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Pubblicazioni recenti - cardiogenic
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Clinical outcomes of patients presenting with spontaneous coronary artery dissection versus takotsubo syndrome: a propensity score analysis.
Eur Heart J Acute Cardiovasc Care2019 Nov;():2048872619886311. doi: 10.1177/2048872619886311.
Macaya Fernando, Vedia Óscar, Salazar Carlos H, Mejía-Rentería Hernán, Ruiz-Pizarro Virginia, Salinas Pablo, Gonzalo Nieves, Pérez-Vizcayno María J, Vilacosta Isidre, Fernández-Ortiz Antonio, Macaya Carlos, Escaned Javier, Núñez-Gil Iván J,
Abstract
BACKGROUND:
Spontaneous coronary artery dissection and takotsubo syndrome are non-atherosclerotic causes of acute coronary syndromes. They share clinical features including female predominance and frequent triggers. We compared the outcomes of patients with spontaneous coronary artery dissection and patients with takotsubo syndrome with similar clinical characteristics.
METHODS:
Patients with spontaneous coronary artery dissection (=81) or takotsubo syndrome (=341) were 1:1 propensity matched according to age, sex, cardiovascular risk factors and clinical presentation. We compared baseline characteristics, effects on left ventricular function, and recurrence of major adverse cardiovascular events; defined as a composite of new hospitalisation for cardiac cause, clinical recurrence (spontaneous coronary artery dissection/takotsubo syndrome), myocardial infarction and death.
RESULTS:
Propensity score yielded 78 pairs: 85% were women, whose average age was 55.3±12.6 years, 28% had two or more cardiovascular risk factors, 37% presented with ST-segment elevation and 5% presented with cardiogenic shock. In the spontaneous coronary artery dissection group, 50% (39/78) of cases involved the left anterior descending artery and 18% (14/78) underwent revascularisation. After a median follow-up of 5 years (interquartile range 2.4-5), major adverse cardiovascular events were significantly higher in the spontaneous coronary artery dissection group (18% (14/78) vs. 8% (6/78); hazard ratio 3.40, 95% confidence interval 1.2-9.4). This was mainly driven by early readmissions for cardiac causes (17% vs. 5%, =0.007). Spontaneous coronary artery dissection was associated with higher peak values of creatinine kinase during admission (creatinine kinase/upper limit of normality 2.49 vs. 1.21, <0.001). Binary left ventricular systolic dysfunction was more prevalent in the takotsubo syndrome group (22% vs. 53%, <0.001), but no significant differences were noted at follow-up (6% vs. 1%, =0.181).
CONCLUSIONS:
In this cohort of middle-aged predominantly female patients presenting with acute coronary syndromes, the diagnosis of spontaneous coronary artery dissection compared to takotsubo syndrome conferred a worse long-term clinical outcome, mainly driven by an increased risk of rehospitalisation for cardiac causes.
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Outcome predictors of cardiogenic shock complicating ST-segment elevation myocardial infarction.
Tunis Med2019 Mar;97(3):476-483.
Boudiche Selim, Guermazi Omar, El Ayech Faten, Ben Halima Manel, Aouinti Mohamed Amine, Ouaghlani Khalil, Rekik Bassem, Khader Nadim, Aloui Hatem, Larbi Noureddine, Farhati Abdeljelil, Mghaieth Fathia, Ouali Sana, Mourali Mohamed Sami,
Abstract
BACKGROUND:
Cardiogenic shock complicating ST elevation myocardial infarction is burdened by a high mortality. There is only limited evidence for the management except for early revascularization and the relative ineffectiveness of intra-aortic balloon pump.
AIM:
Our objectives were to evaluate outcome and predictors of early all-cause 30-day mortality in the setting of cardiogenic shock complicating ST elevation myocardial infarction.
METHODS:
From January 2009 to August 2018, all patients who presented within the first 48 hours of ST elevation myocardial infarction complicated by cardiogenic shock and receiving invasive management were prospectively included.
RESULTS:
The study cohort comprised 122 consecutive patients. The mean age was 65±12 years and 74.5% of patients were males. Left ventricular failure was the most common etiology of cardiogenic shock (72.1%) and mechanical complications occurred in 8.2% of cases. Percutaneous coronary interventions were proposed for all patients and performed in a primary setting in 72.1%. A high prevalence of no reflow was noted (15.6%). Multivessel coronary artery disease was noted in 64.8% and multivessel percutaneous coronary interventions at the index procedure were performed in 22.1% of cases. Intra-aortic balloon pump was used in 17.2% of patients. The 30-day mortality was 58.2%. The only predictor of early mortality was the immediate multivessel percutaneous coronary intervention (OR=4.1, 95%CI 1.1-14.5; p=0.031).
CONCLUSION:
Despite invasive management strategies, 30-day mortality of cardiogenic shock complicating ST elevation myocardial infarction remained as high as 58.2%. Immediate multivessel percutaneous coronary intervention was the only predictor of early mortality.
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Unprotected left main percutaneous coronary intervention: prognostic value of SYNTAX score II.
Tunis Med2019 Apr;97(4):556-563.
Boudiche Selim, Guermazi Omar, Azaiez Fares, Ben Halima Manel, Rekik Bassem, Khader Nadim, Aloui Hatem, Farhati Abdeljelil, Larbi Noureddine, Mghaieth Fathia, Ouali Sana, Mourali Mohamed Sami,
Abstract
BACKGROUND:
Unprotected left main (LM) coronary artery disease (CAD) represents a challenging lesion with a major prognostic impact.
AIM:
Evaluate the clinical outcome and major adverse cardiac events (MACE) predictors of unprotected LM percutaneous coronary intervention (PCI) in an "all-comers" population.
METHODS:
We performed a prospective observational study of patients with unprotected LM stenosis treated by PCI. MACE were defined as the composite endpoint of all-cause death, myocardial infarction and target lesion revascularization.
RESULTS:
From January 2012 to December 2017, 150 consecutive patients who underwent unprotected LM PCI were included. The mean age was 64±12 years and 75.3% were males. Diabetes was noted in 50.7%. Emergent revascularization was performed in 20.7% of cases, including 3.3% patients with cardiogenic shock. Distal LM was involved in 76.7% of cases. A majority of patients (94.0%) had low or intermediate SYNTAX Score I (?32). The median SYNTAX score II was 31.1. Drug-eluting stents were used in 78.7% and bare metal stents in 21.3% of patients, mainly in emergent setting where the former were unavailable. In distal LM PCI, provisional approach was mostly used (81.7%). The median follow-up was 13.4 months. MACE occurred in 23.3% with an estimate of 37.9% at 5 years. Significant predictors of MACE were cardiogenic shock, bare metal stents use, previous PCI, and SYNTAX score II ?30.
CONCLUSION:
Unprotected LM PCI presents encouraging short and long term outcomes. SYNTAX score II might represent a predictor for long-term outcome in this particular lesion subset.
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A comparative study of bypass versus percutaneous intervention for left main disease.
Tunis Med2019 Apr;97(4):533-540.
Slim Mehdi, Meddeb Mohamed Aymen, Neffati Elies, Ghardallou Houda, Lagren Afef, Tarmiz Amine, Kortas Chokri, Gribaa Rym, Boughzela Essia,
Abstract
INTRODUCTION:
Left main coronary artery disease is known as the highest risk lesion subset of ischemic heart disease. Several studies have shown a significant benefit following treatment with coronary artery bypass grafting compared with medical treatment. As a result, surgery has been the standard of care for the revascularization of left main disease for a long time. However, with the remarkable improvements in interventional cardiology, percutaneous coronary intervention has become technically feasible and showed favorable clinical outcomes.
AIM:
We sought to evaluate trends in treatment strategies of left main coronary artery disease over time in Sahloul University Hospital and to compare patient's characteristics as well as early, mid-term and long-term adverse outcomes of each therapeutic option.
METHODS:
From 2005 to 2016, 260 patients with unprotected left main disease (defined as stenosis of at least 50%) were included. 109 patients underwent PCI (group 1), 102 patients underwent Surgery (group 2) and 49 patients were medically treated (group 3). Major cardiac and cerebrovascular events were defined as the composite of: mortality, nonfatal myocardial infarction, stroke, and need for repeat revascularization. Event rates were estimated with Kaplan-Meier analyses.
RESULTS:
Over time, the proportion of patients treated with percutaneous coronary intervention rather than coronary artery bypass grafting increased substantially, whereas the proportion of patients who received medical therapy remained steady. Group 1 patients had more cardiogenic shock (6.4% vs 0%, p=0,01) at presentation compared to group 2. More patients treated with surgery had multivessel disease (73% vs 40%; p <0.001), more distal left main bifurcation lesions (52.3% vs 73.5%; p=0.001) and higher SYNTAX scores (23.3±9.96 vs 32.5±8.7; p <0.001). All the other baseline variables were similar. At follow up, there were no differences, at the adjusted analysis, in the rate of myocardial infarction, cerebrovascular accidents, and the composite endpoint of major cardiovascular and cerebrovascular events (HR: 1, 04; 95% CI: 0.59 to 1.83; p=0.88). Compared to percutaneous coronary intervention group, group 2 has a higher all-cause mortality (p=0.017) driven exclusively by an elevated incidence of operative mortality (13.7% vs. 6.4%; HR: 0.08; 95% CI: 0.017 to 0.43; p=0.003). Nevertheless, long-term advantage of coronary artery bypass grafting over percutaneous coronary intervention was the less need for repeat revascularization (HR: 3.1; 95% CI: 1.26 to 8.12; p=0.014).
CONCLUSION:
Our data show that revascularization therapy have evolved remarkably in the favor of percutaneous coronary intervention over the last decade. Angioplasty and coronary artery bypass graft show comparable safety. However, the need for revascularization is more common after percutaneous treatment.
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Mechanical respiratory support in cardiogenic shock: reply.
Eur J Heart Fail2019 Nov;():. doi: 10.1002/ejhf.1618.
Helgestad Ole K L, Ravn Hanne B, Josiassen Jakob, Udesen Nanna L J, Møller Jacob E,
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Incidence, predictors and outcomes of stress hyperglycemia in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.
Diab Vasc Dis Res2019 Nov;():1479164119883983. doi: 10.1177/1479164119883983.
Khalfallah Mohamed, Abdelmageed Randa, Elgendy Ehab, Hafez Yasser Mostafa,
Abstract
BACKGROUND:
Stress hyperglycemia is a common finding during ST elevation myocardial infarction in diabetic patients and is associated with a worse outcome. However, there are limited data about stress hyperglycemia in non-diabetic patients and its outcome especially in patients undergoing primary percutaneous coronary intervention.
METHODS:
The study was conducted on 660 patients with ST elevation myocardial infarction who were managed with primary percutaneous coronary intervention. Patients were classified into two groups according to the presence of stress hyperglycemia: group I (patients with stress hyperglycemia) and group II (patients without stress hyperglycemia). Patients were analysed for clinical outcome including mortality and the occurrence of major adverse cardiac events.
RESULTS:
Incidence of stress hyperglycemia was 16.8%, multivariate regression analysis identified the independent predictors of stress hyperglycemia, that were family history of diabetes mellitus odds ratio 1.697 (95% confidence interval: 1.077-2.674, ?=?0.023), body mass index >24?kg/m odds ratio 1.906 (95% confidence interval: 1.244-2.922, ?=?0.003) and cardiogenic shock on admission odds ratio 2.517 (95% confidence interval: 1.162-5.451, ?=?0.019). Mortality, cardiogenic shock, contrast induced nephropathy and no reflow phenomenon were significantly higher in stress hyperglycemia group with value?=?0.027, 0.001, 0.020 and 0.037, respectively.
CONCLUSION:
Stress hyperglycemia in non-diabetic patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention is associated with increased incidence of no reflow phenomenon, contrast induced nephropathy, cardiogenic shock and higher mortality.
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Spinal Cord Infarction in a Patient Undergoing Veno-arterial Extracorporeal Membrane Oxygenation.
Acute Crit Care2018 Aug;33(3):187-190. doi: 10.4266/acc.2016.00556.
Shin Beomsu, Cho Yang Hyun, Choi Jin-Ho, Yang Jeong Hoon,
Abstract
Spinal cord infarction is an uncommon, but serious disorder characterized by severe motor impairment and bladder and bowel dysfunction. Spinal cord infarction is likely caused by hypoperfusion at the thoraco-lumbar spinal cord due to diverse reasons. An 81-year-old woman without motor or neurologic dysfunction presented with cardiogenic shock due to acute myocardial infarction. We performed veno-arterial extracorporeal membrane oxygenation (VA ECMO) to maintain adequate organ perfusion. Lower limb weakness was noted on day 1 of ECMO support. Although the symptom persisted, we could not carry out further evaluation because of her hemodynamic instability. After removal of ECMO, spinal magnetic resonance imaging was performed and showed a signal abnormality extending from the level of T5 to the conus medullaris. The patient underwent conservative management, but eventually experienced limb paralysis. Herein, we report a case of spinal cord infarction in a patient with myocardial infarction during VA ECMO support.
Copyright © 2018 The Korean Society of Critical Care Medicine.
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Pneumococcal Pneumonia Resembling Acute Myocardial Infarction in an Adolescent Male.
Pediatr Infect Dis J2019 Nov;():. doi: 10.1097/INF.0000000000002527.
Chiong Yee Keow, Tan Ian, Lim Terence Cw, Thong Wen Yi, Chan Mark Y, Chan Si Min,
Abstract
Myocarditis is commonly associated with viruses. However, we present a novel case of a teenager with pneumococcal pneumonia and bacteremia complicated by myocarditis and rhabdomyolysis, presenting with features of acute ST-elevation myocardial infarction and cardiogenic shock. Physicians should be aware that Streptococcus pneumoniae infection, like Group A Streptococcus, can mimic acute myocardial infarction in young males without cardiovascular risk factors.
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Suppression of Superoxide-Hydrogen Peroxide Production at Site IQ of Mitochondrial Complex I Attenuates Myocardial Stunning and Improves Postcardiac Arrest Outcomes.
Crit Care Med2019 Nov;():. doi: 10.1097/CCM.0000000000004095.
Piao Lin, Fang Yong-Hu, Hamanaka Robert B, Mutlu Gökhan M, Dezfulian Cameron, Archer Stephen L, Sharp Willard W,
Abstract
OBJECTIVES:
Cardiogenic shock following cardiopulmonary resuscitation for sudden cardiac arrest is common, occurring even in the absence of acute coronary artery occlusion, and contributes to high rates of postcardiopulmonary resuscitation mortality. The pathophysiology of this shock is unclear, and effective therapies for improving clinical outcomes are lacking.
DESIGN:
Laboratory investigation.
SETTING:
University laboratory.
SUBJECTS:
C57BL/6 adult female mice.
INTERVENTIONS:
Anesthetized and ventilated adult female C57BL/6 wild-type mice underwent a 4, 8, 12, or 16-minute potassium chloride-induced cardiac arrest followed by 90 seconds of cardiopulmonary resuscitation. Mice were then blindly randomized to a single IV injection of vehicle (phosphate-buffered saline) or suppressor of site IQ electron leak, an inhibitor of superoxide production by complex I of the mitochondrial electron transport chain. Suppressor of site IQ electron leak and vehicle were administered during cardiopulmonary resuscitation.
MEASUREMENTS AND MAIN RESULTS:
Using a murine model of asystolic cardiac arrest, we discovered that duration of cardiac arrest prior to cardiopulmonary resuscitation determined postresuscitation success rates, degree of neurologic injury, and severity of myocardial dysfunction. Post-cardiopulmonary resuscitation cardiac dysfunction was not associated with myocardial necrosis, apoptosis, inflammation, or mitochondrial permeability transition pore opening. Furthermore, left ventricular function recovered within 72 hours of cardiopulmonary resuscitation, indicative of myocardial stunning. Postcardiopulmonary resuscitation, the myocardium exhibited increased reactive oxygen species and evidence of mitochondrial injury, specifically reperfusion-induced reactive oxygen species generation at electron transport chain complex I. Suppressor of site IQ electron leak, which inhibits complex I-dependent reactive oxygen species generation by suppression of site IQ electron leak, decreased myocardial reactive oxygen species generation and improved postcardiopulmonary resuscitation myocardial function, neurologic outcomes, and survival.
CONCLUSIONS:
The severity of cardiogenic shock following asystolic cardiac arrest is dependent on the length of cardiac arrest prior to cardiopulmonary resuscitation and is mediated by myocardial stunning resulting from mitochondrial electron transport chain complex I dysfunction. A novel pharmacologic agent targeting this mechanism, suppressor of site IQ electron leak, represents a potential, practical therapy for improving sudden cardiac arrest resuscitation outcomes.
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Intravascular ultrasound, optical coherence tomography, and fractional flow reserve use in acute myocardial infarction.
Catheter Cardiovasc Interv2019 Nov;():. doi: 10.1002/ccd.28543.
Vallabhajosyula Saraschandra, El Hajj Stephanie C, Bell Malcolm R, Prasad Abhiram, Lerman Amir, Rihal Charanjit S, Holmes David R, Barsness Gregory W,
Abstract
BACKGROUND:
There are limited data on the use of intravascular ultrasound (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) during acute myocardial infarction (AMI).
OBJECTIVES:
To assess the temporal trends of IVUS, OCT, and FFR use in AMI.
METHODS:
A retrospective cohort study from the National Inpatient Sample (2004-2014) was designed to include AMI admissions that received coronary angiography. Administrative codes were used to identify percutaneous coronary intervention (PCI), IVUS, OCT, and FFR. Outcomes included temporal trends, inhospital mortality and resource utilization stratified by IVUS, OCT, or FFR use.
RESULTS:
In 4,419,973 AMI admissions, IVUS, OCT, and FFR were used in 2.6%, 0.1%, and 0.6%, respectively. There was a 22-fold, 118-fold, and 33-fold adjusted increase in IVUS, OCT, and FFR use, respectively, in 2014 compared to the first year of use. Non-ST-elevation AMI presentation, male sex, private insurance coverage, admission to a large urban hospital, and absence of cardiac arrest and cardiogenic shock were associated with higher IVUS, OCT, or FFR use. PCI was performed in 83.2% of the IVUS, OCT, or FFR cohort compared to 64.2% of the control group (p?
CONCLUSIONS:
In AMI, the use of IVUS, OCT, and FFR has increased during 2004-2014. Significant patient and hospital-level disparities exist in the use of these technologies.
© 2019 Wiley Periodicals, Inc.
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Acute Fulminant Myocarditis Following Influenza Vaccination Requiring Extracorporeal Membrane Oxygenation.
Acute Crit Care2019 May;34(2):165-169. doi: 10.4266/acc.2017.00045.
Kim Youn-Jung, Bae Jun-Il, Ryoo Seung Mok, Kim Won Young,
Abstract
The inactivated influenza vaccination is generally safe with mostly mild side effects. We report a rare but fatal adverse event following influenza vaccination. A previously healthy 27-year-old woman who received the influenza vaccination 3 days before presenting to the emergency department had rapidly aggravating dyspnea and mental deterioration. She was diagnosed as having acute fulminant myocarditis with refractory cardiogenic shock, which was successfully managed with veno-arterial extracorporeal membrane oxygenation. The cardiac function of the patient recovered in 3 weeks.
Copyright © 2019 The Korean Society of Critical Care Medicine.
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Cardiogenic shock and multiorgan dysfunction secondary to clozapine.
Rev Psiquiatr Salud Ment2019 Nov;():. doi: S1888-9891(19)30094-1.
Espinosa González María Del Carmen, Nuevo Fernández Laura,
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Right Ventricular Outflow Doppler Predicts Low Cardiac Index in Intermediate Risk Pulmonary Embolism.
Clin Appl Thromb Hemost;25():1076029619886062. doi: 10.1177/1076029619886062.
Brailovsky Yevgeniy, Lakhter Vladimir, Weinberg Ido, Porcaro Katerina, Haines Jeremiah, Morris Stephen, Masic Dalila, Mancl Erin, Bashir Riyaz, Alkhouli Mohamad, Rosenfield Kenneth, Mathew Verghese, Lopez John, Bechara Carlos F, Joyce Cara, Fareed Jawed, Darki Amir,
Abstract
Intermediate-risk pulmonary embolism (PE) has variable outcomes. Current risk stratification models lack the positive predictive value to identify patients at highest risk of PE-related mortality. We identified intermediate-risk PE patients who underwent catheter-based interventions and right heart catheterization (RHC) and identified those with low cardiac index (CI < 2.2 L/min/m). We utilized regression models to identify echocardiographic predictors of low CI and Kaplan Meier curve to evaluate PE-related mortality when stratified by the echocardiographic predictor. Of 174 intermediate-risk PE patients, 41 underwent RHC. Within this cohort, 46.3% had low CI. Univariable linear regression identified right ventricular outflow tract velocity time integral (RVOT VTI), right/left ventricular ratio, S prime, inferior vena cava diameter, and pulmonary artery systolic pressure as potential predictors of low CI. Multivariable linear regression identified RVOT VTI as significant predictor of low CI (? coefficient 0.124, 95% confidence interval [CI]: 0.01-0.24, = .034). Right ventricular outflow tract velocity time integral <9.5 cm was associated with increased PE-related mortality, = .002. A substantial proportion of intermediate-risk PE patients referred for catheter-based interventions had low CI despite normotension. Right ventricular outflow tract velocity time integral was a significant predictor of low CI. Low RVOT VTI was associated with increased PE-related mortality.
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Molecular signature of cardiogenic shock.
Eur Heart J2019 Nov;():. doi: ehz783.
Iborra-Egea Oriol, Rueda Ferran, García-García Cosme, Borràs Eva, Sabidó Eduard, Bayes-Genis Antoni,
Abstract
The incidence of cardiogenic shock (CS) has increased remarkably over the past decade and remains a challenging condition with mortality rates of ?50%. Cardiogenic shock encompasses cardiac contractile dysfunction; however, it is also a multiorgan dysfunction syndrome, often complicated by a systemic inflammatory response with severe cellular and metabolic dysregulations. Here, we review the evidence on the biochemical manifestations of CS, elaborating on current gold standard biomarkers and novel candidates from molecular signatures of CS. Glucose and lactate, both identified over a century ago, remain the only clinically used biomarkers in current predictive risk scores. Novel genomic, transcriptomic, and proteomic data are discussed, and a recently reported molecular score derived from unbiased proteomic discovery, the CS4P, which includes liver fatty acid-binding protein, beta-2-microglobulin, fructose-bisphosphate aldolase B, and SerpinG1 is comprehensively described. Recent advances in -omics technologies provide new insight into a more holistic molecular signature of CS. Thus, we need to open new diagnostic and therapeutic avenues if we aim to improve outcomes.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.
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infection presenting as severe ARDS.
IDCases2019 ;18():e00645. doi: 10.1016/j.idcr.2019.e00645.
Tran Liem T, Helms Jessica L, Sierra-Hoffman Miguel, Stevens Mark L, Deliz-Aguirre Rafael, Castro-Lainez Mirams T, Deliz Rafael J,
Abstract
Murine typhus, also known as endemic typhus, is a disease resulting from an infection caused by the gram-negative bacillus . Murine typhus is identified worldwide, predominantly in tropical and subtropical geographic locations. Transmission occurs through direct inoculation by an arthropod vector, most commonly the rat flea, . rickettsial infections are notorious for disseminated infections throughout the endothelial cells. The increase in permeability is an immediate consequence and has the potential of leading to non-cardiogenic pulmonary edema, otherwise known as acute respiratory distress syndrome (ARDS). Clinical manifestations are non-specific and initially mimic typical viral etiologies, obscuring early diagnosis. As a result, clinicians often do not include rickettsial infections in their differential diagnoses. Definitive diagnosis is based on clinical recognition, epidemiologic awareness, and serological testing. Here we present a confirmed case of murine typhus in a young non-immunocompromised patient who developed ARDS one week from the initial onset of symptoms.
© 2019 The Authors.
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The Patient Selection Criteria for Veno-arterial Extracorporeal Mechanical Oxygenation.
Cureus2019 Sep;11(9):e5709. doi: 10.7759/cureus.5709.
Banga Sandeep, Challa Abhiram, Patel Avani R, Singh Shantanu, Emani Vamsi K,
Abstract
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) plays a crucial role in the management of patients with refractory cardiac and pulmonary dysfunction by providing temporary mechanical hemodynamic and respiratory support. However, the paucity of guidelines on indications for administering it and the failure to timely initiate VA-ECMO often result in a high in-hospital mortality rate and poor six-month outcomes after VA-ECMO deployment. Due to ethical issues, randomized controlled studies with VA-ECMO have not been conducted so that no recommended evidence-based guidelines exist for VA-ECMO patient-selection criteria. Therefore, the indication for administering the device depends solely on expert opinion after reviewing the literature. We conducted a review of the current literature to better understand and classify the need for proper patient selection, including proven indications for VA-ECMO.
Copyright © 2019, Banga et al.
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In-hospital Outcomes and Characteristics of Heart Failure in Sickle Cell Disease.
Cureus2019 Sep;11(9):e5660. doi: 10.7759/cureus.5660.
Fadiran Olusayo, Balogun Abimbola F, Ogunti Richard, Buhari Olajide, Lanka Chandana, Atanda Adebayo, Larbi Daniel A, Prafulla Mehrotra,
Abstract
Sickle cell disease (SCD) predominantly affects African-Americans (AAs) in the United States (US). Due to increasing life expectancy in developed countries, SCD-associated cardiomyopathy is typically seen in adults. The aim of this study was to distinguish hospitalization for this phenotype from traditional heart failure (HF) in AAs. We used the National Inpatient Sample (NIS) database to identify HF hospitalizations in AAs between 2005 and 2014 and stratified them according to SCD status. We compared the characteristics and outcomes before and after matching in a 1:3 ratio for age, gender, insurance, smoking status and admission year. Amongst the 1,195,718 HF admissions in AAs, SCD accounted for 7835. The age (mean ± SD) in the SCD cohort was significantly younger (45.66 ± 13.2) vs non-SCD (64.8 ± 15.2), p<0.001. SCD adults had significantly higher rates of pulmonary hypertension (PH), deep vein thrombosis, and pulmonary embolism while non-SCD adults had higher rates of cardiogenic shock and respiratory failure requiring intubation. The national hospitalization rate for HF in AAs increased from 151 to 257 per million between 2005 and 2011 before declining to 241 per million in 2014. There was a decrease in in-hospital mortality in AAs from 4.8% in 2005 to 3.6% in 2014. We also identified independent predictors of in-hospital mortality in SCD with HF. In conclusion, we described hospitalizations for an emerging heart failure phenotype in AAs. Although there is a national decreasing rate of HF hospitalizations in the US, this may not be reflective of the AA population.
Copyright © 2019, Fadiran et al.
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Takotsubo syndrome and cardiac implantable electronic device therapy.
Sci Rep2019 Nov;9(1):16559. doi: 10.1038/s41598-019-52929-5.
El-Battrawy Ibrahim, Erath Julia W, Lang Siegfried, Ansari Uzair, Behnes Michael, Gietzen Thorsten, Zhou Xiaobo, Borggrefe Martin, Akin Ibrahim,
Abstract
Recent studies have reported that takotsubo syndrome (TTS) patients are suffering from life-threatening arrhythmias. The aim of our study was to understand the short and long-term usefulness of cardiac implantable electronic devices in TTS patients.We constituted a collective of 142 patients in a bi-centric study diagnosed with TTS between 2003 and 2017. The patient groups, divided according to the treatment with (n?=?9, 6.3%) or without cardiac devices (n?=?133, 93.7%), were followed-up to determine the importance of devices and its complications. One patient was treated with a permanent pacemaker, five patients with a wearable cardioverter defibrillator, two patients with a subcutaneous defibrillator and one patient with a transvenous defibrillator. Regular device check-up was documented in all patients, presenting an ongoing high-degree AV-block. Neither device complications nor life-threatening tachyarrhythmias were documented after acute TTS event. However, patients comprising the device group suffered significantly more often from a highly reduced EF (30?±?7.7% versus 39.1?±?9.7%; p?
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Incidence, clinical correlates, timing of occurrence, and consequences of acute thrombus formation in patients undergoing the MitraClip procedure.
Kardiol Pol2019 Nov;():. doi: 10.33963/KP.15056.
Pr?gowski Jerzy, K?apyta Adrian, Chmielak Zbigniew, Skowro?ski Jaros?aw, Szyma?ski Piotr, Mintz Gary S, Stok?osa Patrycjusz, Waci?ski Piotr, Madejczyk Andrzej, Brzozowski Wojciech, Wojtkowska Agnieszka, Chmielecki Micha?, Ga??ska Rafa?, Fija?kowski Marcin, Cie?wierz Dariusz, Wolny Rafa?, Kali?czuk ?ukasz, Kuku?a Krzysztof, Witkowski Adam,
Abstract
BACKGROUND:
Despite adequate heparinization, there are case reports documenting fresh intracardiac thrombus formation during the MitraClip procedure.
AIM:
To evaluate the incidence and clinical consequences of intracardiac thrombus formation during MitraClip implantation.
METHODS:
The clinical data and transesophageal echocardiography (TEE) recorded during 100 consecutive MitraClip procedures (81 males, mean age 67.8 [8.3] years) were reviewed. In all patients heparin bolus was given immediately after successful transseptal puncture, and the ACT was maintained > 250 seconds throughout the procedure.
RESULTS:
Thrombus formation during the procedure was documented in 9 patients (9%). In 6 patients thrombi formed on the transseptal needle/sheath (2 attached to the transseptal sheath in the right atrium and 4 on the transseptal sheath immediately after puncture in the left atrium) and in 3 patients on the MitraClip device itself in the left atrium (2 on the steerable guiding catheter, and 1 on the clip delivery system). Overall, 6 (67%) thrombi formed prior to heparin administration and 3 (33%) after heparin with ACT > 250s. All thrombi were transient and disappeared within minutes. There were no periprocedural ischemic strokes, transient ischemic attacks, or other embolic complications. Patients with thrombi had similar baseline clinical characteristics except for lower ejection fraction (EF: 23 [10%] vs 30 [10%]; p=0.03). Overall, 6 out of 100 patients died in hospital post-procedure: 2 out of 9 with visible thrombus (1 due to electric storm on day 14 and 1 due to cardiogenic shock on day 5) and 4 out of 91 without thrombus (p=0.09).
CONCLUSIONS:
Periprocedural thrombi occur relatively often during the MitraClip procedure, especially in patients with a low LVEF, but are transient.
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Optimal Strategy and Timing of Left Ventricular Venting During Veno-Arterial Extracorporeal Life Support for Adults in Cardiogenic Shock: A Systematic Review and Meta-Analysis.
Circ Heart Fail2019 Nov;12(11):e006486. doi: 10.1161/CIRCHEARTFAILURE.119.006486.
Al-Fares Abdulrahman A, Randhawa Varinder K, Englesakis Marina, McDonald Michael A, Nagpal A Dave, Estep Jerry D, Soltesz Edward G, Fan Eddy,
Abstract
BACKGROUND:
Veno-arterial extracorporeal life support (VA-ECLS) is widely used to treat refractory cardiogenic shock. However, increased left ventricular (LV) afterload in VA-ECLS can worsen pulmonary congestion and compromise myocardial recovery. Our objectives were to explore the efficacy, safety, and optimal timing of adjunctive LV venting strategies.
METHODS:
A systematic search was performed on Medline, EMBASE, PubMed, CDSR, CCRCT, CINAHL, ClinicalTrials.Gov, and WHO ICTRP from inception until January 2019 for all relevant studies, including LV venting. Data were analyzed for mortality and weaning from VA-ECLS on the basis of timing of LV venting, along with adverse complications.
RESULTS:
A total of 7995 patients were included from 62 observational studies, wherein 3458 patients had LV venting during VA-ECLS. LV venting significantly improved weaning from VA-ECLS (odds ratio, 0.62 [95% CI, 0.47-0.83]; =0.001) and reduced short-term (30 day; risk ratio [RR], 0.86 [95% CI, 0.77-0.96]; =0.008) but not in-hospital (RR, 0.92 [95% CI, 0.83-1.01] =0.09) or long-term (6 months; RR, 0.96 [95% CI, 0.90-1.03]; =0.27) mortality. Early (<12 hours; RR, 0.86 [95% CI, 0.75-0.99]; =0.03) but not late (?12 hours; RR, 0.99 [95% CI, 0.71-1.38]; =0.93) LV venting significantly reduced short-term mortality. Patients with LV venting spent more time on VA-ECLS (3.6 versus 2.8 days, <0.001), and mechanical ventilation (7.1 versus 4.6 days, =0.013). With the exception of hemolysis (RR, 2.18 [95% CI, 1.58-3.01]; <0.00001), overall adverse events did not differ.
CONCLUSIONS:
LV venting, especially if done early (<12 hours), appears to be associated with an increased success of weaning and reduced short-term mortality. Future studies are required to delineate the importance of any or early LV venting adjuncts on mortality and morbidity outcomes.
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