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Imazio M, Agrimi C, Cescon L, Panzolli G, Collini V, Sinagra G. Colchicine for the treatment of the spectrum of cardiovascular diseases: current evidence and ongoing perspectives. J Cardiovasc Med (Hagerstown) 2024; 25:653-663. [PMID: 38916229 PMCID: PMC11296275 DOI: 10.2459/jcm.0000000000001647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/25/2024] [Accepted: 05/12/2024] [Indexed: 06/26/2024]
Abstract
Colchicine is one of the oldest drugs in medicine. Traditionally used to treat and prevent gouty attacks, it has been introduced into cardiovascular medicine for the treatment and prevention of pericarditis, starting from the positive experience in the treatment and prevention of polyserositis in familial mediterranean fever. Colchicine is a lipophilic drug that enters the cells and is eliminated by glycoprotein P. As granulocytes are lacking in this protein, colchicine is able to concentrate in these cells, exerting a substantial anti-inflammatory action, even with low oral doses. As these cells may trigger acute cardiovascular events, colchicine has been shown to be efficacious and safe to prevent acute coronary syndromes and ischemic stroke with an efficacy comparable to more established treatments, such as antiplatelet agents and statins. On this basis, colchicine seems a promising, efficacious, well tolerated, and cheap option for the prevention of several cardiovascular events, and it may become an additional pillar in the pharmacologic treatment of cardiovascular diseases.
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Affiliation(s)
- Massimo Imazio
- Department of Medicine (DMED), University of Udine
- Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Udine
| | - Cosimo Agrimi
- Cardiology Specialty School, University of Trieste, Trieste, Italy
| | - Laura Cescon
- Cardiology Specialty School, University of Trieste, Trieste, Italy
| | | | - Valentino Collini
- Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Udine
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2
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Buckley LF, Libby P. Colchicine's Role in Cardiovascular Disease Management. Arterioscler Thromb Vasc Biol 2024; 44:1031-1041. [PMID: 38511324 PMCID: PMC11047118 DOI: 10.1161/atvbaha.124.319851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Colchicine-an anti-inflammatory alkaloid-has assumed an important role in the management of cardiovascular inflammation ≈3500 years after its first medicinal use in ancient Egypt. Primarily used in high doses for the treatment of acute gout flares during the 20th century, research in the early 21st century demonstrated that low-dose colchicine effectively treats acute gout attacks, lowers the risk of recurrent pericarditis, and can add to secondary prevention of major adverse cardiovascular events. As the first Food and Drug Administration-approved targeted anti-inflammatory cardiovascular therapy, colchicine currently has a unique role in the management of atherosclerotic cardiovascular disease. The safe use of colchicine requires careful monitoring for drug-drug interactions, changes in kidney and liver function, and counseling regarding gastrointestinal upset. Future research should elucidate the mechanisms of anti-inflammatory effects of colchicine relevant to atherosclerosis, the potential role of colchicine in primary prevention, in other cardiometabolic conditions, colchicine's safety in cardiovascular patients, and opportunities for individualizing colchicine therapy using clinical and molecular diagnostics.
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Affiliation(s)
- Leo F. Buckley
- Department of Pharmacy, Brigham and Women’s Hospital, Boston MA
| | - Peter Libby
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA
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Martí-Carvajal AJ, De Sanctis JB, Hidalgo R, Martí-Amarista CE, Alegría E, Correa-Pérez A, Monge Martín D, Riera Lizardo RJ. Colchicine for the primary prevention of cardiovascular events. Hippokratia 2022. [DOI: 10.1002/14651858.cd015003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Arturo J Martí-Carvajal
- Cochrane Ecuador. Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud Eugenio Espejo ; Universidad UTE; Quito Ecuador
- Faculty of Medicine; Universidad Francisco de Vitoria; Madrid Spain
- Cátedra Rectoral de Médicina Basada en la Evidencia; Universidad de Carabobo; Valencia Venezuela
| | - Juan Bautista De Sanctis
- The Institute of Molecular and Translational Medicine; Palacky University Olomouc, Faculty of Medicine and Dentistry; Czech Republic Czech Republic
| | - Ricardo Hidalgo
- Cochrane Ecuador. Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud Eugenio Espejo; Universidad Tecnológica Equinoccial; Quito Ecuador
| | | | - Eduardo Alegría
- Faculty of Medicine; Universidad Francisco de Vitoria; Madrid Spain
| | - Andrea Correa-Pérez
- Faculty of Medicine; Universidad Francisco de Vitoria; Madrid Spain
- Clinical Biostatistics Unit; Hospital Universitario Ramón y Cajal (IRYCIS); Madrid Spain
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Schattner A. Colchicine - new horizons for an ancient drug. Review based on the highest hierarchy of evidence. Eur J Intern Med 2022; 96:34-41. [PMID: 34657777 DOI: 10.1016/j.ejim.2021.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 12/19/2022]
Abstract
Colchicine is an old, inexpensive, and relatively safe anti-inflammatory drug traditionally used in gout and over the last 50 years in familial Mediterranean fever. A search of all high-hierarchy studies (randomized controlled trials [RCTs], systematic reviews and meta-analysis of RCTs) over the last 20 years revealed myriad other evidence-based applications. Colchicine seems efficacious in the treatment of acute pericarditis and prevention of recurrences and in the prevention of postcardiac injury syndrome and atrial fibrillation following cardiac surgery or percutaneous interventions. In patients already fully treated with statins and antiplatelet agents following acute coronary syndromes or stable coronary disease, adding low-dose colchicine achieved secondary prevention of major cardiovascular events (myocardial infarction, stroke, or cardiovascular death) with pooled risk reduction 0.75. Colchicine may also be useful in Behcet's syndrome and most recently, in improving outcomes of COVID-19 infection. Colchicine in the low doses used in most trials (≤ 1 mg/d) was generally safe and well-tolerated, excepting diarrhea (approximately 10%) which sometimes led to drug discontinuation. Further RCTs are required to confirm these results, and will likely lead to expanding indications for low-dose colchicine. Increasing numbers of patients will be treated with colchicine in the near future, with improved health outcomes, as long as basic caveats are heeded.
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Affiliation(s)
- Ami Schattner
- The Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
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Borregaard B, Sibilitz KL, Weiss MG, Ekholm O, Lykking EK, Nielsen SN, Riber LP, Dahl JS, Moller JE. Occurrence and predictors of pericardial effusion requiring invasive treatment following heart valve surgery. Open Heart 2022; 9:openhrt-2021-001880. [PMID: 35064056 PMCID: PMC8785202 DOI: 10.1136/openhrt-2021-001880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/04/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To describe the occurrence of significant pericardial effusion, and to investigate characteristics associated with pericardial effusion within three months following heart valve surgery. METHODS A retrospective, observational cohort study including adult patients undergoing heart valve surgery at Odense University Hospital from August 2013 to November 2017. Data were gathered from The Western Denmark Heart Registry and electronic patient records.Cox proportional hazard models were used to investigate the associations between characteristics associated with significant pericardial effusion during index admission and within 3 months. Results are presented as HR with 95% CI. RESULTS In total, 1460 patients were included (70% men, median age 71 years (IQR 63-76)) and of those, n=230 patients (16%) developed significant pericardial effusion.EuroScore II was significantly associated with an increased risk of pericardial effusion during index admission and associated with a lower risk following discharge (index admission HR 1.05, 95% CI 1.02 to 1.08, after discharge HR 0.80, 95% CI 0.69 to 0.92). Increasing age (HR 0.97, 95% CI 0.95 to 0.98 per year) and concomitant coronary artery bypass grafting versus isolated valve surgery (HR 0.58, 95% CI 0.35 to 0.97) were significantly associated with a reduced risk of pericardial effusions in both periods. Being a man (HR 2.30, 95% CI 1.32 to 4.01) and aortic valve disease versus mitral valve disease (HR 2.16, 95% CI 1.20 to 3.90) were significantly associated with an increased risk after discharge. CONCLUSION Significant pericardial effusions requiring drainage were present in 16% of cases following heart valve surgery, and different clinical characteristics were associated with the development of effusion.
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Affiliation(s)
- Britt Borregaard
- Department of Cardiology, Odense Universitetshospital, Odense, Denmark .,Department of Cardiac, Thoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Marc Gjern Weiss
- Department of Cardiac, Thoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Emilie Karense Lykking
- Department of Cardiac, Thoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Stine Nørris Nielsen
- Department of Cardiology, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Peter Riber
- Department of Cardiac, Thoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jordi Sanchez Dahl
- Department of Cardiology, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jacob Eifer Moller
- Department of Cardiology, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Somani N, Breur H. The Efficacy of Corticosteroids, NSAIDs, and Colchicine in the Treatment of Pediatric Postoperative Pericardial Effusion. Pediatr Cardiol 2022; 43:279-289. [PMID: 35061077 PMCID: PMC8850227 DOI: 10.1007/s00246-022-02820-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022]
Abstract
The objective of this study is to investigate and compare the efficacy of corticosteroids, NSAIDs, and colchicine in treating postoperative pericardial effusion (PPE) following cardiac surgery in the pediatric setting, on the basis of available literature. To investigate and compare the efficacy of corticosteroids, NSAIDs, and colchicine in treating postoperative pericardial effusion (PPE) following cardiac surgery in the pediatric setting, on the basis of available literature. A systematic review was conducted by carrying out a database search in PubMed on April 20th, 2021. An English language filter was added, but no time restrictions were applied. Lack of pediatric literature prompted a broadening of the search to include adult literature. One pediatric and four adult studies were included, but the pediatric evidence was not found to be of satisfactory quality, and the findings of adult literature could not be readily generalized to the pediatric setting. No well-founded conclusions could be drawn regarding the efficacy of corticosteroids, NSAIDs, or colchicine in treating PPE, as a striking lack of evidence for their efficacy in the pediatric setting were revealed. A knowledge gap was found in the literature, indicating a need for good-quality randomized controlled trials to bridge this gap.
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Affiliation(s)
- Nirmiti Somani
- Department of Pediatric Cardiology, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands.
| | - Hans Breur
- Department of Pediatric Cardiology, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands
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Maranta F, Cianfanelli L, Grippo R, Alfieri O, Cianflone D, Imazio M. Post-pericardiotomy syndrome: insights into neglected postoperative issues. Eur J Cardiothorac Surg 2021; 61:505-514. [PMID: 34672331 DOI: 10.1093/ejcts/ezab449] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/01/2021] [Accepted: 07/27/2021] [Indexed: 12/20/2022] Open
Abstract
ABSTRACT OBJECTIVES Pericardial effusion is a common complication after cardiac surgery, both isolated and in post-pericardiotomy syndrome (PPS), a condition in which pleuropericardial damage triggers both a local and a systemic inflammatory/immune response. The goal of this review was to present a complete picture of PPS and pericardial complications after cardiac surgery, highlighting available evidence and gaps in knowledge. METHODS A literature review was performed that included relevant prospective and retrospective studies on the subject. RESULTS PPS occurs frequently and is associated with elevated morbidity and significantly increased hospital stays and costs. Nevertheless, PPS is often underestimated in clinical practice, and knowledge of its pathogenesis and epidemiology is limited. Several anti-inflammatory drugs have been investigated for treatment but with conflicting evidence. Colchicine demonstrated encouraging results for prevention. CONCLUSIONS Wider adoption of standardized diagnostic criteria to correctly define PPS and start early treatment is needed. Larger studies are necessary to better identify high-risk patients who might benefit from preventive strategies.
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Affiliation(s)
- Francesco Maranta
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Cianfanelli
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Rocco Grippo
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Domenico Cianflone
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", Udine, Italy
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8
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Imazio M. Clinical Trials in Pericardial Disease: New Paradigm Shift. Curr Cardiol Rep 2021; 23:170. [PMID: 34633515 DOI: 10.1007/s11886-021-01587-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Aim of the review is to discuss the results of major clinical trials and how they can have impact on clinical practice. RECENT FINDINGS Pericardial diseases have been the Cinderella of cardiovascular diseases for many years, but improvements in the knowledge of etiology and the pathophysiology especially of recurrent pericarditis have led to first clinical trials that have demonstrated the efficacy and safety of colchicine on top of standard anti-inflammatory therapies and of anti-IL-1 agents (anakinra and rilonacept) in corticosteroid-dependent and colchicine-resistant pericarditis. Current pooled data suggest that anti-IL-1 agents should be a first option for corticosteroid-dependent and colchicine-resistant recurrent pericarditis with evidence of systemic inflammation by means of elevated C-reactive protein. This could translate into an upgraded recommendation for these agents in future guidelines. Treatment of pericardial diseases is improving moving towards a more personalized therapy according to the presentation and etiology, and new or old drugs could be important to expand the therapeutic spectrum.
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Affiliation(s)
- Massimo Imazio
- Cardiology, Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC) , Cardiothoracic Dpt, Udine, Italy.
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9
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Abstract
Colchicine is a unique, sophisticated anti-inflammatory agent that has been used for decades for the prevention of acute inflammatory flares in gout and familial Mediterranean fever. In recent years, clinical trials have demonstrated its potential in a range of cardiovascular (CV) conditions. Colchicine is avidly taken up by leucocytes, and its ability to bind to tubulin and interfere with microtubular function affects the expression of cytokines and interleukins, and the ability of neutrophils to marginate, ingress, aggregate, express superoxide, release neutrophil extracellular traps, and interact with platelets. In patients with acute and recurrent pericarditis, clinical trials in >1600 patients have consistently shown that colchicine halves the risk of recurrence [relative risk (RR) 0.50, 95% confidence interval (CI) 0.42–0.60]. In patients with acute and chronic coronary syndromes, multicentre randomized controlled trials in >11 000 patients followed for up to 5 years demonstrated that colchicine may reduce the risk of CV death, myocardial infarction, ischaemic stroke and ischaemia-driven revascularization by >30% (RR 0.63, 95% CI 0.49–0.81). The use of colchicine at doses of 0.5–1.0 mg daily in CV trials has proved safe. Early gastrointestinal intolerance limits its use in ∼10% of patients; however, ∼90% of patients tolerate it well over the long term. Despite isolated case reports, clinically relevant drug interactions with moderate to strong CYP3A4 inhibitors/competitors or P-glycoprotein inhibitors/competitors are rare if this dosage of colchicine is used in the absence of advanced renal or liver disease. The aim of this review is to summarize the contemporary data supporting the efficacy and safety of colchicine in patients with CV disease.
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Affiliation(s)
- Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", ASUFC, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Mark Nidorf
- GenesisCare, 3/140 Mounts Bay Rd, Perth, Western Australia, Australia
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10
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Imazio M. Current treatment of recurrent pericarditis: safety considerations and future directions. Expert Opin Drug Saf 2021; 21:183-190. [PMID: 34334059 DOI: 10.1080/14740338.2021.1960980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Recurrent pericarditis is one of the most troublesome complications of pericarditis affecting a substantial amount of patients and often severely impairing the quality of life. Current medical treatments range from non-steroidal anti-inflammatory drugs (NSAIDs), colchicine and corticosteroids to biological agents (anti IL-1 agents, especially anakinra and rilonacept), intravenous immunoglobulins and immunosuppressive treatments. Safety is a major issue to deal with since the disease often affects relatively young or middle-aged patients. AREAS COVERED The review is aimed at providing an update on the efficacy and safety of current medical therapies for recurrent pericarditis including most recent advances represented by anti IL-1 agents. EXPERT OPINION Therapy of recurrent pericarditis has evolved over years leading to a more evidence-based and personalized treatment based on clinical presentation and pathophysiology. The main distinction is between patients with an inflammatory phenotype (e.g. fever, elevation of markers of inflammation, pericardial and/or pleural effusion) vs. those without an inflammatory phenotype. Colchicine and anti IL-1 agents are especially efficacious and indicated for those with an inflammatory phenotype, while corticosteroids, azathioprine and immunoglobulins seem more indicated for those without evidence of systemic inflammation.
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Affiliation(s)
- Massimo Imazio
- Cardiology, Cardiothoracic Department, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
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Andreis A, Imazio M, De Ferrari GM. Colchicine for the treatment of cardiovascular diseases: old drug, new targets. J Cardiovasc Med (Hagerstown) 2021; 22:1-8. [PMID: 32858634 DOI: 10.2459/jcm.0000000000001079] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
: Well known in past centuries as a herbal remedy for osteoarticular pain and commonly used in the treatment of gout and familial Mediterranean fever, colchicine has an emerging role in the setting of cardiovascular diseases. Its unique properties not only target the key mechanisms of recurrent inflammation underlying pericardial syndromes but also inflammation within atherosclerotic plaques, atrial fibrillation recurrence and adverse ventricular remodelling leading to heart failure.The effect of colchicine in the treatment of cardiovascular diseases along with essential pharmacology will be discussed, reviewing the most important and recent clinical studies. Colchicine is a valuable, well tolerated and inexpensive drug in the setting of cardiovascular diseases.
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Affiliation(s)
- Alessandro Andreis
- University Cardiology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
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Ghannem M, Ahmaidi S, Ghannem L, Meimoun P. [Infectious and inflammatory complications occurring after cardiac surgery in cardiac rehabilitation centres]. Ann Cardiol Angeiol (Paris) 2020; 69:424-429. [PMID: 33092786 DOI: 10.1016/j.ancard.2020.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022]
Abstract
Patients undergoing cardiac surgery are older, have complex pathologies and several comorbidities, but need to leave the hospital quickly! Therefore, the mission of cardiac rehabilitation centres has substantially changed. Indeed, if 15 to 25% of patients undergoing cardiac surgery will have a postoperative complication requiring a hospital management (infectious, pericardial, rhythmic, neurologic, pulmonary, digestive, etc.), more than 2/3 of these acute events could be managed by cardiac rehabilitation centres for a lower cost. Therefore, the quickest the patient is transferred to a cardiac rehabilitation centre, the easier the cardiac surgery centre could manage his beds. Infectious complications are the most dreadful, particularly mediastinitis.
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Affiliation(s)
- M Ghannem
- Faculté de médecine de Sousse, avenue M. Karoui, Sousse, Tunisie; Service de cardiologie, hôpital de Gonesse, 2, boulevard du 19-mars-1962, 95500 Gonesse, France; Hôpital de Compiègne, 8, avenue Henri-Adenot, 60200 Compiègne, France.
| | - S Ahmaidi
- EA-3300 APERE, université de Picardie Jules-Verne, 3, rue des Louvels, 80036 Amiens, France
| | - L Ghannem
- Service de cardiologie, hôpital de Gonesse, 2, boulevard du 19-mars-1962, 95500 Gonesse, France
| | - P Meimoun
- Hôpital de Compiègne, 8, avenue Henri-Adenot, 60200 Compiègne, France
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Lehto J, Kiviniemi T. Postpericardiotomy syndrome after cardiac surgery. Ann Med 2020; 52:243-264. [PMID: 32314595 PMCID: PMC7877990 DOI: 10.1080/07853890.2020.1758339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/30/2020] [Accepted: 04/16/2020] [Indexed: 12/13/2022] Open
Abstract
Postpericardiotomy syndrome (PPS) is a well-known complication after cardiac surgery. The syndrome results in prolonged hospital stay, readmissions, and invasive interventions. Previous studies have reported inconsistent results concerning the incidence and risk factors for PPS due to the differences in the applied diagnostic criteria, study designs, patient populations, and procedure types. In recent prospective studies the reported incidences have been between 21 and 29% in adult cardiac surgery patients. However, it has been stated that most of the included diagnoses in the aforementioned studies would be clinically irrelevant. This challenges the specificity and usability of the currently recommended diagnostic criteria for PPS. Moreover, recent evidence suggests that PPS requiring invasive intervention such as the evacuation of pleural and/or pericardial effusion is associated with increased mortality. In the present review, we summarise the existing literature concerning the incidence, clinical features, diagnostic criteria, risk factors, management, and prognosis of PPS. We also propose novel approaches regarding to the definition and diagnosis of PPS. Key messages: Current diagnostic criteria of PPS should be reconsidered, and the analyses should be divided into subgroups according to the severity of the syndrome to achieve more clinically applicable and meaningful results in the future studies. In contrast with the previous presumption, severe PPS - defined as PPS requiring invasive interventions - was recently found to be associated with higher all-cause mortality during the first two years after cardiac surgery. The association with an increased mortality supports the use of relatively aggressive prophylactic methods to prevent PPS. The risk factors clearly increasing the occurrence of PPS are younger age, pleural incision, and valve and ascending aortic procedures when compared to CABG.
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Affiliation(s)
- Joonas Lehto
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Colchicine as a Potential Therapeutic Agent Against Cardiovascular Complications of COVID-19: an Exploratory Review. ACTA ACUST UNITED AC 2020; 2:1419-1429. [PMID: 32838182 PMCID: PMC7398860 DOI: 10.1007/s42399-020-00421-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease-19 (COVID-19) may result in serious complications involving several organ systems, including myocardial tissue. An exaggerated host inflammatory response, described as a cytokine storm, has been linked to play a major role in these complications. Colchicine and other pharmaceutical agents have been proposed to counter the cytokine storm and improve outcomes. In this exploratory review, we utilized a PubMed and Cochrane Database search aiming to identify the biochemical characteristics of the cytokine storm as well as to identify the potential effect of colchicine on these inflammatory biomarkers. The research yielded 30 reports describing the characteristics of the cytokine storm and 44 reports describing the effect of colchicine on various inflammatory biomarkers. According to our research, colchicine may be an agent of interest in the treatment of COVID-19 via its anti-inflammatory properties. However, there are potential drug interactions with cytochrome P450 3A4 inhibitors resulting in acute colchicine toxicities. Additionally, there is scarce evidence regarding the efficacy of colchicine in the acute phase of disease, since most trials evaluated its effect in chronic conditions. In this direction, our team proposes three different hypotheses for evaluating the place of colchicine in the treatment of COVID-19.
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15
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Role of Colchicine in Stroke Prevention: An Updated Meta-Analysis. J Stroke Cerebrovasc Dis 2020; 29:104756. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104756] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/27/2020] [Accepted: 02/11/2020] [Indexed: 12/13/2022] Open
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Nomani H, Mohammadpour AH, Moallem SMH, Sahebkar A. Anti-inflammatory drugs in the prevention of post-operative atrial fibrillation: a literature review. Inflammopharmacology 2019; 28:111-129. [PMID: 31673892 DOI: 10.1007/s10787-019-00653-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 10/03/2019] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF) is a serious and common complication following heart surgery. Cardiac surgery triggers inflammation in the heart and makes it susceptible to the incidence of AF. Therefore, anti-inflammatory drugs may reduce the rate of AF incidence in the post-surgery conditions. Immunosuppressant agents, steroidal anti-inflammatory drugs (corticosteroids), non-aspirin non-steroid anti-inflammatory drugs (NSAIDs), colchicine and omega-3 unsaturated fatty acids (n-3 UFA) are drugs with well-known anti-inflammatory properties. The efficacy, safety and other aspects of using these drugs in the prevention of post-operative AF (POAF) have been reviewed here. Studies evaluating the efficacy of colchicine have shown that it could be effective in the prevention of POAF. However, there is a need for additional studies to find a colchicine regimen with optimal efficacy and higher tolerability. The use of corticosteroids may also be of value based on the most of meta-analyses. In the case of n-3 polyunsaturated fatty acids and NSAIDs, current data fail to support their efficacy in POAF prevention. Moreover, perioperative administration of NSAIDs may be associated with some severe safety considerations. Immunosuppressant agents have not been used for the prevention of POAF. Further studies are needed to find the most effective strategy for POAF prevention with the least safety considerations and the highest health benefits.
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Affiliation(s)
- Homa Nomani
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hooshang Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran. .,Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | - Amirhossein Sahebkar
- Halal Research Center of IRI, FDA, Tehran, Iran. .,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. .,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
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Lutschinger LL, Rigopoulos AG, Schlattmann P, Matiakis M, Sedding D, Schulze PC, Noutsias M. Meta-analysis for the value of colchicine for the therapy of pericarditis and of postpericardiotomy syndrome. BMC Cardiovasc Disord 2019; 19:207. [PMID: 31477020 PMCID: PMC6720402 DOI: 10.1186/s12872-019-1190-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/25/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Colchicine has been used as anti-inflammatory agent in pericardial effusion (PE). We sought to perform a meta-analysis of randomized trials assessing the efficacy and safety of colchicine in patients with pericarditis or postpericardiotomy syndrome (PPS). METHODS In the systematic literature search following the PRISMA statement, 10 prospective randomized controlled studies with 1981 patients with an average follow-up duration of 13.6 months were identified. RESULTS Colchicine reduced the recurrence rate of pericarditis in patients with acute and recurrent pericarditis and reduced the incidence of PPS (RR: 0.57, 95% CI: 0.44-0.74). Additionally, the rate of rehospitalizations as well as the symptom duration after 72 h was significantly decreased in pericarditis (RR 0.33; 95% CI 0.18-0.60; and RR 0.43; 95% CI 0.34-0.54; respectively), but not in PPS. Treatment with colchicine was associated with significantly higher adverse event (AE) rates (RR 1.42; 95% CI 1.05-1.92), with gastrointestinal intolerance being the leading AE. The reported number needed to treat (NNT) for the prevention of recurrent pericarditis ranged between 3 and 5. The reported NNT for PPS prevention was 10, and the number needed to harm (NNH) was 12, respectively. Late colchicine administration > 7 days after heart surgery did not reduce postoperative PE. CONCLUSIONS Our meta-analysis confirms that colchicine is efficacious and safe for prevention of recurrent pericarditis and PPS, while it reduces rehospitalizations and symptom duration in pericarditis. The clinical use of colchicine for the setting of PPS and postoperative PE after heart surgery should be investigated in further multicenter RCT.
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Affiliation(s)
- Leon L Lutschinger
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Angelos G Rigopoulos
- Mid-German Heart Center, Department of Internal Medicine III (KIM III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Informatics and Data Science (IMSID), University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
| | - Marios Matiakis
- Mid-German Heart Center, Department of Internal Medicine III (KIM III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Daniel Sedding
- Mid-German Heart Center, Department of Internal Medicine III (KIM III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Paul Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Michel Noutsias
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany. .,Mid-German Heart Center, Department of Internal Medicine III (KIM III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany.
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18
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Tuck BC, Townsley MM. Clinical Update in Pericardial Diseases. J Cardiothorac Vasc Anesth 2019; 33:184-199. [DOI: 10.1053/j.jvca.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Indexed: 01/15/2023]
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19
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Lubbers ER, Price MV, Mohler PJ. Arrhythmogenic Substrates for Atrial Fibrillation in Obesity. Front Physiol 2018; 9:1482. [PMID: 30405438 PMCID: PMC6204377 DOI: 10.3389/fphys.2018.01482] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 10/01/2018] [Indexed: 12/19/2022] Open
Abstract
Global obesity rates have nearly tripled since 1975. This obesity rate increase is mirrored by increases in atrial fibrillation (AF) that now impacts nearly 10% of Americans over the age of 65. Numerous epidemiologic studies have linked incidence of AF and obesity and other obesity-related diseases, including hypertension and diabetes. Due to the wealth of epidemiologic data linking AF with obesity-related disease, mechanisms of AF pathogenesis in the context of obesity are an area of ongoing investigation. However, progress has been somewhat slowed by the complex phenotype of obesity; separating the effects of obesity from those of related sequelae is problematic. While the initiation of pathogenic pathways leading to AF varies with disease (including increased glycosylation in diabetes, increased renin angiotensin aldosterone system activation in hypertension, atrial ischemia in coronary artery disease, and sleep apnea) the pathogenesis of AF is united by shared mediators of altered conduction in the atria. We suggest focusing on these downstream mediators of AF in obesity is likely to yield more broadly applicable data. In the context of obesity, AF is driven by the interrelated processes of inflammation, atrial remodeling, and oxidative stress. Obesity is characterized by a constant low-grade inflammation that leads to increased expression of pro-inflammatory cytokines. These cytokines contribute to changes in cardiomyocyte excitability. Atrial structural remodeling, including fibrosis, enlargement, and fatty infiltration is a prominent feature of AF and contributes to the altered conduction. Finally, obesity impacts oxidative stress. Within the cardiomyocyte, oxidative stress is increased through both increased production of reactive oxygen species and by downregulation of scavenging enzymes. This increased oxidative stress modulates of cardiomyocyte excitability, increasing susceptibility to AF. Although the initiating insults vary, inflammation, atrial remodeling, and oxidative stress are conserved mechanisms in the pathophysiology of AF in the obese patients. In this review, we highlight mechanisms that have been shown to be relevant in the pathogenesis of AF across obesity-related disease.
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Affiliation(s)
- Ellen R. Lubbers
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Medical Scientist Training Program, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Morgan V. Price
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Peter J. Mohler
- The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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20
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Schenone AL, Menon V. Colchicine in Pericardial Disease: from the Underlying Biology and Clinical Benefits to the Drug-Drug Interactions in Cardiovascular Medicine. Curr Cardiol Rep 2018; 20:62. [PMID: 29904810 DOI: 10.1007/s11886-018-1008-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This is an in-depth review on the mechanism of action, clinical utility, and drug-drug interactions of colchicine in the management of pericardial disease. RECENT FINDINGS Recent evidence about therapeutic targets on pericarditis has demonstrated that NALP3 inflammasome blockade is the cornerstone in the clinical benefits of colchicine. Such benefits extend from acute and recurrent pericarditis to transient constriction and post-pericardiotomy syndrome. Despite the increased utilization of colchicine in cardiovascular medicine, safety concerns remains unsolved regarding the long-term use of colchicine in the cardiac patient. Moreover, recent evidence has demonstrated that numerous cardiovascular medications, ranging from antihypertensive medication to antiarrhythmics, are known to interact with the CYP3A4 and/or P-gp system increasing the toxicity potential of colchicine. The use of adjunctive colchicine in the management of inflammatory pericardial diseases is standard of care in current practice. It is advised that a careful medication reconciliation with emphasis on pharmacokinetic is completed before prescribing colchicine in order to avoid harmful interaction by finding an alternative regimen or adjusting colchicine dosing.
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Affiliation(s)
- Aldo L Schenone
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J3-129, Cleveland, OH, 44195, USA.
| | - Venu Menon
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J3-129, Cleveland, OH, 44195, USA
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21
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Wamboldt R, Bisleri G, Glover B, Haseeb S, Tse G, Liu T, Baranchuk A. Primary prevention of post-pericardiotomy syndrome using corticosteroids: a systematic review. Expert Rev Cardiovasc Ther 2018; 16:405-412. [PMID: 29745734 DOI: 10.1080/14779072.2018.1475231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Rachel Wamboldt
- Division of Cardiology, Kingston Health Science Center, Queen’s University, Kingston, Canada
| | - Gianluigi Bisleri
- Division of Cardiovascular Surgery, Kingston Health Science Center, Queen’s University, Kingston, Canada
| | - Benedict Glover
- Division of Cardiology, Kingston Health Science Center, Queen’s University, Kingston, Canada
| | - Sohaib Haseeb
- Division of Cardiology, Kingston Health Science Center, Queen’s University, Kingston, Canada
| | - Gary Tse
- Department of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R., China
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology Second Hospital of Tianjin Medical University, Tianjin, China
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Science Center, Queen’s University, Kingston, Canada
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22
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Trout GO, Hoz RDL, Alfaro LM, Córdoba AP, Consuegra GA. Manejo de derrame pericárdico: revisión sistemática de la literatura. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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23
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Lennerz C, Barman M, Tantawy M, Sopher M, Whittaker P. Colchicine for primary prevention of atrial fibrillation after open-heart surgery: Systematic review and meta-analysis. Int J Cardiol 2017; 249:127-137. [DOI: 10.1016/j.ijcard.2017.08.039] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/07/2017] [Accepted: 08/14/2017] [Indexed: 12/16/2022]
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Abstract
Colchicine is one of the oldest known drugs that remains part of the current pharmacopeia. Recent studies have examined the efficacy of colchicine in cardiology with promising results. We conducted a search of electronic databases for studies on colchicine in cardiovascular medicine published through October 2016. As the utilization of colchicine in the management of cardiac conditions grows, it is paramount that internists and cardiologists are familiarized with its benefits and risks. We present a comprehensive review of the role of colchicine in the management of cardiovascular diseases with a strong emphasis on side effects and potential drug interactions.
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25
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Themelin N, Cappeliez S, Houben JJ, El Nakadi B. A successful transdiaphragmatic shunting for a late and recurrent pericardial effusion following coronary bypass. Interact Cardiovasc Thorac Surg 2017; 25:140-141. [PMID: 28329193 DOI: 10.1093/icvts/ivx021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/03/2017] [Indexed: 11/13/2022] Open
Abstract
Although pericardial effusion (PE) is common after cardiac surgery, late and recurrent cardiac tamponade that occurs more than 5-7 days after coronary artery bypass grafting is an infrequent complication. Moreover, the treatment of PE resistant to medical therapy, percutaneous drainage and pleuro-pericardial window remains a therapeutic challenge. We report the case of a recalcitrant PE with high-daily volume outflow drainage, finally treated with success, with a transdiaphragmatic pleuro-peritoneal shunting by laparoscopic approach.
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Affiliation(s)
- Nicolas Themelin
- Department of Cardio-Thoracic Surgery, CHU Marie Curie, Charleroi, Belgium
| | - Serge Cappeliez
- Department of Cardio-Thoracic Surgery, CHU Marie Curie, Charleroi, Belgium
| | | | - Badih El Nakadi
- Department of Cardio-Thoracic Surgery, CHU Marie Curie, Charleroi, Belgium
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26
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Maisch B, Klingel K, Perings S, Baldus S. Kommentar zu den 2015-Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zu Perikarderkrankungen. DER KARDIOLOGE 2017. [DOI: 10.1007/s12181-017-0137-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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27
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Papageorgiou N, Briasoulis A, Lazaros G, Imazio M, Tousoulis D. Colchicine for prevention and treatment of cardiac diseases: A meta-analysis. Cardiovasc Ther 2017; 35:10-18. [PMID: 27580061 DOI: 10.1111/1755-5922.12226] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS Colchicine has been suggested to be beneficial in preventing recurrent pericarditis. The goal of this study was to review all randomized controlled trials that assess the use of colchicine for the prevention and treatment of cardiac diseases. METHODS We performed a meta-analysis of the effects of colchicine on pericarditis, postpericardiotomy syndrome and postprocedural atrial fibrillation recurrence, in-stent restenosis, gastrointestinal adverse effects, and treatment discontinuation rates. We conducted an EMBASE and MEDLINE search for prospective controlled trials. RESULTS We identified 17 prospective controlled randomized studies with 2082 patients that received colchicine and 1982 controls with an average follow-up duration of 12 months. Treatment with colchicine is associated with reduced risk of pericarditis recurrence/postpericardiotomy syndrome (OR: 0.37; 95% CI: 0.29-0.47; P<0.001) and lower recurrence of atrial fibrillation rates after cardiac surgery and ablation procedures. However, gastrointestinal side effects were more common in patients treated with colchicine (OR: 2.6; 95% CI: 1.82-3.72; P<0.001) in all subgroups except for those treated for prevention of recurrent pericarditis. The higher rates of side effects resulted in higher incidence of treatment discontinuation in patients treated with colchicine. CONCLUSION Colchicine appears to be efficacious and well tolerated for recurrent pericarditis/postpericardiotomy syndrome and recurrence of postprocedural atrial fibrillation. However, its efficacy may be limited by its gastrointestinal adverse events and treatment discontinuation rates particularly in postoperative patients.
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Affiliation(s)
- Nikolaos Papageorgiou
- Barts Heart Centre, St Bartholomew's Hospital, London, UK.,First Cardiology Department, University of Athens Medical School, Hippokration General Hospital, Athens, Greece
| | | | - George Lazaros
- First Cardiology Department, University of Athens Medical School, Hippokration General Hospital, Athens, Greece
| | - Massimo Imazio
- Cardiology Department, Maria Vittoria Hospital, Torino, Italy.,Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Dimitris Tousoulis
- First Cardiology Department, University of Athens Medical School, Hippokration General Hospital, Athens, Greece
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28
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Imazio M, Gaido L, Battaglia A, Gaita F. Contemporary management of pericardial effusion: practical aspects for clinical practice. Postgrad Med 2017; 129:178-186. [PMID: 28135875 DOI: 10.1080/00325481.2017.1285676] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A pericardial effusion (PE) is a relatively common finding in clinical practice. It may be either isolated or associated with pericarditis with or without an underlying disease. The aetiology is varied and may be either infectious (especially tuberculosis as the most common cause in developing countries) or non-infectious (cancer, systemic inflammatory diseases). The management is essentially guided by the hemodynamic effect (presence or absence of cardiac tamponade), the presence of concomitant pericarditis or underlying disease, and its size and duration. The present paper reviews the current knowledge on the aetiology, classification, diagnosis, management, therapy, and prognosis of PE in clinical practice.
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Affiliation(s)
- Massimo Imazio
- a Department of Medical Sciences , University Cardiology, AOU Città della Salute e della Scienza di Torino, and University of Torino , Torino , Italy
| | - Luca Gaido
- a Department of Medical Sciences , University Cardiology, AOU Città della Salute e della Scienza di Torino, and University of Torino , Torino , Italy
| | - Alberto Battaglia
- a Department of Medical Sciences , University Cardiology, AOU Città della Salute e della Scienza di Torino, and University of Torino , Torino , Italy
| | - Fiorenzo Gaita
- a Department of Medical Sciences , University Cardiology, AOU Città della Salute e della Scienza di Torino, and University of Torino , Torino , Italy
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29
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Ghods K, Razavi MR, Forozeshfard M. Performance, pain, and quality of life on use of central venous catheter for management of pericardial effusions in patients undergoing coronary artery bypass graft surgery. J Pain Res 2016; 9:887-892. [PMID: 27826210 PMCID: PMC5096756 DOI: 10.2147/jpr.s116483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Different pericardial catheters have been suggested as an effective alternative method for drainage of pericardial effusion. The aim of this study was to determine the performance, pain, and quality of life on use of central venous catheter (CVC) for drainage of pericardial effusion in patients undergoing open heart surgery. Fifty-five patients who had developed pericardial effusion after an open heart surgery (2012-2015) were prospectively assessed. Triple-lumen central catheters were inserted under echocardiographic guidance. Clinical, procedural, complication, and outcome details were analyzed. Intensity of pain and quality of life of patients were assessed using the numerical rating scale and Short-Form Health Survey. CVC was inserted for 36 males and 19 females, all of whom had a mean age of 58.5±15 years, and the mean duration of the open heart surgery was 8±3.5 hours. The mean central venous pressure catheter life span was 14.6 days. No cases of recurrent effusion and complication were reported. The technical success rate of procedure was 100%. Intensity of pain and quality of life of patients had improved during follow-up. CVC insertion is a safe and effective technique for the management of pericardial effusion in patients after open heart surgery.
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Affiliation(s)
- Kamran Ghods
- Clinical Research Development Unit (CRDU), Department of Cardiovascular Surgery, Kowsar Hospital
| | | | - Mohammad Forozeshfard
- Cancer Research Center, Department of Anesthesiology, Semnan University of Medical Sciences, Semnan, Iran
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Abstract
Eleven years after the publication of the first guidelines worldwide on pericardial diseases by the European Society of Cardiology (ESC), the international expert group of the ESC has updated the original document of 28 pages with 275 references. The final version of the new guidelines is more voluminous with 44 pages of recommendations but only 233 references. A continuing medical education (CME) certified update of the 2004 guidelines was published in the journal Herz volume 7/2014. In comparison to 2004 the 2015 guidelines have remained virtually unchanged in the sections detailing diagnostics, differential diagnosis, pathology and pathophysiology. Substantial progress has been made in magnetic resonance imaging (MRI) of pericarditis and epicarditis and in the practically universal recommendation of colchicine for all forms of pericarditis and pericardial effusion, whether acute, chronic or recurrent. This can truly be called progress; however, little has changed since 2004 even in tertiary referral centers or universities with respect to the etiological classification of acute or recurrent forms of pericarditis or pericardial effusion. By classifying pericardial syndromes much too often as idiopathic when a malignant or bacterial cause has been excluded, the underlying cause is often overlooked. Standstill in diagnosis is in the end regress because we too often lag behind our actual diagnostic and interventional possibilities.
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31
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Wang MX, Deng XL, Mu BY, Cheng YJ, Chen YJ, Wang Q, Huang J, Zhou RW, Huang CB. Effect of colchicine in prevention of pericardial effusion and atrial fibrillation: a meta-analysis. Intern Emerg Med 2016; 11:867-76. [PMID: 27378573 DOI: 10.1007/s11739-016-1496-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/22/2016] [Indexed: 11/25/2022]
Abstract
Randomized, controlled trials (RCTs) have assessed the effect of colchicine therapy in prevention of pericardial effusion (PE) and atrial fibrillation (AF). However, the effects are still inconclusive. PubMed, Cochrane Library, Google Scholar, and EMBASE database were searched. Primary outcome was the risk of PE and AF. Ten RCTs with 1981 patients and a mean follow-up of 12.6 months were included. Colchicine therapy was not associated with a significantly lower risk of post-operative PE (RR, 0.89; 95 % CI 0.70-1.13; p = 0.33, I (2) = 72.8 %) and AF (RR, 0.77; 95 % CI 0.52-1.13; p = 0.18, I (2) = 47.3 %). However, rates of pericarditis recurrence, symptoms persistence, and pericarditis-related hospitalization were significantly decreased with colchicine treatment. In addition, cardiac tamponade occurrence was similar between groups, and adverse events were significantly higher in the colchicine group. Colchicine may not significantly decrease the post-operative risk of PE and AF. However, only limited studies about patients undergoing cardiac surgery provide data about PE and AF.
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Affiliation(s)
- Ming-Xuan Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiao-Long Deng
- Department of Neurology, Wuhan Medical & Healthcare Center for Women and Children, Wuhan Children's Hospital, Wuhan, Hubei, China
| | - Bing-Yao Mu
- Department of Rheumatology, Beijing Hospital, No. 1, Dahua Road, East District, Beijing, China
| | - Yong-Jing Cheng
- Department of Rheumatology, Beijing Hospital, No. 1, Dahua Road, East District, Beijing, China
| | - Ying-Juan Chen
- Department of Rheumatology, Beijing Hospital, No. 1, Dahua Road, East District, Beijing, China
| | - Qian Wang
- Department of Rheumatology, Beijing Hospital, No. 1, Dahua Road, East District, Beijing, China
| | - Jia Huang
- Department of Rheumatology, Beijing Hospital, No. 1, Dahua Road, East District, Beijing, China
| | - Rong-Wei Zhou
- Department of Rheumatology, Beijing Hospital, No. 1, Dahua Road, East District, Beijing, China
| | - Ci-Bo Huang
- Department of Rheumatology, Beijing Hospital, No. 1, Dahua Road, East District, Beijing, China.
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Imazio M, Brucato A, Badano L, Charron P, Adler Y. Whatʼs new in 2015 ESC guidelines on pericardial diseases? J Cardiovasc Med (Hagerstown) 2016; 17:315-22. [DOI: 10.2459/jcm.0000000000000358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, Brucato A, Gueret P, Klingel K, Lionis C, Maisch B, Mayosi B, Pavie A, Ristić AD, Sabaté Tenas M, Seferovic P, Swedberg K, Tomkowski W. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015; 36:2921-2964. [PMID: 26320112 PMCID: PMC7539677 DOI: 10.1093/eurheartj/ehv318] [Citation(s) in RCA: 1405] [Impact Index Per Article: 156.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Yehuda Adler
- Corresponding authors: Yehuda Adler, Management, Sheba Medical Center, Tel Hashomer Hospital, City of Ramat-Gan, 5265601, Israel. Affiliated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel, Tel: +972 03 530 44 67, Fax: +972 03 530 5118,
| | - Philippe Charron
- Corresponding authors: Yehuda Adler, Management, Sheba Medical Center, Tel Hashomer Hospital, City of Ramat-Gan, 5265601, Israel. Affiliated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel, Tel: +972 03 530 44 67, Fax: +972 03 530 5118,
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Imazio M, Gaita F. Colchicine for postoperative pericardial effusions: not the magic bullet for all kind of pericardial diseases! BRITISH HEART JOURNAL 2015; 101:1693-4. [DOI: 10.1136/heartjnl-2015-308184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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