Aim: To conduct a meta‐analysis and systematic review to examine the effects of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) on clinical biomarkers of inflammation and oxidative stress in patients with type 2 diabetes. Methods: Medline, Embase and the Cochrane Library were searched for randomised controlled trials (RCTs) that examined changes with GLP‐1RAs in a priori selected biomarkers of inflammation: C‐reactive protein (CRP), adiponectin, tumour necrosis factor‐alpha (TNFα), plasminogen activator inhibitor‐1, interleukin‐6, leptin; and of oxidative stress: malondialdehyde (MDA); 8‐iso‐prostaglandin F2α; and 8‐hydroxy‐2′‐deoxyguanosine (8‐OHdG). Results: We included 40 eligible RCTs (n = 6749) with a median follow‐up of 6 months, a mean participant age of 53.1 years, 56.3% females, glycated haemoglobin (HbA1c) 55.6 mmol/mol, body mass index 28.8 kg/m ² and diabetes duration 7.46 years. Analysis of GLP‐1RAs versus standard diabetes therapies or placebo revealed significant reductions in CRP, TNFα and MDA, and significant increases in adiponectin for (mean difference −0.54 mg/L [−0.75, −0.34]; standard mean difference [SMD] −0.39 [−0.62, −0.15]; SMD −0.84 [−1.61, −0.06] and SMD 0.30 [0.12, 0.49], respectively [95% confidence intervals]). Systolic blood pressure decreased significantly and was significantly and strongly correlated with a reduction in CRP. Homeostatic model assessment of insulin resistance was also significantly correlated with a reduction in CRP, but HbA1c was not. Conclusions: There is strong evidence supporting clinically relevant anti‐inflammatory and antioxidant effects of GLP‐1RAs. This may be used to guide future targeted clinical use of GLP‐1RAs and the development of medications seeking to target the cardioprotective properties of GLP‐1RAs.

Background: Access site vascular and bleeding complications remain problematic for patients undergoing transcatheter aortic valve replacement (TAVR). Ultrasound-guided transfemoral access approach has been suggested as a technique to reduce access site complications, but there is wide variation in adoption in TAVR. We performed a systematic review and meta-analysis to compare access site vascular and bleeding complications according to the Valve Academic Research Consortium-2 classification following the use of either ultrasound- or conventional fluoroscopy-guided transfemoral TAVR access. Methods: Medline, Embase, Web of Science, and The Cochrane Library were searched to November 2020 for studies comparing ultrasound- and fluoroscopy-guided access for transfemoral TAVR. A priori defined primary outcomes were extracted: (1) major, (2) minor, and (3) major and minor (total) access site vascular complications and (4) life-threatening/major, (5) minor, and (6) life-threatening, major, and minor (total) access site bleeding complications. Results: Eight observational studies (n=3875) were included, with a mean participant age of 82.8 years, STS score 5.81, and peripheral vascular disease in 23.5%. An ultrasound-guided approach was significantly associated with a reduced risk of total (Mantel-Haenszel odds ratio [MH-OR], 0.50 [95% CI, 0.35–0.73]), major (MH-OR, 0.51 [95% CI, 0.35–0.74]), and minor (MH-OR, 0.59 [95% CI, 0.38–0.91]) access site vascular complications. Ultrasound guidance was also significantly associated with total access site bleeding complications (MH-OR, 0.59 [95% CI, 0.39–0.90]). The association remained significant in sensitivity analyses of maximally adjusted minor and total vascular access site complications (MH-OR, 0.51 [95% CI, 0.29–0.90]; MH-OR, 0.44 [95% CI, 0.20–0.99], respectively). Conclusions: In the absence of randomized studies, our data suggests a potential benefit for ultrasound guidance to obtain percutaneous femoral access in TAVR. Registration: URL: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42020218259.

International guidelines recommend screening of first-degree relatives (FDR) of people with bicuspid aortic valves (BAVs). However, the prevalence of BAV and of aortic dilatation amongst family members is uncertain. A systematic review and meta-analysis of original reports of screening for BAV. Databases including MEDLINE, Embase, and Cochrane CENTRAL were searched from inception to December 2021 using relevant search terms. Data were sought on the screened prevalence of BAV and aortic dilatation. The protocol was specified prior to the searches being performed, and standard meta-analytic techniques were used. Twenty-three observational studies met inclusion criteria (n = 2297 index cases; n = 6054 screened relatives). The prevalence of BAV amongst relatives was 7.3% [95% confidence interval (CI) 6.1%–8.6%] overall and per family was 23.6% (95% CI 18.1%–29.5%). The prevalence of aortic dilatation amongst relatives was 9.4% (95% CI 5.7%–13.9%). Whilst the prevalence of aortic dilatation was particularly high in relatives with BAV (29.2%; 95% CI 15.3%–45.1%), aortic dilatation alongside tricuspid aortic valves was a more frequent finding, as there were many more family members with tricuspid valves than BAV. The prevalence estimate amongst relatives with tricuspid valves (7.0%; 95% CI 3.2%–12.0%) was higher than reported in the general population. Screening family members of people with BAV can identify a cohort substantially enriched for the presence of bicuspid valve, aortic enlargement, or both. The implications for screening programmes are discussed, including in particular the substantial current uncertainties regarding the clinical implications of aortic findings. Left: prevalence estimates from meta-analysis for identification of bicuspid aortic valves (BAV) in screened relatives and identification of an affected family with at least one individual with newly found BAV per families screened, in addition to prevalence estimates for aortic dilatation of screened relatives overall and specifically amongst individuals also identified to have BAV or tricuspid aortic valves. Right: a visual representation of the estimated proportions of each finding from pooled screening programmes, by individuals (above) and by families screened (below).

Aims: To conduct a meta‐analysis of randomized controlled trials (RCTs) to assess the effect of sodium‐glucose cotransporter‐2 (SGLT2) inhibitors on inflammatory biomarkers. Methods: Medline, Embase and the Cochrane Library were searched for RCTs investigating the effect of SGLT2 inhibitors on inflammatory biomarkers, adipokine profiles and insulin sensitivity. Results: Thirty‐eight RCTs were included (14 967 participants, 63.3% male, mean age 62 ± 8.6 years) with a median (interquartile range) follow‐up of 16 (12–24) weeks. Meta‐analysis showed that SGLT2 inhibitors significantly improved adiponectin, interleukin‐6, tumour necrosis factor receptor‐1 (vs. placebo alone: standardized mean difference [SMD] 0.34 [95% confidence interval {CI} 0.23, 0.45], mean difference [MD] −0.85 pg/mL [95% CI −1.32, −0.38], SMD −0.13 [95% CI −0.20, −0.06], respectively), leptin and homeostatic model assessment of insulin resistance index (vs. control: SMD −0.20 [95% CI −0.33, −0.07], MD −0.83 [95% CI −1.32, −0.33], respectively). There were no significant changes in C‐reactive protein (CRP), tumour necrosis factor‐α, plasminogen activator inhibitor‐1, fibroblast growth factor‐21 or monocyte chemoattractant protein‐1. Conclusions: Our analysis shows that SGLT2 inhibitors likely improve adipokine biomarkers and insulin sensitivity, but there is little evidence that SGLT2 inhibitors improve other inflammatory biomarkers including CRP.

Artificial intelligence and machine learning (ML) models are rapidly being applied to the analysis of cardiac computed tomography (CT). We sought to provide an overview of the contemporary advances brought about by the combination of ML and cardiac CT. Six searches were performed in Medline, Embase, and the Cochrane Library up to November 2021 for (i) CT-fractional flow reserve (CT-FFR), (ii) atrial fibrillation (AF), (iii) aortic stenosis, (iv) plaque characterization, (v) fat quantification, and (vi) coronary artery calcium score. We included 57 studies pertaining to the aforementioned topics. Non-invasive CT-FFR can accurately be estimated using ML algorithms and has the potential to reduce the requirement for invasive angiography. Coronary artery calcification and non-calcified coronary lesions can now be automatically and accurately calculated. Epicardial adipose tissue can also be automatically, accurately, and rapidly quantified. Effective ML algorithms have been developed to streamline and optimize the safety of aortic annular measurements to facilitate pre-transcatheter aortic valve replacement valve selection. Within electrophysiology, the left atrium (LA) can be segmented and resultant LA volumes have contributed to accurate predictions of post-ablation recurrence of AF. In this review, we discuss the latest studies and evolving techniques of ML and cardiac CT.