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Pubblicazioni recenti - cardiogenic
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Timely extracorporeal membrane oxygenation assist reduces mortality after bypass surgery in patients with acute myocardial infarction.
J Card Surg2019 Sep;():. doi: 10.1111/jocs.14258.
Hamiko Marwan, Slottosch Ingo, Scherner Max, Gestrich Christopher, Wahlers Thorsten, Putensen Christian, Mellert Fritz, Treede Hendrik, Dewald Oliver, Duerr Georg Daniel,
Abstract
BACKGROUND:
Patients with acute myocardial infarction (AMI) are at high risk when undergoing emergency coronary artery bypass graft (CABG)-surgery. Their outcome remains poor despite increased use of extracorporeal membrane oxygenation (ECMO). We investigated the impact of timing for perioperative ECMO-support in these patients.
METHODS:
In this retrospective double-center study, we evaluated 201 patients with AMI undergoing CABG, dividing them into the following groups: No-ECMO (n?=?101), preoperative ECMO (pre-ECMO, n?=?6), intraoperative ECMO (ECC-ECMO, n?=?67), and postoperative ECMO (post-ECMO, n?=?27). We evaluated the impact of ECMO timing on postoperative mortality, organ function, and length of stay, comparing these to predicted outcome using different risk-scores.
RESULTS:
Post-ECMO patients showed lowest 30-day-survival (40.7%), while earlier ECMO-start was associated with better outcome (50.7% in extracorporeal circulation [ECC]-ECMO and 66.7% in pre-ECMO patients). On admission, only pre-ECMO and ECC-ECMO patients showed higher surgery- and intensive-care-unit (ICU)-related risk-scores. In pre- and ECC-ECMO patients, the first significant increase in lactate-levels (>4?mmol/L) was observed preoperatively, while this occurred 1 hour postoperatively in post-ECMO patients. Bilirubin was increased in all patients, decreasing after 3 and 12 days in pre- and ECC-ECMO patients, respectively, but only after 18 days in post-ECMO patients. Multiple ICU risk-scores did not discriminate survival-probability correctly. Only the ECMO-related survival after veno-arterial-ECMO-score correctly predicted the significantly lower survival in post-ECMO patients.
CONCLUSION:
Our study shows that timely ECMO-support is associated with earlier bilirubin-downtrend and higher survival in patients with AMI after CABG. Lactate-increase greater than 4?mmol/L seems to be a helpful threshold to trigger the timely onset of ECMO-therapy, providing better survival.
© 2019 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals, Inc.
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A diver's guide to subaquatic envenomation in the Mediterranean.
Diving Hyperb Med2019 Sep;49(3):225-228. doi: 10.28920/dhm49.3.225-228.
Todd James, Edsell Mark,
Abstract
INTRODUCTION:
Between 40,000 and 50,000 divers and swimmers are envenomated each year and diving as a hobby is becoming increasingly popular. In the Mediterranean, envenomation is most often by Weever fish, Scorpion fish and jellyfish but coral and sea urchins may also be venomous.
ENVENOMATION:
Most stings cause local inflammation, oedema and pain. The severity of pain varies with the venom and the amount injected. In severe cases, stings may be life-threatening due to cardiogenic or anaphylactic shock or penetration of vital structures.
MANAGEMENT:
Most cases of envenomation are preventable with a combination of measures including the avoidance of contact through good buoyancy control, the wearing of body-suits, and by maintaining visual awareness. Immediate management is to return to the surface, elevate and wash the site of injury. Immersion in hot water followed by simple analgesics for pain relief has been shown to be more effective than other methods. More severe cases should be identified by symptoms including confusion and heavy bleeding and referred to qualified medical care.
CONCLUSION:
Envenomation by subaquatic species is common and preventable yet the dissemination of the appropriate knowledge is limited. This knowledge summary provides pertinent information aimed at divers in preventing and managing such injuries.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
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Structured review of post-cardiotomy extracorporeal membrane oxygenation: part 1-Adult patients.
J Heart Lung Transplant2019 Aug;():. doi: S1053-2498(19)31632-8.
Lorusso Roberto, Raffa Giuseppe Maria, Alenizy Khalid, Sluijpers Niels, Makhoul Maged, Brodie Daniel, McMullan Mike, Wang I-Wen, Meani Paolo, MacLaren Graeme, Kowalewski Mariusz, Dalton Heidi, Barbaro Ryan, Hou Xiaotong, Cavarocchi Nicholas, Chen Yih-Sharng, Thiagarajan Ravi, Alexander Peta, Alsoufi Bahaaldin, Bermudez Christian A, Shah Ashish S, Haft Jonathan, D'Alessandro David A, Boeken Udo, Whitman Glenn J R,
Abstract
Cardiogenic shock, cardiac arrest, acute respiratory failure, or a combination of such events, are all potential complications after cardiac surgery which lead to high mortality. Use of extracorporeal temporary cardio-circulatory and respiratory support for progressive clinical deterioration can facilitate bridging the patient to recovery or to more durable support. Over the last decade, extracorporeal membrane oxygenation (ECMO) has emerged as the preferred temporary artificial support system in such circumstances. Many factors have contributed to widespread ECMO use, including the relative ease of implantation, effectiveness, versatility, low cost relative to alternative devices, and potential for full, not just partial circulatory support. While there have been numerous publications detailing the short and midterm outcomes of ECMO support, specific reports about post-cardiotomy ECMO (PC-ECMO), are limited, single-center experiences. Etiology of cardiorespiratory failure leading to ECMO implantation, associated ECMO complications, and overall patient outcomes may be unique to the PC-ECMO population. Despite the rise in PC-ECMO use over the past decade, short-term survival has not improved. This report, therefore, aims to present a comprehensive overview of the literature with respect to the prevalence of ECMO use, patient characteristics, ECMO management, and in-hospital and early post-discharge patient outcomes for those treated for post-cardiotomy heart, lung, or heart-lung failure.
Copyright © 2019 International Society for Heart and Lung Transplantation. All rights reserved.
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Mechanical Circulatory Support in Transcatheter Aortic Valve Implantation in the United States (from the National Inpatient Sample).
Am J Cardiol2019 Aug;():. doi: S0002-9149(19)30953-1.
Alkhalil Ahmad, Hajjar Richard, Ibrahim Homam, Ruiz Carlos E,
Abstract
Acute circulatory collapse may rarely occur during transcatheter aortic valve implantation (TAVI). In such cases, immediate mechanical circulatory support (MCS) as a bridge to remedial interventions may be required. To define the rate of MCS utilization in TAVI patients and identify the predictors of MCS utilization in a cohort of TAVI patients. TAVI patients between January 2012 and September 2015 were identified in the National Inpatient Sample (NIS) by using the International Classification of Diseases, 9th Revision. Trend weights were used to generate the national estimates of MCS rate in TAVI. Multivariate regression analysis was done to identify predictors of MCS use. A total 60,985 patients underwent TAVI with 1,695 patients receiving MCS (2.8%) during index hospitalization. The most common type of MCS was intra-aortic balloon pump in 52%, followed by extra corporeal membrane oxygenator in 34%, then percutaneous ventricular assist device in 7.4%. Rate of MCS use declined over the study period from 3% in 2012 (Q1) to 1.8% in 2015 (Q3). The use of MCS during TAVI was associated with 10-fold increase in-hospital mortality (27.1% vs 2.8%, p <0.001). Predictors of MCS were congestive heart failure (OR?=?2.58, p <0.001), transapical access (OR?=?1.92, p <0.001), respiratory complication (OR?=?5.19, p <0.001), acute myocardial infarction (OR?=?4.21, p <0.001), cardiac arrest (OR?=?10.65, p <0.001), and cardiogenic shock (OR?=?19.09, p <0.001). In conclusion, the rate of MCS during TAVI hospitalization in the United States declined between 2012 and 2015. MCS during TAVI was associated with a 10-fold increase in in-hospital mortality.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Cardiogenic Shock After Arterial Y-Graft Coronary Bypass Surgery Secondary to Critical Stenoses of the Left Subclavian and Left Main Coronary Arteries.
Can J Cardiol2019 Jun;():. doi: S0828-282X(19)30428-3.
Joshi Francis R, Snoer Martin, Asferg Camilla, Tilsted Hans-Henrik, Bang Lia E, Bech Bo,
Abstract
We present a case of a 62-year-old man who was in cardiogenic shock. He had a history of coronary artery bypass grafting 4 years previously, with left internal mammary radial artery Y-grafting to a left dominant coronary circulation. Critical stenoses of the left main coronary and left subclavian arteries were seen at angiography. An occluded abdominal aorta precluded the use of mechanical circulatory support. The patient underwent high-risk stenting of the left subclavian artery with a successful outcome. The case highlights the unresolved issue of screening for subclavian stenoses in patients being considered for revascularization with arterial Y-grafting.
Copyright © 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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Sedation versus general anaesthesia in endovascular therapy for anterior circulation acute ischaemic stroke: the multicentre randomised controlled AMETIS trial study protocol.
BMJ Open2019 Sep;9(9):e027561. doi: 10.1136/bmjopen-2018-027561.
Chabanne Russell, Fernandez-Canal Charlotte, Degos Vincent, Lukaszewicz Anne-Claire, Velly Lionel, Mrozek Segolene, Perrigault Pierre-François, Molliex Serge, Tavernier Benoit, Dahyot-Fizelier Claire, Verdonk Franck, Caumon Elodie, Masgrau Aurélie, Begard Marc, Chabert Emmanuel, Ferrier Anna, Jaber Samir, Bazin Jean-Etienne, Pereira Bruno, Futier Emmanuel, ,
Abstract
INTRODUCTION:
Endovascular thrombectomy is the standard of care for anterior circulation acute ischaemic stroke (AIS) secondary to emergent large vessel occlusion in patients who qualify. General anaesthesia (GA) or conscious sedation (CS) is usually required to ensure patient comfort and avoid agitation and movement during thrombectomy. However, the question of whether the use of GA or CS might influence functional outcome remains debated. Indeed, conflicting results exist between observational studies with better outcomes associated with CS and small monocentric randomised controlled trials favouring GA. Therefore, we aim to evaluate the effect of CS versus GA on functional outcome and periprocedural complications in endovascular mechanical thrombectomy for anterior circulation AIS.
METHODS AND ANALYSIS:
Anesthesia Management in Endovascular Therapy for Ischemic Stroke (AMETIS) trial is an investigator initiated, multicentre, prospective, randomised controlled, two-arm trial. AMETIS trial will randomise 270 patients with anterior circulation AIS in a 1:1 ratio, stratified by centre, National Institutes of Health Stroke Scale (?15?or >15) and association of intravenous thrombolysis or not to receive either CS or GA. The primary outcome is a composite of functional independence at 3 months and absence of perioperative complication occurring by day 7 after endovascular therapy for anterior circulation AIS. Functional independence is defined as a modified Rankin Scale score of 0-2 by day 90. Perioperative complications are defined as intervention-associated arterial perforation or dissection, pneumonia or myocardial infarction or cardiogenic acute pulmonary oedema or malignant stroke evolution occurring by day 7.
ETHICS AND DISSEMINATION:
The AMETIS trial was approved by an independent ethics committee. Study began in august 2017. Results will be published in an international peer-reviewed medical journal.
TRIAL REGISTRATION NUMBER:
NCT03229148.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Gender differences in clinical characteristic and in-hospital outcome in patients with takotsubo syndrome.
Pol Arch Intern Med2019 Sep;():. doi: 10.20452/pamw.14970.
Budnik Monika, Nowak Rados?aw, Fija?kowski Marcin, Kochanowski Janusz, Nargie??o Ewa, Pi?tkowski Rados?aw, Peller Micha?, Kucharz Jakub, Jaguszewski Mi?osz, Grucha?a Marcin, Opolski Grzegorz,
Abstract
INTRODUCTION:
Takotsubo syndrome (TTS) is an acute revesible left ventricular dysfunction which occurs mainly in postmenopausal women.
OBJECTIVES:
The goal of this study was to compare course of disease and prognoses in male and female patients with TTS in two large Polish academic hospitals.
PATIENTS AND METHODS:
The analysis included 232 patients (211 women and 21 men) hospitalized at the 1st Department of Cardiology, Warsaw and 1st Department of Cardiology, Gdansk.
RESULTS:
Men who developed TTS were more likely to live alone than women. Physical stress was trigger of TTS more often in men than women. There were no differences in the frequency of risk factors and comorbidities, with the exception of higher prevalence of smoking in men. Concerning the cardiac biomarkers, both at admission and peak NTproBNP levels were significantly more elevated in women. ST depression was found more frequently in men than in women (6.2 vs. 25%). Ejection fraction was lower among male patients at discharge (50 vs. 60%), despite the same length of hospitalization. In-hospital outcome (arrhytmias, mechanical complications, cardiogenic shock, mortality) was similar in both groups. Beta-adrenolytics and statins were more frequently prescribed for women than for men (74.5 vs 52.4% and 68.3 vs 38.1%, respectively). Moreover, there was a tendency toward more frequent use of P2Y12 inhibitors for men (23.8 vs 10.4%).
CONCLUSIONS:
There are some differences in clinical course of male and female patients with TTS. However, in-hospital outcome was similar.
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Prognostic implications of microcirculatory perfusion versus macrocirculatory perfusion in cardiogenic shock: a CULPRIT-SHOCK substudy.
Eur Heart J Acute Cardiovasc Care2019 Sep;():2048872619870035. doi: 10.1177/2048872619870035.
Wijntjens Gilbert Wm, Fengler Karl, Fuernau Georg, Jung Christian, den Uil Corstiaan, Akin Sakir, van de Hoef Tim P, ?erpytis Rokas, Diletti Roberto, Henriques José Ps, ?erpytis Pranas, Thiele Holger, Piek Jan J,
Abstract
BACKGROUND:
After early revascularisation, restoration of macrocirculatory perfusion parameters is the primary objective in the management of cardiogenic shock complicated acute myocardial infarction. Nevertheless, vital organ perfusion may be compromised at the systemic microcirculatory level, even in patients with preserved macrohaemodynamics. Microvascular perfusion was shown to have independent prognostic value for early mortality. The present study aims to compare the prognostic value of microcirculatory versus macrocirculatory perfusion parameters.
METHODS:
This substudy of the culprit lesion-only percutaneous coronary intervention versus multivessel percutaneous coronary intervention in cardiogenic shock (CULPRIT-SHOCK) trial examined the sublingual capillary network using videomicroscopy post-percutaneous coronary intervention to determine the proportion of perfused capillaries (<20 µm) and perfused capillary density. Thirty-day follow-up was performed to obtain the occurrence of a combined clinical endpoint of all-cause death and renal replacement therapy.
RESULTS:
Videomicroscopy measurements were performed in 66 patients. There was a significant adjusted association between microcirculatory perfusion parameters and the combined clinical endpoint (proportion of perfused capillaries: =0.020; perfused capillary density: =0.035), whereas there was no significant adjusted association between macrocirculatory perfusion parameters and the combined clinical endpoint (systolic blood pressure: =0.205). Normotensive patients with compromised microcirculatory perfusion parameters had a higher risk of the combined clinical endpoint than normotensive patients with preserved microcirculatory perfusion parameters (proportion of perfused capillaries: Breslow =0.014; perfused capillary density: Breslow =0.076).
CONCLUSIONS:
There is a significant and independent association between microcirculatory perfusion parameters perfused capillary density and proportion of perfused capillaries and the combined clinical endpoint of all-cause death and renal replacement therapy at 30 days follow-up. In patients with loss of haemodynamic coherence between microcirculatory and macrocirculatory perfusion parameters, microcirculatory perfusion parameters confer dominant prognostic value.
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Contemporary prevalence, trends, and outcomes of coronary chronic total occlusions in acute myocardial infarction with cardiogenic shock.
Int J Cardiol Heart Vasc2019 Sep;24():100414. doi: 10.1016/j.ijcha.2019.100414.
Vallabhajosyula Saraschandra, Prasad Abhiram, Gulati Rajiv, Barsness Gregory W,
Abstract
Background:
There are limited data on the prevalence and outcomes of chronic total occlusions (CTO) of the coronary artery in acute myocardial infarction with cardiogenic shock (AMI-CS) patients.
Methods:
Using the National Inpatient Sample, all admissions with AMI-CS that underwent diagnostic angiography between January 1, 2008, and December 31, 2014, were included. CTO, percutaneous coronary intervention (PCI), comorbidities and concomitant cardiac arrest was identified for all admissions. Outcomes of interest included temporal trends, in-hospital mortality, and resource utilization in cohorts with and without CTO.
Results:
In this 7-year period, 163,628 admissions with AMI-CS admissions met the inclusion criteria, with 68% being ST-elevation AMI-CS. CTO was noted in 27,343 (16.7%) admissions, with an increase in prevalence during the study period. The cohort with CTOs was more likely to be male and bearing private insurance. The CTO cohort had higher cardiovascular comorbidity, higher rates of cardiac arrest and higher use of PCI and mechanical circulatory support. The presence of a CTO was independently associated with higher in-hospital mortality (adjusted odds ratio 1.20 [95% confidence interval 1.16-1.23]; ?
Conclusions:
In this cohort of AMI-CS admissions that underwent diagnostic angiography, the presence of a CTO identified a higher risk cohort that had higher in-hospital mortality.
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Spinal Epidural Hematoma Following Epidural Catheter Removal in a Patient with Postoperative Urgent Coronary Intervention and Intra-Aortic Balloon Pumping (IABP): A Case Report.
Am J Case Rep2019 Sep;20():1356-1359. doi: 10.12659/AJCR.917716.
Mimata Ryosuke, Higashi Midoriko, Yasui Madoka, Hirai Takanao, Yamaura Ken,
Abstract
BACKGROUND It is still challenging to remove an epidural catheter in a postoperative patient receiving urgent antiplatelet and anticoagulation therapy for acute coronary syndrome. CASE REPORT While under general anesthesia combined with thoracic epidural anesthesia, a 72-year-old male patient underwent right radical nephrectomy for renal cell carcinoma. On postoperative day 1 (POD1), the patient experienced bradycardia and a decrease in blood pressure, and he was diagnosed acute myocardial infarction. Intra-aortic balloon pumping (IABP) was induced for cardiogenic shock, and urgent thrombus aspiration and coronary balloon angioplasty were performed. On POD3, the surgeon removed the epidural catheter under both antiplatelet and anticoagulation therapy. At that time, the platelet count was 45×10?/L and the activated partial thromboplastin time (APTT) was 72.2 seconds. Four hours after the epidural catheter was removed, the patient complained of bilateral fatigue in legs and developed a loss of sensation. Six hours after the epidural catheter was removed, he developed motor paralysis and became completely paralyzed in both limbs after 9 hours. At 19 hours after the epidural catheter was removed, emergency magnetic resonance imaging detected a spinal epidural hematoma at the level of Th9-11 with compression of the spinal cord. Emergency laminectomy was performed to decompress and remove the spinal epidural hematoma at 18 hours after the onset of sensorimotor symptoms. After surgery and rehabilitation, these symptoms had only slightly improved. CONCLUSIONS In patients with urgent antithrombotic therapy for urgent percutaneous coronary intervention (PCI) with an IABP for acute coronary syndrome, the epidural catheter should not be removed until the IABP and heparin are discontinued, and platelet counts have recovered.
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Predictors of survival in patients with acute coronary syndrome undergoing percutaneous coronary intervention of unprotected left main coronary artery stenosis.
Catheter Cardiovasc Interv2019 Sep;():. doi: 10.1002/ccd.28495.
Staudacher Dawid L, Schmitt Charlotte, Zirlik Andreas, Zehender Manfred, Stachon Peter, Bothe Wolfgang, Zotzmann Viviane, Bode Christoph, von Zur Muehlen Constantin,
Abstract
OBJECTIVE:
Aim of this study was to investigate predictors of survival in unstable patients with high SYNTAX-1-score.
BACKGROUND:
In significant unprotected left main coronary artery (ULMCA) stenosis, treatment options include percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). While CABG is recommended for stable patients with ULMCA stenosis and a SYNTAX-1-score?>?32, PCI may be preferable in unstable or high operative risk patients.
METHODS:
Retrospective single-center all-comers registry study.
RESULTS:
A total of 142 patients underwent ULMCA-PCI (~72.9?years, 23.2% females, 54.2% survival in 2-year follow-up), 84 of whom had a SYNTAX-1?>?32 (37.4 ±?12.8). Patients in the high-SYNTAX-1-group (score?>?32) were more often in an acute condition compared to low-SYNTAX-2-group (score???32) including acute myocardial infarction (76.2% vs. 57.4%, p =?.024), cardiogenic shock (48.2% vs. 14.8%, p =?.001), or need for mechanical support (36.1% vs. 11.1%, p =?.001). Survival was predicted by the acute condition including cardiogenic shock (OR 0.06 and 0.05) and myocardial infarction (OR 0.03 and 0.34) in both groups. Performance of the SYNTAX-1-score was limited in our patient collective in both groups (c-index 0.65 vs. 0.63) while SYNTAX-2-PCI-score performed better (c-index 0.67 vs. 0.67). EuroScore II had the best discriminative ability (c-index 0.87 vs. 0.78).
CONCLUSIONS:
The majority of patients undergoing ULMCA-PCI presented in acute conditions with high SYNTAX-1-score, and is therefore underrepresented in clinical trials. Prognosis was best predicted by the acute condition and the EuroScore II. These data suggest that therapy in unstable patients should be guided by clinical condition over the anatomical SYNTAX-1-score.
© 2019 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals, Inc.
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MR-imaging pattern is not a predictor of occult atrial fibrillation in patients with cryptogenic stroke.
J Neurol2019 Sep;():. doi: 10.1007/s00415-019-09524-5.
Vollmuth C, Stoesser S, Neugebauer H, Hansel A, Dreyhaupt J, Ludolph A C, Kassubek J, Althaus K,
Abstract
BACKGROUND:
To date, insertable cardiac monitors (ICMs) are the most effective method for the detection of occult atrial fibrillation (AF) in cryptogenic stroke. The overall detection rate after 12 months, however, is low and ranges between 12.4 and 33.3%, even if clinical predictors are considered. Ischemic stroke patients due to cardiogenic embolism present with particular lesion patterns. In patients with cryptogenic stroke, MR-imaging pattern may be a valuable predictor for AF.
METHODS:
This is an MRI-based, retrospective, observational, comparative, single-center study of 104 patients who underwent ICM implantation after cryptogenic stroke. The findings were compared to a reference group with related stroke etiology, i.e., 166 patients with embolic stroke due to AF detected for the first time by long-term ECG. Lesion patterns were evaluated with regard to affected territories, distribution (cortical, lacunar, scattered), lesion volume, and lesion size (diameter of the lesion size?>?20 mm).
RESULTS:
The MR-imaging analysis of acute ischemic lesions yielded no association between AF and lesion size or volume, arterial vessel distribution, or the number of affected territories. There was no significant difference between the cohorts regarding ischemic patterns (cortical lesions, scattered lesions, and lacunar infarcts). An important clinical inference of our findings is that 10% (2 of 20) of cases in the ICM group in whom AF was detected had a lacunar infarct pattern. Similar results were shown in cases of ischemic stroke patients with AF detected for the first time by long-term ECG, with 10.9% (16 of 147) of them showing lacunar infarcts. The analysis of chronic MRI lesions revealed no differences between the groups in the rate of chronic lesions, arterial vessel distribution, or the number of affected territories. Left atrial size (LA size) and the presence of atrial runs in long-term ECG were independently associated with AF.
CONCLUSIONS:
In this MRI-based analysis of patients with cryptogenic stroke who had received ICM implantation, the detection rate of AF in patients with ICM was not related to the imaging pattern. In addition, the lacunar infarct pattern should not be an exclusion criterion for ICM insertion in patients with cryptogenic stroke. ICM insertion in patients with cryptogenic stroke should not be evaluated solely on the basis of reference to infarct patterns.
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Thyroid Storm-induced Severe Dilated Cardiomyopathy and Ventricular Tachycardia.
Cureus2019 Jul;11(7):e5079. doi: 10.7759/cureus.5079.
Sourial Kirolus, Borgan Saif M, Mosquera Jorge E, Abdelghani Loui, Javaid Aamir,
Abstract
Thyroid storm is an extreme form of hyperthyroidism associated with a high mortality rate. Heart failure is considered the leading cause of mortality in patients with thyroid storm, though the underlying cardiac pathology is unclear. Approximately 6% of patients with thyroid storm have heart failure symptoms as the initial presenting complaint. Roughly, one-third of these patients develop dilated cardiomyopathy (DCM). In this report, we present a case of cardiogenic pulmonary edema and sustained ventricular tachycardia in a patient with hyperthyroidism presenting with thyroid storm.
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Frequency and factors related to not receiving acute reperfusion therapy in patients with ST elevation myocardial infarction; a single specialty cardiac center.
J Pak Med Assoc2019 Sep;69(9):1313-1319.
Aijaz Saba, Ghazni Muhammad Salman, Malik Rehan, Pathan Asad,
Abstract
OBJECTIVE:
To determine the frequency of no reperfusion therapy, its reasons, hospital management and intermediate-term outcome s of ST- elevation my ocardial in farction patients .
METHODS:
The retrospective ambi-directional observational study was conducted at Tabba Heart Institute, Karachi, and comprised record of ST-elevation myocardial infarction patients without immediate reperfusion therapy with symptom onset time of ?12 hours who presented between January 2013 and December 2017. Prospective follow-up of all patients was performed till June 2018. Coronary angiography, non-invasive stress tests, medications and late revascularisation were explored. Predictors of hospital mortality and major adverse cardiovascular events at follow-up were analysed. Data was analysed using SPSS 19.
RESULTS:
Of the 1977 records evaluated, 218(11%) patients of mean age 60.3±12.4 years did not receive immediate reperfusion therapy. Coronary angiography was done in 163(74.7%) patients of whom 45(27.6%) were taken for immediate procedure. Besides, 26 (11.9%) patients died during hospital stay. Predictors of hospital mortality were no revascularisation (odds ratio: 24.1, 95% confidence interval: 1.3-500), cardiogenic shock (odds ratio: 65, 95% confidence interval: 5.7-745) and tachycardia (odds ratio: 17, 95% confidence interval: 1.2-254.5) at presentation. Predictor of major adverse cardiovascular events was guideline-directed medical therapy (hazard ratio 2.6, 95% confidence interval: 1.16-6.2) at discharge, while revascularisation was not a significant predictor (p>0.05).
Conclusion:
A huge number of salvageable ST-elevation myocardial infarction patients failed to receive reperfusion therapy. There is a huge potential of improvement in ST-elevation myocardial infarction care in terms of increasing community awareness, prompt reperfusion therapy and usage of optimal medical therapy.
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Timing of initiation of intra-aortic balloon pump in patients with acute myocardial infarction complicated by cardiogenic shock: A meta-analysis.
Clin Cardiol2019 Sep;():. doi: 10.1002/clc.23264.
Cui Kongyong, Lyu Shuzheng, Liu Hong, Song Xiantao, Yuan Fei, Xu Feng, Zhang Min, Zhang Mingduo, Wang Wei, Zhang Dongfeng, Tian Jinfan, Yan Yunfeng, Zhou Kuo, Chen Lingxiao,
Abstract
BACKGROUND:
For patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) undergoing primary percutaneous coronary intervention (PCI), the optimal timing of the initiation of intra-aortic balloon pump (IABP) therapy remains unclear. Therefore, we performed the first meta-analysis to compare the outcomes of IABP insertion before vs after primary PCI in this population.
METHODS:
Electronic databases of PubMed, EMBASE, and Cochrane Library were comprehensively searched from inception to April 1, 2019, to identify the eligible studies. The main outcomes were short-term (in-hospital or 30?days) and long-term (??6 months) mortality. In addition, pooled analysis of risk-adjusted data were also performed to control for confounding factors.
RESULTS:
Seven observational studies and two sub-analysis of randomized controlled trials involving 1348 patients were included. Compared to patients inserted IABP after PCI, patients who received IABP therapy before primary PCI had similar risks of short-term (odds ratio [OR] 0.88, 95% CI 0.49 to 1.59) and long-term (OR 0.99, 95% CI 0.58 to 1.68) all-cause mortality. Moreover, a pooled analysis of risk-adjusted data also found similar effects of the two therapies on short-term (OR 0.65, 95% CI 0.34 to 1.25) and long-term (OR 0.68, 95% CI 0.17 to 2.72) mortality. Besides, no significant difference was found between the two groups with respect to reinfarction, repeat revascularization, stroke, renal failure, and major bleeding.
CONCLUSIONS:
The timing of the initiation of IABP therapy does not appear to impact short-term and long-term survival in patients with AMI complicated by CS undergoing primary PCI.
© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.
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Percutaneous venoarterial extracorporeal membrane oxygenation as a bridge to double valve implantation in acute biventricular heart failure with profound cardiogenic shock.
J Card Surg2019 Sep;():. doi: 10.1111/jocs.14255.
Maybauer Marc O, El Banayosy Aly, Hooker Robert L, Vanhooser David W, Harper Michael D, Mihu Mircea R, Swant Laura V, Horstmanshof Douglas A, Koerner Michael M,
Abstract
A 71-year-old woman was admitted with acute hypoxic and hypercapnic respiratory failure and cardiogenic shock, secondary to acute on chronic biventricular systolic and diastolic congestive heart failure and severe aortic and mitral valve stenosis. She further presented with pulmonary hypertension and moderate-to-severe tricuspid regurgitation requiring high and increasing doses of vasopressors. The patient was percutaneously cannulated for venoarterial extracorporeal membrane oxygenation (VA-ECMO) and stabilized on ECMO, with a urine output of 17.3?L within the following 8 days. Balloon valvuloplasty and/or transcatheter aortic valve replacement were discussed but ruled out by the multidisciplinary team considering the mitral valve could not be fully addressed. Though lung function was not fully optimized, a window of opportunity was identified and used for double valve replacement on day 8 of VA-ECMO support. After a 24-hour vasoplegic period, the patient was extubated to continuous positive airway pressure and further transitioned to nasal cannula, following which she recovered well.
© 2019 Wiley Periodicals, Inc.
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The role of extracorporeal membrane oxygenation in an acute basal ventricular septal rupture.
Eur J Cardiothorac Surg2019 Aug;():. doi: ezz235.
Matos Daniel, Madeira Marcio, Nolasco Tiago, Neves José Pedro,
Abstract
A 74-year-old man was admitted with a post-acute myocardial infarction basal ventricular septal rupture. Onset of cardiogenic shock led to the implantation of a percutaneous veno-arterial extracorporeal membrane oxygenation (ECMO) system with an additional venous drainage cannula into the right ventricle. The ventricular septal defect was repaired with concomitant tricuspid valvuloplasty and mitral bioprosthesis implantation after 14?days. ECMO support was temporarily converted into a veno-venous system to wean the patient off cardiopulmonary bypass. The patient was discharged 3?weeks after surgery. This case illustrates the role of this extracorporeal life support system in the setting of postinfarction ventricular septal rupture.
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Prophylactic LVAD Enabling High-Risk Mitral Repair-Extending Beyond the Guidelines.
Innovations (Phila)2019 Sep;():1556984519874801. doi: 10.1177/1556984519874801.
Hage Fadi, Hage Ali, Smith Stuart, Dave Nagpal A, Chu Michael W A,
Abstract
Both surgical and percutaneous mitral repair remain contraindicated in patients with severe degenerative mitral regurgitation (DMR) with severe left ventricular (LV) dysfunction because of inadequate LV reserve and increased LV work with a competent mitral valve. We report a 55-year-old gentleman who presented in cardiogenic shock with missed severe DMR and severe LV dysfunction, in whom we performed a high-risk mitral repair and insertion of a prophylactic CentriMag LV assist device. This innovative approach was found to be successful with significant patient improvement in both LV function and clinical symptoms with a competent mitral valve.
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Response by Schrage et al to Letter Regarding Article, "Impella Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Matched-Pair IABP-SHOCK II Trial 30-Day Mortality Analysis".
Circulation2019 Sep;140(11):e559-e560. doi: 10.1161/CIRCULATIONAHA.119.041637.
Schrage Benedikt, Schneider Steffen, Zeymer Uwe, Thiele Holger, Westermann Dirk,
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Letter by O'Neill and Ohman Regarding Article, "Impella Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock: Matched-Pair IABP-SHOCK II Trial 30-Day Mortality Analysis".
Circulation2019 Sep;140(11):e557-e558. doi: 10.1161/CIRCULATIONAHA.119.040831.
O'Neill William W, Ohman E Magnus,
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