DONA ORA
Pubblicazioni recenti - cardiogenic
-
Acute myocardial infarction in the young with diabetes mellitus- national inpatient sample study with sex-based difference in outcomes.
Int J Cardiol2020 Aug;():. doi: S0167-5273(20)33529-4.
Chakraborty Sandipan, Amgai Birendra, Bandyopadhyay Dhrubajyoti, Patel Neelkumar, Hajra Adrija, Narasimhan Bharat, Rai Devesh, Aggarwal Gaurav, Ghosh Raktim K, Yandrapalli Srikanth, Aronow Wilbert S, Fonarow Gregg C, Naidu Srihari S,
Abstract
BACKGROUND:
Mortality after AMI is on the decreasing trend; however, this favorable trend is not observed in the young, especially women. Therefore, we conducted a retrospective analysis using the Nationwide Inpatient Sample (NIS) to identify sex-based outcomes following AMI in young with diabetes.
METHODS:
NIS 2010-2014 was used to identify all patients with AMI using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Men (N?=?30,950) and women (N?=?17,928) patients diagnosed with diabetes were identified and stratified as young if age?>?18 and?
RESULTS:
Young women with AMI and concomitant diabetes having a higher burden of overall traditional and non-traditional comorbidities. NSTEMI was the major presentation in women as compared to men. Young women with AMI and concomitant diabetes were less likely to receive revascularization with PCI [51.1% vs. 58.2%; OR 0.86, CI 0.78-0.94] or CABG [7.9% vs. 10.1%; OR 0.64, CI 0.54-0.75]. Adjusted all-cause in-hospital mortality did not differ significantly between the two groups [OR 1.06, CI 0.74-1.52]. Women had lower odds of developing cardiogenic shock, ventricular arrhythmias, and AKI, and were more likely to develop major bleeding requiring transfusion, and mitral regurgitation.
CONCLUSION:
There were significant differences between young men and women with diabetes in terms of baseline characteristics and clinical presentation, use of revascularization, and cardiac complications, yet overall, in-hospital mortality does not appear to differ. More studies are needed to identify the interaction of sex and diabetes in young AMI population, and areas for practice improvement.
Copyright © 2020. Published by Elsevier B.V.
Guarda su PubMed
-
Intraaortic Balloon Pump: Looking at the other side.
Artif Organs2020 Aug;():. doi: 10.1111/aor.13797.
Gelsomino Sandro, de Jong Monique Mj,
Abstract
Intraaortic balloon pump (IABP) has been the most commonly employed cardiac assist device in the past, although, in recent years, its use in cardiogenic shock has been questioned. The pathophysiology of the proximal part of the balloon has been well studied, whereas, hemodynamics and flow below the distal portion of the balloon have not been fully understood yet. The distal flow contains a three-wave flow pattern during diastolic balloon expansion: a flow reduction in early diastole, a backflow in mid-diastole followed by a tele-diastolic flow. More research on this topic is warranted to understand better the physics of the distal part of the balloon and its interaction with the three components of the local regulatory system: intrinsic (local metabolic and myogenic), extrinsic (autonomic nervous system) and humoral (local or circulating vasoactive substances). These new insights will be a guide for new balloon designs that will allow enhancing better performance and improved outcomes.
This article is protected by copyright. All rights reserved.
Guarda su PubMed
-
ST-segment elevation myocardial infarction: Historical perspective and new horizons.
Neth Heart J2020 Aug;28(Suppl 1):93-98. doi: 10.1007/s12471-020-01443-9.
Zijlstra F, Suryapranata H, de Boer M-J,
Abstract
After a brief history of the emergence of modern therapy for acute ST-elevation myocardial infarction, we discuss the issues that dominate ongoing studies and are the focus of intense debates. The role of angiography, pharmacotherapy, thrombus aspiration, management of multi-vessel disease, mechanical complications and cardiogenic shock and the quest for myocardial salvage are discussed.
Guarda su PubMed
-
Still a Long Way to Go in Treating Cardiogenic Shock in Acute Myocardial Infarction.
Circ J2020 Aug;():. doi: 10.1253/circj.CJ-20-0765.
Kang Jeehoon, Ahn Hyojeong, Lee Hak Seung, Cho Hyun-Jai,
Guarda su PubMed
-
Transition to Advanced Therapies Among Elderly Patients Supported by Extracorporeal Membrane Oxygenation Therapy: Chouairi et al, ECMO in the Elderly.
J Card Fail2020 Aug;():. doi: S1071-9164(20)30902-7.
Chouairi Fouad, Vallabhajosyula Saraschandra, Mullan Clancy, Mori Makoto, Geirsson Arnar, Desai Nihar R, Ahmad Tariq, Miller P Elliott,
Abstract
BACKGROUND:
While the utilization of extracorporeal membrane oxygenation (ECMO) continues to increase, very little is known about how age influences the transition to definitive advanced therapies.
METHODS:
Using the National Inpatient Sample database from 2008 to 2017, we analyzed patients supported by ECMO for cardiogenic shock and separated patients into 2 age cohorts (<65 years and ?65 years). Primary outcomes of interest included the proportion of patients undergoing orthotopic cardiac transplantation (OHT) and left ventricular assist device (LVAD) implantation.
RESULTS:
Over the study period, we identified 16,132 hospitalizations with CS requiring ECMO support. Significantly fewer patients in the older group underwent OHT compared to the younger group (0.4% vs. 1.2%, P<0.001). Compared to the younger group, a lower proportion of those ?65 years received an LVAD (3.7% vs. 5.8%, P<0.001). LVAD implantation increased over the study period in both age cohorts while OHT increased only in the <65 group (P<0.05, all). After multivariable adjustment, patients in the oldest age group were still less likely to receive an LVAD (Odds ratio [OR] 0.54; Confidence interval [CI]: 0.43-0.69, P<0.001), and continued to have the highest odds of in-hospital mortality (OR 1.53; CI:1.39-1.69, P<0.001).
CONCLUSIONS:
Survival of patients ?65 years requiring ECMO for cardiogenic shock is poor and less often includes transition to definitive advanced therapies. While we must stress that no patient should be denied ECMO based solely on age, we believe our results may be helpful for providers when counseling patients and their families.
Copyright © 2020. Published by Elsevier Inc.
Guarda su PubMed
-
In-Hospital Outcomes and Trends of Tricuspid Valve Surgery in Heart Transplant Patients.
Biomed Hub;5(1):247-256. doi: 10.1159/000507179.
Mohammed Moghniuddin, Rali Aniket S, Buechler Tyler, Vuddanda Venkat, Arshi Juwairiya, Hosseini Dehkordi Seyed Hamed, Chandler Jonathan, Weidling Robert, Abicht Travis, Haglund Nicholas, Sauer Andrew, Shah Zubair,
Abstract
Introduction:
Tricuspid valve (TV) regurgitation is the most common valvular pathology after orthotopic heart transplant (OHT). The number of transplants being performed is increasing with patients living longer after heart transplant. Data on TV surgery in OHT recipients is limited.
Methods:
We sought to analyze the outcomes of patients undergoing TV surgery from a large diverse, multicentric, nationwide cohort using the Nationwide Inpatient Sample (NIS) database.
Results:
A total of 42,766 TV repair or replacement (bioprosthetic and mechanical) involving adult patients (age ?18 years) between 2007 and September 2015 were identified. Of these, 366 were performed in patients with OHT. TV repair was the most common surgery performed in both groups (OHT group and native heart group). Compared to the native group, patients with OHT had a significantly higher incidence of cardiogenic shock (20 vs. 11%, = 0.024), acute kidney injury (AKI) (59 vs. 30%, < 0.001), and AKI requiring hemodialysis (13 vs. 4%, < 0.001). Also, the mean length of stay for the index admission was significantly longer in the OHT group (27 vs. 17 days, = 0.008). The mortality rate was similar between the two groups (7 vs. 8%, = 0.753). The number of TV surgeries performed in OHT patients from 2007 to 2014 have remained stable ( = 0.803) compared to those in native heart patients which showed a significantly increasing trend ( = 0.019) during the same time period.
Conclusions:
TV surgery remains an important treatment modality among the OHT population and carries a similar mortality during index hospitalization as that in native heart patients undergoing TV surgery.
Copyright © 2020 by S. Karger AG, Basel.
Guarda su PubMed
-
Conservative Treatment for Right Ventricular Free Wall Rupture in a Patient with Acute Myocardial Infarction.
Case Rep Cardiol2020 ;2020():8836627. doi: 10.1155/2020/8836627.
Firdaus Mohd Al-Baqlish Mohd, Rahim Nur Syahirah Abdul, Rusdi Nurtasneem, Idris Nor Saadah, Mohd Said Mohd Ridzuan, Abidin Imran Zainal,
Abstract
Ventricular wall rupture possesses a high mortality rate in patients with acute myocardial infarction. We presented a case of a ninety-year-old gentleman who presented with acute inferolateral myocardial infarction in cardiogenic shock and right ventricular free wall rupture. He was treated conservatively and survived.
Copyright © 2020 Mohd Al-Baqlish Mohd Firdaus et al.
Guarda su PubMed
-
Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction.
World J Cardiol2020 Jun;12(6):231-247. doi: 10.4330/wjc.v12.i6.231.
Y-Hassan Shams,
Abstract
Myocardial infarction (MI) is defined as myocardial cell death due to prolonged myocardial ischemia. Clinically, troponin rise and/or fall have become the "defining feature of MI" according to the universal definition of MI (UD-MI). Takotsubo syndrome (TS) and TS-related disease conditions also cause troponin elevation with typical rise and/or fall pattern but through a mechanism other than coronary ischemia. By strict application of the clinical diagnostic criteria for type-1 MI, type-2 MI, type-3 MI, and MI with non-obstructive coronary arteries according to the UD-MI including the fourth one published recently, TS and most of the 26 other causes of troponin elevation mentioned in the fourth UD-MI may erroneously be classified as MI. The existing evidence argues for the case that TS by itself is not a MI. Hyper-activation of the autonomic-sympathetic nervous system including local cardiac sympathetic hyper-activation and disruption with nor-epinephrine churn and spillover is the most probable cause of TS. This autonomic neuro-cardiogenic (ANCA) mechanism results in myocardial "cramp" (stunning), the severity and duration of which depend on the degree of the sympathetic-hyperactivation and nor-epinephrine spillover. The myocardial cramp may squeeze the cytosolic free troponin pools causing mild to moderate troponin elevation in TS and TS-related disease conditions. This ANCA syndrome, which has hitherto been enveloped by the UD-MI over more than one decade, may occur in acute, recurrent, and chronic forms. In this critical review, the controversies of UD-MI, evidence for ANCA syndrome, and a hypothetical mechanism for the troponin elevation in ANCA syndrome are provided.
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Guarda su PubMed
-
Takotsubo syndrome triggered by coronary artery embolism in a patient with chronic atrial fibrillation.
J Cardiol Cases2020 Aug;22(2):45-47. doi: 10.1016/j.jccase.2020.01.005.
Sakatani Akiya, Kume Kiyoshi, Nishio Mayu, Hirooka Keiji, Hayashi Toru,
Abstract
Although takotsubo syndrome is defined as a reversible heart failure syndrome with the absence of obstructive coronary artery disease, some cases of concomitant takotsubo syndrome and acute myocardial infarction have been reported. We herein describe the case of a patient with chronic nonvalvular atrial fibrillation who was not receiving anticoagulant therapy, who developed takotsubo syndrome triggered by acute myocardial infarction probably due to coronary artery thromboembolism. < Takotsubo syndrome triggered by acute myocardial infarction rarely occurs. Patients with a broad infarct-area require careful management because of the development of adverse events such as cardiogenic shock.>.
© 2020 Japanese College of Cardiology. Published by Elsevier Ltd.
Guarda su PubMed
-
Primary Angioplasty in a Catastrophic Presentation: Acute Left Main Coronary Total Occlusion-The ATOLMA Registry.
J Interv Cardiol2020 ;2020():5246504. doi: 10.1155/2020/5246504.
Gutiérrez-Barrios A, Gheorghe L, Camacho-Freire S, Valencia-Serrano F, Cañadas-Pruaño D, Calle-Pérez G, Alarcón de la Lastra I, Silva E, García-Molinero D, Agarrado-Luna A, Zayas-Ruedas R, Vázquez-García R, Serra A,
Abstract
Objectives:
To determine the outcome predictors of in-hospital mortality in acute total occlusion of the left main coronary artery (ATOLMA) patients referred to emergent angioplasty and to describe the clinical presentation and the long-term outcome of these patients.
Background:
ATOLMA is an uncommon angiographic finding that usually leads to a catastrophic presentation. Limited and inconsistent data have been previously reported regarding true ATOLMA, yet comprehensive knowledge remains scarce.
Methods:
This is a multicenter retrospective cohort that includes patients presenting with myocardial infarction due to a confirmed ATOLMA who underwent emergency percutaneous coronary intervention (PCI).
Results:
In the period of the study, 7930 emergent PCI were performed in the five participating centers, and 46 of them had a true ATOLMA (0.58%). At admission, cardiogenic shock was present in 89% of patients, and cardiopulmonary resuscitation was required in 67.4%. All the patients had right dominance. Angiographic success was achieved in 80.4% of the procedures, 13 patients (28.2%) died during the catheterization, and the in-hospital mortality rate was 58.6% (27/46). At one-year and at the final follow-up, 18 patients (39%) were alive, including four cases successfully transplanted. Multivariate analysis showed that postprocedural TIMI flow was the only independent predictor of in-hospital mortality (OR 0.23, (95% CI 0.1-0.36), < 0.001).
Conclusions:
Our study confirms that the clinical presentation of ATOLMA is catastrophic, presenting a high in-hospital mortality rate; nevertheless, primary angioplasty in this setting is feasible. Postprocedural TIMI flow resulted as the only independent predictor of in-hospital mortality. In-hospital survivors presented an encouraging outcome. ATOLMA and left dominance could be incompatible with life.
Copyright © 2020 A. Gutiérrez-Barrios et al.
Guarda su PubMed
-
Using Multiple-Steps Bioinformatic Analysis to Predict the Potential MicroRNA Targets by Cardiogenic HoxA11.
J Chin Med Assoc2020 Jul;():. doi: 10.1097/JCMA.0000000000000397.
Wang Chien-Ying, Liu Szu-Yuan, Kuo Fu-Hsuan, Lin Heng-Fu, Liu Chao-Yu, Yang Yi-Ping, Tsai Fu-Ting, Huang Wei-Chun, Tarng Yih-Wen, Lin Hsin-Chi, Lu Kai-Hsi, Yu Wen-Chung, Yang Meng-Yin,
Abstract
BACKGROUND:
In this study, our major aim is to Using multiple-steps bioinformatic analysis to predict cardiogenic genes with targeting mRNA profiling for predicting cardiogenic HoxA11 gene.
METHODS:
We firstly analyzed the microarray data with bioinformatic measurement, including combining with Panel module 1 (mouse embryonic stem cells; mESC), Panel module 2(mouse induced pluripotent stem cells; miPSC), and Panel module 3 (Gene list form literature of heart development). A literature-based comparison of the two microarrays and a software-based (Targetscan program, www.targetscan.org) comparative analysis of the two datasets. Furthermore, we select the common central pathways and potential candidate genes involved in the cardiomyocyte-lineaged differentiation and development.
RESULTS:
Schematic presentation of a putative miR181a target site in Hox-A11 3'UTR. The bioinformatic result showed that potential interacted cardiogenic targets of Tbx5, Tbx20, Mal2c, Nkx2.5, cTNT, Cx43, MHC, and MCK in different treatment groups of pluripotent stem cells by using a literature-based comparison of the two microarrays and a software-based gene-lineage system.
CONCLUSION:
Our findings support that mir181a is an up-stream regulating MicroRNA to target the 3'UTR of HoxA11 mRNA during the process of cardiomyocyte differentiation.
Guarda su PubMed
-
Blood lactate predicts survival after percutaneous implantation of extracorporeal life support for refractory cardiac arrest or cardiogenic shock complicating acute coronary syndrome: insights from the CareGem registry.
Intern Emerg Med2020 Aug;():. doi: 10.1007/s11739-020-02459-0.
Porto Italo, Mattesini Alessio, D'Amario Domenico, Sorini Dini Carlotta, Della Bona Roberta, Scicchitano Marco, Vergallo Rocco, Martellini Antonio, Caporusso Simona, Trani Carlo, Burzotta Francesco, Bruno Piergiorgio, Di Mario Carlo, Crea Filippo, Valente Serafina, Massetti Massimo,
Abstract
Refractory cardiogenic shock (RCS) or refractory cardiac arrest (RCA) complicating acute coronary syndrome (ACS) is associated with extremely high mortality rate. Veno-arterial extracorporeal life support (VA-ECLS) represents a valuable therapeutic option to stabilize patients' condition before or at the time of emergency revascularization. We analyzed 29 consecutive patients with RCS or RCA complicating ACS, and implanted with VA-ECLS in two centers who have adopted a similar, structured approach to ECLS implantation. Data were collected from January 2010 to December 2015 and ECLS had to be percutaneously implanted either before (within 48 h) or at the time of attempted percutaneous coronary revascularization (PCI). We investigated in-hospital outcome and factors associated with survival. Twenty-one (72%) were implanted for RCA, whereas 8 (28%) were implanted on ECLS for RCS. All RCA were witnessed and no-flow time was shorter than 5 min in all cases but one. All patients underwent attempted emergency PCI, using radial access in ten cases (34.5%), whereas in three patients a subsequent CABG was performed. Overall, ten patients (34.5%) survived, nine of them with a good neurological outcome. Life threatening complications, including stroke (4 pts), leg ischemia (4 pts), intestinal ischemia (5 pts), and deep vein thrombosis 2 pts), occurred frequently, but were not associated with in-hospital death. Main cause of death was multi-organ failure. PCI variables did not predict survival. Survivors were younger, with shorter low-flow time, and with ECLS mainly implanted for RCS. At multivariate analysis, levels of lactate at ECLS implantation (OR 4.32, 95%CI 1.01-18.51, p?=?0.049) emerged as the only variable that independently predicted survival. In patients with RCA or RCS complicating ACS who are percutaneously implanted with ECLS before or at the time of coronary revascularization, in hospital survival rate is higher than 30%. Level of lactate at ECLS implantation appears to be the most important factor to predict survival.
Guarda su PubMed
-
Transcatheter mitral valve repair in patients with chronic liver disease: Insights from the national inpatient sample.
Catheter Cardiovasc Interv2020 Aug;():. doi: 10.1002/ccd.29173.
Khan Muhammad U, Khan Muhammad Z, Khan Safi U, Kaluski Edo,
Abstract
OBJECTIVE:
To evaluate contemporary national trends of morbidity, mortality, and healthcare utilization in patients with mitral regurgitation (MR) and co-existing chronic liver disease (CLD) undergoing transcatheter mitral valve repair (TMVR).
METHODS:
The National Inpatient Sample (NIS) was used to assess trends in patients undergoing TMVR between January 2012 and December 2017. Propensity match analysis was done to compare it to subjects without underlying CLD. Logistic regression analysis was used to identify predictors of in-hospital mortality.
RESULTS:
Of 15,270 patients undergoing TMVR, 569 (3.7%) had coexisting CLD. Patients with CLD had a higher proportion of males (61.3 vs 52.6%; p
CONCLUSION:
Patients with MR undergoing TMVR, with coexisting CLD bear substantially higher comorbidities, complication rates, and inpatient mortality compared with those without CLD. A favorable temporal trend of in-hospital mortality among these subjects is noteworthy.
© 2020 Wiley Periodicals LLC.
Guarda su PubMed
-
Neutrophil/lymphocyte ratio predicts in-hospital complications in Takotsubo syndrome. Results from a prospective multi-center registry.
Clin Cardiol2020 Aug;():. doi: 10.1002/clc.23442.
Santoro Francesco, Guastafierro Francesca, Zimotti Tecla, Mallardi Adriana, Leopizzi Alessandra, Cannone Michele, Di Biase Matteo, Brunetti Natale Daniele,
Abstract
BACKGROUND:
Several hematological indices including subtypes of leukocytes populations have been associated with cardiovascular outcome. Takotsubo syndrome (TTS) is a form of acute heart failure syndrome featured by several in-hospital complications (IHCs).
HYPOTHESIS:
Hematological indices at admission may predict IHCs in TTS patients.
METHODS:
One hundred and sixty consecutive patients with TTS were enrolled in a multicenter prospective registry. Clinical data, admission hemogram, and IHCs were recorded.
RESULTS:
Incidence of IHCs was 37%, including pulmonary edema 9%, cardiogenic shock 9%, need of invasive ventilation 10%, death 8%, stroke 2.5%, and left ventricular thrombi 6%. Patients with IHCs were older, more frequently male, with physical stressor-induced TTS, lower left ventricular ejection fraction at admission. Neutrophil/lymphocyte ratio (NLr) (12?±?12 vs 7?±?8, P = .002) and white blood cells/mean platelet volume ratio (1.2?±?0.5 vs 1.0?±?0.5, P = .03) at admission were significantly higher in patients with IHCs. NLr values were predictor of IHCs (Odds ratios [OR] 1.07, 95% CI 1.03-1.11, P?
CONCLUSIONS:
NLr is an independent predictor of IHCs in patients admitted with TTS. Admission hemogram may represent a potential tool for prediction of IHCs in TTS.
© 2020 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.
Guarda su PubMed
-
Outcomes After First- Versus Second-Generation Drug-Eluting Stent Thrombosis (from the REAL-ST Registry).
Am J Cardiol2020 Jul;():. doi: S0002-9149(20)30680-9.
Horie Kazunori, Kuramitsu Shoichi, Shinozaki Tomohiro, Ohya Masanobu, Otake Hiromasa, Yamanaka Futoshi, Shiomi Hiroki, Natsuaki Masahiro, Nakazawa Gaku, Tada Norio, Ando Kenji, Kadota Kazushige, Saito Shigeru, Kimura Takeshi, ,
Abstract
Limited data exist on the comparison of clinical outcomes after first- and second-generation drug-eluting stent (DES) thrombosis. From the Retrospective Multicenter Registry of Stent Thrombosis (ST) After First- and Second-Generation DES Implantation registry, this study evaluated 655 ST patients (first-generation DES thrombosis [G1-ST], n?=?342; second-generation DES thrombosis [G2-ST], n?=?313). After propensity score matching, the final study population consisted of 159 matched patients. The primary end point was the cumulative 1-year incidence of mortality. The mortality after G2-ST at 1 year was similar to that after G1-ST (23.0% vs 22.9%, p?=?0.76). Also, the G2-ST group showed a significantly lower rate of target lesion revascularization than the G1-ST group (9.7% vs 17.1%, p?=?0.01). Risk factors of 1-year mortality included cardiogenic shock or arrest at the time of ST, multivessel ST, left ventricular ejection fraction ?40%, advanced age, and final thrombolysis in myocardial infarction flow grade ?2. In conclusion, patients with G2-ST showed a similar 1-year mortality to those with G1-ST, highlighting that ST remains a life-threatening complication in the second-generation DES era.
Copyright © 2020 Elsevier Inc. All rights reserved.
Guarda su PubMed
-
Radial or femoral access in primary percutaneous coronary intervention (PCI): Does the choice matters?
Indian Heart J;72(3):166-171. doi: S0019-4832(20)30094-8.
Batra Mahesh Kumar, Rai Lajpat, Khan Naveed Ullah, Mengal Muhammad Naeem, Khowaja Sanam, Hassan Rizvi Syed Nadeem, Saghir Tahir, Qamar Nadeem, Sial Jawaid Akbar, Karim Musa,
Abstract
BACKGROUND:
This study was conducted with the aim of providing a quantitative appraisal of clinical outcomes of trans-radial access for primary percutaneous coronary interventions (PCI) in patients with ST-segment evaluation myocardial infarction (STEMI).
METHODS:
In this study, we compared two propensity-matched cohorts of patients who underwent primary PCI via trans-radial (TRA) and trans-femoral access (TFA) in a 1:1 ratio. The profile of two cohorts was matched for gender, age, and body mass index, diabetes, hypertension, family history, and smoking. The outcomes of primary PCI were compared for the two cohorts which included all-cause in-hospital mortality, heart failure, re-infarction, cardiogenic shock, bleeding, transfusion, cerebrovascular accident, and dialysis.
RESULTS:
This analysis was performed on a total of 2316 patients with 1158 patients each in the TRA and TFA group. We observed significantly lower rates of mortality, 0.8% (9) vs. 3.5% (41); p < 0.001 and bleeding, 0.5% (6) vs.1.6% (19); p = 0.009 with shorter hospital stay, 1.61 ± 1.39 vs. 1.98 ± 1.5 days, in trans-radial vs. trans-femoral. However, both fluoroscopic time and contrast volume were significantly higher in the TRA as compared to TFA group 15.57 ± 8.16 vs. 12.79 ± 7.82 min; p < 0.001 and 143.22 ± 45.33 vs. 133.78 ± 45.97; p < 0.001 respectively.
CONCLUSIONS:
Compared with TFA access, TRA for primary PCI is safe for patients with STEMI, it was found to be associated with a significant reduction in in-hospital mortality and bleeding complications.
Copyright © 2020 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.
Guarda su PubMed
-
Extracorporeal Membrane Oxygenation for Amniotic Fluid Embolism-Induced Cardiac Arrest in the First Trimester of Pregnancy: A Case Report.
Crit Care Explor2020 Jul;2(7):e0162. doi: 10.1097/CCE.0000000000000162.
Creel-Bulos Christina, Hassani Brian, Stentz Michael J, Budhrani Gaurav, Daneshmand Mani A, Jabaley Craig S, Groff Robert F,
Abstract
Amniotic fluid embolism is a rare obstetric emergency that can be accompanied by profound hypoxemia, coagulopathy, hemorrhage, and cardiogenic shock. Extracorporeal membrane oxygenation may provide a rescue strategy in amniotic fluid embolism with cardiopulmonary collapse. Approaches to anticoagulation must be balanced against the risk of hemorrhage with concomitant coagulopathy. Although extracorporeal membrane oxygenation has been described for cardiopulmonary collapse in the setting of amniotic fluid embolism, its initiation as a bridge to hemostasis and cardiopulmonary recovery in amniotic fluid embolism-induced hemorrhagic and cardiogenic shock remains a novel resuscitation strategy.
Design Subject and Intervention:
We present a case detailing the initiation of extracorporeal life support with veno-arterio-venous extracorporeal membrane oxygenation in a patient with hemorrhagic shock and cardiopulmonary failure due to amniotic fluid embolism. The patient was ultimately discharged home 19 days after presentation free from neurologic or other significant disability.
Main Results and Conclusion:
Through this case, we describe a tailored approach to extracorporeal life support initiation and advanced extracorporeal membrane oxygenation management as a bridge to recovery in patients with mixed shock. Additionally, we discuss how the culmination of prehospital, outpatient and inpatient provider teamwork, easily portable extracorporeal membrane oxygenation equipment, and multispecialty collaboration can afford promising therapeutic options for patients who were previously deemed ineligible for extracorporeal life support.
Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
Guarda su PubMed
-
Acute myocardial infarction with cardiogenic shock in a young physically active physician concurrently using the anabolic steroid sustanon: A case report.
Biomed Rep2020 Sep;13(3):14. doi: 10.3892/br.2020.1321.
Alrabadi Nasr, Jarrah Mohamad Ismail, Alzoubi Karem Hasan,
Abstract
The association between ischemic heart disease (IHD) and the concurrent use of anabolic androgenic steroids (AASs) is underestimated in clinical settings. The tendency of patients to not disclose AASs use may explain this underestimation. In the present case report, the clinical case of a 26-year-old physically active male, who was a physician, without any classical coronary risk factors, who presented with chest pain that was misdiagnosed by the peripheral care unit as skeletal muscle pain is described. Later, the patient was brought to our central hospital (King Abdullah University Hospital) suffering from a massive acute myocardial infarction with marked ECG changes and cardiogenic shock. Following stabilization of his condition, a detailed history of the patient was taken, during which the patient admitted that he was a chronic user of the anabolic steroid sustanon (250 mg, once/week for 6 months) and amino acid supplements (whey protein isolate, 6 tabs every day for 1 year). Specific cardiac markers were increased and the patient exhibited dynamic ischemic changes in his electrocardiogram. Notably, the coronary angiogram of the patient demonstrated ostial occlusion of the left anterior descending artery, which was associated with mid-right coronary artery embolic obstruction. Other than the anabolic steroids and protein supplementation use, the patient history, examination and lab evaluation were normal. During follow up, the patient continued to suffer heart failure with low ejection fraction. In addition, he developed apical thrombus 2 months after primary admission. The patient developed tachycardia in spite of optimal medical treatment and finally received an implantable cardioverter defibrillator. Physicians should always be aware of the possibility of AASs use in young physically active patients. IHD should always be suspected and investigated with typical chest pain in healthy young patients, even if regular risk factors are not present. Medical professionals should not be excluded as potential AASs users/abusers.
Copyright © 2020, Spandidos Publications.
Guarda su PubMed
-
The science of safety: complications associated with the use of mechanical circulatory support in cardiogenic shock and best practices to maximize safety.
F1000Res2020 ;9():. doi: F1000 Faculty Rev-794.
Kapur Navin K, Whitehead Evan H, Thayer Katherine L, Pahuja Mohit,
Abstract
Acute mechanical circulatory support (MCS) devices are widely used in cardiogenic shock (CS) despite a lack of high-quality clinical evidence to guide their use. Multiple devices exist across a spectrum from modest to complete support, and each is associated with unique risks. In this review, we summarize existing data on complications associated with the three most widely used acute MCS platforms: the intra-aortic balloon pump (IABP), Impella systems, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We review evidence from available randomized trials and highlight challenges comparing complication rates from case series and comparative observational studies where a lack of granular data precludes appropriate matching of patients by CS severity. We further offer a series of best practices to help shock practitioners minimize the risk of MCS-associated complications and ensure the best possible outcomes for patients.
Copyright: © 2020 Kapur NK et al.
Guarda su PubMed
-
Endogenous Retrovirus-Derived lncRNA BANCR Promotes Cardiomyocyte Migration in Humans and Non-human Primates.
Dev Cell2020 Jul;():. doi: S1534-5807(20)30580-3.
Wilson Kitchener D, Ameen Mohamed, Guo Hongchao, Abilez Oscar J, Tian Lei, Mumbach Maxwell R, Diecke Sebastian, Qin Xulei, Liu Yonggang, Yang Huaxiao, Ma Ning, Gaddam Sadhana, Cunningham Nathan J, Gu Mingxia, Neofytou Evgenios, Prado Maricela, Hildebrandt Thomas B, Karakikes Ioannis, Chang Howard Y, Wu Joseph C,
Abstract
Transposable elements (TEs) comprise nearly half of the human genome and are often transcribed or exhibit cis-regulatory properties with unknown function in specific processes such as heart development. In the case of endogenous retroviruses (ERVs), a TE subclass, experimental interrogation is constrained as many are primate-specific or human-specific. Here, we use primate pluripotent stem-cell-derived cardiomyocytes that mimic fetal cardiomyocytes in vitro to discover hundreds of ERV transcripts from the primate-specific MER41 family, some of which are regulated by the cardiogenic transcription factor TBX5. The most significant of these are located within BANCR, a long non-coding RNA (lncRNA) exclusively expressed in primate fetal cardiomyocytes. Functional studies reveal that BANCR promotes cardiomyocyte migration in vitro and ventricular enlargement in vivo. We conclude that recently evolved TE loci such as BANCR may represent potent de novo developmental regulatory elements that can be interrogated with species-matching pluripotent stem cell models.
Copyright © 2020 Elsevier Inc. All rights reserved.
Guarda su PubMed
