Objectives: A systematic review and meta-analysis was performed to evaluate the potential prognostic role of serum uric acid (SUA) in patients with chronic heart failure (CHF).Methods: The Embase, PubMed, Web of Science and Cochrane Library databases were searched up to 5 April 2021 for relevant publications. Random effects model was used to pool data. STATA15.0 software was used to perform meta-analysis. Heterogeneity was assessed using the Cochran Q statistic (significance level of P < 0.10) and I² statistics (significance level of 50%).Results: Ultimately, 18 publications reporting adverse events in CHF patients were included. The results indicate reveal associations between a high level of SUA and the risk of all-cause mortality (HR 2.24, 95% CI 1.49–3.37), cardiovascular mortality (HR 1.14, 95% CI 1.06–1.23), and the composite of death or cardiac events (HR 1.26, 95% CI 1.01–1.56) in CHF patients. A 1 mg/dL increase in serum uric acid led to 4% (HR 1.04, 95% CI 1.02–1.05) and 9% (HR 1.09, 95% CI 1.03–1.17) increases in the risk of all-cause mortality and the composite endpoint of death or cardiac events in CHF patients, respectively.Conclusion: Serum uric acid is positively associated with the risk of adverse events in CHF patients. This study protocol has been registered at PROSPERO as CRD42021247084 (https://www.crd.york.ac.uk/PROSPERO).Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO.

This study aims to investigate the association between the platelet-to-high-density lipoprotein cholesterol ratio (PHR) and diabetes/prediabetes in US adults. Data from the 2005–2018 National Health and Nutrition Examination Survey (NHANES) were analyzed in this study. The PHR was calculated by dividing platelet count by HDL-C concentration. Diabetes and prediabetes were classified according to established clinical criteria. Multivariate logistic regression analyses were employed to estimate odds ratios (ORs) and 95% CIs. We used a two-stage logistic regression model with restricted cubic splines (RCS) to evaluate potential non-linear relationships and to identify inflection points. The discriminative ability of the model was evaluated using receiver operating characteristic (ROC) curves, with the area under the curve (AUC) used to measure model performance. Sensitivity and specificity at the optimal threshold were also reported. Furthermore, subgroup and interaction analyses were conducted to determine variations across different population groups. The study included 20,229 eligible participants, with a mean age of 47.84 years, and 51.80% being female. Among the participants, 14.29% were diagnosed with diabetes, and 44.36% with prediabetes. A positive association was observed between PHR and diabetes/prediabetes. After adjusting for model 3, the OR for the combined outcome of diabetes and prediabetes associated with a per-unit increase in PHR was 1.17 (95% CI: 1.05–1.30). Participants in the highest PHR quartile had an OR of 2.55 (95% CI: 1.52–4.28) compared to those in the lowest quartile. Two-stage regression analysis identified a breakpoint at PHR = 4.55, with a positive association observed when PHR was below this value (OR = 1.33, 95% CI: 1.03–1.70). ROC analysis demonstrated good discriminatory ability of the model, with an AUC of 0.824 (95% CI: 0.803–0.845), sensitivity of 83.2%, and specificity of 66.5%. Stratified analyses revealed significant associations between PHR and diabetes/prediabetes across most demographic groups, with interactions observed for sex, alcohol consumption, and BMI, suggesting these factors may modify the association. This study suggests that an elevated PHR may be associated with a higher likelihood of diabetes and prediabetes. Consequently, PHR could serve as a valuable marker for estimating the association of diabetes and prediabetes development.

Purpose: This study aimed to assess the efficacy and safety of Panax notoginseng saponin (PNS) injection, when combined with conventional treatment (CT), for acute myocardial infarction (AMI).Methods: Comprehensive searches were conducted in seven databases from inception until 28 September 2023. The search aimed to identify relevant randomized controlled trials (RCTs) focusing on PNS injection in the context of AMI. This meta-analysis adhered to the PRISMA 2020 guidelines, and its protocol was registered with PROSPERO (number: CRD42023480131).Result: Twenty RCTs involving 1,881 patients were included. The meta-analysis revealed that PNS injection, used adjunctively with CT, significantly improved treatment outcomes compared to CT alone, as evidenced by the following points: (1) enhanced total effective rate [OR = 3.09, p < 0.05]; (2) decreased incidence of major adverse cardiac events [OR = 0.32, p < 0.05]; (3) reduction in myocardial infarct size [MD = −6.53, p < 0.05]; (4) lower ST segment elevation amplitude [MD = −0.48, p < 0.05]; (5) mitigated myocardial injury as indicated by decreased levels of creatine kinase isoenzymes [MD = −11.19, p < 0.05], cardiac troponin T [MD = −3.01, p < 0.05], and cardiac troponin I [MD = −10.72, p < 0.05]; (6) enhanced cardiac function, reflected in improved brain natriuretic peptide [MD = −91.57, p < 0.05], left ventricular ejection fraction [MD = 5.91, p < 0.05], left ventricular end-diastolic dimension [MD = −3.08, p < 0.05], and cardiac output [MD = 0.53, p < 0.05]; (7) reduced inflammatory response, as shown by lower levels of C-reactive protein [MD = −2.99, p < 0.05], tumor necrosis factor-α [MD = −6.47, p < 0.05], interleukin-6 [MD = −24.46, p < 0.05], and pentraxin-3 [MD = −2.26, p < 0.05]; (8) improved vascular endothelial function, demonstrated by decreased endothelin-1 [MD = −20.56, p < 0.05] and increased nitric oxide [MD = 1.33, p < 0.05]; (9) alleviated oxidative stress, evidenced by increased superoxide dismutase levels [MD = 25.84, p < 0.05]; (10) no significant difference in adverse events [OR = 1.00, p = 1.00].Conclusion: This study highlighted the efficacy and safety of adjunctive PNS injections in enhancing AMI patient outcomes beyond CT alone. Future RCTs need to solidify these findings through rigorous methods.Systematic Review Registration: (https://www.crd.york.ac.uk/PROSPERO/), identifier (CRD42023480131)

Purpose: There is increasing evidence that left atrial appendage flow velocity (LAAFV) is linked to the recurrence of atrial fibrillation (AF) after catheter ablation (CA), suggesting the potential predictable significance of LAAFV in this setting. We performed a systematic review and meta-analysis to assess whether LAAFV is association with AF recurrence after CA.Methods: Up to May 1, 2022, six databases (PubMed, EMBASE, Web of Science, Cochrane Library, Scopus, and CINAHL) were searched for literature reporting the association between LAAFV and AF recurrence after CA. All statistical analyses were carried out using STATA version 16 software. Heterogeneity was determined by the Cochrane’s Q test and I² statistics. The Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of each included study, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was adopted to evaluate the quality of evidence.Result: Sixteen studies with 5,006 AF patients after CA (1,479 patients with AF recurrence, 3,527 without AF recurrence) were included in the meta-analysis. The meta-analysis of 15 studies (16 data sets) showed that patients with recurrence exhibited lower LAAFV values than those without recurrence [standardized mean difference (SMD): −0.65, 95% CI: −0.88 to −0.42, P < 0.01]. Moreover, we evaluated the association of LAAFV and the risk of AF recurrence after CA. Nine studies (11 data sets) defined LAAFV as continuous variables, and the pooled analysis suggested that for every 1 cm/s rise in LAAFV values, the risk of AF recurrence after CA decreased by 3% [Odds Ratio (OR): 0.97, 95% CI: 0.95 to 0.99, P < 0.01]. Seven studies defined LAAFV as categorical variables, and the pooled analysis showed that lower LAAFV were associated with an increased risk of AF recurrence after CA [OR: 2.28, 95% CI: 1.46 to 3.57, P < 0.01]. The subgroup analyses showed that the association between LAAFV and AF recurrence after CA was not significantly affected by the AF type and ablation procedure. The NOS indicated that included studies were moderate to high quality, while the GRADE assessment suggested a low certainty of the evidence.Conclusion: Lower LAAFV may be associated with an increased risk of AF recurrence after CA. Further studies with well designed and randomized studies for LAAFV should be conducted.Systematic review registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022333627].

Objectives: To evaluate the association between left atrial appendage volume (LAAV) and atrial fibrillation (AF) recurrence after catheter ablation (CA) and explore the potential mechanism. Design: Systematic review and meta-analysis. Data sources: PubMed, EMBASE, Web of Science and Cochrane Library databases were searched systematically from inception through 28 September 2024 to identify relevant studies. Eligibility criteria: Observational studies that estimated the association between LAAV and AF recurrence. Data extraction and synthesis: Two independent investigators screened studies for inclusion and extracted data. Statistical heterogeneity was assessed using the Cochrane Q-test and I², with p 50% indicating significant heterogeneity. This study used a random-effects model to account for potential heterogeneity. The quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS), Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I tool) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Publication bias was examined through funnel plots and Egger’s test. Result: Seventeen studies (3078 patients) were included. Meta-analysis of 11 studies suggested that LAAV was significantly associated with the risk of AF recurrence in both univariate (HR 1.06, 95%CI 1.04 to 1.08, p<0.01; I ² =49.7%) and multivariate analyses (HR 1.10, 95%CI 1.05 to 1.16, p<0.01; I ² =77.4%). The relationship between LAAV and recurrence of persistent AF (HR 1.11, 95% CI 1.03 to 1.20, p0.05; I² = 0%). Meta-analysis of 13 studies suggested that patients with recurrence had larger LAAV values than those without recurrence (standardised mean difference (SMD) 0.54, 95% CI 0.36 to 0.71, p<0.01; I ² =67.9%), and persistent AF patients had larger LAAV values than paroxysmal AF (SMD 0.29, 95% CI 0.02 to 0.57, p=0.05; I ² =60.6%). Sensitivity analyses did not change these results. Subgroup analyses largely aligned with the overall findings, though study design and sample size contributed to heterogeneity. The mean NOS scores indicated moderate to high study quality; ROBINS-I assessments showed that most studies had a low to moderate overall risk of bias; and the GRADE approach rated the certainty of outcome evidence as low. Conclusions: Our study suggests that LAAV may be a significant predictor of AF recurrence after CA. Incorporating LAAV into pre-ablation screening may enhance risk stratification, guiding tailored follow-up and treatment strategies. PROSPERO registration number: CRD42022339910.

Background: Atrial fibrillation (AF) is a risk factor for cognitive dysfunction. Although catheter ablation (CA) is one of the main treatments for AF, whether it can improve cognitive function in patients with AF remains unclear. We conducted a systematic review and meta-analysis to evaluate the cognitive outcome post-CA procedure.Methods: Two investigators independently searched the PubMed, EMBASE, Web of Science, CNKI, WanFang, and VIP databases from inception to September 2021 for all the potentially eligible studies. The outcomes of interest included dementia or cognitive disorder through scoring or recognized classification criteria. Heterogeneity was determined by using Cochrane's Q test and calculating the I². A random-effects model was used to incorporate the potential effects of heterogeneity. The Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of each included study, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was adopted to evaluate the quality of evidence.Result: Thirteen studies including 40,868 patients were included, among which 12,086 patients received AF ablation. Meta-analysis indicated that patients with AF ablation had a lower risk of dementia incidence in comparison to patients with AF without ablation [hazard ratio (HR): 0.60, 95% CI: 0.43 to 0.84, p = 0.003 I² = 40%]. Significant differences were observed in the incidence of new-onset dementia [risk ratio (RR): 0.43, 95% CI: 0.28 to 0.65, p < 0.0001 I² = 84%]; the changes in the Montreal Cognitive Assessment (MoCA) score [weighted mean difference (WMD): 1.00, 95% CI: 0.36 to 1.64, p < 0.005 I² = 0%] and Mini-Mental State Examination (MMSE) score (WMD: 0.98, 95% CI: 0.69 to 1.26, p < 0.00001 I² = 0%]. However, in subgroup analysis, we did not observe significant changes in MoCA score at < 3 months (WMD: 1.20, 95% CI: −0.19 to 2.58, p = 0.09 I² = 50%) and changes in cognitive function scores between the radiofrequency group and cryoballoon group [standard mean difference (SMD): 0.39, 95% CI: −0.47 to 1.24, p = 0.38 I² = 87%]. The NOS indicated that included studies were moderate to high quality, while the quality of evidence assessed by GRADE was low in 2 and very low in 2.Conclusion: We analyzed the related cognitive outcomes after AF ablation. In the overall population, AF ablation had a positive trend for improving cognitive function at >3 months post-procedure. However, AF ablation might not be related to the improvement of cognitive function at < 3 months.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021285198.