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Pubblicazioni recenti - cardiogenic
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Is Ferroptosis a Key Component of the Process Leading to Multiorgan Damage in COVID-19?
Antioxidants (Basel)2021 Oct;10(11):. doi: 1677.
Fratta Pasini Anna Maria, Stranieri Chiara, Girelli Domenico, Busti Fabiana, Cominacini Luciano,
Abstract
Even though COVID-19 is mostly well-known for affecting respiratory pathology, it can also result in several extrapulmonary manifestations, leading to multiorgan damage. A recent reported case of SARS-CoV-2 myocarditis with cardiogenic shock showed a signature of myocardial and kidney ferroptosis, a novel, iron-dependent programmed cell death. The term ferroptosis was coined in the last decade to describe the form of cell death induced by the small molecule erastin. As a specific inducer of ferroptosis, erastin inhibits cystine-glutamate antiporter system Xc-, blocking transportation into the cytoplasm of cystine, a precursor of glutathione (GSH) in exchange with glutamate and the consequent malfunction of GPX4. Ferroptosis is also promoted by intracellular iron overload and by the iron-dependent accumulation of polyunsaturated fatty acids (PUFA)-derived lipid peroxides. Since depletion of GSH, inactivation of GPX4, altered iron metabolism, and upregulation of PUFA peroxidation by reactive oxygen species are peculiar signs of COVID-19, there is the possibility that SARS-CoV-2 may trigger ferroptosis in the cells of multiple organs, thus contributing to multiorgan damage. Here, we review the molecular mechanisms of ferroptosis and its possible relationship with SARS-CoV-2 infection and multiorgan damage. Finally, we analyze the potential interventions that may combat ferroptosis and, therefore, reduce multiorgan damage.
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Lung Ultrasound for Imaging of B-Lines in Dogs and Cats-A Prospective Study Investigating Agreement between Three Types of Transducers and the Accuracy in Diagnosing Cardiogenic Pulmonary Edema, Pneumonia and Lung Neoplasia.
Animals (Basel)2021 Nov;11(11):. doi: 3279.
?obaczewski Andrzej, Czopowicz Micha?, Moroz Agata, Mickiewicz Marcin, Stabi?ska Marta, Petelicka Hanna, Frymus Tadeusz, Szalu?-Jordanow Olga,
Abstract
Transthoracic heart and lung ultrasound (LUS) was performed in 200 dogs and cats with dyspnea to evaluate the agreement between the results obtained using three types of transducers (microconvex, linear, and phased array) and to determine the accuracy of LUS in discriminating between three conditions commonly causing dyspnea in companion animals: cardiogenic pulmonary edema (CPE), pneumonia, and lung neoplasm. The agreement beyond chance was assessed using the weighted Cohen's kappa coefficient (?). The highest values of ? (>0.9) were observed for the pair of microconvex and linear transducers. To quantify B-lines the lung ultrasound score (LUS) was developed as a sum of points describing the occurrence of B-lines for each of 8 standardized thoracic locations. The accuracy of LUS was determined using the area under ROC curve (AUROC). In dogs AUROC of LUS was 75.9% (CI 95%: 65.0% to 86.8%) for distinguishing between lung neoplasms and the two other causes of dyspnea. In cats AUROC of LUS was 83.6% (CI 95%: 75.2% to 92.0%) for distinguishing between CPE and the two other causes of dyspnea. The study shows that results obtained with microconvex and linear transducers are highly consistent and these two transducers can be used interchangeably. Moreover, the LUS may help identify dogs with lung neoplasms and cats with CPE, however its diagnostic accuracy is only fair to moderate.
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Percutaneous angio-guided versus surgical veno-arterial ECLS implantation in patients with cardiogenic shock or cardiac arrest.
Resuscitation2021 Nov;():. doi: S0300-9572(21)00473-1.
Saiydoun Gabriel, Gall Emmanuel, Boukantar Madjid, Fiore Antonio, Mongardon Nicolas, Masi Paul, Bagate François, Radu Costin, Bergoend Eric, Mangiameli Andrea, de Roux Quentin, Mekontso Dessap Armand, Langeron Olivier, Folliguet Thierry, Teiger Emmanuel, Gallet Romain,
Abstract
BACKGROUND:
Veno-arterial Extracorporeal Life Support (V-A ECLS) has gained increasing place into the management of patients with refractory cardiogenic shock or cardiac arrest. Both surgical and percutaneous approach can be used for cannulation, but percutaneous approach has been associated with fewer complications. Angio-guided percutaneous cannulation and decannulation may further decrease the rate of complication. We aimed to compare outcome and complication rates in patients supported with V-A ECLS through percutaneous angio-guided versus surgical approach.
METHODS:
We included all patients with emergent peripheral femoro-femoral V-A ECLS implantation for refractory cardiogenic shock or cardiac arrest in our center from March 2018 to March 2021. Survival and major complications (major bleeding, limb ischemia and groin infection) rates were compared between the percutaneous angio-guided and the surgical groups.
RESULTS:
One hundred twenty patients received V-A ECLS, 59 through surgical approach and 61 through angio-guided percutaneous approach. Patients' baseline characteristics and severity scores were equally balanced between the 2 groups. Thirty-day mortality was not significantly different between the 2 approaches. However, angio-guided percutaneous cannulation was associated with fewer major vascular complications (42% vs. 11%, p>0.0001) and a higher rate of V-A ECLS decannulation. In multivariate analysis, percutaneous angio-guided implantation of V-A ECLS was independently associated with a lower probability of major complications.
CONCLUSION:
Compared to surgical approach, angio-guided percutaneous V-A ECLS implantation is associated with fewer major vascular complications. Larger studies are needed to confirm those results and address their impact on mortality.
Copyright © 2021 Elsevier B.V. All rights reserved.
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Computational and in vitro validation of cardiogenic induction of quercetin on adipose-derived mesenchymal stromal cells through the inhibition of Wnt and non-Smad-dependent TGF-? pathways.
J Cell Biochem2021 Nov;():. doi: 10.1002/jcb.30189.
Azadian Zahra, Hosseini Saadi, Dizjikan Zohre Panahi, Kazemi Javad, Marzouni Eisa Tahmasbpour, Wang Peng-Yuan, Alipour Atefeh, Shahsavarani Hosein,
Abstract
Exploiting human mesenchymal stem cells (hMSCs) was proposed as a promising therapeutic approach for cardiovascular disease due to their capacity to differentiate into cardiac cells. Though modulation of the intracellular signaling pathways dominantly WNT/? catenin and transforming growth factor-? (TGF-?) have been reported to promote differentiation of hMSCs into cardiomyocytes in the prevailing literature, a safe and reproducible system for their clinical application has not yet turned into reality. In the present study, the molecular docking-based strategy was first applied for evaluating the potency of some natural phenolic compounds in the modulation of Wnt and TGF-? signaling pathways using a vital class of crystallographic protein structures of WNT signaling regulators such as Frizzled, Disheveled, GSK3-?, ?-catenin, LRP 5/6 extracellular domain, Tankyrase and their variety of active pockets. Then, the impacts of plant-derived chemical compounds on the regulation of the relevant signals for the differentiation of hMSCs into the definitive mesoderm lineage and cardiac progenitors were assessed in vitro. Data obtained revealed the synergistic activity of Wnt and TGF-? superfamily to direct cardiac differentiation in human cardiogenesis by comparing cardiac gene expression in the presence and absence of the TGF-? inhibitors. We found that the inhibitory effect of canonical Wnt/?-catenin is sufficient to cause proper cardiomyocyte differentiation, but the TGF-? pathway plays a vital role in enhancing the expression of the cardiomyocyte-specific marker (cTnT). It was found that quercetin, a p38MAPK inhibitor with the high energy dock to the active pocket of Wnt receptors, promotes cardiac differentiation via the inhibition of both Wnt and non-Smad TGF-? pathways. Altogether, data presented here can contribute to the development of a feasible and efficient cardiac differentiation protocol as an "off-the-shelf" therapeutic source using novel natural agents for cardiac repair or regeneration.
© 2021 Wiley Periodicals LLC.
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Left ventricular unloading before percutaneous coronary intervention is associated with improved survival in patients with acute myocardial infarction complicated by cardiogenic shock: A systematic review and meta-analysis.
Cardiovasc Revasc Med2021 Nov;():. doi: S1553-8389(21)00717-X.
Miyashita Satoshi, Banlengchit Run, Marbach Jeffrey A, Chweich Haval, Kawabori Masashi, Kimmelstiel Carey D, Kapur Navin K,
Abstract
BACKGROUND:
Left ventricular unloading with Impella may improve survival outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). However, the optimal timing to initiate left ventricular unloading has yet to be established. Therefore, we conducted a systematic review and meta-analysis to compare survival in patients with AMI-CS who were supported with Impella prior to PCI (pre-PCI) to those in whom support was initiated following PCI (post-PCI).
METHODS:
All studies that evaluated the impact of pre-PCI versus post-PCI Impella placement in patients with AMI-CS were included. Primary endpoints included in-hospital, 30-day, and 6-month survival rates.
RESULTS:
We identified five observational studies comparing outcomes in 432 patients with AMI-CS, of which 173 patients were treated with Impella pre-PCI and 259 patients post-PCI. Patients in the pre-PCI group had lower in-hospital mortality compared to patients in the post-PCI group (RR 0.62, 95% CI: 0.50-0.76, I = 0%). The lower mortality rate in the pre-PCI group remained evident at 30 days (HR 0.60, 95% CI: 0.47-0.78, I = 0%) and at 6 months (HR 0.66, 95% CI: 0.44-0.97, I = 0%). There was no difference in the risk of adverse events including reinfarction, stroke, major bleeding, acute ischemic limb, access site bleeding, and hemolysis.
CONCLUSIONS:
In this meta-analysis of studies evaluating survival among AMI-CS patients with left ventricular unloading initiated pre- versus post-PCI, Impella placement prior to PCI was associated with improved survival.
Copyright © 2021 Elsevier Inc. All rights reserved.
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Acute myocardial infarction and cardiogenic shock Interventional approach to management in the cardiac catheterization laboratories.
Curr Cardiol Rev2021 Nov;():. doi: 10.2174/1573403X17666211125090929.
Tehrani Behnam N, Damluji Abdulla A, Batchelor Wayne B,
Abstract
Despite advances in early reperfusion and a technologic renaissance in the space of mechanical circulatory support (MCS), cardiogenic shock (CS) remains the leading cause of in-hospital mortality following acute myocardial infarction (AMI). Given the challenges inherent to conducting adequately powered randomized controlled trials in this time-sensitive, hemodynamically complex, and highly lethal syndrome, treatment recommendations have been derived from AMI patient without shock. In this review, we aimed to (1) examine the pathophysiology and the new classification system for CS; (2) provide a comprehensive evidence-based review for best practices for interventional management of AMI-CS in the cardiac catheterization laboratory; and (3) highlight the concept of how frailty and geriatric syndromes can be integrated in the decision process and where medical futility lies in the spectrum of AMI-CS care. Management strategies in the cardiac catheterization laboratory for CS include optimal vascular access, periprocedural antithrombotic therapy, culprit lesion versus multi-vessel revascularization, selective utilization of hemodynamic MCS tailored to individual shock hemometabolic profiles, and management of cardiac arrest. Efforts to advance clinical evidence for patients with CS should be concentrated on (1) the coordination of multi-center registries; (2) development of pragmatic clinical trial designed to evaluate innovative therapies; (3) establishment of multidisciplinary care models that will inform quality care and improve clinical outcomes.
Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.
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Current interventional therapies in acute pulmonary embolism.
Prog Cardiovasc Dis2021 Nov;():. doi: S0033-0620(21)00128-6.
Jamil Alisha, Johnston-Cox Hillary, Pugliese Steven, Nathan Ashwin S, Fiorilli Paul, Khandhar Sameer, Weinberg Mitchell D, Giri Jay, Kobayashi Taisei,
Abstract
Pulmonary embolism (PE) is the third leading cause of cardiovascular mortality. The management of PE is currently evolving given the development of new technologies and team-based approaches. This document will focus on risk stratification of PEs, review of the current interventional therapies, the role of clinical endpoints to assess the effectiveness of different interventional therapies, and the role for mechanical circulatory support in the complex management of this disease.
Copyright © 2021. Published by Elsevier Inc.
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[Acute Coronary Syndrome (ACS) in Preclinical Emergency Medicine].
Anasthesiol Intensivmed Notfallmed Schmerzther2021 Dec;56(11-12):734-745. doi: 10.1055/a-1330-5226.
Schieffer Bernhard, Kreutz Julian, Markus Birgit, Schäfer Ann-Christin,
Abstract
Acute coronary syndrome (ACS) is a common diagnosis in preclinical emergency medicine. The term summarizes the acute manifestations of coronary artery disease. It ranges from unstable angina pectoris via cardiogenic shock to sudden cardiac death. The leading key symptom is chest pain. With this trigger symptom, a clinical diagnostic algorithm is initiated, acting quickly on the suspected diagnosis of acute myocardial infarction. Due to the potentially life-threatening course, rapid diagnosis and initiation of therapeutic measures is crucial. Pre-clinical antithrombotic medication and therapy for accompanying symptoms are paramount. As part of the initial assessment, important differential diagnoses should be considered and, within the first 10 minutes after medical contact, an ECG diagnosis should differentiate between ACS with and without ST segment elevations. If ACS is diagnosed, acetylsalicylic acid should be given to inhibit platelet aggregation. The benefits outweigh the very low risk of unnecessary administration. Patients with ACS should be taken to hospital immediately for coronary interventions (PCI). In the case of an ACS with ST segment elevations, reperfusion therapy should be carried out within 120 minutes. In the case of an ACS without ST segment elevations, the time limit (2?-?72?h) until reperfusion is based on the risk stratification. In the majority of cases, the coronary stenosis causing the infarction can be treated with PCI. However, invasive diagnostics show no significant stenosis in a significant proportion of patients with myocardial infarction (prevalence 1?-?14%). This is known as "myocardial infarction with non-obstructive coronary arteries" (MINOCA) and further differential diagnosis should be initiated in these patients.
Thieme. All rights reserved.
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Bilevel positive airway pressure ventilation for non-COPD acute hypercapnic respiratory failure patients: A systematic review and meta-analysis.
Ann Thorac Med;16(4):306-322. doi: 10.4103/atm.atm_683_20.
Faqihi Bandar M, Trethewey Samuel P, Morlet Julien, Parekh Dhruv, Turner Alice M,
Abstract
The effectiveness of bi-level positive airway pressure (BiPAP) in patients with acute hypercapnic respiratory failure (AHRF) due to etiologies other than chronic obstructive pulmonary disease (COPD) is unclear. To systematically review the evidence regarding the effectiveness of BiPAP in non-COPD patients with AHRF. The Cochrane Library, MEDLINE, EMBASE, and CINAHL Plus were searched according to prespecified criteria (PROSPERO-CRD42018089875). Randomized controlled trials (RCTs) assessing the effectiveness of BiPAP versus continuous positive airway pressure (CPAP), invasive mechanical ventilation, or O therapy in adults with non-COPD AHRF were included. The primary outcomes of interest were the rate of endotracheal intubation (ETI) and mortality. Risk-of-bias assessment was performed, and data were synthesized and meta-analyzed where appropriate. Two thousand four hundred and eighty-five records were identified after removing duplicates. Eighty-eight articles were identified for full-text assessment, of which 82 articles were excluded. Six studies, of generally low or uncertain risk-of-bias, were included involving 320 participants with acute cardiogenic pulmonary edema (ACPO) and solid tumors. No significant differences were seen between BiPAP ventilation and CPAP with regard to the rate of progression to ETI (risk ratio [RR] = 1.49, 95% confidence interval [CI], 0.63-3.62, = 0.37) and in-hospital mortality rate (RR = 0.71, 95% CI, 0.25-1.99, = 0.51) in patients with AHRF due to ACPO. The efficacy of BiPAP appears similar to CPAP in reducing the rates of ETI and mortality in patients with AHRF due to ACPO. Further research on other non-COPD conditions which commonly cause AHRF such as obesity hypoventilation syndrome is needed.
Copyright: © 2021 Annals of Thoracic Medicine.
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Predictors of mortality following extracorporeal membrane oxygenation support in an unselected, critically ill patient population.
Postepy Kardiol Interwencyjnej2021 Sep;17(3):290-297. doi: 10.5114/aic.2021.109149.
Édes István Ferenc, Németh Balázs Tamás, Hartyánszky István, Szilveszter Bálint, Kulyassa Péter, Fazekas Levente, Pólos Miklós, Németh Endre, Becker Dávid, Merkely Béla,
Abstract
Introduction:
Mechanical circulatory support (MCS) has been established as a means of augmenting circulation in patients with critically decreased systolic function due to a variety of underlying clinical reasons. Different methods of MCS may be used, with the venous-arterial extracorporeal membrane oxygenation system (VA-ECMO) being one of the most utilized devices in everyday care.
Aim:
To determine independent predictors influencing mortality outcomes following VA-ECMO therapy in a large, unselected, adult, critically ill patient population in cardiogenic shock (CS).
Material and methods:
Data on 235 consecutive, real-world VA-ECMO treatments were assessed. Analysis was conducted for all subjects requiring MCS with the VA-ECMO as the first instalment, regardless of underlying cause or eventual upgrade. All potential clinical factors influencing mortality were examined and evaluated.
Results:
Overall mortality was ~66% at median 28 days follow-up and significantly depended upon pH
Conclusions:
Mortality in patients requiring VA-ECMO remains high. We conclude that only decreased pH values and advanced age clearly influence mortality in this MCS scenario. ACS also bodes unfavorably, whereas hTX as an indication clearly shows better survival.
Copyright: © 2021 Termedia Sp. z o. o.
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Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock. Reply.
N Engl J Med2021 Nov;385(22):2108-2109. doi: 10.1056/NEJMc2114890.
Mathew Rebecca, Di Santo Pietro, Hibbert Benjamin,
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Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock.
N Engl J Med2021 Nov;385(22):2108. doi: 10.1056/NEJMc2114890.
Gibson Lauren E, Chang Marvin G, Berra Lorenzo,
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Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock.
N Engl J Med -
Predictors of Complications Secondary to Infective Endocarditis and Their Associated Outcomes: A Large Cohort Study from the National Emergency Database (2016-2018).
Infect Dis Ther2021 Nov;():. doi: 10.1007/s40121-021-00563-y.
Mir Tanveer, Uddin Mohammed, Qureshi Waqas T, Regmi Neelambuj, Tleyjeh Imad M, Saydain Ghulam,
Abstract
INTRODUCTION:
Literature regarding outcomes and predictors of complications secondary to infective endocarditis (IE) is limited. We aimed to study the outcomes and predictors of complications of IE.
METHODS:
Data from a national emergency department sample, which constitutes 20% sample of hospital-owned emergency departments in the USA, were analyzed for hospital visits for IE. Complications of endocarditis were obtained by using ICD codes. Multivariable generalized linear method was used to evaluate predictors of in-hospital mortality and complications.
RESULTS:
Out of 255,838 adult IE patients (mean age 60.3?±?20.1 years, 48.5% females), 97,803 (38.2%) patients developed one or more major complications. The major complications were cardiovascular system complications [57,900 (22.6%)], neurologic [42,851 (16.7%)] complications, and renal [16,236 (6.4%)] complications. These included cardiogenic shock [3873 (1.5%)], septic shock [25,798 (10.1%)], acute heart failure [35,602 (14%)], systemic thromboembolism (STE) [21,390 (8.36%)], heart block [11,430 (4.47%)], in-hospital dialysis [2880 (1.1%)], and disseminated intravascular coagulation (DIC) [2704 (1.1%)]. Patients with complicated IE had risk of mortality (adjusted RR 1.12, 95% CI 1.11-1.13, p?0.001). The complications strongly associated with mortality were septic shock (RR 1.29, 95% CI 1.27-1.30, p?0.001), cardiogenic shock (RR 1.24, 95% CI 1.20-1.29, p?0.001), DIC (RR 1.4, 95% CI 1.35-1.46, p?0.001), and STE (RR 1.07, 95% CI 1.05-1.08, p?0.001). Staphylococci were the predominant causative organisms (30.8%) among the complicated IE subgroups with higher associated mortality (42.8%). The main predictors of complications from IE were congenital heart disease, history of congestive heart failure, high Elixhauser comorbidity profile, staphylococcal infection, and fungal infections. The prevalence of cardiogenic shock increased over the study years from 1.13 to 1.98% (p-trend 0.04).
CONCLUSION:
Complicated IE is not uncommon and is associated with significant mortality. Staphylococcal infections were associated with high mortality rates. There has been an increasing trend of cardiogenic shock among IE patients across the US. Further research is needed to improve the outcomes of complicated endocarditis.
© 2021. The Author(s).
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Safety of Intravenous Cangrelor Administration for Antiplatelet Bridging in Hospitalized Patients: A Retrospective Study.
J Invasive Cardiol2021 Nov;():. doi: JIC20211124-1.
Johnson Bryce V, Horton Edward R, Domenico Christopher, Nathan Ashwin S, Fanaroff Alexander C, Acker Michael A, Kolansky Daniel M,
Abstract
OBJECTIVE:
We aimed to characterize outcomes associated with cangrelor administration used in an antiplatelet bridging strategy in real-world clinical scenarios within a large academic medical system.
BACKGROUND:
Cangrelor has been used for antiplatelet bridging in perioperative settings or for patients unable to take oral medications. Prior studies in these settings have reported bleeding rates from 0%-40%.
METHODS:
Patients were retrospectively identified via chart review and included if they were over 18 years old, had coronary or peripheral arterial stents, and had received at least 1 hour of cangrelor infusion during inpatient admission. The primary endpoint was Bleeding Academic Research Consortium (BARC) 3-5 bleeding during cangrelor infusion or within 48 hours of discontinuation; secondary endpoints were bleeding events defined by Thrombolysis in Myocardial Infarction (TIMI), Global Use of Strategies to Open Occluded Arteries (GUSTO), and International Society on Thrombosis and Hemostasis (ISTH) criteria, as well as BARC 2 bleeding.
RESULTS:
Thirty-one patients met the inclusion criteria. Cangrelor indications were bridging to procedure in 22 patients (71.0%) and inability to take oral P2Y12 inhibitors in 9 patients (29.0%). Twenty-three patients (74.2%) were men, 11 patients (35.5%) were in cardiogenic shock, and 4 patients (12.9%) were on extracorporeal membrane oxygenation (ECMO) at the time of administration. No patients received cangrelor for routine percutaneous coronary intervention. Of the 31 patients, 13 (41.9%) had BARC 3-5 bleeding and 7 (22.6%) expired during hospitalization. All 4 patients on ECMO suffered BARC 3-5 bleeding.
CONCLUSIONS:
We reviewed the use of cangrelor for antiplatelet bridging in real-world clinical scenarios and observed higher rates of clinically significant bleeding than seen in other similar studies. Our study suggests careful consideration when using cangrelor in a sick patient population.
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Incidence and Long-Term Outcomes of Stroke in Patients Presenting With ST-Segment Elevation-Myocardial Infarction: Insights From the Midwest STEMI Consortium.
J Am Heart Assoc2021 Nov;():e022489. doi: 10.1161/JAHA.121.022489.
Megaly Michael, Yildiz Mehmet, Tannenbaum Edward, Okeson Brynn, Dworak Marshall W, Garberich Ross, Sharkey Scott, Aguirre Frank, Tannenbaum Mark, Smith Timothy D, Henry Timothy D, Garcia Santiago,
Abstract
Background Contemporary real-world data on stroke in patients presenting with ST-segment-elevation myocardial infarction (STEMI) are scarce. Methods and Results We evaluated the incidence, trends, cause, and predictors of stroke from 2003 to 2019 in 4 large regional STEMI programs in the upper Midwest that use similar transfer and treatment protocols. We also evaluated the long-term impact of stroke on 5-year mortality. Multivariate logistic and Cox regression analysis was used to identify variables independently associated with stroke in patients presenting with STEMI and identify variables associated with 5-year mortality. A total of 12 868 patients presented with STEMI during the study period. Stroke occurred in 98 patients (0.76%). The incidence of stroke remained stable over time (0.5% in 2003, 1.2% in 2019; -trend=0.22). Most (75%) of strokes were ischemic, with a median time to stroke symptoms of 14 hours after primary percutaneous coronary intervention (interquartile range, 4-72 hours), which led to a small minority (3%) receiving endovascular treatment and high in-hospital mortality (18%). On multivariate regression analysis, age (increment of 10 years) (odds ratio [OR], 1.32; 95% CI, 1.10-1.58; -value=0.003) and preintervention cardiogenic shock (OR, 2.03; (95% CI, 1.03-3.78; =0.032)) were associated with a higher risk of in-hospital stroke. In-hospital stroke was independently associated with increased risk of 5-year mortality (hazard ratio, 2.01; 95% CI, 1.13-3.57; =0.02). Conclusions In patients presenting with STEMI, the risk of stroke is low (0.76%). A stroke in patients presenting with STEMI is associated with significantly higher in-hospital (18%) and long-term mortality (35% at 5 years). Stroke was associated with double the risk of 5-year death.
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Effect of Timing of Staged Percutaneous Coronary Intervention on Clinical Outcomes in Patients With Acute Coronary Syndromes.
J Am Heart Assoc2021 Nov;():e023129. doi: 10.1161/JAHA.121.023129.
Otsuka Tatsuhiko, Bär Sarah, Losdat Sylvain, Kavaliauskaite Raminta, Ueki Yasushi, Zanchin Christian, Lanz Jonas, Praz Fabien, Häner Jonas, Siontis George C M, Zanchin Thomas, Stortecky Stefan, Pilgrim Thomas, Windecker Stephan, Räber Lorenz,
Abstract
Background Complete revascularization reduces cardiovascular events in patients with acute coronary syndromes (ACSs) and multivessel disease. The optimal time point of non-target-vessel percutaneous coronary intervention (PCI) remains a matter of debate. The aim of this study was to investigate the impact of early (
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Neurological outcomes of out-of-hospital cardiac arrest occurring in Tokyo train and subway stations.
Resusc Plus2021 Dec;8():100175. doi: 10.1016/j.resplu.2021.100175.
Miyako J, Nakagawa K, Sagisaka R, Tanaka S, Takeuchi H, Takyu H, Tanaka H,
Abstract
Objectives:
The purpose of this study was to identify a relationship between the background environment, bystander and emergency medical services intervention, and favourable neurological outcomes (CPC1-2) one-month after out-of-hospital cardiac arrest (OHCA) occurred at Tokyo train and subway stations.
Methods:
This retrospective observational study used OHCA data between 2014 and 2018 that occurred at train stations in Tokyo. The eligible 954 patients were analysed for correlation between background, time frame, and location. Multivariable logistic regression models were used to estimate factors associated with CPC1-2 in patients with cardiogenic OHCA.
Results:
A total of 886 OHCA cases, cardiogenic (n=562) and non-cardiogenic (n=324), met the inclusion criteria. Of the cardiogenic cases, 71.9% occurred at the platform and on-a-train. One-month CPC1-2 was achieved in 32.0% of cardiogenic OHCAs, which included 47.3% during morning rush hour, 24.7% during daytime hours, 40.2% during evening rush hour, and 20.5% during night-time/early morning hours. CPC1-2 had significant correlation with morning rush hour (adjusted odds ratio [AOR],4.52; 95% confidence interval [CI], 1.09-18.78), evening rush hour (AOR, 6.85; 95% CI, 1.51-31.15), public access defibrillation (AOR, 5.19; 95% CI, 1.38-19.51), and ventricular fibrillation or pulseless ventricular tachycardia (AOR, 7.56; 95% CI, 1.35-42.43).
Conclusion:
A total of 71.9% of cardiogenic OHCAs occurred at platforms and on trains. To improve neurological outcomes of OHCAs at stations, AED installations on train platforms are necessary. Additionally, using artificial intelligence-based platform monitoring for early detection of OHCAs and offering CPR training are required.
© 2021 The Author(s).
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Lipopolysaccharide induces pyroptosis through regulation of autophagy in cardiomyocytes.
Cardiovasc Diagn Ther2021 Oct;11(5):1025-1035. doi: 10.21037/cdt-21-293.
He You-Fu, Huang Jing, Qian Yu, Liu De-Bin, Liu Qi-Fang,
Abstract
Background:
Autophagy, a stress response in eukaryotic cells, is closely related to cardiogenic diseases. Pyroptosis, a newly discovered way of programmed cell death, also plays an important role in cardiovascular disease. However, the role and relationship of autophagy and pyroptosis in lipopolysaccharide (LPS)-induced inflammatory response of cardiomyocytes were still unclear.
Methods:
Western blot was performed to determine the expression of poly ADP-ribosepolmesera-1 (PARP-1), LC3B, NLRP3 and GSDMD in cardiomyocytes after the treatment of LPS. Transfection of si-LC3B, western blot and immunofluorescence (IF) staining were performed to investigate the role of autophagy in LPS-induced pyroptosis. Co-immunoprecipitation (Co-IP) assays and quantitative real-time PCR (qRT-PCR) were conducted to explore whether PARP-1 binding to LC3B and modulating its expression. Transfections of si-PARP-1, western blot and IF were carried out to confirm the role of PARP-1 in the regulation of LPS-induced pyroptosis by autophagy.
Results:
LPS induces autophagy and pyroptosis in cardiomyocytes, enhanced the level of autophagy and inhibited the level of pyroptosis in the concentration of 4 µg/mL. We further proved that autophagy inhibits LPS-induced pyroptosis in cardiomyocytes. In addition, PARP-1 binding to LC3B and regulate the expression of LC3B. Finally, we proved that knockdown of PARP-1 rescued the inhibition of autophagy on LPS-induced pyroptosis of cardiomyocytes.
Conclusions:
LPS induces pyroptosis through regulation of autophagy via PARP-1 at a specific concentration, above which it causes deposition of autophagy flow to promote pyroptosis. Inhibiting LPS-induced pyroptosis could be a promising therapeutic target in treating cardiovascular diseases.
2021 Cardiovascular Diagnosis and Therapy. All rights reserved.
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Non-Surgical Resolution of Inflow Cannula Obstruction of a Left Ventricular Assist Device: A Case Report.
J Chest Surg2021 Nov;():. doi: 10.5090/jcs.21.075.
Lee Yoonseo, Sung Kiick, Kim Wook Sung, Jeong Dong Seop, Shinn Sung Ho, Cho Yang Hyun,
Abstract
A 55-year-old woman who had received an implantable left ventricular assist device 3 months earlier presented with dyspnea and a low-flow alarm of the device. Computed tomography and log-file analysis of the device system suggested inflow cannula obstruction. Since the patient had cardiogenic shock due to pump failure, venoarterial extracorporeal membrane oxygenation (ECMO) was initiated. With ECMO, surgical exchange of the pump was considered. However, the obstruction spontaneously resolved without surgical intervention. It turned out that an obstructive thrombus was washed out by rebooting the pump. Moreover, the thrombus was embolized in the patient's left subclavian artery. The patient underwent heart transplantation 4 months after the pump obstruction accident and continued to do well.
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