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Suzuki S, Teraoka N, Ito K, Okuma Y, Kimura K, Minamisawa M, Ebisawa S, Motoki H, Imamura H, Seto T, Kuwahara K. A novel predictive score model for successful weaning from mechanical circulatory support in patients with cardiogenic shock. J Card Fail 2024:S1071-9164(24)00314-2. [PMID: 39147310 DOI: 10.1016/j.cardfail.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/25/2024] [Accepted: 07/08/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Clinical evidence regarding predictors of successful weaning from mechanical circulatory support (MCS) is lacking. This study aimed to create a simple risk score to predict successful weaning from MCS in patients with cardiogenic shock. METHODS This retrospective single-center cohort study included 114 consecutive patients with cardiogenic shock treated with veno-arterial extracorporeal membrane oxygenation or IMPELLA between January 2013 and June 2023. Patients with out-of-hospital cardiac arrest were excluded. The primary endpoint was successful weaning from MCS defined as successful decannulation without the need for MCS re-implantation and survival to discharge. Multivariable logistic regression with a stepwise variable selection was performed to generate the prediction model. We first developed a general weaning score model, and then created a simple version of the score model using the same variables. RESULTS Fifty-five patients were successfully weaned from MCS. The following variables measured during weaning evaluation were selected as the components of the weaning score model: acute myocardial infarction (AMI), mean blood pressure, left ventricular ejection fraction (LVEF), lactate level, and QRS duration. According to the results, we conducted a novel weaning score model to predict successful weaning from MCS: 1.774-2.090×(AMI)+0.062×[mean blood pressure (mmHg)]+0.139×[LVEF (%)]-0.322×[Lactate (mg/dl)]-0.066×[QRS (msec)]. The following variables were selected as the components of the simple version of the weaning score model: AMI, mean blood pressure ≥80 mmHg, lactate <10 mg/dL, QRS duration ≤95 msec, and LVEF >35%. CONCLUSIONS We developed a simple model to predict successful weaning from MCS in patients with cardiogenic shock.
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Affiliation(s)
- Sho Suzuki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Nami Teraoka
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kii Ito
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yukari Okuma
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuhiro Kimura
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masatoshi Minamisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Hiroshi Imamura
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tatsuichiro Seto
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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Diaz Sanmartin LA, Gruslova AB, Nolen DR, Feldman MD, Valvano JW. Measurement of left ventricular volume with admittance incorporated onto percutaneous ventricular assist device. Med Biol Eng Comput 2024:10.1007/s11517-024-03168-y. [PMID: 39004652 DOI: 10.1007/s11517-024-03168-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 07/06/2024] [Indexed: 07/16/2024]
Abstract
Percutaneous ventricular assist devices (pVADs) incorporated with admittance electrodes have been validated in animal studies for accurate instantaneous volumetric measurements. Since miniaturization of the pVAD profile is a priority to reduce vascular complications in patients, our study aimed to validate admittance measurements using three electrodes instead of the standard four. Complex admittance was measured between an electrode pair and a pVAD metallic blood-intake tip, both with finite element analysis and on the benchtop. The catheter and electrode arrays were first simulated inside prolate ellipsoid models of the left ventricle (LV) demonstrating current flow throughout all parts of the LV as well as minimal influence of off-center catheter placement in the recorded signal. Admittance measurements were validated in 3D-printed models of healthy and dilated hearts (100-400 mL end-diastolic volumes). Minimal interference between a pVAD motor and the current signal of our admittance system was demonstrated. A modified Wei's equation focused on three electrodes was developed to be compatible with reduced profile pVADs occurring clinically, incorporated with admittance electrodes and wires. The modified equation was compared against Wei's original equation showing improved accuracy of calculated volumes. Reducing electrode footprint can simplify the incorporation of Admittance technology on any pVAD, allowing for instantaneous recognition of native heart recovery and assistance with pVAD weaning.
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Affiliation(s)
- Luis A Diaz Sanmartin
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Aleksandra B Gruslova
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Drew R Nolen
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Marc D Feldman
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jonathan W Valvano
- Department of Electrical Engineering, University of Texas at Austin, Austin, TX, USA.
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Mazurek R, Kariya T, Sakata T, Mavropoulos SA, Ravichandran AJ, Romeo FJ, Yamada KP, Ishikawa K. Negative Impact of Acute Reloading after Mechanical Left Ventricular Unloading. J Cardiovasc Transl Res 2024; 17:233-241. [PMID: 37022610 PMCID: PMC10556198 DOI: 10.1007/s12265-023-10371-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/08/2023] [Indexed: 04/07/2023]
Abstract
Mechanical LV unloading for acute myocardial infarction (MI) is a promising supportive therapy to reperfusion. However, no data is available on exit strategy. We evaluated hemodynamic and cellular effects of reloading after Impella-mediated LV unloading in Yorkshire pigs. First, we conducted an acute study in normal heart to observe effects of unloading and reloading independent of MI-induced ischemic effects. We then completed an MI study to investigate optimal exit strategy on one-week infarct size, no-reflow area, and LV function with different reloading speeds. Initial studies showed that acute reloading causes an immediate rise in end-diastolic wall stress followed by a significant increase in cardiomyocyte apoptosis. The MI study did not result in any statistically significant findings; however, numerically smaller average infarct size and no-reflow area in the gradual reloading group prompt further examination of reloading approach as an important clinically relevant consideration.
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Affiliation(s)
- Renata Mazurek
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1014, New York, NY, 10029, USA
| | - Taro Kariya
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1014, New York, NY, 10029, USA
| | - Tomoki Sakata
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1014, New York, NY, 10029, USA
| | - Spyros A Mavropoulos
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1014, New York, NY, 10029, USA
| | - Anjali J Ravichandran
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1014, New York, NY, 10029, USA
| | - Francisco J Romeo
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1014, New York, NY, 10029, USA
| | - Kelly P Yamada
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1014, New York, NY, 10029, USA
| | - Kiyotake Ishikawa
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1014, New York, NY, 10029, USA.
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Slack RJ, McGain F, Cox N, French C, Cheng V, Stub D, Zakhem B, Dade F, Bloom JE, Chan W, Yang Y. Structured Weaning From the Impella Left Ventricular Micro-Axial Pump in Acute Myocardial Infarction With Cardiogenic Shock and Protected Percutaneous Coronary Intervention: Experience From a Non-Cardiac Surgical Centre. Heart Lung Circ 2024; 33:460-469. [PMID: 38388259 DOI: 10.1016/j.hlc.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/08/2023] [Accepted: 12/10/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND The Impella (Abiomed, Danvers, MA, USA) temporary percutaneous left ventricular assist device is increasingly used as mechanical circulatory support in patients with acute myocardial infarction-cardiogenic shock (AMICS) or those undergoing high-risk protected percutaneous coronary intervention (PCI). The optimal weaning regimen remains to be defined. METHOD We implemented a structured weaning protocol in a series of 10 consecutive patients receiving Impella support for protected PCI or AMICS treated with PCI in a high volume non-cardiac surgery centre. Weaning after revascularisation was titrated to native heart recovery using both haemodynamic and echocardiographic parameters. RESULTS Ten patients (eight male, two female; aged 43-70 years) received Impella support for AMICS (80%) or protected PCI (20%). Cardiogenic shock was of Society for Cardiac Angiography & Interventions grade C-E of severity in 80%, and median left ventricular end-diastolic pressure was 31 mmHg. Protocol implementation allowed successful weaning in eight of 10 patients with a median support time of 29 hours (range, 4-48 hours). Explantation was associated with an increase in heart rate (81 vs 88 bpm; p=0.005), but no significant change in Cardiac Index (2.9 vs 2.9 L/min/m2), mean arterial pressure (79 vs 82 mmHg), vasopressor requirement (10% vs 10%), or serum lactate (1.0 vs 1.0). Median durations of intensive care and hospital stay were 3 and 6 days, respectively. At 30 days, the mortality rate was 20%, with median left ventricular ejection fraction of 40%. CONCLUSIONS A structured and dynamic weaning protocol for patients with AMICS and protected PCI supported by the Impella device is feasible in a non-cardiac surgery centre. Larger studies are needed to assess generalisability of such a weaning protocol.
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Affiliation(s)
- Ryan J Slack
- Intensive Care Unit Department, Western Health, Melbourne, Vic, Australia
| | - Forbes McGain
- Intensive Care Unit Department, Western Health, Melbourne, Vic, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, Melbourne, Vic, Australia
| | - Craig French
- Intensive Care Unit Department, Western Health, Melbourne, Vic, Australia
| | - Victoria Cheng
- Department of Cardiology, Western Health, Melbourne, Vic, Australia
| | - Dion Stub
- Department of Cardiology, Western Health, Melbourne, Vic, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Brian Zakhem
- Department of Cardiology, Western Health, Melbourne, Vic, Australia
| | - Fabien Dade
- Intensive Care Unit Department, Western Health, Melbourne, Vic, Australia
| | - Jason E Bloom
- Department of Cardiology, Western Health, Melbourne, Vic, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - William Chan
- Department of Cardiology, Western Health, Melbourne, Vic, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Yang Yang
- Intensive Care Unit Department, Western Health, Melbourne, Vic, Australia.
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Lenz M, Krychtiuk KA, Zilberszac R, Heinz G, Riebandt J, Speidl WS. Mechanical Circulatory Support Systems in Fulminant Myocarditis: Recent Advances and Outlook. J Clin Med 2024; 13:1197. [PMID: 38592041 PMCID: PMC10932153 DOI: 10.3390/jcm13051197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Fulminant myocarditis (FM) constitutes a severe and life-threatening form of acute cardiac injury associated with cardiogenic shock. The condition is characterised by rapidly progressing myocardial inflammation, leading to significant impairment of cardiac function. Due to the acute and severe nature of the disease, affected patients require urgent medical attention to mitigate adverse outcomes. Besides symptom-oriented treatment in specialised intensive care units (ICUs), the necessity for temporary mechanical cardiac support (MCS) may arise. Numerous patients depend on these treatment methods as a bridge to recovery or heart transplantation, while, in certain situations, permanent MCS systems can also be utilised as a long-term treatment option. Methods: This review consolidates the existing evidence concerning the currently available MCS options. Notably, data on venoarterial extracorporeal membrane oxygenation (VA-ECMO), microaxial flow pump, and ventricular assist device (VAD) implantation are highlighted within the landscape of FM. Results: Indications for the use of MCS, strategies for ventricular unloading, and suggested weaning approaches are assessed and systematically reviewed. Conclusions: Besides general recommendations, emphasis is put on the differences in underlying pathomechanisms in FM. Focusing on specific aetiologies, such as lymphocytic-, giant cell-, eosinophilic-, and COVID-19-associated myocarditis, this review delineates the indications and efficacy of MCS strategies in this context.
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Affiliation(s)
- Max Lenz
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria (W.S.S.)
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Konstantin A. Krychtiuk
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria (W.S.S.)
| | - Robert Zilberszac
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria (W.S.S.)
| | - Gottfried Heinz
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria (W.S.S.)
| | - Julia Riebandt
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Walter S. Speidl
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria (W.S.S.)
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria
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6
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Xu C, Xu H, Liu B. Head and neck squamous cell carcinoma-specific prognostic signature and drug sensitive subtypes based on programmed cell death-related genes. PeerJ 2023; 11:e16364. [PMID: 38025757 PMCID: PMC10668860 DOI: 10.7717/peerj.16364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Background As a complex group of malignancies, head and neck squamous cell carcinoma (HNSC) is one of the leading causes of cancer mortality. This study aims to establish a reliable clinical classification and gene signature for HNSC prognostic prediction and precision treatments. Methods A consensus clustering analysis was performed to group HNSC patients in The Cancer Genome Atlas (TCGA) database based on genes linked to programmed cell death (PCD). Differentially expressed genes (DEGs) between subtypes were identified using the "limma" R package. The TCGA prognostic signature and PCD-related prognostic genes were found using a least absolute shrinkage and selection operator (LASSO) regression analysis and univariate Cox regression analysis. The robustness of the LASSO analysis was validated using datasets GSE65858 and GSE41613. A cell counting kit-8 (CCK-8) test, Western blot, and real-time reverse transcriptase-polymerase chain reaction (RT-qPCR) were used to evaluate the expression and viability of prognostic genes. Results Four molecular subtypes were identified in PCD-related genes. Subtype C4 had the best prognosis and the highest immune score, while subtype C1 exhibited the most unfavorable outcomes. Three hundred shared DEGs were identified among the four subtypes, and four prognostic genes (CTLA4, CAMK2N1, PLAU and CALML5) were used to construct a TCGA-HNSC prognostic model. High-risk patients manifested poorer prognosis, more inflammatory pathway enrichment, and lower immune cell infiltration. High-risk patients were more prone to immune escape and were more likely to be resistant to Cisplatin and 5-Fluorouracil. Prognosis prediction was validated in external datasets. The expression of CTLA4, CAMK2N1, PLAU and CALML5 was enhanced in CAL-27 and SCC-25 cell lines, and CALML5 inhibited CAL-27 and SCC-25 cell viability. Conclusion This study shares novel insights into HNSC classification and provides a reliable PCD-related prognostic signature for prognosis prediction and treatment for patients with HNSC.
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Affiliation(s)
- Chengbo Xu
- Department of Otolaryngology Head and Neck Surgery, Jinhua Wenrong Hospital, Jinhua, China
| | - Hongfang Xu
- Department of Otolaryngology Head and Neck Surgery, Jinhua Wenrong Hospital, Jinhua, China
| | - Baimei Liu
- Department of Otolaryngology Head and Neck Surgery, Yongkang First People’s Hospital, Yongkang, China
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7
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Matassini MV, Marini M, Angelozzi A, Angelini L, Shkoza M, Compagnucci P, Falanga U, Battistoni I, Pongetti G, Francioni M, Piva T, Mucaj A, Nicolini E, Maolo A, Di Eusanio M, Munch C, Dello Russo A, Perna G. Clinical outcomes and predictors of success with Impella weaning in cardiogenic shock: a single-center experience. Front Cardiovasc Med 2023; 10:1171956. [PMID: 37416919 PMCID: PMC10321515 DOI: 10.3389/fcvm.2023.1171956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Cardiogenic shock (CS) is a severe syndrome with poor prognosis. Short-term mechanical circulatory support with Impella devices has emerged as an increasingly therapeutic option, unloading the failing left ventricle (LV) and improving hemodynamic status of affected patients. Impella devices should be used for the shortest time necessary to allow LV recovery because of time-dependent device-related adverse events. The weaning from Impella, however, is mostly performed in the absence of established guidelines, mainly based on the experience of the individual centres. Methods The aim of this single center study was to retrospectively evaluate whether a multiparametrical assessment before and during Impella weaning could predict successful weaning. The primary study outcome was death occurring during Impella weaning and secondary endpoints included assessment of in-hospital outcomes. Results Of a total of 45 patients (median age, 60 [51-66] years, 73% male) treated with an Impella device, 37 patients underwent impella weaning/removal and 9 patients (20%) died after the weaning. Non-survivors patients after impella weaning more commonly had a previous history of known heart failure (p = 0.054) and an implanted ICD-CRT (p = 0.01), and were more frequently treated with continuous renal replacement therapy (p = 0.02). In univariable logistic regression analysis, lactates variation (%) during the first 12-24 h of weaning, lactate value after 24 h of weaning, left ventricular ejection fraction (LVEF) at the beginning of weaning, and inotropic score after 24 h from weaning beginning were associated with death. Stepwise multivariable logistic regression identified LVEF at the beginning of weaning and lactates variation (%) in the first 12-24 h from weaning beginning as the most accurate predictors of death after weaning. The ROC analysis indicated 80% accuracy (95% confidence interval = 64%-96%) using the two variables in combination to predict death after weaning from Impella. Conclusions This single-center experience on Impella weaning in CS showed that two easily accessible parameters as LVEF at the beginning of weaning and lactates variation (%) in the first 12-24 h from weaning begin were the most accurate predictors of death after weaning.
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Affiliation(s)
- M. V. Matassini
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Marini
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A. Angelozzi
- Unit of Cardiology and Cardiac Intensive Therapy, Cardiovascular Department, G. Mazzini Hospital, Teramo, Italy
| | - L. Angelini
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Shkoza
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - P. Compagnucci
- Cardiology and Arrhythmology Clinic and Department of Biomedical Sciences and Public Health, University Hospital Ospedali Riuniti di Ancona and Marche Polytechnic University, Ancona, Italy
| | - U. Falanga
- Cardiology and Arrhythmology Clinic and Department of Biomedical Sciences and Public Health, University Hospital Ospedali Riuniti di Ancona and Marche Polytechnic University, Ancona, Italy
| | - I. Battistoni
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - G. Pongetti
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Francioni
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - T. Piva
- Interventional Cardiology-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A. Mucaj
- Interventional Cardiology-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - E. Nicolini
- Interventional Cardiology-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A. Maolo
- Interventional Cardiology-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Di Eusanio
- Cardiac Surgery Unit, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - C. Munch
- Anaesthesia and Cardiac Surgery Intensive Care, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A. Dello Russo
- Cardiology and Arrhythmology Clinic and Department of Biomedical Sciences and Public Health, University Hospital Ospedali Riuniti di Ancona and Marche Polytechnic University, Ancona, Italy
| | - G. Perna
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
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Geller BJ, Sinha SS, Kapur NK, Bakitas M, Balsam LB, Chikwe J, Klein DG, Kochar A, Masri SC, Sims DB, Wong GC, Katz JN, van Diepen S. Escalating and De-escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e50-e68. [PMID: 35862152 DOI: 10.1161/cir.0000000000001076] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The use of temporary mechanical circulatory support in cardiogenic shock has increased dramatically despite a lack of randomized controlled trials or evidence guiding clinical decision-making. Recommendations from professional societies on temporary mechanical circulatory support escalation and de-escalation are limited. This scientific statement provides pragmatic suggestions on temporary mechanical circulatory support device selection, escalation, and weaning strategies in patients with common cardiogenic shock causes such as acute decompensated heart failure and acute myocardial infarction. The goal of this scientific statement is to serve as a resource for clinicians making temporary mechanical circulatory support management decisions and to propose standardized approaches for their use until more robust randomized clinical data are available.
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9
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Anand S, Barry T, Arsanjani R, LeMond L. Echocardiography in Cardiac Assist Devices. Rev Cardiovasc Med 2022; 23:253. [PMID: 39076924 PMCID: PMC11266755 DOI: 10.31083/j.rcm2307253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/11/2022] [Accepted: 06/20/2022] [Indexed: 07/31/2024] Open
Abstract
In patients with medically refractory heart failure or cardiogenic shock, both temporary and durable mechanical circulatory support devices can be used to support cardiac circulation. Both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are widely available, relatively noninvasive, and avoid radiation exposure. Thus, echocardiography is an invaluable tool that provides vital information aiding in preprocedure evaluation, placement, management, and weaning of cardiac assist devices. The purpose of this article is to review the utility of both TTE and TEE in managing patients with cardiac assist devices.
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Affiliation(s)
- Senthil Anand
- Department of Cardiology, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Timothy Barry
- Department of Cardiology, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Reza Arsanjani
- Department of Cardiology, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Lisa LeMond
- Department of Cardiology, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
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Hernandez-Montfort J, Miranda D, Randhawa VK, Sleiman J, de Armas YS, Lewis A, Taimeh Z, Alvarez P, Cremer P, Perez-Villa B, Navas V, Hakemi E, Velez M, Hernandez-Mejia L, Sheffield C, Brozzi N, Cubeddu R, Navia J, Estep JD. Hemodynamic-based Assessment and Management of Cardiogenic Shock. US CARDIOLOGY REVIEW 2022. [DOI: 10.15420/usc.2021.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cardiogenic shock (CS) remains a deadly disease entity challenging patients, caregivers, and communities across the globe. CS can rapidly lead to the development of hypoperfusion and end-organ dysfunction, transforming a predictable hemodynamic event into a potential high-resource, intense, hemometabolic clinical catastrophe. Based on the scalable heterogeneity from a cellular level to healthcare systems in the hemodynamic-based management of patients experiencing CS, we present considerations towards systematic hemodynamic-based transitions in which distinct clinical entities share the common path of early identification and rapid transitions through an adaptive longitudinal situational awareness model of care that influences specific management considerations. Future studies are needed to best understand optimal management of drugs and devices along with engagement of health systems of care for patients with CS.
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Affiliation(s)
| | - Diana Miranda
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Varinder Kaur Randhawa
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Jose Sleiman
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Yelenis Seijo de Armas
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Antonio Lewis
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Ziad Taimeh
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Paulino Alvarez
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Paul Cremer
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Bernardo Perez-Villa
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Viviana Navas
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Emad Hakemi
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Mauricio Velez
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Luis Hernandez-Mejia
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Cedric Sheffield
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Nicolas Brozzi
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Robert Cubeddu
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Jose Navia
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Jerry D Estep
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
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Roscoe A, Zochios V. Echocardiography in Weaning Right Ventricular Mechanical Circulatory Support: Are We Measuring the Right Stuff? J Cardiothorac Vasc Anesth 2021; 36:362-366. [PMID: 34688542 DOI: 10.1053/j.jvca.2021.09.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew Roscoe
- Department of Anesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anesthesia, National Heart Centre Singapore, Singapore.
| | - Vasileios Zochios
- Department of Critical Care Medicine and ECMO Unit, University Hospitals of Leicester National Health Service Trust, Glenfield Hospital, Leicester, United Kingdom.
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