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Pubblicazioni recenti - cardiogenic
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Parameters associated with successful weaning of veno-arterial extracorporeal membrane oxygenation: a systematic review.
Crit Care2022 Dec;26(1):375. doi: 10.1186/s13054-022-04249-w.
Charbonneau Francis, Chahinian Karina, Bebawi Emmanuel, Lavigueur Olivier, Lévesque Émilie, Lamarche Yoan, Serri Karim, Albert Martin, Noly Pierre-Emmanuel, Cournoyer Alexis, Cavayas Yiorgos Alexandros,
Abstract
PURPOSE:
Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) can be used to restore organ perfusion in patients with cardiogenic shock until native heart recovery occurs. It may be challenging, however, to determine when patients can be weaned successfully from ECMO-surviving without requiring further mechanical support or heart transplant. We aimed to systematically review the medical literature to determine the biomarkers, hemodynamic and echocardiographic parameters associated with successful weaning of VA-ECMO in adults with cardiogenic shock and to present an evidence-based weaning algorithm incorporating key findings.
METHOD:
We systematically searched PubMed, Embase, ProQuest, Google Scholars, Web of Science and the Grey literature for pertinent original research reports. We excluded studies limited to extracorporeal cardiopulmonary resuscitation (ECPR) as the neurological prognosis may significantly alter the decision-making process surrounding the device removal in this patient population. Studies with a mixed population of VA-ECMO for cardiogenic shock or cardiac arrest were included. We excluded studies limited to patients in which ECMO was only used as a bridge to VAD or heart transplant, as such patients are, by definition, never "successfully weaned." We used the Risk of Bias Assessment tool for Non-Randomized Studies. The study was registered on the International prospective register of systematic reviews (PROSPERO CRD42020178641).
RESULTS:
We screened 14,578 records and included 47 that met our pre-specified criteria. Signs of lower initial severity of shock and myocardial injury, early recovery of systemic perfusion, left and right ventricular recovery, hemodynamic and echocardiographic stability during flow reduction trial and/or pump-controlled retrograde trial off predicted successful weaning. The most widely used parameter was the left ventricular outflow tract velocity time integral, an indicator of stroke volume. Most studies had a moderate or high risk of bias. Heterogeneity in methods, timing, and conditions of measurements precluded any meta-analysis.
CONCLUSIONS:
In adult patients on VA-ECMO for cardiogenic shock, multiple biomarkers, hemodynamic and echocardiographic parameters may be used to track resolution of systemic hypoperfusion and myocardial recovery in order to identify patients that can be successfully weaned.
© 2022. The Author(s).
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Peripartum Cardiomyopathy-Induced Cardiogenic Shock Causing Hypoxic-Ischemic Encephalopathy in a COVID-19 Patient.
Case Rep Crit Care2022 ;2022():7114732. doi: 7114732.
Le Minh Khoi, Nguyen Thanh Hieu,
Abstract
BACKGROUND:
Cardiogenic shock complicating peripartum cardiomyopathy (PPCM) is a rare but lethal syndrome. The etiology of PPCM is not fully elucidated and is probably multifactorial, and viral infection might play some role. It has been documented that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) directly invades the cardiomyocytes and most commonly damages this vital organ via complex systemic devastating mechanisms. . A 28-year-old pregnant female was admitted to a COVID-19 field hospital due to a SARS-CoV-2 infection. She gave birth by spontaneous vaginal delivery at 34 gestational weeks. Six hours after the delivery, she presented signs of hemodynamic collapse and became comatosed, requiring a transfer to the COVID-19 intensive care center. The brain magnetic resonance imaging excluded thromboembolism, intracerebral hemorrhage, and central nervous system infection and revealed a hypoxic-ischemic encephalopathy. Bedside echocardiography documented a dilated left ventricle and severely reduced left ventricular systolic function with an ejection fraction of 24%. The management was aimed at a cardiogenic shock secondary to peripartum cardiomyopathy. The clinical course was favorable: the hemodynamics stabilized, the cognitive function fully recovered, and the patient was extubated on the second day of admission to the intensive care unit. The patient was discharged from the hospital ten days after admission. Neurological and cardiovascular checkups six months after discharge showed full recovery.
CONCLUSION:
Peripartum cardiomyopathy-induced cardiogenic shock with severe neurological consequences in COVID-19 patients was rare but did exist. A systemic approach and vigorous efforts to pinpoint the accurate diagnosis played important roles in the prompt and appropriate management.
Copyright © 2022 Minh Khoi Le and Thanh Hieu Nguyen.
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A giant and double-walled left atrial ball thrombus complicating a mitral stenosis: case report-a truck tire into the heart.
Eur Heart J Case Rep2022 Nov;6(11):ytac443. doi: ytac443.
Selimi Adelina, Ianni Umberto, Molisana Michela, Parato Vito Maurizio,
Abstract
BACKGROUND:
High thromboembolic risk associated with rheumatic mitral stenosis has been well established, especially in concomitant atrial fibrillation; however, the presence of left atrium ball thrombus is an uncommon finding.
CASE SUMMARY:
A 75-year-old woman with a history of mild rheumatic mitral stenosis was admitted to Emergency Department with cardiogenic shock and high ventricular rate atrial fibrillation. Emergency electrical cardioversion was performed-before trans-oesophageal echocardiography (TOE)-due to haemodynamic deterioration which restored sinus rhythm.Transthoracic echocardiography (TTE) revealed severe reduction of left ventricular ejection fraction (LVEF: 15%), severe rheumatic mitral stenosis and a large, perfectly rounded mass, situated at the ostium of left upper pulmonary vein. Due to the persistence of haemodynamic instability and acute pulmonary oedema the patient was intubated and mechanically ventilated and treated with intravenous administration of inotropes and high doses of diuretics. During the stay in Intensive Care Unit, a TOE confirmed a spherical and double-walled mass suggesting a working diagnosis of left atrial ball thrombus (LABT). The case was discussed in Heart Team and considering the poor haemodynamic status in the contest of refractory cardiogenic shock with evidence of multi-organ failure, emergency surgical thrombectomy and mitral valve replacement was deemed prohibitive. Patient developed cardiac arrest and emergency TTE showed left atrial mass engaged into the mitral valve totally obstructing the left ventricle inflow tract. The autopsy and histologic examination confirmed the thrombotic nature of the mass.
DISCUSSION:
A free-floating ball thrombus in the left atrium is an unusual occurrence in rheumatic mitral stenosis and it may cause fatal systemic embolization or acute left ventricular inflow obstruction, resulting in syncope, pulmonary congestion, and sudden cardiac death. When possible, emergency surgical thrombectomy and mitral valve replacement can be life-saving.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Outcomes of Patients With Primary Cardiac Diagnoses Admitted to Cardiac vs Noncardiac Intensive Care Units.
JACC Adv2022 Oct;1(4):. doi: 100114.
Brusca Samuel B, Galiatsatos Panagis, Warner Sarah, Li Xiaobai, Powell-Wiley Tiffany M, Kadri Sameer S, Solomon Michael A,
Abstract
BACKGROUND:
Demographics in cardiac intensive care units (CICUs) have evolved, with increased prevalence of noncardiac critical illnesses.
OBJECTIVES:
This study compares outcomes of patients with primary cardiac diagnoses admitted to CICUs vs those of patients with primary cardiac diagnoses admitted to noncardiac ICUs.
METHODS:
The Cerner Health Facts Database was queried to identify adults with primary cardiac diagnoses admitted to ICUs within 48 hours of presentation between 2009 and 2014. Only hospitals with multiple ICUs including a CICU were studied. Information on ICU staffing was not available. A univariate analysis of ICU type (model 1) and multivariate analyses incorporating patient- and hospital-level variables (model 2) and concurrent, noncardiac, ICU-level diagnoses (model 3) were utilized to assess the impact of ICU type on inpatient mortality.
RESULTS:
Of 16,163 encounters across 14 hospitals, 8,499 (52.6%) were admitted to CICUs and 7,664 (47.4%) to noncardiac ICUs. Univariate analysis (model 1) demonstrated increased mortality in noncardiac ICUs compared to CICUs (odds ratio [OR]: 1.47, 95% CI: 1.32-1.64;
CONCLUSIONS:
In this historical cohort study evaluating CICU outcomes prior to the evolution of proposed staffing and care model modernization, survival of cardiac patients with concurrent, noncardiac critical illnesses may have been better with the expertise available in general system ICUs. These results may support contemporary efforts to increase the capacity to manage noncardiac critical illnesses in CICUs.
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Fluid overload and mortality in critically ill patients with severe heart failure and cardiogenic shock-An observational cohort study.
Front Med (Lausanne)2022 ;9():1040055. doi: 1040055.
Waskowski Jan, Michel Matthias C, Steffen Richard, Messmer Anna S, Pfortmueller Carmen A,
Abstract
OBJECTIVE:
Patients with heart failure (HF) and cardiogenic shock are especially prone to the negative effects of fluid overload (FO); however, fluid resuscitation in respective patients is sometimes necessary resulting in FO. We aimed to study the association of FO at ICU discharge with 30-day mortality in patients admitted to the ICU due to severe heart failure and/or cardiogenic shock.
METHODS:
Retrospective, single-center cohort study. Patients with admission diagnoses of severe HF and/or cardiogenic shock were eligible. The following exclusion criteria were applied: (I) patients younger than 16 years, (II) patients admitted to our intermediate care unit, and (III) patients with incomplete data to determine FO at ICU discharge. We used a cumulative weight-adjusted definition of fluid balance and defined more than 5% as FO. The data were analyzed by univariate and adjusted univariate logistic regression.
RESULTS:
We included 2,158 patients in our analysis. 185 patients (8.6%) were fluid overloaded at ICU discharge. The mean FO in the FO group was 7.2% [interquartile range (IQR) 5.8-10%]. In patients with FO at ICU discharge, 30-day mortality was 22.7% compared to 11.7% in non-FO patients ( 0.05). Baseline lactate (adjusted OR 1.27; 95% CI 1.13-1.42;
CONCLUSION:
In patients admitted to the ICU due to severe HF and/or cardiogenic shock, FO at ICU discharge seems not to be associated with 30-day mortality.
Copyright © 2022 Waskowski, Michel, Steffen, Messmer and Pfortmueller.
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Feasibility of Very Early Identification of Cardiogenic Shock by Semi-automated Ultrasound Exam in the Emergency Department.
Cureus2022 Oct;14(10):e30927. doi: e30927.
Morales Gabriel, Adedipe Adeyinka, Morse Sophie, McCabe James, Mahr Claudius, Nichol Graham,
Abstract
Background Cardiogenic shock (CS) is critical end-organ hypoperfusion due to reduced cardiac output. Early therapy, such as vasoactive agents or the initiation of mechanical circulatory support (MCS), requires early diagnosis and is associated with better outcomes. A novel ultrasound platform (GE Healthcare, Milwaukee, WI) has semi-automated imaging software (SAIS), which could simplify the point-of-care ultrasound (POCUS) diagnosis of CS. We assessed the feasibility of using POCUS with SAIS in patients in shock, determined the ability of SAIS to identify the subset of patients with CS, and described the process and outcome of care of patients with vs. without CS after presenting to Emergency Department (ED) with hypotension. Methods This prospective case-control study was conducted at an urban ED. Physicians with prior POCUS education received one hour of training with the study device. The qualitative ejection fraction was determined by visual assessment. SAIS measurements of hemodynamics were made with the study device and included left ventricle outflow tract velocity time integral (LVOT VTI), inferior vena cava collapsibility or distensibility indices, and pulmonary B-line assessment. ED patients with a systolic blood pressure ? 90 mmHg or need for a vasopressor initiation in the ED were enrolled. The diagnosis of CS was determined by a medical record review. All data were summarized descriptively. Results Twenty-nine cases underwent POCUS, and 87 controls did not. Baseline characteristics, process, and outcome of care were similar between groups. Seventy-nine percent (79%) of cases had a complete POCUS with SAIS. Of these, 55% had reduced LVOT VTI, 38% had IVC collapsibility
Copyright © 2022, Morales et al.
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Case report: Cefoperazone-sulbactam induced Kounis syndrome and cardiogenic shock.
Front Cardiovasc Med2022 ;9():1061586. doi: 1061586.
Ding Peng, Zhou Yuan, Long Kun-Lan, Zhang Li, Gao Pei-Yang,
Abstract
BACKGROUND:
Kounis syndrome is a hypersensitive coronary artery disease caused by the body's exposure to allergens, which is induced by various drugs and environmental factors. This entity has been described primarily in isolated case reports and case series. We report a case of type III Kounis syndrome caused by cefoperazone-sulbactam.
CASE PRESENTATION:
A 79-year-old man who received an infusion of cefoperazone-sulbactam in Respiratory Department of our hospital for recurrent infections. 28 minutes later, he developed skin flushing of the trunk and extremities, soon followed by loss of consciousness and shock. With antianaphylaxis, pressor therapy, and fluid rehydration, the patient was admitted to the ICU for treatment. During which, he experienced recurrent ventricular fibrillation and a progressive increase in troponin I levels. The ECG of the patient showed that the ST segment elevation of lead II, III, avF, and V3R-V5R was 0.10-0.20 MV. An urgent coronary angiography showed an in-stent thrombosis in the middle part of the right coronary artery, occlusion of the distal flow with TIMI grade 0. The diagnosis was type III Kounis syndrome with cardiogenic shock. Despite aggressive treatment, the patient died on day 7 after ICU admission.
CONCLUSION:
Kunis syndrome is a life-threatening disease, and therefore allergic reactions in patients with a history of cephalosporin allergy and coronary stent implantation should be considered and treated promptly.
Copyright © 2022 Ding, Zhou, Long, Zhang and Gao.
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Contemporary Management of Concomitant Cardiac Arrest and Cardiogenic Shock Complicating Myocardial Infarction.
Mayo Clin Proc2022 Dec;97(12):2333-2354. doi: 10.1016/j.mayocp.2022.06.027.
Vallabhajosyula Saraschandra, Verghese Dhiran, Henry Timothy D, Katz Jason N, Nicholson William J, Jaber Wissam A, Jentzer Jacob C,
Abstract
Cardiogenic shock (CS) and cardiac arrest (CA) are the most life-threatening complications of acute myocardial infarction. Although there is a significant overlap in the pathophysiology with approximately half the patients with CS experiencing a CA and approximately two-thirds of patients with CA developing CS, comprehensive guideline recommendations for management of CA + CS are lacking. This paper summarizes the current evidence on the incidence, pathophysiology, and short- and long-term outcomes of patients with acute myocardial infarction complicated by concomitant CA + CS. We discuss the hemodynamic factors and unique challenges that need to be accounted for while developing treatment strategies for these patients. A summary of expert-based step-by-step recommendations to the approach and treatment of these patients, both in the field before admission and in-hospital management, are presented.
Copyright © 2022 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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Disparity of Performance Measure by Door-to-Balloon Time Between a Rural and Urban Area for Management of Patients With ST-Segment Elevation Myocardial Infarction?- Insights From the Nationwide Japan Acute Myocardial Infarction Registry.
Circ J2022 Dec;():. doi: 10.1253/circj.CJ-22-0454.
Fukui Kento, Takahashi Jun, Hao Kiyotaka, Honda Satoshi, Nishihira Kensaku, Kojima Sunao, Takegami Misa, Sakata Yasuhiko, Itoh Tomonori, Watanabe Tetsu, Takayama Morimasa, Sumiyoshi Tetsuya, Kimura Kazuo, Yasuda Satoshi, ,
Abstract
BACKGROUND:
Although a door-to-balloon (D2B) time ?90 min is recognized as a key indicator of timely reperfusion for patients with ST-segment elevation myocardial infarction (STEMI), it is unclear whether regional disparities in the prognostic value of D2B remain in contemporary Japan.Methods?and?Results: We retrospectively analyzed 17,167 STEMI patients (mean [±SD] age 68±13 years, 77.6% male) undergoing primary percutaneous coronary intervention. With reference to the Japanese median population density of 1,147 people/km, patients were divided into 2 groups: rural (n=6,908) and urban (n=10,259). Compared with the urban group, median D2B time was longer (70 vs. 62 min; P90 min, regardless of residential area, whereas multivariable analysis identified prolonged D2B time as a predictor of in-hospital death only in the rural group (adjusted odds ratio 1.57; 95% confidence interval 1.18-2.09; P=0.002). Importantly, the rural-urban disparity in in-hospital mortality emerged most distinctively among patients with Killip Class IV and a D2B time >90 min.
CONCLUSIONS:
These data suggest that there is a substantial rural-urban gap in the prognostic significance of D2B time among STEMI patients, especially those with cardiogenic shock and a prolonged D2B time.
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Outcomes of isolated CABG from "OPCAB favor institution" for patients with left ventricular dysfunction.
Gen Thorac Cardiovasc Surg2022 Dec;():. doi: 10.1007/s11748-022-01894-4.
Itoda Yoshifumi, Morooka Kazuki, Tateishi Retsu, Haba Fumiya, Ono Shunya, Tsukioka Yusuke, Nakahara Yoshinori, Kanemura Takeyuki,
Abstract
OBJECTIVES:
Although off-pump coronary artery bypass (OPCAB) has been reported to have better short-term results than on-pump coronary artery bypass (ONCAB) in terms of bleeding and stroke even in patients with cardiac dysfunction, details are unknown. The purpose of this study was to evaluate the outcomes of CABG (coronary artery bypass graft) in patients with low cardiac function based on our treatment policy.
METHODS:
Retrospectively, we reviewed patients with low ejection fraction (35%), who underwent isolated OPCAB or ONCAB between 2013 and 2020 in our institute.
RESULTS:
Isolated CABG was performed for 67 patients: 54 OPCABs and 13 ONCABs. In the ONCAB group, six were converted from OPCAB. Patients with AMI, heart failure, liver dysfunction, cardiogenic shock, and ventricular arrhythmia were more common in the ONCAB group. More patients required postoperative mechanical circulatory support in the ONCAB group. Intra-operative blood transfusion, ICU stay, intubation time, and hospital stay were significantly worse in the ONCAB group. Postoperative graft patency was 91.5%. Hospital mortality was 7.5%. Mid-term survival at 30-day, 1-year, and 5-year were 98.5%, 84.6%, and 75.8%, respectively.
CONCLUSION:
In our institute, ONCAB was selected for the patients who could not complete treatment with OPCAB due to poor preoperative circulatory status. Our treatment policy for the patients with impaired cardiac function was acceptable.
© 2022. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.
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DOT1L regulates chamber-specific transcriptional networks during cardiogenesis and mediates postnatal cell cycle withdrawal.
Nat Commun2022 Dec;13(1):7444. doi: 10.1038/s41467-022-35070-2.
Cattaneo Paola, Hayes Michael G B, Baumgarten Nina, Hecker Dennis, Peruzzo Sofia, Aslan Galip S, Kunderfranco Paolo, Larcher Veronica, Zhang Lunfeng, Contu Riccardo, Fonseca Gregory, Spinozzi Simone, Chen Ju, Condorelli Gianluigi, Dimmeler Stefanie, Schulz Marcel H, Heinz Sven, Guimarães-Camboa Nuno, Evans Sylvia M,
Abstract
Mechanisms by which specific histone modifications regulate distinct gene networks remain little understood. We investigated how H3K79me2, a modification catalyzed by DOT1L and previously considered a general transcriptional activation mark, regulates gene expression during cardiogenesis. Embryonic cardiomyocyte ablation of Dot1l revealed that H3K79me2 does not act as a general transcriptional activator, but rather regulates highly specific transcriptional networks at two critical cardiogenic junctures: embryonic cardiogenesis, where it was particularly important for left ventricle-specific genes, and postnatal cardiomyocyte cell cycle withdrawal, with Dot1L mutants having more mononuclear cardiomyocytes and prolonged cardiomyocyte cell cycle activity. Mechanistic analyses revealed that H3K79me2 in two distinct domains, gene bodies and regulatory elements, synergized to promote expression of genes activated by DOT1L. Surprisingly, H3K79me2 in specific regulatory elements also contributed to silencing genes usually not expressed in cardiomyocytes. These results reveal mechanisms by which DOT1L successively regulates left ventricle specification and cardiomyocyte cell cycle withdrawal.
© 2022. The Author(s).
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Mechanical Circulatory Support in Patients With COVID-19 Presenting With Myocardial Infarction.
Am J Cardiol2022 Nov;187():76-83. doi: 10.1016/j.amjcard.2022.09.030.
Guddeti Raviteja R, Sanina Cristina, Jauhar Rajiv, Henry Timothy D, Dehghani Payam, Garberich Ross, Schmidt Christian W, Nayak Keshav R, Shavadia Jay S, Bagai Akshay, Alraies Chadi, Mehra Aditya, Bagur Rodrigo, Grines Cindy, Singh Avneet, Patel Rajan A G, Htun Wah Wah, Ghasemzadeh Nima, Davidson Laura, Acharya Deepak, Kabour Ameer, Hafiz Abdul Moiz, Amlani Shy, Wasserman Hal S, Smith Timothy, Kapur Navin K, Garcia Santiago,
Abstract
ST-segment elevation myocardial infarction (STEMI) complicating COVID-19 is associated with an increased risk of cardiogenic shock and mortality. However, little is known about the frequency of use and clinical impact of mechanical circulatory support (MCS) in these patients. We sought to define patterns of MCS utilization, patient characteristics, and outcomes in patients with COVID-19 with STEMI. The NACMI (North American COVID-19 Myocardial Infarction) is an ongoing prospective, observational registry of patients with COVID-19 positive (COVID-19+) with STEMI with a contemporary control group of persons under investigation who subsequently tested negative for COVID-19 (COVID-19-). We compared the baseline characteristics and in-hospital outcomes of COVID-19+ and patients with COVID-19- according to the use of MCS. The primary outcome was a composite of in-hospital mortality, stroke, recurrent MI, and repeat unplanned revascularization. A total of 1,379 patients (586 COVID-19+ and 793 COVID-19-) enrolled in the NACMI registry between January 2020 and November 2021 were included in this analysis; overall, MCS use was 12.3% (12.1% [n = 71] COVID-19+/MCS positive [MCS+] vs 12.4% [n = 98] COVID-19-/MCS+). Baseline characteristics were similar between the 2 groups. The use of percutaneous coronary intervention was similar between the groups (84% vs 78%; p = 0.404). Intra-aortic balloon pump was the most frequently used MCS device in both groups (53% in COVID-19+/MCS+ and 75% in COVID-19-/MCS+). The primary outcome was significantly higher in COVID-19+/MCS+ patients (60% vs 30%; p = 0.001) because of very high in-hospital mortality (59% vs 28%; p = 0.001). In conclusion, patients with COVID-19+ with STEMI requiring MCS have very high in-hospital mortality, likely related to the significantly higher pulmonary involvement compared with patients with COVID-19- with STEMI requiring MCS.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Comment: Analysis of Bicarbonate-Based Purge Solution in Patients With Cardiogenic Shock Supported Via Impella Ventricular Device.
Ann Pharmacother2022 Dec;():10600280221139458. doi: 10.1177/10600280221139458.
Moretz Jeremy D, Corbett Scott, Bilazarian Seth,
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Pheochromocytoma-induced "inverted" takotsubo cardiomyopathy and cardiogenic shock: case report.
Anaesthesiol Intensive Ther2022 ;54(4):341-343. doi: 10.5114/ait.2022.121100.
Odierna Italia, Pagano Tommaso, Erra Aniello, Oliveri Lucia, Pasquale Milena, Muoio Raffaele, Petrosino Massimo, Albano Francesco, Pepe Lidia,
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Clinician and Algorithmic Application of the 2019 and 2022 Society of Cardiovascular Angiography and Intervention Shock Stages in the Critical Care Cardiology Trials Network Registry.
Circ Heart Fail2022 Dec;():e009714. doi: 10.1161/CIRCHEARTFAILURE.122.009714.
Patel Siddharth M, Berg David D, Bohula Erin A, Baird-Zars Vivian M, Barnett Christopher F, Barsness Gregory W, Chaudhry Sunit-Preet, Daniels Lori B, van Diepen Sean, Ghafghazi Shahab, Goldfarb Michael J, Jentzer Jacob C, Katz Jason N, Kenigsberg Benjamin B, Lawler Patrick R, Miller P Elliot, Papolos Alexander I, Park Jeong-Gun, Potter Brian J, Prasad Rajnish, Singam N Sarma V, Sinha Shashank S, Solomon Michael A, Teuteberg Jeffrey J, Morrow David A, ,
Abstract
BACKGROUND:
Algorithmic application of the 2019 Society of Cardiovascular Angiography and Intervention (SCAI) shock stages effectively stratifies mortality risk for patients with cardiogenic shock. However, clinician assessment of SCAI staging may differ. Moreover, the implications of the 2022 SCAI criteria update remain incompletely defined.
METHODS:
The Critical Care Cardiology Trials Network is a multicenter registry of cardiac intensive care units (CICUs). Between 2019 and 2021, participating centers (n=32) contributed at least a 2-month snapshot of consecutive medical CICU admissions. In-hospital mortality was assessed across 3 separate staging methods: clinician assessment, Critical Care Cardiology Trials Network algorithmic application of the 2019 SCAI criteria, and a revision of the Critical Care Cardiology Trials Network application using the 2022 SCAI criteria.
RESULTS:
Of 9612 admissions, 1340 (13.9%) presented with cardiogenic shock with in-hospital mortality of 35.2%. Both clinician and algorithm-based staging using the 2019 SCAI criteria identified a stepwise gradient of mortality risk (stage C-E: 19.0% to 83.7% and 14.6% to 52.2%, respectively;
CONCLUSIONS:
Both clinician and algorithm-based application of the 2019 SCAI stages identify a stepwise gradient of mortality risk, although clinician-staging may better allocate higher risk patients into advanced SCAI stages. Updated algorithmic staging using the 2022 SCAI criteria and vasoactive-inotropic score further refines risk stratification.
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Imaging for Transcatheter Mitral Valve Edge-to-Edge Repair for an Unusual Cause of Cardiogenic Shock.
Circ Cardiovasc Imaging2022 Dec;():e014588. doi: 10.1161/CIRCIMAGING.122.014588.
Lu Zhi-Nan, Chen Qi, Lam Yat-Yin, Song Guangyuan,
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Existence of "obesity paradox" in cardiogenic shock: More questions than answers.
Heart Lung -
Delayed ventricular septal rupture repair on patient outcomes after myocardial infarction: A systematic review.
Curr Probl Cardiol2022 Nov;():101521. doi: 10.1016/j.cpcardiol.2022.101521.
Rashid Haroon, Kumar Kantash, Ullah Asif, Kamin Matiullah, Shafique Muhammad, Elahi Azaan, Najam Ali, Zaidi Syed Muhammad Jawad, Asad Muhammad, Mahmoodi Amin, Malik Jahanzeb,
Abstract
BACKGROUND:
Even though the prevalence of VSR after MI is only 1-3%, the mortality associated with the condition is more than 80%. Very few studies in the literature have described in detail the treatment options for delayed VSR repair.
OBJECTIVE:
This systematic review was conducted to evaluate the outcomes of delayed ventricular septal rupture (VSR) repair following acute myocardial infarction (AMI).
METHODS:
Digital databases were searched systematically to identify studies reporting the outcomes of delayed VSR repair. Detailed study and patient-level baseline characteristics including the type of study, sample size, follow-up, number of delayed repairs, time to repair, outcomes (in terms of major adverse cardiovascular events), and predictors of outcome were abstracted.
RESULTS:
A total of 12 studies, recruiting 8,579 patients were included in the final analysis. Male gender, young age (
CONCLUSION:
This study demonstrated that delayed VSR repair can reduce mortality in patients who develop VSR after AMI. Furthermore, the use of LVADs can prolong the time of surgery, and the use of inotropes can predict survival benefits in this patient cohort.
Copyright © 2022. Published by Elsevier Inc.
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Oxygen Therapy Confers Little Benefit in Patients with Acute ST-Segment Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis.
Altern Ther Health Med2022 Dec;():. doi: AT7324.
Wang Xinjuan, Su Huaqin, Mao Bixiu, Lu Yangchun, He Lianping,
Abstract
OBJECTIVE:
We aimed to investigate the clinical benefit of oxygen therapy in patients with acute ST-segment elevation myocardial infarction (STEMI).
METHODS:
We searched PubMed, Embase and the Cochrane Library from database inception to June 2020 to identify randomized controlled trials (RCTs) on oxygen therapy in acute STEMI. Literature screening, data extraction and study quality assessment were independently carried out by the 2 investigators according to the predefined eligibility criteria, and RevMan 5.3 analysis software was utilized for all analyses.
RESULTS:
Finally, 5 RCTs with a total of 4824 patients with STEMI were eligible for further meta-analysis. The RCT results demonstrated that oxygen therapy exerted non-significant effects in reducing the risks for short-term all-cause mortality (risk ratio [RR] = 1.21; 95% CI, 0.80-1.53; P = .53), cardiac arrest (RR = 1.20; 95% CI, 0.94-1.54; P = .79), recurrent myocardial infarction (MI) (RR = 0.68; 95% CI, 0.43-1.08; P = .10) and cardiogenic shock (RR = 0.81; 95% CI, 0.58-1.15; P = .24) and the incidence of other outcome indicators of acute STEMI.
CONCLUSIONS:
Oxygen therapy does not provide more benefits than adverse effects in patients with acute STEMI. Personalized oxygen treatment based on dynamic oxygen saturation is recommended in patients with hypoxia. Supplemental oxygen in patients with acute STEMI has no effect on reducing infarct size, and has no benefit in all-cause mortality, cardiogenic shock, etc.
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Left atrial appendage aneurysm resection following the onset of a cardiogenic stroke: a case report.
J Surg Case Rep2022 Nov;2022(11):rjac549. doi: rjac549.
Isa Hideki, Nakatsu Tomoki, Kimura Fumiaki,
Abstract
A left atrial appendage aneurysm (LAAA) is a rare congenital or acquired anomaly that often causes fatal complications. Although many reports recommend surgical resection for treatment, there is no clear definition of LAAA. Therefore, the diagnosis and treatment are ambiguous. A 73-year-old woman with cardiogenic stroke was admitted to our hospital because of a suspected LAAA as the source of the embolus. She was incidentally diagnosed with LAAA seven years ago, which was managed with continuous anticoagulation therapy, although atrial fibrillation was not observed. The patient underwent aneurysm resection, and the postoperative course was uneventful.As LAAA symptoms are nonspecific, careful observation is required when LAAA is suspected. The risks associated with surgery are generally low and the surgical outcome is good; however, even with appropriate medical therapy, fatal complications can occur. Therefore, surgical resection of the LAAA should be considered even in asymptomatic patients, considering the low surgical risk.
Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2022.
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