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Pubblicazioni recenti - cardiogenic
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Contrast transesophageal three dimensional echocardiographic imaging for patent foramen ovale: a needful role?
Monaldi Arch Chest Dis2020 Oct;90(4):. doi: 10.4081/monaldi.2020.1278.
Al Sergani Reem, Michele Sara Di, Kinsara Abdulhalim J, Galzerano Domenico, Vriz Olga, Elmahi Isra, Cittadini Antonio, Colonna Paolo, AlKattan Khaled M,
Abstract
We report a case of a 55-year-old male admitted for cardiogenic embolic ischemic stroke work up. A transesophageal (TE) echocardiography (E) with contrast study to rule out patent foramen ovale (PFO) was performed; two-dimensional (2D) analysis did not detect any bubbles passage during Valsalva manoeuvre in the standard 2D cross sectional planes; further real time three-dimensional (3D) TEE imaging revealed passage of bubbles in the left atrium (LA) by both real-time 3DTEE imaging and by the 2D unconventional cross-sectional planes allowed by 3DTEE imaging. Even though 2DTEE is considered to be the gold standard modality for diagnosing PFO, it has some limitations. It has never been reported about usefulness of 3DTEE in PFO imaging. Even in the presence of only a report, our case suggests that 3DE could have an additional value and will compliment 2D imaging in PFO assessment.
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Rapid Response to Cytokine Storm Inhibition using Anakinra in a Patient with COVID-19 Myocarditis.
CJC Open2020 Oct;():. doi: 10.1016/j.cjco.2020.10.003.
Trpkov Cvetan, MacMullan Paul, Feuchter Patricia, Kachra Rahim, Heydari Bobak, Merchant Naeem, Bristow Michael S, White James A,
Abstract
A 62-year-old female with COVID-19 developed acute respiratory failure and cardiogenic shock in the setting of a systemic hyper-inflammatory state and apparent ST-elevation myocardial infarction. Cardiac magnetic resonance (CMR) imaging showed fulminant acute myocarditis with severe left ventricular dysfunction. Treatment with the recombinant interleukin-1 (IL-1) receptor antagonist anakinra and dexamethasone resulted in rapid clinical improvement, reduction in serum inflammatory markers and a marked recovery in CMR-based markers of inflammation and contractile dysfunction. The patient was subsequently discharged from hospital. Emerging evidence supports use of anti-inflammatory therapies, including anakinra and dexamethasone, in severe COVID-19.
© 2020 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
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Incidence of acute myocardial infarction-related cardiogenic shock during corona virus disease 19 (COVID-19) pandemic.
Int J Cardiol Heart Vasc2020 Oct;():100659. doi: 10.1016/j.ijcha.2020.100659.
Lauridsen M D, Butt J H, Řstergaard L, Mřller J E, Hassager C, Gerds T, Kragholm K, Phelps M, Schou M, Torp-Pedersen C, Gislason G, Křber L, Fosbřl E L,
Abstract
Aims:
The hospitalization of patients with MI has decreased during global lockdown due to the COVID-19 pandemic. Whether this decrease is associated with more severe MI, e.g. MI-CS, is unknown. We aimed to examine the association of Corona virus disease (COVID-19) pandemic and incidence of acute myocardial infarction with cardiogenic shock (MI-CS).
Methods:
On March 11, 2020, the Danish government announced national lock-down. Using Danish nationwide registries, we identified patients hospitalized with MI-CS. Incidence rates (IR) and incidence rate ratios (IRR) were used to compare MI-CS before and after March 11 in 2015-2019 and in 2020.
Results:
We identified 11,769 patients with MI of whom 696 (5.9%) had cardiogenic shock in 2015-2019. In 2020, 2,132 MI patients were identified of whom 119 had cardiogenic shock (5.6%). The IR per 100,000 person years before March 11 in 2015-2019 was 9.2 (95% CI: 8.3-10.2) and after 8.9 (95% CI: 8.0-9.9). In 2020, the IR was 7.5 (95% CI: 5.8-9.7) before March 11 and 7.7 (95% CI: 6.0-9.9) after. The IRRs comparing the 2020-period with the 2015-2019 period before and after March 11 (lockdown) were 0.81 (95% CI: 0.59-1.12) and 0.87 (95% CI: 0.57-1.32), respectively. The IRR comparing the 2020-period during and before lockdown was 1.02 (95% CI: 0.74-1.41). No difference in 7-day mortality or in-hospital management was observed between study periods.
Conclusion:
We could not identify a significant association of the national lockdown on the incidence of MI-CS, along with similar in-hospital management and mortality in patients with MI-CS.
© 2020 Published by Elsevier B.V.
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ATRIAL FIBRILLATION IN A PEDIATRIC PATIENT WITH COVID-19 INFECTION.
Cardiol Young2020 Oct;():1-9. doi: 10.1017/S1047951120003893.
Santi Aura Daniella, Aquino Paolo, Dorfman Molly,
Abstract
The SARS-CoV-2 (COVID-19) pandemic has challenged our initial predictions of its ramifications, both short and long term. Cardiovascular manifestations of COVID-19 in pediatric patients remains a topic of investigation as literature is lacking. We describe new onset atrial fibrillation in a pediatric patient with a history of COVID-19 infection. Understanding of cardiogenic effects of COVID-19 can help minimize delay in diagnosis.
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Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation: A Patient-Level, Multicenter Analysis.
JACC Cardiovasc Interv2020 Oct;():. doi: S1936-8798(20)31853-7.
Jung Richard G, Simard Trevor, Kovach Christopher, Flint Kelsey, Don Creighton, Di Santo Pietro, Adamo Marianna, Branca Luca, Valentini Francesca, Benito-González Tomás, Fernández-Vázquez Felipe, Estévez-Loureiro Rodrigo, Berardini Alessandra, Conti Nicolina, Rapezzi Claudio, Biagini Elena, Parlow Simon, Shorr Risa, Levi Amos, Manovel Ana, Cardenal-Piris Rosa, Diaz Fernandez Jose, Shuvy Mony, Haberman Dan, Sala Alessandra, Alkhouli Mohamad A, Marini Claudia, Bargagna Marta, Schiavi Davide, Denti Paolo, Markovic Sinisa, Buzzatti Nicola, Chan Vincent, Hynes Mark, Mesana Thierry, Labinaz Marino, Pappalardo Federico, Taramasso Maurizio, Hibbert Benjamin,
Abstract
OBJECTIVES:
The aim of this study was to evaluate the outcome of transcatheter mitral valve repair (TMVr) in patients with cardiogenic shock and significant mitral regurgitation (MR).
BACKGROUND:
Patients in cardiogenic shock with severe MR have a poor prognosis in the setting of conventional medical therapy. Because of its favorable safety profile, TMVr is being increasingly used as an acute therapy in this population, though its efficacy remains unknown.
METHODS:
A multicenter, collaborative, patient-level analysis was conducted. Patients with cardiogenic shock and moderate to severe (3+) or severe (4+) MR who were not surgical candidates were treated with TMVr. The primary outcome was in-hospital mortality Secondary outcomes included 90-day mortality, heart failure (HF) hospitalization, and the combined event rate of 90-day mortality and HF hospitalization following dichotomization by TMVr device success.
RESULTS:
Between January 2011 and February 2019, 141 patients across 14 institutions met the inclusion criteria. In-hospital mortality occurred in 22 patients (15.6%), at 90 days in 38 patients (29.5%), and at one year in 55 patients (42.6%). Median length of hospital stay following TMVr was 10 days (interquartile range: 6 to 20 days). HF hospitalization occurred in 26 patients (18.4%) at a median of 73 days (interquartile range: 26 to 546 days). When stratified by TMVr procedural results, successful TMVr reduced rates of in-hospital mortality (hazard ratio [HR]: 0.36; 95% confidence interval [CI]: 0.13 to 0.98; p = 0.04), 90-day mortality (HR: 0.36; 95% CI: 0.16 to 0.78; p = 0.01), and the composite of 90-day mortality and HF hospitalization (HR: 0.41; 95% CI: 0.19 to 0.90; p = 0.03).
CONCLUSIONS:
TMVr may improve short- and intermediate-term mortality in high-risk patients with cardiogenic shock and moderate to severe MR. Randomized studies are needed to definitively establish MR as a therapeutic target in patients with cardiogenic shock.
Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.
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Mitral Regurgitation in Cardiogenic Shock: A Novel Target for Transcatheter Therapy?
JACC Cardiovasc Interv -
Guanfacine toxic ingestion with subsequent cardiogenic pulmonary edema: A case report.
Am J Emerg Med2020 Jul;():. doi: S0735-6757(20)30584-2.
Bridwell Rachel E, Larson Neil P, Rosenthal Jennifer B, Wray Jesse, Baker Zachary, Cibrario Amber, Oliver Joshua J,
Abstract
Guanfacine is a central alpha-2 agonist often prescribed for Attention-deficit hyperactive disorder as well as tic disorder, with a usual dose of 1-4 mg per day. Due to its sympatholytic mechanism of action, Guanfacine can cause autonomic instability and hypotension. It can additionally cause cardiac dysfunction to include symptomatic bradycardias and contractility suppression. The authors present a case of a 17 year-old male with an ingestion of 80 mg of extended release Guanfacine with delayed onset cardiogenic pulmonary edema requiring mechanical ventilation. Previous pediatric ingestions have generated bradycardia, hypotension, and decreased level of consciousness, responsive to intravenous fluids, vasopressors, and occasionally naloxone. However, cardiogenic pulmonary edema from reduced cardiac contractility is a novel consequence of extended release Guanfacine ingestion. With Guanfacine's extended half-life, this unique case underscores the importance of emergency providers' familiarity with this toxidrome as well the necessity for prolonged, close observation following Guanfacine ingestion.
Published by Elsevier Inc.
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Mechanical support for high-risk coronary artery bypass grafting.
Indian J Thorac Cardiovasc Surg2018 Dec;34(Suppl 3):287-296. doi: 10.1007/s12055-018-0740-1.
Ali Jason M, Abu-Omar Yasir,
Abstract
Mechanical circulatory support devices are being used to an increasing extent. The use of these devices as an adjunct to cardiac surgery to support ventricular function has contributed to improved outcomes for the highest risk patients. In the context of patients undergoing coronary artery bypass grafting, there are several potential indications for mechanical circulatory support: preoperatively in the setting of acute cardiogenic shock, or in patients with intractable angina with or without haemodynamic compromise; at induction of anaesthesia prophylactically in patients with critical coronary anatomy and/or severely impaired left ventricular function; intraoperatively in the setting of failure to wean from cardiopulmonary bypass; or postoperatively in patients who develop an intractable low cardiac output state. The use of the intra-aortic balloon pump, veno-arterial extracorporeal membrane oxygenation, TandemHeart, Impella and central ventricular assist devices will be considered in the setting of high-risk patients undergoing coronary artery bypass grafting.
© The Author(s) 2018.
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Complete versus incomplete coronary revascularization: definitions, assessment and outcomes.
Nat Rev Cardiol2020 Oct;():. doi: 10.1038/s41569-020-00457-5.
Gaba Prakriti, Gersh Bernard J, Ali Ziad A, Moses Jeffrey W, Stone Gregg W,
Abstract
Coronary artery disease is the leading cause of morbidity and mortality worldwide. Selected patients with obstructive coronary artery disease benefit from revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Many (but not all) studies have demonstrated increased survival and greater freedom from adverse cardiovascular events after complete revascularization (CR) than after incomplete revascularization (ICR) in patients with multivessel disease. However, achieving CR after PCI or CABG surgery might not be feasible owing to patient comorbidities, anatomical factors, and technical or procedural considerations. These factors also mean that comparisons between CR and ICR are subject to multiple confounders and are difficult to understand or apply to real-world clinical practice. In this Review, we summarize and critically appraise the evidence linking various types of ICR to adverse outcomes in patients with multivessel disease and stable ischaemic heart disease, non-ST-segment elevation acute coronary syndrome or ST-segment elevation myocardial infarction, with or without cardiogenic shock. In addition, we provide practical recommendations for revascularization in patients with high-risk multivessel disease to optimize their long-term clinical outcomes and identify areas requiring future clinical investigation.
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Accuracy assessment of noninvasive cardiac output monitoring in the hemodynamic monitoring in critically ill patients.
Ann Palliat Med2020 Sep;9(5):3506-3512. doi: 10.21037/apm-20-1731.
Zhu Guijun, Zhang Kun, Fu Yuxin, Hu Zhenjie,
Abstract
BACKGROUND:
The consistency of cardiac output (CO) measured by noninvasive cardiac output monitoring (NICOM), pulse index continuous cardiac output (PiCCO), and ultrasound in the hemodynamic monitoring of critically ill patients was studied. Using the NICOM built-in passive leg raising (PLR) test, stroke volume index variation (?SVI) was calculated and was used to predict volume responsiveness in patients with circulatory shock (excluding cardiogenic shock).
METHODS:
Critically ill patients requiring hemodynamic monitoring were admitted during the study period. The CO of each included patient under hemodynamic monitoring was measured by NICOM plus PiCCO or ultrasound, and the consistency of the measured COs was analyzed. By the NICOM built-in PLR test, ?SVI was calculated and was used to predict volume responsiveness.
RESULTS:
The CO of 58 patients was measured by NICOM and ultrasound, and the COs measured by these two methods were consistent. The CO of 40 patients was measured by NICOM and PiCCO, and the COs measured by these two methods were consistent. The volume responsiveness of all 98 patients was assessed by the NICOM built-in PLR test. A total of 60 patients had ?SVI >10%, so they underwent the fluid challenge. Among them, 43 patients were positive by both the NICOM built-in PLR and fluid challenge. When using ?SVI to predict volume responsiveness in patients with circulatory shock (excluding cardiogenic shock), the area under the receiver operating characteristic curve was 0.754 (95% confidence interval, 0.626-0.856), and the cut-off value was 18% (sensitivity: 88.37%, specificity: 52.94%), indicating that ?SVI has value in predicting the volume responsiveness of patients with noncardiogenic circulatory shock.
CONCLUSIONS:
NICOM had good consistency with ultrasound and PiCCO in the hemodynamic monitoring of critically ill patients and can be for hemodynamic monitoring and evaluation in critically ill patients. The ?SVI obtained by the NICOM built-in PLR test has certain clinical value in predicting the volume responsiveness of patients with circulatory shock (excluding cardiac shock) and provides a method for evaluating the volume responsiveness of critically ill patients.
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Management for the drowning patient.
Chest2020 Oct;():. doi: S0012-3692(20)34896-0.
Szpilman David, Morgan Paddy,
Abstract
Drowning is "the process of experiencing respiratory impairment from submersion or immersion in liquid". According to WHO, drowning claim the lives of more than 40 people every hour of every day. Drowning involves some physiological principles and medical interventions that are unique. It occurs in a deceptively hostile environment that involves an underestimation of the dangers or an overestimation of water competency. It has been estimated that more than 90% are preventable. When water is aspirated into the airways, coughing is the initial reflex response. The acute lung injury alters the exchange of O in different proportions. The combined effects of fluid in the lungs, loss of surfactant and increased capillary-alveolar permeability result in decreased lung compliance, increased right-to-left shunting in the lungs, atelectasis, and alveolitis, a non-cardiogenic pulmonary edema. Salt and fresh water aspiration cause similar pathology. If the person is not rescued, aspiration continues and hypoxemia leads to loss of consciousness and apnea in seconds to minutes. As a consequence, hypoxic cardiac arrest occurs. The decision to admit to an ICU should consider patient´s drowning severity and co-or-premorbid conditions. Ventilation therapy should achieve an intrapulmonary shunt of 20% or less, or PaO2:FiO2 of 250 or more. Premature ventilatory weaning may cause the return of pulmonary edema with the need for re-intubation, and an anticipation of prolonged hospital stays and further morbidity. This review includes all the essentials steps from the first call to action until the best practice at the pre-hospital, emergency department, and hospitalization.
Copyright © 2020. Published by Elsevier Inc.
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Fulminant myocarditis in a patient with coronavirus disease 2019 and rapid myocardial recovery following treatment.
ESC Heart Fail2020 Oct;():. doi: 10.1002/ehf2.13041.
Gay Hawkins C, Sinha Arjun, Michel Eriberto, Mozer Anthony B, Budd Ashley, Feinstein Matthew J, Benzuly Keith H, Al-Qamari Abbas, Pawale Amit A, Vorovich Esther E,
Abstract
Coronavirus disease 2019 (COVID-19) is a global pandemic increasingly encountered in the clinical setting. It typically manifests as a respiratory illness, although cardiac involvement is common and portends a worse prognosis. We present the case of a 56-year-old male admitted with COVID-19 fulminant myocarditis and cardiogenic shock. We discuss important aspects of the multidisciplinary and interventional care involved in treating cardiogenic shock as well as the likely mechanisms of, and potential treatment for, COVID-19 myocarditis. The various pathways of myocardial injury, including direct viral damage, macrophage activation, and lymphocytic infiltration, are outlined in detail in addition to associated pathology such as cytokine release syndrome. COVID-19 is a complex and multisystem disease process; in addition to supportive care, specific consideration should be given to the underlying mechanism of injury for each patient.
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
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The Impact of COPD on in-Hospital Outcomes in Patients with Takotsubo Cardiomyopathy.
Int J Chron Obstruct Pulmon Dis2020 ;15():2333-2341. doi: 10.2147/COPD.S267289.
Li Pengyang, Lu Xiaojia, Teng Catherine, Cai Peng, Kranis Mark, Dai Qiying, Wang Bin,
Abstract
Purpose:
Chronic obstructive pulmonary disease (COPD) is a known comorbidity of takotsubo cardiomyopathy (TCM), and COPD exacerbation is a potential triggering factor of TCM. The association between COPD and in-hospital outcomes and complications among TCM patients is not well established. We sought to assess the effect of COPD on hospitalized patients with a primary diagnosis of TCM.
Methods:
We conducted a retrospective cohort study in patients with a primary diagnosis of TCM with or without COPD using the latest National Inpatient Sample from 2016-2017. We identified 3139 patients admitted with a primary diagnosis of TCM by the ICD-10-CM coding system; 684 of those patients also had a diagnosis of COPD. We performed propensity score matching in a 1:2 ratio (n=678 patients, matched COPD group; n=1070, matched non-COPD group) and compared in-hospital outcomes and complications between TCM patients with and without a COPD diagnosis.
Results:
Before matching, the COPD group had worse outcomes compared with the non-COPD group in inpatient death (2.9% vs 1.3%, p=0.006), length of stay (LOS) (4.02±2.99 days vs 3.27±3.39 days, p<0.001), hospitalization charges ($55,242.68±47,637.40 vs $48,316.97±47,939.84, p=0.001), and acute respiratory failure (ARF) (22.5% vs 7.7%, p<0.001), respectively. After propensity score matching, the matched COPD group, compared with the matched non-COPD group, had a higher inpatient mortality rate (2.9% vs1.0%, p=0.005), longer LOS (4.02±3.00 days vs 3.40±3.54 days, p<0.001), higher hospitalization charges ($55,409.23±47,809.13 vs $46,469.60±42,209.10, p<0.001), and a higher incidence of ARF (22.6% vs 8.2%, p<0.001) and cardiogenic shock (5.6% vs 3.3%, p=0.024), respectively.
Conclusion:
Patients with COPD who are hospitalized for TCM have higher rates of inpatient mortality, ARF, cardiogenic shock, as well as a longer LOS, and higher charges of stay than those without COPD. Prospective studies are warranted to examine the effect of early intervention or treatment of COPD on short- and long-term outcomes of TCM.
© 2020 Li et al.
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Unique patterns of cardiogenic and fibrotic gene expression in rat cardiac fibroblasts.
Vet World2020 Aug;13(8):1697-1708. doi: 10.14202/vetworld.2020.1697-1708.
Tachampa Kittipong, Wongtawan Tuempong,
Abstract
Background and Aim:
Cardiac fibroblasts are important for both normal and pathological states of the heart, but the knowledge in cell physiology and genomics is still poorly understood. The aims of the present study were; first, to investigate the expression of cardiac and fibrotic genes in rat cardiac fibroblasts compared to cardiomyocytes and other fibroblasts (skin and muscle fibroblasts), second, to examine the in vitro effect of serum concentration on fibroblast gene expression. The findings can potentially be applied in ischemia/reperfusion models.
Materials and Methods:
Rat cardiac fibroblasts were collected and cultured in different conditions, and their gene expression (21 cardiogenic genes and 16 fibrotic genes) was compared with cardiomyocytes and other fibroblasts using comparative quantitative polymerase chain reaction. We also mimicked myocardial ischemia/reperfusion by depleting and then adding a serum into the culture in conventional culture (10% serum).
Results:
Cardiac fibroblasts expressed most of the cardiogenic genes, but their expression levels were significantly lower than in cardiomyocytes, while almost all fibrotic genes in the cardiac fibroblasts were significantly more highly expressed than in cardiomyocytes, except matrix metallopeptidase 9 (Mmp9) which also had greater expression in other fibroblasts. After mimicking cardiac ischemia and reperfusion in vitro by starving and then adding a serum into the cardiac fibroblast culture, the results revealed that Mmp9 expression was significantly increased (>30 times) after increasing but not reducing the serum in the culture. The expression of most cardiogenic and fibrotic genes in cardiac fibroblasts tended to decrease after increasing the serum in the culture. These changes were specific to cardiac fibroblasts but no other fibroblasts.
Conclusion:
Cardiac fibroblasts have a distinct pattern of gene expression from other fibroblasts and cardiomyocytes. They are also sensitive to high serum concentration but not affected by serum depletion, suggesting that the process of developing cardiac fibrosis might be stimulated by reperfusion or overcirculation rather than ischemia. The cell starvation followed the adding of serum may serve as a useful model to study cardiac fibrosis cause by the change of blood flow.
Copyright: © Tachampa and Wongtawan.
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Implantation of Impella CP left ventricular assist device under the guidance of three-dimensional intracardiac echocardiography.
Sci Rep2020 Oct;10(1):17485. doi: 10.1038/s41598-020-74220-8.
Yastrebov Konstantin, Brunel Laurencie, Paterson Hugh S, Williams Zoe A, Wise Innes K, Burrows Christopher S, Bannon Paul G,
Abstract
Impella CP is a percutaneously inserted left ventricular assist device indicated for temporary mechanical cardiac support during high risk percutaneous coronary interventions and for cardiogenic shock. The potential application of Impella has become particularly relevant during the current COVID-19 pandemic, for patients with acute severe heart failure complicating viral illness. Standard implantation of the Impella CP is performed under fluoroscopic guidance. Positioning of the Impella CP can be confirmed with transthoracic or transoesophageal echocardiography. We describe an alternative approach to guide intracardiac implantation of the Impella CP using two-dimensional and three-dimensional intracardiac echocardiography. This new technique can be useful in selected groups of patients when fluoroscopy, transthoracic and transoesophageal echocardiography is deemed inapplicable or limited for epidemiological or clinical reasons. Intracardiac three-dimensional echocardiography is a feasible alternative to the traditional techniques for implantation of an Impella CP device but careful consideration must be given to the potential limitations and complications of this technique.
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Physician prediction of 1-year mortality in the cardiac catheterization laboratory: comparison to a validated risk score.
Coron Artery Dis2020 Oct;():. doi: 10.1097/MCA.0000000000000967.
Sarathy Kiran, Jung Richard G, Simard Trevor, Parlow Simon, Di Santo Pietro, Moreland Robert, Jung Young, Abdel-Razek Omar, Boland Paul, Russo Juan J, Chong Aun-Yeong, So Derek, Froeschl Michael, Dick Alexander, Glover Christopher, Labinaz Marino, Le May Michel, Hibbert Benjamin,
Abstract
BACKGROUND:
Physician perception of procedural risk and clinical outcome can affect revascularization decision making. Public reporting of percutaneous coronary intervention outcomes accentuates the need for accuracy in risk prediction in order to avoid a treatment paradox of undertreating the highest risk patients. Our study compares a validated risk score to physician prediction (PP) of 1-year mortality based on clinical impression at the time of invasive angiography.
METHODS AND RESULTS:
We performed a cohort study between August 2015 and May 2018 to determine the discriminative accuracy of interventional cardiologists on one-year mortality of the treated patient. PP of one-year mortality was compared to the New York State Percutaneous Coronary Intervention Reporting System (NYPCIRS) score in predicting mortality. Three thousand seven hundred ninety-two patients were followed with a median follow-up period of 14.4 months (interquartile range 12.4-18.1 months) and 165 patients (4.4%) died within one-year. PP of mortality was associated with one-year mortality with a hazard ratio of 8.78 (95% confidence interval 5.24-14.71, P < 0.0001). Clinical presentation in the form of cardiogenic shock, return of spontaneous circulation, and liver and renal dysfunction were associated with PP. Diagnostic accuracy and specificity were improved in PP compared to NYPCIRS. The combination of PP to NYPCIRS improved the overall c-statistic and diagnostic yield.
CONCLUSION:
PP appears to be especially specific and accurate for prediction of mortality compared to NYPCIRS though it lacks sensitivity. Furthermore, the combination of PP with NYPCIRS improved the c-statistic and diagnostic yield. Overall, the utility of PP with an objective risk score improves the diagnostic accuracy of mortality prediction.
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Mortality Predictors in Elderly Patients With Cardiogenic Shock on Venoarterial Extracorporeal Life Support. Analysis From the Extracorporeal Life Support Organization Registry.
Crit Care Med2020 Oct;():. doi: 10.1097/CCM.0000000000004695.
Kowalewski Mariusz, Zieli?ski Kamil, Maria Raffa Giuseppe, Meani Paolo, Lo Coco Valeria, Jiritano Federica, Fina Dario, Matteucci Matteo, Chiarini Giovanni, Willers Anne, Simons Jorik, Suwalski Piotr, Gaudino Mario, Di Mauro Michele, Maessen Jos, Lorusso Roberto,
Abstract
OBJECTIVES:
Since significantly higher mortality is observed in elderly patients undergoing venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock, decision-making in this setting is challenging. We aimed to elucidate predictors of unfavorable outcomes in these elderly (? 70 yr) patients.
DESIGN:
Analysis of international worldwide extracorporeal life support organization registry.
SETTING:
Refractory cardiogenic shock due to various etiologies (cardiac arrest excluded).
PATIENTS:
Elderly patients (? 70 yr).
INTERVENTIONS:
Venoarterial extracorporeal membrane oxygenation.
MEASUREMENTS AND MAIN RESULTS:
Three age groups (70-74, 75-79, ?80 yr) were in-depth analyzed. Uni- and multivariable analysis were performed. From January 1997 to December 2018, 2,644 patients greater than or equal to 70 years (1,395 [52.8%] 70-74 yr old, 858 [32.5%] 75-79 yr, and 391 [14.8%] ? 80 yr old) were submitted to venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock with marked increase in the most recent years. Peripheral access was applied in majority of patients. Median extracorporeal membrane oxygenation support duration was 3.5 days (interquartile range: 1.6-6.1 d), (3.9 d [3.7-4.6 d] in patients ? 80 yr) (p < 0.001). Weaning from extracorporeal membrane oxygenation was possible in 1,236 patients (46.7%). Overall in-hospital mortality was estimated at 68.3% with highest crude mortality rates observed in 75-79 years old subgroup (70.1%). Complications were mostly cardiovascular and bleeding, without apparent differences between subgroups. Airway pressures, 24-hour pH after extracorporeal membrane oxygenation start, extracorporeal membrane oxygenation duration, and renal replacement therapy were predictive of higher mortality. In-hospital mortality was lower in heart transplantation recipients, posttranscatheter aortic valve replacement, and pulmonary embolism; conversely, higher mortality followed extracorporeal membrane oxygenation institution after coronary artery bypass + valve and in decompensated chronic heart failure, and nearly 100% mortality followed in extracorporeal membrane oxygenation for sepsis.
CONCLUSIONS:
This study confirmed the remarkable increase of venoarterial extracorporeal membrane oxygenation use in elderly affected by refractory cardiogenic shock. Despite in-hospital mortality remains high, venoarterial extracorporeal membrane oxygenation should still be considered in such setting even in elderly patients, since increasing age itself was not linked to increased mortality, whereas several predictors may guide indication and management.
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Gender-based outcomes of impeller pumps percutaneous ventricular assist devices.
Catheter Cardiovasc Interv2020 Oct;():. doi: 10.1002/ccd.29222.
Osman Mohammed, Syed Moinuddin, Abdul Ghaffar Yasir, Patel Brijesh, Abugroun Ashraf, Kheiri Babikir, Kawsara Akram, Kadiyala Madhavi, Balla Sudarshan, Daggubati Ramesh,
Abstract
BACKGROUND:
There is paucity of data focusing on females' outcomes after the use of impeller pumps percutaneous ventricular assist devices (IPVADs).
METHODS:
Patients who received IPVADs during the period of October 1st, 2015-December 31, 2017, were identified from the United States National Readmission Database. A 1:1 propensity score matching was used to compare the outcomes between females and males.
RESULTS:
A total of 19,278 (Female = 5,456; Male = 13,822) patients were included in the current analysis. After propensity score matching and among all-comers who were treated with IPVADs, females had higher in-hospital major adverse events (MAEs) (38 vs. 32.6%, p?
CONCLUSIONS:
Among all-comers who received IPVADs, females suffered higher morbidity and mortality compared to males. Higher morbidity driven mainly by higher rates of major bleeding was seen among females who received IPVADs for the hemodynamic support during HRPCI and comparable outcomes were observed when the IPVADs were used for CS.
© 2020 Wiley Periodicals LLC.
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Beating heart left ventricle thrombectomy through mini-left-anterior thoracotomy for a patient with cardiogenic shock.
Gen Thorac Cardiovasc Surg2020 Oct;():. doi: 10.1007/s11748-020-01510-3.
Mutsuga Masato, Usui Akihiko,
Abstract
Left ventricular (LV) thrombus is frequently occurred with dilated cardiomyopathy (DCM) when a patient receives extracorporeal membrane oxygenation (ECMO) support for cardiogenic shock. LV decompression techniques are sometimes required immediately after ECMO support. However, LV thrombus is a contra indication for LV assist device (LVAD). We planned a mini-left-anterior thoracotomy instead of using sternotomy, and used beating heart under ECMO support. LV was opened through apex and thrombectomy was performed by finger manipulation and the remained thrombus was removed by balloon guided technique. Our technique is a simple and durable method for removing LV thrombus under ECMO support and might be considered as a supplementary procedure before temporally LVAD.
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Efficacy of extracorporeal membrane oxygenation before surgery of a post-infarction ventricular septal rupture in cardiogenic shock.
Interact Cardiovasc Thorac Surg2020 Oct;():. doi: ivaa159.
Takaki Hidenobu, Hashizume Kenichi, Matsuoka Tadashi, Ikebata Koki,
Abstract
A 73-year-old man with an acute myocardial infarction experienced severe cardiogenic shock due to an inferior ventricular septal rupture with a massive left-to-right shunt. Emergency surgery was considered a too high mortality risk. The patient was implanted with an extracorporeal membrane oxygenation system as a bridge to surgery. On the seventh day after admission, the ventricular septal defect was successfully repaired. Our case study demonstrates that extracorporeal membrane oxygenation could be an option in cases of ventricular septal rupture as a bridge for stabilizing patients.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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