Pubblicazioni recenti - cardiogenic shock
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Prognostic impact of preoperative atrial fibrillation in patients undergoing heart surgery in cardiogenic shock.
Sci Rep2023 Dec;13(1):21818. doi: 10.1038/s41598-023-47642-3.
Kowalewski Mariusz, Raffa Giuseppe M, Pasierski Micha?, Ko?odziejczak Michalina, Litwinowicz Rados?aw, Wa?ha Wojciech, Wojakowski Wojciech, Rogowski Jan, Jasi?ski Marek, Widenka Kazimierz, Hirnle Tomasz, Deja Marek, Bartus Krzysztof, Lorusso Roberto, Tobota Zdzis?aw, Maruszewski Bohdan, Suwalski Piotr, ,
Abstract
Surgical intervention in the setting of cardiogenic shock (CS) is burdened with high mortality. Due to acute condition, detailed diagnoses and risk assessment is often precluded. Atrial fibrillation (AF) is a risk factor for perioperative complications and worse survival but little is known about AF patients operated in CS. Current analysis aimed to determine prognostic impact of preoperative AF in patients undergoing heart surgery in CS. We analyzed data from the Polish National Registry of Cardiac Surgery (KROK) Procedures. Between 2012 and 2021, 332,109 patients underwent cardiac surgery in 37 centers; 4852 (1.5%) patients presented with CS. Of those 624 (13%) patients had AF history. Cox proportional hazards models were used for computations. Propensity score (nearest neighbor) matching for the comparison of patients with and without AF was performed. Median follow-up was 4.6 years (max.10.0), mean age was 62 (±?15) years and 68% patients were men. Thirty-day mortality was 36% (1728 patients). The origin of CS included acute myocardial infarction (1751 patients, 36%), acute aortic dissection (1075 patients, 22%) and valvular dysfunction (610 patients, 13%). In an unadjusted analysis, patients with underlying AF had almost 20% higher mortality risk (HR 1.19, 95% CIs 1.06-1.34; P?=?0.004). Propensity score matching returned 597 pairs with similar baseline characteristics; AF remained a significant prognostic factor for worse survival (HR 1.19, 95% CI 1.00-1.40; P?=?0.045). Among patients with CS referred for cardiac surgery, history of AF was a significant risk factor for mortality. Role of concomitant AF ablation and/or left atrial appendage occlusion or more aggressive perioperative circulatory support should be addressed in the future.
© 2023. The Author(s).
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Venoarterial Extracorporeal Membrane Oxygenation for Myocardial Infarction-Related Cardiogenic Shock: Not a Time to Sit Idly By.
J Cardiothorac Vasc Anesth2023 Oct;():. doi: S1053-0770(23)00857-1.
Gonzalez-Ciccarelli Luis F, Nabzdyk Christoph, Bohman John Kyle, Wittwer Erica, Seelhammer Troy,
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Heart failure related cardiogenic shock: An ISHLT consensus conference content summary.
J Heart Lung Transplant2023 Nov;():. doi: S1053-2498(23)02029-6.
Kanwar Manreet K, Billia Filio, Randhawa Varinder, Cowger Jennifer A, Barnett Christopher M, Chih Sharon, Ensminger Stephan, Hernandez-Montfort Jaime, Sinha Shashank S, Vorovich Esther, Proudfoot Alastair, Lim Hoong S, Blumer Vanessa, Jennings Douglas L, Reshad Garan A, Renedo Maria F, Hanff Thomas C, Baran David A, ,
Abstract
In recent years, there have been significant advancements in the understanding, risk-stratification, and treatment of cardiogenic shock (CS). Despite improved pharmacologic and device-based therapies for CS, short-term mortality remains as high as 50%. Most recent efforts in research have focused on CS related to acute myocardial infarction, even though heart failure related CS (HF-CS) accounts for >50% of CS cases. There is a paucity of high-quality evidence to support standardized clinical practices in approach to HF-CS. In addition, there is an unmet need to identify disease-specific diagnostic and risk-stratification strategies upon admission, which might ultimately guide the choice of therapies, and thereby improve outcomes and optimize resource allocation. The heterogeneity in defining CS, patient phenotypes, treatment goals and therapies has resulted in difficulty comparing published reports and standardized treatment algorithms. An International Society for Heart and Lung Transplantation (ISHLT) consensus conference was organized to better define, diagnose, and manage HF-CS. There were 54 participants (advanced heart failure and interventional cardiologists, cardiothoracic surgeons, critical care cardiologists, intensivists, pharmacists, and allied health professionals), with vast clinical and published experience in CS, representing 42 centers worldwide. State-of-the-art HF-CS presentations occurred with subsequent breakout sessions planned in an attempt to reach consensus on various issues, including but not limited to models of CS care delivery, patient presentations in HF-CS, and strategies in HF-CS management. This consensus report summarizes the contemporary literature review on HF-CS presented in the first half of the conference (part 1), while the accompanying document (part 2) covers the breakout sessions where the previously agreed upon clinical issues were discussed with an aim to get to a consensus.
Copyright © 2023 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
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Consensus statements from the International Society for Heart and Lung Transplantation consensus conference: Heart failure-related cardiogenic shock.
J Heart Lung Transplant2023 Nov;():. doi: S1053-2498(23)02065-X.
Baran David A, Billia Filio, Randhawa Varinder, Cowger Jennifer A, Barnett Christopher M, Chih Sharon, Ensminger Stephan, Hernandez-Montfort Jaime, Sinha Shashank S, Vorovich Esther, Proudfoot Alastair, Lim Hoong Sern, Blumer Vanessa, Jennings Douglas L, Reshad Garan A, Renedo Maria Florencia, Hanff Thomas C, Kanwar Manreet K, ,
Abstract
The last decade has brought tremendous interest in the problem of cardiogenic shock. However, the mortality rate of this syndrome approaches 50%, and other than prompt myocardial revascularization, there have been no treatments proven to improve the survival of these patients. The bulk of studies have been in patients with acute myocardial infarction, and there is little evidence to guide the clinician in those patients with heart failure cardiogenic shock (HF-CS). An International Society for Heart and Lung Transplant consensus conference was organized to better define, diagnose, and manage HF-CS. There were 54 participants (advanced heart failure and interventional cardiologists, cardiothoracic surgeons, critical care cardiologists, intensivists, pharmacists, and allied health professionals) with vast clinical and published experience in CS, representing 42 centers worldwide. This consensus report summarizes the results of a premeeting survey answered by participants and the breakout sessions where predefined clinical issues were discussed to achieve consensus in the absence of robust data. Key issues discussed include systems for CS management, including the "hub-and-spoke" model vs a tier-based network, minimum levels of data to communicate when considering transfer, disciplines that should be involved in a "shock team," goals for mechanical circulatory support device selection, and optimal flow on such devices. Overall, the document provides expert consensus on some important issues facing practitioners managing HF-CS. It is hoped that this will clarify areas where consensus has been reached and stimulate future research and registries to provide insight regarding other crucial knowledge gaps.
Copyright © 2023 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
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SHARK FIN ECG PATTERN IN A PATIENT WITH TAKOTSUBO SYNDROME - CASE STUDY AND LITERATURE REVIEW.
Pol Merkur Lekarski2023 ;51(5):575-580. doi: 10.36740/Merkur202305119.
Elikowski Waldemar, Szcz??niewski Patryk, Ferta?a Natalia, Zawodna-Marsza?ek Magdalena, Albrecht Joanna, ?ytkiewicz Marcin,
Abstract
Shark fin or triangular QRS-ST-T waveform ECG pattern, also known as lambda-wave ST elevation or giant R wave syndrome, is a particular ECG presentation where QRS complex, ST-segment and T-wave are fused in a unique complex. Originally described in some patients with ST-segment elevation myocardial infarction (STEMI) during the acute phase, it has been found to be associated with a high risk of ventricular fibrillation and cardiogenic shock as well as with a high in-hospital mortality. However, shark fin ECG pattern has also been reported in patients with non-acute coronary syndrome related ST-elevation (NASTEP), including stress-induced takotsubo syndrome (TTS). Fourteen such cases (all females) have been reported so far. The authors present a case of a 56-year-old male with shark fin ECG pattern associated with TTS triggered by burn injuries of head, back, upper, lower limbs and the respiratory tract. Due to respiratory insufficiency and heart failure with hemodynamic compromise, he required mechanical ventilation and catecholamines use. Echocardiography showed apical and midventricular akinesia with left ventricular ejection fraction and global longitudinal strain reduced to 30% and -6.8%, respectively and a high segmental post-systolic index. Shark fin pattern maintained within 2 days, then ST-T evolution was observed. Echocardiographic improvement followed by almost normalization were seen after 6 and 9 days, respectively. No cardiac arrhythmias were recorded as in most of the described cases with shark fin ECG and TTS.
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Research progress of intra-aortic balloon counterpulsation in the treatment of acute myocardial infarction with cardiogenic shock: A review.
Medicine (Baltimore)2023 Dec;102(49):e36500. doi: 10.1097/MD.0000000000036500.
Li Mengxian, Hu Liqun, Li Lei,
Abstract
The mortality rate of patients with acute myocardial infarction complicated with cardiogenic shock is very high, and in recent years, intra-aortic balloon counterpulsation has been used more and more. It plays a very important role in improving left ventricular ejection, increasing coronary artery perfusion pressure and reducing myocardial oxygen consumption. This article reviews the development of intra-aortic balloon counterpulsation in the treatment of acute myocardial infarction with cardiogenic shock in recent years.
Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.
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Facility-based approach for the management of acute ST segment elevation myocardial infarction with cardiogenic shock in a rural medical centre: the Durango model.
Open Heart2023 Dec;10(2):. doi: e002299.
Carter Andrew Joseph, Raffoul Jad, Lane Linden, LeSage Leah, Langenhorst Shelley, Smolin Matthew, Dempsey Michael, Hughes David, Gleason Michael, Weiss Steven, Anderson William D,
Abstract
INTRODUCTION:
Cardiogenic shock (CS) complicates 5%-15% of cases of acute myocardial infarction (AMI) with inpatient mortality greater than 40%. The implementation of standardised protocols may improve clinical outcomes in patients with AMI-CS.
METHODS AND ANALYSIS:
The Durango model is a prospective single-centre registry designed to enable early identification of patients with STEMI-CS to facilitate primary reperfusion therapy with a shock team management algorithm in a rural level II heart attack centre. This prospective registry includes all patients >18 years of age presenting with STEMI with or without CS beginning on 1 February 2023. The primary outcome measures are adherence to model-based documentation of SCAI shock Classification prehospital and in the ED with appropriate STEMI shock alert for AMI and stages C, D, E shock; use of mechanical circulatory support Pre-PCI and door to support time
ETHICS AND DISSEMINATION:
This study was approved by the Institutional Review Board with a waiver of informed consent. The findings will be submitted for publication in a peer-review open access journal on completion of the study.
CONCLUSIONS:
The Durango model will demonstrate that the implementation of a STEMI shock team can be feasible in a rural medical centre through comprehensive education of a diverse group providers with different levels of experience, continuous model/device proficiency training and performance feedback.
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Principle and design of clinical efficacy observation of extracorporeal cardiac shock wave therapy for patients with myocardial ischemia-reperfusion injury: A prospective randomized controlled trial protocol.
PLoS One2023 ;18(12):e0294060. doi: e0294060.
Li Xianbin, Zhang Chaoyue, Liu Changzhi, Ma Yiming, Shi Yunke, Ye Yujia, Ma Xuejuan, Liu Yixi, Luo Xiang, Lin Fanru, Wang Jincheng, Tao Jifa, Lun Jinping, Cai Hongyan, Hu Zhao,
Abstract
BACKGROUND:
Acute ST-segment elevation myocardial infarction (STEMI) remains a serious life threatening event with a poor prognosis due to myocardial ischemia/reperfusion injury despite coronary revascularization. Extracorporeal cardiac shock wave (ECSW) is a safe, effective and non-invasive new method for the treatment of cardiovascular diseases. The current results show that extracorporeal cardiac shock wave provides a new treatment option for patients with severe and advanced coronary heart disease. However, there are relatively few clinical studies on the application of in vitro cardiac shock waves in patients with myocardial ischemia-reperfusion injury. We hypothesized that extracorporeal cardiac shock therapy would also be effective in reducing clinical endpoints in patients with STEMI reperfusion.
OBJECTIVE:
This study is order to provide a new therapeutic method for patients with myocardial ischemia-reperfusion injury and reveal the possible mechanism of ECSW for ischemia-reperfusion injury.
METHODS AND MATERIALS:
CEECSWIIRI is a single-center, prospective randomized controlled trial that plans to enroll 102 eligible patients with acute ST-segment elevation myocardial infarction reperfusion. Eligible patients with STEMI reperfusion will be randomly divided into external cardiac shock therapy (ECSW) trial group and blank control group. The blank control group will receive optimal drug therapy, and the experimental group will receive optimal drug therapy combined with ECSW. The shock wave treatment plan will be 3-month therapy, specifically 1 week of treatment per month, 3 weeks of rest, 3 times of ECSW in each treatment week, respectively on the first day, the third day and the fifth day of the treatment week, lasting for 3 months and follow-up for 2 years. The primary endpoint will be to assess the 2-year improvement in all-cause death, re-hospitalization due to cardiovascular disease, major unintentional cerebrovascular events, including cardiogenic death, myocardial infarction, heart failure, arrhythmia, emergency coronary revascularization, and stroke in patients with STEMI reperfusion. Secondary endpoints will include improvements in angina pectoris, quality of life, cardiac structure and function, coronary microcirculation, and endothelial progenitor cell-derived miR-140-3p in relation to survival outcomes.
TRIAL REGISTRATION NUMBER:
ClinicalTrial.gov.org PRS:NCT05624203; Date of registration: November 12, 2022.
Copyright: © 2023 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Accredited Cardiac Arrest Centers Facilitate eCPR and Improve Neurological Outcome.
Resuscitation2023 Dec;():110069. doi: 10.1016/j.resuscitation.2023.110069.
Voß Fabian, Thevathasan Tharusan, Heinrich Scholz Karl, Böttiger Bernd W, Scheiber Daniel, Kabiri Payam, Bernhard Michael, Kienbaum Peter, Jung Christian, Westenfeld Ralf, Skurk Carsten, Adler Christoph, Kelm Malte,
Abstract
BACKGROUND:
Out-of-hospital cardiac arrest (OHCA) remains a frequent medical emergency with low survival rates even after a return of spontaneous circulation (ROSC). Growing evidence supports formation of dedicated teams in scenarios like cardiogenic shock to improve prognosis. Thus, the European Resuscitation Council (ERC) recommended introduction of Cardiac Arrest Centers (CAC) in their 2015 guidelines. Here, we aimed to elucidate the effects of newly introduced CACs in Germany regarding survival rate and neurological outcome.
METHODS:
A multicenter retrospective observational cohort study was performed at three university hospitals and outcomes after OHCA were compared before and after CAC accreditation. Primary outcomes were survival until discharge and favorable neurological status (CPC 1 or 2) at discharge.
RESULTS:
In total 784 patients (368 before and 416 after CAC accreditation) were analyzed. Rates of immediate percutaneous coronary intervention (40 vs. 52%, p= 0.01) and implementation of extracorporeal CPR (8 vs. 13%, p 0.99).
CONCLUSION:
CAC accreditation is linked to higher rates of favorable neurological outcome and unchanged overall survival.
Copyright © 2023. Published by Elsevier B.V.
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Exposure to severe hyperoxemia worsens survival and neurological outcome in patients supported by veno-arterial extracorporeal membrane oxygenation: a meta-analysis.
Resuscitation2023 Dec;():110071. doi: 10.1016/j.resuscitation.2023.110071.
Tigano Stefano, Caruso Alessandro, Liotta Calogero, La Via Luigi, Vargas Maria, Romagnoli Stefano, Landoni Giovanni, Sanfilippo Filippo,
Abstract
BACKGROUND:
Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a rescue treatment in refractory cardiogenic shock (CS) or refractory cardiac arrest (CA). Exposure to hyperoxemia is common during VA-ECMO, and its impact on patient's outcome remains unclear.
METHODS:
We conducted a systematic review (PubMed and Scopus) and meta-analysis investigating the effects of exposure to severe hyperoxemia on mortality and poor neurological outcome in patients supported by VA-ECMO. When both adjusted and unadjusted Odds Ratio (OR) were provided, we used the adjusted one. Results are reported as OR and 95% confidence interval (CI). Subgroup analyses were conducted according to VA-ECMO indication and hyperoxemia thresholds.
RESULTS:
Data from 10 observational studies were included. Nine studies reported data on mortality (n=5 refractory CA, n=4 CS), and 4 on neurological outcome. As compared to normal oxygenation levels, exposure to severe hyperoxemia was associated with higher mortality (nine studies; OR:1.80 [1.16-2.78];p=0.009;I=83%; low certainty of evidence) and worse neurological outcome (four studies; OR:1.97 [1.30-2.96];p=0.001;I=0%; low certainty of evidence). Magnitude and effect of these findings remained valid in subgroup analyses conducted according to different hyperoxemia thresholds (>200 or >300 mmHg) and VA-ECMO indication, although the association with mortality remained uncertain in the refractory CA population (p=0.13). Analysis restricted to studies providing adjusted OR data confirmed an increased likelihood of poorer neurological outcome (three studies; OR:2.11 [1.32-3.38];p=0.002) in patients exposed to severe hyperoxemia but did not suggest higher mortality (five studies; OR:1.68 [0.89-3.18];p=0.11).
CONCLUSIONS:
Severe hyperoxemia exposure after initiation of VA-ECMO may be associated with an almost doubled increased probability of poor neurological outcome and mortality. Clinical efforts should be made to avoid severe hyperoxemia during VA-ECMO support.
Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.
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Adding an extension piece to the end of the purge side arm of the Impella device can prevent the incidence of the cassette breaking and decrease the Impella device failure rate: Impact of practice change on patient outcome.
Perfusion2023 Dec;():2676591231220305. doi: 10.1177/02676591231220305.
Satashia Parthkumar, White Andrew, Isha Shahin, Hanson Abby, Jenkins Anna, Blasavage Jessica, Matos Nikki, Tomlinson Amanda, Zhang Stephanie, Quinones Quintin, Waldron Nathan, Bhattacharyya Anirban, Kiley Sean, Guru Pramod, Chaudhury Sanjay, Shapiro Anna, Moreno Franco Pablo, Sanghavi Devang K,
Abstract
Impella 5.5® with Smart Assist is a minimally invasive Left Ventricular Assist Devices (LVAD) approved by the Food and Drug Administration (FDA) for treating ongoing cardiogenic shock for up to 14 days. The Impella® intends to reduce ventricular workload and provide the circulatory support necessary for myocardial recovery. Compared to standard practice, does adding an extension piece to the purge tube side arm of the Impella® Device decrease the incidence of device failure and positively impact the health outcome of adult patients receiving Impella® support? A retrospective chart review of ICU patients was done at a tertiary care center from August 2018 to August 2022 to assess the differences in patient outcomes related to Impella® Device utilization before and after the implementation of the extension piece to the purge tube sidearm. Among patients reviewed, a total of 20 were included in our review, with seven not having the purge tube side arm extension added, while 13 patients had the extension. The two study groups had no significant difference in patient health outcomes. Additionally, there were no instances of device failure requiring explanation without the extension tubing. However, there were no cases of the purge cassette cracking with the addition of the extension tubing. The addition of extension tubing to the purge cassette of the Impella® Device did not impact patient health outcomes or the incidence of device failure. There was a complete reduction in the incidence of the purge cassette cracking, which could reduce the potential for infection or device failure over a long period of mechanical support. There is a need for long-term prospective studies to confirm the results.
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A Case Series of Dengue Myocarditis: A Complication Observed in Dengue Patients.
Cureus2023 Nov;15(11):e48285. doi: e48285.
Sud Ritika, Agarwal Niharika, Aishwarya Varthiya, Aggarwal Anshika, S Yogesh, Kalawatia Mihit, Sangoi Ravi, Ahmed Nida A, Palande Amisha, Mittal Gaurav,
Abstract
Dengue is a prevalent arthropod-born viral disease with a wide spectrum of clinical presentations ranging from undifferentiated fever to a more severe form of the disease, dengue hemorrhagic fever, and dengue shock syndrome. However, atypical manifestations such as hepatic, neurological, cardiac, and kidney involvement are increasingly being reported, thus the term "expanded dengue syndrome". We report a series of cases with an atypical presentation of dengue fever marked by various cardiac manifestations, including cardiogenic shock secondary to myocardial involvement.
Copyright © 2023, Sud et al.
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Point-of-Care Echocardiographic Evaluation of the Pericardium.
Semin Ultrasound CT MR2023 Dec;():. doi: S0887-2171(23)00106-3.
Butcher Amy, Castillo Cesar,
Abstract
Acute pericardial conditions such as tamponade are often rapidly progressive and can become life-threatening without timely diagnosis and intervention. In this review, we aim to describe bedside ultrasonographic evaluation of the pericardium and diagnostic criteria for tamponade, identify confounders in the diagnosis of pericardial tamponade, and delineate procedural details of ultrasound-guided pericardiocentesis.
Published by Elsevier Inc.
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Rare Etiology of Cardiogenic Shock in Pregnancy.
Circ Heart Fail2023 Dec;():e011006. doi: 10.1161/CIRCHEARTFAILURE.123.011006.
Labrada Lyana, Panah Lindsay, Johnson Joyce, Brennan Kaitlyn, Pasrija Chetan, Grace Matthew, Menachem Jonathan, Rali Aniket S,
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Balloon atrial septostomy versus left atrial cannulation for left heart decompression in children with dilated cardiomyopathy and myocarditis on extracorporeal membrane oxygenation: An ELSO registry analysis.
Perfusion2023 Dec;():2676591231220816. doi: 10.1177/02676591231220816.
Perry Tanya, Greenberg Jason W, Cooper David S, Smith Reanna, Benscoter Alexis L, Koh Wonshill, Ryan Thomas D, Lehenbauer David G, Brown Tyler N, Zafar Farhan, Thiagarajan Ravi R, Sweberg Todd M, Morales David Ls,
Abstract
INTRODUCTION:
In children with myocarditis or dilated cardiomyopathy (DCM) on extracorporeal membrane oxygenation (ECMO) for cardiogenic shock, it is often necessary to decompress the left heart to minimize distension and promote myocardial recovery. We compare outcomes in those who underwent balloon atrial septostomy (BAS) versus direct left atrial (LA) drainage for left heart decompression in this population.
METHODS:
Retrospective study of the Extracorporeal Life Support Organization (ELSO) multicenter registry of patients ? 18 years with myocarditis or DCM on ECMO who underwent LA decompression. Descriptive and univariate statistics assessed association of patient factors with decompression type. Multivariable logistic regression sought independent associations with outcomes.
RESULTS:
369 pediatric ECMO runs were identified. 52% myocarditis, 48% DCM, overall survival 74%. 65% underwent BAS and 35% LA drainage. Patient demographics including age, weight, gender, race/ethnicity, diagnosis, pre-ECMO pH, mean airway pressure, and arrest status were similar. 89% in the BAS group were peripherally cannulated onto ECMO, versus 3% in the LA drainage group (
CONCLUSIONS:
In children with myocarditis or DCM, there was a three times greater likelihood for mortality with LA drainage versus BAS for LA decompression. When adjusted for central cannulation groups only, there was better recovery in the LA drainage group and no difference in mortality. Further prospective evaluation is warranted.
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Cardiogenic shock etiology and exit strategy impact survival in patients with Impella 5.5.
Int J Artif Organs2023 Dec;():3913988231214180. doi: 10.1177/03913988231214180.
Sicke McKenzie, Modi Shan, Hong Yeahwa, Bashline Michael, Klass Wyatt, Horn Ed, Hansra Barinder S, Ramanan Raj, Fowler Jeffrey, Sumzin Nikita, Rivosecchi Ryan M, Chaudhary Rahul, Ziegler Luke A, Hess Nicholas R, Agrawal Nishant, Kaczorowski David J, Hickey Gavin W,
Abstract
BACKGROUND:
Despite historical differences in cardiogenic shock (CS) outcomes by etiology, outcomes by CS etiology have yet to be described in patients supported by temporary mechanical circulatory support (MCS) with Impella 5.5.
OBJECTIVES:
This study aims to identify differences in survival and post-support destination for these patients in acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF) CS at a high-volume, tertiary, transplant center.
METHODS:
A retrospective review of patients who received Impella 5.5 at our center from November 2020 to June 2022 was conducted.
RESULTS:
Sixty-seven patients underwent Impella 5.5 implantation for CS; 23 (34%) for AMI and 44 (66%) for ADHF. AMI patients presented with higher SCAI stage, pre-implant lactate, and rate of prior MCS devices, and fewer days from admission to implantation. Survival was lower for AMI patients at 30?days, 90?days, and discharge. No difference in time to all-cause mortality was found when excluding patients receiving transplant. There was no significant difference in complication rates between groups.
CONCLUSIONS:
ADHF-CS patients with Impella 5.5 support have a significantly higher rate of survival than patients with AMI-CS. ADHF patients were successfully bridged to heart transplant more often than AMI patients, contributing to increased survival.
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Smoker's paradox in transcatheter aortic valve replacement: A National Inpatient Sample analysis from 2015 to 2020.
Cardiovasc Revasc Med2023 Nov;():. doi: S1553-8389(23)00921-1.
Li Renxi, Luo Qianyun, Yanavitski Marat, Huddleston Stephen J,
Abstract
BACKGROUND:
While smoking is recognized as a risk factor for multiple cardiovascular conditions, prior research has identified a smoker paradox, wherein smokers had better post-procedural outcomes following transcatheter aortic valve replacement (TAVR) in the initial years of its introduction among high-risk patients only. In recent years, TAVR has expanded to significant larger groups of low-risk patients and became the dominate approach for aortic valve replacement. Consequently, the study cohort from the previous research can no longer represent the current patient populations undergoing TAVR. This study aimed to examine the impact of smoking on TAVR outcomes in the later post-TAVR era.
METHODS:
Patients who underwent TAVR were identified in the National Inpatient Sample (NIS) database from the last quarter of 2015-2020 by ICD-10-PCS. Patients were stratified into two cohorts based on smoker status. Multivariable analysis was performed comparing in-hospital post-TAVR outcomes. Adjusted pre-procedural variables included sex, age, race, socioeconomic status, comorbidities, and hospital characteristics.
RESULTS:
A total number of 58,934 patients who underwent TAVR were identified including 23,683 smokers and 35,251 non-smokers. Compared to non-smokers, smokers had lower in-hospital mortality (aOR 0.589, p
CONCLUSION:
This study identified the smoker paradox in the later post-TAVR era with remarkably broad protection from many complications and lower mortality. The reasons underlying this apparent smoker paradox merit deeper investigation.
Copyright © 2023 Elsevier Inc. All rights reserved.
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Sex Differences in Myocarditis Hospitalizations: Rates, Outcomes, and Hospital characteristics in the National Readmission Database.
Curr Probl Cardiol2023 Dec;():102233. doi: 10.1016/j.cpcardiol.2023.102233.
Elzanaty Ahmed M, Aglan Amro, Yassen Mohammed, Royfman Rachel, Maraey Ahmed, Khalil Mahmoud, Ranabothu Meghana, Lakhani Shikha, Waack Andrew, Elsheikh Eman, Eltahawy Ehab,
Abstract
Inflammation of the myocardium, or myocarditis, presents with varied severity, from mild to life-threatening such as cardiogenic shock or ventricular tachycardia storm. Existing data on sex-related differences in its presentation and outcomes are scarce. Using the Nationwide Readmission Database (2016-2019), we identified myocarditis hospitalizations and stratified them according to sex to either males or females. Multivariable regression analyses were used to determine the association between sex and myocarditis outcomes. The primary outcome was in-hospital mortality, and the secondary outcomes included sudden cardiac death (SCD), cardiogenic shock (CS), use of mechanical circulatory support (MCS), and 90-day readmissions. We found a total of 12,997 myocarditis hospitalizations, among which 4,884 (37.6%) were females. Compared to males, females were older (51±15.6 years vs. 41.9±14.8 in males) and more likely to have connective tissue disease, obesity, and a history of coronary artery disease. No differences were noted between the two groups with regards to in-hospital mortality (adjusted odds ratio [aOR] 1.20; confidence interval [CI] 0.93-1.53; P=0.16), SCD (aOR:1.18; CI 0.84-1.64; P=0.34), CS (aOR: 1.01; CI 0.85-1.20;P=0.87), or use of MCS (aOR: 1.07; CI:0.86-1.34; P=0.56). In terms of interventional procedures, females had lower rates of coronary angiography (aOR: 0.78; CI 0.70-0.88; P
Copyright © 2023. Published by Elsevier Inc.
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Clinical phenotypes of cardiogenic shock survivors: insights into late host responses and long-term outcomes.
ESC Heart Fail2023 Dec;():. doi: 10.1002/ehf2.14596.
Soussi Sabri, Ahmadiankalati Mojtaba, Jentzer Jacob C, Marshall John C, Lawler Patrick R, Herridge Margaret, Mebazaa Alexandre, Gayat Etienne, Lu Zihang, Dos Santos Claudia C, ,
Abstract
AIMS:
An elevated risk of adverse events persists for years in cardiogenic shock (CS) survivors with high mortality rate and physical/mental disability. This study aims to link clinical CS-survivor phenotypes with distinct late host-response patterns at intensive care unit (ICU) discharge and long-term outcomes using model-based clustering.
METHODS AND RESULTS:
In the original prospective, observational, international French and European Outcome Registry in Intensive Care Units (FROG-ICU) study, ICU patients with CS on admission were identified (N = 228). Among them, 173 were discharged alive from the ICU and included in the current study. Latent class analysis was applied to identify distinct CS-survivor phenotypes at ICU discharge using 15 readily available clinical and laboratory variables. The primary endpoint was 1 year of mortality after ICU discharge. Secondary endpoints were readmission and physical/mental disability [short form-36 questionnaire (SF-36) score] within 1 year after ICU discharge. Two distinct phenotypes at ICU discharge were identified (A and B). Patients in Phenotype B (38%) were more anaemic and had higher circulating levels of lactate, sustained kidney injury, and persistent elevation in plasma markers of inflammation, myocardial fibrosis, and endothelial dysfunction compared with Phenotype A. They had also a higher rate of non-ischaemic origin of CS and right ventricular dysfunction on admission. CS survivors in Phenotype B had higher 1 year of mortality compared with Phenotype A (P = 0.045, Kaplan-Meier analysis). When adjusted for traditional risk factors (i.e. age, severity of illness, and duration of ICU stay), Phenotype B was independently associated with 1 year of mortality [adjusted hazard ratio = 2.83 (95% confidence interval 1.21-6.60); P = 0.016]. There was a significantly lower physical quality of life in Phenotype B patients at 3 months (i.e. SF-36 physical component score).
CONCLUSIONS:
A phenotype with sustained inflammation, myocardial fibrosis, and endothelial dysfunction at ICU discharge was identified from readily available data and was independently associated with poor long-term outcomes in CS survivors.
© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Beta-blocker management in patients admitted for acute heart failure and reduced ejection fraction: a review and expert consensus opinion.
Front Cardiovasc Med2023 ;10():1263482. doi: 1263482.
Schurtz Guillaume, Mewton Nathan, Lemesle Gilles, Delmas Clément, Levy Bruno, Puymirat Etienne, Aissaoui Nadia, Bauer Fabrice, Gerbaud Edouard, Henry Patrick, Bonello Laurent, Bochaton Thomas, Bonnefoy Eric, Roubille François, Lamblin Nicolas,
Abstract
The role of the beta-adrenergic signaling pathway in heart failure (HF) is pivotal. Early blockade of this pathway with beta-blocker (BB) therapy is recommended as the first-line medication for patients with HF and reduced ejection fraction (HFrEF). Conversely, in patients with severe acute HF (AHF), including those with resolved cardiogenic shock (CS), BB initiation can be hazardous. There are very few data on the management of BB in these situations. The present expert consensus aims to review all published data on the use of BB in patients with severe decompensated AHF, with or without hemodynamic compromise, and proposes an expert-recommended practical algorithm for the prescription and monitoring of BB therapy in critical settings.
© 2023 Schurtz, Mewton, Lemesle, Delmas, Levy, Puymirat, Aissaoui, Bauer, Gerbaud, Henry, Bonello, Bochaton, Bonnefoy, Roubille and Lamblin.
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