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Pubblicazioni recenti - cardiogenic
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MitraClip to Treat Severe Ischemic Mitral Regurgitation During Impella CP Support in a 70-Year-Old Woman.
Tex Heart Inst J2020 Aug;47(4):306-310. doi: 10.14503/THIJ-18-6901.
Ashraf Said, Ando Tomo, Blank Nimrod, Munir Ahmad, Schreiber Theodore,
Abstract
Acute mitral regurgitation is a life-threatening complication of acute myocardial infarction. We present the case of a 70-year-old woman who had acute myocardial infarction complicated by severe mitral regurgitation and cardiogenic shock. Although current guidelines recommend mitral valve surgery for such patients, surgery often carries prohibitive risk of morbidity and mortality. Thus, in certain patients, percutaneous repair may be the only viable treatment option. In this case, we used a 3-step percutaneous approach involving coronary artery revascularization with a drug-eluting stent in the left circumflex coronary artery, mechanical circulatory support with an Impella CP pump for cardiogenic shock, and mitral valve repair with the MitraClip system for severe mitral regurgitation. After successful intervention, our patient regained hemodynamic stability and showed clinical improvement at one-month follow-up.
© 2020 by the Texas Heart® Institute, Houston.
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Interventricular Septal Rupture in a 62-Year-Old Man With Familial Amyloid Polyneuropathy.
Tex Heart Inst J2020 Aug;47(4):302-305. doi: 10.14503/THIJ-18-6799.
Pidello Stefano, Simonato Erika, Orzan Fulvio, Frea Simone, Barreca Antonella, Rinaldi Mauro, Boffini Massimo,
Abstract
Cardiac involvement in familial amyloid polyneuropathy consists of arrhythmias, conduction disturbances, and heart failure. To our knowledge, heart rupture has never been described in association with this condition. We report the case of a 62-year-old man with a 6-year history of refractory familial amyloid polyneuropathy who underwent liver transplantation. The operation was complicated by severe hypotension because the neuropathy involved the autonomic system. Perioperatively, the patient had a myocardial infarction, and during the next 10 days, a complete interventricular septal rupture developed, resulting in a systemic-to-pulmonary shunt. Coronary angiographic findings were normal. However, the shunt caused unstable hemodynamics, resulting in cardiogenic shock. An attempt to close the rupture percutaneously failed. The patient underwent successful heart transplantation 50 days later. Macroscopic examination of the explanted heart showed thickening of both ventricles, septal rupture, and a gray scar in the interventricular septum around the cavity. Histopathologic examination revealed intramural amyloid angiopathy. Our case shows that heart rupture can occur in patients with familial amyloid polyneuropathy who have no history of obstructive coronary artery disease, perhaps as a result of tissue fragility caused by amyloid angiopathy. Therefore, autonomic disturbances should be regarded with concern and promptly treated in the perioperative period.
© 2020 by the Texas Heart® Institute, Houston.
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Disseminated Intravascular Coagulation Score Is Related to Short-term Mortality in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation After Cardiac Surgery.
ASAIO J2021 Jan;():. doi: 10.1097/MAT.0000000000001333.
Wang Liangshan, Shao Juanjuan, Fan Eddy, Jia Ming, Wang Hong, Hou Xiaotong,
Abstract
Disseminated intravascular coagulation (DIC) score is associated with short-term mortality in various conditions but has not been studied in postcardiotomy cardiogenic shock (PCS) patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO). The objective of this study was to evaluate the relationship between DIC score at day 1 from VA-ECMO initiation and short-term mortality. We included all PCS patients supported with VA-ECMO at the Beijing Anzhen Hospital between January 2015 and December 2018. Multivariable logistic regression analysis was performed to assess the relationship between DIC score at day 1 and in-hospital mortality, and adjust for potential confounding variables. Of 222 PCS patients treated with VA-ECMO, 145 (65%) patients were weaned from VA-ECMO, and median (IQR) ECMO support duration was five (3-6) days. In-hospital mortality was 53%. The median (IQR) DIC score at day 1 was five (4-6). Patients with DIC score ?5 at day 1 (overt DIC) had higher in-hospital mortality as compared with patients with DIC score <5 (64% vs. 22%; P < 0.001). After adjusting for age, sex, ECMO indication, and peak serum lactate, a one-point rise in DIC score [OR, 2.20; 95% confidence intervals (CI), 1.64-2.95] or DIC score ?5 at day 1 (OR, 4.98; 95% CI, 2.42-10.24) was associated with an increased risk of in-hospital mortality. The area under the receiver operating characteristic curve for DIC score at day 1 was 0.76 (95% CI, 0.69-0.82). Our study suggests that DIC score at day 1 is associated with short-term mortality in patients undergoing VA-ECMO after cardiac surgery, independent of age, sex, disease characteristics, and severity of illness.
Copyright © 2021 by the American Society for Artificial Internal Organs.
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Use of Tissue Plasminogen Activator Alteplase Purge Solution in an Impella 5.5 Heart Pump.
ASAIO J2021 Jan;():. doi: 10.1097/MAT.0000000000001349.
Tunney Robert K, Tidwell William P, Kumar Anupam A, Brinkley Marshall,
Abstract
Standardized Impella purge solutions have traditionally consisted of 5-40% dextrose with or without unfractionated heparin as a means of anticoagulation. Such a solution serves to create a pressure barrier preventing entry of blood into the pump's motor housing with heparin providing adequate purge pathway patency in the event of this occurring. We present a case of tissue plasminogen activator (tPA, Activase) utilization in lieu of the recommended purge solution due to concern for thrombus formation of the purge pathway in a 51-year-old male with cardiogenic shock status-post Impella 5.5 heart pump placement for hemodynamic support while awaiting heart transplantation. The purge solution was successfully administered for 48 hours without complication and a reduction in average purge pressure with increase in purge flow rate was observed.
Copyright © 2021 by the American Society for Artificial Internal Organs.
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[The challenge of cardiogenic shock. Business of many or of a few?]
G Ital Cardiol (Rome)2021 Feb;22(2):137-139. doi: 10.1714/3514.35028.
Casella Gianni, Cuccia Claudio, Smecca Ignazio Maria,
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[Clinical pathway for cardiogenic shock. A proposal from ANMCO Tuscany].
G Ital Cardiol (Rome)2021 Feb;22(2):122-136. doi: 10.1714/3514.35027.
Valente Serafina, Anselmi Francesca, Sorini Dini Carlotta, Iadanza Alessandro, Casolo Giancarlo,
Abstract
Cardiogenic shock is a clinical syndrome characterized by hypotension and hypoperfusion due to the inability of the heart to provide adequate cardiac output. It is an infrequent clinical condition still burdened by high mortality rates. In patients with cardiogenic shock rapid diagnosis, multiparameter monitoring and timely therapeutic strategies with pharmacological agents or mechanical circulatory support are necessary to provide adequate peripheral tissue perfusion and to improve outcome. Recent investigations reported lower mortality rates to be associated with clinical pathways based on a well-organized network, and on admission in high-volume specialized hospitals (Shock Center) with a dedicated multidisciplinary team (Shock Team). The aim of this clinical pathway for cardiogenic shock is to describe the best organization to ensure to Tuscan citizens an equal access to care independently of the site where they suffer from cardiogenic shock.
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The Association Between Hyperlipidemia and In-Hospital Outcomes in Takotsubo Cardiomyopathy.
Diabetes Metab Syndr Obes2021 ;14():117-126. doi: 10.2147/DMSO.S282009.
Li Pengyang, Lu Xiaojia, Teng Catherine, Hadley Michelle, Cai Peng, Dai Qiying, Wang Bin,
Abstract
Purpose:
Hyperlipidemia (HLD) is one of the most common cardiovascular risk factors and is prevalent in patients with takotsubo cardiomyopathy (TCM), but the association between HLD and TCM patients' outcomes is unclear. We investigated the impact of HLD on the in-hospital outcomes of TCM patients.
Patients and Methods:
Our retrospective cohort study used the latest available data from the National Inpatient Sample (2016-2017). Using the ICD-10 code, we identified 3139 patients with a primary diagnosis of TCM, 1530 of whom had HLD. We compared in-hospital outcomes between HLD and non-HLD groups before and after propensity score matching.
Results:
In the unmatched cohort, the HLD group had lower incidences of cardiac arrest, cardiogenic shock, and acute respiratory failure (ARF); shorter length of stay (LOS); and lower total charges (All p<0.05). In-hospital mortality (p=0.102) and ventricular arrhythmia (p=0.235) rates did not differ. After propensity score matching, the HLD group had lower rates of in-hospital mortality (1.1% vs 2.4%, p=0.027), ARF (9.1% vs 12.1%, p = 0.022) and cardiogenic shock (3.4% vs 5.6%, p=0.012), shorter LOS (3.20 ± 3.27 days vs 3.57 ± 3.14 days, p=0.005), and lower total charges (p=0.013). The matched groups did not differ significantly regarding cardiac arrest (p=0.141), ventricular arrhythmia (p=0.662) or acute kidney injury (AKI) (p = 0.167).
Conclusion:
Counterintuitively, HLD was associated with better in-hospital outcomes in both the unmatched and propensity-matched cohorts of hospitalized TCM patients. Further studies are needed to investigate the mechanisms that may contribute to the association in TCM patients with HLD.
© 2021 Li et al.
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Cardiorespiratory arrest after iso-osmolar iodinated contrast injection: A case report of contrast-induced encephalopathy following contrast-enhanced computed-tomography.
Medicine (Baltimore)2021 Jan;100(2):e24035. doi: 10.1097/MD.0000000000024035.
Yao Li-Ding, Zhu Xiu-Liang, Yang Run-Lin, Zhang Min-Ming,
Abstract
RATIONALE:
Contrast-induced encephalopathy (CIE) is a rare complication caused by administration of intravascular contrast media and characterized by acute reversible neurological disturbance. Most of the CIE cases are reported after arterial administration of contrast media such as during cerebral or coronary angiographies, yet only a few articles have reported CIE secondary to intravenous contrast. A case of CIE secondary to intravenous contrast administration is reported here.
PATIENT CONCERNS:
A 68-year-old man was admitted to our hospital for contrast-enhanced chest computed-tomography (CT) examination due to suspected pulmonary nodules. After CT examination, the patient lost consciousness and experienced a cardiorespiratory arrest. An emergency plain brain CT was done immediately which showed abnormal cortical contrast enhancement and cerebral sulci hyperdensity.
DIAGNOSES:
After excluding other differential diagnoses such as electrolytes imbalance, hypo/hyperglycemia, cardiogenic pathologies and other neurological emergencies such as cerebral hemorrhage, cerebral infarction, the final diagnosis of CIE was made.
INTERVENTIONS:
The patient was admitted to the intensive care unit for further management. A series of supportive treatments were arranged.
OUTCOMES:
Follow-up visits at the outpatient clinic showed no lasting neurological deficits.
LESSONS:
CIE should be considered as 1 of the differential diagnoses for a patient with acute neurologic symptoms after iodinate contrast administration. Neuroradiological imaging examinations are essential to rule out other etiologies such as acute cerebral infarction or intracranial hemorrhage.
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
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Acute lung injury - from pathophysiology to treatment.
Physiol Res2021 Jan;69(Suppl 3):S353-S366.
Mokrá D,
Abstract
Acute lung injury is characterized by acute respiratory insufficiency with tachypnea, cyanosis refractory to oxygen, decreased lung compliance, and diffuse alveolar infiltrates on chest X-ray. The 1994 American-European Consensus Conference defined "acute respiratory distress syndrome, ARDS" by acute onset after a known trigger, severe hypoxemia defined by PaO2/FiO2
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Stress hyperglycemia, cardiac glucotoxicity, and critically ill patient outcomes current clinical and pathophysiological evidence.
Physiol Rep2021 Jan;9(2):e14713. doi: 10.14814/phy2.14713.
Scheen Marc, Giraud Raphael, Bendjelid Karim,
Abstract
Stress hyperglycemia is a transient increase in blood glucose during acute physiological stress in the absence of glucose homeostasis dysfunction. Its's presence has been described in critically ill patients who are subject to many physiological insults. In this regard, hyperglycemia and impaired glucose tolerance are also frequent in patients who are admitted to the intensive care unit for heart failure and cardiogenic shock. The hyperglycemia observed at the beginning of these cardiac disorders appears to be related to a variety of stress mechanisms. The release of major stress and steroid hormones, catecholamine overload, and glucagon all participate in generating a state of insulin resistance with increased hepatic glucose output and glycogen breakdown. In fact, the observed pathophysiological response, which appears to regulate a stress situation, is harmful because it induces mitochondrial impairment, oxidative stress-related injury to cells, endothelial damage, and dysfunction of several cellular channels. Paradigms are now being challenged by growing evidence of a phenomenon called glucotoxicity, providing an explanation for the benefits of lowering glucose levels with insulin therapy in these patients. In the present review, the authors present the data published on cardiac glucotoxicity and discuss the benefits of lowering plasma glucose to improve heart function and to positively affect the course of critical illness.
© 2021 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.
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Intravenous Immunoglobulin Therapy in Myocarditis.
Iran J Allergy Asthma Immunol2020 Aug;19(4):323-336. doi: 10.18502/ijaai.v19i4.4109.
Mansourabadi Amir Hossein, Gol Mohammad Pour Afrakoti Ladan, Shahi Abbas, Shabanian Reza, Amirzargar Aliakbar,
Abstract
Myocarditis is an inflammatory disease of the myocardium with lymphocyte infiltration and myocyte necrosis leading to a wide range of clinical presentations including heart failure, arrhythmia, and cardiogenic shock. Infectious and noninfectious agents may trigger the disease. The fact that immunosuppressive drugs are useful in several kinds of autoimmune myocarditis is proof of the autoimmune mechanisms involved in the development of myocarditis. Pathogenic mechanisms in myocardial inflammation are including inflammasome activation followed by myocyte destruction, myocarditis, and pericarditis. Intravenous immunoglobulin (IVIG) is a serum product made up of immunoglobulins, widely used in a variety of diseases. This product is effective in several immune-mediated pathologies. As well as the determined usage of IVIG in Kawasaki disease, IVIG may be useful in several kinds of heart failure including fulminant myocarditis, acute inflammatory cardiomyopathy, Giant Cell Myocarditis, and peripartum cardiomyopathy. Generally, IVIG is used in two different doses of low dose (200 to 400 mg/kg) and high dose (2 g/kg) regimen. The exact therapeutic effects of IVIG are not clear, however over the last decades, our knowledge about its mechanism of function has greatly enhanced. IVIG administration should be based on the accepted protocols of its transfusion. In this review article, we try to provide an overview of the different kinds of myocarditis, pathologic mechanisms and their common treatments and evaluation of the administration of IVIG in these diseases. Furthermore, we will review current protocols using IVIG in each disease individually.
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Outcomes of COVID-19 Positive Acute Coronary Syndrome Patients; a multisource Electronic Healthcare Records Study from England.
J Intern Med2021 Jan;():. doi: 10.1111/joim.13246.
Rashid Muhammad, Wu Jianhua, Timmis Adam, Curzen Nick, Clarke Sarah, Zaman Azfar, Nolan James, Shoaib Ahmad, Mohamed Mohamed O, de Belder Mark A, Deanfield John, Gale Chris P, Mamas Mamas A,
Abstract
BACKGROUND:
Patients with underlying cardiovascular disease and Coronavirus disease 2019 (COVID-19) infection are at increased risk of morbidity and mortality.
OBJECTIVES:
This study was designed to characterise the presenting profile and outcomes of patients hospitalized with acute coronary syndrome (ACS) and COVID-19 infection.
METHODS:
This observational cohort study was conducted using multisource data from all acute NHS hospitals in England. All consecutive patients hospitalized with diagnosis of ACS with or without COVID-19 infection between 1 March- 31 May 2020 were included. The primary outcome was in-hospital and 30-day mortality.
RESULTS:
A total of 12,958 patients were hospitalized with ACS during the study period, of which 517 (4.0%) were COVID-19 positive and were more likely to present with non-ST elevation acute myocardial infarction. COVID-19 ACS group were generally older, Black Asian and Minority ethnicity, more comorbid and had unfavourable presenting clinical characteristics such as elevated cardiac troponin, pulmonary oedema, cardiogenic shock and poor left ventricular systolic function compared with non-COVID-19 ACS group. They were less likely to receive an invasive coronary angiography (67.7% vs 81.0%), percutaneous coronary intervention (PCI) (30.2% vs 53.9%) and dual antiplatelet medication (76.3% vs 88.0%). After adjusting for all the baseline differences, patients with COVID-19 ACS had higher in-hospital (adjusted odds ratio (aOR) 3.27 95% confidence interval (CI) 2.41-4.42) and 30-day mortality (aOR 6.53 95%CI 5.1-8.36) compared to the non COVID-19 ACS group.
CONCLUSION:
COVID-19 infection was present in 4% of patients hospitalized with an ACS in England and is associated with lower rates of guideline recommended treatment and significant mortality hazard.
This article is protected by copyright. All rights reserved.
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Rare cause of cardioembolic stroke and central retinal artery occlusion.
BMJ Case Rep2021 Jan;14(1):. doi: e236420.
Johari Muhamad Izzad, Ismail Mohd Noor, Mohamad Fadhilah, Yusof Mohd Aizuddin,
Abstract
Primary cardiac valve tumours are rare. This is a case report of a 32-year-old non-smoker man with a history of stroke 1?year prior and no other cardiovascular risk factors. The patient was admitted to our acute stroke ward for recurrent left hemiparesis, slurring of speech, facial asymmetry and central retinal artery occlusion. Initial laboratory investigations and ECG were normal. An urgent CT brain showed a large hypodense area at the right frontal, parietal, temporal, occipital region with effaced sulci and right lateral ventricle with midline shift and cerebral oedema in keeping with acute infarction. We proceeded with CT angiography of the cerebral and carotid on the following day, which revealed no evidence of thrombosis, aneurysm or arteriovenous malformation. There were no abnormal beaded vessels to suggest vasculitis. Transthoracic echocardiography revealed a large mobile mass in the left atrium. Meanwhile, MRI cardiac confirmed a large ill-defined mobile solid mass attached to the mitral valve's inferoseptal component suggestive of mitral valve myxoma. This case report highlights the significance of considering a cardiogenic source of emboli in patients with large cerebral infarcts and other cardiac embolic phenomena. Imaging modalities such as echocardiography and cardiac MRI will help detect treatable conditions, such as valvular myxoma and prevent further complications.
© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.
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Comparison of Hospitalization Trends and Outcomes in Acute Myocardial Infarction Patients with versus without Opioid Use Disorder.
Am J Cardiol2021 Jan;():. doi: S0002-9149(21)00034-5.
Ranka Sagar, Dalia Tarun, Acharya Prakash, Taduru Siva Sagar, Pothuru Suveenkrishna, Mahmood Uzair, Stack Brianna, Shah Zubair, Gupta Kamal,
Abstract
Discrepancies in medical care are well known to adversely affect patients with opioid abuse disorders (OUD), including management and outcomes of acute myocardial infarction (AMI) in patients with OUD. We used the National Inpatient Sample was queried from Jan 2006 to Sept 2015 to identify all patients ?18years admitted with a primary diagnosis of AMI (weighted N=13,030; unweighted N=2670) and concomitant OUD. Patients using other non-opiate illicit drugs were excluded. Propensity matching (1:1) yielded well matched 2253 pairs among which intergroup comparison of invasive revascularization strategies and cardiac outcomes was performed. The prevalence of OUD patients with AMI over the last decade has doubled, from 163 (2006) to 326 cases (2015) per 100 000 admissions for AMI. The OUD group underwent less cardiac catheterization (63.2% vs 72.2%; p<0.001), percutaneous coronary intervention (37.0% vs 48.5%; p<0.001) and drug eluting stent placement (32.3% vs 19.5%; p<0.001) compared to non-OUD. No differences in in-hospital mortality/cardiac outcomes were noted. Among subgroup of STEMI patients (26.2% of overall cohort), the OUD patients were less likely to receive percutaneous coronary intervention (67.9% vs 75.5%; p=0.002), drug eluting stent (31.4% vs 47.9%; p<0.001) with a significantly higher mortality (7.4% vs 4.3%), and cardiogenic shock (11.7% vs 7.9%). No differences in the frequency of coronary bypass grafting was noted in AMI or its subgroups. In conclusion, OUD patients presenting with AMI receive less invasive treatment compared to those without OUD. OUD patients presenting with STEMI have worse in-hospital outcomes with increased mortality and cardiogenic shock.
Copyright © 2021. Published by Elsevier Inc.
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Ineffective Perfusion: An Ominous Sign No Matter How You Measure It.
JACC Cardiovasc Imaging -
Spontaneous coronary artery dissection with cardiogenic shock: How frequent is it? How should we treat it?
Catheter Cardiovasc Interv2021 Jan;97(1):78-79. doi: 10.1002/ccd.29449.
Smith Timothy, Henry Timothy D,
Abstract
Spontaneous Coronary Artery Dissection (SCAD) may represent 1-2% of all STEMI and 20-25% of STEMI in women <50. Cardiogenic shock is relatively low (2-3%) in the overall SCAD population but may occur in up to 25% of SCAD patients with STEMI. The ideal treatment for a SCAD patient with cardiogenic shock requires thoughtful patient specific-management decisions in regards to both the choice of revascularization and the choice of mechanical circulatory support. When treated appropriately these patients have excellent long-term outcome, with mortality lower than STEMI or cardiogenic shock related to atherosclerosis.
© 2021 Wiley Periodicals LLC.
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Outcomes of ST-elevation myocardial infarction by age and sex in a low-income urban community: The Montefiore STEMI Registry.
Clin Cardiol2020 Oct;43(10):1100-1109. doi: 10.1002/clc.23412.
Bortnick Anna E, Shahid Muhammad, Shitole Sanyog G, Park Michael, Broder Anna, Rodriguez Carlos J, Scheuer James, Faillace Robert, Kizer Jorge R,
Abstract
OBJECTIVES:
To compare outcomes by age and sex in race/ethnic minorities presenting with ST-elevation myocardial infarction (STEMI), as studies are limited.
METHODS:
We studied sociodemographics, management, and outcomes in 1208 STEMI patients evaluated for primary percutaneous coronary intervention between 2008 and 2014 at Montefiore Health System (Bronx, NY). A majority of patients self-identified as nonwhite, and nearly two-thirds were young (<45?years) or middle-aged (45-64?years).
RESULTS:
Risk factors varied significantly across age groups; with more women and non-Hispanic whites, hypertension, diabetes, dyslipidemia, prior cardiovascular disease, non-sinus rhythm, and collagen vascular disease in the older age group (?65?years); and higher body mass index, smoking, cocaine use, human immunodeficiency virus (HIV) infection and family history of heart disease in the young. Younger women had lower summary socioeconomic scores than younger men. Middle-aged women had more obesity and dysmetabolism, while men had more heavy alcohol use. There was greater disease severity with increasing age; with higher cardiac biomarkers, 3-vessel disease, cardiogenic shock, and coronary artery bypass grafting. Older patients had higher rates of death and death or readmission over 4.3 (interquartile range 2.4, 6.0) years of follow-up. Middle-aged women had higher rates of death or any readmission than men, but these differences were not significant after adjustment.
CONCLUSIONS:
These findings indicate a high burden of risk factors in younger adults with STEMI from an inner-city community. Programs to target sociobehavioral factors in disadvantaged settings, including substance abuse, obesity, and risk of HIV, are necessary to more effectively address health disparities in STEMI and its adverse consequences.
© 2020 The Authors. Clinical Cardiology published by Wiley Periodicals, LLC.
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Temporary surgical ventricular assist device for treatment of acute myocardial infarction and refractory cardiogenic shock in the percutaneous device era.
J Artif Organs2021 Jan;():. doi: 10.1007/s10047-020-01236-2.
Singh Sameer K, Witer Lucas, Kaku Yuji, Masoumi Amirali, Fried Justin A, Yuzefpolskaya Melana, Colombo Paolo C, Sayer Gabriel, Uriel Nir, Naka Yoshifumi, Takayama Hiroo, Takeda Koji,
Abstract
BACKGROUND:
Acute myocardial infarction with refractory cardiogenic shock (AMI-RCS) is associated with poor outcomes. Several percutaneous mechanical circulatory support devices exist; however, limitations exist regarding long-term use. Herein, we describe our experience with the temporary surgical CentriMag VAD.
METHODS:
We reviewed 74 patients with AMI-RCS who underwent CentriMag VAD insertion as bridge-to-decision device from 2007 to 2020. Patients were divided into groups based on introduction of the "shock team" model: Era 1 (2007-2014, n?=?51) and Era 2 (2015-2020, n?=?23).
RESULTS:
Era 2 had higher proportion of patients with INTERMACS Profile I. The use of percutaneous MCS as bridge to VAD and the use of minimally invasive VAD were higher in Era 2. There were fewer postoperative bleeding events in Era 2 (80% vs 61%, p?=?.07). Thirty-day mortality was 23% and 1-year survival was 55%, which were no differences between eras. Destinations after CentriMag VAD included myocardial recovery (39%), durable LVAD (27%), and transplantation (5%).
CONCLUSION:
CentriMag VAD device represents a viable bridge-to-decision device with acceptable short- and long-term outcomes for patients with AMI-RCS. Stable outcomes in a progressively sicker population may be related to changes in practice patterns as well as introduction of the "shock team" concept.
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Predicting Survival After VA-ECMO for Refractory Cardiogenic Shock: Validating the SAVE Score.
CJC Open2021 Jan;3(1):71-81. doi: 10.1016/j.cjco.2020.09.011.
Amin Faizan, Lombardi Julia, Alhussein Mosaad, Posada Juan Duero, Suszko Adrian, Koo Margaret, Fan Eddy, Ross Heather, Rao Vivek, Alba Ana Carolina, Billia Filio,
Abstract
Background:
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used increasingly to support patients who are in cardiogenic shock. Due to the risk of complications, prediction models may aid in identifying patients who would benefit most from VA-ECMO. One such model is the Survival After Veno-Arterial Extracorporeal Membrane Oxygenation (SAVE) score. Therefore, we wanted to validate the utility of the SAVE score in a contemporary cohort of adult patients.
Methods:
Retrospective data were extracted from electronic health records of 120 patients with cardiogenic shock supported with VA-ECMO between 2011 and 2018. The SAVE score was calculated for each patient to predict survival to hospital discharge. We assessed the SAVE score calibration by comparing predicted vs observed survival at discharge. We assessed discrimination with the area under the receiver operating curve using logistic regression.
Results:
A total of 45% of patients survived to hospital discharge. Survivors had a significantly higher mean SAVE score (-9.3 ± 4.1 in survivors vs -13.1 ± 4.4, respectively; = 0.001). SAVE score discrimination was adequate (c = 0.77; 95% confidence interval 0.69-0.86; < 0.001). SAVE score calibration was limited, as observed survival rates for risk classes II-V were higher in our cohort (II: 67% vs 58%; III: 78% vs 42%; IV: 61% vs 30%; and V: 29% vs 18%).
Conclusions:
The SAVE score underestimates survival in a contemporary North American cohort of adult patients with cardiogenic shock. Its inaccurate performance could lead to denying ECMO support to patients deemed to be too high risk. Further studies are needed to validate additional predictive models for patients requiring VA-ECMO.
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc.
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Takotsubo Syndrome a Rare Entity in COVID-19: a Systemic Review-Focus on Biomarkers, Imaging, Treatment, and Outcome.
SN Compr Clin Med2021 Jan;():1-11. doi: 10.1007/s42399-021-00743-4.
Sharma Kamal, Desai Hardik D, Patoliya Jaimini V, Jadeja Dhigishaba M, Gadhiya Dhruv,
Abstract
Takotsubo syndrome(TTS) is attributed to catecholamine surge, which is also observed in COVID-19 disease due to the cytokine storm. We performed a systematic literature search using PubMed, Embase, and the Cochrane Central Register of Controlled Trials retrospectively to identify COVID-19-associated TTS case reports and evaluated patient-level demographics, laboratory markers clinical attributes, treatment given, and outcomes. There are 27 cases reported of TTS associated with COVID-19 infection of which 44.5% were male. Reported median age was 57 years (IQR: 39-65) and 62.95 years (IQR: 50.5-73.5) in case series and individual patients' cases in database, respectively. The time interval from the symptom onset to TTS diagnosis was median 6.5 days (IQR: 1.0-8.0) in case series and 6.7 days (IQR: 4-10) in individual patients' database. The median LVEF was 36% (IQR: 35-37) and 38.15%(IQR: 30-42.5%-[male: 40.33% (IQR: 33-44.2)] and female [37.15% (IQR: 30-40)] in case series and individual-patients' database, respectively. Troponin was elevated in all patients except one patient. 77.2% patients of TTS with COVID-19 had an elevated C-reactive protein and/or D-dimer. Twelve out of 22 (54.5%) patients developed cardiac complication such as cardiogenic-shock, atrial fibrillation, acute heart failure, supraventricular tachycardia, and biventricular heart failure. Nineteen out of 26 (73.07%) patients were discharged, and three were hospitalized due to acute respiratory distress syndrome and needed extracorporeal membrane oxygenation or ongoing maternal age. There were 4 (14.8%) mortality. There was no major gender difference observed in development of TTS in COVID-19 unlike COVID-19 per se. Older median age group for TTS in COVID-19 patients irrespective of cardiovascular comorbidities and gender probably reflects age as an independent risk factor. Patients who developed TTS had higher mortality rate especially if they developed cardiogenic shock.
© The Author(s), under exclusive licence to Springer Nature Switzerland AG part of Springer Nature 2021.
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