201
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Muzafarova T, Motovska Z, Hlinomaz O, Kala P, Hromadka M, Precek J, Mrozek J, Matejka J, Kettner J, Bis J, Jarkovsky J. The Prognosis of Cardiogenic Shock Following Acute Myocardial Infarction-an Analysis of 2693 Cases From a Prospective Multicenter Registry. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:538-539. [PMID: 37721142 PMCID: PMC10534133 DOI: 10.3238/arztebl.m2023.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Tamilla Muzafarova
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Czech Republic,
| | - Zuzana Motovska
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Czech Republic,
| | - Ota Hlinomaz
- First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne’s University Hospital Brno, Czech Republic
| | - Petr Kala
- Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Czech Republic
| | - Milan Hromadka
- Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Jan Precek
- First Internal Cardiology Clinic, University Hospital Olomouc, Czech Republic
| | - Jan Mrozek
- Cardiovascular Department, University Hospital Ostrava, Czech Republic
| | - Jan Matejka
- Department of Cardiology, Regional Hospital Pardubice, Czech Republic
| | - Jiri Kettner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Bis
- First Department of Internal Medicine – Cardioangiology, University Hospital, Faculty of Medicine, Charles University, Hradec Králové, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- The Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
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202
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Chandrasekhar A, Padrós-Valls R, Pallarès-López R, Palanques-Tost E, Houstis N, Sundt TM, Lee HS, Sodini CG, Aguirre AD. Tissue perfusion pressure enables continuous hemodynamic evaluation and risk prediction in the intensive care unit. Nat Med 2023; 29:1998-2006. [PMID: 37550417 DOI: 10.1038/s41591-023-02474-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/27/2023] [Indexed: 08/09/2023]
Abstract
Treatment of circulatory shock in critically ill patients requires management of blood pressure using invasive monitoring, but uncertainty remains as to optimal individual blood pressure targets. Critical closing pressure, which refers to the arterial pressure when blood flow stops, can provide a fundamental measure of vascular tone in response to disease and therapy, but it has not previously been possible to measure this parameter routinely in clinical care. Here we describe a method to continuously measure critical closing pressure in the systemic circulation using readily available blood pressure monitors and then show that tissue perfusion pressure (TPP), defined as the difference between mean arterial pressure and critical closing pressure, provides unique information compared to other hemodynamic parameters. Using analyses of 5,988 admissions to a modern cardiac intensive care unit, and externally validated with 864 admissions to another institution, we show that TPP can predict the risk of mortality, length of hospital stay and peak blood lactate levels. These results indicate that TPP may provide an additional target for blood pressure optimization in patients with circulatory shock.
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Affiliation(s)
- Anand Chandrasekhar
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Raimon Padrós-Valls
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roger Pallarès-López
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA
| | - Eric Palanques-Tost
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA
| | - Nicholas Houstis
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Healthcare Transformation Lab, Massachusetts General Hospital, Boston, MA, USA
| | - Thoralf M Sundt
- Cardiac Surgery Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hae-Seung Lee
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Charles G Sodini
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Aaron D Aguirre
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.
- Healthcare Transformation Lab, Massachusetts General Hospital, Boston, MA, USA.
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA.
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203
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Abstract
Cardiogenic shock is characterized by tissue hypoxia caused by circulatory failure arising from inadequate cardiac output. In addition to treating the pathologic process causing impaired cardiac function, prompt hemodynamic support is essential to reduce the risk of developing multiorgan dysfunction and to preserve cellular metabolism. Pharmacologic therapy with the use of vasopressors and inotropes is a key component of this treatment strategy, improving perfusion by increasing cardiac output, altering systemic vascular resistance, or both, while allowing time and hemodynamic stability to treat the underlying disease process implicated in the development of cardiogenic shock. Despite the use of mechanical circulatory support recently garnering significant interest, pharmacologic hemodynamic support remains a cornerstone of cardiogenic shock management, with over 90% of patients receiving at least 1 vasoactive agent. This review aims to describe the pharmacology and hemodynamic effects of current pharmacotherapies and provide a practical approach to their use, while highlighting important future research directions.
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Affiliation(s)
- Jason E. Bloom
- Department of CardiologyAlfred HealthMelbourneAustralia
- Baker Heart and Diabetes InstituteMelbourneAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - William Chan
- Department of CardiologyAlfred HealthMelbourneAustralia
- Baker Heart and Diabetes InstituteMelbourneAustralia
| | - David M. Kaye
- Department of CardiologyAlfred HealthMelbourneAustralia
- Baker Heart and Diabetes InstituteMelbourneAustralia
| | - Dion Stub
- Department of CardiologyAlfred HealthMelbourneAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
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204
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Modi SP, Hong Y, Sicke MM, Hess NR, Klass WJ, Ziegler LA, Rivosecchi RM, Hickey GW, Kaczorowski DJ, Ramanan R. Concomitant Use of VA-ECMO and Impella Support for Cardiogenic Shock. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.24.23293127. [PMID: 37546750 PMCID: PMC10402237 DOI: 10.1101/2023.07.24.23293127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Background VA-ECMO with concomitant Impella support (ECpella) is an emerging treatment modality for cardiogenic shock (CS). Survival outcomes by CS etiology with ECpella support have not been well-described. Methods This study was a retrospective, single-center analysis of patients with cardiogenic shock due to acute myocardial infarction (AMI-CS) or decompensated heart failure (ADHF-CS) supported with ECpella from December 2020 to January 2023. Primary outcomes included 90-day survival post-discharge and destination after support. Secondary outcomes included complications post-ECpella support. Results A total of 44 patients were included (AMI-CS, n = 20, and ADHF-CS, n = 24). Patients with AMI-CS and ADHF-CS had similar survival 90 days post-discharge (p = .267) with similar destinations after ECpella support (p = .220). Limb ischemia and acute kidney injury occurred more frequently in patients presenting with AMI-CS (p=.013; p = .030). Patients with initial Impella support were more likely to survive ECpella support and be bridged to transplant (p=.033) and less likely to have a cerebrovascular accident (p=.016). Sub-analysis of ADHF-CS patients into acute-on-chronic decompensated heart failure and de novo heart failure demonstrated no difference in survival or destination. Conclusion ECpella can be used to successfully manage patients with CS. There is no difference in survival or destination for AMI-CS and ADHF-CS in patients with ECpella support. Patients with initial Impella support are more likely to survive ECpella support and bridge to transplant. Future multicenter studies are required to fully analyze the differences between AMI-CS and ADHF-CS with ECpella support.
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Affiliation(s)
- Shan P Modi
- Department of Critical Care Medicine, University of Pittsburgh Medical Center Pittsburgh, PA
| | - Yeahwa Hong
- Department of Surgery, University of Pittsburgh Medical Center Pittsburgh, PA
| | - McKenzie M Sicke
- School of Medicine, University of Pittsburgh Medical Center Pittsburgh, PA
| | - Nicholas R Hess
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pittsburgh, PA
| | - Wyatt J Klass
- Heart and Vascular Institute, University of Pittsburgh Medical Center Pittsburgh, PA
| | - Luke A Ziegler
- Heart and Vascular Institute, University of Pittsburgh Medical Center Pittsburgh, PA
| | - Ryan M Rivosecchi
- Department of Pharmacy, University of Pittsburgh Medical Center Pittsburgh, PA
| | - Gavin W Hickey
- Division of Cardiology, University of Pittsburgh Medical Center Pittsburgh, PA
| | - David J Kaczorowski
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pittsburgh, PA
| | - Raj Ramanan
- Department of Critical Care Medicine, University of Pittsburgh Medical Center Pittsburgh, PA
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205
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Liu Y, Zeng M, Zhou Y, Qiu W, Zeng R, Zhou Y. Effect of intra-aortic balloon pump with veno-arterial extracorporeal membrane oxygenation in acute myocardial infarction with cardiogenic shock: A meta-analysis. Perfusion 2023:2676591231189941. [PMID: 37498618 DOI: 10.1177/02676591231189941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND The effectiveness of a concomitant intra-aortic balloon pump (IABP) with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) intervention in acute myocardial infarction with cardiogenic shock (AMICS) patients is contested in the literature. This study sought to compare short-term mortality weaning rate from VA-ECMOin AMICS cases. METHODS We conducted a literature review and compared the primary and secondary endpoints in the following treatment groups of AMICS patients: (1) VA-ECMO plus IABP vs. IABP alone and (2) VA-ECMO plus IABP vs. VA-ECMO alone. The primary endpoint was in-hospital all-cause mortality; while 30-days mortality, weaning from VA-ECMO, and vascular complications comprised secondary endpoints. RESULTS VA-ECMO concomitant with IABP was administered to 3,580 (76.4%) patients, while IABP alone and VA-ECMO alone treatments accounted for 1.7% and 21.9% of the patients, respectively. We found that in-hospital mortality was significantly lower in patients treated with VA-ECMO plus IABP vs. VA-ECMO alone (odds ratio (OR) = 0.52; 95% Confidence Interval (CI) = 0.21-1.31; I-squared statistic (I2 = 30%) or IABP alone (OR = 0.20; 95% CI = 0.08-0.55; I2 = 0%). Additionally, 30-days mortality was significantly lower in patients treated with VA-ECMO plus IABP vs. VA-ECMO alone (OR = 0.31; 95% CI = 0.25-0.40; I2 = 0%) or IABP alone (OR = 0.24; 95% CI = 0.11-0.50; I2 = 0%). A significant difference was observed in weaning from VA-ECMO in patients treated with VA-ECMO plus IABP vs. VA-ECMO alone (OR = 1.91; 95% CI = 1.09-3.33; I2 = 0%). CONCLUSION In-hospital and 30-days mortality were significantly lower in AMICS patients treated with VA-ECMO plus IABP vs. VA-ECMO alone or IABP alone. VA-ECMO with concomitant IABP could increase the proportion of patients weaned from VA-ECMO, significantly reducing in-hospital mortality, without increasing complications.
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Affiliation(s)
- Yidan Liu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Min Zeng
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yifang Zhou
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenjie Qiu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ruixiang Zeng
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yuanshen Zhou
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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206
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van Diepen S, Arias-Mendoza A, Sinha SS. The North American perspective on short-term mechanical circulatory support for cardiogenic shock: could differences in policy be driving differences in temporary mechanical circulatory support use? EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:486-489. [PMID: 37319359 DOI: 10.1093/ehjacc/zuad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Sean van Diepen
- Department of Critical Care Medicine, Division of Cardiology, Department of Medicine, University of Alberta, 8440-11 St, Edmonton, AB T6G 2B7, Canada
| | | | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA, USA
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207
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Yamga E, Mantena S, Rosen D, Bucholz EM, Yeh RW, Celi LA, Ustun B, Butala NM. Optimized Risk Score to Predict Mortality in Patients With Cardiogenic Shock in the Cardiac Intensive Care Unit. J Am Heart Assoc 2023; 12:e029232. [PMID: 37345819 PMCID: PMC10356069 DOI: 10.1161/jaha.122.029232] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/01/2023] [Indexed: 06/23/2023]
Abstract
Background Mortality prediction in critically ill patients with cardiogenic shock can guide triage and selection of potentially high-risk treatment options. Methods and Results We developed and externally validated a checklist risk score to predict in-hospital mortality among adults admitted to the cardiac intensive care unit with Society for Cardiovascular Angiography & Interventions Shock Stage C or greater cardiogenic shock using 2 real-world data sets and Risk-Calibrated Super-sparse Linear Integer Modeling (RiskSLIM). We compared this model to those developed using conventional penalized logistic regression and published cardiogenic shock and intensive care unit mortality prediction models. There were 8815 patients in our training cohort (in-hospital mortality 13.4%) and 2237 patients in our validation cohort (in-hospital mortality 22.8%), and there were 39 candidate predictor variables. The final risk score (termed BOS,MA2) included maximum blood urea nitrogen ≥25 mg/dL, minimum oxygen saturation <88%, minimum systolic blood pressure <80 mm Hg, use of mechanical ventilation, age ≥60 years, and maximum anion gap ≥14 mmol/L, based on values recorded during the first 24 hours of intensive care unit stay. Predicted in-hospital mortality ranged from 0.5% for a score of 0 to 70.2% for a score of 6. The area under the receiver operating curve was 0.83 (0.82-0.84) in training and 0.76 (0.73-0.78) in validation, and the expected calibration error was 0.9% in training and 2.6% in validation. Conclusions Developed using a novel machine learning method and the largest cardiogenic shock cohorts among published models, BOS,MA2 is a simple, clinically interpretable risk score that has improved performance compared with existing cardiogenic-shock risk scores and better calibration than general intensive care unit risk scores.
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Affiliation(s)
- Eric Yamga
- Department of Medicine Centre Hospitalier de l'Université de Montréal (CHUM) Montreal QC Canada
| | | | - Darin Rosen
- Johns Hopkins School of Medicine Baltimore MD USA
| | - Emily M Bucholz
- University of Colorado School of Medicine Aurora CO USA
- Heart Institute, Children's Hospital of Colorado Aurora CO USA
| | - Robert W Yeh
- Harvard Medical School Boston MA USA
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology Beth Israel Deaconess Medical Center Boston MA USA
| | - Leo A Celi
- Harvard Medical School Boston MA USA
- Laboratory for Computational Physiology, MIT Institute for Medical Engineering and Science, Massachusetts Institute of Technology Cambridge MA USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health Boston MA USA
| | - Berk Ustun
- Halıcıoğlu Data Science Institute University of California San Diego CA USA
| | - Neel M Butala
- University of Colorado School of Medicine Aurora CO USA
- Rocky Mountain Regional VA Medical Center Aurora CO USA
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208
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Buckel M, Proudfoot AG. Time for a rethink in cardiogenic shock: the shock to survival framework document. Br J Hosp Med (Lond) 2023; 84:1-8. [PMID: 37490447 DOI: 10.12968/hmed.2023.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Cardiogenic shock remains a time-critical, complex syndrome that continues to present challenges to clinicians and healthcare systems. Despite advances in the fields of cardiovascular and critical care medicine, mortality remains high. This article summarises the recent shock to survival document, which outlined the current and ideal future state of cardiogenic shock care nationally to improve patient outcomes. Shock to survival emphasises the need for education and training in the early recognition of the hypoperfusion that is pathognomomic of cardiogenic shock. Improved provision of focused cardiac ultrasound is essential to confirm a cardiac cause. Early identification of the patient with cardiogenic shock should be supported by access to defined pathways of care, including specialist shock centres and multiprofessional teams with domain expertise and the capability to manage the myriad of causative aetiologies. Given the absence of high-quality data to inform practice nationally, robust datasets are an unmet need to inform best practice, guide design of clinical services and pathways and drive innovation through research and clinical trials.
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Affiliation(s)
- Marie Buckel
- Pan-London Intensive Care Medicine Training Programme, London, UK
| | - Alastair G Proudfoot
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, London, UK
- Critical Care and Perioperative Medicine Group, Queen Mary University of London, London, UK
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209
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Di Santo P, Dehghan K, Mao B, Jung RG, Fadare D, Paydar J, Parlow S, Motazedian P, Prosperi-Porta G, Abdel-Razek O, Joseph J, Goh CY, Chung K, Mulloy A, Ramirez FD, Simard T, Hibbert B, Mathew R, Russo JJ. Milrinone vs Dobutamine for the Management of Cardiogenic Shock: Implications of Renal Function and Injury. JACC. ADVANCES 2023; 2:100393. [PMID: 38938997 PMCID: PMC11198346 DOI: 10.1016/j.jacadv.2023.100393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 03/22/2023] [Accepted: 04/06/2023] [Indexed: 06/29/2024]
Abstract
Background Cardiogenic shock is associated with poor clinical outcomes. There is a paucity of prospective data examining the efficacy and safety of inotropic therapy in patients with cardiogenic shock and renal dysfunction. Objectives This study sought to examine the treatment effect of milrinone compared to dobutamine in relation to renal function. Methods In this post hoc analysis of the DOREMI (Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock) trial, we examined clinical outcomes with milrinone compared to dobutamine after stratification based on baseline estimated glomerular filtration rate (eGFR) 60 ml/min/1.73 m2 and acute kidney injury (AKI). The primary outcome was the composite of in-hospital death from any cause, resuscitated cardiac arrest, receipt of a cardiac transplant or mechanical circulatory support, nonfatal myocardial infarction, transient ischemic attack or stroke, or initiation of renal replacement therapy. Results Baseline eGFR <60 ml/min/1.73 m2 and AKI were observed in 78 (45%) and 124 (65%) of patients, respectively. The primary outcome and death from any cause occurred in 99 (52%) and 76 (40%) patients, respectively. eGFR <60 ml/min/1.73 m2 did not appear to modulate the treatment effect of milrinone compared to dobutamine. In contrast, there was a significant interaction between the treatment effect of milrinone compared to dobutamine and AKI with respect to the primary outcome (P interaction = 0.02) and death (P interaction = 0.04). The interaction was characterized by lower risk of primary outcome and death with milrinone compared to dobutamine in patients without, but not with, AKI. Conclusions In patients requiring inotropic support for cardiogenic shock, baseline renal dysfunction and AKI are common. A modulating effect of AKI on the relative efficacy of milrinone compared to dobutamine was observed, characterized by attenuation of a potential clinical benefit with milrinone compared to dobutamine in patients who develop AKI.
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Affiliation(s)
- Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Kooroush Dehghan
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brennan Mao
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard G. Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Fadare
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - John Paydar
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pouya Motazedian
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Graeme Prosperi-Porta
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Joanne Joseph
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Cheng Yee Goh
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kevin Chung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew Mulloy
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - F. Daniel Ramirez
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Juan J. Russo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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210
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Kim AR, Hyun J, Lee SE, Hong JA, Kang PJ, Jung SH, Kim MS. Prognosis of Venoarterial Extracorporeal Membrane Oxygenation in Mixed, Cardiogenic and Septic Shock. ASAIO J 2023; 69:658-664. [PMID: 37018827 DOI: 10.1097/mat.0000000000001933] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Mixed cardiogenic-septic shock (MS), defined as the combination of cardiogenic (CS) and septic (SS) shock, is often encountered in cardiac intensive care units. Herein, the authors compared the impact of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in MS, CS, and SS. Of 1,023 patients who received VA-ECMO from January 2012 to February 2020 at a single center, 211 with pulmonary embolism, hypovolemic shock, aortic dissection, and unknown causes of shock were excluded. The remaining 812 patients were grouped based on the cause of shock at VA-ECMO application: i) MS (n = 246, 30.3%), ii) CS (n = 466, 57.4%), iii) SS (n = 100, 12.3%). The MS group was younger and had lower left ventricular ejection fraction than the CS or SS group did. The 30 day and 1 year mortalities were the highest in SS (30 day mortality: 50.4% vs. 43.3% vs. 69.0%, p < 0.001 for MS versus CS versus SS, respectively; 1 year mortality: 67.5% vs. 53.2% vs. 81.0%, p < 0.001 for MS versus CS versus SS, respectively). Posthoc analysis showed that the 30 day mortality of MS was not different from CS, while the 1 year mortality of MS was worse than CS but better than SS. Venoarterial extracorporeal membrane oxygenation application for MS may help improve survival and should therefore be considered if indicated.
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Affiliation(s)
- Ah-Ram Kim
- From the Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Junho Hyun
- From the Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Eun Lee
- From the Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Ae Hong
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Pil-Je Kang
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min-Seok Kim
- From the Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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211
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Hyun J, Cho JY, Youn JC, Kim D, Cho DH, Park SM, Jung MH, Cho HJ, Park SM, Choi JO, Chung WJ, Yoo BS, Kang SM. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Advanced and Acute Heart Failure. INTERNATIONAL JOURNAL OF HEART FAILURE 2023; 5:111-126. [PMID: 37554692 PMCID: PMC10406557 DOI: 10.36628/ijhf.2023.0019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 08/10/2023]
Abstract
The Korean Society of Heart Failure (KSHF) Guidelines provide evidence-based recommendations based on Korean and international data to guide adequate diagnosis and management of heart failure (HF). Since introduction of 2017 edition of the guidelines, management of advanced HF has considerably improved, especially with advances in mechanical circulatory support and devices. The current guidelines addressed these improvements. In addition, we have included recently updated evidence-based recommendations regarding acute HF in these guidelines. In summary, Part IV of the KSHF Guidelines covers the appropriate diagnosis and optimized management of advanced and acute HF.
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Affiliation(s)
- Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Min Park
- Department of Cardiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Metra M, Chioncel O, Davison B, Filippatos G, Mebazaa A, Pagnesi M, Adamo M, Novosadova M, Ponikowski P, Simmons P, Soffer J, Simonson S, Cotter G. Safety and Efficacy of Istaroxime 1.0 and 1.5 µg/kg/min for Patients With Pre-Cardiogenic Shock. J Card Fail 2023; 29:1097-1103. [PMID: 37075941 DOI: 10.1016/j.cardfail.2023.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Istaroxime was shown, in a small study, to increase systolic blood pressure (SBP) in patients with pre-cardiogenic shock (CS) due to acute heart failure (AHF). OBJECTIVES In the current analysis, we describe the effects of 2 doses of istaroxime 1.0 (Ista-1) and 1.5 µg/kg/min (Ista-1.5). METHODS The target dose of istaroxime, administered in a double-blind, placebo-controlled fashion, was 1.5 µg/kg/min in the first cohort (n = 24), and it was reduced to 1.0 µg/kg/min in subsequent patients (n = 36). RESULTS Ista-1 was associated with numerically larger effects on SBP area under the curve, with a 93.6% relative increase from baseline during the first 6 hours with Ista-1 vs 39.5% for Ista-1.5, and with a 49.4% and 24.3% relative increase, respectively, at 24 hours. Compared to placebo, Ista-1.5 had more worsening HF events until day 5 and fewer days alive out of hospital (DAOH) through day 30. Ista-1 had no worsening HF events, and DAOH to day 30 were significantly increased. Effects on echocardiographic measures were similar, although decreases in left ventricular end systolic and diastolic volumes were numerically larger in the Ista-1 group. Ista-1, but not Ista-1.5, showed numerically smaller creatinine increases and larger decreases in natriuretic peptides as compared to placebo. There were 5 serious adverse events in Ista-1.5 (4 of which were cardiac) but only 1 in Ista-1. CONCLUSIONS In patients with pre-CS due to AHF, istaroxime 1.0 µg/kg/min induced beneficial effects on SBP and DAOH. Clinical benefits appear to be reached at dosages less than 1.5 ug/kg/min.
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Affiliation(s)
- Marco Metra
- Cardiology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases Prof. C.C. Iliescu, Bucharest, Romania; University of Medicine Carol Davila, Bucharest, Romania
| | - Beth Davison
- Momentum Research, Durham, NC, USA; Université Paris Cité; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Paris, France
| | - Gerasimos Filippatos
- Department of Cardiology, University of Cyprus, School of Medicine & National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Alexandre Mebazaa
- Université Paris Cité; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Paris, France; Department of Anesthesiology and Critical Care and Burn Unit, Hôpital Saint-Louis Lariboisière, FHU PROMICE, DMU Parabol, APHP.Nord, Paris, France
| | - Matteo Pagnesi
- Cardiology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | | | | | | | - Gad Cotter
- Momentum Research, Durham, NC, USA; Université Paris Cité; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Paris, France.
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213
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Ferrel MN, Raza SS, Tang P, Haft J, Ala AAE. Cannulation strategies for extracorporeal membrane oxygenation. Indian J Thorac Cardiovasc Surg 2023; 39:91-100. [PMID: 37525707 PMCID: PMC10387010 DOI: 10.1007/s12055-023-01537-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 08/02/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is a type of extracorporeal life support (ECLS) in which the function of the heart and/or lungs is partially or completely replaced by a portable system that provides prolonged support to critically ill patients with respiratory or cardiac failure. There are two major variants of ECMO: veno-venous (VV) ECMO and veno-arterial (VA) ECMO. VV ECMO replaces the function of the lung in which it uses a cannula to remove venous blood and oxygenates it using the extracorporeal system, and returns the blood to the right atrium to be pumped to the body. VA ECMO is slightly different in that it replaces the function of the heart and lungs by returning oxygenated blood to the aorta. As a therapy for respiratory failure, ECMO minimizes hypoxia, diminishes lung stress and strain, and allows lung protective mechanical ventilation. As a support for acute and terminal heart failure, ECMO reduces preload, increases aortic flow, and allows for end-organ perfusion. Due to its physiological support and advantages, it is used for a variety of chronic and acute support purposes such as bridge therapy for heart/lung transplant, durable ventricular assist devices, and intermediate-term mechanical support postoperatively. Our review gives a broad overview of the two main types of ECMO strategies and their clinical indications, cannulation strategies, unique clinical utility, and their limitations.
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Affiliation(s)
| | - Syed Sikandar Raza
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48197 USA
| | - Paul Tang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48197 USA
| | - Jonathan Haft
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48197 USA
| | - Ashraf Abou El Ala
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48197 USA
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Araki T, Kondo T, Imaizumi T, Sumita Y, Nakai M, Tanaka A, Okumura T, Yang M, Butt JH, Petrie MC, Murohara T. Relationship between the volume of cases and in-hospital mortality in patients with cardiogenic shock receiving short-term mechanical circulatory support. Am Heart J 2023; 261:109-123. [PMID: 37031832 DOI: 10.1016/j.ahj.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND We examined the relationship between annual case volume at each hospital and outcome in cardiogenic shock (CS) patients receiving mechanical circulatory support (MCS) devices. METHODS This cross-sectional study used the Japanese nationwide database to identify patients receiving short-term MCS for CS between April 2012 and March 2020. Of 65,837 patients, 3 subcohorts were created; the intra-aortic balloon pump (IABP) alone (n = 48,643), the extracorporeal membrane oxygenation (ECMO) (n = 16,871), and the Impella cohorts (n = 696). RESULTS The median annual case volume was 13.5 (7.4-22.1) in the IABP alone cohort, 6.4 (3.4-11.0) in the ECMO cohort, and 7.5 (4.0-10.7) in the Impella cohort. The highest quintile for the volume of cases in the IABP alone and ECMO had the lowest in-hospital mortality (IABP alone, 25.1% in quintile 1 vs 15.2% in quintile 5; ECMO, 73.7% in quintile 1 in 67.4% in quintile 5). Adjusted ORs for in-hospital mortality decreased as case volume increased (IABP alone, 0.63 [0.58-0.68] in quintile 5; ECMO, 0.73 [0.65-0.82] in quintile 5, with the lowest quintile as reference) but did not decrease significantly in the Impella (0.90 [0.58-1.39] in tertile 3, with the lowest tertile as reference). In the continuous models with the case volume as a continuous variable, adjusted ORs for in-hospital mortality decreased to 28 IABP cases/year and 12 ECMO cases/year. They did not decrease or became almost flat above that. CONCLUSIONS Higher volumes of IABP and ECMO are associated with a lower mortality. There is an upper limit to the decline. Centralizing patients with refractory CS in a particular hospital might improve patient outcomes in each region.
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Affiliation(s)
- Takashi Araki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
| | - Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mingming Yang
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Jawad H Butt
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Mark C Petrie
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Abu Sardaneh A, Penm J, Oliver M, Gattas D, Mclachlan A, Patanwala A. Comparison of metaraminol versus no metaraminol on time to resolution of shock in critically ill patients. Eur J Hosp Pharm 2023; 30:214-220. [PMID: 34620686 PMCID: PMC10359804 DOI: 10.1136/ejhpharm-2021-003035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/28/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE There is limited evidence to support metaraminol use in critically ill patients. Metaraminol is not included as a vasopressor choice in international guidelines for the management of shock. Nevertheless, metaraminol is used in rates up to 42% in this patient population. The objective of this study was to investigate the effectiveness of metaraminol for the treatment of critically ill patients with shock. METHODS A single-centre retrospective matched observational study was conducted in a 54-bed intensive care unit of a tertiary hospital. Patients aged 16 years or older who were admitted from 2017 to 2019 with shock were included. Patients treated with metaraminol and norepinephrine (MET-NOR) were compared with those treated with norepinephrine without metaraminol (NOR). The primary outcome was the time to resolution of shock defined as the time to cessation of vasopressors. The secondary outcome was vasopressor-free days until 28 days. RESULTS There were 286 patients included in this study, including 143 patients in each group. The median time to resolution of shock was 44 hours (IQR 28-66 hours) in the MET-NOR group compared with 27 hours (IQR 14-63 hours) in the NOR group (95% CI of median difference 7 to 19 hours; p<0.01). The Cox regression analysis for the time to resolution of shock showed no significant difference between groups (HR 1.24, 95% CI 0.96 to 1.60; p=0.10). However, the proportional hazards assumption was not met (p<0.01). The median number of vasopressor-free days until 28 days was 26 days (IQR 24-27 days) in the MET-NOR group compared with 27 days (IQR 25-27 days) in the NOR group (95% CI of median difference -0.8 to -0.1 day; p<0.01). CONCLUSION In critically ill patients, metaraminol may be associated with a longer time to resolution of shock compared with those who do not receive metaraminol.
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Affiliation(s)
- Arwa Abu Sardaneh
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Jonathan Penm
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Pharmacy, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Matthew Oliver
- Department of Emergency Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David Gattas
- School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Intensive Care Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Andrew Mclachlan
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Asad Patanwala
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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216
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McCallum W, Sarnak MJ. Cardiorenal Syndrome in the Hospital. Clin J Am Soc Nephrol 2023; 18:933-945. [PMID: 36787124 PMCID: PMC10356127 DOI: 10.2215/cjn.0000000000000064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023]
Abstract
The cardiorenal syndrome refers to a group of complex, bidirectional pathophysiological pathways involving dysfunction in both the heart and kidney. Upward of 60% of patients admitted for acute decompensated heart failure have CKD, as defined by an eGFR of <60 ml/min per 1.73 m 2 . CKD, in turn, is one of the strongest risk factors for mortality and cardiovascular events in acute decompensated heart failure. Although not well understood, the mechanisms in the cardiorenal syndrome include venous congestion, arterial underfilling, neurohormonal activation, inflammation, and endothelial dysfunction. Arterial underfilling may lead to activation of the renin-angiotensin-aldosterone system and sympathetic nervous system, leading to sodium reabsorption and vasoconstriction. Venous congestion likely also mediates and perpetuates these maladaptive pathways. To rule out intrinsic kidney disease that is distinct from the cardiorenal syndrome, one should obtain a careful history, review longitudinal eGFR trends, assess albuminuria and proteinuria, and review the urine sediment and kidney imaging. The hallmark of the cardiorenal syndrome is intense sodium avidity and diuretic resistance, often requiring a combination of diuretics with varying pharmacological targets, and monitoring of urinary response to guide escalations in therapy. Invasive means of decongestion may be required including ultrafiltration or KRT such as peritoneal dialysis, which is often better tolerated from a hemodynamic perspective than intermittent hemodialysis. Strategies for increasing forward perfusion in states of low cardiac output and cardiogenic shock may include afterload reduction and inotropes and, in the most severe cases, mechanical circulatory support devices, many of which have kidney-specific considerations.
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Affiliation(s)
- Wendy McCallum
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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217
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Singhvi A, Punnen J. Acute mechanical circulatory support for cardiogenic shock in India. Indian J Thorac Cardiovasc Surg 2023; 39:47-62. [PMID: 37525701 PMCID: PMC10387029 DOI: 10.1007/s12055-023-01530-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 08/02/2023] Open
Abstract
Cardiogenic shock continues to have high morbidity and mortality, despite advances in the field. Temporary mechanical circulatory support (TMCS) devices, if instituted in a timely fashion, can help stabilize critically ill patients with cardiogenic shock from various aetiologies and cardiac arrest, and provide time for organ recovery or till durable support or transplantation can be achieved. Currently, several options for TMCS devices exist. In this review, we discuss indications, contraindications, characteristics of the various available devices, and important issues pertaining to their management.
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Affiliation(s)
- Aditi Singhvi
- Narayana Institute of Cardiac Sciences, Narayana Health, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India
| | - Julius Punnen
- Narayana Institute of Cardiac Sciences, Narayana Health, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India
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218
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Hyun J, Cho JY, Youn JC, Kim D, Cho DH, Park SM, Jung MH, Cho HJ, Park SM, Choi JO, Chung WJ, Yoo BS, Kang SM. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Advanced and Acute Heart Failure. Korean Circ J 2023; 53:452-471. [PMID: 37525390 PMCID: PMC10406529 DOI: 10.4070/kcj.2023.0115] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 08/02/2023] Open
Abstract
The Korean Society of Heart Failure (KSHF) Guidelines provide evidence-based recommendations based on Korean and international data to guide adequate diagnosis and management of heart failure (HF). Since introduction of 2017 edition of the guidelines, management of advanced HF has considerably improved, especially with advances in mechanical circulatory support and devices. The current guidelines addressed these improvements. In addition, we have included recently updated evidence-based recommendations regarding acute HF in these guidelines. In summary, Part IV of the KSHF Guidelines covers the appropriate diagnosis and optimized management of advanced and acute HF.
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Affiliation(s)
- Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Min Park
- Department of Cardiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Mahtta D, Manandhar P, Wegermann ZK, Wojdyla D, Megaly M, Kochar A, Virani SS, Rao SV, Elgendy IY. Outcomes and Institutional Variation in Arterial Access Among Patients With AMI and Cardiogenic Shock Undergoing PCI. JACC Cardiovasc Interv 2023; 16:1517-1528. [PMID: 37380235 DOI: 10.1016/j.jcin.2023.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Contemporary data comparing the outcomes of transradial access (TRA) vs transfemoral access (TFA) among patients presenting with acute myocardial infarction and cardiogenic shock (AMI-CS) undergoing percutaneous coronary intervention (PCI) are limited. OBJECTIVES This study examines in-hospital outcomes and institutional variation among patients with AMI-CS undergoing TRA-PCI vs TFA-PCI. METHODS Patients admitted with AMI-CS from the NCDR CathPCI registry between April 2018 and June 2021 were included. Multivariable logistic regression and inverse probability weighting models were used to assess the association between access site and in-hospital outcomes. A falsification analysis using non-access site-related bleeding was performed. RESULTS Among 35,944 patients with AMI-CS undergoing PCI, 25.6% were performed with TRA. The proportion of TRA-PCI increased over the study period (22.0% in the second quarter of 2018 vs 29.1% in the second quarter of 2021; P-trend <0.001). Significant institutional-level variability in the use of TRA-PCI was also observed: 20.9% of all sites using TRA in <2% of PCIs (low utilization) vs 1.9% of all sites using TRA in >80% of PCIs (high utilization). Patients undergoing TRA-PCI had a significantly lower adjusted incidence of major bleeding (odds ratio [OR]: 0.71; 95% confidence interval [CI]: 0.67-0.76), mortality (OR: 0.73; 95% CI: 0.69-0.78), vascular complications (OR: 0.67; 95% CI: 0.54-0.84), and new dialysis (OR: 0.86; 95% CI: 0.77-0.97). There was no difference in non-access site related bleeding (OR: 0.93; 95% CI: 0.84-1.03). Sensitivity analyses revealed similar benefit with TRA-PCI among patients without arterial cross-over. There were no significant interactions observed between TRA-PCI with mechanical circulatory support and in-hospital outcomes. CONCLUSIONS In this large nationwide contemporary analysis of patients with AMI-CS, about quarter of PCIs were performed via TRA with wide variability across US institutions. TRA-PCI was associated with significantly lower incidence of in-hospital major bleeding, mortality, vascular complications, and new dialysis. This benefit was observed irrespective of mechanical circulatory support use.
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Affiliation(s)
- Dhruv Mahtta
- Division of Cardiovascular Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | | | - Zachary K Wegermann
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel Wojdyla
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael Megaly
- Willis Knighton Heart Institute, Shreveport, Louisiana, USA
| | - Ajar Kochar
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA; Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Salim S Virani
- Division of Cardiovascular Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Sunil V Rao
- NYU Langone Health System, New York, New York, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky HealthCare, Lexington, Kentucky, USA.
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220
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Claessen B, Peters E. Radial Access for PCI in Acute Myocardial Infarction Related Cardiogenic Shock: Underused, Underappreciated? JACC Cardiovasc Interv 2023; 16:1529-1530. [PMID: 37380236 DOI: 10.1016/j.jcin.2023.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Bimmer Claessen
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Elma Peters
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Yu Y, Rao J, Xu Q, Xiao J, Cheng P, Wang J, Xi W, Wang P, Zhang Y, Wang Z. Phenotyping cardiogenic shock that showed different clinical outcomes and responses to vasopressor use: a latent profile analysis from MIMIC-IV database. Front Med (Lausanne) 2023; 10:1186119. [PMID: 37425299 PMCID: PMC10325854 DOI: 10.3389/fmed.2023.1186119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/01/2023] [Indexed: 07/11/2023] Open
Abstract
Background Cardiogenic shock (CS) is increasingly recognized as heterogeneous in its severity and response to therapies. This study aimed to identify CS phenotypes and their responses to the use of vasopressors. Method The current study included patients with CS complicating acute myocardial infarction (AMI) at the time of admission from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Laboratory and clinical variables were collected and used to conduct latent profile (LPA) analysis. Furthermore, we used a multivariable logistic regression (LR) model to explore the independent association between the use of vasopressors and endpoints. Result A total of 630 eligible patients with CS after AMI were enrolled in the study. The LPA identified three profiles of CS: profile 1 (n = 259, 37.5%) was considered as the baseline group; profile 2 (n = 261, 37.8%) was characterized by advanced age, more comorbidities, and worse renal function; and profile 3 (n = 170, 24.6%) was characterized by systemic inflammatory response syndrome (SIRS)-related indexes and acid-base balance disturbance. Profile 3 showed the highest all-cause in-hospital mortality rate (45.9%), followed by profile 2 (43.3%), and profile 1 (16.6%). The LR analyses showed that the phenotype of CS was an independent prognostic factor for outcomes, and profiles 2 and 3 were significantly associated with a higher risk of in-hospital mortality (profile 2: odds ratio [OR] 3.95, 95% confidence interval [CI] 2.61-5.97, p < 0.001; profile 3: OR 3.90, 95%CI 2.48-6.13, p < 0.001) compared with profile 1. Vasopressor use was associated with an improved risk of in-hospital mortality for profile 2 (OR: 2.03, 95% CI: 1.15-3.60, p = 0.015) and profile 3 (OR: 2.91, 95% CI: 1.02-8.32, p = 0.047), respectively. The results of vasopressor use showed no significance for profile 1. Conclusion Three phenotypes of CS were identified, which showed different outcomes and responses to vasopressor use.
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Affiliation(s)
- Yue Yu
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jin Rao
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Qiumeng Xu
- Department of Orthopaedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jian Xiao
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Pengchao Cheng
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Junnan Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Wang Xi
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Pei Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yufeng Zhang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhinong Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
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Matassini MV, Marini M, Angelozzi A, Angelini L, Shkoza M, Compagnucci P, Falanga U, Battistoni I, Pongetti G, Francioni M, Piva T, Mucaj A, Nicolini E, Maolo A, Di Eusanio M, Munch C, Dello Russo A, Perna G. Clinical outcomes and predictors of success with Impella weaning in cardiogenic shock: a single-center experience. Front Cardiovasc Med 2023; 10:1171956. [PMID: 37416919 PMCID: PMC10321515 DOI: 10.3389/fcvm.2023.1171956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Cardiogenic shock (CS) is a severe syndrome with poor prognosis. Short-term mechanical circulatory support with Impella devices has emerged as an increasingly therapeutic option, unloading the failing left ventricle (LV) and improving hemodynamic status of affected patients. Impella devices should be used for the shortest time necessary to allow LV recovery because of time-dependent device-related adverse events. The weaning from Impella, however, is mostly performed in the absence of established guidelines, mainly based on the experience of the individual centres. Methods The aim of this single center study was to retrospectively evaluate whether a multiparametrical assessment before and during Impella weaning could predict successful weaning. The primary study outcome was death occurring during Impella weaning and secondary endpoints included assessment of in-hospital outcomes. Results Of a total of 45 patients (median age, 60 [51-66] years, 73% male) treated with an Impella device, 37 patients underwent impella weaning/removal and 9 patients (20%) died after the weaning. Non-survivors patients after impella weaning more commonly had a previous history of known heart failure (p = 0.054) and an implanted ICD-CRT (p = 0.01), and were more frequently treated with continuous renal replacement therapy (p = 0.02). In univariable logistic regression analysis, lactates variation (%) during the first 12-24 h of weaning, lactate value after 24 h of weaning, left ventricular ejection fraction (LVEF) at the beginning of weaning, and inotropic score after 24 h from weaning beginning were associated with death. Stepwise multivariable logistic regression identified LVEF at the beginning of weaning and lactates variation (%) in the first 12-24 h from weaning beginning as the most accurate predictors of death after weaning. The ROC analysis indicated 80% accuracy (95% confidence interval = 64%-96%) using the two variables in combination to predict death after weaning from Impella. Conclusions This single-center experience on Impella weaning in CS showed that two easily accessible parameters as LVEF at the beginning of weaning and lactates variation (%) in the first 12-24 h from weaning begin were the most accurate predictors of death after weaning.
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Affiliation(s)
- M. V. Matassini
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Marini
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A. Angelozzi
- Unit of Cardiology and Cardiac Intensive Therapy, Cardiovascular Department, G. Mazzini Hospital, Teramo, Italy
| | - L. Angelini
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Shkoza
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - P. Compagnucci
- Cardiology and Arrhythmology Clinic and Department of Biomedical Sciences and Public Health, University Hospital Ospedali Riuniti di Ancona and Marche Polytechnic University, Ancona, Italy
| | - U. Falanga
- Cardiology and Arrhythmology Clinic and Department of Biomedical Sciences and Public Health, University Hospital Ospedali Riuniti di Ancona and Marche Polytechnic University, Ancona, Italy
| | - I. Battistoni
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - G. Pongetti
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Francioni
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - T. Piva
- Interventional Cardiology-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A. Mucaj
- Interventional Cardiology-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - E. Nicolini
- Interventional Cardiology-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A. Maolo
- Interventional Cardiology-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Di Eusanio
- Cardiac Surgery Unit, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - C. Munch
- Anaesthesia and Cardiac Surgery Intensive Care, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A. Dello Russo
- Cardiology and Arrhythmology Clinic and Department of Biomedical Sciences and Public Health, University Hospital Ospedali Riuniti di Ancona and Marche Polytechnic University, Ancona, Italy
| | - G. Perna
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
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Accorsi TAD, Paixão MR, Souza Júnior JLD, Gaz MVB, Cardoso RG, Köhler KF, Lima KDA, Tarasoutchi F. Valvular Heart Disease Emergencies: A Comprehensive Review Focusing on the Initial Approach in the Emergency Department. Arq Bras Cardiol 2023; 120:e20220707. [PMID: 37341248 DOI: 10.36660/abc.20220707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/05/2023] [Indexed: 06/22/2023] Open
Abstract
Valvular heart disease (VHD) is an increasing health problem worldwide. Patients with VHD may experience several cardiovascular-related emergencies. The management of these patients is a challenge in the emergency department, especially when the previous heart condition is unknown. Specific recommendations for the initial management are currently poor. This integrative review proposes an evidence-based three-step approach from bedside VHD suspicion to the initial treatment of the emergencies. The first step is the suspicion of underlying valvular condition based on signs and symptoms. The second step comprises the attempt to confirm the diagnosis and assessment of VHD severity with complementary tests. Finally, the third step addresses the diagnosis and treatment options for heart failure, atrial fibrillation, valvular thrombosis, acute rheumatic fever, and infective endocarditis. In addition, several images of complementary tests and summary tables are provided for physician support.
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Affiliation(s)
- Tarso Augusto Duenhas Accorsi
- Unidade de Pronto Atendimento , Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
- Instituto do Coração (InCor), Faculdade de Medicina , USP , São Paulo , SP - Brasil
| | - Milena Ribeiro Paixão
- Unidade de Pronto Atendimento , Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
- Instituto do Coração (InCor), Faculdade de Medicina , USP , São Paulo , SP - Brasil
| | | | | | - Ricardo Galesso Cardoso
- Unidade de Pronto Atendimento , Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
| | - Karen Francine Köhler
- Unidade de Pronto Atendimento , Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
| | - Karine De Amicis Lima
- Unidade de Pronto Atendimento , Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
| | - Flavio Tarasoutchi
- Instituto do Coração (InCor), Faculdade de Medicina , USP , São Paulo , SP - Brasil
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224
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Kochan A, Lee T, Moghaddam N, Milley G, Singer J, Cairns JA, Wong GC, Jentzer JC, van Diepen S, Alviar C, Fordyce CB. Reperfusion Delays and Outcomes Among Patients With ST-Segment-Elevation Myocardial Infarction With and Without Cardiogenic Shock. Circ Cardiovasc Interv 2023; 16:e012810. [PMID: 37339233 DOI: 10.1161/circinterventions.122.012810] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/18/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Mortality remains high in patients with ST-segment-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS), and early reperfusion has been shown to improve outcomes. We analyzed the association between first medical contact (FMC)-to-percutaneous coronary angiography time with mortality and major adverse cardiovascular events among patients with STEMI with and without CS. METHODS We performed a retrospective analysis of the Vancouver Coastal Health Authority STEMI registry, including all patients with STEMI who received primary percutaneous coronary angiography between January 1, 2010, and December 31, 2020, and stratified them by presence or absence of CS at hospital arrival. The primary outcome was in-hospital mortality, the secondary outcome was in-hospital major adverse cardiovascular events, defined as a composite of the first occurrence of mortality, cardiac arrest, heart failure, intracerebral hemorrhage, cerebrovascular accident, or reinfarction. Mixed effects logistic regression with restricted cubic splines was used to estimate the relationships between FMC-to-device time and the outcomes in the CS and non-CS groups. RESULTS 2929 patients were included, 9.4% (n=275) had CS. Median FMC-to-device time was 113.5 (interquartile range, 93.0-145.0) and 103.0 (interquartile range, 85.0-130.0) minutes for patients with CS and without CS, respectively. More patients with CS had FMC-to-device times above guideline recommendations (76.6% versus 54.1%, P<0.001). Between 60 and 90 minutes, for each 10-minute increase in FMC-to-device time, absolute mortality for patients with CS increased by 4% to 7%, whereas for patients without CS, it increased by <0.5%. CONCLUSIONS Among patients with STEMI undergoing primary percutaneous coronary angiography, reperfusion delays among patients with CS are associated with significantly worse outcomes. Strategies to reduce FMC-to-device times for patients with STEMI presenting with CS are required.
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Affiliation(s)
- Andrew Kochan
- Division of Cardiology, Department of Medicine (A.K., J.A.C., G.C.W., C.B.F.), University of British Columbia, Vancouver, Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L., J.S.), University of British Columbia, Vancouver, Canada
| | - Nima Moghaddam
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC (N.M.)
| | - Grace Milley
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC (N.M.)
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L., J.S.), University of British Columbia, Vancouver, Canada
| | - John A Cairns
- Division of Cardiology, Department of Medicine (A.K., J.A.C., G.C.W., C.B.F.), University of British Columbia, Vancouver, Canada
| | - Graham C Wong
- Division of Cardiology, Department of Medicine (A.K., J.A.C., G.C.W., C.B.F.), University of British Columbia, Vancouver, Canada
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (J.C.J.)
| | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Canada (S.v.D.)
| | - Carlos Alviar
- The Leon H. Charney Division of Cardiovascular Medicine, New York University Grossman School of Medicine, NY (C.A.)
| | - Christopher B Fordyce
- Division of Cardiology, Department of Medicine (A.K., J.A.C., G.C.W., C.B.F.), University of British Columbia, Vancouver, Canada
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225
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Ayalon N, Jacobs AK. Enhancing Regional ST-Segment-Elevation Myocardial Infarction Care: A Shock to the System. Circ Cardiovasc Interv 2023; 16:e013177. [PMID: 37339238 DOI: 10.1161/circinterventions.123.013177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Nir Ayalon
- Evans Department of Medicine, Section of Cardiology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, MA
| | - Alice K Jacobs
- Evans Department of Medicine, Section of Cardiology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, MA
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226
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Wei D, Sun Y, Chen R, Meng Y, Wu W. Age‑adjusted Charlson comorbidity index and in‑hospital mortality in critically ill patients with cardiogenic shock: A retrospective cohort study. Exp Ther Med 2023; 25:299. [PMID: 37229315 PMCID: PMC10203756 DOI: 10.3892/etm.2023.11998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/13/2023] [Indexed: 05/27/2023] Open
Abstract
Evidence regarding the relationship between age-adjusted Charlson comorbidity index (ACCI) and in-hospital mortality is limited. Therefore, the present study investigated whether there was an independent association between ACCI and in-hospital mortality in critically ill patients with cardiogenic shock (CS) after adjusting for other covariates (age, sex, history of disease, scoring system, in-hospital management, vital signs at presentation, laboratory findings and vasopressors). ACCI, calculated retrospectively after hospitalization between 2008 and 2019, was derived from intensive care unit (ICU) admissions at the Beth Israel Deaconess Medical Center (Boston, MA, USA). Patients with CS were classified into two categories based on predefined ACCI scores (low, <8; high, ≥8). Based on baseline ACCI, the risk of in-hospital mortality in patients with CS was calculated using a multivariate Cox proportional risk model, and the threshold effect was calculated using a two-piece linear regression model. The in-hospital mortality rate was ~1.5 times greater in the ACCI high group compared with that in the ACCI low group [hazard ratio (HR)=1.45; 95% confidence interval (CI), 1.14-1.86]. Additional analysis showed that ACCI had a curvilinear association with in-hospital mortality risk in patients with CS, with a saturation effect predicted at 4.5. When ACCI was >4.5, the risk of in-hospital CS death increased significantly with increasing ACCI (HR=1.122; 95% CI, 1.054-1.194). Overall, ACCI was an independent predictor of in-hospital mortality in ICU patients with CS. A non-linear relationship was revealed between ACCI and in-hospital mortality, where in-hospital mortality increased significantly when ACCI was >4.5.
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Affiliation(s)
- Dongmei Wei
- Department of Cardiovascular Medicine, Liuzhou Traditional Chinese Medical Hospital, Liuzhou, Guangxi Zhuang Autonomous Region 545001, P.R. China
- Department of Cardiovascular Medicine, Guangzhou University of Chinese Medicine First Affiliated Hospital, Guangzhou, Guangdong 510405, P.R. China
| | - Yang Sun
- Department of Cardiovascular Medicine, Guangxi University of Chinese Medicine, Nanning, Guangxi Zhuang Autonomous Region 530000, P.R. China
| | - Rongtao Chen
- Department of Cardiovascular Medicine, Guangxi University of Chinese Medicine, Nanning, Guangxi Zhuang Autonomous Region 530000, P.R. China
| | - Yuanting Meng
- Department of Cardiovascular Medicine, Guangxi University of Chinese Medicine, Nanning, Guangxi Zhuang Autonomous Region 530000, P.R. China
| | - Wei Wu
- Department of Cardiovascular Medicine, Guangzhou University of Chinese Medicine First Affiliated Hospital, Guangzhou, Guangdong 510405, P.R. China
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Scolari FL, Schneider D, Fogazzi DV, Gus M, Rover MM, Bonatto MG, de Araújo GN, Zimerman A, Sganzerla D, Goldraich LA, Teixeira C, Friedman G, Polanczyk CA, Rohde LE, Rosa RG, Wainstein RV. Reply to the letter "Understanding lactate and its clearance during extracorporeal membrane oxygenation for supporting refractory cardiogenic shock patients". BMC Cardiovasc Disord 2023; 23:250. [PMID: 37173648 PMCID: PMC10182605 DOI: 10.1186/s12872-023-03273-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023] Open
Abstract
This is a reply to the letter titled "Understanding lactate and its clearance during extracorporeal membrane oxygenation for supporting refractory cardiogenic shock patients" by Eva Rully Kurniawati et al. In response to the concerns raised about our paper published in BMC Cardiovascular Disorders, titled "Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study," we have addressed the confounding bias on the population included and the use of VA-ECMO and Impella CP. Furthermore, we have provided new data on the correlation of oxygen supply and lactate levels at admission of cardiogenic shock.
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Affiliation(s)
- Fernando Luís Scolari
- Research Projects Office, Division of Cardiology, Hospital Moinhos de Vento (HMV), Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 630, Porto Alegre, RS, 90035-001, Brazil.
| | - Daniel Schneider
- Research Projects Office, HMV, Rua Ramiro Barcelos 630, Porto Alegre, RS, 90035-001, Brazil
| | - Débora Vacaro Fogazzi
- Research Projects Office, HMV, Rua Ramiro Barcelos 630, Porto Alegre, RS, 90035-001, Brazil
| | - Miguel Gus
- Division of Cardiology, HMV, Rua Tiradentes, 333, Porto Alegre, RS, 90560-030, Brazil
| | - Marciane Maria Rover
- Division of Cardiology, Heart Failure and Transplant Division, HMV, Instituto de Cardiologia - Fundação Universitária de Cardiologia, Av. Princesa Isabel, 395, Porto Alegre, RS, 90040- 371, Brazil
| | - Marcely Gimenes Bonatto
- Cardiology Department, Transplant Division, Irmandade Hospital da Santa Casa de Misericórdia de Curitiba, Praça Rui Barbosa, 694, Curitiba, PR, 80010-030, Brazil
| | - Gustavo Neves de Araújo
- Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, Porto Alegre, RS, 2350, 90035-007, Brazil
| | - André Zimerman
- Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, Porto Alegre, RS, 2350, 90035-007, Brazil
| | - Daniel Sganzerla
- Research Projects Office, HMV, Rua Ramiro Barcelos 630, Porto Alegre, RS, 90035-001, Brazil
| | - Lívia Adams Goldraich
- Division of Cardiology, HCPA, Rua Ramiro Barcelos, Porto Alegre, Porto Alegre, 2350, 90035-007, RS, RS, Brazil
| | - Cassiano Teixeira
- Division of Critical Care Medicine, HMV, R. Tiradentes, 333, Porto Alegre, 90560-030, Brazil
| | - Gilberto Friedman
- Division of Critical Care Medicine, HCPA, Rua Ramiro Barcelos 630, Porto Alegre, 90035-001, Brazil
| | - Carisi Anne Polanczyk
- Division of Cardiology, HMV, HCPA, UFRGS, Associate Professor of Medicine, Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, UFRGS, R. Tiradentes, 333, Porto Alegre, 90560-030, Brazil
| | - Luis Eduardo Rohde
- Division of Cardiology, HMV, HCPA, UFRGS, Associate Professor of Medicine, Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, UFRGS, R. Tiradentes, 333, Porto Alegre, 90560-030, Brazil
| | - Regis Goulart Rosa
- Research Projects Office, HMV, Rua Ramiro Barcelos 630, Porto Alegre, RS, 90035-001, Brazil
| | - Rodrigo Vugman Wainstein
- Research Projects Office, Division of Cardiology, HMV, HCPA, Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, UFRGS, Rua Ramiro Barcelos 630, 10º andar, Porto Alegre, RS, 90035-004, Brazil
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228
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El Nasasra A, Hochadel M, Zahn R, Schneider A, Thiele H, Darius H, Behrens S, Schumacher B, Ince H, Zeymer U. Outcomes After Left Main Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock (from the German ALKK PCI Registry). Am J Cardiol 2023; 197:77-83. [PMID: 37173201 DOI: 10.1016/j.amjcard.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/05/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023]
Abstract
Early revascularization therapy with percutaneous coronary intervention (PCI) has been shown to improve outcomes in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Data from consecutive patients with AMI and CS treated with PCI enrolled into the prospective Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte-PCI registry were centrally collected and analyzed. Patients were divided into 4 groups with PCI for left main (LM), 1-vessel, 2-vessel, and 3-vessel diseases. Patients' characteristics, procedural features, antithrombotic therapies, and in-hospital complications were compared between the 4 groups. Between 2010 and 2015 a total of 2,348 consecutive patients with AMI and CS were treated by PCI in 51 hospitals, 295 for LM (15 for protected, 280 for unprotected) and single-vessel (n = 491), 2-vessel (n = 524), and 3-vessel disease (n = 1,038). Thrombolysis in myocardial infarction 3 patency of the culprit lesion after PCI was 84.3%, 84.0%, 80.8%, and 84.6% in single-vessel, 2-vessel, 3-vessel disease, and LM PCI, respectively, whereas in-hospital mortality was 27.9%, 33.9%, 46.5%, and 55.9%. Bleeding rates were low (2.0%-2.3 %) and not different between groups. In a multivariate analysis a higher age, thrombolysis in myocardial infarction flow <3 after PCI, 3-vessel disease, and LM PCI were independent predictors of mortality. In conclusion, PCI of the LM is performed in about 12.5% of patients with AMI and CS and was associated with a high procedural success rate, whereas mortality is increased with LM PCI.
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Affiliation(s)
- Aref El Nasasra
- Department of Cardiology, Klinikum Ludwigshafen, Ludwigshafen, Germany; Department of Cardiology, Soroka University Medical Center, Be'er Sheva, Israel.
| | - Mathias Hochadel
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Ralf Zahn
- Department of Cardiology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | | | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | | | | | | | - Uwe Zeymer
- Department of Cardiology, Klinikum Ludwigshafen, Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
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229
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Choi KH, Yang JH, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Ahn CM, Yu CW, Park IH, Jang WJ, Kim HJ, Bae JW, Kwon SU, Lee HJ, Lee WS, Jeong JO, Park SD, Kang TS, Gwon HC. Culprit-Only Versus Immediate Multivessel Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction Complicating Advanced Cardiogenic Shock Requiring Venoarterial-Extracorporeal Membrane Oxygenation. J Am Heart Assoc 2023; 12:e029792. [PMID: 37158104 DOI: 10.1161/jaha.123.029792] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Background Despite the benefit of culprit-only percutaneous coronary intervention (PCI) in the CULPRIT-SHOCK (Culprit Lesion Only PCI Versus Multi-vessel PCI in Cardiogenic Shock) trial, the optimal revascularization strategy for refractory cardiogenic shock (CS) requiring mechanical circulatory support devices remains controversial. This study aimed to compare clinical outcomes between the culprit-only and immediate multivessel PCI strategies in patients with acute myocardial infarction complicated by CS who underwent venoarterial-extracorporeal membrane oxygenation before revascularization. Methods and Results This study included patient-pooled data from the RESCUE (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Devices for Korean Patients With Cardiogenic Shock) and SMC-ECMO (Samsung Medical Center-Extracorporeal Membrane Oxygenation) registries. A total of 315 patients with acute myocardial infarction with multivessel disease who underwent venoarterial-extracorporeal membrane oxygenation before revascularization attributable to refractory CS were included in this analysis. The study population was classified into culprit-only versus immediate multivessel PCI according to nonculprit lesion treatment strategies. The primary end point was 30-day mortality or renal-replacement therapy, and the key secondary end point was 12-month follow-up mortality. Among the study population, 175 (55.6%) underwent culprit-only PCI and 140 (44.4%) underwent immediate multivessel PCI. Compared with culprit-only PCI, immediate multivessel PCI was associated with significantly lower risks of 30-day mortality or renal-replacement therapy (68.0% versus 54.3%; P=0.018) and all-cause mortality during 12 months of follow-up (59.5% versus 47.5%; hazard ratio [HR], 0.689 [95% CI, 0.506-0.939]; P=0.018) in patients with acute myocardial infarction and CS who underwent venoarterial-extracorporeal membrane oxygenation before revascularization. These results were also consistent in the 99 pairs of propensity score-matched population (60.6% versus 43.6%; HR, 0.622 [95% CI, 0.420-0.922]; P=0.018). Conclusions Among patients with acute myocardial infarction with multivessel disease complicated by advanced CS requiring venoarterial-extracorporeal membrane oxygenation before revascularization, immediate multivessel PCI was associated with lower incidences of 30-day mortality or renal replacement therapy and 12-month follow-up mortality, compared with culprit-only PCI. Registration Information clinicaltrials.gov. Identifier: NCT02985008.
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital Yonsei University College of Medicine Seoul South Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine Korea University Anam Hospital Seoul Republic of Korea
| | - Ik Hyun Park
- Department of Cardiology Samsung Changwon Hospital, Sungkyunkwan University School of Medicine Changwon South Korea
| | - Woo Jin Jang
- Department of Cardiology Ewha Woman's University Seoul Hospital, Ehwa Woman's University School of Medicine Seoul Republic of Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Medicine Konkuk University Medical Center Seoul South Korea
| | - Jang-Whan Bae
- Department of Internal Medicine Chungbuk National University College of Medicine Cheongju South Korea
| | - Sung Uk Kwon
- Division of Cardiology, Department of Internal Medicine Ilsan Paik Hospital, University of Inje College of Medicine Seoul South Korea
| | - Hyun-Jong Lee
- Division of Cardiology, Department of Medicine Sejong General Hospital Bucheon South Korea
| | - Wang Soo Lee
- Division of Cardiology, Department of Medicine Chung-Ang University Hospital Seoul South Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine Chungnam National University Hospital Daejeon Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Department of Medicine Inha University Hospital Incheon South Korea
| | - Tae-Soo Kang
- Division of Cardiovascular Medicine, Department of Internal Medicine Dankook University Hospital, Dankook University College of Medicine Cheonan South Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
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George TJ, Sheasby J, DiMaio JM, Kabra N, Rawitscher DA, Afzal A. Outcomes of surgical Impella placement in acute cardiogenic shock. Proc AMIA Symp 2023; 36:415-421. [PMID: 37334083 PMCID: PMC10269385 DOI: 10.1080/08998280.2023.2205817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Although a role for percutaneous Impella devices has been established, there is a paucity of data regarding the utility and outcomes of larger surgically implanted Impella devices. Methods We conducted a retrospective review of all surgical Impella implants at our institution. All Impella 5.0 and Impella 5.5 devices were included. The primary outcome was survival. Secondary outcomes included hemodynamic and end-organ perfusion as well as commonly encountered surgical complications. Results From 2012 to 2022, 90 surgical Impella devices were implanted. The median age was 63 [53-70] years, the mean creatinine was 2.07 ± 1.22 mg/dL, and the average lactate level was 3.32 ± 2.90 mmol/L. Prior to implantation, 47 patients (52%) were supported with vasoactive agents, while 43 (48%) were also supported with another device. The most common etiology of shock was acute on chronic heart failure (50, 56%), followed by acute myocardial infarction (22, 24%), and postcardiotomy (17, 19%). Overall, 69 patients (77%) survived to device removal, and 57 (65%) survived to hospital discharge. One-year survival was 54%. Neither etiology of heart failure nor device strategy was associated with 30-day or 1-year survival. On multivariable modeling, the number of vasoactive medications prior to device implantation was strongly associated with 30-day mortality (hazard ratio 1.94 [1.27-2.96], P < 0.01). Surgical Impella placement was associated with a significant decreased need for vasoactive infusions (P < 0.01) and decreased acidosis (P = 0.01). Conclusions Surgical Impella support for patients in acute cardiogenic shock is associated with lower vasoactive medication use, improved hemodynamics, increased end-organ perfusion, and acceptable morbidity and mortality.
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Affiliation(s)
- Timothy J. George
- Department of Advanced Heart Failure and Mechanical Circulatory Support, Baylor Scott & White The Heart Hospital – Plano, Plano, Texas
| | - Jenelle Sheasby
- Department of Advanced Heart Failure and Mechanical Circulatory Support, Baylor Scott & White The Heart Hospital – Plano, Plano, Texas
| | - J. Michael DiMaio
- Department of Advanced Heart Failure and Mechanical Circulatory Support, Baylor Scott & White The Heart Hospital – Plano, Plano, Texas
| | - Nitin Kabra
- Department of Advanced Heart Failure and Mechanical Circulatory Support, Baylor Scott & White The Heart Hospital – Plano, Plano, Texas
| | - David A. Rawitscher
- Department of Advanced Heart Failure and Mechanical Circulatory Support, Baylor Scott & White The Heart Hospital – Plano, Plano, Texas
| | - Aasim Afzal
- Department of Advanced Heart Failure and Mechanical Circulatory Support, Baylor Scott & White The Heart Hospital – Plano, Plano, Texas
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231
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Sinha SS, Pahuja M, Kataria R, Blumer V, Hernandez-Montfort J, Kanwar M, Garan AR, Zhang Y, Marbach JA, Khalif A, Vallabhajosyula S, Nathan S, Abraham J, Li B, Thayer KL, Baca P, Dieng F, Harwani NM, Yin MY, Faugno AJ, Faraz HA, Guglin M, Hickey GW, Wencker D, Hall S, Schwartzman AD, Khalife W, Li S, Mahr C, Kim JH, Bhimaraj A, Ton VK, Vorovich E, Burkhoff D, Kapur NK. Treatment Intensity for the Management of Cardiogenic Shock: Comparison Between STEMI and Non-STEMI. JACC. ADVANCES 2023; 2:100314. [PMID: 38939594 PMCID: PMC11198573 DOI: 10.1016/j.jacadv.2023.100314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/01/2023] [Indexed: 06/29/2024]
Abstract
Background Cardiogenic shock is a leading cause of mortality in patients with acute myocardial infarction. Objectives The authors sought to compare clinical characteristics, hospital trajectory, and drug and device use between patients with ST-segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) and those without (non-ST-segment elevation myocardial infarction complicated by cardiogenic shock [NSTEMI-CS]). Methods We analyzed data from 1,110 adult admissions with cardiogenic shock complicating acute myocardial infarction (AMI-CS) across 17 centers within Cardiogenic Shock Working Group. The primary end point was in-hospital mortality. Results Our study included 1,110 patients with AMI-CS, of which 731 (65.8%) had STEMI-CS and 379 (34.2%) had NSTEMI-CS. Most patients were male (STEMI-CS: 71.6%, NSTEMI-CS: 66.5%) and White (STEMI-CS: 53.8%, NSTEMI-CS: 64.1%). In-hospital mortality was 41% and was similar among patients with STEMI-CS and NSTEMI-CS (43% vs 39%, P = 0.23). Patients with out-of-hospital cardiac arrest had higher in-hospital mortality in patients with NSTEMI-CS (63% vs 36%, P = 0.006) as compared to patients with STEMI-CS (52% vs 41%, P = 0.16). Similar results were observed for in-hospital cardiac arrest in patients with STEMI-CS (63% vs 33%, P < 0.001) and NSTEMI-CS (60% vs 32%, P < 0.001). Only 27% of patients with STEMI-CS and 12% of NSTEMI-CS received both a drug and temporary mechanical circulatory support device during the first 24 hours, which increased to 78% and 61%, respectively, throughout the course of the hospitalization (P < 0.001 for both). Conclusions Despite increasing use of inotropic and vasoactive support and mechanical circulatory support throughout the hospitalization, both patients with STEMI-CS and NSTEMI-CS remain at increased risk for in-hospital mortality. Randomized controls trials are needed to elucidate whether timing and sequence of escalation of support improves outcomes in patients with AMI-CS.
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Affiliation(s)
- Shashank S. Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Mohit Pahuja
- University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Rachna Kataria
- Brown University, Lifespan Cardiovascular Center, Providence, Rhode Island, USA
| | - Vanessa Blumer
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Manreet Kanwar
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - A. Reshad Garan
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Yijing Zhang
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Adnan Khalif
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | | | | | - Jacob Abraham
- Providence Heart Institute, Center for Cardiovascular Analytics, Research, and Data Science (CARDS), Providence St. Joseph Health, Portland, Oregon, USA
| | - Borui Li
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Paulina Baca
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Fatou Dieng
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Neil M. Harwani
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Michael Y. Yin
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Anthony J. Faugno
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Maya Guglin
- Indiana University Health Advanced Heart and Lung Care, Indianapolis, Indiana, USA
| | - Gavin W. Hickey
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Detlef Wencker
- Advanced Heart Disease Program, Baylor Scott & White Health, Temple, Texas, USA
| | - Shelley Hall
- Baylor Scott & White Advanced Heart Failure Clinic, Dallas, Texas, USA
| | | | - Wissam Khalife
- University of Texas Medical Branch, Galveston, Texas, USA
| | - Song Li
- University of Washington Medical Center, Seattle, Washington, USA
| | - Claudius Mahr
- University of Washington Medical Center, Seattle, Washington, USA
| | - Ju H. Kim
- Houston Methodist Research Institute, Houston, Texas, USA
| | | | | | | | | | - Navin K. Kapur
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
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Mijares-Rojas IA, Trujillo LG, Lecompte-Osorio PA, Martinez Trevino EF, Munagala M. Aortic Dissection From an Intra-aortic Balloon Pump: A Dangerous Complication to Keep in Mind. Cureus 2023; 15:e39122. [PMID: 37332456 PMCID: PMC10273174 DOI: 10.7759/cureus.39122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
Despite the benefits of the intra-aortic balloon pump (IABP) being a subject of debate, it remains a widely available and easy-to-use mechanical circulatory support device. Nonetheless, its use is not exempt from complications. Aortic dissection from IABP is an infrequent but deathly complication. We describe a case in which early recognition of the condition led to control through an endovascular approach. A 57-year-old male was admitted for acute decompensated heart failure requiring intravenous inotropic agents. While undergoing assessment for a heart transplant, he developed cardiogenic shock requiring initiation of mechanical circulatory support with an IABP. A few hours after device implantation, the patient developed acute tearing chest pain and was found to have an acute dissection in the descending thoracic aorta. Prompt liaison with the endovascular team led to a thoracic endovascular aortic repair to control the extent of the lesion.
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Affiliation(s)
- Ivan A Mijares-Rojas
- Internal Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | - Luis G Trujillo
- Internal Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | - Paola A Lecompte-Osorio
- Internal Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
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Arrigo M, Blet A, Morley-Smith A, Aissaoui N, Baran DA, Bayes-Genis A, Chioncel O, Desch S, Karakas M, Moller JE, Poess J, Price S, Zeymer U, Mebazaa A. Current and future trial design in refractory cardiogenic shock. Eur J Heart Fail 2023; 25:609-615. [PMID: 36987926 DOI: 10.1002/ejhf.2838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/23/2023] [Accepted: 03/26/2023] [Indexed: 03/30/2023] Open
Affiliation(s)
- Mattia Arrigo
- Department of Internal Medicine, Stadtspital Zurich Triemli, Zurich, Switzerland
| | - Alice Blet
- Department of Anesthesia and Intensive Care, Croix-Rousse Hospital, North Hospital Group, Hospices Civils de Lyon and CRCL, UMRS Inserm 1052/CNRS 5286, University Claude Bernard Lyon 1, Centre Léon Bérard, Lyon, France
| | - Andrew Morley-Smith
- Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nadia Aissaoui
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris, Hôpital Cochin, AP-HP and Université de Paris, After-ROSC Network, INSERM U970, Paris, France
| | - David A Baran
- Section of Heart Failure, Transplant and MCS, Cleveland Clinic Heart Vascular and Thoracic Institute, Weston, FL, USA
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, CIBERCV, Universitat Autonoma, Barcelona, Spain
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases "Prof. C.C. Iliescu", and University of Medicine Carol Davila, Bucharest, Romania
| | - Steffen Desch
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Mahir Karakas
- Department of Intensive Care Medicine, University Medical Center, Hamburg Eppendorf, Hamburg, Germany
| | - Jacob Eifer Moller
- Department of Cardiology, Heart Center, Copenhagen University Hospital Rigshospitalet and Department of Cardiology, Odense University Hospital, Denmark
| | - Janine Poess
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Susanna Price
- Royal Brompton & Harefield Hospitals, National Heart & Lung Institute, Imperial College, London, UK
| | - Uwe Zeymer
- Klinikum Ludwigshafen und Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care Medicine, AP-HP, St. Louis and Lariboisière University Hospitals and INSERM UMR-S 942, MASCOT, Université de Paris, Paris, France
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234
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Cheewatanakornkul S, Duangpakdee P, Khwannimit B, Bhurayanontachai R, Geater SL, Geater AF. Validation of the prognostic scoring system for in -hospital mortality prediction in cardiogenic shock patients requiring veno -arterial extracorporeal membrane oxygenation. Asian Cardiovasc Thorac Ann 2023; 31:321-331. [PMID: 37036252 DOI: 10.1177/02184923231167302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND A few prognostic scoring systems have been developed for predicting mortality in patients with cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO), albeit with variations in performance. This study aimed to assess and compare various mortality prediction models in a cohort of patients receiving VA-ECMO following cardiogenic shock or arrest. METHODS We retrospectively analyzed 77 patients with cardiogenic shock who were placed on VA-ECMO support between March 2014 and August 2021. The APACHE II, SAPS II, SAVE, Modified SAVE, ENCOURAGE, and ECMO-ACCEPTS scores were calculated for each patient to predict the in-hospital mortality. RESULTS Fifty-six (72.7%) patients died. All prediction model scores, except the ECMO-ACCEPTS, differed significantly between non-survivors and survivors as follows: ENCOURAGE, 23 versus 16 (p < 0.001); SAVE, -6 versus -3 (p = 0.008); Modified SAVE, -5 versus 0 (p = 0.005); APACHE II, 32 versus 22 (p = 0.009); and SAPS II, 67 versus 49 (p = 0.002). The ENCOURAGE score demonstrated the best discriminatory ability with an area under the receiver-operating characteristic curve of 0.81 (95% confidence interval: 0.7-0.81). All prognostic scoring systems possessed limited calibration ability. However, the SAPS II, SAVE, and ENCOURAGE scores had lower Akaike and Bayesian information criteria values, which were consistent with the results of the Hosmer-Lemeshow C statistic test, indicating better performance than the other scores. CONCLUSIONS The ENCOURAGE score can help predict in-hospital mortality in all subsets of VA-ECMO patients, even though it was originally designed to predict intensive care unit mortality in the post-acute myocardial infarction setting.
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Affiliation(s)
- Sirichai Cheewatanakornkul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Pongsanae Duangpakdee
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Bodin Khwannimit
- Division of Critical Care, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Rungsun Bhurayanontachai
- Division of Critical Care, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Sarayut Lucien Geater
- Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Alan Frederick Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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235
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Milne B, Dalzell J, Kunst G. Management of cardiogenic shock after acute coronary syndromes. BJA Educ 2023; 23:172-181. [PMID: 37124173 PMCID: PMC10140595 DOI: 10.1016/j.bjae.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 01/27/2023] [Indexed: 03/29/2023] Open
Affiliation(s)
- B. Milne
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - G. Kunst
- King's College Hospital NHS Foundation Trust, London, UK
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236
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Hamzaoui O, Boissier F. Hemodynamic monitoring in cardiogenic shock. JOURNAL OF INTENSIVE MEDICINE 2023; 3:104-113. [PMID: 37188114 PMCID: PMC10175734 DOI: 10.1016/j.jointm.2022.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/09/2022] [Accepted: 10/19/2022] [Indexed: 05/17/2023]
Abstract
Cardiogenic shock (CS) is a life-threatening condition characterized by acute end-organ hypoperfusion due to inadequate cardiac output that can result in multiorgan failure, which may lead to death. The diminished cardiac output in CS leads to systemic hypoperfusion and maladaptive cycles of ischemia, inflammation, vasoconstriction, and volume overload. Obviously, the optimal management of CS needs to be readjusted in view of the predominant dysfunction, which may be guided by hemodynamic monitoring. Hemodynamic monitoring enables (1) characterization of the type of cardiac dysfunction and the degree of its severity, (2) very early detection of associated vasoplegia, (3) detection and monitoring of organ dysfunction and tissue oxygenation, and (4) guidance of the introduction and optimization of inotropes and vasopressors as well as the timing of mechanical support. It is now well documented that early recognition, classification, and precise phenotyping via early hemodynamic monitoring (e.g., echocardiography, invasive arterial pressure, and the evaluation of organ dysfunction and parameters derived from central venous catheterization) improve patient outcomes. In more severe disease, advanced hemodynamic monitoring with pulmonary artery catheterization and the use of transpulmonary thermodilution devices is useful to facilitate the right timing of the indication, weaning from mechanical cardiac support, and guidance on inotropic treatments, thus helping to reduce mortality. In this review, we detail the different parameters relevant to each monitoring approach and the way they can be used to support optimal management of these patients.
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Affiliation(s)
- Olfa Hamzaoui
- Service de Médecine Intensive Réanimation, Hôpital Robert Debré, Université de Reims, Reims 51092, France
- Unité HERVI, Hémostase et Remodelage Vasculaire Post-Ischémie, EA 3801, Reims 51092, France
| | - Florence Boissier
- Médecine Intensive Réanimation, Hôpital Universitaire de Poitiers, Poitiers 90577, France
- INSERM CIC 1402 (ALIVE Group), Université de Poitiers, Poitiers 90577, France
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237
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Eftychiou S, Kalakoutas A, Proudfoot A. The role of temporary mechanical circulatory support in de novo heart failure syndromes with cardiogenic shock: A contemporary review. JOURNAL OF INTENSIVE MEDICINE 2023; 3:89-103. [PMID: 37188124 PMCID: PMC10175707 DOI: 10.1016/j.jointm.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 05/17/2023]
Abstract
Cardiogenic shock (CS) is a complex clinical syndrome with a high mortality rate. It can occur to due to multiple etiologies of cardiovascular disease and is phenotypically heterogeneous. Acute myocardial infarction-related CS (AMI-CS) has historically been the most prevalent cause, and thus, research and guidance have focused primarily on this. Recent data suggest that the burden of non-ischemic CS is increasing in the population of patents requiring intensive care admission. There is, however, a paucity of data and guidelines to inform the management of these patients who fall into two broad groups: those with existing heart failure and CS and those with no known history of heart failure who present with "de novo" CS. The use of temporary mechanical circulatory support (MCS) has expanded across all etiologies, despite its high cost, resource intensity, complication rates, and lack of high-quality outcome data. Herein, we discuss the currently available evidence on the role of MCS in the management of patients with de novo CS to include fulminant myocarditis, right ventricular (RV) failure, Takotsubo syndrome, post-partum cardiomyopathy, and CS due to valve lesions and other cardiomyopathies.
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Affiliation(s)
| | - Antonis Kalakoutas
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0AG, UK
- Barts and the London School of Medicine and Dentistry, London E1 2AD, UK
| | - Alastair Proudfoot
- Department of Perioperative Medicine, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK
- Queen Mary University of London, London EC1M 6BQ, UK
- Department of Anaesthesiology and Intensive Care, German Heart Centre Berlin, Berlin 13353, Germany
- Corresponding author: Alastair Proudfoot, Department of Perioperative Medicine, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK
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238
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Bottiroli M, Calini A, Morici N, Tavazzi G, Galimberti L, Facciorusso C, Ammirati E, Russo C, Montoli A, Mondino M. Acute kidney injury in patients with acute decompensated heart failure-cardiogenic shock: Prevalence, risk factors and outcome. Int J Cardiol 2023:S0167-5273(23)00612-5. [PMID: 37119942 DOI: 10.1016/j.ijcard.2023.04.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Acute Kidney Injury (AKI) represents a major complication of acute heart failure and cardiogenic shock (CS). There is a paucity of data on AKI complicating acutely decompensated heart failure patients presenting with CS (ADHF-CS). We aimed to investigate AKI prevalence, risk factors and outcomes in this subgroup of patients. METHODS Retrospective observational study on patients admitted for ADHF-CS to our 12-bed Intensive Care Unit (ICU), between January 2010 and December 2019. Demographic, clinical, and biochemical variables were collected at baseline and during hospital stay. RESULTS Eighty-eight patients were consecutively recruited. The predominant etiologies were idiopathic dilated cardiomyopathy (47%), followed by post-ischemic (24%). AKI was diagnosed in 70 (79.5%) of patients. Forty-three out of 70 patients met the criteria for AKI at ICU admission. On multivariate analysis, a central venous pressure (CVP) higher than 10 mmHg (OR 3.9; 95%CI 1.2-12.6; p = 0.025) and serum lactate higher than 3 mmol/L (OR 4.1; 95%CI 1.01-16.3; p = 0.048) were identified to be independently associated with AKI. Age and AKI stage were independent predictors of 90-day mortality. CONCLUSION AKI is a common and early complication of ADHF-CS. Venous congestion and severe hypoperfusion are risk factors for AKI development. Early detection and prevention of AKI could lead to better outcome in this clinical subgroup.
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Affiliation(s)
- Maurizio Bottiroli
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Angelo Calini
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nuccia Morici
- Cardio-Respiratory Department, IRCCS Don Carlo Gnocchi Foundation, Milan, Italy
| | - Guido Tavazzi
- Department of Anesthesia, Critical Care and Pain Medicine, San Matteo Hospital, Pavia University, Pavia, Italy
| | | | - Clorinda Facciorusso
- Anesthesia and Critical Care Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Enrico Ammirati
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Claudio Russo
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alberto Montoli
- Nephrology, Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michele Mondino
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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239
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Arafat AA, Almedimigh AA, Algarni KD, Ismail HH, Pragliola C, Adam AI, AlBarrak M, Osman A, Albabtain MA, Tantawy TM. Concomitant intra-aortic balloon pump and veno-arterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock. Int J Artif Organs 2023:3913988231170890. [PMID: 37125784 DOI: 10.1177/03913988231170890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We aimed to compare the outcomes of ECMO with and without IABP for postcardiotomy cardiogenic shock. The study included 103 patients who needed ECMO for postcardiotomy cardiogenic shock. Patients were grouped according to the use of IABP into ECMO without IABP (n = 43) and ECMO with IABP (n = 60). The study endpoints were hospital complications, successful weaning, and survival. Patients with IABP had lower preoperative ejection fraction (p = 0.002). There was no difference in stroke (p = 0.97), limb ischemic (p = 0.32), and duration of ICU stay (p = 0.11) between groups. Successful weaning was non-significantly higher with IABP (36 (60%) vs 19 (44.19%); p = 0.11). Predictors of successful weaning were inversely related to the high pre-ECMO lactate levels (OR: 0.89; p = 0.01), active endocarditis (OR: 0.06; p = 0.02), older age (OR: 0.95; p = 0.02), and aortic valve replacement (OR: 0.26; p = 0.04). There was no difference in survival between groups (p = 0.80). Our study did not support the routine use of IABP during ECMO support.
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Affiliation(s)
- Amr A Arafat
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | | | - Khaled D Algarni
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Huda H Ismail
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Claudio Pragliola
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Adam I Adam
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Mohammed AlBarrak
- Intensive Care Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Ahmed Osman
- Intensive Care Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Intensive Care Department, Cairo University, Cairo, Egypt
| | - Monirah A Albabtain
- Cardiology Clinical Pharmacy Department, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
| | - Tarek M Tantawy
- Intensive Care Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Intensive Care Department, Cairo University, Cairo, Egypt
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240
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Parlow S, Santo PD, Sterling LH, Goodliffe L, Motazedian P, Prosperi-Porta G, Morgan B, Koopman Z, Jung RG, Lepage-Ratte MF, Robinson L, Feagan H, Simard T, Wells GA, Kyeremanteng K, Ainsworth C, Amin F, Marbach JA, Fernando SM, Labinaz M, Belley-Cote EP, Hibbert B, Mathew R. Inotrope versus Placebo Therapy in Cardiogenic Shock: Rationale and Study Design of the CAPITAL DOREMI2 Trial. Am Heart J 2023; 262:83-89. [PMID: 37094667 DOI: 10.1016/j.ahj.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Cardiogenic shock (CS) is a state of end-organ hypoperfusion related to cardiac dysfunction. Current guidelines recommend consideration of inotrope therapy in patients with CS, however no robust data support their use. The purpose of the CAPITAL DOREMI2 trial is to examine the efficacy and safety of inotrope therapy against placebo in the initial resuscitation of patients with CS. METHODS AND DESIGN This is a multi-center, double-blind, randomized, placebo-controlled trial comparing single-agent inotrope therapy to placebo in patients with CS. A total of 346 participants with Society for Cardiovascular Angiography and Interventions class C or D CS will be randomized in a 1:1 fashion to inotrope or placebo therapy, which will be administered over a 12-hour period. After this period, participants will continue open-label therapies at the discretion of the treating team. The primary outcome is a composite of all-cause in-hospital death, and, as measured during the 12-hour intervention period, any of: sustained hypotension or high dose vasopressor requirements, lactate greater than 3.5 mmol/L at 6 hours or thereafter, need for mechanical circulatory support, arrhythmia leading to emergent electrical cardioversion, and resuscitated cardiac arrest. All participants will be followed for the duration of their hospitalization, and secondary outcomes will be assessed at the time of discharge. IMPLICATION This trial will be the first to establish the safety and efficacy of inotrope therapy against placebo in a population of patients with CS and has the potential to alter the standard care provided to this group of patients.
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Affiliation(s)
- Simon Parlow
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Critical Care Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Lee H Sterling
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Laura Goodliffe
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Pouya Motazedian
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Graeme Prosperi-Porta
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Baylie Morgan
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Zandra Koopman
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Melissa Fay Lepage-Ratte
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa Robinson
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hannah Feagan
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Craig Ainsworth
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Faizan Amin
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey A Marbach
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Shannon M Fernando
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, Ontario, Canada
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Emilie P Belley-Cote
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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241
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Giordani AS, Baritussio A, Vicenzetto C, Peloso-Cattini MG, Pontara E, Bison E, Fraccaro C, Basso C, Iliceto S, Marcolongo R, Caforio ALP. Fulminant Myocarditis: When One Size Does Not Fit All - A Critical Review of the Literature. Eur Cardiol 2023; 18:e15. [PMID: 37405349 PMCID: PMC10316338 DOI: 10.15420/ecr.2022.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/12/2022] [Indexed: 07/06/2023] Open
Abstract
Fulminant myocarditis, rather than being a distinct form of myocarditis, is instead a peculiar clinical presentation of the disease. The definition of fulminant myocarditis has varied greatly in the last 20 years, leading to conflicting reports on prognosis and treatment strategies, mainly because of varied inclusion criteria in different studies. The main conclusion of this review is that fulminant myocarditis may be due to different histotypes and aetiologies that can be diagnosed only by endomyocardial biopsy and managed by aetiology-directed treatment. This life-threatening presentation requires rapid, targeted management both in the short term (mechanical circulatory support, inotropic and antiarrhythmic treatment and endomyocardial biopsy) and in the long term (including prolonged follow-up). Fulminant presentation has also recently been identified as a risk factor for worsened prognosis, even long after the resolution of the acute phase of myocarditis.
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Affiliation(s)
- Andrea Silvio Giordani
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Anna Baritussio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Cristina Vicenzetto
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Maria Grazia Peloso-Cattini
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Elena Pontara
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Elisa Bison
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Chiara Fraccaro
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Sabino Iliceto
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Renzo Marcolongo
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Alida Linda Patrizia Caforio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
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242
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Ezad SM, Ryan M, Donker DW, Pappalardo F, Barrett N, Camporota L, Price S, Kapur NK, Perera D. Unloading the Left Ventricle in Venoarterial ECMO: In Whom, When, and How? Circulation 2023; 147:1237-1250. [PMID: 37068133 PMCID: PMC10217772 DOI: 10.1161/circulationaha.122.062371] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/20/2023] [Indexed: 04/19/2023]
Abstract
Venoarterial extracorporeal membrane oxygenation provides cardiorespiratory support to patients in cardiogenic shock. This comes at the cost of increased left ventricle (LV) afterload that can be partly ascribed to retrograde aortic flow, causing LV distension, and leads to complications including cardiac thrombi, arrhythmias, and pulmonary edema. LV unloading can be achieved by using an additional circulatory support device to mitigate the adverse effects of mechanical overload that may increase the likelihood of myocardial recovery. Observational data suggest that these strategies may improve outcomes, but in whom, when, and how LV unloading should be employed is unclear; all techniques require balancing presumed benefits against known risks of device-related complications. This review summarizes the current evidence related to LV unloading with venoarterial extracorporeal membrane oxygenation.
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Affiliation(s)
- Saad M Ezad
- British Heart Foundation Centre of Research Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, London, UK
| | - Matthew Ryan
- British Heart Foundation Centre of Research Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, London, UK
| | - Dirk W Donker
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Cardiovascular & Respiratory Physiology (CRPH), University of Twente, Enschede, The Netherlands
| | - Federico Pappalardo
- Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Nicholas Barrett
- Department of Critical Care Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Luigi Camporota
- Department of Critical Care Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Susanna Price
- Departments of Critical Care & Cardiology, Royal Brompton & Harefield Hospitals, London, UK
- National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Divaka Perera
- British Heart Foundation Centre of Research Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, London, UK
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243
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Hill KL, Rustin MA, Asche MA, Bennett CE, Patel PC, Jentzer JC. Cardiogenic Shock Classification and Associated Mortality Risk. Mayo Clin Proc 2023; 98:771-783. [PMID: 37028976 DOI: 10.1016/j.mayocp.2022.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/30/2022] [Accepted: 12/16/2022] [Indexed: 04/09/2023]
Abstract
The Society for Cardiovascular Angiography and Interventions (SCAI) Shock Classification was developed to create standardized language describing the severity of cardiogenic shock (CS). The purposes of this review were to evaluate short-term and long-term mortality rates at each SCAI shock stage for patients with or at risk for CS, which has not been studied previously, and to propose using the SCAI Shock Classification to develop algorithms for clinical status monitoring. A detailed literature search was conducted for articles published from 2019 through 2022 in which the SCAI shock stages were used to assess the mortality risk. In total, 30 articles were reviewed. The SCAI Shock Classification at hospital admission revealed a consistent and reproducible graded association between shock severity and mortality risk. Furthermore, shock severity correlated incrementally with mortality risk even after patients were stratified for diagnosis, treatment modalities, risk modifiers, shock phenotype, and underlying cause. The SCAI Shock Classification system can be used to evaluate mortality across populations of patients with or at risk for CS including those with different causes, shock phenotypes, and comorbid conditions. We propose an algorithm that uses clinical parameters incorporating the SCAI Shock Classification into the electronic health record to continually reassess and reclassify the presence and severity of CS across time throughout hospitalization. The algorithm has the potential to alert the care team and a CS team, leading to earlier recognition and stabilization of the patient, and may facilitate the use of treatment algorithms and prevent CS deterioration, leading to improved outcomes.
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Affiliation(s)
- Katherine L Hill
- Department of Nursing, Mayo Clinic, Rochester, MN; Doctor of Nursing Program, Winona State University, Winona, MN
| | - Mark A Rustin
- Department of Nursing, Mayo Clinic, Rochester, MN; Doctor of Nursing Program, Winona State University, Winona, MN
| | | | | | - Parag C Patel
- Division of Heart Failure and Transplant, Mayo Clinic, Jacksonville, FL
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
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Mehta S, Fried J, Nemeth S, Kurlansky P, Kaku Y, Melehy A, Char S, Masoumi A, Sayer G, Uriel N, Takeda K. Society for Cardiovascular Angiography and Interventions Shock Classification to Stratify Outcomes of Extracorporeal Membrane Oxygenation. ASAIO J 2023; 69:352-359. [PMID: 36730984 PMCID: PMC10065877 DOI: 10.1097/mat.0000000000001813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We applied the Society for Cardiovascular Angiography and Interventions (SCAI) schema to cardiogenic shock (CS) patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) to assess performance in this high acuity group of patients. Records of adult patients receiving VA-ECMO for CS at our institution from 01/2015 to 12/2019 were reviewed. Post-cardiotomy and noncardiogenic shock patients were excluded. A total of 245 patients were included, with a median age of 59 years [IQR: 48-67]; 159 (65%) were male. There were 34 (14%) patients in Stage C, 82 (33%) in D, and 129 (53%) in E. Of E patients, 88 (68%) were undergoing cardiopulmonary resuscitation. Median ECMO duration decreased with stage (C:7, D:6, E:4 days, P < 0.001). In-hospital mortality increased (C:35%, D:56%, E:71%, P < 0.001) and myocardial recovery decreased with stage (C:65%, D:35%, E:30%, P < 0.001). Acute kidney injury (C:35%, D:45%, E:54%, P = 0.045), acute liver failure (C:32%, D:66%, E:76%, P < 0.001), and infection (C:35%, D:28%, E:16%, P = 0.004) varied among groups. Multivariable analysis revealed age (HR=1.02), male sex (HR=0.62), and E classification (HR=2.69) as independently associated with 1-year mortality. Competing-risks regression identified D (SHR=0.53) and E classification (SHR=0.45) as inversely associated with myocardial recovery. In patients treated with VA-ECMO for CS, the SCAI classification provided robust risk stratification.
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Affiliation(s)
- Sanket Mehta
- Department of Surgery, Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, NY, USA
| | - Justin Fried
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Samantha Nemeth
- Center of Innovation and Outcomes Research, Department of Surgery, Columbia University, New York, NY, USA
| | - Paul Kurlansky
- Department of Surgery, Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, NY, USA
- Center of Innovation and Outcomes Research, Department of Surgery, Columbia University, New York, NY, USA
| | - Yuji Kaku
- Department of Surgery, Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, NY, USA
| | - Andrew Melehy
- Department of Surgery, Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, NY, USA
| | - Steven Char
- Department of Surgery, Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, NY, USA
| | - Amirali Masoumi
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Gabriel Sayer
- Center of Innovation and Outcomes Research, Department of Surgery, Columbia University, New York, NY, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Koji Takeda
- Department of Surgery, Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, NY, USA
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245
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Salter BS, Gross CR, Weiner MM, Dukkipati SR, Serrao GW, Moss N, Anyanwu AC, Burkhoff D, Lala A. Temporary mechanical circulatory support devices: practical considerations for all stakeholders. Nat Rev Cardiol 2023; 20:263-277. [PMID: 36357709 PMCID: PMC9649020 DOI: 10.1038/s41569-022-00796-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 11/12/2022]
Abstract
Originally intended for life-saving salvage therapy, the use of temporary mechanical circulatory support (MCS) devices has become increasingly widespread in a variety of clinical settings in the contemporary era. Their use as a short-term, prophylactic support vehicle has expanded to include procedures in the catheterization laboratory, electrophysiology suite, operating room and intensive care unit. Accordingly, MCS device design and technology continue to develop at a rapid pace. In this Review, we describe the functionality, indications, management and complications associated with temporary MCS, together with scenario-specific utilization, goal-directed development and bioengineering of future devices. We address various considerations for the use of temporary MCS devices in both prophylactic and rescue scenarios, with input from stakeholders from various cardiovascular specialties, including interventional and heart failure cardiology, electrophysiology, cardiothoracic anaesthesiology, critical care and cardiac surgery.
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Affiliation(s)
- Benjamin S Salter
- Department of Anaesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Caroline R Gross
- Department of Anaesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Menachem M Weiner
- Department of Anaesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gregory W Serrao
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, NY, USA
| | - Noah Moss
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, NY, USA
| | - Anelechi C Anyanwu
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Mount Sinai, New York, NY, USA
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246
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Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Heart Lung Transplant 2023; 42:e1-e64. [PMID: 36805198 DOI: 10.1016/j.healun.2022.10.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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247
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Gorder K, Young W, Kapur NK, Henry TD, Garcia S, Guddeti RR, Smith TD. Mechanical Circulatory Support in COVID-19. Heart Fail Clin 2023; 19:205-211. [PMID: 36863812 PMCID: PMC9973539 DOI: 10.1016/j.hfc.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Despite aggressive care, patients with cardiopulmonary failure and COVID-19 experience unacceptably high mortality rates. The use of mechanical circulatory support devices in this population offers potential benefits but confers significant morbidity and novel challenges for the clinician. Thoughtful application of this complex technology is of the utmost importance and should be done in a multidisciplinary fashion by teams familiar with mechanical support devices and aware of the particular challenges provided by this complex patient population.
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Affiliation(s)
- Kari Gorder
- The Christ Hospital Heart and Vascular Institute, 2139 Auburn Avenue, Cincinnati OH 45219, USA.
| | - Wesley Young
- The Christ Hospital Heart and Vascular Institute, 2139 Auburn Avenue, Cincinnati OH 45219, USA. https://twitter.com/wesyoungpa
| | - Navin K Kapur
- Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Timothy D Henry
- The Christ Hospital Heart and Vascular Institute, 2139 Auburn Avenue, Cincinnati OH 45219, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH 45219, USA. https://twitter.com/HenrytTimothy
| | - Santiago Garcia
- Minneapolis Heart Institute, 800 East, 28th Street, Minneapolis, MN 55407, USA
| | - Raviteja R Guddeti
- Minneapolis Heart Institute, 800 East, 28th Street, Minneapolis, MN 55407, USA. https://twitter.com/RavitejaGuddeti
| | - Timothy D Smith
- The Christ Hospital Heart and Vascular Institute, 2139 Auburn Avenue, Cincinnati OH 45219, USA. https://twitter.com/TimDSmithMD
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248
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Carroll AM, Farr M, Russell SD, Schlendorf KH, Truby LK, Gilotra NA, Vader JM, Patel CB, DeVore AD. Beyond Stage C: Considerations in the Management of Patients with Heart Failure Progression and Gaps in Evidence. J Card Fail 2023; 29:818-831. [PMID: 36958390 DOI: 10.1016/j.cardfail.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/07/2023] [Accepted: 02/24/2023] [Indexed: 03/25/2023]
Abstract
Despite treatment with contemporary medical therapies for chronic heart failure (HF), there has been an increase in the prevalence of patients progressing to more advanced disease. Patients progressing to and living at the interface of severe Stage C and Stage D HF are underrepresented in clinical trials, and there is a lack of high-quality evidence to guide clinical decision making. For patients with a severe HF phenotype, the medical therapies used for patients with a less advanced stage of illness are often no longer tolerated nor provide adequate clinical stability. The limited data on these patients highlights the need to increase formal research characterizing this high-risk population. This review summarizes existing clinical trial data on and incorporates our considerations for approaches to the medical management of patients advanced "beyond Stage C" HF.
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Affiliation(s)
- Aubrie M Carroll
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Maryjane Farr
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Stuart D Russell
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Kelly H Schlendorf
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren K Truby
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nisha A Gilotra
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Justin M Vader
- Department of Medicine, Division of Cardiology, Washington University, St Louis, MO, USA
| | - Chetan B Patel
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Adam D DeVore
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
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249
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Liu L, Ding W, He L, Yang Y, Guan F, Sun X, Peng Y, Chen X, Zhao W, Xiao Y, Luo P. RGD and Scutellarin Conjugate (WK001) Targeting Platelet Glycoprotein IIb/IIIa Receptor Protects from Myocardial Ischemia/Reperfusion Injury: Synthesis, Characterization, and Bioactivity Evaluation. Bioconjug Chem 2023; 34:477-488. [PMID: 36740781 DOI: 10.1021/acs.bioconjchem.2c00439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Myocardial ischemia/reperfusion (MI/R) injury is an unresolved clinical challenge. The blockade of binding fibrinogen by glycoprotein IIb/IIIa (GPIIb-IIIa) inhibitors has become a new therapeutic approach against MI/R injury. In this study, we modified the RGD structure to combine with scutellarin and synthesized a novel peptide, scutellarin-HomoArg-Gly-Asp-Trp-NH2 (WK001). Herein, reported experimental and docking evidence indicates that WK001 provides immediate and potent platelet inhibition, with stronger inhibition of platelet aggregation than eptifibatide and scutellarin. In particular, it is administered intravenously to prevent thrombus formation and attenuate myocardial fibrosis progression in vivo. Therefore, WK001 could be developed as an antiplatelet drug to treat thrombosis-associated diseases, such as stroke and myocardial infarction.
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Affiliation(s)
- Lancong Liu
- State Key Laboratories for Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau999078, China
| | - Wenfeng Ding
- Shenzhen Winkey Technology Co., Ltd., Shenzhen518000, China
| | - Lili He
- State Key Laboratories for Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau999078, China
| | - Yi Yang
- State Key Laboratories for Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau999078, China
| | - Fuyi Guan
- Shenzhen Winkey Technology Co., Ltd., Shenzhen518000, China
| | - Xinlin Sun
- Shenzhen Winkey Technology Co., Ltd., Shenzhen518000, China
| | - Yan Peng
- Shenzhen Winkey Technology Co., Ltd., Shenzhen518000, China
| | - Xue Chen
- Shenzhen Winkey Technology Co., Ltd., Shenzhen518000, China
| | - Wenhao Zhao
- Shenzhen Winkey Technology Co., Ltd., Shenzhen518000, China
| | - Yu Xiao
- Shenzhen Winkey Technology Co., Ltd., Shenzhen518000, China
| | - Pei Luo
- State Key Laboratories for Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau999078, China
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Not all Shock States Are Created Equal: A Review of the Diagnosis and Management of Septic, Hypovolemic, Cardiogenic, Obstructive, and Distributive Shock. Anesthesiol Clin 2023; 41:1-25. [PMID: 36871993 DOI: 10.1016/j.anclin.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Shock in the critically ill patient is common and associated with poor outcomes. Categories include distributive, hypovolemic, obstructive, and cardiogenic, of which distributive (and usually septic distributive) shock is by far the most common. Clinical history, physical examination, and hemodynamic assessments & monitoring help differentiate these states. Specific management necessitates interventions to correct the triggering etiology as well as ongoing resuscitation to maintain physiologic milieu. One shock state may convert to another and may have an undifferentiated presentation; therefore, continual re-assessment is essential. This review provides guidance for intensivists for management of all shock states based on available scientific evidence.
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