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Dergilev K, Zubkova E, Guseva A, Tsokolaeva Z, Goltseva Y, Beloglazova I, Ratner E, Andreev A, Partigulov S, Lepilin M, Menshikov M, Parfyonova Y. Tumor Necrosis Factor-Alpha Induces Proangiogenic Profiling of Cardiosphere-Derived Cell Secretome and Increases Its Ability to Stimulate Angiogenic Properties of Endothelial Cells. Int J Mol Sci 2023; 24:16575. [PMID: 38068898 PMCID: PMC10706276 DOI: 10.3390/ijms242316575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
Ischemic heart disease and its complications, such as myocardial infarction and heart failure, are the leading causes of death in modern society. The adult heart innately lacks the capacity to regenerate the damaged myocardium after ischemic injury. Multiple lines of evidence indicated that stem-cell-based transplantation is one of the most promising treatments for damaged myocardial tissue. Different kinds of stem cells have their advantages for treating ischemic heart disease. One facet of their mechanism is the paracrine effect of the transplanted cells. Particularly promising are stem cells derived from cardiac tissue per se, referred to as cardiosphere-derived cells (CDCs), whose therapeutic effect is mediated by the paracrine mechanism through secretion of multiple bioactive molecules providing immunomodulatory, angiogenic, anti-fibrotic, and anti-inflammatory effects. Although secretome-based therapies are increasingly being used to treat various cardiac pathologies, many obstacles remain because of population heterogeneity, insufficient understanding of potential modulating compounds, and the principles of secretome regulation, which greatly limit the feasibility of this technology. In addition, components of the inflammatory microenvironment in ischemic myocardium may influence the secretome content of transplanted CDCs, thus altering the efficacy of cell therapy. In this work, we studied how Tumor necrosis factor alpha (TNFa), as a key component of the pro-inflammatory microenvironment in damaged myocardium from ischemic injury and heart failure, may affect the secretome content of CDCs and their angiogenic properties. We have shown for the first time that TNFa may act as a promising compound modulating the CDC secretome, which induces its profiling to enhance proangiogenic effects on endothelial cells. These results allow us to elucidate the underlying mechanisms of the impact of the inflammatory microenvironment on transplanted CDCs and may contribute to the optimization of CDC efficiency and the development of the technology for producing the CDC secretome with enhanced proangiogenic properties for cell-free therapy.
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Affiliation(s)
- Konstantin Dergilev
- Federal State Budgetary, Institution National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, 121552 Moscow, Russia
| | - Ekaterina Zubkova
- Federal State Budgetary, Institution National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, 121552 Moscow, Russia
| | - Alika Guseva
- Federal State Budgetary, Institution National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, 121552 Moscow, Russia
| | - Zoya Tsokolaeva
- Federal State Budgetary, Institution National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, 121552 Moscow, Russia
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 141534 Moscow, Russia
| | - Yulia Goltseva
- Federal State Budgetary, Institution National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, 121552 Moscow, Russia
| | - Irina Beloglazova
- Federal State Budgetary, Institution National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, 121552 Moscow, Russia
| | - Elizaveta Ratner
- Federal State Budgetary, Institution National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, 121552 Moscow, Russia
| | - Alexander Andreev
- Federal State Budgetary, Institution National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, 121552 Moscow, Russia
| | - Stanislav Partigulov
- Federal State Budgetary, Institution National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, 121552 Moscow, Russia
| | - Mikhail Lepilin
- Federal State Budgetary, Institution National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, 121552 Moscow, Russia
| | - Mikhail Menshikov
- Federal State Budgetary, Institution National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, 121552 Moscow, Russia
| | - Yelena Parfyonova
- Federal State Budgetary, Institution National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, 121552 Moscow, Russia
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Cotter G, Davison BA, Lam CSP, Metra M, Ponikowski P, Teerlink JR, Mebazaa A. Acute Heart Failure Is a Malignant Process: But We Can Induce Remission. J Am Heart Assoc 2023; 12:e031745. [PMID: 37889197 PMCID: PMC10727371 DOI: 10.1161/jaha.123.031745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Acute heart failure is a common and increasingly prevalent condition, affecting >10 million people annually. For those patients who survive to discharge, early readmissions and death rates are >30% everywhere on the planet, making it a malignant condition. Beyond these adverse outcomes, it represents one of the largest drivers of health care costs globally. Studies in the past 2 years have demonstrated that we can induce remissions in this malignant process if therapy is instituted rapidly, at the first acute heart failure episode, using full doses of all available effective medications. Multiple studies have demonstrated that this goal can be achieved safely and effectively. Now the urgent call is for all stakeholders, patients, physicians, payers, politicians, and the public at large to come together to address the gaps in implementation and enable health care providers to induce durable remissions in patients with acute heart failure.
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Affiliation(s)
- Gad Cotter
- Heart InitiativeDurhamNC
- Momentum Research, IncDurhamNC
- Université Paris Cité, INSERM UMR‐S 942 (MASCOT)ParisFrance
| | - Beth A. Davison
- Heart InitiativeDurhamNC
- Momentum Research, IncDurhamNC
- Université Paris Cité, INSERM UMR‐S 942 (MASCOT)ParisFrance
| | - Carolyn S. P. Lam
- National Heart Centre SingaporeSingapore
- Duke–National University of SingaporeSingapore
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical UniversityWrocławPoland
| | - John R. Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of MedicineUniversity of California San FranciscoSan FranciscoCA
| | - Alexandre Mebazaa
- Université Paris Cité, INSERM UMR‐S 942 (MASCOT)ParisFrance
- Department of Anesthesiology and Critical Care and Burn UnitSaint‐Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, APHP NordParisFrance
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3
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Gálvez-Barrón C, Pérez-López C, Villar-Álvarez F, Ribas J, Formiga F, Chivite D, Boixeda R, Iborra C, Rodríguez-Molinero A. Machine learning for the development of diagnostic models of decompensated heart failure or exacerbation of chronic obstructive pulmonary disease. Sci Rep 2023; 13:12709. [PMID: 37543661 PMCID: PMC10404284 DOI: 10.1038/s41598-023-39329-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/24/2023] [Indexed: 08/07/2023] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are two chronic diseases with the greatest adverse impact on the general population, and early detection of their decompensation is an important objective. However, very few diagnostic models have achieved adequate diagnostic performance. The aim of this trial was to develop diagnostic models of decompensated heart failure or COPD exacerbation with machine learning techniques based on physiological parameters. A total of 135 patients hospitalized for decompensated heart failure and/or COPD exacerbation were recruited. Each patient underwent three evaluations: one in the decompensated phase (during hospital admission) and two more consecutively in the compensated phase (at home, 30 days after discharge). In each evaluation, heart rate (HR) and oxygen saturation (Ox) were recorded continuously (with a pulse oximeter) during a period of walking for 6 min, followed by a recovery period of 4 min. To develop the diagnostic models, predictive characteristics related to HR and Ox were initially selected through classification algorithms. Potential predictors included age, sex and baseline disease (heart failure or COPD). Next, diagnostic classification models (compensated vs. decompensated phase) were developed through different machine learning techniques. The diagnostic performance of the developed models was evaluated according to sensitivity (S), specificity (E) and accuracy (A). Data from 22 patients with decompensated heart failure, 25 with COPD exacerbation and 13 with both decompensated pathologies were included in the analyses. Of the 96 characteristics of HR and Ox initially evaluated, 19 were selected. Age, sex and baseline disease did not provide greater discriminative power to the models. The techniques with S and E values above 80% were the logistic regression (S: 80.83%; E: 86.25%; A: 83.61%) and support vector machine (S: 81.67%; E: 85%; A: 82.78%) techniques. The diagnostic models developed achieved good diagnostic performance for decompensated HF or COPD exacerbation. To our knowledge, this study is the first to report diagnostic models of decompensation potentially applicable to both COPD and HF patients. However, these results are preliminary and warrant further investigation to be confirmed.
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Affiliation(s)
- César Gálvez-Barrón
- Research Area, Consorci Sanitari Alt Penedès i Garraf, Sant Pere de Ribes-Barcelona, Barcelona, Spain.
| | - Carlos Pérez-López
- Research Area, Consorci Sanitari Alt Penedès i Garraf, Sant Pere de Ribes-Barcelona, Barcelona, Spain
| | | | - Jesús Ribas
- Department of Pneumology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Francesc Formiga
- Geriatric Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - David Chivite
- Geriatric Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Ramón Boixeda
- Department of Internal Medicine, Hospital de Mataró, Mataró-Barcelona, Spain
| | - Cristian Iborra
- Department of Cardiology, IIS Fundación Jiménez Díaz, Madrid, Spain
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Yano H, Onoue K, Tokinaga S, Ioka T, Ishihara S, Hashimoto Y, Nakada Y, Nakagawa H, Ueda T, Seno A, Nishida T, Watanabe M, Saito Y. Overexpression of GRK2 in vascular smooth muscle leads to inappropriate hypertension and acute heart failure as in clinical scenario 1. Sci Rep 2023; 13:7707. [PMID: 37173348 PMCID: PMC10182096 DOI: 10.1038/s41598-023-34209-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Clinical scenario 1 (CS1) is acute heart failure (HF) characterized by transient systolic blood pressure (SBP) elevation and pulmonary congestion. Although it is managed by vasodilators, the molecular mechanism remains unclear. The sympathetic nervous system plays a key role in HF, and desensitization of cardiac β-adrenergic receptor (AR) signaling due to G protein-coupled receptor kinase 2 (GRK2) upregulation is known. However, vascular β-AR signaling that regulates cardiac afterload remains unelucidated in HF. We hypothesized that upregulation of vascular GRK2 leads to pathological conditions similar to CS1. GRK2 was overexpressed in vascular smooth muscle (VSM) of normal adult male mice by peritoneally injected adeno-associated viral vectors driven by the myosin heavy chain 11 promoter. Upregulation of GRK2 in VSM of GRK2 overexpressing mice augmented the absolute increase in SBP (+ 22.5 ± 4.3 mmHg vs. + 36.0 ± 4.0 mmHg, P < 0.01) and lung wet weight (4.28 ± 0.05 mg/g vs. 4.76 ± 0.15 mg/g, P < 0.01) by epinephrine as compared to those in control mice. Additionally, the expression of brain natriuretic peptide mRNA was doubled in GRK2 overexpressing mice as compared to that in control mice (P < 0.05). These findings were similar to CS1. GRK2 overexpression in VSM may cause inappropriate hypertension and HF, as in CS1.
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Affiliation(s)
- Hiroki Yano
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Shiho Tokinaga
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Tomoko Ioka
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Satomi Ishihara
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Yukihiro Hashimoto
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Yasuki Nakada
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Hitoshi Nakagawa
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Ayako Seno
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan.
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Koivisto T, Lahdenoja O, Hurnanen T, Koskinen J, Jafarian K, Vasankari T, Jaakkola S, Kiviniemi TO, Airaksinen KEJ. Mechanocardiography-Based Measurement System Indicating Changes in Heart Failure Patients during Hospital Admission and Discharge. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22249781. [PMID: 36560149 PMCID: PMC9783454 DOI: 10.3390/s22249781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/27/2022] [Accepted: 12/04/2022] [Indexed: 05/26/2023]
Abstract
Heart failure (HF) is a disease related to impaired performance of the heart and is a significant cause of mortality and treatment costs in the world. During its progression, HF causes worsening (decompensation) periods which generally require hospital care. In order to reduce the suffering of the patients and the treatment cost, avoiding unnecessary hospital visits is essential, as hospitalization can be prevented by medication. We have developed a data-collection device that includes a high-quality 3-axis accelerometer and 3-axis gyroscope and a single-lead ECG. This allows gathering ECG synchronized data utilizing seismo- and gyrocardiography (SCG, GCG, jointly mechanocardiography, MCG) and comparing the signals of HF patients in acute decompensation state (hospital admission) and compensated condition (hospital discharge). In the MECHANO-HF study, we gathered data from 20 patients, who each had admission and discharge measurements. In order to avoid overfitting, we used only features developed beforehand and selected features that were not outliers. As a result, we found three important signs indicating the worsening of the disease: an increase in signal RMS (root-mean-square) strength (across SCG and GCG), an increase in the strength of the third heart sound (S3), and a decrease in signal stability around the first heart sound (S1). The best individual feature (S3) alone was able to separate the recordings, giving 85.0% accuracy and 90.9% accuracy regarding all signals and signals with sinus rhythm only, respectively. These observations pave the way to implement solutions for patient self-screening of the HF using serial measurements.
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Affiliation(s)
- Tero Koivisto
- Department of Computing, University of Turku, 20500 Turku, Finland
| | - Olli Lahdenoja
- Department of Computing, University of Turku, 20500 Turku, Finland
| | - Tero Hurnanen
- Department of Computing, University of Turku, 20500 Turku, Finland
| | - Juho Koskinen
- Department of Computing, University of Turku, 20500 Turku, Finland
| | | | - Tuija Vasankari
- Heart Center, Turku University Hospital, University of Turku, 20520 Turku, Finland
| | - Samuli Jaakkola
- Heart Center, Turku University Hospital, University of Turku, 20520 Turku, Finland
| | - Tuomas O Kiviniemi
- Heart Center, Turku University Hospital, University of Turku, 20520 Turku, Finland
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Mohyeldin M, Tavares LB, Boorenie M, Abureesh D, Ejaz S, Durrani L, Khan S. Efficacy of Sacubitril/Valsartan in the Setting of Acute Heart Failure: A Systematic Review. Cureus 2021; 13:e18740. [PMID: 34659932 PMCID: PMC8516021 DOI: 10.7759/cureus.18740] [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: 09/24/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022] Open
Abstract
Acute decompensated heart failure (ADHF) is one of the conditions associated with high rates of mortality and morbidity, in addition to its economic burden. Sacubitril/valsartan, the emerging drug in the field of heart failure, has been showing favorable outcomes in patients with heart failure with reduced ejection fraction (HFrEF). However, its efficacy in patients with acute decompensated heart failure remains obscure. This systematic review aims to offer more clarity to this established gap of knowledge. PubMed, ScienceDirect, and ScienceOpen were explored to gain access to studies on this topic. We conducted a systematic review to evaluate the safety and efficacy of using sacubitril/valsartan in the acute setting. Five clinical trials, 10 observational studies, including two abstracts, in addition to seven case reports and one editorial, were obtained and analyzed. Key outcomes of interest were safety and tolerability, efficacy reflected by N-terminal proB-type natriuretic peptide (NT-proBNP), and other serum and echocardiographic parameters. Additionally, target dose attainment, rehospitalization rates, and hemodynamics effect were also outcomes of interest. Based on our findings, the use of sacubitril/valsartan in patients with ADHF and cardiogenic shock is an effective measure. Although most of the results pointed to its safety, some of them showed the outcome of serious adverse events recommending its cautious use.
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Affiliation(s)
- Moiud Mohyeldin
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Lorena B Tavares
- Bioethics, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Mustafa Boorenie
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Deya Abureesh
- Neurological Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Saman Ejaz
- Obstetrics and Gynaecology, California Institute of Behavioural Neurosciences & Psychology, Fairfield, USA
| | - Lubna Durrani
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Ilic A, Todorovic D, Mutavdzin S, Boricic N, Bozic Nedeljkovic B, Stankovic S, Simic T, Stevanovic P, Celic V, Djuric D. Translocator Protein Modulation by 4'-Chlorodiazepam and NO Synthase Inhibition Affect Cardiac Oxidative Stress, Cardiometabolic and Inflammatory Markers in Isoprenaline-Induced Rat Myocardial Infarction. Int J Mol Sci 2021; 22:2867. [PMID: 33799869 PMCID: PMC8000569 DOI: 10.3390/ijms22062867] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/17/2022] Open
Abstract
The possible cardioprotective effects of translocator protein (TSPO) modulation with its ligand 4'-Chlorodiazepam (4'-ClDzp) in isoprenaline (ISO)-induced rat myocardial infarction (MI) were evaluated, alone or in the presence of L-NAME. Wistar albino male rats (b.w. 200-250 g, age 6-8 weeks) were divided into 4 groups (10 per group, total number N = 40), and certain substances were applied: 1. ISO 85 mg/kg b.w. (twice), 2. ISO 85 mg/kg b.w. (twice) + L-NAME 50 mg/kg b.w., 3. ISO 85 mg/kg b.w. (twice) + 4'-ClDzp 0.5 mg/kg b.w., 4. ISO 85 mg/kg b.w. (twice) + 4'-ClDzp 0.5 mg/kg b.w. + L-NAME 50 mg/kg b.w. Blood and cardiac tissue were sampled for myocardial injury and other biochemical markers, cardiac oxidative stress, and for histopathological evaluation. The reduction of serum levels of high-sensitive cardiac troponin T hs cTnT and tumor necrosis factor alpha (TNF-α), then significantly decreased levels of serum homocysteine Hcy, urea, and creatinine, and decreased levels of myocardial injury enzymes activities superoxide dismutase (SOD) and glutathione peroxidase (GPx) as well as lower grades of cardiac ischemic changes were demonstrated in ISO-induced MI treated with 4'-ClDzp. It has been detected that co-treatment with 4'-ClDzp + L-NAME changed the number of registered parameters in comparison to 4'-ClDzp group, indicating that NO (nitric oxide) should be important in the effects of 4'-ClDzp.
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Affiliation(s)
- Ana Ilic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic—Dedinje”, 11000 Belgrade, Serbia; (A.I.); (V.C.)
| | - Dusan Todorovic
- Institute of Medical Physiology “Richard Burian”, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.T.); (S.M.)
| | - Slavica Mutavdzin
- Institute of Medical Physiology “Richard Burian”, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.T.); (S.M.)
| | - Novica Boricic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Biljana Bozic Nedeljkovic
- Institute for Physiology and Biochemistry “Ivan Djaja”, Faculty of Biology, University of Belgrade, 11000 Belgrade, Serbia;
| | - Sanja Stankovic
- Center for Medical Biochemistry, Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Tatjana Simic
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Predrag Stevanovic
- Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Clinical Hospital Center “Dr. Dragisa Misovic—Dedinje”, 11000 Belgrade, Serbia;
| | - Vera Celic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic—Dedinje”, 11000 Belgrade, Serbia; (A.I.); (V.C.)
| | - Dragan Djuric
- Institute of Medical Physiology “Richard Burian”, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.T.); (S.M.)
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Cotter G, Davison BA, Edwards C, Takagi K, Cohen-Solal A, Mebazaa A. Acute heart failure treatment: a light at the end of the tunnel? Eur J Heart Fail 2021; 23:698-702. [PMID: 33547866 DOI: 10.1002/ejhf.2116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/18/2021] [Accepted: 01/31/2021] [Indexed: 12/27/2022] Open
Affiliation(s)
- Gad Cotter
- Momentum Research, Inc., Durham, NC, USA.,Inserm U942 MASCOT, Paris, France
| | - Beth A Davison
- Momentum Research, Inc., Durham, NC, USA.,Inserm U942 MASCOT, Paris, France
| | | | | | | | - Alexandre Mebazaa
- Inserm U942 MASCOT, Paris, France.,Department of Anesthesiology and Critical Care Medicine, AP-HP, Saint Louis Lariboisière University Hospitals, Paris, France
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9
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Davison BA, Senger S, Sama IE, Koch GG, Mebazaa A, Dickstein K, Samani NJ, Metra M, Anker SD, Cleland JG, Ng LL, Mordi IR, Zannad F, Filippatos GS, Hillege HL, Ponikowski P, van Veldhuisen DJ, Lang CC, van der Meer P, Núñez J, Bayés-Genís A, Edwards C, Voors AA, Cotter G. Is acute heart failure a distinctive disorder? An analysis from BIOSTAT-CHF. Eur J Heart Fail 2021; 23:43-57. [PMID: 33340221 DOI: 10.1002/ejhf.2077] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/13/2020] [Accepted: 12/04/2020] [Indexed: 12/13/2022] Open
Abstract
AIMS This retrospective analysis sought to identify markers that might distinguish between acute heart failure (HF) and worsening HF in chronic outpatients. METHODS AND RESULTS The BIOSTAT-CHF index cohort included 2516 patients with new or worsening HF symptoms: 1694 enrolled as inpatients (acute HF) and 822 as outpatients (worsening HF in chronic outpatients). A validation cohort included 935 inpatients and 803 outpatients. Multivariable models were developed in the index cohort using clinical characteristics, routine laboratory values, and proteomics data to examine which factors predict adverse outcomes in both conditions and to determine which factors differ between acute HF and worsening HF in chronic outpatients, validated in the validation cohort. Patients with acute HF had substantially higher morbidity and mortality (6-month mortality was 12.3% for acute HF and 4.7% for worsening HF in chronic outpatients). Multivariable models predicting 180-day mortality and 180-day HF readmission differed substantially between acute HF and worsening HF in chronic outpatients. Carbohydrate antigen 125 was the strongest single biomarker to distinguish acute HF from worsening HF in chronic outpatients, but only yielded a C-index of 0.71. A model including multiple biomarkers and clinical variables achieved a high degree of discrimination with a C-index of 0.913 in the index cohort and 0.901 in the validation cohort. CONCLUSIONS This study identifies different characteristics and predictors of outcome in acute HF patients as compared to outpatients with chronic HF developing worsening HF. The markers identified may be useful in better diagnosing acute HF and may become targets for treatment development.
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Affiliation(s)
- Beth A Davison
- Momentum Research, Inc., Durham, NC, USA.,Inserm U-942 MASCOT, Paris, France
| | | | - Iziah E Sama
- University of Groningen, Groningen, The Netherlands
| | - Gary G Koch
- University of North Carolina, Chapel Hill, NC, USA
| | - Alexandre Mebazaa
- Université de Paris, Department of Anesthesia, Burn and Critical Care, Hôpitaux Universitaires Saint Louis Lariboisière, Paris, France
| | | | - Nilesh J Samani
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, University of Brescia, Brescia, Italy
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John G Cleland
- National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK
| | - Leong L Ng
- Division of Molecular and Clinical Medicine, Medical Research Institute, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
| | - Ify R Mordi
- Division of Molecular and Clinical Medicine, Medical Research Institute, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
| | - Faiez Zannad
- Inserm CIC-P 1433, Université de Lorraine, CHRU de Nancy, FCRIN INI-CRCT, Nancy, France
| | | | | | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | - Chim C Lang
- Division of Molecular and Clinical Medicine, Medical Research Institute, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
| | | | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Antoni Bayés-Genís
- Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Gad Cotter
- Momentum Research, Inc., Durham, NC, USA.,Inserm U-942 MASCOT, Paris, France
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10
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Prehospital Treatment of Acute Pulmonary Edema with Intravenous Bolus and Infusion Nitroglycerin. Prehosp Disaster Med 2020; 35:663-668. [PMID: 33023684 DOI: 10.1017/s1049023x20001193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The study describes the implementation of a prehospital treatment algorithm that included intravenous (IV) bolus (IVB) nitroglycerin (NTG) followed by maintenance infusion for the treatment of acute pulmonary edema (APE) in a single, high-volume Emergency Medical Services (EMS) system. METHODS This is a retrospective chart review of patients who received IVB NTG for APE in a large EMS system in Minnesota and Wisconsin (USA). Inclusion criteria for treatment included a diagnosis of APE, systolic blood pressure ≥120mmHg, and oxygen saturation (SpO2) ≤93% following 800mcg of sublingual NTG. Patients received a 400mcg IVB of NTG, repeated every two minutes as needed, and subsequent infusion at 80mcg/min for transport times ≥10 minutes. RESULTS Forty-four patients were treated with IVB NTG. The median total bolus dose was 400mcg. Twenty patients were treated with NTG infusion following IVB NTG. The median infusion rate was 80mcg/min. For all patients, the initial median blood pressure was 191/113mmHg. Five minutes following IVB NTG, it was 160/94mmHg, and on arrival to the emergency department (ED) it was 152/90mmHg. Five minutes after the initial dose of IVB NTG, median SpO2 increased to 92% from an initial reading of 88% and was 94% at hospital arrival. One episode of transient hypotension occurred during EMS transport. CONCLUSION Patients treated with IVB NTG for APE had reduction in blood pressure and improvement in SpO2 compared to their original presentation. Prehospital treatment of APE with IVB appears to be feasible and safe. A randomized trial is needed to confirm these findings.
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11
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Agasthi P, Pujari SH, Mookadam F, Tseng A, Venepally NR, Wang P, Allam M, Sweeney J, Eleid M, Fortuin FD, Holmes DR, Beohar N, Arsanjani R. Does a Gradient-Adjusted Cardiac Power Index Improve Prediction of Post-Transcatheter Aortic Valve Replacement Survival Over Cardiac Power Index? Yonsei Med J 2020; 61:482-491. [PMID: 32469172 PMCID: PMC7256004 DOI: 10.3349/ymj.2020.61.6.482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/03/2020] [Accepted: 04/11/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Cardiac power (CP) index is a product of mean arterial pressure (MAP) and cardiac output (CO). In aortic stenosis, however, MAP is not reflective of true left ventricular (LV) afterload. We evaluated the utility of a gradient-adjusted CP (GCP) index in predicting survival after transcatheter aortic valve replacement (TAVR), compared to CP alone. MATERIALS AND METHODS We included 975 patients who underwent TAVR with 1 year of follow-up. CP was calculated as (CO×MAP)/[451×body surface area (BSA)] (W/m²). GCP was calculated using augmented MAP by adding aortic valve mean gradient (AVMG) to systolic blood pressure (CP1), adding aortic valve maximal instantaneous gradient to systolic blood pressure (CP2), and adding AVMG to MAP (CP3). A multivariate Cox regression analysis was performed adjusting for baseline covariates. Receiver operator curves (ROC) for CP and GCP were calculated to predict survival after TAVR. RESULTS The mortality rate at 1 year was 16%. The mean age and AVMG of the survivors were 81±9 years and 43±4 mm Hg versus 80±9 years and 42±13 mm Hg in the deceased group. The proportions of female patients were similar in both groups (p=0.7). Both CP and GCP were independently associated with survival at 1 year. The area under ROCs for CP, CP1, CP2, and CP3 were 0.67 [95% confidence interval (CI), 0.62-0.72], 0.65 (95% CI, 0.60-0.70), 0.66 (95% CI, 0.61-0.71), and 0.63 (95% CI 0.58-0.68), respectively. CONCLUSION GCP did not improve the accuracy of predicting survival post TAVR at 1 year, compared to CP alone.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA.
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Andrew Tseng
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN, USA
| | - Nithin R Venepally
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Panwen Wang
- Department of Health Sciences Research, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Mohamed Allam
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - John Sweeney
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Mackram Eleid
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN, USA
| | - Floyd David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN, USA
| | - Nirat Beohar
- Columbia University, Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
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12
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Tomasoni D, Lombardi CM, Sbolli M, Cotter G, Metra M. Acute heart failure: More questions than answers. Prog Cardiovasc Dis 2020; 63:599-606. [PMID: 32283133 DOI: 10.1016/j.pcad.2020.04.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 12/19/2022]
Abstract
Acute heart failure (AHF) is a life-threatening condition with a dramatic burden in terms of symptoms, morbidity and mortality. It is a specific syndrome requiring urgent, life-saving treatment. Multiple specific pathophysiologic mechanisms may be involved, including congestion, inflammation, and neurohormonal activation. This process eventually leads to symptoms, end-organ damage, and adverse outcomes. Clinical presentation varies, but it almost universally includes worsening of congestion associated with different degrees of hypoperfusion. Due to substantial early symptoms burden and high morbidity and mortality, patients with AHF require intensive monitoring and intravenous treatment. However, beyond variable improvement in congestion, none of the available intravenous therapies for AHF was shown to improve longer term outcomes. Although oral treatment with guideline-directed therapies for stable patients with HF and reduced ejection fraction (HFrEF) before discharge may fully prevent subsequent episodes, proof that this strategy may benefit patients is lacking. First, most patients with AHF have preserved EF (HFpEF) where no therapies have been shown to be effective. Second, all therapies developed for patients with HFrEF were tested for efficacy on outcomes in patients who were stable without recent AHF. Hence, the implementation of these chronic therapies during an AHF episode is untested. Third, the problem to better treat AHF patients in their early phase remains crucial with treatment strategies largely untested, yet. Further studies targeting AHF specific mechanisms, such as inflammation and end-organ damage, and finding effective intravenous drugs remain therefore warranted.
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Affiliation(s)
- Daniela Tomasoni
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy.
| | - Carlo Mario Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | - Marco Sbolli
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | | | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
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13
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Abawi D, Faragli A, Schwarzl M, Manninger M, Zweiker D, Kresoja KP, Verderber J, Zirngast B, Maechler H, Steendijk P, Pieske B, Post H, Alogna A. Cardiac power output accurately reflects external cardiac work over a wide range of inotropic states in pigs. BMC Cardiovasc Disord 2019; 19:217. [PMID: 31615415 PMCID: PMC6792198 DOI: 10.1186/s12872-019-1212-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/26/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Cardiac power output (CPO), derived from the product of cardiac output and mean aortic pressure, is an important yet underexploited parameter for hemodynamic monitoring of critically ill patients in the intensive-care unit (ICU). The conductance catheter-derived pressure-volume loop area reflects left ventricular stroke work (LV SW). Dividing LV SW by time, a measure of LV SW min- 1 is obtained sharing the same unit as CPO (W). We aimed to validate CPO as a marker of LV SW min- 1 under various inotropic states. METHODS We retrospectively analysed data obtained from experimental studies of the hemodynamic impact of mild hypothermia and hyperthermia on acute heart failure. Fifty-nine anaesthetized and mechanically ventilated closed-chest Landrace pigs (68 ± 1 kg) were instrumented with Swan-Ganz and LV pressure-volume catheters. Data were obtained at body temperatures of 33.0 °C, 38.0 °C and 40.5 °C; before and after: resuscitation, myocardial infarction, endotoxemia, sevoflurane-induced myocardial depression and beta-adrenergic stimulation. We plotted LVSW min- 1 against CPO by linear regression analysis, as well as against the following classical indices of LV function and work: LV ejection fraction (LV EF), rate-pressure product (RPP), triple product (TP), LV maximum pressure (LVPmax) and maximal rate of rise of LVP (LV dP/dtmax). RESULTS CPO showed the best correlation with LV SW min- 1 (r2 = 0.89; p < 0.05) while LV EF did not correlate at all (r2 = 0.01; p = 0.259). Further parameters correlated moderately with LV SW min- 1 (LVPmax r2 = 0.47, RPP r2 = 0.67; and TP r2 = 0.54). LV dP/dtmax correlated worst with LV SW min- 1 (r2 = 0.28). CONCLUSION CPO reflects external cardiac work over a wide range of inotropic states. These data further support the use of CPO to monitor inotropic interventions in the ICU.
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Affiliation(s)
- Dawud Abawi
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Alessandro Faragli
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Michael Schwarzl
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf Martinistr 52, 20246, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Martin Manninger
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz , Auenbruggerplatz 15, 8036 Graz, Austria
| | - David Zweiker
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz , Auenbruggerplatz 15, 8036 Graz, Austria
| | - Karl-Patrik Kresoja
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Leipzig Heart Institute at Heart Center Leipzig, Leipzig, Germany
| | - Jochen Verderber
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz , Auenbruggerplatz 15, 8036 Graz, Austria
| | - Birgit Zirngast
- Department of Cardiothoracic Surgery, Medical University of Graz Auenbruggerplatz 29, 8036 Graz, Graz, Austria
| | - Heinrich Maechler
- Department of Cardiothoracic Surgery, Medical University of Graz Auenbruggerplatz 29, 8036 Graz, Graz, Austria
| | - Paul Steendijk
- Department of Cardiology, Leiden University Medical Center, PO 9600, 2300 RC, Leiden, The Netherlands
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Heiner Post
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Cardiology, Contilia Heart and Vessel Centre, St. Marien-Hospital Mülheim, 45468, Mülheim, Germany
| | - Alessio Alogna
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
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14
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Werner M, Wernly B, Lichtenauer M, Franz M, Kabisch B, Muessig JM, Masyuk M, Schulze PC, Hoppe UC, Kelm M, Lauten A, Jung C. Real-world extravascular lung water index measurements in critically ill patients : Pulse index continuous cardiac output measurements: time course analysis and association with clinical characteristics. Wien Klin Wochenschr 2019; 131:321-328. [PMID: 31069475 DOI: 10.1007/s00508-019-1501-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 04/16/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Pulse index continuous cardiac output (PiCCO) is used for hemodynamic assessment. This study describes real world extravascular lung water index (EVLWI) measurements at three time points and relates them to other hemodynamic parameters and mortality in critically ill patients admitted to a medical intensive care unit (ICU). METHODS A total of 198 patients admitted to a tertiary medical university hospital between February 2004 and December 2010 were included in this retrospective analysis. Patients were admitted for various diseases such as sepsis (n = 22), myocardial infarction (n = 53), pulmonary embolism (n = 3), cardiopulmonary resuscitation (n = 15), acute heart failure (AHF; n = 21) and pneumonia (n = 25). RESULTS Patients included in this analysis were severely ill as represented by the high simplified acute physiology score 2 (SAPS2, 42 ± 18) and acute physiology and chronic health evaluation score 2 (APACHE2' 22 ± 9). Real-world values at three time points are provided. Intra-ICU mortality rates did not differ between the EVLWI > 7 vs. the ELVWI < 7 groups (15% vs. 13%; p = 0.82) and no association between hemodynamic measurements obtained by PiCCO with long-term mortality could be shown. CONCLUSION There were no associations of any PiCCO measurements with mortality most probably due to selection bias towards severely ill patients. Future prospective studies with predefined inclusion criteria and treatment algorithms are necessary to evaluate the value of PiCCO for prediction of mortality against simple clinical tools such as jugular venous pressure, edema and auscultation.
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Affiliation(s)
- Matthias Werner
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Marcus Franz
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Bjoern Kabisch
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Johanna M Muessig
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Maryna Masyuk
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Paul Christian Schulze
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Uta C Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Alexander Lauten
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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15
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Platelet to Lymphocyte Ratio on Admission and Prognosis in Patients with Acute Cardiogenic Pulmonary Edema. J Emerg Med 2018; 55:465-471. [PMID: 30115388 DOI: 10.1016/j.jemermed.2018.06.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/01/2018] [Accepted: 06/12/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acute heart failure is a heterogenous syndrome defined by a number of factors, such as its physiopathology, clinical picture, time of onset, and relation to acute coronary syndrome. Acute cardiogenic pulmonary edema (ACPE) constitutes approximately 10-20% of acute heart failure syndromes, and it is the most dramatic symptom of left heart failure. Platelet to lymphocyte ratio (PLR) is a relatively novel inflammatory marker that can be utilized for prognosis in various disease processes. OBJECTIVE In this study, we investigated the value of the PLR for the prediction of mortality in patients with ACPE. METHODS A total of 115 patients hospitalized with a diagnosis of ACPE were included in this study. The patients were divided into tertile groups according to their PLR values: high (PLR > 194.97), medium (98.3-194.97), and low tertile (PLR < 98.3). RESULTS We compared the PLR groups for in-hospital mortality and total mortality after discharge. Multivariate Cox regression analysis showed that PLR was independently associated with total mortality (hazard ratio 5.657; 95% confidence interval 2.467-12.969; p < 0.001). Survival analysis using the Kaplan-Meier curve showed that the high-PLR group had a significantly higher mortality rate than the other groups. CONCLUSIONS We showed an association between high PLR and mortality in patients with ACPE. PLR, together with other inflammatory markers and clinical findings, may be used as an adjunctive parameter for the stratification of mortality risk, hospitalization, or discharge criteria scoring.
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16
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Carubelli V, Bonadei I, Castrini AI, Gorga E, Ravera A, Lombardi C, Metra M. Prognostic value of the absolute lymphocyte count in patients admitted for acute heart failure. J Cardiovasc Med (Hagerstown) 2018; 18:859-865. [PMID: 27541359 DOI: 10.2459/jcm.0000000000000428] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Low relative lymphocyte count is an important prognostic marker in acute heart failure (AHF); however, it could be influenced by other abnormalities in white cells count. Our purpose is to evaluate if low absolute lymphocyte count (ALC) is an independent predictor of events in patients with AHF. METHODS In a retrospective analysis, we included 309 patients with AHF, divided into two groups according to the median value of ALC at admission (1410 cells/μl). The primary end point was all-cause mortality or urgent heart transplantation within 1 year. RESULTS Patients with low ALC were older and had more comorbidity, namely atrial fibrillation, chronic kidney disease, chronic obstructive pulmonary disease and anemia. Low ALC was associated with higher all-cause mortality or urgent heart transplantation at 1 year (24.3 vs 13.0%; P = 0.012). In a multivariable model, the independent predictors of mortality at 1 year were ALC 1410 cells/μl or less at admission [hazard ratio 2.04; CI (confidence interval) 95% (1.06-3.95); P = 0.033], age [hazard ratio 1.08; CI 95% (1.04-1.12); P < 0.001], baseline serum creatinine [hazard ratio 1.25; CI 95% (1.05-1.50); P = 0.012] and baseline serum Na [hazard ratio 0.91; CI 95% (0.85-0.98); P = 0.013]. CONCLUSION Low ALC in patients with AHF is associated with higher in-hospital mortality during the hospitalization and is an independent predictor of long-term mortality.
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Affiliation(s)
- Valentina Carubelli
- Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Brescia, Italy
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17
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Fujita T, Inomata T, Yazaki M, Iida Y, Kaida T, Ikeda Y, Nabeta T, Ishii S, Maekawa E, Yanagisawa T, Koitabashi T, Takeuchi I, Ako J. Hemodilution after Initial Treatment in Patients with Acute Decompensated Heart Failure. Int Heart J 2018; 59:573-579. [DOI: 10.1536/ihj.17-307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Teppei Fujita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital
| | - Mayu Yazaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Yuichiro Iida
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Toyoji Kaida
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Yuki Ikeda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Shunsuke Ishii
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Toshimi Koitabashi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Ichiro Takeuchi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
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18
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McDonald K, Troughton R, Dahlström U, Dargie H, Krum H, van der Meer P, McDonagh T, Atherton JJ, Kupfer K, San George RC, Richards M, Doughty R. Daily home BNP monitoring in heart failure for prediction of impending clinical deterioration: results from the HOME HF study. Eur J Heart Fail 2018; 20:474-480. [DOI: 10.1002/ejhf.1053] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 08/22/2017] [Accepted: 08/28/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Kenneth McDonald
- Heart Failure Unit; St. Vincent's University Hospital and University College Dublin; Dublin Ireland
| | - Richard Troughton
- Department of Medicine; University of Otago; Christchurch New Zealand
| | - Ulf Dahlström
- Department of Cardiology and Department of Medical and Health Sciences; Linkoping University; Linkoping Sweden
| | - Henry Dargie
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; UK
| | - Henry Krum
- Faculty of Medicine and Health Sciences; Monash University; Victoria Australia
| | - Peter van der Meer
- Faculty of Medical Sciences, Cardiology and Thorax Surgery; University Medical Center Groningen; Groningen The Netherlands
| | | | - John J. Atherton
- Cardiology; Royal Brisbane Hospital and University of Queensland; Australia
| | | | | | - Mark Richards
- Department of Medicine; University of Otago; Christchurch New Zealand
| | - Robert Doughty
- Faculty of Medical and Health Sciences; University of Auckland; New Zealand
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19
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Kingma JG, Simard D, Rouleau JR, Drolet B, Simard C. The Physiopathology of Cardiorenal Syndrome: A Review of the Potential Contributions of Inflammation. J Cardiovasc Dev Dis 2017; 4:E21. [PMID: 29367550 PMCID: PMC5753122 DOI: 10.3390/jcdd4040021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 11/25/2017] [Accepted: 11/26/2017] [Indexed: 12/12/2022] Open
Abstract
Inter-organ crosstalk plays an essential role in the physiological homeostasis of the heart and other organs, and requires a complex interaction between a host of cellular, molecular, and neural factors. Derangements in these interactions can initiate multi-organ dysfunction. This is the case, for instance, in the heart or kidneys where a pathological alteration in one organ can unfavorably affect function in another distant organ; attention is currently being paid to understanding the physiopathological consequences of kidney dysfunction on cardiac performance that lead to cardiorenal syndrome. Different cardiorenal connectors (renin-angiotensin or sympathetic nervous system activation, inflammation, uremia, etc.) and non-traditional risk factors potentially contribute to multi-organ failure. Of these, inflammation may be crucial as inflammatory cells contribute to over-production of eicosanoids and lipid second messengers that activate intracellular signaling pathways involved in pathogenesis. Indeed, inflammation biomarkers are often elevated in patients with cardiac or renal dysfunction. Epigenetics, a dynamic process that regulates gene expression and function, is also recognized as an important player in single-organ disease. Principal epigenetic modifications occur at the level of DNA (i.e., methylation) and histone proteins; aberrant DNA methylation is associated with pathogenesis of organ dysfunction through a number of mechanisms (inflammation, nitric oxide bioavailability, endothelin, etc.). Herein, we focus on the potential contribution of inflammation in pathogenesis of cardiorenal syndrome.
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Affiliation(s)
- John G Kingma
- Department of Medicine, Faculty of Medicine, Pavillon Ferdinand Vandry, 1050, Avenue de la Médecine, Université Laval, Quebec, QC G1V 0A6, Canada.
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, 2725, Chemin Sainte-Foy, Quebec, QC G1V 4G5, Canada.
| | - Denys Simard
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, 2725, Chemin Sainte-Foy, Quebec, QC G1V 4G5, Canada.
| | - Jacques R Rouleau
- Department of Medicine, Faculty of Medicine, Pavillon Ferdinand Vandry, 1050, Avenue de la Médecine, Université Laval, Quebec, QC G1V 0A6, Canada.
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, 2725, Chemin Sainte-Foy, Quebec, QC G1V 4G5, Canada.
| | - Benoit Drolet
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, 2725, Chemin Sainte-Foy, Quebec, QC G1V 4G5, Canada.
- Faculty of Pharmacy, Pavillon Ferdinand Vandry, 1050, Avenue de la Médecine, Université Laval, Quebec, QC G1V 0A6, Canada.
| | - Chantale Simard
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, 2725, Chemin Sainte-Foy, Quebec, QC G1V 4G5, Canada.
- Faculty of Pharmacy, Pavillon Ferdinand Vandry, 1050, Avenue de la Médecine, Université Laval, Quebec, QC G1V 0A6, Canada.
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Abstract
PURPOSE OF REVIEW Acute decompensated heart failure is a serious and common condition where close monitoring of symptoms, vital signs, haemodynamic and other markers are needed after the patient is admitted to hospital as the in-hospital outcome is poor. This review focuses on advances in the assessment and monitoring of these patients. RECENT FINDINGS The adoption of the CHAMP acronym to identify precipitating factors and of the classification using wet-warm, wet-cold, dry-warm and dry-cold categories is an improvement regarding assessment. Although the outcome of acute decompensated heart failure has remained poor with no new treatments found for a number of years, a structured approach to assessment and monitoring is now available.
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Affiliation(s)
- Danish Ali
- Department of Cardiology, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Prithwish Banerjee
- Department of Cardiology, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
- Faculty of Health & Life Sciences, Coventry University, Coventry, UK.
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Ferreira J. Vascular phenotypes of acute decompensated vs. new-onset heart failure: treatment implications. ESC Heart Fail 2017; 4:679-685. [PMID: 28960929 PMCID: PMC5695185 DOI: 10.1002/ehf2.12210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/20/2017] [Accepted: 08/09/2017] [Indexed: 12/28/2022] Open
Abstract
Aims Acute heart failure (HF) is a frequent and life‐threatening syndrome with heterogeneous clinical, haemodynamic, and neurohormonal features. This article describes the vascular phenotypes associated with acute decompensated chronic HF (ADCHF), and new‐onset acute HF (NOAHF). Data Synthesis Worsening of chronic HF occurs with full activation of adaptive mechanisms that maintain blood pressure (BP) and systemic perfusion. Rapid onset of HF in the setting of previous normal functioning heart not only does not allow full activation of adaptive mechanisms but also generates inappropriate responses from systemic endothelium leading to low BP/hypotension. Consequently, the treatment of ADCHF is based on diuretics and vasodilators, while in NOAHF, vasoconstrictors may be required to maintain BP to allow the correction of the acute cardiac disease. Conclusions Patients with ADCHF and NOAHF present different vascular phenotypes with treatment implications.
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Affiliation(s)
- Jorge Ferreira
- Department of Cardiology, Hospital Santa Cruz, CHLO, Av Prof Reynaldo Santos, 2790-134, Carnaxide, Portugal
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22
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Cotter G, Cohen-Solal A, Davison BA, Mebazaa A. RELAX-AHF, BLAST-AHF, TRUE-AHF, and other important truths in acute heart failure research. Eur J Heart Fail 2017; 19:1355-1357. [PMID: 28836728 DOI: 10.1002/ejhf.934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/24/2017] [Accepted: 06/05/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Gad Cotter
- Momentum Research, Inc., Durham, NC, USA
| | - Alain Cohen-Solal
- Research Medical Unit, INSERM, U-942, 'BIOmarkers in CArdioNeuroVAScular diseases', Université Paris VII-Denis Diderot, Assistance Publique-Hôpitaux de Paris, Paris, France.,Service de Cardiologie, Hôpital Lariboisière, Paris, France
| | | | - Alexandre Mebazaa
- Research Medical Unit, INSERM, U-942, 'BIOmarkers in CArdioNeuroVAScular diseases', Université Paris VII-Denis Diderot, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Anesthesiology and Critical Care Medicine, AP-HP, Saint Louis Lariboisière University Hospitals, Paris, France
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23
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Eryonucu B, Güler N, Güntekin U, Tuncer M. Comparison of the Effects of Nitroglycerin and Nitroprusside on Transmitral Doppler Flow Parameters in Patients with Hypertensive Urgency. Ann Pharmacother 2017; 39:997-1001. [PMID: 15886286 DOI: 10.1345/aph.1e562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND: Sodium nitroprusside (NIP) and nitroglycerin (NIT) are frequently selected agents for acutely reducing blood pressure. However, it is not clear which agent is more efficacious in improving left ventricular filling pressure in hypertensive crises. OBJECTIVE: To compare the acute effects of nitroglycerin (NIT) and nitroprusside (NIP) on transmitral Doppler filling parameters in patients with hypertensive urgency. METHODS: We identified 37 patients from our emergency department with hypertensive urgency and left ventricular filling abnormalities. Hypertensive urgency was defined as a severe blood pressure elevation without evidence of progressive end-organ injury. Patients were randomized to receive an infusion of NIT or NIP. NIT was infused at a starting dose of 10 μg/min; NIP was infused at a starting dose of 0.25 μg/kg/min. The infusion rates were adjusted to decrease mean arterial pressure by 25%, and this reduction was obtained within 2 hours in all patients. Diastolic filling parameters were measured by using echocardiography before and after treatment. Pulsed-wave Doppler transmitral flow velocities were used. Early diastolic flow, atrial contraction signal, early diastolic flow/atrial contraction signal, deceleration time, and isovolumetric relaxation time (IVRT) were measured. RESULTS: There were no differences between groups in baseline demographic and echocardiographic parameters. Blood pressure decreased significantly in both treatment groups. In posttreatment echocardiographic examinations, atrial contraction signal, deceleration time, and IVRT were significantly decreased in both treatment groups. Early diastolic flow was significantly decreased in the NIT group. There were no significant differences between the groups in terms of posttreatment early diastolic flow, atrial contraction signal, deceleration time, and IVRT values. CONCLUSIONS: In hypertensive urgency with left ventricular filling abnormalities, reduction of blood pressure associated with NIT or NIP treatment may improve transmitral Doppler filling parameters. There were no differences demonstrated between the 2 agents.
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Affiliation(s)
- Beyhan Eryonucu
- Medical Faculty, Department of Cardiology, Yüzüncü Yil University, Van, Turkey.
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24
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Henri C, Rouleau JL. Acute Pulmonary Edema and Acute Coronary Syndrome: Mostly a Trigger or an Associated Phenomenon? Can J Cardiol 2016; 32:1200-1202. [DOI: 10.1016/j.cjca.2015.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022] Open
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Tesak M, Kala P, Jarkovsky J, Poloczek M, Bocek O, Jerabek P, Kubková L, Manousek J, Spinar J, Mebazaa A, Parenica J, Cohen-Solal A. The value of novel invasive hemodynamic parameters added to the TIMI risk score for short-term prognosis assessment in patients with ST segment elevation myocardial infarction. Int J Cardiol 2016; 214:235-40. [PMID: 27077540 DOI: 10.1016/j.ijcard.2016.03.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 03/04/2016] [Accepted: 03/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND We compared the prognostic capacity of conventional and novel invasive parameters derived from the slope of the preload recruitable stroke work relationship (PRSW) in STEMI patients and assessed their contribution to the TIMI risk score. METHODS Left ventricular end-diastolic pressure (EDP), ejection fraction (EF), pressure adjusted maximum rate of pressure change in the left ventricle (dP/dt/P), aortic systolic pressure to EDP ratio (SBP/EDP) and end-diastolic volume adjusted stroke work (EW), derived from the slope of the PRSW relationship, were obtained during the emergency cardiac catheterization in 523 STEMI patients. The predictive power of the analyzed parameters for 30-day and 1-year mortality was evaluated using C-statistics and reclassification analysis was adopted to assess the improvement in TIMI score. RESULTS The highest area under the curve (AUC) values for 30-day mortality were observed for EW (0.872(95% confidence interval 0.801-0.943)), SBP/EDP (0.843(0.758-0.928)) and EF (0.833(0.735-0.931)); p<0.001 for all values. For 1-year mortality the best predictive value was found for EW (0.806(0.724-0.887) and EF (0.793(0.703-0.883)); p<0.001 for both. The addition of EDP, SBP/EDP ratio and EW to TIMI score significantly increased the AUC according to De Long's test. For 30-day mortality, increased discriminative power following addition to the TIMI score was observed for EW and SBP/EDP (Integrated Discrimination Improvement was 0.086(0.033-0.140), p=0.002 and 0.078(0.028-0.128), p=0.002, respectively). CONCLUSIONS EW and SBP/EDP are prognostic markers with high predictive value for 30-day and 1-year mortality. Both parameters, easily obtained during emergency catheterization, improve the discriminatory capacity of the TIMI score for 30-day mortality.
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Affiliation(s)
- Martin Tesak
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; Hospital Trebic, Trebic, Czech Republic
| | - Petr Kala
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Poloczek
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Otakar Bocek
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Jerabek
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
| | - Lenka Kubková
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
| | - Jan Manousek
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
| | - Jindrich Spinar
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, Department of Cardiovascular Disease, University Hospital St Anne's, Brno, Czech Republic
| | - Alexandre Mebazaa
- INSERM UMR-S 942, Department of Anaesthesiology and Critical Care Medicine, Lariboisière University Hospital, AP-HP University Paris Diderot, Paris, France; Cardiac Diseases and Biomarkers Unit, INSERM UMR-S 942, Department of Cardiology, Lariboisière University Hospital Paris, France
| | - Jiri Parenica
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, Department of Cardiovascular Disease, University Hospital St Anne's, Brno, Czech Republic.
| | - Alain Cohen-Solal
- INSERM UMR-S 942, Department of Anaesthesiology and Critical Care Medicine, Lariboisière University Hospital, AP-HP University Paris Diderot, Paris, France; Cardiac Diseases and Biomarkers Unit, INSERM UMR-S 942, Department of Cardiology, Lariboisière University Hospital Paris, France
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26
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Heckle MR, Flatt DM, Sun Y, Mancarella S, Marion TN, Gerling IC, Weber KT. Atrophied cardiomyocytes and their potential for rescue and recovery of ventricular function. Heart Fail Rev 2016; 21:191-8. [DOI: 10.1007/s10741-016-9535-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Acute heart failure (AHF) emerges as a major and growing epidemiological concern with high morbidity and mortality rates. Current therapies in patients with acute heart failure rely on different strategies. Patients with hypotension, hypoperfusion, or shock require inotropic support, whereas diuretics and vasodilators are recommended in patients with systemic or pulmonary congestion. Traditionally inotropic agents, referred to as Ca2+ mobilizers load the cardiomyocyte with Ca2+ and thereby increase oxygen consumption and risk for arrhythmias. These limitations of traditional inotropes may be avoided by sarcomere targeted agents. Direct activation of the cardiac sarcomere may be achieved by either sensitizing the cardiac myofilaments to Ca2+ or activating directly the cardiac myosin. In this review, we focus on sarcomere targeted inotropic agents, emphasizing their mechanisms of action and overview the most relevant clinical considerations.
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28
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Piper S, McDonagh T. The Role of Intravenous Vasodilators in Acute Heart Failure Management. Eur J Heart Fail 2014; 16:827-34. [DOI: 10.1002/ejhf.123] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/20/2014] [Accepted: 05/23/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Susan Piper
- Department of Cardiovascular Research; King's College; London UK
| | - Theresa McDonagh
- Department of Cardiovascular Research; King's College; London UK
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29
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Peacock WF, Chandra A, Char D, Collins S, Der Sahakian G, Ding L, Dunbar L, Fermann G, Fonarow GC, Garrison N, Hu MY, Jourdain P, Laribi S, Levy P, Möckel M, Mueller C, Ray P, Singer A, Ventura H, Weiss M, Mebazaa A. Clevidipine in acute heart failure: Results of the A Study of Blood Pressure Control in Acute Heart Failure-A Pilot Study (PRONTO). Am Heart J 2014; 167:529-36. [PMID: 24655702 DOI: 10.1016/j.ahj.2013.12.023] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/28/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Rapid blood pressure (BP) control improves dyspnea in hypertensive acute heart failure (AHF). Although effective antihypertensives, calcium-channel blockers are poorly studied in AHF. Clevidipine is a rapidly acting, arterial selective intravenous calcium-channel blocker. Our purpose was to determine the efficacy and safety of clevidipine vs standard-of-care intravenous antihypertensive therapy (SOC) in hypertensive AHF. METHODS This is a randomized, open-label, active control study of clevidipine vs SOC in emergency department patients with AHF having systolic BP ≥160 mm Hg and dyspnea ≥50 on a 100-mm visual analog scale (VAS). Coprimary end points were median time to, and percent attaining, a systolic BP within a prespecified target BP range (TBPR) at 30 minutes. Dyspnea reduction was the main secondary end point. RESULTS Of 104 patients (mean [SD] age 61 [14.9] years, 52% female, 80% African American), 51 received clevidipine and 53 received SOC. Baseline mean (SD) systolic BP and VAS dyspnea were 186.5 (23.4) mm Hg and 64.8 (19.6) mm. More clevidipine patients (71%) reached TBPR than did those receiving SOC (37%; P = .002), and clevidipine was faster to TBPR (P = .0006). At 45 minutes, clevidipine patients had greater mean (SD) VAS dyspnea improvement than did SOC patients (-37 [20.9] vs -28 mm [21.7], P = .02), a difference that remained significant up to 3 hours. Serious adverse events (24% vs 19%) and 30-day mortality (3 vs 2) were similar between clevedipine and SOC, respectively, and there were no deaths during study drug administration. CONCLUSIONS In hypertensive AHF, clevidipine safely and rapidly reduces BP and improves dyspnea more effectively than SOC.
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Affiliation(s)
| | | | | | | | | | - Li Ding
- The Medicine's Company, Parsippany, NJ
| | - Lala Dunbar
- Louisiana Health Sciences Center, New Orleans, LA
| | | | | | | | | | | | - Said Laribi
- Université Paris Diderot and Hospital Lariboisière, Paris, France
| | | | | | | | - Patrick Ray
- Tenon Hospital, University of Paris, Paris, France
| | | | | | - Mason Weiss
- Centinela Hospital Medical Center, Inglewood, CA
| | - Alex Mebazaa
- Université Paris Diderot and Hospital Lariboisière, Paris, France
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30
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Abstract
Descriptions of the pathophysiology of heart failure have gone through a substantial evolution in the last 50 years. It is now recognised that heart failure can occur in the presence and also in the absence of a reduction in left ventricular function. In the former situation, this classically has been described to lead to hypotension and secondary salt and volume retention by the kidneys, further aggravating cardiac function. In the latter, this has been described to lead to pulmonary congestion because of impaired cardiac diastolic filling. These concepts have further evolved in the discrimination of 'acute vascular' versus 'acute congestive' heart failure. The current paper builds the argument from numerous smaller observational studies that irrespective of the clinical presentation of heart failure, fluid congestion is the key. If left ventricular function is preserved, fluid retention is probably due to the inability of damaged kidneys to excrete the large amounts of salt ingested with modern diet. In the extreme of end-stage renal disease requiring haemodialysis, heart failure is frequent, but can be prevented almost entirely by strict volume control. Unfortunately, the absence of systematic studies describing fluid volumes and renal haemodynamic and reabsorptive function in patients with acute heart failure precludes the final proof of our concept. This paper therefore is a strong call for mechanistic research in this area.
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Affiliation(s)
- Evert J Dorhout Mees
- Emeritus Professor of Medicine/Nephrology, Utrecht University, Oude Zutphenseweg 3, 7251HL Vorden, The Netherlands.
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31
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Prise en charge du choc cardiogénique d’origine ischémique : mise au point. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0859-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cotter G, Metra M, Milo-Cotter O, Dittrich HC, Gheorghiade M. Fluid overload in acute heart failure - Re-distribution and other mechanisms beyond fluid accumulation. Eur J Heart Fail 2014; 10:165-9. [DOI: 10.1016/j.ejheart.2008.01.007] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Revised: 01/09/2008] [Accepted: 01/15/2008] [Indexed: 10/22/2022] Open
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Metra M, Ponikowski P, Cotter G, Davison BA, Felker GM, Filippatos G, Greenberg BH, Hua TA, Severin T, Unemori E, Voors AA, Teerlink JR. Effects of serelaxin in subgroups of patients with acute heart failure: results from RELAX-AHF. Eur Heart J 2013; 34:3128-36. [PMID: 23999454 PMCID: PMC3800849 DOI: 10.1093/eurheartj/eht371] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 08/08/2013] [Accepted: 08/09/2013] [Indexed: 02/06/2023] Open
Abstract
AIM Patients hospitalized for acute heart failure (AHF) differ with respect of many clinical characteristics which may influence their prognosis and response to treatment. We have assessed possible differences in the effects of serelaxin on dyspnoea relief, 60 Day outcomes and 180 Day mortality across patient subgroups in the RELAX-AHF trial. METHODS AND RESULTS Subgroups were based on pre-specified covariates (age, sex, race, geographic region, estimated glomerular filtration rate, time from presentation to randomization, baseline systolic blood pressure, history of diabetes, atrial fibrillation, ischaemic heart disease, cardiac devices, i.v. nitrates at randomization). Other covariates which may modify the efficacy of AHF treatment were also analysed. Subgroup analyses did not show any difference in the effects of serelaxin vs. placebo on dyspnoea relief or on the incidence of cardiovascular death or rehospitalizations for heart failure or renal failure at 60 days. Nominally significant interactions between some patient subgroups and the effects of serelaxin on 180 days cardiovascular and all-cause mortality were noted but should be interpreted cautiously due to the number of comparisons and the low incidence of deaths in the subgroups at lower risk. CONCLUSION The effects of serelaxin vs. placebo appeared to be similar across subgroups of patients in RELAX-AHF.
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Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | | | | | - G. Michael Felker
- Duke University School of Medicine, Duke Heart Center, Durham, NC, USA
| | | | | | | | | | - Elaine Unemori
- Corthera, Inc., a Member of the Novartis Group of Companies, San Carlos, CA, USA
| | | | - John R. Teerlink
- University of California at San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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Putaala J, Lehto M, Meretoja A, Silvennoinen K, Curtze S, Kääriäinen J, Koivunen RJ, Kaste M, Tatlisumak T, Strbian D. In-Hospital Cardiac Complications after Intracerebral Hemorrhage. Int J Stroke 2013; 9:741-6. [DOI: 10.1111/ijs.12180] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background and purpose Data on cardiac complications and their precipitants after intracerebral hemorrhage are scarce. We examined the frequency and risk factors for serious in-hospital cardiac events in a large cohort of consecutive intracerebral hemorrhage patients. Methods A retrospective chart review of 1013 consecutive patients with nontraumatic intracerebral hemorrhage treated at the Helsinki University Central Hospital (2005–2010). We excluded patients with intraparenchymal hematoma related to sub-arachnoid hemorrhage or intracerebral hemorrhage because of fibrinolytic therapies for acute ischemic stroke or myocardial infarction. Serious in-hospital cardiac event was defined as any of in-hospital poststroke acute myocardial infarction, ventricular fibrillation or tachycardia, moderate to serious acute heart failure, or cardiac death. Results Among the 948 patients included, ≥1 serious in-hospital cardiac event occurred in 39 (4·1%) patients after a median delay of two-days from stroke onset (acute myocardial infarction in three patients, ventricular fibrillation or tachycardia in three patients, acute heart failure in 36 patients, and cardiac death in three patients). Hospital stay was longer in patients with serious in-hospital cardiac event than in those without (median 12, interquartile range 7–19 vs. 8, 3–14; P = 0·001), with no difference in in-hospital mortality (23·1% vs. 24·3%; P = 0·86). In multivariable logistic regression analysis adjusted for age, gender, and diabetes, atrial fibrillation during hospitalization (odds ratio 6·68 for new-onset atrial fibrillation, 95% confidence interval 2·11–21·18; 4·46 for old atrial fibrillation, 2·08–9·56), and history of myocardial infarction (3·20, 1·18–8·66) were independently associated with serious in-hospital cardiac events. Conclusions After intracerebral hemorrhage, 4% of patients suffer an acute serious cardiac complication. Those with history of myocardial infarction or in-hospital atrial fibrillation are at greater risk for such events.
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Affiliation(s)
- J. Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - M. Lehto
- Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - A. Meretoja
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
- Melbourne Brain Centre at the Royal Melbourne Hospital, Department of Medicine, University of Melbourne, Florey Neuroscience Institutes, Melbourne, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
| | - K. Silvennoinen
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - S. Curtze
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - J. Kääriäinen
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - R.-J. Koivunen
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - M. Kaste
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - T. Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - D. Strbian
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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Colombo PC, Ganda A, Lin J, Onat D, Harxhi A, Iyasere JE, Uriel N, Cotter G. Inflammatory activation: cardiac, renal, and cardio-renal interactions in patients with the cardiorenal syndrome. Heart Fail Rev 2013; 17:177-90. [PMID: 21688186 DOI: 10.1007/s10741-011-9261-3] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although inflammation is a physiologic response designed to protect us from infection, when unchecked and ongoing it may cause substantial harm. Both chronic heart failure (CHF) and chronic kidney disease (CKD) are known to cause elaboration of several pro-inflammatory mediators that can be detected at high concentrations in the tissues and blood stream. The biologic sources driving this chronic inflammatory state in CHF and CKD are not fully established. Traditional sources of inflammation include the heart and the kidneys which produce a wide range of pro-inflammatory cytokines in response to neurohormones and sympathetic activation. However, growing evidence suggests that non-traditional biomechanical mechanisms such as venous and tissue congestion due to volume overload are also important as they stimulate endotoxin absorption from the bowel and peripheral synthesis and release of pro-inflammatory mediators. Both during the chronic phase and, more rapidly, during acute exacerbations of CHF and CKD, inflammation and congestion appear to amplify each other resulting in a downward spiral of worsening cardiac, vascular, and renal functions that may negatively impact patients' outcome. Anti-inflammatory treatment strategies aimed at attenuating end organ damage and improving clinical prognosis in the cardiorenal syndrome have been disappointing to date. A new therapeutic paradigm may be needed, which involves different anti-inflammatory strategies for individual etiologies and stages of CHF and CKD. It may also include specific (short-term) anti-inflammatory treatments that counteract inflammation during the unsettled phases of clinical decompensation. Finally, it will require greater focus on volume overload as an increasingly significant source of systemic inflammation in the cardiorenal syndrome.
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Affiliation(s)
- Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, College of Physicians and Surgeons, New York, NY, USA.
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Charach G, Shochat M, Rabinovich A, Ayzenberg O, George J, Charach L, Rabinovich P. Preventive treatment of alveolar pulmonary edema of cardiogenic origin. J Geriatr Cardiol 2013; 9:321-7. [PMID: 23341835 PMCID: PMC3545247 DOI: 10.3724/sp.j.1263.2012.07231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 10/09/2012] [Accepted: 11/23/2012] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of preventive treatment (PT) on alveolar pulmonary edema (APE) of cardiogenic origin using a monitor based on principles of internal thoracic impedance (ITI) measurements. METHODS We conducted blinded clinical trials on patients with ST-elevation myocardial infarction (STEMI) and monitored whether the condition would progress to APE. ITI was measured non-invasively by the Edema Guard Monitor (EGM, model RS-207) every 30 min. The measurement threshold for the diagnosis of APE was fixed at > 12% decrease in ITI from baseline as described in our methodology. The patients were divided into one group that received standard treatment after the appearance of clinical signs of APE without considering the prediction of APE by EGM devise (Group 1), and another group of asymptomatic patients in whom development of APE was predicted by using only EGM measurements (Group 2). The latter participants' PT consisted of furosemide, intravenous nitroglycerine and supplemental oxygen. RESULTS One-hundred and fifty patients with acute STEMI were enrolled into this study. Group 1 included 100 patients (53% males, age 64.1 ± 12.6 years). Treatment was started after the clinical appearance of overt signs of APE. Group 2 included 50 patients (54% males, age 65.2 ± 11.9 years) who received PT based on EGM measurements. Group 2 had significantly fewer cases of APE (n = 4, 8%) than Group 1 (n = 100, 100%) (P > 0.001). While APE was lethal in six (6%) Group 1 patients, PT resulted in prompt resolution of APE in all four (8%) Group 2 patients. CONCLUSION ITI is a useful modality for early diagnosis and PT of pulmonary edema of cardiogenic origin.
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Affiliation(s)
- Gideon Charach
- Department of Internal Medicine "C", Tel Aviv Sourasky Medical Center, 6 Weizman Street Tel Aviv 64239, Israel
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37
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Manne JR, Kasirye Y, Epperla N, Garcia-Montilla RJ. Non-cardiogenic pulmonary edema complicating electroconvulsive therapy: short review of the pathophysiology and diagnostic approach. Clin Med Res 2012; 10:131-6. [PMID: 22031475 PMCID: PMC3421372 DOI: 10.3121/cmr.2011.1030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Acute pulmonary edema complicating electroconvulsive therapy is an extremely uncommon event that has rarely been described in the literature. Different theories, including one suggesting a cardiogenic component, have been proposed to explain its genesis. The present report describes a classic presentation of this condition with review of its potential mechanisms and diagnostic approach. After successful completion of a session of electroconvulsive therapy, a 42-year-old woman with major depressive disorder developed acute systemic high blood pressure, shortness of breath, and hemoptysis. A chest radiograph demonstrated diffuse bilateral pulmonary infiltrates. Initially cardiogenic pulmonary edema was presumed, but an extensive diagnostic work-up demonstrated normal systolic and diastolic left ventricular function, and with only supportive measures, a complete clinical and radiographic recovery was achieved within 48 hours. The present case does not support any cardiogenic mechanism in the genesis of this condition.
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Affiliation(s)
- Janaki R Manne
- Department of Hospital Medicine, Marshfield Clinic, Marshfield, WI 54449, USA.
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Ochagavía A, Zapata L, Carrillo A, Rodríguez A, Guerrero M, Ayuela JM. [Evaluation of contractility and postloading in the intensive care unit]. Med Intensiva 2012; 36:365-74. [PMID: 22482957 DOI: 10.1016/j.medin.2012.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 02/19/2012] [Indexed: 11/26/2022]
Abstract
Cardiovascular failure is a common disorder in critical care medicine. When admitted to the ICU, patients with hemodynamic deterioration should be examined rapidly to correctly assess the main determinants of cardiovascular function (preload, afterload and contractility). This review examines the assessment of contractility and afterload involving the combined use of several hemodynamic monitors, which allows different approaches to the same problem, with a view to improving the efficiency of management and treatment in critically ill patients.
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Affiliation(s)
- A Ochagavía
- Servicio de Medicina Intensiva, Hospital de Sabadell, CIBER Enfermedades Respiratorias, Institut Universitari Parc Tauli, UAB, Sabadell, Barcelona, España.
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40
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Ennezat PV, Le Jemtel TH, Logeart D, Maréchaux S. [Heart failure with preserved ejection fraction: a systemic disorder?]. Rev Med Interne 2012; 33:370-80. [PMID: 22424669 DOI: 10.1016/j.revmed.2012.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 01/30/2012] [Accepted: 02/14/2012] [Indexed: 11/18/2022]
Abstract
When the syndrome of heart failure (HF) is due to left ventricular (LV) systolic dysfunction the clinical manifestations and natural history of the syndrome depend primarily on the severity of LV systolic dysfunction. In contrast, when the syndrome is attributed to LV diastolic dysfunction multiple comorbidities are responsible for the clinical manifestations and the natural history of the syndrome. The present review underscores the multifactorial pathogenesis of the syndrome of HF associated with LV diastolic dysfunction that nowadays is more properly referred to as HF with preserved LV ejection fraction (HFpEF) than to diastolic HF. The prognosis is similarly poor whether HF is due to systolic dysfunction or associated with diastolic dysfunction. The cause of death that is commonly non-cardiovascular in HFpEF supports the pathogenic importance of comorbidities in this condition. Hypertension, chronic kidney disease (CKD), diabetes, obesity and sleep disorder breathing are among the most frequent comorbidities in HFpEF. These comorbidities account for the multiple clinical presentations of the syndrome of HFpEF. Limited functional capacity is in HFpEF largely related to the downward spiral between CKD mediated fluid accumulation and LV stiffness as well as altered ventricular-vascular coupling. The diagnosis of HFpEF currently relies on 2D-Doppler echocardiography findings of impaired LV relaxation and increased LV stiffness and to a lesser extent on biomarkers. Owing to both lack of stringent inclusion and exclusion enrollment criteria and mistaken therapeutic target, placebo-controlled randomized therapeutic trials have been so far negative in HFpEF.
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Affiliation(s)
- P-V Ennezat
- EA 2693, IFR 114, université de Lille Nord de France, 1, place de Verdun, 59045 Lille, France.
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41
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Phan TT, Shivu GN, Abozguia K, Sanderson JE, Frenneaux M. The pathophysiology of heart failure with preserved ejection fraction: from molecular mechanisms to exercise haemodynamics. Int J Cardiol 2011; 158:337-43. [PMID: 21794933 DOI: 10.1016/j.ijcard.2011.06.113] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 06/24/2011] [Accepted: 06/25/2011] [Indexed: 12/27/2022]
Abstract
The pathophysiology of HfpEF is complex. In this review we discuss the molecular aspects of HfpEF as well as the profoundly disturbed haemodynamics with particular focus on exercise haemodynamic abnormalities.
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Affiliation(s)
- Thanh T Phan
- The James Cook University Hospital, Middlesbrough, UK.
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42
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Abstract
Relaxin, a naturally-occurring hormone in the insulin family, was discovered to have a physiologic role in pregnancy. Named initially for its relaxing effect on the pubic ligament, relaxin receptors have since been found to be widely distributed in many organs in both males and females. Acting through multiple pathways, including the stimulation of gelatinases leading to activation of endothelin type B receptors and subsequently nitric oxide, relaxin has been shown to cause vasodilation. In animal models and studies in humans, relaxin has been shown to increase cardiac output and renal perfusion. Due to these effects, relaxin has been examined as a treatment for acute heart failure. The results of phase I and II trials have shown favorable clinical trends without any major adverse events, suggesting that relaxin has the potential to be an effective medication for acute heart failure in conjunction with or in place of current treatments.
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Schlosshan D, Elliott M. Prognostic indicators in patients presenting with acute cardiogenic pulmonary edema treated with CPAP: it's not the acid that matters, it's back to basics. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:1009. [PMID: 21138600 PMCID: PMC3219987 DOI: 10.1186/cc9325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Several prognostic markers have been identified for patients admitted with acute cardiogenic pulmonary edema. Most of the markers are based on clinical risk scores. Unlike hypercapnic respiratory failure, acidosis is not an adverse predictor in these patients. Hemodynamic variables that assess pathophysiological mechanisms may be more helpful to guide appropriate management.
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Affiliation(s)
- Dominik Schlosshan
- Department of Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK.
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45
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Acute Heart Failure Syndromes: Emergency Department Presentation, Treatment, and Disposition: Current Approaches and Future Aims. Circulation 2010; 122:1975-96. [DOI: 10.1161/cir.0b013e3181f9a223] [Citation(s) in RCA: 213] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Peacock FW, Varon J, Ebrahimi R, Dunbar L, Pollack CV. Clevidipine for severe hypertension in acute heart failure: a VELOCITY trial analysis. ACTA ACUST UNITED AC 2010; 16:55-9. [PMID: 20412469 DOI: 10.1111/j.1751-7133.2009.00133.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute severe hypertension occurs in approximately 50% of patients with acute heart failure (AHF). Clevidipine, the latest-generation dihydropyridine calcium channel blocker, may be useful in the treatment of this patient population. The Evaluation of the Effect of Ultra-Short-Acting Clevidipine in the Treatment of Patients With Severe Hypertension (VELOCITY) trial enrolled 126 patients with systolic blood pressure (SBP) >180 mm Hg for treatment with clevidipine to a patient-specific prespecified initial target range (ITR) of SBP to be achieved within 30 minutes. Of the enrolled patients, 19 had AHF on presentation. Primary end points were the percentage in whom ITR was achieved within 30 minutes and the number whose SBP was below the ITR after 3 minutes of clevidipine infusion. Among the 19 AHF patients in VELOCITY, median time to ITR was 11.3 minutes (95% confidence interval, 7-19). ITR was reached in most patients (94%) within 30 minutes. No patient had hypotension below the ITR, and heart rate remained stable. At 18 hours, 16 of 19 patients had received continuous clevidipine infusion, and their SBP was reduced by mean of 50 mm Hg (25%) from baseline. There were no treatment-related adverse events or adverse events that led to clevidipine discontinuation. Clevidipine safely decreases SBP in AHF and does not cause unexpected hypotension. The results of this post hoc subgroup analysis suggest that clevidipine is safe, well tolerated, and efficacious in AHF patients with hypertension.
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Affiliation(s)
- Frank W Peacock
- Department of Emergency Medicine, Cleveland Clinic, Cleveland, OH 44195-0001, USA.
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Metra M, Felker GM, Zacà V, Bugatti S, Lombardi C, Bettari L, Voors AA, Gheorghiade M, Dei Cas L. Acute heart failure: multiple clinical profiles and mechanisms require tailored therapy. Int J Cardiol 2010; 144:175-9. [PMID: 20537739 DOI: 10.1016/j.ijcard.2010.04.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 04/02/2010] [Indexed: 11/16/2022]
Abstract
Acute heart failure (HF) is the most common diagnosis at discharge in patients aged >65years. It carries a dismal prognosis with a high in-hospital mortality and very high post-discharge mortality and re-hospitalization rates. It is a complex clinical syndrome that cannot be described as a single entity as it varies widely with respect to underlying pathophysiologic mechanisms, clinical presentations and, likely, treatments. It is the aim of this paper to describe some of the main clinical presentations of acute HF. Amongst them, we will consider de novo HF versus acutely decompensated chronic HF, HF caused, and/or worsened, by myocardial ischemia, acute HF with low, normal, or high systolic blood pressure, acute HF caused by lung congestion or fluid retention or fluid redistribution to the lungs, and acute HF with comorbidities (diabetes, anemia, renal insufficiency, etc.). Different pathophysiologic mechanisms and clinical presentations may coexist in the same patient. Identification and, whenever possible, treatment of underlying pathophysiologic mechanisms may become important for acute HF management.
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Affiliation(s)
- Marco Metra
- Cardiology, Department of Experimental and Applied Medicine, University of Brescia, Italy.
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48
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Longhini C, Molino C, Fabbian F. Cardiorenal syndrome: still not a defined entity. Clin Exp Nephrol 2010; 14:12-21. [PMID: 20174850 DOI: 10.1007/s10157-009-0257-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Accepted: 11/26/2009] [Indexed: 01/22/2023]
Abstract
Because of the increasing incidence of cardiac failure and chronic renal failure due to the progressive aging of the population, the extensive application of cardiac interventional techniques, the rising rates of obesity and diabetes mellitus, coexistence of heart failure and renal failure in the same patient are frequent. More than half of subjects with heart failure had renal impairment, and mortality worsened incrementally across the range of renal dysfunctions. In patients with heart failure, renal dysfunction can result from intrinsic renal disease, hemodynamic abnormalities, or their combination. Severe pump failure leads to low cardiac output and hypotension, and neurohormonal activation produces both fluid retention and vasoconstriction. However, the cardiorenal connection is more elaborate than the hemodynamic model alone; effects of the renin-angiotensin system, the balance between nitric oxide and reactive oxygen species, inflammation, anemia and the sympathetic nervous system should be taken into account. The management of cardiorenal patients requires a tailored therapy that prioritizes the preservation of the equilibrium of each individual patient. Intravascular volume, blood pressure, renal hemodynamic, anemia and intrinsic renal disease management are crucial for improving patients' survival. Complications should be foreseen and prevented, looking carefully at basic physical examination, weight and blood pressure monitoring, and blood, urine urea and electrolytes measurement.
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Affiliation(s)
- Carlo Longhini
- Department of Clinical and Experimental Medicine, University Hospital, St. Anna, Corso Giovecca, 203, 44100, Ferrara, Italy
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Gray A, Goodacre S, Nicholl J, Masson M, Sampson F, Elliott M, Crane S, Newby DE. The Development of a Simple Risk Score to Predict Early Outcome in Severe Acute Acidotic Cardiogenic Pulmonary Edema. Circ Heart Fail 2010; 3:111-7. [DOI: 10.1161/circheartfailure.108.820183] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Acute cardiogenic pulmonary edema is a common medical emergency with high early mortality. Initial clinical assessment would benefit from accurate mortality prediction. We aimed to develop a simple clinical score based on presenting characteristics that would predict 7-day mortality in patients with acute cardiogenic pulmonary edema.
Methods and Results—
We used data from patients recruited to the 3CPO trial (a pragmatic multicenter trial comparing continuous positive airway pressure, noninvasive positive pressure ventilation, and standard oxygen therapy in emergency department patients with acute cardiogenic pulmonary edema) to investigate the association between baseline characteristics and 7-day mortality. Factors associated with mortality (
P
<0.1) were entered into a multivariable model. Independent predictors of mortality from the multivariable model (
P
<0.05) were assigned integer weights based on their coefficients and incorporated into a risk score. The discriminant ability of the score was tested by receiver operator characteristic analysis. Data from 1069 patients (78±10 years; 43% men; 7-day mortality, 9.6%) were analyzed. Multivariable analysis identified age (
P
=0.003), systolic blood pressure (
P
<0.001), and Glasgow Coma Scale motor component dichotomized and simplified to the ability to obey commands or not (
P
=0.02) as the only independent predictors of 7-day mortality. These were weighted and used to develop a risk score ranging from 0 (7-day mortality, 1.9%; 95% CI, 0.8 to 4.5) to 7 (7-day mortality, 100%; 95% CI, 34.2 to 100). Receiver operator characteristic analysis demonstrated good risk prediction with a c-statistic of 0.794 (95% CI, 0.745 to 0.843). A simplified 3-point score with no weighting had a c-statistic of 0.754 (95% CI, 0.701 to 0.807).
Conclusions—
A simple clinical score based on age, systolic blood pressure, and the ability to obey commands predicts early mortality in patients with acute cardiogenic pulmonary edema.
Clinical Trial Registration—
clinicaltrials.gov Identifier: ISRCTN077448447.
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Affiliation(s)
- Alasdair Gray
- From the Royal Infirmary of Edinburgh, Department of Emergency Medicine (A.G., M.M.), Edinburgh, United Kingdom; University of Sheffield, Medical Care Research Unit, School of Health & Related Research (S.G., J.N., F.S.), Sheffield, United Kingdom; University of Edinburgh, Department of Cardiology (D.E.N.), Edinburgh, United Kingdom; Leeds Teaching Hospitals Trust, Department of Respiratory Medicine (M.E.), Leeds, United Kingdom; York Hospitals National Health Service Foundation Trust,
| | - Steve Goodacre
- From the Royal Infirmary of Edinburgh, Department of Emergency Medicine (A.G., M.M.), Edinburgh, United Kingdom; University of Sheffield, Medical Care Research Unit, School of Health & Related Research (S.G., J.N., F.S.), Sheffield, United Kingdom; University of Edinburgh, Department of Cardiology (D.E.N.), Edinburgh, United Kingdom; Leeds Teaching Hospitals Trust, Department of Respiratory Medicine (M.E.), Leeds, United Kingdom; York Hospitals National Health Service Foundation Trust,
| | - Jon Nicholl
- From the Royal Infirmary of Edinburgh, Department of Emergency Medicine (A.G., M.M.), Edinburgh, United Kingdom; University of Sheffield, Medical Care Research Unit, School of Health & Related Research (S.G., J.N., F.S.), Sheffield, United Kingdom; University of Edinburgh, Department of Cardiology (D.E.N.), Edinburgh, United Kingdom; Leeds Teaching Hospitals Trust, Department of Respiratory Medicine (M.E.), Leeds, United Kingdom; York Hospitals National Health Service Foundation Trust,
| | - Moyra Masson
- From the Royal Infirmary of Edinburgh, Department of Emergency Medicine (A.G., M.M.), Edinburgh, United Kingdom; University of Sheffield, Medical Care Research Unit, School of Health & Related Research (S.G., J.N., F.S.), Sheffield, United Kingdom; University of Edinburgh, Department of Cardiology (D.E.N.), Edinburgh, United Kingdom; Leeds Teaching Hospitals Trust, Department of Respiratory Medicine (M.E.), Leeds, United Kingdom; York Hospitals National Health Service Foundation Trust,
| | - Fiona Sampson
- From the Royal Infirmary of Edinburgh, Department of Emergency Medicine (A.G., M.M.), Edinburgh, United Kingdom; University of Sheffield, Medical Care Research Unit, School of Health & Related Research (S.G., J.N., F.S.), Sheffield, United Kingdom; University of Edinburgh, Department of Cardiology (D.E.N.), Edinburgh, United Kingdom; Leeds Teaching Hospitals Trust, Department of Respiratory Medicine (M.E.), Leeds, United Kingdom; York Hospitals National Health Service Foundation Trust,
| | - Mark Elliott
- From the Royal Infirmary of Edinburgh, Department of Emergency Medicine (A.G., M.M.), Edinburgh, United Kingdom; University of Sheffield, Medical Care Research Unit, School of Health & Related Research (S.G., J.N., F.S.), Sheffield, United Kingdom; University of Edinburgh, Department of Cardiology (D.E.N.), Edinburgh, United Kingdom; Leeds Teaching Hospitals Trust, Department of Respiratory Medicine (M.E.), Leeds, United Kingdom; York Hospitals National Health Service Foundation Trust,
| | - Steve Crane
- From the Royal Infirmary of Edinburgh, Department of Emergency Medicine (A.G., M.M.), Edinburgh, United Kingdom; University of Sheffield, Medical Care Research Unit, School of Health & Related Research (S.G., J.N., F.S.), Sheffield, United Kingdom; University of Edinburgh, Department of Cardiology (D.E.N.), Edinburgh, United Kingdom; Leeds Teaching Hospitals Trust, Department of Respiratory Medicine (M.E.), Leeds, United Kingdom; York Hospitals National Health Service Foundation Trust,
| | - Dave E. Newby
- From the Royal Infirmary of Edinburgh, Department of Emergency Medicine (A.G., M.M.), Edinburgh, United Kingdom; University of Sheffield, Medical Care Research Unit, School of Health & Related Research (S.G., J.N., F.S.), Sheffield, United Kingdom; University of Edinburgh, Department of Cardiology (D.E.N.), Edinburgh, United Kingdom; Leeds Teaching Hospitals Trust, Department of Respiratory Medicine (M.E.), Leeds, United Kingdom; York Hospitals National Health Service Foundation Trust,
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Right ventricular function in myocardial infarction complicated by cardiogenic shock: Improvement with levosimendan. Crit Care Med 2009; 37:3017-23. [PMID: 19661807 DOI: 10.1097/ccm.0b013e3181b0314a] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Levosimendan improves left ventricular hemodynamic function in patients with cardiogenic shock. However, its impact on right ventricular performance has not been determined. We compared the hemodynamic effects of levosimendan on left and right ventricular function in patients with intractable cardiogenic shock following myocardial infarction. DESIGN Observational hemodynamic study. SETTING Tertiary care center university hospital. PATIENTS Fifty-six patients with cardiogenic shock secondary to myocardial infarction were treated with percutaneous revascularization (including intra-aortic balloon pump when appropriate) and commenced on conventional inotropic therapy. INTERVENTION Twenty-five consecutive patients with cardiogenic shock due to myocardial infarction who had not improved sufficiently with conventional therapy (including dobutamine and norepinephrine) received levosimendan (as a bolus of 12 microg/kg per minute for 10 mins then 0.1 microg/kg per minute--0.2 mug/kg per minute) as "bail-out" therapy for 24 hrs while invasive hemodynamic parameters were recorded. MEASUREMENTS AND MAIN RESULTS Levosimendan therapy was associated with a significant increase in cardiac index from 2.1 +/- 0.1 to 3.0 +/- 0.2 L x min x m (p < .01). In addition, levosimendan enhanced right ventricular cardiac power index (0.14 +/- 0.19 to 0.18W +/- 0.12, p < .001), while pulmonary vascular resistance fell from 227.7 +/- 94.5 to 178.1 +/- 62.3 dyne x s x cm (p = .002). No significant change in central venous pressure or mean pulmonary artery pressure was observed. The observed hemodynamic improvement was sustained after the levosimendan infusion was stopped. CONCLUSIONS Levosimendan infusion for cardiogenic shock following acute myocardial infarction improved hemodynamic parameters of right ventricular performance. Furthermore, we describe the use of right ventricular cardiac power index as a hemodynamic parameter of right ventricular performance.
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