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Pubblicazioni recenti - cardiogenic
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Circular RNA UBAP2 (hsa_circ_0007367) Correlates with Microcirculatory Perfusion and Predicts Outcomes of Cardiogenic Shock Patients Undergoing Extracorporeal Membrane Oxygenation Support.
Shock2022 Jun;57(6):200-210. doi: 10.1097/SHK.0000000000001937.
Li Jiani, Yu Zhexuan, Zeng Jianfeng, Liu Zhaoyuan, Zhao Zongkai, Zhang Yu, Li Guanhua,
Abstract
BACKGROUND:
Severe microcirculatory disturbance is common in patients with cardiogenic shock necessitating extracorporeal membrane oxygenation (ECMO), however, biomarkers linked to microcirculation and clinical outcome are scarce. Herein we identified a circular RNA, hsa_circ_0007367, rooted from the ubiquitin-associated protein 2 (UBAP2) gene, namely circUBAP2, and evaluated its biological function and the associations with microcirculation and the prognosis.
METHODS:
Patients on ECMO with cardiogenic shock were included if qualified sublingual microcirculation parameters could be obtained and were categorized into the survivor group or non-survivor group. Macro-circulatory, microcirculatory data, cytokine levels, and relative circUBAP2 expressions were collected before, at 24?h, and at ECMO weaning off, respectively. The effects of circUBAP2 on the migration, polarization, cytokine productions, and inflammatory pathways in macrophage NR8383 cells were investigated using in vitro methods.
RESULTS:
Thirty-three patients with an average age of 58.0?years were enrolled, including 19 survivors and 14 non-survivors. The survivors had higher small vessel density, perfused small vessel density (PSVD), and microvascular flow index (MFI) throughout the ECMO course than did the non-survivors. Relative expression of circUBAP2 (hsa_circ_0007367) correlated with the microcirculatory parameters and satisfactorily predicted the 30-day in-hospital mortality. A multivariable logistic model was developed, showing following four predictors: age (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.00-1.12), time from shock to ECMO (OR 1.10, 95% CI 1.01-1.20), PVSD (OR 0.14, 95% CI 0.02-0.89), and the circUBAP2 expression (OR 0.25, 95% CI 0.08-0.78). In addition, circUBAP2 inhibited the migratory activity and promoted M2 polarization in macrophages, declining the productions of cytokines (tumor necrosis factor [TNF]-?, interleukin [IL]-1?, and monocyte chemotactic protein [MCP]-1) and the PI3K/Akt/mTOR pathway.
CONCLUSION:
The expression of circUBAP2 correlates with microcirculatory perfusion and has the potential in predicting outcomes for on-ECMO patients with cardiogenic shock.
Copyright © 2022 by the Shock Society.
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Outcomes in cardiogenic shock: the role of surrogate endpoints.
Curr Opin Crit Care2022 Jun;():. doi: 10.1097/MCC.0000000000000963.
Kosyakovsky Leah B, Marbach Jeffrey A, Nguyen Khoa, Mukundan Srini, Chweich Haval, Kapur Navin K,
Abstract
PURPOSE OF REVIEW:
Early revascularization, invasive hemodynamic profiling, and initiation of temporary mechanical circulatory support (MCS) have all become routine components of cardiogenic shock (CS) management. Despite this evolution in clinical practice, patient selection and timing of treatment initiation remain a significant barrier to achieving sustained improvement in CS outcomes. Recent efforts to standardize CS management, through the development of treatment algorithms, have relied heavily on surrogate endpoints to drive therapeutic decisions. The present review aims to provide an overview of the basis of evidence for those surrogate endpoints commonly employed in clinical trials and CS management algorithms.
RECENT FINDINGS:
Recent publications from both observational and randomized cohorts have demonstrated the utility of surrogate endpoints in risk stratifying patients with CS. In particular, invasive hemodynamics using pulmonary artery catheters to guide initiation and weaning of MCS, biochemical markers that portend imminent end-organ failure, and clinical risk scores that combine multiple hemodynamic and laboratory parameters have demonstrated an ability to prognosticate outcomes in patients with CS.
SUMMARY:
Although further validation is necessary, multiple clinical, hemodynamic, and biochemical markers have demonstrated utility as surrogate endpoints in CS, and will undoubtedly assist physicians in clinical decision-making.
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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Surgical Treatment Following Stent Angioplasty for High-Risk Neonates With Critical Coarctation of the Aorta.
World J Pediatr Congenit Heart Surg2022 Jul;13(4):426-435. doi: 10.1177/21501351221099933.
Grieshaber Philippe, Merbecks Moritz, Jaschinski Christoph, Fonseca Elizabeth, Arnold Raoul, Karck Matthias, Gorenflo Matthias, Loukanov Tsvetomir,
Abstract
BACKGROUND:
Neonatal coarctation of the aorta (CoA) is primarily treated by surgical repair. However, under certain high-risk constellations, initial stent angioplasty may be considered followed by surgical repair. We report our experience with this staged approach. All patients undergoing surgical CoA repair following prior stenting at our institution between January 2011 and December 2019 were included in this retrospective analysis. The patients were classified to be at high risk because of cardiogenic shock, associated complex cardiac malformations, neonatal infection, necrotizing enterocolitis, and extracardiac conditions, respectively. Outcomes were analyzed and compared with neonates who underwent surgical CoA repair without prior stenting in the same observation period.
RESULTS:
Twenty-six neonates received stent implantation at a median age of 20 days (IQR 9-33 days). Subsequent surgical repair was conducted at an age of 4.2 months (IQR 3.2-6.1 months) with a median body weight of 5.6?kg (IQR 4.5-6.5?kg). Cardiopulmonary bypass was applied in 96% of cases. Extended end-to-end anastomosis was possible in 11 patients. Extended reconstruction with patch material was necessary in the remaining patients. One fatality (3.8%) occurred 33 days postoperatively. At a median follow-up of 5.2 years after initial stenting, all remaining patients were alive; 15/25 patients (60%) were free from re-intervention. Of note, re-intervention rates were comparable in neonates (n?=?76) who were operated on with native CoA (28/74 patients; 38%; ?=?.67).
CONCLUSIONS:
Neonatal stent angioplasty for CoA results in increased complexity of the subsequent surgical repair. Nevertheless, this staged approach allows to bridge high-risk neonates to later surgical repair with reduced perioperative risk and acceptable midterm outcomes.
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Investigating the Paracrine Role of Perinatal Derivatives: Human Amniotic Fluid Stem Cell-Extracellular Vesicles Show Promising Transient Potential for Cardiomyocyte Renewal.
Front Bioeng Biotechnol2022 ;10():902038. doi: 10.3389/fbioe.2022.902038.
Costa Ambra, Balbi Carolina, Garbati Patrizia, Palamà Maria Elisabetta Federica, Reverberi Daniele, De Palma Antonella, Rossi Rossana, Paladini Dario, Coviello Domenico, De Biasio Pierangela, Ceresa Davide, Malatesta Paolo, Mauri Pierluigi, Quarto Rodolfo, Gentili Chiara, Barile Lucio, Bollini Sveva,
Abstract
Cardiomyocyte renewal represents an unmet clinical need for cardiac regeneration. Stem cell paracrine therapy has attracted increasing attention to resurge rescue mechanisms within the heart. We previously characterized the paracrine effects that human amniotic fluid-derived stem cells (hAFSC) can exert to provide cardioprotection and enhance cardiac repair in preclinical models of myocardial ischemia and cardiotoxicity. Here, we analyze whether hAFSC secretome formulations, namely, hAFSC conditioned medium (hAFSC-CM) over extracellular vesicles (hAFSC-EVs) separated from it, can induce cardiomyocyte renewal. c-KIT+ hAFSC were obtained by leftover samples of II trimester prenatal amniocentesis (fetal hAFSC) and from clinical waste III trimester amniotic fluid during scheduled C-section procedures (perinatal hAFSC). hAFSC were primed under 1% O to enrich hAFSC-CM and EVs with cardioactive factors. Neonatal mouse ventricular cardiomyocytes (mNVCM) were isolated from cardiac tissue of R26pFUCCI2 mice with cell cycle fluorescent tagging by mutually exclusive nuclear signal. mNVCM were stimulated by fetal versus perinatal hAFSC-CM and hAFSC-EVs to identify the most promising formulation for assessment in a R26pFUCCI2 neonatal mouse model of myocardial infarction (MI) intraperitoneal delivery. While the perinatal hAFSC secretome did not provide any significant cardiogenic effect, fetal hAFSC-EVs significantly sustained mNVCM transition from S to M phase by 2-fold, while triggering cytokinesis by 4.5-fold over vehicle-treated cells. Treated mNVCM showed disorganized expression of cardiac alpha-actinin, suggesting cytoskeletal re-arrangements prior to cell renewal, with a 40% significant downregulation of and a positive trend of polymerized F-Actin. Fetal hAFSC-EVs increased cardiomyocyte cell cycle progression by 1.8-fold in the 4-day-old neonatal left ventricle myocardium short term after MI; however, such effect was lost at the later stage. Fetal hAFSC-EVs were enriched with a short isoform of Agrin, a mediator of neonatal heart regeneration acting by YAP-related signaling; yet application of YAP inhibitor verteporfin partially affected EV paracrine stimulation on mNVCM. EVs secreted by developmentally juvenile fetal hAFSC can support cardiomyocyte renewal to some extension, intercellular conveyance of candidates possibly involving Agrin in combination with other factors. These perinatal derivative promising cardiogenic effects need further investigation to define their specific mechanism of action and enhance their potential translation into therapeutic opportunity.
Copyright © 2022 Costa, Balbi, Garbati, Palamà, Reverberi, De Palma, Rossi, Paladini, Coviello, De Biasio, Ceresa, Malatesta, Mauri, Quarto, Gentili, Barile and Bollini.
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Coronary Artery Occlusion during Transcatheter Aortic Valve Implantation: Early Recognition Have Better Outcome.
Heart Views;23(1):55-59. doi: 10.4103/heartviews.heartviews_27_22.
Baghi Mohamed Abdunasser M, Othman Khaled Taufek, Alnabti Abdu Rahman H, Abujalala Salem M,
Abstract
Transcatheter aortic valve implantation (TAVI) is one of the rapidly evolving treatment strategies for severe aortic stenosis. Included in this category are inoperable, high, intermediate, and low surgical risk patients. It has varying types of complications that may require urgent surgical or transcatheter interventions to prevent procedural mortality and morbidity. Coronary artery occlusion is a rare and dreaded complication of TAVI. Here, we report a 73-year-old man who was diagnosed with severe aortic stenosis and underwent transfemoral TAVI. Unfortunately, during preimplantation balloon valvuloplasty, the patient developed severe hypotension along with ischemic changes on the electrocardiographic monitor. Promptly, coronary angiography was performed which revealed complete occlusion of the left anterior descending artery secondary to embolic debris. He was successfully rescued by manual aspiration thrombectomy (MAT). MAT results in restoration of coronary flow and reversal of shock condition before completing TAVI procedure.
Copyright: © 2022 Heart Views.
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Unusual case of cerebral embolism after initiation of selexipag for sarcoidosis-related pulmonary hypertension: a case report.
Radiol Case Rep2022 Sep;17(9):3009-3014. doi: 10.1016/j.radcr.2022.05.064.
Inoue Naoya, Morikawa Shuji,
Abstract
: Pulmonary hypertension is a rare complication of sarcoidosis. The pathogenesis of sarcoidosis-related pulmonary hypertension is multifactorial, and patients with sarcoidosis-related pulmonary hypertension can have variable treatment responses and prognoses. While selexipag (Nippon Shinyaku / Kyoto / Japan) was recently approved in Japan for the treatment of pulmonary hypertension, the risk of cerebral infarction has not been clearly reported. : A 63-year-old Asian female with a diagnosis of ocular and cutaneous sarcoidosis developed shortness of breath and was referred to our department to rule out cardiac sarcoidosis. Swan-Ganz catheterization was performed, and she was diagnosed with pulmonary arterial hypertension and started on selexipag. A few days after starting treatment, she presented with hemiplegia and was diagnosed with cardiogenic cerebral embolism by using magnetic resonance imaging. As there was no evidence of pre-existing intracardiac thrombosis, we suspected unusual cerebral embolism. Echocardiography revealed a deep venous thrombus and a bubble study revealed a right-left shunt through a patent foramen ovale. : The initiation of selexipag improved pulmonary blood flow and caused cerebral embolism, which was an unusual and unexpected event. This report highlights the importance of confirming the presence of patent foramen ovale and a deep venous thrombus before starting treatment for pulmonary hypertension.
© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.
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How to clarify the mechanism of multi-systemic inflammatory syndrome related to COVID-19.
J Cardiol Cases -
2022 AHA/ACC Key Data Elements and Definitions for Cardiovascular and Noncardiovascular Complications of COVID-19: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards.
J Am Coll Cardiol2022 Jun;():. doi: S0735-1097(22)04579-X.
, Bozkurt Biykem, Das Sandeep R, Addison Daniel, Gupta Aakriti, Jneid Hani, Khan Sadiya S, Koromia George Augustine, Kulkarni Prathit A, LaPoint Kathleen, Lewis Eldrin F, Michos Erin D, Peterson Pamela N, Turagam Mohit K, Wang Tracy Y, Yancy Clyde W,
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Cardiovascular Toxicities with Chimeric Antigen Receptor T-cell Therapy.
Curr Cardiol Rev2022 Jun;():. doi: 10.2174/1573403X18666220623152350.
Gill Jashan,
Abstract
Chimeric antigen receptor (CAR) T-cell therapy has shown remarkable efficacy in treating highly refractory and relapsing hematological malignancies in pediatric and adult patients. However, this promising therapy is limited by severe and potentially life-threatening toxicities. Cytokine release syndrome (CRS) is the most commonly observed of these toxicities. The cardiovascular manifestations of CRS include tachycardia, hypotension, left ventricular dysfunction, arrhythmias, troponin elevation, cardiogenic shock, and pulmonary edema. Recent data suggest that cardiotoxicities may be transient and reversible in younger patients with few cardiac comorbidities; however, cardiotoxicities may be fatal in older patients with significant cardiac risk factors. The literature remains sparse regarding long-term cardiotoxicities associated with CAR-T cell therapy. Furthermore, consensus guidelines for monitoring and prevention of cardiotoxicities remain ill-defined. Therefore, this review will detail the cardiovascular toxicities of CAR T-cell therapy seen in clinical trials and observational studies, summarize treatment approaches for CRS, outline the currently adopted surveillance protocols for CAR T-cell associated cardiotoxicity, and explore the future directions of research in this rapidly emerging field.
Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.
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A Rescue Use of ECPELLA for Sepsis-Induced Cardiogenic Shock Followed by Mitral Valve Replacement.
Medicina (Kaunas)2022 May;58(6):. doi: 698.
Nakamura Makiko, Imamura Teruhiko, Oshima Akira, Sobajima Mitsuo, Yokoyama Shigeki, Doi Toshio, Fukahara Kazuaki, Kinugawa Koichiro,
Abstract
The use of veno-arterial extracorporeal membrane oxygenation (ECMO) in patients with sepsis-induced cardiogenic shock has been reported, but the clinical implication of the Impella percutaneous axial-flow left ventricular assist device for such patients remains unknown. We had a 37-year-old man with septic shock and severely reduced cardiac function. Veno-arterial ECMO and concomitant Impella CP support ameliorated his end-organ dysfunction and achieved cardiac recovery, whereas severe mitral valve regurgitation due to chordal rupture developed later. Mitral valve replacement concomitant with ECMO removal as well as an Impella upgrade successfully treated the patient. ECMO and Impella support might be an effective therapeutic strategy for the bridge to recovery in patients with sepsis-induced cardiogenic shock; however, paying attention to mitral chordal rupture is highly encouraged.
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Non-STEMI vs. STEMI Cardiogenic Shock: Clinical Profile and Long-Term Outcomes.
J Clin Med2022 Jun;11(12):. doi: 3558.
Martínez María José, Rueda Ferran, Labata Carlos, Oliveras Teresa, Montero Santiago, Ferrer Marc, El Ouaddi Nabil, Serra Jordi, Lupón Josep, Bayés-Genís Antoni, García-García Cosme,
Abstract
Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI). In AMI-CS, the ST segment deviation on ECG may be elevated (STEMI-CS) or non-elevated (NSTEMI-CS), which may influence prognosis. Our aim was to analyze the clinical profile, acute-phase prognosis, and long-term outcomes of CS relative to the ST pattern on admission. In a prospective registry of 4647 AMI patients admitted to the intensive cardiac care unit of a university hospital between 2010 and 2019, we compared the clinical characteristics, 30-days case fatality, and long-term outcomes of AMI-CS, based on the presence of ST-segment deviation. AMI-CS developed in 239 (5.1%) patients (26.4% women): 190 (79.5%) STEMI-CS and 49 (20.5%) NSTEMI-CS. The mean age was 69.7 years. The STEMI-CS patients had larger infarcts and more mechanical complications than the NSTEMI-CS patients. The NSTEMI-CS patients had a greater prevalence of hypertension, diabetes, peripheral vascular disease, previous cardiovascular comorbidities, three-vessel disease, and left main disease than the STEMI-CS patients. The STEMI-CS patients had higher 30-day mortality than the NSTEMI-CS (59.5% vs. 36.7%; = 0.004), even after multivariable adjustment (HR 1.91; 95% CI 1.16-3.14), but no differences in mortality were observed at 3 years. In conclusion, the 30-day case-fatality is higher in STEMI-CS, but the long-term outcome is similar in both groups.
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Usefulness of CHEST Score in Predicting Clinical Outcomes of COVID-19 in Heart Failure and Non-Heart-Failure Cohorts.
J Clin Med2022 Jun;11(12):. doi: 3495.
Rola Piotr, Doroszko Adrian, Trocha Ma?gorzata, Giniewicz Katarzyna, Kujawa Krzysztof, Gawry? Jakub, Matys Tomasz, Gajecki Damian, Madziarski Marcin, Zieli?ski Stanis?aw, Skalec Tomasz, Drobnik Jaros?aw, Sebastian Agata, Zubkiewicz-Zar?bska Anna, Adamik Barbara, Kaliszewski Krzysztof, Kili?-Pstrusinska Katarzyna, Matera-Witkiewicz Agnieszka, Pomorski Micha?, Protasiewicz Marcin, Soko?owski Janusz, W?odarczak Szymon, Jankowska Ewa Anita, Madziarska Katarzyna,
Abstract
BACKGROUND:
Patients with heart failure represent a vulnerable population for COVID-19 and are prone to having worse prognoses and higher fatality rates. Still, the clinical course of the infection is dynamic, and complication occurrence in particular in patients with heart failure is fairly unpredictable. Considering that individual components of the CHEST (C2: Coronary Artery Diseases (CAD)/Chronic obstructive pulmonary disease (COPD); H: Hypertension; E: Elderly (Age ? 75); S: Systolic HF; T: Thyroid disease) are parallel to COVID-19 mortality risk factors, we evaluate the predictive value of CHEST score in patients with heart failure (HF) Material and Methods: The retrospective medical data analysis of 2184 COVID-19 patients hospitalized in the University Hospital in Wroclaw between February 2020 and June 2021 was the basis of the study. The measured outcomes included: in-hospital mortality, 3-month and 6-month all-cause-mortality, non-fatal end of hospitalization, and adverse in-hospital clinical events.
RESULTS:
The heart failure cohort consists of 255 patients, while 1929 patients were assigned to the non-HF cohort. The in-hospital, 3-month, and 6-month mortality rates were highest in the HF cohort high-risk CHEST stratum, reaching 38.61%, 53.96%, and 65.36%, respectively. In the non-HF cohort, in-hospital, 3-month, and 6-month mortalities were also highest in the high-risk CHEST stratum and came to 26.39%, 52.78%, and 65.0%, respectively. An additional point in the CHEST score increased the total death intensity in 10% of HF subjects (HR 1.100, 95% CI 0.968-1.250 = 0.143) while in the non-HF cohort, the same value increased by 62.3% (HR 1.623, 95% CI 1.518-1.734 < 0.0001).
CONCLUSIONS:
The CHEST score risk in the HF cohort failed to show discriminatory performance in terms of mortality and other clinical adverse outcomes during hospitalization. CHEST score in the non-HF cohort showed significantly better performance in terms of predicting in-hospital and 6-month mortality and other non-fatal clinical outcomes such as cardiovascular events (myocardial injury, acute heart failure, myocardial infarction, cardiogenic shock), pneumonia, sepsis, and acute renal injury.
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The Early Dynamic Change in Cardiac Enzymes and Renal Function Is Associated with Mortality in Patients with Fulminant Myocarditis on Extracorporeal Membrane Oxygenation: Analysis of a Single Center's Experience.
Healthcare (Basel)2022 Jun;10(6):. doi: 1063.
Ho Ching-Lin, Ju Teressa Reanne, Lee Chi Chan, Lin Hsin-Ti, Wang Alexander-Lee, Chen Robert Jeenchen, Lin You-Cian,
Abstract
(1) Background: Fulminant myocarditis (FM) could result in hemodynamic derangement and fatal arrhythmia. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is used to maintain organ perfusion in FM patients complicating cardiogenic shock. The present study aims to assess the static and dynamic factors in association with mortality in FM patients on V-A ECMO (2) Methods: Twenty-eight patients were enrolled between 2013 to 2019 for analysis (3) Results: In-hospital survival rate was 78.5%. There was no statistical difference in demographics and baseline laboratory data between survivors and non-survivors. However, within 24 h after ECMO support, CK-MB increased by 96.8% among non-survivors, but decreased by 23.7% among survivors ( = 0.022). Troponin I increased by 378% among non-survivors and 1.7% among survivors ( = 0.032). Serum creatinine increased by 108% among non-survivors, but decreased by 8.5% among survivors ( = 0.005). The receiver operating characteristic curve suggested an increase in serum creatinine by 68% within 24 h after ECMO support was associated with increased mortality with an area under the curve of 0.91. (4) Conclusions: V-A ECMO is an excellent tool to support FM patients with cardiogenic shock. The early dynamic change of renal function and cardiac enzymes may be useful for outcome assessment.
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Lung Sonography in Critical Care Medicine.
Diagnostics (Basel)2022 Jun;12(6):. doi: 1405.
Breitkopf Robert, Treml Benedikt, Rajsic Sasa,
Abstract
During the last five decades, lung sonography has developed into a core competency of intensive care medicine. It is a highly accurate bedside tool, with clear diagnostic criteria for most causes of respiratory failure (pneumothorax, pulmonary edema, pneumonia, pulmonary embolism, chronic obstructive pulmonary disease, asthma, and pleural effusion). It helps in distinguishing a hypovolemic from a cardiogenic, obstructive, or distributive shock. In addition to diagnostics, it can also be used to guide ventilator settings, fluid administration, and even antimicrobial therapy, as well as to assess diaphragmatic function. Moreover, it provides risk-reducing guidance during invasive procedures, e.g., intubation, thoracocentesis, or percutaneous dilatational tracheostomy. The recent pandemic has further increased its scope of clinical applications in the management of COVID-19 patients, from their initial presentation at the emergency department, during their hospitalization, and after their discharge into the community. Despite its increasing use, a consensus on education, assessment of competencies, and certification is still missing. Deep learning and artificial intelligence are constantly developing in medical imaging, and contrast-enhanced ultrasound enables new diagnostic perspectives. This review summarizes the clinical aspects of lung sonography in intensive care medicine and provides an overview about current training modalities, diagnostic limitations, and future developments.
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Laboratory Predictors of Prognosis in Cardiogenic Shock Complicating Acute Myocardial Infarction.
Biomedicines2022 Jun;10(6):. doi: 1328.
Muzafarova Tamilla, Motovska Zuzana,
Abstract
Cardiogenic shock is a state of reduced cardiac output leading to hypotension, pulmonary congestion, and hypoperfusion of tissues and vital organs. Despite the advances in intensive care over the last years, the morbidity and mortality of patients remain high. The available studies of patients with cardiogenic shock suggest a connection between clinical variables, the level of biomarkers, the results of imaging investigations, strategies of management and the outcome of this group of patients. The management of patients with cardiogenic shock initially complicating acute myocardial infarction is challenging, and the number of studies in this area is growing fast. The purpose of this review is to summarize the currently available evidence on cardiogenic shock initially complicating acute myocardial infarction with particular attention to predictors of prognosis, focusing on laboratory variables (established and new), and to discuss the practical implementation. Currently available scoring systems developed during the past few decades predict the clinical outcome of this group of patients using some of the established biomarkers among other variables. With the new laboratory biomarkers that have shown their predictive value in cardiogenic shock outcomes, a new design of scoring systems would be of interest. Identifying high-risk patients offers the opportunity for early decision-making.
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2022 AHA/ACC Key Data Elements and Definitions for Cardiovascular and Noncardiovascular Complications of COVID-19: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards.
Circ Cardiovasc Qual Outcomes2022 Jun;():101161HCQ0000000000000111. doi: 10.1161/HCQ.0000000000000111.
Bozkurt Biykem, Das Sandeep R, Addison Daniel, Gupta Aakriti, Jneid Hani, Khan Sadiya S, Koromia George Augustine, Kulkarni Prathit A, LaPoint Kathleen, Lewis Eldrin F, Michos Erin D, Peterson Pamela N, Turagam Mohit K, Wang Tracy Y, Yancy Clyde W,
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Prevalence of Reticulocytosis in the Absence of Anemia in Dogs with Cardiogenic Pulmonary Edema Due to Myxomatous Mitral Valve Disease: A Retrospective Study.
Vet Sci2022 Jun;9(6):. doi: 293.
Choi Sol-Ji, Yoon Won-Kyoung, Ahn Hyerin, Song Woo-Jin, Choi Ul-Soo,
Abstract
Myxomatous mitral valve disease (MMVD) is the most common heart disease in small breed dogs. Dogs with MMVD commonly show clinical signs of dyspnea due to cardiogenic pulmonary edema (CPE). Reticulocytosis in the absence of anemia (RAA) is a hematological finding in hypoxic conditions. We aimed to assess the prevalence of RAA in dogs with CPE due to MMVD, and evaluate whether RAA is reversible with amelioration of dyspnea. Twenty-nine client-owned dogs with CPE due to MMVD were included. Dogs who died within 6 weeks of the onset of CPE were included in the non-survival group, while the others comprised the survival group. Of the 21 dogs, RAA was observed in 17 dogs (80.9%). In the RAA group, the absolute reticulocyte count significantly decreased as CPE resolved ( < 0.001). The mean absolute reticulocyte count in the RAA group was 163.90 ± 50.77 on the first measurement and 78.84 ± 25.64 after resolution of CPE. In the RAA group, no significant differences in mean absolute reticulocyte count were observed between the survival and non-survival groups at either the first or second measurement. Our results indicate that RAA occurs in dogs with MMVD-related CPE and can resolve after resolution of CPE.
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Structured Allocation of Transcatheter Aortic Valve Replacement Patients during Coronavirus Disease 2019 Pandemic: Impact on Patient Selection and Clinical Results.
J Cardiovasc Dev Dis2022 Jun;9(6):. doi: 189.
Berisha Nora, Klein Kathrin, Veulemans Verena, Maier Oliver, Piayda Kerstin, Binnebößel Stephan, Afzal Shazia, Polzin Amin, Westenfeld Ralf, Horn Patrick, Jung Christian, Kelm Malte, Quast Christine, Zeus Tobias,
Abstract
Due to shortages of medical resources during the Coronavirus Disease 2019 (COVID-19) pandemic, an allocation algorithm for Transcatheter Aortic Valve Replacement (TAVR) was established. We investigated the impact on patient selection and procedural results. In total, 456 TAVR patients before (pre-COVID-19 group) and 456 TAVR patients after (COVID-19 group) the implementation of our allocation algorithm were compared. Concerning patient characteristics, the COVID-19 group revealed a higher rate of cardiac decompensations/cardiogenic shocks (10.5% vs. 1.3%; < 0.001), severe angina pectoris (Canadian Cardiovascular Society (CCS) II, III and IV: 18.7% vs. 11.8%; = 0.004), troponin elevation (>14 ng/L: 84.9% vs. 77%; = 0.003) and reduced left ventricular ejection fraction (LVEF) (<45%: 18.9% vs. 12%; = 0.006). Referring to procedural characteristics, more predilatations (46.3% vs. 35.1%; = 0.001) and a longer procedural time (80.2 min (+/-29.4) vs. 66.9 min (+/-17.5); < 0.001) were observed. The success rate was evenly high; no differences in safety parameters were reported. Examining the utilization of hospital resources, the COVID-19 group showed a shorter in-hospital stay (8.4 days (+/-5.9) vs. 9.5 days (+/-9.33); = 0.041) and fewer TAVR patients were treated per month (39 (+/-4.55) vs. 46.11 (+/-7.57); = 0.03). Our allocation algorithm supported prioritization of sicker patients with similar efficient and safe TAVR procedures. In-hospital stay could be shortened.
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Kidney Failure among Patients with Takotsubo Syndrome or Myocardial Infarction: A Retrospective Analysis.
J Cardiovasc Dev Dis2022 Jun;9(6):. doi: 186.
Bill Verena, El-Battrawy Ibrahim, Kummer Marvin, Mügge Andreas, Aweimer Assem, Behnes Michael, Akin Ibrahim,
Abstract
Takotsubo syndrome (TTS) is a syndrome with ambiguous pathophysiology. Impaired kidney function (KF) seems to impact the outcome of patients with TTS. We hypothesized that KF worsens the outcome among TTS patients and furthermore, TTS patients with concomitant KF experience more adverse events compared to myocardial infarction (MI) patients with concomitant KF. This retrospective single-center study comprised two groups (cohorts) of patients including patients with TTS and concomitant KF ( = 61, 27.1%) and patients with MI and concomitant KF ( = 164, 72.9%). The clinical outcomes were delineated as short-term outcomes defined as in-hospital adverse events during index hospitalization and long-term outcomes defined as adverse events over five-year clinical follow-ups. All-cause mortality, stroke, cardiopulmonary resuscitation (CPR), life-threatening arrhythmias, need for respiratory support, and cardiogenic shock with subsequent use of inotropic agents during index hospitalization were denoted as in-hospital adverse events. All-cause mortality, rehospitalization due to heart failure, stroke, thromboembolic events, and the recurrence of primary pathology (TTS and MI) were analyzed during five-year follow-ups after index hospitalization. A higher mortality rate was noted among TTS patients with KF compared to TTS without KF. In addition, in-hospital event rates in patients with TTS and concomitant KF compared to MI and concomitant KF were comparable with the exception of a higher rate of respiratory support in TTS patients. The mortality rate was significantly higher among patients with TTS and KF at 4 years (29.5% vs. 15.9%, = 0.02) and 5 years (34.4% vs. 20.7%, = 0.03) in comparison to patients with MI and concomitant KF. In contrast, the rate of re-hospitalization related to heart failure was higher at 30 days, and at one-, four-, and five-year follow-ups in patients suffering from MI and KF compared to TTS and concomitant KF. Additionally, the recurrence of MI after 4 and 5 years was higher than the recurrence of TTS (4.9% vs. 15.2%; 4.9% vs. 16.5%). There were no differences in life-threatening arrhythmias and stroke in both groups. Patients with TTS and concomitant KF have higher all-cause mortality when compared to MI and concomitant KF. The mechanisms responsible remain to be determined.
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Unusual drug reaction with features of colchicine toxicity in patient on colchicine and allopurinol.
J Cutan Pathol2022 Jun;():. doi: 10.1111/cup.14280.
Salari Behzad, Joseph Mallory, Eshaq Milad, Lowe Lori, Fullen Douglas R,
Abstract
A 58-year-old woman was admitted for heart failure and concern for cardiogenic shock. The patient had been recently placed on colchicine and allopurinol, four months and three weeks respectively, prior to admission. Upon admission, she had a cutaneous eruption that had started abruptly several days after allopurinol initiation. It included multiple erythematous papules with scant scale on the forearms and numerous erythematous papules on the legs. Because of the varied morphologic presentation, biopsies from both the thigh and forearm were performed for a suspected drug reaction. The specimen from the thigh demonstrated a superficial dermal band-like lymphocytic infiltrate with dyskeratosis and numerous intraepidermal mitotic figures predominantly in metaphase. In addition, there were neutrophils with leukocytoclasia. The specimen from the forearm showed superficial perivascular lymphocytic inflammation and intraepidermal dyskeratosis with mitotic figures similar to the thigh biopsy specimen but without a dermal neutrophilic infiltrate. An unusual drug eruption with features of colchicine toxicity was favored. Colchicine toxicity is not a commonly encountered clinical scenario and cutaneous findings have only rarely been described. Herein we report an exceedingly rare case of an unusual drug reaction with "colchicine figures" (i.e. ring-shaped mitotic figures arrested in metaphase) consistent with colchicine toxicity.
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