Pubblicazioni recenti - cardiogenic shock
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Contemporary trends in mortality related to high-risk pulmonary embolism in US from 1999 to 2019.
Thromb Res2023 Jun;228():72-80. doi: 10.1016/j.thromres.2023.05.028.
Zuin Marco, Bikdeli Behnood, Davies Julia, Krishnathasan Darsiya, Rigatelli Gianluca, Roncon Loris, Bilato Claudio, Piazza Gregory,
Abstract
BACKGROUND:
Population-based data on high-risk pulmonary embolism (PE) mortality trends in the United States (US) are scant.
OBJECTIVES:
To assess current trends in US mortality related to high-risk PE over the past 21 years and determine differences by sex, race, ethnicity, age and census region.
METHODS:
Data were extracted from the Centers for Disease Control and Prevention (CDC) Wide-ranging ONline Data for Epidemiologic Research (WONDER) to determine trends in age-adjusted mortality rates (AAMR) per 100,000 people, due to high-risk PE. To calculate nationwide annual trends, we assessed the average (AAPC) and annual percent change (APC) with relative 95 % confidence intervals (CIs) using Joinpoint regression.
RESULTS:
Between 1999 and 2019, high-risk PE was listed as the underlying cause of death in 209,642 patients, corresponding to an AAMR of 3.01 per 100,000 people (95 % CI: 2.99 to 3.02). AAMR from high-risk PE remained stable from 1999 to 2007 [APC: -0.2 %, (95 % CI: -2.0 to 0.5, p = 0.22)] and then significantly increased [APC: 3.1 % (95 % CI: 2.6 to 3.6), p
CONCLUSIONS:
In an US population analysis, high-risk PE mortality rate increased, with racial, sex-based, and regional variations. Further studies are needed to understand root causes for these trends and to implement appropriate corrective strategies.
Copyright © 2023 Elsevier Ltd. All rights reserved.
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Impact of annual volume of cases and Intensive Cardiac Care Unit availability on mortality of patients with acute myocardial infarction- related cardiogenic shock treated at revascularization capable centers.
Eur Heart J Acute Cardiovasc Care2023 Jun;():. doi: zuad061.
Barrionuevo-Sánchez M Isabel, Viana-Tejedor Ana, Ariza-Solé Albert, Del Prado Náyade, Rosillo Nicolás, Sánchez-Salado José Carlos, Lorente Victòria, Jorge-Pérez Pablo, Noriega Francisco Javier, Ferrera Carlos, Alegre Oriol, Llaó Isaac, Bernal José Luis, Triguero Laura, Fernández-Pérez Cristina, González-Costello José, Marcos Marta, de la Cuerda Francisco, Carmona Jesús, Cequier Angel, Fernández-Ortiz Antonio, Pérez-Villacastín Julián, Comin-Colet Josep, Elola Francisco Javier,
Abstract
BACKGROUND:
Cardiogenic shock (CS) is associated with high mortality. The purpose of this study was to assess the impact of Hospital structure-related variables on mortality in patients with CS treated at percutaneous and surgical revascularization capable centers (psRCC) from a large nationwide registry.
METHODS:
Retrospective observational study including consecutive patients with main or secondary diagnosis of CS and ST elevation myocardial infarction (STEMI). Patients discharged from Spanish National Healthcare System psRCC were included (2016-2020). The association between the volume of CS cases attended by each center, availability of Intensive Cardiac Care Unit (ICCU) and heart transplantation (HT) programs and in-hospital mortality was assessed by multilevel logistic regression models.
RESULTS:
The study population consisted of 3,074 CS-STEMI episodes, of whom 1,759 (57.2%) occurred in 26 centers with ICCU. A total of 17/44 hospitals (38.6%) were high-volume centers and 19/44 (43%) centers had HT programs availability. Treatment at HT centers was not associated with a lower mortality (p?=?0.121). Both high volume of cases and ICCU showed a trend to an association with lower mortality in the adjusted model (OR: 0.87 and 0.88, respectively). The interaction between both variables was significantly protective (OR 0.72; p?=?0.024). After propensity score matching, mortality was lower in high volume hospitals with ICCU [OR?=?0.79; p?=?0.007].
CONCLUSIONS:
Most CS-STEMI patients were attended at psRCC with high volume of cases and ICCU available. The combination of high-volume and ICCU availability showed the lowest mortality. These data should be taken into account when designing regional networks for CS management.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Cystatin C as a Predictor of Major Adverse Cardiovascular Event in Patients with Acute Myocardial Infarction Without Cardiogenic Shock and Renal Impairment After Coronary Intervention.
Int J Gen Med2023 ;16():2219-2227. doi: 10.2147/IJGM.S415595.
Wasyanto Trisulo, Yasa Ahmad, Yudhistira Yoga,
Abstract
PURPOSE:
To prove that cystatin C is a predictor of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), either with ST-segment Elevation (AMI-EST) or without ST-segment elevation (AMI-NEST), without cardiogenic shock or renal impairment.
PATIENT AND METHODS:
This was an observational cohort study. Samples were obtained from AMI patients who underwent PCI between February 2022 and March 2022 at the Intensive Cardiovascular Care Unit. Cystatin C levels were measured before PCI. MACE were observed within 6 months. Comparisons between normally distributed continuous data were performed using the -test; test was used for non-normally distributed data. Categorical data were compared using the chi-squared test. The cut-off point of cystatin C levels to predict MACE was analyzed using Receiver Operating Characteristics (ROC).
RESULTS:
The participants were 40 AMI patients, consisting of 32 patients (80%) with AMI-EST and eight patients (20%) diagnosed with AMI-NEST, who were evaluated for the occurrence of MACE within 6 months after PCI. Ten patients (25%) developed MACE during follow-up [(MACE (+)], and the rest were in the MACE (-) group. Cystatin C levels were significantly higher in the MACE (+) group (p=0.021). ROC analysis revealed a cystatin C level of 1.21 mg/dL; cystatin C > 1.21 is associated with MACE risk, showing a significant relationship with the odds ratio value reaching 26.00, with 95% CI (3.99-169.24).
CONCLUSION:
Cystatin C level is an independent predictor of MACE in patients with AMI without cardiogenic shock or renal impairment after PCI.
© 2023 Wasyanto et al.
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Successful extended use of Impella 5.5 as a bridge to heart transplantation.
J Surg Case Rep2023 Jun;2023(6):rjad262. doi: rjad262.
Sharaf Omar M, Diaz-Ayllon Hannia P, Myers Elisha M, Ahmed Mustafa M, Bleiweis Mark S, Jeng Eric I,
Abstract
We present the case of a 60-year-old gentleman who was admitted with acute-on-chronic cardiogenic shock and was supported with axillary Impella 5.5® for 123 days prior to heart transplantation. Total length of temporary mechanical circulatory support (MCS) was 132 days, which included 9 days with an intra-aortic balloon pump prior to Impella. During support, the patient remained extubated, participated in regular ambulation and rehabilitation with physical therapy and had continuous monitoring of device positioning. He did not experience any vascular or septic events while on temporary MCS and had improved hemodynamics and renal function after Impella initiation. Post-transplantation course was uncomplicated, and he is doing well without evidence for allograft dysfunction over 581 days post-transplantation. To our knowledge, this is the longest Impella 5.5®-supported patient during the new United Network for Organ Sharing Heart Allocation era who was successfully bridged to heart transplantation with over 1-year follow-up.
Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2023.
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Cardiogenic shock and severe secondary mitral regurgitation successfully treated with transcatheter edge-to-edge repair: a case report.
Eur Heart J Case Rep2023 Jun;7(6):ytad240. doi: ytad240.
Shabbir Muhammad Asim, Tiwari Nidhish, Burdorf Adam, Moulton Michael, Velagapudi Poonam,
Abstract
BACKGROUND:
Cardiogenic shock (CS) associated with severe mitral regurgitation (MR) forebodes a high risk of morbidity and mortality. Transcatheter edge-to-edge repair (TEER) is a rapidly evolving technique for severe MR in haemodynamically stable patients. However, the safety and efficacy of TEER for severe MR in CS are not well established.
CASE SUMMARY:
An 83-year-old male presented with dyspnoea and was hospitalized for heart failure. Chest X-ray revealed pulmonary oedema. Transthoracic echocardiography showed severely depressed ejection fraction (EF) with severe secondary MR. Right heart catheterization confirmed a low cardiac index. Diuretics and inotropes were administered. Due to persistent hypotension, we could not wean inotropes. The patient was deemed high risk for surgery by the heart team, and a decision was made to proceed with TEER with MitraClip. Under transoesophageal echocardiography and fluoroscopic guidance, two MitraClips were deployed sequentially. The MR grade was reduced to two mild jets subsequently. The patient was weaned off inotropes and eventually discharged. At the 30-day follow-up, he was participating in physical activities such as golf.
DISCUSSION:
Cardiogenic shock complicated by severe MR carries high mortality. With severe MR, the forward stroke volume is lower than the stated EF leading to poor organ perfusion. Inotropes and/or mechanical circulatory support devices are paramount for initial stabilization; however, they do not treat underlying MR. Transcatheter edge-to-edge repair with MitraClip has been shown to improve survival in CS patients with severe MR in observational studies. However, prospective trials are lacking. Our case demonstrates the utility of MitraClip to treat severe secondary MR refractory to medical therapy in a CS patient. The heart team must evaluate risks and benefits of this therapy in CS patients.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Central Oxygen Venous Saturation and Mortality in Patients Undergoing Coronary Artery Bypass Grafting.
Ther Clin Risk Manag2023 ;19():447-454. doi: 10.2147/TCRM.S407454.
Rodríguez-Scarpetta María A, Sepúlveda-Tobón Andrés M, Daza-Arana Jorge E, Lozada-Ramos Heiler, Álzate-Sánchez Rodrigo A,
Abstract
PURPOSE:
Central venous oxygen saturation (ScvO) has been reported as a prognostic marker of in-hospital mortality when it is below 60% in certain situations. Nevertheless, it has not been widely reported in patients undergoing coronary artery bypass graft (CABG). The study determined the association between ScvO and in-hospital mortality in patients undergoing CABG in a high-complexity health institution in Santiago de Cali, Colombia.
PATIENTS AND METHODS:
A retrospective cohort study was conducted with patients undergoing isolated CABG. The subject sample included 515 subjects aged 18 years or older. Exposure was defined as ScvO
RESULTS:
A total of 103 exposed and 412 unexposed subjects were included. The final model revealed a higher mortality risk in individuals with ScvO 75 years), low socioeconomic stratum, chronic kidney failure before surgery, unstable angina before surgery, ischemia time (>60 min), and intra-operative inotrope use. The primary cause of death was cardiogenic shock (54.7%), followed by sepsis (25.0%) and postoperative bleeding (17.2%).
CONCLUSION:
The study identified an association between ScvO
© 2023 Rodríguez-Scarpetta et al.
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Shark Fin Occlusive Myocardial Infarction ECG Pattern Post-cardiac Arrest Misinterpreted As Ventricular Tachycardia.
Cureus2023 May;15(5):e38708. doi: e38708.
Escabi-Mendoza Jose, Diaz-Rodriguez Porfirio E, Silva-Cantillo Richard D,
Abstract
In addition to the well-known convex ST-segment elevation myocardial infarction (STEMI) pattern associated with acute occlusive myocardial infarction (OMI), there are other cases that are recognized as OMI without fulfilling the established characteristic STEMI criteria. Over one-fourth of the patients initially classified as having non-STEMI can be re-classified as having OMI by recognizing other STEMI equivalent patterns. We report a case of a 79-year-old man with multiple comorbidities who was brought to the ED by paramedics with a two-hour history of ongoing chest pain. During transport, the patient suffered a cardiac arrest associated with ventricular fibrillation (VF) that required electric defibrillation and active cardiopulmonary resuscitation. Upon ED arrival, the patient was unresponsive, with a heart rate of 150 beats/min and ECG evidence of wide-QRS tachycardia that was misinterpreted as ventricular tachycardia (VT). He was further managed with intravenous amiodarone, mechanical ventilation, sedation, and unsuccessful defibrillation therapy. Upon persistence of the wide-QRS tachycardia and clinical instability, the cardiology team was emergently consulted for bedside assistance. On further review of the ECG, a shark fin (SF) OMI pattern was identified, indicative of an extensive anterolateral OMI. A bedside echocardiogram revealed a severe left ventricular systolic dysfunction with marked anterolateral and apical akinesia. The patient underwent a successful percutaneous coronary intervention (PCI) to an ostial left anterior descending (LAD) culprit occlusion with hemodynamic support but ultimately died due to multiorgan failure and refractory ventricular arrhythmias. This case illustrates an infrequent OMI presentation (
Copyright © 2023, Escabi-Mendoza et al.
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Takotsubo cardiomyopathy following blunt trauma: Early recognition and diagnosis.
Trauma Case Rep2023 Aug;46():100855. doi: 100855.
Cimaroli Sawyer, Maniar Yesha, Ciancarelli James, Stright Adam, Joseph D'Andrea,
Abstract
BACKGROUND:
Takotsubo Cardiomyopathy (TTC) is characterized by reversible left ventricular apical ballooning in the absence of angiographically significant coronary artery disease. While TTC is usually preceded by an emotionally stressful event, physical trauma has been documented as a precipitating incident as well.
CASE SUMMARY:
An 82-year-old female with no past medical history, presented to the emergency department following a motor vehicle collision. Trauma workup was significant for an ulnar fracture, elevated cardiac enzymes, and ST-segment changes. Bedside echocardiogram revealed apical ballooning. She underwent cardiac catheterization, which failed to demonstrate significant coronary artery disease. The patient developed cardiogenic shock and required temporary vasopressor support after failing a trial of intra-aortic balloon pump.
CONCLUSION:
Takotsubo Cardiomyopathy is a rare complication of trauma, which presents with signs and symptoms similar to acute coronary syndrome (ACS) but without evidence of obstructive coronary artery disease. Following trauma, signs of ACS in elderly women should raise provider's suspicion for TTC and prompting bedside echocardiography, which can assist with early diagnosis.
© 2023 The Authors. Published by Elsevier Ltd.
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Pregnancy-related spontaneous coronary artery dissection: a rare cause of acute coronary syndrome in the third trimester.
BMC Cardiovasc Disord2023 Jun;23(1):292. doi: 10.1186/s12872-023-03323-7.
Vongbunyong Kenny, Chua Frederick, Ghashghaei Roxana,
Abstract
BACKGROUND:
Spontaneous Coronary Artery Dissection (SCAD) is a rare cause of myocardial infarction and sudden cardiac death that is mostly seen in younger patients without significant cardiac risk factors. The mechanism by which SCAD causes an acute coronary event is related to the compromise of the coronary artery lumen as a result of hematoma within the vessel wall. In comparison to their non-pregnant counterparts, when SCAD is associated with pregnancy, it has been associated with an increased risk of life-threatening arrhythmias, cardiogenic shock, and death. The underlying mechanism behind SCAD is not yet fully understood, and despite the condition's high mortality rate, it remains underdiagnosed.
CASE PRESENTATION:
Our case features a 38-year-old woman at 29 weeks of gestation presenting with chest pain that persisted despite initial management. Coronary angiography revealed a Type 2a spontaneous dissection of the left anterior descending artery. Given the risks of percutaneous coronary intervention in SCAD management and overall clinical stability, the patient was treated with conservative management.
CONCLUSION:
SCADs are a rare cause of acute coronary syndrome that can be found in patients without any prior cardiac risk factors. It is important to have a high index of suspicion when diagnosing SCADs given, they can cause life-threatening arrhythmias, cardiogenic shock, and death. This case highlights considerations that must be taken into account when treating P-SCAD, as opposed to SCAD in the postpartum period.
© 2023. The Author(s).
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Congenital membranous ostial stenosis of the left atrial appendage as a secondary finding in a patient with ST elevation myocardial infarction: a case report.
Eur Heart J Case Rep2023 Jun;7(6):ytad251. doi: ytad251.
Hanke David, Hamadanchi Ali, Schulze P Christian, Franz Marcus,
Abstract
BACKGROUND:
Stenoses of the left atrial appendage (LAA) represent a common complication after incomplete surgical ligation. However, the idiopathic entity is very rare. So far, there is uncertainty about the thromboembolic risk and potential benefit of anticoagulation in these patients. We report on congenital ostial stenosis of the LAA as a secondary finding in a patient with myocardial infarction.
CASE SUMMARY:
A 56-year-old patient presented with acute heart failure secondary to ST elevation myocardial infarction (STEMI) and eventually progressed to cardiogenic shock. A percutaneous coronary intervention and stent placement in the first diagonal branch and in the left anterior descending artery was performed in two sessions. There was a new onset of typical atrial flutter and paroxysmal atrial fibrillation with haemodynamically relevant tachycardia. Before synchronized electrical cardioversion, we performed transoesophageal echocardiography. Left atrial thrombi were ruled out. Surprisingly, we found membranous ostial stenosis of the LAA, resulting in a bidirectional flow pattern. After 28 days of treatment in the intensive care unit the patient had full clinical recovery.
DISCUSSION:
Given the very rare cases of congenital LAA ostial stenosis, there is uncertainty about the thrombogenicity and the potential benefit of anticoagulation or even a percutaneous closure of the LAA. We discuss possible similarities regarding the thromboembolic risk of patients with an idiopathic narrowing of the LAA to patients with incomplete surgical ligation and patients with a device leak after percutaneous LAA closure. Congenital ostial LAA stenosis represents a clinically relevant condition and may be considered as a potential hazard for thromboembolism.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Effect of Impella 5.5 on Preexisting Functional Mitral Regurgitation in Patients with Heart Failure-Related Cardiogenic Shock.
Struct Heart2022 Aug;6(4):100072. doi: 100072.
Kataria Rachna, Khalil Abdurrahman, Coglianese Erin, Crowley Jerome, Silverman Michael G, Shelton Kenneth, Michel Eriberto, D'Alessandro David, Ton Van-Khue,
Abstract
BACKGROUND:
Heart failure-related cardiogenic shock (HF-CS) is increasingly common. Moderate/severe functional mitral regurgitation (FMR) is commonly seen in patients presenting with decompensated heart failure and is associated with worse outcomes. Percutaneous mechanical circulatory support devices are increasingly used to provide hemodynamic support for ongoing CS. There is no description of the impact of Impella device on hemodynamic response when used in combination with preexisting FMR.
METHODS:
Retrospective review of patients aged ?18 years, who underwent Impella 5.5 implant for HF-CS, and who had a transthoracic echocardiogram performed pre- and post-Impella.
RESULTS:
Of 24 patients, 33% had moderate-to-severe/severe FMR, 38% had mild-moderate/moderate FMR, and 29% had trace/mild FMR on pre-Impella transthoracic echocardiogram. Additional right ventricular assist device was simultaneously inserted in 3 patients, of whom 1 had severe, 1 had moderate, and another had mild FMR pre-Impella. Despite maximally tolerated Impella unloading, 6 patients (25%) had persistent moderate-severe/severe FMR, and 9 (37.5%) patients had persistent moderate FMR. Overall, however, there was a decrease in central venous pressure, pulmonary artery diastolic pressure, serum lactate, and vasoactive-inotrope score at 24 ?hours post-Impella, and survival was high at 83%.
CONCLUSIONS:
In a retrospective cohort of patients admitted with HF-CS who underwent Impella 5.5 implant for hemodynamic support, Impella did not seem to acutely ameliorate FMR severity. Despite this, there was a significant improvement in hemodynamic response at 24 ?hours post-Impella. In carefully selected patients, especially those with isolated left ventricular failure, Impella 5.5 may provide adequate hemodynamic support even in the presence of higher severity FMR.
© 2022 The Author(s).
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Genome-phenome wide association study of broadly defined headache.
Brain Commun2023 ;5(3):fcad167. doi: fcad167.
Hsu Wan-Ting, Lee Yu-Ting, Tan Jasmine, Chang Yung-Han, Qian Frank, Liu Kuei-Yu, Hsiung Jo-Ching, Yo Chia-Hung, Tang Sung-Chun, Jiang Xia, Lee Chien-Chang,
Abstract
Until recently, most genetic studies of headache have been conducted on participants with European ancestry. We therefore conducted a large-scale genome-wide association study of self-reported headache in individuals of East Asian ancestry (specifically those who were identified as Han Chinese). In this study, 108 855 participants were enrolled, including 12 026 headache cases from the Taiwan Biobank. For broadly defined headache phenotype, we identified a locus on Chromosome 17, with the lead single-nucleotide polymorphism rs8072917 (odds ratio 1.08, = 4.49 × 10), mapped to two protein-coding genes and . For severe headache phenotype, we found a strong association on Chromosome 8, with the lead single-nucleotide polymorphism rs13272202 (odds ratio 1.30, = 1.02 × 10), mapped to gene . We then conducted a conditional analysis and a statistical fine-mapping of the broadly defined headache-associated and identified a single credible set of with rs8072917 supporting that this lead variant was the true causal variant on gene region. replicated the result of previous studies and played important roles in the biological mechanism of broadly defined headache. On the basis of the previous results found in the Taiwan Biobank, we conducted phenome-wide association studies for the lead variants using data from the UK Biobank and found that the causal variant (single-nucleotide polymorphism rs8072917) was associated with muscle symptoms, cellulitis and abscess of face and neck, and cardiogenic shock. Our findings foster the genetic architecture of headache in individuals of East Asian ancestry. Our study can be replicated using genomic data linked to electronic health records from a variety of countries, therefore affecting a wide range of ethnicities globally. Our genome-phenome association study may facilitate the development of new genetic tests and novel drug mechanisms.
© The Author(s) 2023. Published by Oxford University Press on behalf of the Guarantors of Brain.
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Cardiogenic Shock Due to Serotonin Syndrome Induced Takotsubo Cardiomyopathy.
Cureus2023 May;15(5):e38595. doi: e38595.
Yazdi Vahid, Cox Zachary, Patel Mitra, Yazdi Bayan, Chacko Paul,
Abstract
Takotsubo cardiomyopathy causes transient left ventricular dysfunction. It typically has a favorable prognosis but rarely leads to complications such as cardiogenic shock. Also known as stress-induced cardiomyopathy, it is precipitated by emotional or physical stress. Serotonin syndrome can cause severe stress due to excessive serotonergic activity in the central nervous system. We report a case of cardiogenic shock precipitated by serotonin syndrome-induced takotsubo cardiomyopathy. Only one other documented case has exhibited cardiogenic shock in this setting.
Copyright © 2023, Yazdi et al.
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Comparison of Risk Models in the Prediction of 30-Day Mortality in Acute Myocardial Infarction-Associated Cardiogenic Shock.
Struct Heart2022 Nov;6(6):100116. doi: 100116.
Ranard Lauren S, Guber Kenneth, Fried Justin, Takeda Koji, Kaku Yuji, Karmpaliotis Dimitrios, Sayer Gabriel, Rabbani Leroy, Burkhoff Daniel, Uriel Nir, Kirtane Ajay J, Masoumi Amirali,
Abstract
BACKGROUND:
There are numerous risk-prediction models applied to acute myocardial infarction-related cardiogenic shock (AMI-CS) patients to determine a more accurate prognosis and to assist in patient triage. There is wide heterogeneity among the risk models including the nature of predictors evaluated and their specific outcome measures. The aim of this analysis was to evaluate the performance of 20 risk-prediction models in AMI-CS patients.
METHODS:
Patients included in our analysis were admitted to a tertiary care cardiac intensive care unit with AMI-CS. Twenty risk-prediction models were computed utilizing vitals assessments, laboratory investigations, hemodynamic markers, and vasopressor, inotropic and mechanical circulatory support available from within the first 24 ?hours of presentation. Receiver operating characteristic curves were used to assess the prediction of 30-day mortality. Calibration was assessed with a Hosmer-Lemeshow test.
RESULTS:
Seventy patients (median age 63 years, 67% male) were admitted between 2017 and 2021. The models' area under the curve (AUC) ranged from 0.49 to 0.79, with the Simplified Acute Physiology Score II score having the most optimal discrimination of 30-day mortality (AUC: 0.79, 95% confidence interval [CI]: 0.67-0.90), followed by the Acute Physiology and Chronic Health Evaluation-III score (AUC: 0.72, 95% CI: 0.59-0.84) and the Acute Physiology and Chronic Health Evaluation-II score (AUC: 0.67, 95% CI: 0.55-0.80). All 20 risk scores demonstrated adequate calibration ( > 0.05 for all).
CONCLUSIONS:
Among the models tested in a data set of patients admitted with AMI-CS, the Simplified Acute Physiology Score II risk score model demonstrated the highest prognostic accuracy. Further investigations are required to improve the discriminative capabilities of these models or to establish new, more streamlined and accurate methods for mortality prognostication in AMI-CS.
© 2022 The Author(s).
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Left Atrial-Veno-Arterial Extracorporeal Membrane Oxygenation: Step-By-Step Procedure and Case Example.
Struct Heart2022 Nov;6(6):100117. doi: 100117.
Lemor Alejandro, Basir Mir B, O'Neill Brian P, Cowger Jennifer, Frisoli Tiberio, Lee James C, Wang Dee Dee, Alaswad Khaldoon, O'Neill William, Villablanca Pedro A,
Abstract
Veno-arterial extracorporeal membrane oxygenation is used in patients requiring biventricular support; however, its use increases the afterload. In patients with severe aortic insufficiency or severe left ventricular disfunction, it will increase left-side filling pressures, hence the need for left ventricle unloading with an additional mechanical circulatory support device. We present a case of a patient with cardiogenic shock and severe aortic insufficiency who underwent left atrial veno-arterial extracorporeal membrane oxygenation and provide a step-by-step explanation of the technique.
© 2022 The Author(s).
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Takotsubo syndrome and cardiogenic shock: Authors' response.
Eur Heart J Open2023 May;3(3):oead054. doi: oead054.
Santoro Francesco, Núñez Gil Iván J, Stiermaier Thomas, Eitel Ingo, Arcari Luca, Brunetti Natale Daniele,
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Clinical implication of intra-aortic balloon pumping in patients with Takotsubo syndrome and cardiogenic shock.
Eur Heart J Open -
The Role of Focused 2-Dimensional Echocardiography in Managing Left Ventricular Outflow Tract Obstruction Mimicking Cardiogenic Shock.
J Intensive Care Med2023 Jun;():8850666231180814. doi: 10.1177/08850666231180814.
Harrington Julia, Aron Jonathan, Lashin Hazem,
Abstract
Left ventricular outflow tract obstruction (LVOTO) is a common cardiogenic shock (CS) mimic. We present 3 cases of patients presenting with CS following myocardial infarction, exhibiting a poor response to conventional treatment with inotropy and mechanical circulatory support. This triggered echocardiographic assessment by critical care physicians using focused 2-dimensional (2D) echocardiography. This timely assessment identified anterior mitral valve leaflet entrainment into the left ventricular outflow tract (LVOT), causing LVOTO as the underlying shock mechanism. Echocardiographic findings have led to significant changes in management. The patients underwent fluid administration, weaning from inotropy, and mechanical circulatory support explantation, leading to relief of LVOTO and improved hemodynamics. Critical care basic 2D echocardiography accreditations focus on myocardial function and pericardial effusions. Relevant societies administering these accreditations should consider adding LVOT assessment to enable timely diagnosis of this life-threatening CS mimic.
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Characteristics and Outcomes of Acute Cerebrovascular Events in Patients With Cardiogenic Shock on Mechanical Circulatory Support.
Am J Cardiol2023 Jun;():. doi: S0002-9149(23)00206-0.
Nair Raunak M, Ghimire Bindesh, Abdelghaffar Bahaa, Saleem Talha, Vural Adil, Higgins Andrew, Lee Ran, Cremer Paul C, Rampersad Penelope, Menon Venu,
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Radiosurgery for ventricular tachycardia (RAVENTA): interim analysis of a multicenter multiplatform feasibility trial.
Strahlenther Onkol2023 Jun;():1-10. doi: 10.1007/s00066-023-02091-9.
Krug David, Zaman Adrian, Eidinger Lina, Grehn Melanie, Boda-Heggemann Judit, Rudic Boris, Mehrhof Felix, Boldt Leif-Hendrik, Hohmann Stephan, Merten Roland, Buergy Daniel, Fleckenstein Jens, Kluge Anne, Rogge Annette, Both Marcus, Rades Dirk, Tilz Roland Richard, Olbrich Denise, König Inke R, Siebert Frank-Andre, Schweikard Achim, Vonthein Reinhard, Bonnemeier Hendrik, Dunst Jürgen, Blanck Oliver,
Abstract
BACKGROUND:
Single-session cardiac stereotactic radiation therapy (SBRT) has demonstrated promising results for patients with refractory ventricular tachycardia (VT). However, the full safety profile of this novel treatment remains unknown and very limited data from prospective clinical multicenter trials are available.
METHODS:
The prospective multicenter multiplatform RAVENTA (radiosurgery for ventricular tachycardia) study assesses high-precision image-guided cardiac SBRT with 25?Gy delivered to the VT substrate determined by high-definition endocardial and/or epicardial electrophysiological mapping in patients with refractory VT ineligible for catheter ablation and an implanted cardioverter defibrillator (ICD). Primary endpoint is the feasibility of full-dose application and procedural safety (defined as an incidence of serious [grade ??3] treatment-related complications ??5% within 30 days after therapy). Secondary endpoints comprise VT burden, ICD interventions, treatment-related toxicity, and quality of life. We present the results of a protocol-defined interim analysis.
RESULTS:
Between 10/2019 and 12/2021, a total of five patients were included at three university medical centers. In all cases, the treatment was carried out without complications. There were no serious potentially treatment-related adverse events and no deterioration of left ventricular ejection fraction upon echocardiography. Three patients had a decrease in VT episodes during follow-up. One patient underwent subsequent catheter ablation for a new VT with different morphology. One patient with local VT recurrence died 6 weeks after treatment in cardiogenic shock.
CONCLUSION:
The interim analysis of the RAVENTA trial demonstrates early initial feasibility of this new treatment without serious complications within 30 days after treatment in five patients. Recruitment will continue as planned and the study has been expanded to further university medical centers.
TRIAL REGISTRATION NUMBER:
NCT03867747 (clinicaltrials.gov). Registered March 8, 2019. Study start: October 1, 2019.
© 2023. The Author(s).
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