radial, longitudinal, and circumferential peak systolic strain, rotation, and twist. Results: Compared with postrace, biventricular volumes, ejection fraction, and LV mass index remained unchanged at 30-day follow-up. Global T2 SI was significantly higher in the postrace CMR (postrace 10.5 ± 6% vs. follow-up 3.9 ± 3.8%, P = 0.004) and presented with a relative apical sparing distribution (P < 0.001) matched by reduction of radial peak systolic strain of basal segments (P = 0.003). Apical rotation and twist were significantly higher immediately after the competition compared with follow-up (P < 0.05). Conclusion: Strenuous exercise in master triathletes is associated with a reversible regional increase in myocardial edema and reduction of radial peak systolic strain, both presenting with a relative apical sparing pattern.
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