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Pubblicazioni recenti - cardiogenic
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New insights into cardiogenic shock and coronary revascularization after acute myocardial infarction.
Arch Cardiovasc Dis2020 Feb;():. doi: S1875-2136(20)30025-5.
Gerbaud Edouard, Elbaz Meyer, Lattuca Benoit,
Abstract
Cardiogenic shock complicating acute myocardial infarction is challenging, and continues to be associated with high rates of in-hospital and long-term mortality. Coronary revascularization is critical for improving prognosis in CS. Thus, a systematic protocol-driven approach to cardiogenic shock, the development of specialized cardiac care centres, technical advances in interventional cardiology enabling treatment of more complex and severe lesions, the availability of recent antithrombotic therapies and the evolution of new haemodynamic support devices are important considerations in current management of cardiogenic shock complicating acute ischaemic heart disease. Despite these potentially meaningful developments, several substantial gaps in knowledge still exist regarding optimal coronary revascularization of patients with cardiogenic shock. This review will describe current principles in the revascularization of these patients, with a focus on: the time to transfer and revascularize; the choice of vascular access site; the need for complete revascularization or only a culprit lesion strategy; the optimal antithrombotic therapy; the type, place and timing of haemodynamic support; and the medical care system network.
Copyright © 2020. Published by Elsevier Masson SAS.
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Development of a predictive scale for cardioembolic stroke using extracted thrombi and angiographic findings.
J Clin Neurosci2020 Feb;():. doi: S0967-5868(19)31383-9.
Kim Bomi, Kim Yeon Mee, Jin Sung-Cheol, Lee Jun-Won, Lee Byung In, Kim Sung Eun, Shin Kyong Jin, Park JinSe, Park Kang Min, Kim Si Eun, Park Seongho, Ha Sam Yeol,
Abstract
We analyzed the histopathological findings of the clots obtained from patients with acute ischemic stroke by mechanical thrombectomy. We then developed a clinical scoring system for predicting pathogenic causes in patients with undetermined ischemic stroke using these histopathological and the angiographic findings during endovascular treatment. Only cases with the occlusion of the intracranial internal carotid artery or the proximal part of the middle cerebral artery were included in this study. Histopathologic findings of clots were compared and analyzed using the Trial of Org 10,172 in Acute Stroke Treatment (TOAST; large artery atherosclerosis, cardioembolic, and undetermined groups) and angiographic occlusion type (AOT; branching-site occlusion and truncal-type occlusion groups) classification systems. Fifty-two patients had enough clots extracted by mechanical thrombectomy for full histopathologic examination. There was no significant within-group difference in the fraction of components in the thrombi for either the TOAST or AOT system; however, the platelet distribution patterns were different. The large artery atherosclerotic group and truncal-type occlusion group had mostly peripheral patterns, whereas the cardioembolic group, undetermined group and branching-site occlusion group had mostly clustering patterns (p = 0.02 in TOAST classification; p = 0.007 in AOT classification). Patients with scores of 3 or 4 on our new scale had a sensitivity of 93.5% and a specificity of 100% for cardioembolic stroke. The BOCS scale, developed using a combination of the TOAST and AOT classification systems, may be helpful as an adjunctive diagnostic tool for identifying cases caused by cardiogenic embolism in patients with undetermined ischemic stroke.
Copyright © 2020 Elsevier Ltd. All rights reserved.
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Angioplasty balloon entrapped fully inflated and detached within the left main coronary artery.
Cardiovasc Revasc Med2020 Feb;():. doi: S1553-8389(20)30076-2.
Omer Abdel Rahman, Bianco Michael, Lodhi Aadil, Sattur Sudhakar, Kaluski Edo,
Abstract
Described is a complication of rescue left main coronary stenting due to threatened left main closure following a "valve in valve" TAVR procedure. Left main stent post dilatation with a NC Trek balloon was complicated by a failure to deflate the balloon. The patient spiraled into cardiogenic shock and was stabilized by an intra-aortic balloon pump. Attempts to withdraw the balloon resulted in shearing of the balloon off the shaft. Parallel wiring and sequential balloon dilatations allowed left main bifurcation stenting while crushing the inflated balloon underneath the stent's struts. Follow up of 13?months was uneventful. The management of entrapped inflated coronary balloon is reviewed.
Copyright © 2020. Published by Elsevier Inc.
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National prevalence, trends and outcomes of takotsubo syndrome in hospitalizations with prior history of mediastinal/intrathoracic cancer and radiation therapy.
Int J Cardiol2020 Feb;():. doi: S0167-5273(20)30251-5.
Desai Rupak, Desai Aakash, Abbas Shabber A, Patel Upenkumar, Bansod Snehal, Damarlapally Nanush, Doshi Rajkumar, Savani Sejal, Gangani Kishorbhai, Sachdeva Rajesh, Kumar Gautam,
Abstract
BACKGROUND:
Radiation therapy (RT) for cancers in thoracic/mediastinal region has been linked with heart damage following years of radiation exposure. However, prevalence of takotsubo syndrome (TTS) in patients with prior intrathoracic/mediastinal malignancies treated with RT has never been analyzed on a large scale.
METHODS:
We identified adult hospitalizations with prior mediastinal/intrathoracic cancer and RT and TTS using ICD-9 CM codes and the National Inpatient Sample (2007-2014) after excluding current admissions for chemotherapy. We then assessed the prevalence, odds, trends and in-hospital outcomes of TTS-related admissions in patients with vs. without prior intrathoracic cancer and RT.
RESULTS:
We identified a total of 5,991,314 hospitalizations with prior intrathoracic/mediastinal malignancies and RT (~73 yrs., 85.2% female), of which 7663 (0.13%, 128 per 100,000) were diagnosed with TTS (~74 yrs., 95.8% females, 88.1% white). Higher odds and rising trends in TTS per 100,000 hospitalizations (from 31 to 241) were seen among patients with prior intrathoracic malignancies and RT as compared to those without (from 19 to 104) (p < 0.001). All-cause in-hospital mortality (4.6% vs 2.8%; OR 1.45; 95%CI 1.29-1.63, p < 0.001), cardiogenic shock (4.3% vs 0.2%), cardiac arrest (3.1% vs 0.9%), arrhythmia (34.3% vs 24.6%), stroke (3.6% vs 2.8%), respiratory failure (14.5% vs 4.6%), and median length of stay and hospital charges were significantly higher in the TTS cohort.
CONCLUSIONS:
This study showed higher odds and increasing trends in TTS-related admissions with worse in-hospital outcomes among patients with prior intrathoracic/mediastinal cancer and RT, irrespective of the time interval from cancer diagnosis or RT to TTS occurrence.
Copyright © 2020 Elsevier B.V. All rights reserved.
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Increasing use of the Impella®-pump in severe cardiogenic shock: a word of caution.
Interact Cardiovasc Thorac Surg2020 Feb;():. doi: ivaa015.
Vasin Sergey, Philipp Alois, Floerchinger Bernhard, Rastogi Priyank, Lunz Dirk, Mueller Thomas, Schmid Christof, Camboni Daniele,
Abstract
Impella® pumps are increasingly utilized in patients in cardiogenic shock. We report on a case series where Impella support was insufficient, and a switch to venoarterial extracorporeal membrane oxygenation (VA ECMO) became necessary. ECMO patients with previous Impella devices were identified utilizing our institutional ECMO database. Since 2014, 10 patients with a mean age of 62?±?3?years were identified. Despite correct placement of all Impella pumps, cardiogenic shock persisted with progressive multi-organ failure (Impella type 2.5/CP n?=?6/4 patients). Femoro-femoral VA ECMO was implanted percutaneously on the contralateral side with the Impella initially left on standby but retracted into the descending aorta for transport reasons after a mean support time of 20?±?8?h. All patients were able to unload their heart by left ventricular ejection with a blood pressure amplitude of 15?±?3?mmHg on VA ECMO support. After VA ECMO implantation haemodynamic parameters improved significantly within 24?h of support (mean serum lactate levels decreased from 92?±?17 to 44?±?10?mg/dl, P?=?0.031). Survival to hospital discharge was 70%. These data indicate that the Impella 2.5® and CP® might not be sufficient in profound cardiogenic shock. Comparative studies are necessary to specify which patient population benefits from which type of circulatory support.
© 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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Left ventricle unloading, coronary artery oxygenation or both?
Cardiovasc Revasc Med -
Acute myocardial infarction-cardiogenic shock in patients with prior coronary artery bypass grafting: A 16-year national cohort analysis of temporal trends, management and outcomes.
Int J Cardiol2020 Feb;():. doi: S0167-5273(19)35970-4.
Vallabhajosyula Saraschandra, Kumar Vinayak, Vallabhajosyula Saarwaani, Subramaniam Anna V, Patlolla Sri Harsha, Verghese Dhiran, Ya'Qoub Lina, Stulak John M, Sandhu Gurpreet S, Prasad Abhiram, Holmes David R, Barsness Gregory W,
Abstract
BACKGROUND:
There are limited data on the outcomes of acute myocardial infarction with cardiogenic shock (AMI-CS) in patients with prior coronary artery bypass grafting (CABG).
METHODS:
A retrospective cohort of AMI-CS admissions during 2000-2016 from the National Inpatient Sample was created and prior CABG status was identified. Outcomes of interest included in-hospital mortality and resource utilization in the two cohorts. Temporal trends of prevalence, in-hospital mortality, and cardiac procedures were evaluated.
RESULTS:
In 513,288 AMI-CS admissions, prior CABG was performed in 22,832 (4.4%). Adjusted temporal trends showed a 2-fold increase in CS in both cohorts. There was a temporal increase in coronary angiography and percutaneous coronary intervention (PCI) across both cohorts. The cohort with prior CABG was on average older, of male sex, of white race, and with higher comorbidity. The cohort with prior CABG received coronary angiography (50% vs. 75%), PCI (32% vs. 49%), right heart catheterization/pulmonary artery catheterization (15% vs. 20%), mechanical circulatory support (26% vs. 46%) less frequently compared to those without (all p < 0.001). The cohort with CABG had higher in-hospital mortality (53% vs. 37%; adjusted odds ratio 1.41 [95% confidence interval 1.36-1.46]), greater use of do not resuscitate status (13% vs. 6%), shorter lengths of hospital stay (7 ± 8 vs. 10 ± 12 days), lower hospitalization costs ($92,346 ± 139,565 vs. 138,508 ± 172,895) and fewer discharges to home (39% vs. 43%) (all p < 0.001).
CONCLUSIONS:
In AMI-CS, admission with prior CABG was older and had lower use of cardiac procedures and higher in-hospital mortality compared to those without prior CABG.
Copyright © 2020 Elsevier B.V. All rights reserved.
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The atherogenic index of plasma plays an important role in predicting the prognosis of type 2 diabetic subjects undergoing percutaneous coronary intervention: results from an observational cohort study in China.
Cardiovasc Diabetol2020 Feb;19(1):23. doi: 10.1186/s12933-020-0989-8.
Qin Zheng, Zhou Kuo, Li Yueping, Cheng Wanjun, Wang Zhijian, Wang Jianlong, Gao Fei, Yang Lixia, Xu Yingkai, Wu Yafeng, He Hua, Zhou Yujie,
Abstract
BACKGROUND:
Many studies have reported the predictive value of the atherogenic index of plasma (AIP) in the progression of atherosclerosis and the prognosis of percutaneous coronary intervention (PCI). However, the utility of the AIP for prediction is unknown after PCI among type 2 diabetes mellitus (T2DM).
METHODS:
2356 patients with T2DM who underwent PCI were enrolled and followed up for 4 years. The primary outcome was major cardiovascular and cerebrovascular adverse events (MACCEs), considered to be a combination of cardiogenic death, myocardial infarction, repeated revascularization, and stroke. Secondary endpoints included all-cause mortality, target vessel revascularization (TVR), and non-target vessel revascularization (non-TVR). Multivariate Cox proportional hazards regression modelling found that the AIP was correlated with prognosis and verified by multiple models. According to the optimal cut-off point of the ROC curve, the population was divided into high/low-AIP groups. A total of 821 pairs were successfully matched using propensity score matching. Then, survival analysis was performed on both groups.
RESULTS:
The overall incidence of MACCEs was 20.50% during a median of 47.50 months of follow-up. The multivariate Cox proportional hazards regression analysis before matching suggested that the AIP was an independent risk factor for the prognosis of T2DM after PCI (hazard ratio [HR] 1.528, 95% CI 1.100-2.123, P?=?0.011). According to the survival analysis of the matched population, the prognosis of the high AIP group was significantly worse than that of the low AIP group (HR (95% CI) 1.614 (1.303-2.001), P?
CONCLUSIONS:
The AIP, a comprehensive index of lipid management in patients with T2DM, affects prognosis after PCI. The prognosis of diabetic patients with high levels of the AIP included more MACCEs and was not affected by LDL-C levels. It is recommended to monitor the AIP for lipid management in diabetic patients after PCI and ensure that the AIP is not higher than 0.318. Trial registration This is an observational cohort study that does not involve interventions. So we didn't register. We guarantee that the research is authentic and reliable, and hope that your journal can give us a chance.
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Semiquantitative Ultrasound Assessment of Lung Aeration Correlates With Lung Tissue Inflammation.
Ultrasound Med Biol2020 Feb;():. doi: S0301-5629(20)30044-2.
Yousef Nadya, Vigo Giulia, Shankar-Aguilera Shivani, De Luca Daniele,
Abstract
We studied the relationship between ultrasound-assessed lung aeration and inflammation in a particular population of ventilated preterm neonates with mild-to-moderate lung inflammation and no congenital heart defect. Lung aeration estimated by a semiquantitative lung ultrasound score significantly correlated with several inflammatory markers both at cellular (neutrophil count in bronchoalveolar lavage: ??=?0.400, p?=?0.018) and molecular level (total proteins: ??=?0.524, p?=?0.021; interleukine-8: ??=?0.523, p?=?0.021; granulocytes-macrophages colony stimulating factor: ??=?0.493, p?=?0.020; all measured in bronchoalveolar lavage and expressed as epithelial lining fluid concentrations). Lung ultrasound might detect changes in lung aeration attributable to mild-to-moderate local inflammation if cardiogenic lung edema is excluded. Thus, it is possible to describe some levels of lung inflammation with semiquantitative lung ultrasound.
Copyright © 2020 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.
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Waitlist and post-transplant outcomes in patients listed with intra-aortic balloon pump for heart transplant: United Network for Organ Sharing registry.
Int J Artif Organs2020 Feb;():391398820903312. doi: 10.1177/0391398820903312.
Duran Antonio, Nguyen Duc T, Graviss Edward A, Bhimaraj Arvind, Trachtenberg Barry, Hussain Imad, Park Muyng, Estep Jerry D, Suarez Eric E, Guha Ashrith,
Abstract
BACKGROUND:
Intra-aortic balloon pump as bridge-to-transplant (BTT) has been used successfully in patients with refractory cardiogenic shock. However, the waitlist mortality in this population is high and predictors of waitlist mortality in this population are not known. We sought to identify predictors for waitlist mortality in patients listed with intra-aortic balloon pump and risk factors for 1-year mortality after heart transplant in this population.
METHODS:
We identified patients listed for heart transplantation with intra-aortic balloon pump in the United Network for Organ Sharing data set from 1994 to 2015. Univariable and multivariable Cox proportional hazards models were used to identify predictors of waitlist mortality and 1-year post-transplant mortality.
RESULTS:
From 1945 patients listed with intra-aortic balloon pump, 67.5% (N?=?1313) were alive at 1?year and waitlist mortality was 32.5% (N?=?632). We found that higher pulmonary vascular resistance, need for inotropes, and need for mechanical ventilation were associated with higher waitlist mortality. Mechanical ventilation and dialysis prior to transplantation were important predictors of 1-year post-transplant mortality.
CONCLUSION:
Predictors of mortality such as high pulmonary vascular resistance, dialysis dependence, inotrope, and ventilator dependence in patients listed with intra-aortic balloon pump can help us identify those patients that are at high risk of dying prior to a heart transplantation.
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Trends in cardiogenic shock complicating acute myocardial infarction.
Eur J Heart Fail2020 Feb;():. doi: 10.1002/ejhf.1750.
Aissaoui Nadia, Puymirat Etienne, Delmas Clément, Ortuno Sofia, Durand Eric, Bataille Vincent, Drouet Elodie, Bonello Laurent, Bonnefoy-Cudraz Eric, Lesmeles Gilles, Guerot Emmanuel, Schiele Francois, Simon Tabassome, Danchin Nicolas,
Abstract
AIMS:
Few studies describe recent changes in the prevalence, management, and outcomes of cardiogenic shock (CS) patients complicating acute myocardial infarction (AMI) in the era of widespread use of invasive strategies. The aim of the present study was to analyse trends observed in CS complicating AMI over the past 10?years, focusing on the timing of CS occurrence (i.e. primary CS, CS on admission vs. secondary CS, CS developed subsequently during hospitalization).
METHODS AND RESULTS:
Three nationwide French registries conducted and designed to evaluate AMI management and outcomes in 'real-life' practice included consecutive AMI patients (n = 9951) admitted to intensive cardiovascular care units (ICCUs) over a 1-month period, 5?years apart. The prevalence of CS complicating AMI decreased from 2005 to 2015: 5.9%, mean age 74.1?±?12.7 in 2005; 4.0%, mean age 73.9?±?12.7 in 2010, 2.8%, mean age 71.1?±?15.0 in 2015 (P?
CONCLUSION:
Cardiogenic shock complicating AMI has become less frequent but, if present, CS, and particularly secondary CS, carries a very high mortality, which has not substantially improved over the past 10?years, in spite of the more frequent use of invasive strategies.
© 2020 The Authors. European Journal of Heart Failure © 2020 European Society of Cardiology.
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An unexpected electrocardiogram sign of subacute left ventricular free wall rupture: Its early awareness may be lifesaving.
World J Emerg Med2020 ;11(2):117-119. doi: 10.5847/wjem.j.1920-8642.2020.02.009.
Wu Hong-Yi, Qian Ju-Ying, Wang Qi-Bing, Ge Jun-Bo,
Abstract
BACKGROUND:
Post-infarct left ventricular free wall rupture (LVFWR) is not always an immediately catastrophic complication. The rupture can be subacute, allowing time for diagnosis and intervention. Accordingly, early recognition of the entity may be lifesaving.
METHODS:
We present an electrocardiogram (ECG) change pattern in two cases, which was erroneously attributed to ischemia. Two women in their 80s were admitted to our institute after experiencing the sudden onset of chest pain. They were managed as anterior ST-segment elevation myocardial infarction without reperfusion treatment. Unfortunately, they experienced a recurrence of severe chest pain with cardiogenic shock during hospitalisation. The ECG recorded at that time showed a ST-segment re-elevation in infract-related leads.
RESULTS:
The two cases were regrettably received a misjudgement of reinfarction at first, and one of the patients even was administrated with tirofiban. Afterwards the diagnosis of subacute LVFWR was made through antemortem echocardiography.
CONCLUSION:
New ST-segment elevation (STE) in infarct-associated leads, coupled with recurrence of chest pain and new-onset hypotension, may constitute the premonitory signs of a subacute LVFWR.
Copyright: © World Journal of Emergency Medicine.
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Immunotherapy-Associated Myocarditis.
Klin Onkol2020 ;33(1):20-22. doi: 10.14735/amko202020.
Spisarová M,
Abstract
The influence of checkpoint inhibitors on the balance between activation and inhibition of T-lymphocytes is strong. The development of checkpoint inhibitors has led to treatments for many malignancies but has also facilitated auto-immune disease. These immunotherapeutic agents could exacerbate already present autoimmune disease or could cause new complications in patients with no prior history of autoimmunity. Monoclonal antibodies targeting immune check points, namely anti-CTLA4 or anti-PD-1/PD-L1, are generally well tolerated; however, treatment with these drugs is associated with a variety of adverse events, such as cardiotoxicity, among others. The main mechanism of cardiac damage is lymphocytic myocarditis, which can consequently cause many symptoms of cardiovascular disease - from asymptomatic elevation of cardiac markers, heart failure, and arrhythmias to cardiogenic shock. Other adverse events include pericardium damage or Tako-tsubo cardiomyopathy. The author declares she has no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.
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Long-term Outcomes Associated With Total Arterial Revascularization vs Non-Total Arterial Revascularization.
JAMA Cardiol2020 Feb;():. doi: 10.1001/jamacardio.2019.6104.
Rocha Rodolfo V, Tam Derrick Y, Karkhanis Reena, Wang Xuesong, Austin Peter C, Ko Dennis T, Gaudino Mario, Royse Alistair, Fremes Stephen E,
Abstract
Importance:
The optimal conduits for coronary artery bypass grafting (CABG) remain controversial in multivessel coronary artery disease.
Objective:
To compare the long-term clinical outcomes of total arterial revascularization (TAR) vs non-TAR (CABG with at least 1 arterial and 1 saphenous vein graft) in a multicenter population-based study.
Design, Setting, and Participants:
This multicenter population-based cohort study using propensity score matching took place from October 2008 to March 2017 in Ontario, Canada, with a mean and maximum follow-up of 4.6 and 9.0 years, respectively. Individuals with primary isolated CABG were identified, with at least 1 arterial graft. Exclusion criteria were individuals from out of province and younger than 18 years. Patients undergoing a cardiac reoperation or those in cardiogenic shock were also excluded because these conditions would potentially bias the surgeon toward not performing TAR. Analysis began April 2019.
Exposures:
Total arterial revascularization.
Main Outcomes and Measures:
Primary outcome was time to first event of a composite of death, myocardial infarction, stroke, or repeated revascularization (major adverse cardiac and cerebrovascular events). Secondary outcomes included the individual components of the primary outcome.
Results:
Of 49?404 individuals with primary isolated CABG, 2433 (4.9%) received TAR, with the total number of bypasses being 2, 3, and 4 or more vessels in 1521 (62.5%), 865 (35.6%), and 47 individuals (1.9%), respectively. The mean (SD) age was 61.2 (10.4) years and 1983 (81.5%) were men. After propensity score matching, 2132 patient pairs were formed, with equal total number of bypasses (mean [SD], 2.4?[0.5]) but with more arterial grafts in the TAR group (mean [SD], 2.4?[0.5] vs 1.2?[0.4]; P?
Conclusions and Relevance:
Total arterial revascularization was associated with improved long-term freedom from major adverse cardiac and cerebrovascular events, death, and myocardial infarction and may be the procedure of choice for patients with reasonable life expectancy requiring CABG.
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Infective endocarditis in French Polynesia: Epidemiology, treatments and outcomes.
Arch Cardiovasc Dis2020 Feb;():. doi: S1875-2136(20)30032-2.
Blanchard Virginie, Pagis Bruno, Richaud Rainui, Moronval Fréderic, Lutinier Renaud, Gallais Katell, Le Goanvic Christophe, Fontan Anthony, Girardot Sylvain, Ah-Kang Florence, Atger Olivier, Iung Bernard, Lavie-Badie Yoan,
Abstract
BACKGROUND:
French Polynesia is a French overseas collectivity in the South Pacific Ocean, where data on infective endocarditis (IE) are lacking.
AIMS:
To investigate the epidemiology and outcomes of IE in French Polynesia.
METHODS:
All hospital records from consecutive patients hospitalized in Taaone Hospital, Tahiti, from 2015 to 2018, with an International Classification of Diseases, 10th revision, separation diagnosis of IE (I330), were reviewed retrospectively.
RESULTS:
From 190 hospital charts reviewed, 105 patients with a final diagnosis of IE, confirmed according to the modified Duke criteria, were included. The median duration of follow-up was 71 days (interquartile range 18-163 days). The mean age was 55±17 years, and there were 68 men (65%). Thirty-five patients (33%) had a history of rheumatic carditis and 43 (41%) had a prosthetic valve. There were 40 (38%) cases of staphylococcal IE, 32 (30%) of streptococcal IE and six (6%) of enterococcal IE. Cardiogenic shock, septic shock and clinically relevant cerebral complications were strongly associated with death from any cause (hazard ratio [HR] 16.85, 95% confidence interval [CI] 5.45-52.05 [P<0.001]; HR 2.62, 95% CI 1.23-5.56 [P=0.01]; and HR 4.14, 95% CI 1.92-8.92 [P<0.001], respectively). Seventy-three patients (69%) had a theoretical indication for surgery, which was performed in 38 patients (36%). Lack of surgery when there was a theoretical indication was significantly associated with death (HR 6.93, 95% CI 3.47-13.83; P<0.0001).
CONCLUSIONS:
The pattern of IE in French Polynesia differs from Western countries in many ways. Postrheumatic valvular disease remains the main underlying disease, and access to emergency heart surgery is still a challenge.
Copyright © 2020. Published by Elsevier Masson SAS.
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"Do we have to replace the balloon pump when it fails?"
Hastings Cent Rep2020 Jan;50(1):10-13. doi: 10.1002/hast.1078.
Bibler Trevor M, Crist Jamie M, Malek Janet, Childress Andrew M,
Abstract
Mrs. Duong had coronary artery disease, ischemic cardiomyopathy, and mildly altered mental status when her case was presented before an advanced heart therapy medical review board. She was accepted for left ventricular assist device placement pending additional insight into her cognitive state. Before the LVAD could be implanted, however, Mrs. Duong went into cardiogenic shock, and her heart failure team placed an intra-aortic balloon pump in her subclavian artery. Within two weeks, Mrs. Duong became IABP dependent and deconditioned. The attending deemed her as lacking capacity to make complex medical decisions, and the medical review board officially declined her for LVAD placement. The heart failure and CICU teams feel that Mrs. Duong is not being helped by the care they are giving her. They recommend terminal weaning of the IABP and initiation of comfort care. Her family disagrees, pointing to activities like continued eating and interacting with family. At an impasse after yet another family meeting, the attending for the heart failure team asks the clinical ethics consultant, "Do we have to replace the balloon pump when it fails?"
© 2020 The Hastings Center.
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Successful support of cardiogenic shock due to a ruptured papillary muscle using an Impella 5.0.
Artif Organs -
Bridging INTERMACS 1 patients from VA-ECMO to LVAD via Impella 5.0: De-escalate and ambulate.
J Crit Care2020 Jan;():. doi: S0883-9441(19)31374-7.
Bertoldi Letizia F, Pappalardo Federico, Lubos Edith, Grahn Hanno, Rybczinski Meike, Barten Markus J, Legros Tim, Bertoglio Luca, Schrage Benedikt, Westermann Dirk, Lapenna Elisabetta, Reichenspurner Hermann, Bernhardt Alexander M,
Abstract
PURPOSE:
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) stabilizes patients in refractory cardiogenic shock. However, ECMO-related complications strongly affect the outcome, especially if a long-term LVAD is needed.
METHODS AND MATERIALS:
We describe a new strategy in management of INTERMACS 1 patients consisting in early weaning from VA-ECMO with axillary Impella 5.0 as a bridge to LVAD implantation. Nine patients in two European centres are described.
RESULTS:
All patients were implanted with VA-ECMO for initial hemodynamic and metabolic stabilization. After a median time of 8 days, Impella 5.0 was implanted. Impella support allowed in all patients weaning from inotropes and from VA-ECMO (after a median time of 22 h). No patients had right ventricular failure after ECMO-weaning and most patients were mobilized and orally fed (88.9%) during Impella support. All patient underwent LVAD implantation after a median Impella time of 17 days. Only one patient had right-ventricular failure after LVAD implantation. All patients were discharged from hospital after a median time of 40 days.
CONCLUSION:
Early weaning from VA-ECMO with Impella 5.0 as a bridge to LVAD is a safe and effective strategy in management of INTERMACS 1 patients. This approach minimizes ECMO-related complications and allows patient mobilization and right ventricular function optimization before LVAD implantation.
Copyright © 2019. Published by Elsevier Inc.
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Regional Variation in the Management and Outcomes of Acute Myocardial Infarction With Cardiogenic Shock in the United States.
Circ Heart Fail2020 Feb;13(2):e006661. doi: 10.1161/CIRCHEARTFAILURE.119.006661.
Vallabhajosyula Saraschandra, Patlolla Sri Harsha, Dunlay Shannon M, Prasad Abhiram, Bell Malcolm R, Jaffe Allan S, Gersh Bernard J, Rihal Charanjit S, Holmes David R, Barsness Gregory W,
Abstract
BACKGROUND:
There are few studies evaluating regional disparities in the care of acute myocardial infarction-cardiogenic shock (AMI-CS).
METHODS AND RESULTS:
Using the National Inpatient Sample from 2000 to 2016, we identified adults with a primary diagnosis of AMI and concomitant CS admitted to the United States census regions of Northeast, Midwest, South, and West. Interhospital transfers were excluded. End points of interest included in-hospital mortality, use of coronary angiography, percutaneous coronary intervention, mechanical circulatory support, hospitalization costs, length of stay, and discharge disposition. Multivariable regression was used to adjust for potential confounding. Of the 402 825 AMI-CS admissions, 16.8%, 22.5%, 39.3%, and 21.4% were admitted to the Northeast, Midwest, South, and West, respectively. Higher rates of ST-elevation AMI-CS were noted in the Midwest and West. Admissions to the Northeast were on average characterized by a higher frequency of whites, Medicare beneficiaries, and lower rates of cardiac arrest. Admissions to the Northeast were less likely to receive coronary angiography, percutaneous coronary intervention, and mechanical circulatory support, despite the highest rates of extracorporeal membrane oxygenation use. Compared with the Northeast, in-hospital mortality was lower in the Midwest (adjusted odds ratio [aOR], 0.96 [95% CI, 0.93-0.98]; <0.001) and West (aOR, 0.96 [95% CI, 0.94-0.98]; =0.001) but higher in the South (aOR, 1.04 [95% CI, 1.01-1.06]; =0.002). The Midwest (aOR, 1.68 [95% CI, 1.62-1.74]; <0.001), South (aOR, 1.86 [95% CI, 1.80-1.92]; <0.001), and West (aOR, 1.93 [95% CI, 1.86-2.00]; <0.001) had higher discharges to home.
CONCLUSIONS:
There remain significant regional disparities in the management and outcomes of AMI-CS.
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Breaking hearts and taking names: A case of sarcoidosis related effusive-constrictive pericarditis.
Respir Med2020 Jan;163():105879. doi: S0954-6111(20)30019-6.
Valentin Ramon, Keeley Ellen C, Ataya Ali, Gomez-Manjarres Diana, Petersen John, Arnaoutakis George J, Drew Peter, Barnes Matt, Patel Divya C,
Abstract
INTRODUCTION:
Pericardial involvement of sarcoidosis is a rare cause for acute heart failure, and usually occurs as a result of the development of a pericardial effusion leading to cardiac tamponade. Even rarer still, is the manifestation of constrictive pericarditis. We report a case of sarcoidosis with lung, pleural, and pericardial involvement with effusive-constrictive pericarditis leading to cardiac tamponade.
CASE PRESENTATION:
A 34-year-old Caucasian man presented for evaluation of a history of worsening exertional dyspnea, edema, and weight loss. A high-resolution chest computed tomography showed diffuse pulmonary nodules with upper lobe predominance and in a perilymphatic distribution; large right pleural effusion; and large pericardial effusion with pericardial thickening. A transthoracic echocardiogram demonstrated early tamponade physiology for which a pericardial drain was placed. After removal of the drain he developed cardiogenic shock from cardiac tamponade attributed to the reaccumulation of a pericardial effusion and urgent pericardial window was performed. Serial echocardiography was concerning for organization and localization of the pericardial fluid. Cardiac magnetic resonance imaging demonstrated a significant reduction in pericardial slippage between the parietal and visceral layers around the heart collectively suggestive of constrictive pericarditis. Confirmation of effusive-constrictive pericarditis was noted on right heart catheterization. He then underwent pericardiectomy, which on histopathologic evaluation demonstrated non-necrotizing granulomas, thus confirming pericardial involvement of sarcoidosis.
CONCLUSIONS:
We report a case demonstrating unique manifestations of sarcoidosis; effusive-constrictive pericarditis presenting with acute congestive heart failure.
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