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Pubblicazioni recenti - cardiogenic
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Point-of-care ultrasound (PoCUS) in the early diagnosis of novel coronavirus 2019 disease (COVID-19) in a first-level emergency department during a SARS-CoV-2 outbreak in Italy: a real-life analysis.
Intern Emerg Med2021 Apr;():. doi: 10.1007/s11739-021-02643-w.
Bianchi Simone, Savinelli Caterina, Paolucci Elisa, Pelagatti Lorenzo, Sibona Erica, Fersini Natalia, Buggea Michele, Tozzi Camilla, Allescia Germana, Paolini Diana, Lanigra Michele,
Abstract
In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) spread worldwide, challenging emergency departments (EDs) with the need of rapid diagnosis for appropriate allocation in dedicated setting. Many authors highlighted the role of lung ultrasound (LUS) in management of the novel coronavirus disease 2019 (COVID-19). The study aims to analyze the performance of LUS in the early identification of COVID-19 patients in ED during a SARS-CoV-2 outbreak. We prospectively collected consecutive adult patients admitted to a first-level ED in Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation Florence with history or symptoms suggestive for COVID-19 that underwent LUS during the ED management. LUS findings were categorized in 6 discrete main etiological patterns. "A", "Cardiogenic B" and "Typical C" patterns were referred as non-COVID-19-suggestive, while "Atypical" B or C patterns, "Multiple Consolidations" pattern and "ARDS" pattern were referred as COVID-19-suggestive. The primary outcome was the diagnosis of SARS-CoV-2 infection. From 12 March to 12 May 2020, 360 patients were enrolled. COVID-19 suggestive LUS findings were significantly associated with final COVID-19 diagnosis (86% in COVID-19 vs 29% in non-COVID-19, p?
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Acute Severe Mitral Regurgitation Secondary to Ischemic Papillary Muscle Rupture: A Case Report.
Cureus2021 Mar;13(3):e13996. doi: 10.7759/cureus.13996.
Alam Loba, Lasam Glenmore, Fishberg Robert, Powell David,
Abstract
Mitral valve rupture secondary to ischemic papillary muscle necrosis is rare in the contemporary era due to improved revascularization techniques. However, when it does occur, prompt diagnosis and urgent surgical intervention can be lifesaving. A 69-year-old male with morbid obesity, hypothyroidism, and a family history of coronary artery disease presented to the hospital with chest pain and dyspnea that began five hours prior. He had an acute infero-postero-lateral myocardial infarction due to total occlusion of the left circumflex artery that was revascularized with the deployment of a drug-eluting stent. Two days after the myocardial infarction, the patient had an episode of ventricular tachycardia. He subsequently went into respiratory distress from flash pulmonary edema and developed cardiogenic shock due to acute mitral valve rupture. The patient underwent surgical mitral valve replacement, extracorporeal membranous oxygenation (ECMO), and hemodialysis. His course was complicated by an acute lower gastrointestinal bleed that progressed into multiorgan failure and eventually his demise. This case highlights the need to include papillary muscle rupture high on the differential when evaluating a hemodynamically unstable patient in the setting of an acute myocardial infarction (MI). Rapid diagnosis by urgent bedside echocardiogram and surgical intervention is crucial.
Copyright © 2021, Alam et al.
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Recurrent Stress-Induced Cardiomyopathy With Cardiogenic Shock Requiring Impella Left Ventricular Assist Device.
Cureus2021 Mar;13(3):e13910. doi: 10.7759/cureus.13910.
Feghaly Julien, Oman Zachary, Das Debapria, Abo-Salem Elsayed,
Abstract
Stress-induced cardiomyopathy (SIC) is associated with varying etiologies. We present a case of a 65-year-old female with recurrent SIC secondary to seizures who presented in cardiogenic shock requiring mechanical circulatory support using an Impella CP via the right axillary approach.
Copyright © 2021, Feghaly et al.
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[One-stage surgery in patients with both cardiac and non-cardiac diseases].
Beijing Da Xue Xue Bao Yi Xue Ban2021 Mar;53(2):327-331.
Yang Y, Xiao F, Wang J, Song B, Li X H, Zhang S J, He Z S, Zhang H, Yin L,
Abstract
OBJECTIVE:
To investigate the possibility and feasibility of one-stage cardiac and non-cardiac surgery.
METHODS:
From July 1999 to August 2018, one hundred and eleven patients suffering from cardiac and non-cardiac diseases were treated by one-stage cardiac and non-cardiac operation in Department of Cardiac Surgery and Thoracic Surgery, General Surgery, Urinary Surgery, and Gynecology, Peking University First Hospital. There were 83 males (74.8%) and 28 females (25.2%), aged 41 to 84 years [mean age: (64.64±8.97) years]. The components of the cardiac disease included coronary heart disease, valvular heart disease, cardiac tumors, chronic constrictive pericarditis and congenital heart disease. The components of the non-cardiac diseases included lung benign and malignant diseases, thymoma and thymic cyst, breast cancer, chest wall giant hemangioma, digestive tract benign and malignant diseases, urinary system carcinoma and gynecological diseases.
RESULTS:
Two patients died after operations in hospital; thus, the hospital mortality rate was 1.8%. One patient died of multiple organ failure on the 153th days after emergency coronary artery bypass grafting (CABG) combined with radical resection of bladder cancer. The other of pericardium stripping with lung cancer operation died of the multiple organ failure on the tenth day after surgery. The remaining 109 patients recovered and were discharged. There were 13 cases of complications during the days in hospital. The total operative morbidity was 11.7%: postoperative hemorrhage in 2 cases (1.8%), pulmonary infection and hypoxemia in 3 cases (2.7%), hemorrhage of upper digestive tract in 1 case (0.9%), incisional infection in 3 cases (2.7%), subphrenic abscess in 1 case (0.9%), and postoperative acute renal failure and hemofiltration in 3 case (2.7%). Of the 109 patients discharged, 108 patients were followed up. All the patients survived for 6 months, and 21 patients died due to tumor recurrence or metastasis within 1 to 5 years of follow-up, but no cardiogenic death. During the follow-up period, 1 patient developed cardiac dysfunction, 1 patient underwent percutaneous coronary intervention (PCI), 1 patient had cerebral hemorrhage due to excessive postoperative anticoagulation, and 1 patient suffered from incisional hernia.
CONCLUSION:
One-stage surgeries in patients suffering from both cardiac and non-cardiac benign or malignant diseases are safe and possible with satisfactory short-term and long-term survival.
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Fibroblast GATA-4 and GATA-6 promote myocardial adaptation to pressure overload by enhancing cardiac angiogenesis.
Basic Res Cardiol2021 Apr;116(1):26. doi: 10.1007/s00395-021-00862-y.
Dittrich Gesine M, Froese Natali, Wang Xue, Kroeger Hannah, Wang Honghui, Szaroszyk Malgorzata, Malek-Mohammadi Mona, Cordero Julio, Keles Merve, Korf-Klingebiel Mortimer, Wollert Kai C, Geffers Robert, Mayr Manuel, Conway Simon J, Dobreva Gergana, Bauersachs Johann, Heineke Joerg,
Abstract
Heart failure due to high blood pressure or ischemic injury remains a major problem for millions of patients worldwide. Despite enormous advances in deciphering the molecular mechanisms underlying heart failure progression, the cell-type specific adaptations and especially intercellular signaling remain poorly understood. Cardiac fibroblasts express high levels of cardiogenic transcription factors such as GATA-4 and GATA-6, but their role in fibroblasts during stress is not known. Here, we show that fibroblast GATA-4 and GATA-6 promote adaptive remodeling in pressure overload induced cardiac hypertrophy. Using a mouse model with specific single or double deletion of Gata4 and Gata6 in stress activated fibroblasts, we found a reduced myocardial capillarization in mice with Gata4/6 double deletion following pressure overload, while single deletion of Gata4 or Gata6 had no effect. Importantly, we confirmed the reduced angiogenic response using an in vitro co-culture system with Gata4/6 deleted cardiac fibroblasts and endothelial cells. A comprehensive RNA-sequencing analysis revealed an upregulation of anti-angiogenic genes upon Gata4/6 deletion in fibroblasts, and siRNA mediated downregulation of these genes restored endothelial cell growth. In conclusion, we identified a novel role for the cardiogenic transcription factors GATA-4 and GATA-6 in heart fibroblasts, where both proteins act in concert to promote myocardial capillarization and heart function by directing intercellular crosstalk.
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Simultaneous kissing stents in acute left main total occlusion complicated with cardiogenic shock.
BMJ Case Rep2021 Apr;14(4):. doi: e241245.
Alsagaff Mochamad Yusuf, Hidayat Dwi Fachrul Octafian, Daida Hiroyuki,
Abstract
We present a case of acute left main bifurcation lesion presenting as very high-risk non-ST elevation acute coronary syndrome. Consequently, an immediate invasive strategy for this complex anatomical lesion in an unstable patient requires an emergent bailout strategy to restore the haemodynamic condition.Our case shows the simultaneous kissing stents technique in a patient with a true left main bifurcation lesion (Medina 1-1-1) as a strategy to overcome the compromised haemodynamics. This protocol would be an alternative life-saving strategy in an acute setting.
© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.
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[Safety and efficacy of ultrafiltration on heart failure patients with reduced ejection fraction and diuretic resistance: results from a single-center randomized controlled trial].
Zhonghua Xin Xue Guan Bing Za Zhi2021 Apr;49(4):340-344. doi: 10.3760/cma.j.cn112148-20200816-00646.
Shen X L, Li L, Ma J, Zhang B J, Ge Z R, Liu X Z, Zu L B Y, He Y, Jiang S B,
Abstract
To investigate the safety and efficacy of ultrafiltration on diuretic sensitivity in heart failure patients with reduced ejection fraction and diuretic resistance. This was a single-center randomized controlled trial. A total of 148 heart failure patients with reduced ejection fraction admitted to the Hospital of Traditional Chinese Medicine of Xinjiang Uygur Autonomous Region from June 2010 to June 2020 were enrolled in this study, and these patients were randomly divided (ratio 1:1) into the ultrafiltration group (74) and the control group (=74). All patients were treated with diuretics, cardiotonic, vasodilator and other comprehensive drugs according to relevant guidelines. After grouping, the patients in the control group were treated with standard treatment plan, while patients in the ultrafiltration group were treated with ultrafiltration on top of standard therapy. Diuretic drugs were discontinued during ultrafiltration, and intravenously furosemide (40 mg) was given immediately and 24 hours after the end of ultrafiltration. Clinical data including gender, age, complicated diseases, New York Heart Association function classification, etc. were collected. Effectiveness indicators include urine volume (the first 12-hour and 24-hour urine volume and the second 24-hour urine volume after using diuretic), body weight and dyspnea severity core. Safety indicators include systolic blood pressure, serum creatinine, serum Na concentration, blood K concentration and the number of deaths before and after intervention. Two patients in the control group died due to worsening heart failure after randomization and were excluded in this study, 146 patients were finally analyzed (72 patients in the control group and 74 patients in the ultrafiltration group). There were 93 males, and the age was (68.3±11.2) years. There was no significant difference between patients in the ultrafiltration group and the control group in gender, age, body weight, course of disease, dyspnea severity score, New York Heart Association function classification ?/?, the proportion of patients with severe edema of both lower limbs, the proportion of patients with complicated diseases, and basic medication (all >0.05). After using diuretics, the urine volume of the first 12 and 24 hours and the second 24 hours were significantly higher in the ultrafiltration group than in the control group (all <0.05). Body weight decreased significantly after ultrafiltration treatment as compared with that before intervention in the ultrafiltration group (<0.05). Compared with the control group, the dyspnea severity score was significantly improved in the ultrafiltration group (<0.05). There was no significant difference in systolic blood pressure, serum creatinine, serum Na concentration, blood K concentration of patients between ultrafiltration group and control group before and after intervention (au >0.05). During the clinical diagnosis and treatment, 2 male patients in the control group died, and the cause of death was aggravation of basic diseases complicated with acute heart failure and cardiogenic shock. There was no death in the ultrafiltration group, and there were no obvious clinical adverse events during and after ultrafiltration. Ultrafiltration therapy is safe and can improve diuretic sensitivity in heart failure patients with reduced ejection fraction and diuretic resistance.
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Propensity score-based analysis of long-term follow-up in patients supported with durable centrifugal left ventricular assist devices: the EUROMACS analysis.
Eur J Cardiothorac Surg2021 Apr;():. doi: ezab144.
Potapov Evgenij V, Nersesian Gaik, Lewin Daniel, Özbaran Mustafa, de By Theo M M H, Stein Julia, Pya Yuri, Gummert Jan, Ramjankhan Faiz, Zembala Michael O, Damman Kevin, Carrel Thierry, Meyns Bart, Zimpfer Daniel, Netuka Ivan,
Abstract
OBJECTIVES:
The HeartWare HVAD (HW) and the HeartMate3 (HM3) are presently the most commonly used continuous-flow left ventricular assist devices worldwide. We compared the outcomes of patients supported with either of these 2 devices based on data from the EUROMACS (European Registry for Patients with Mechanical Circulatory Support).
METHODS:
A retrospective analysis of the survival and complications profile in propensity score-matched adult patients enrolled in the EUROMACS between 01 January 2016 and 01 September 2020 and supported with either an HW or HM3. Matching included demographic parameters, severity of cardiogenic shock and risk-modifying end-organ parameters that impact long-term survival. Survival on device and major postoperative adverse events were analysed.
RESULTS:
Following 1:1 propensity score matching, each group consisted of 361 patients. Patients were well balanced (<0.1 standardized mean difference). The median follow-up was similar in both groups [396 (interquartile range (IQR) 112-771) days for HW and 376 (IQR 100-816) days for HM3]. The 2-year survival was similar in both groups [HW: 61% 95% confidence interval (CI) (56-67%) vs HM3: 68% 95% CI (63-73%) (stratified hazard ratio for mortality: 1.13 95% CI (0.83-1.54), P?=?0.435].The cumulative incidence for combined major adverse events and unexpected readmissions was similar in both groups [subdistribution hazard ratio (SHR) 1.0 (0.84-1.21), P?=?0.96]. Patients in the HW group demonstrated a higher risk of device malfunction [SHR 2.44 (1.45-3.71), P?
CONCLUSIONS:
Mid-term survival in both groups was similar in a propensity-matched analysis. The risk of device malfunction, neurological dysfunction and intracranial bleeding was significantly higher in HW patients.
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Variability in reporting of key outcome predictors in acute myocardial infarction cardiogenic shock trials.
Catheter Cardiovasc Interv2021 Apr;():. doi: 10.1002/ccd.29710.
Tyler Jeffrey M, Brown Christopher, Jentzer Jacob Colin, Baran David A, van Diepen Sean, Kapur Navin K, Garberich Ross F, Garcia Santiago, Sharkey Scott W, Henry Timothy D,
Abstract
BACKGROUND:
Among acute myocardial infarction patients with cardiogenic shock (AMICS), a number of key variables predict mortality, including cardiac arrest (CA) and shock classification as proposed by Society for Cardiovascular Angiography and Intervention (SCAI). Given this prognostic importance, we examined the frequency of reporting of high risk variables in published randomized controlled trials (RCTs) of AMICS patients.
METHODS:
We identified 15 RCTs enrolling 2,500 AMICS patients and then reviewed rates of CA, baseline neurologic status, right heart catheterization data, lactate levels, inotrope and vasopressor requirement, hypothermia, mechanical ventilation, left ventricular ejection fraction (LVEF), mechanical circulatory support, and specific cause of death based on the primary manuscript and Data in S1.
RESULTS:
A total of 2,500 AMICS patients have been enrolled in 15 clinical trials over 21?years with only four trials enrolling >80 patients. The reporting frequency and range for key prognostic factors was: neurologic status (0% reported), hypothermia (28% reported, prevalence 33-75%), specific cause of death (33% reported), cardiac index and wedge pressure (47% reported, range 1.6-2.3 L?min m and 15-24?mmHg), lactate (60% reported, range 4-7.7?mmol/L), LVEF (73% reported, range 25-45%), CA (80% reported, prevalence 0-92%), MCS (80% reported, prevalence 13-100%), and mechanical ventilation (93% reported, prevalence 35-100%). This variability was reflected in the 30-day mortality which ranged from 20-73%.
CONCLUSIONS:
In a comprehensive review of seminal RCTs in AMICS, important predictors of outcome were frequently not reported. Future efforts to standardize CS trial data collection and reporting may allow for better assessment of novel therapies for AMICS.
© 2021 Wiley Periodicals LLC.
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Transcatheter mitral valve repair for severe functional mitral regurgitation and cardiogenic shock.
Cardiovasc Revasc Med2021 Apr;():. doi: S1553-8389(21)00186-X.
Bretzman John, El Hajj Stephanie, Simard Trevor, Guerrero Mayra,
Abstract
Patients with acute mitral regurgitation and cardiogenic shock have poor outcomes. Many patients do not qualify for surgery and are left with no treatment options. We present the case of a 76-year-old woman with severe mitral regurgitation, cardiogenic shock, and prohibitive surgical risk who was successfully treated with transcatheter mitral valve edge to edge repair. We also review the existing data that supports transcatheter mitral valve edge to edge repair in this setting.
Copyright © 2021 Elsevier Inc. All rights reserved.
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Epidemiological profile, management and outcomes of patients with acute coronary syndrome: Single centre experience from a tertiary care hospital in North India.
Indian Heart J;73(2):174-179. doi: S0019-4832(20)30415-6.
Sharma Yash Paul, Santosh Vemuri Krishna, Bootla Dinakar, Kanabar Kewal, Pruthvi C R, Kaur Navjyot, Prasad Nevali Krishna, Panda Prashant, Kasinadhuni G, Uppal Lipi, Mohanty Soumitra,
Abstract
BACKGROUND:
Cardiovascular disease is the leading cause of death in India. Our aim is to study the clinical, epidemiological profile and in-hospital outcomes of patients presenting with acute coronary syndrome.
METHODS:
We did a prospective single center observational study of the 1203 patients presenting with ACS to a tertiary referral center in North India over a period of one year (July 2018-June 2019).
RESULTS:
The mean age of study population was 58.4 ± 12.5 years. STEMI and NSTE-ACS accounted for 69.9% and 31.1% respectively. 62.1% of our patients were from rural background. The median time to hospital admission was 600 min for STEMI patients, thrombolysis was performed in 52% of cases. Cardiogenic shock at presentation was noted in 18%. Coronary angiography and percutaneous coronary intervention were done in 1062 (88.3%) and 733 (60.9%) patients respectively. The overall in-hospital mortality was 7.6%. STEMI patients had higher mortality than NSTE-ACS (8.9% vs 4.5% p < 0.001). Female gender (OR-3.306 C.I. 1.87-5.845), severe MR (OR-4.65, C.I.-1.187-18.18), acute kidney injury (AKI) at admission (OR-5.15, C.I.-2.5-10.63), higher Killip class (class III/IV) (OR-3.378,C.I.-1.292-8.849), AF (OR-3.25, C.I.-1,18-8.92), complete heart block (CHB) (OR-4.44,C.I.-2.09-9.43) and right bundle branch block (RBBB) (OR-2.86, C.I.-1.2-6.8) were significant predictors of in hospital mortality.
CONCLUSIONS:
Our study represents the predominance of STEMI as the initial ACS presentation with a considerable delay in first medical contact and higher prevalence of cardiogenic shock (CS). STEMI patients had higher mortality. Female sex, severe MR, AKI, higher Killips class, AF, CHB, RBBB being predictors of high in-hospital mortality in ACS patients.
Copyright © 2020 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.
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Patient and Surgeon Predictors of Mitral and Tricuspid Valve Repair for Infective Endocarditis.
Semin Thorac Cardiovasc Surg2021 Apr;():. doi: S1043-0679(21)00162-3.
Brescia Alexander A, Watt Tessa M F, Rosenbloom Liza M, Williams Aaron M, Bolling Steven F, Romano Matthew A, ,
Abstract
Mitral repair (MVr) is superior to replacement for degenerative disease; however, its benefit is less established for endocarditis. We report outcomes of repair or replacement for mitral/tricuspid endocarditis and identify predictors of MVr. Patients undergoing first-time surgery for mitral (n=260) or tricuspid (n=71) endocarditis between 1992-2018 were identified. Patients with aortic endocarditis were excluded. Primary outcome was all-cause mortality and secondary outcome was MVr. Patients were stratified into active and treated endocarditis separately for mitral and tricuspid groups. Predictors of MVr were assessed through multivariable logistic regression and adjusted likelihood of MVr through marginal effects estimates. A mitral specialist was defined by performing ?25 annual degenerative MVr. Among 331 patients, 70% (181/260) of those with mitral valve endocarditis and 52% (37/71) of those with tricuspid endocarditis underwent repair. The MVr group compared with replacement had a higher proportion of elective acuity and less diabetes, hypertension, active endocarditis, cardiogenic shock, and dialysis. Estimated 5-year survival did not differ between repair versus replacement for active mitral (68±14% vs. 60±14%, p=0.34) or tricuspid endocarditis (60±17% vs. 61±19%, p=0.67), but was superior after repair for treated mitral endocarditis (86±7% vs. 51±24%, p=0.014). Independent predictors of mortality included dialysis for active and treated mitral endocarditis, and mitral replacement (vs. MVr) for treated mitral endocarditis. The likelihood of MVr was 82±5% for mitral specialists and 47±9% for non-specialists (p<0.001). MVr for endocarditis should be pursued, if feasible. Importantly, achieving MVr was driven not only by patient factors, but also surgeon experience.
Copyright © 2021. Published by Elsevier Inc.
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Prognostic Implication of RV Coupling to Pulmonary Circulation for Successful Weaning From Extracorporeal Membrane Oxygenation.
JACC Cardiovasc Imaging2021 Apr;():. doi: S1936-878X(21)00197-2.
Kim Darae, Park Yoonjee, Choi Ki Hong, Park Taek Kyu, Lee Joo Myung, Cho Yang Hyun, Choi Jin-Oh, Jeon Eun-Seok, Yang Jeong Hoon,
Abstract
OBJECTIVES:
The aim of this study was to explore if right ventricular (RV) contractile function and its coupling to pulmonary circulation (PC) were associated with successful weaning from venoarterial-extracorporeal membrane oxygenation (VA-ECMO) at maintenance of pump flow.
BACKGROUND:
Limited data are available on predictors of successful weaning from VA-ECMO. under full cardiac support of VA-ECMO.
METHODS:
A total of 79 patients with cardiogenic shock underwent transthoracic echocardiography to evaluate weaning from ECMO and were prospectively enrolled between 2016 and 2019. The noninvasively measured RV-PC coupling index was acquired by indexing tricuspid annular S' velocity, tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and RV free-wall longitudinal strain (FWLS) to right ventricular systolic pressure (RVSP).
RESULTS:
Transthoracic echocardiography was performed at a median 3.0 days (range 1 to 6 days) after ECMO initiation at a median ECMO flow of 3.2 l/min (range 3.0 to 3.6 l/min). The RV-PC coupling matrix, tricuspid annular S'/RVSP, TAPSE/RVSP, and RV FWLS/RVSP exhibited satisfactory predictive performances for predicting successful weaning from ECMO. Using the best cutoff values derived from the area under the receiver-operator characteristic curve, tricuspid annular S'/RVSP demonstrated a significantly better predictive performance than conventional echocardiographic parameters (left ventricular ejection fraction >20%, left ventricular outflow tract time-velocity integral ?10 cm, and mitral annular S' ?6 cm/s).
CONCLUSIONS:
Echocardiographic RV-PC coupling metrics exhibited a significantly better performance for predicting successful weaning from VA ECMO compared with conventional echocardiographic criteria at maintenance of pump flow.
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Emergency TAVI in cardiogenic shock and cardiorenal syndrome secondary to severe bicuspid aortic stenosis.
BMJ Case Rep2021 Apr;14(4):. doi: e239003.
Byrne Luke, Wheen Peter, O'Connor Stephen,
Abstract
A 78-year man with severe aortic stenosis awaiting elective surgical aortic valve replacement presented with worsening New York Heart Association IV shortness of breath. Despite appropriate heart failure treatment, he deteriorated and developed cardiogenic shock and cardiorenal syndrome which progressed despite inotropic support. A non-contrast-gated CT coronary angiogram was arranged in light of acute renal failure which revealed a bicuspid aortic valve. Three-dimensional transoesophageal echocardiography guidance was used to assist annulus sizing. An emergency transcatheter aortic valve replacement (eTAVI) was carried out 5?days into admission with a 34?mm Core Valve Evolut Pro valve with a no contrast technique. The patient's blood pressure and urine output improved and no procedural complications were encountered. He was discharged after 21 days and has remained well subsequently. This case highlights the utility of eTAVI and demonstrates the feasibility of a no contrast approach.
© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.
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Estimation of stressed blood volume in patients with cardiogenic shock from acute myocardial infarction and decompensated heart failure.
J Card Fail2021 Apr;():. doi: S1071-9164(21)00123-8.
Whitehead Evan H, Thayer Katherine L, Sunagawa Kenji, Hernandez-Montfort Jaime, Reshad Geran A, Kanwar Manreet, Sinha Shashank, Mahr Claudius, Kapur Navin K, Burkhoff Daniel,
Abstract
BACKGROUND:
Sympathetically mediated re-distribution of blood from the unstressed venous reservoir to the hemodynamically active stressed compartment is thought to contribute to congestion in cardiogenic shock. We employed a novel computational method to estimate stressed blood volume in cardiogenic shock and assess its relationship with clinical outcomes.
METHODS:
Hemodynamic parameters including estimated stressed blood volume (eSBV) were compared among patients from the Cardiogenic Shock Working Group (CSWG) registry with a complete set of hemodynamic data. eSBV was compared across shock etiologies (AMI vs HF-CS), SCAI stage, and between survivors and non-survivors.
RESULTS:
Among 528 CS patients analyzed, mean eSBV was 2423 mL/70 kg and increased with increasing SCAI stage (B, 2029; C, 2305; D, 2496; E, 2707 mL/70 kg, p<0.001). eSBV was significantly higher among HF-CS patients who died compared with survivors (2733 vs 2357 mL/70 kg, p<0.001), while no significant difference was observed between outcome groups in AMI-CS (2501 vs 2384 ml/70kg, p=0.19) CONCLUSIONS: : eSBV is a novel integrated index of congestion which correlates with shock severity. eSBV was higher in patients with HF-CS who died while no difference was observed in AMI-CS, suggesting that congestion may play a more significant role in the deterioration of patients with HF-CS.
Copyright © 2021. Published by Elsevier Inc.
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The Range of Cardiogenic Shock Survival by Clinical Stage: Data From the Critical Care Cardiology Trials Network Registry.
Crit Care Med2021 Apr;():. doi: 10.1097/CCM.0000000000004948.
Lawler Patrick R, Berg David D, Park Jeong-Gun, Katz Jason N, Baird-Zars Vivian M, Barsness Gregory W, Bohula Erin A, Carnicelli Anthony P, Chaudhry Sunit-Preet, Jentzer Jacob C, Menon Venu, Metkus Thomas, Nativi-Nicolau Jose, Phreaner Nicholas, Sinha Shashank S, Teuteberg Jeffrey J, van Diepen Sean, Morrow David A, ,
Abstract
OBJECTIVES:
Cardiogenic shock presents with variable severity. Categorizing cardiogenic shock into clinical stages may improve risk stratification and patient selection for therapies. We sought to determine whether a structured implementation of the 2019 Society for Cardiovascular Angiography and Interventions clinical cardiogenic shock staging criteria that is ascertainable in clinical registries discriminates mortality in a contemporary population with or at-risk for cardiogenic shock.
DESIGN:
We developed a pragmatic application of the Society for Cardiovascular Angiography and Interventions cardiogenic shock staging criteria-A (at-risk), B (beginning), C (classic cardiogenic shock), D (deteriorating), or E (extremis)-and examined outcomes by stage.
SETTING:
The Critical Care Cardiology Trials Network is an investigator-initiated multicenter research collaboration coordinated by the TIMI Study Group (Boston, MA). Consecutive admissions with or at-risk for cardiogenic shock during two annual 2-month collection periods (2017-2019) were analyzed.
PATIENTS:
Patients with or at-risk for cardiogenic shock.
MEASUREMENTS AND MAIN RESULTS:
Of 8,240 CICU admissions reviewed, 1,991 (24%) had or were at-risk for cardiogenic shock. Distributions across the five stages were as follows: A: 33%; B: 7%; C: 16%; D: 23%; and E: 21%. Overall in-hospital mortality among patients with established cardiogenic shock was 39%; however, mortality varied from only 15.8% to 32.1% to 62.5% across stages C, D, and E (Cochran-Armitage ptrend < 0.0001). The Society for Cardiovascular Angiography and Interventions stages improved mortality prediction beyond the Sequential Organ Failure Assessment and Intra-Aortic Balloon Pumpin Cardiogenic Shock II scores.
CONCLUSIONS:
Although overall mortality in cardiogenic shock remains high, it varies considerably based on clinical stage, identifying stage C as relatively lower risk. We demonstrate a pragmatic adaptation of the Society for Cardiovascular Angiography and Interventions cardiogenic shock stages that effectively stratifies mortality risk and could be leveraged for future clinical research.
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Point-of-care ultrasound after attempted suicidal hanging.
Arch Pediatr2021 Apr;():. doi: S0929-693X(21)00047-6.
Palanca Arias D, Gutiérrez Sánchez A, Estaben Boldova V, Ayerza Casas A, Madurga Revilla P, García Íñiguez J P,
Abstract
Focused cardiac ultrasound (FoCUS) can provide critical information quickly to determine the etiology after cardiac arrest and may expedite a diagnosis in order to identify underlying treatable causes. We present a case of reversible acute left ventricular dysfunction after cardiopulmonary resuscitation following attempted suicide by hanging presenting with severe hypoxemia. FoCUS revealed findings consistent with severe left ventricular dysfunction, and point-of-care ultrasound (PoCUS) ruled out pneumothorax. These findings, in conjunction with the clinical presentation, facilitated an early identification and rapid evaluation of cardiogenic shock; furthermore, they led to the use of FoCUS, which can provide critical information quickly on site for a patient who is suddenly symptomatic after severe mechanical asphyxia in the pediatric emergency department, pediatric intensive care unit, or the prehospital setting.
Copyright © 2021 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.
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Percutaneous mitral valve repair with MitraClip device in hemodynamically unstable patients: A systematic review.
Catheter Cardiovasc Interv2021 Apr;():. doi: 10.1002/ccd.29703.
Martinez-Gomez Eduardo, McInerney Angela, Tirado-Conte Gabriela, de Agustin Jose Alberto, Jimenez-Quevedo Pilar, Escudero Andrés, Pozo Osinalde Eduardo, Viana-Tejedor Ana, Goirigolzarri Josebe, Marroquin Luis, Vivas David, Ferrera Carlos, Noriega Francisco, Restrepo-Cordoba Maria Alejandra, Gonzalo Nieves, Escaned Javier, Fernández-Ortiz Antonio, Amat-Santos Ignacio, Estevez-Loureiro Rodrigo, Macaya Carlos, Nombela-Franco Luis,
Abstract
BACKGROUND:
Very few data exist on percutaneous mitral valve repair (PMVr) in unstable patients with concomitant moderate-severe mitral regurgitation (MR). The purpose of this systematic review was to evaluate baseline characteristics, management and clinical outcomes of critically ill patients undergoing PMVr with MitraClip.
METHODS:
We conducted a systematic review of the published data on MitraClip from its first use in 2003 to December 2020. Studies referring to critically ill patients in cardiogenic shock or acute refractory pulmonary edema were included. A total of 40 publications including 254 patients with significant MR (Grade 4 in 91%) were included.
RESULTS:
Mean age was 70?±?12?years with mean Euroscore II and STS of 21?±?13 and 20.5?±?16, respectively. Clinical presentation was with cardiogenic shock and acute myocardial infarction in 72.8 and 60.0% of patients, respectively. Device success was achieved in 238 (93.7%) patients with a significant reduction in MR (Grade???2 in 91.8%, p?
CONCLUSIONS:
Percutaneous mitral valve repair with MitraClip device is a technically feasible and potentially viable management option in high-risk patients with cardiogenic shock or refractory pulmonary edema and concomitant moderate-severe MR. Prospective trials are required to confirm these findings, and definitively determine the value of MitraClip in hemodynamically unstable patients.
© 2021 Wiley Periodicals LLC.
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Monitoring skin blood flow to rapidly identify alterations in tissue perfusion during fluid removal using continuous veno-venous hemofiltration in patients with circulatory shock.
Ann Intensive Care2021 Apr;11(1):59. doi: 10.1186/s13613-021-00847-z.
Mongkolpun Wasineenart, Bakos Péter, Vincent Jean-Louis, Creteur Jacques,
Abstract
BACKGROUND:
Continuous veno-venous hemofiltration (CVVH) can be used to reduce fluid overload and tissue edema, but excessive fluid removal may impair tissue perfusion. Skin blood flow (SBF) alters rapidly in shock, so its measurement may be useful to help monitor tissue perfusion.
METHODS:
In a prospective, observational study in a 35-bed department of intensive care, all patients with shock who required fluid removal with CVVH were considered for inclusion. SBF was measured on the index finger using skin laser Doppler (Periflux 5000, Perimed, Järfälla, Sweden) for 3 min at baseline (before starting fluid removal, T0), and 1, 3 and 6 h after starting fluid removal. The same fluid removal rate was maintained throughout the study period. Patients were grouped according to absence (Group A) or presence (Group B) of altered tissue perfusion, defined as a 10% increase in blood lactate from T0 to T6 with the T6 lactate???1.5 mmol/l. Receiver operating characteristic curves were constructed and areas under the curve (AUROC) calculated to identify variables predictive of altered tissue perfusion. Data are reported as medians [25th-75th percentiles].
RESULTS:
We studied 42 patients (31 septic shock, 11 cardiogenic shock); median SOFA score at inclusion was 9 [8-12]. At T0, there were no significant differences in hemodynamic variables, norepinephrine dose, lactate concentration, ScvO or ultrafiltration rate between groups A and B. Cardiac index and MAP did not change over time, but SBF decreased in both groups (p?
CONCLUSION:
Baseline SBF and its early reduction after initiation of fluid removal using CVVH can predict worsened tissue perfusion, reflected by an increase in blood lactate levels.
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Vasopressor Load: Sounding the Alarm in Management of Cardiogenic Shock Associated With Acute Myocardial Infarction.
Crit Care Med2021 May;49(5):865-869. doi: 10.1097/CCM.0000000000004906.
Wiley Brandon M, Eckman Peter M, Jentzer Jacob C,
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