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Hongisto M, Lassus J, Tarvasmäki T, Sans-Roselló J, Tolppanen H, Kataja A, Jäntti T, Sabell T, Banaszewski M, Silva-Cardoso J, Parissis J, Jurkko R, Spinar J, Castrén M, Mebazaa A, Masip J, Harjola VP. Soluble urokinase-type plasminogen activator receptor improves early risk stratification in cardiogenic shock. Eur Heart J Acute Cardiovasc Care 2022; 11:zuac096. [PMID: 35949144 PMCID: PMC9629697 DOI: 10.1093/ehjacc/zuac096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/14/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022]
Abstract
AIMS Soluble urokinase-type plasminogen activator receptor (suPAR) is a biomarker reflecting the level of immune activation. It has been shown to have prognostic value in acute coronary syndrome and heart failure as well as in critical illness. Considering the complex pathophysiology of cardiogenic shock (CS), we hypothesized suPAR might have prognostic properties in CS as well. The aim of this study was to assess the kinetics and prognostic utility of suPAR in CS. METHODS AND RESULTS SuPAR levels were determined in serial plasma samples (0-96 h) from 161 CS patients in the prospective, observational, multicentre CardShock study. Kinetics of suPAR, its association with 90-day mortality, and additional value in risk-stratification were investigated. The median suPAR-level at baseline was 4.4 [interquartile range (IQR) 3.2-6.6)] ng/mL. SuPAR levels above median were associated with underlying comorbidities, biomarkers reflecting renal and cardiac dysfunction, and higher 90-day mortality (49% vs. 31%; P = 0.02). Serial measurements showed that survivors had significantly lower suPAR levels at all time points compared with nonsurvivors. For risk stratification, suPAR at 12 h (suPAR12h) with a cut-off of 4.4 ng/mL was strongly associated with mortality independently of established risk factors in CS: OR 5.6 (95% CI 2.0-15.5); P = 0.001) for death by 90 days. Adding suPAR12h > 4.4 ng/mL to the CardShock risk score improved discrimination identifying high-risk patients originally categorized in the intermediate-risk category. CONCLUSION SuPAR associates with mortality and improves risk stratification independently of other previously known risk factors in CS patients.
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Affiliation(s)
- Mari Hongisto
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Johan Lassus
- Cardiology, University of Helsinki and Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Tuukka Tarvasmäki
- Cardiology, University of Helsinki and Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Jordi Sans-Roselló
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Biomedical Research Institute IIB-Sant Pau, CIBER-CV, Spain
| | - Heli Tolppanen
- Cardiology, University of Helsinki and Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Anu Kataja
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Toni Jäntti
- Cardiology, University of Helsinki and Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Tuija Sabell
- Cardiology, University of Helsinki and Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | | | - Jose Silva-Cardoso
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, São João University Medical Center, Faculty of Medicine, University of Porto, Porto, Portugal
| | - John Parissis
- ER and Heart Failure Unit, Attikon University Hospital, National and Kapodestrian University of Athens, Athens, Greece
| | - Raija Jurkko
- Cardiology, University of Helsinki and Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Jindrich Spinar
- St. Ann university hospital and Medical faculty Masaryk University, Brno, Czech Republic
| | - Maaret Castrén
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | | | - Josep Masip
- Research Direction, Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
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Hongisto M, Lassus J, Tarvasmäki T, Sionis A, Sans‐Rosello J, Tolppanen H, Kataja A, Jäntti T, Sabell T, Lindholm MG, Banaszewski M, Silva Cardoso J, Parissis J, Di Somma S, Carubelli V, Jurkko R, Masip J, Harjola V. Mortality risk prediction in elderly patients with cardiogenic shock: results from the CardShock study. ESC Heart Fail 2021; 8:1398-1407. [PMID: 33522124 PMCID: PMC8006692 DOI: 10.1002/ehf2.13224] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/14/2020] [Accepted: 01/07/2021] [Indexed: 12/23/2022] Open
Abstract
AIMS This study aimed to assess the utility of contemporary clinical risk scores and explore the ability of two biomarkers [growth differentiation factor-15 (GDF-15) and soluble ST2 (sST2)] to improve risk prediction in elderly patients with cardiogenic shock. METHODS AND RESULTS Patients (n = 219) from the multicentre CardShock study were grouped according to age (elderly ≥75 years and younger). Characteristics, management, and outcome between the groups were compared. The ability of the CardShock risk score and the IABP-SHOCK II score to predict in-hospital mortality and the additional value of GDF-15 and sST2 to improve risk prediction in the elderly was evaluated. The elderly constituted 26% of the patients (n = 56), with a higher proportion of women (41% vs. 21%, P < 0.05) and more co-morbidities compared with the younger. The primary aetiology of shock in the elderly was acute coronary syndrome (84%), with high rates of percutaneous coronary intervention (87%). Compared with the younger, the elderly had higher in-hospital mortality (46% vs. 33%; P = 0.08), but 1 year post-discharge survival was excellent in both age groups (90% in the elderly vs. 88% in the younger). In the elderly, the risk prediction models demonstrated an area under the curve of 0.75 for the CardShock risk score and 0.71 for the IABP-SHOCK II score. Incorporating GDF-15 and sST2 improved discrimination for both risk scores with areas under the curve ranging from 0.78 to 0.84. CONCLUSIONS Elderly patients with cardiogenic shock have higher in-hospital mortality compared with the younger, but post-discharge outcomes are similar. Contemporary risk scores proved useful for early mortality risk prediction also in the elderly, and risk stratification could be further improved with biomarkers such as GDF-15 or sST2.
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Affiliation(s)
- Mari Hongisto
- Division of Emergency Medicine, Department of Emergency Medicine and ServicesHelsinki University HospitalPO Box 900Helsinki00029 HUSFinland
| | - Johan Lassus
- Cardiology, University of Helsinki and Heart and Lung CentreHelsinki University HospitalHelsinkiFinland
| | - Tuukka Tarvasmäki
- Cardiology, University of Helsinki and Heart and Lung CentreHelsinki University HospitalHelsinkiFinland
| | - Alessandro Sionis
- Cardiology DepartmentHospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Biomedical Research Institute IIB‐Sant Pau, CIBER‐CVBarcelonaSpain
| | - Jordi Sans‐Rosello
- Cardiology DepartmentHospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Biomedical Research Institute IIB‐Sant Pau, CIBER‐CVBarcelonaSpain
| | - Heli Tolppanen
- Cardiology, University of Helsinki and Heart and Lung CentreHelsinki University HospitalHelsinkiFinland
| | - Anu Kataja
- Division of Emergency Medicine, Department of Emergency Medicine and ServicesHelsinki University HospitalPO Box 900Helsinki00029 HUSFinland
| | - Toni Jäntti
- Cardiology, University of Helsinki and Heart and Lung CentreHelsinki University HospitalHelsinkiFinland
| | - Tuija Sabell
- Cardiology, University of Helsinki and Heart and Lung CentreHelsinki University HospitalHelsinkiFinland
| | | | - Marek Banaszewski
- Intensive Cardiac Therapy ClinicNational Institute of CardiologyWarsawPoland
| | - Jose Silva Cardoso
- CINTESIS—Center for Health Technology and Services Research, Department of Cardiology, Faculty of MedicineUniversity of Porto, São João University Medical CentrePortoPortugal
| | - John Parissis
- ER and Heart Failure UnitAttikon University HospitalAthensGreece
| | - Salvatore Di Somma
- Department of Medical Surgery, Sciences and Translational MedicineSapienza University of RomeRomeItaly
| | - Valentina Carubelli
- Cardiology Division, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity and Civil Hospital of BresciaBresciaItaly
| | - Raija Jurkko
- Cardiology, University of Helsinki and Heart and Lung CentreHelsinki University HospitalHelsinkiFinland
| | - Josep Masip
- Critical Care DepartmentHospital Sant Joan Despi Moisès Broggi, Consorci Sanitari Integral, University of BarcelonaBarcelonaSpain
| | - Veli‐Pekka Harjola
- Division of Emergency Medicine, Department of Emergency Medicine and ServicesHelsinki University HospitalPO Box 900Helsinki00029 HUSFinland
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3
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Jäntti T, Tarvasmäki T, Harjola VP, Pulkki K, Turkia H, Sabell T, Tolppanen H, Jurkko R, Hongisto M, Kataja A, Sionis A, Silva-Cardoso J, Banaszewski M, DiSomma S, Mebazaa A, Haapio M, Lassus J. Predictive value of plasma proenkephalin and neutrophil gelatinase-associated lipocalin in acute kidney injury and mortality in cardiogenic shock. Ann Intensive Care 2021; 11:25. [PMID: 33547528 PMCID: PMC7865050 DOI: 10.1186/s13613-021-00814-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/20/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a frequent form of organ injury in cardiogenic shock. However, data on AKI markers such as plasma proenkephalin (P-PENK) and neutrophil gelatinase-associated lipocalin (P-NGAL) in cardiogenic shock populations are lacking. The objective of this study was to assess the ability of P-PENK and P-NGAL to predict acute kidney injury and mortality in cardiogenic shock. RESULTS P-PENK and P-NGAL were measured at different time points between baseline and 48 h in 154 patients from the prospective CardShock study. The outcomes assessed were AKI defined by an increase in creatinine within 48 h and all-cause 90-day mortality. Mean age was 66 years and 26% were women. Baseline levels of P-PENK and P-NGAL (median [interquartile range]) were 99 (71-150) pmol/mL and 138 (84-214) ng/mL. P-PENK > 84.8 pmol/mL and P-NGAL > 104 ng/mL at baseline were identified as optimal cut-offs for AKI prediction and independently associated with AKI (adjusted HRs 2.2 [95% CI 1.1-4.4, p = 0.03] and 2.8 [95% CI 1.2-6.5, p = 0.01], respectively). P-PENK and P-NGAL levels at baseline were also associated with 90-day mortality. For patients with oliguria < 0.5 mL/kg/h for > 6 h before study enrollment, 90-day mortality differed significantly between patients with low and high P-PENK/P-NGAL at baseline (5% vs. 68%, p < 0.001). However, the biomarkers provided best discrimination for mortality when measured at 24 h. Identified cut-offs of P-PENK24h > 105.7 pmol/L and P-NGAL24h > 151 ng/mL had unadjusted hazard ratios of 5.6 (95% CI 3.1-10.7, p < 0.001) and 5.2 (95% CI 2.8-9.8, p < 0.001) for 90-day mortality. The association remained significant despite adjustments with AKI and two risk scores for mortality in cardiogenic shock. CONCLUSIONS High levels of P-PENK and P-NGAL at baseline were independently associated with AKI in cardiogenic shock patients. Furthermore, oliguria before study inclusion was associated with worse outcomes only if combined with high baseline levels of P-PENK or P-NGAL. High levels of both P-PENK and P-NGAL at 24 h were found to be strong and independent predictors of 90-day mortality. TRIAL REGISTRATION NCT01374867 at www.clinicaltrials.gov , registered 16 Jun 2011-retrospectively registered.
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Affiliation(s)
- Toni Jäntti
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 HUS, Helsinki, Finland.
| | - Tuukka Tarvasmäki
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 HUS, Helsinki, Finland
| | - Veli-Pekka Harjola
- Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Kari Pulkki
- HUSLAB Diagnostic Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Heidi Turkia
- HUSLAB Diagnostic Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tuija Sabell
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 HUS, Helsinki, Finland
| | - Heli Tolppanen
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 HUS, Helsinki, Finland
| | - Raija Jurkko
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 HUS, Helsinki, Finland
| | - Mari Hongisto
- Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Anu Kataja
- Internal Medicine, Department of Internal Medicine and Rehabilitation, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de La Santa Creu I Sant Pau, Biomedical Research Institute IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jose Silva-Cardoso
- CINTESIS, Department of Cardiology, São João Hospital Center, and Porto Medical School, University of Porto, Porto, Portugal
| | - Marek Banaszewski
- Intensive Cardiac Therapy Clinic, National Institute of Cardiology, Warsaw, Poland
| | - Salvatore DiSomma
- Department of Medical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy
| | - Alexandre Mebazaa
- INSERM U942, Department of Anesthesia and Critical Care, Hôpital Lariboisière, APHP, University Paris Diderot, Paris, France
| | - Mikko Haapio
- Nephrology, Department of Nephrology, Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Johan Lassus
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 HUS, Helsinki, Finland
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Karr J, Iverson G, Isokuortti H, Kataja A, Brander A, Öhman J, Luoto T. A-04 Signs of Injury, Preexisting Health Conditions, and Emergency Department Discharge Location among Older Adults with Mild Traumatic Brain Injuries. Arch Clin Neuropsychol 2020. [DOI: 10.1093/arclin/acaa067.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Preexisting health conditions are associated with worse outcome following mild traumatic brain injury (MTBI), which is especially important in MTBI management among older adults. This study focused on older adults who presented to an emergency department (ED) following uncomplicated MTBI, examining the relationship between clinical signs of MTBI, preexisting conditions, and the location of ED discharge.
Method
Participants included older adults (n = 616, men = 44.8%, ≥55 years-old) who presented to the Tampere University Hospital ED with uncomplicated MTBI (GCS = 15; ground-level falls = 72.4%). Data were collected retrospectively from hospital records, including clinical signs of injury, preexisting health conditions [including preinjury abnormalities on head computed tomography (CT)], and location of follow-up (i.e., home versus other health/rehabilitation facility). A higher odds ratio (OR) indicated a greater likelihood of continued care discharge to another health facility.
Results
Among participants 55–69 years-old, preexisting neurological diseases (OR = 2.92), mental/behavioral health conditions (OR = 3.05), and CT abnormalities (OR = 3.02) were associated with greater odds of continued care. Among participants 70+ years-old, preexisting neurological diseases (OR = 2.60) and CT abnormalities (OR = 2.12) were associated with greater odds of continued care. Preexisting circulatory system diseases, loss of consciousness, and amnesia were not associated with greater odds of continued care for either age group.
Conclusions
Among older adults with uncomplicated MTBIs, preexisting health conditions were associated with greater odds of continued care than loss of consciousness or amnesia. These findings reveal the importance of preexisting health conditions in the acute clinical management of MTBI in older adults, in that preexisting conditions have greater associations with care planning than clinical signs of injury.
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5
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Kataja A, Tarvasmäki T, Lassus J, Sionis A, Mebazaa A, Pulkki K, Banaszewski M, Carubelli V, Hongisto M, Jankowska E, Jurkko R, Jäntti T, Kasztura M, Parissis J, Sabell T, Silva-Cardoso J, Spinar J, Tolppanen H, Harjola VP. Kinetics of procalcitonin, C-reactive protein and interleukin-6 in cardiogenic shock - Insights from the CardShock study. Int J Cardiol 2020; 322:191-196. [PMID: 32841617 DOI: 10.1016/j.ijcard.2020.08.069] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 08/09/2020] [Accepted: 08/17/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Inflammatory responses play an important role in the pathophysiology of cardiogenic shock (CS). The aim of this study was to investigate the kinetics of procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6) in CS and to assess their relation to clinical presentation, other biochemical variables, and prognosis. METHODS Levels of PCT, CRP and IL-6 were analyzed in serial plasma samples (0-120h) from 183 patients in the CardShock study. The study population was dichotomized by PCTmax ≥ and < 0.5 μg/L, and IL-6 and CRPmax above/below median. RESULTS PCT peaked already at 24 h [median PCTmax 0.71 μg/L (IQR 0.24-3.4)], whereas CRP peaked later between 48 and 72 h [median CRPmax 137 mg/L (59-247)]. PCT levels were significantly higher among non-survivors compared with survivors from 12 h on, as were CRP levels from 24 h on (p < 0.001). PCTmax ≥ 0.5 μg/L (60% of patients) was associated with clinical signs of systemic hypoperfusion, cardiac and renal dysfunction, acidosis, and higher levels of blood lactate, IL-6, growth-differentiation factor 15 (GDF-15), and CRPmax. Similarly, IL-6 > median was associated with clinical signs and biochemical findings of systemic hypoperfusion. PCTmax ≥ 0.5 μg/L and IL-6 > median were associated with increased 90-day mortality (50% vs. 30% and 57% vs. 22%, respectively; p < 0.01 for both), while CRPmax showed no prognostic significance. The association of inflammatory markers with clinical infections was modest. CONCLUSIONS Inflammatory markers are highly related to signs of systemic hypoperfusion in CS. Moreover, high PCT and IL-6 levels are associated with poor prognosis.
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Affiliation(s)
- Anu Kataja
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
| | - Tuukka Tarvasmäki
- Cardiology, University of Helsinki and Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Johan Lassus
- Cardiology, University of Helsinki and Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Alessandro Sionis
- Acute and Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, CIBER-CV, Universitat Autonoma de Barcelona, Spain
| | - Alexandre Mebazaa
- INSERM U942, APHP, Hôpitaux Universitaires Saint Louis Lariboisière and University Paris Diderot, Paris, France
| | - Kari Pulkki
- Department of Clinical Chemistry, University of Turku and Turku University Hospital, Turku, Finland
| | - Marek Banaszewski
- Intensive Cardiac Therapy Clinic, Institute of Cardiology, Warsaw, Poland
| | - Valentina Carubelli
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Brescia, Italy
| | - Mari Hongisto
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Ewa Jankowska
- Department of Heart Diseases, Wroclaw Medical University and Center for Heart Diseases, University Hospital in Wroclaw, Poland
| | - Raija Jurkko
- Cardiology, University of Helsinki and Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Toni Jäntti
- Cardiology, University of Helsinki and Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Monika Kasztura
- Department of Food Hygiene and Consumer Health Protection, Faculty of Veterinary Medicine, Wroclaw, Poland
| | - John Parissis
- Heart Failure and ER, Attikon University Hospital, University of Athens, Athens, Greece
| | - Tuija Sabell
- Cardiology, University of Helsinki and Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Jose Silva-Cardoso
- São João University Hospital Center, Department of Cardiology and CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Portugal
| | - Jindrich Spinar
- Internal Cardiology Department, University Hospital St. Ann and Medical Faculty, Brno, Czech Republic
| | - Heli Tolppanen
- Cardiology, University of Helsinki and Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
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Sabell T, Banaszewski M, Lassus J, Nieminen MS, Tolppanen H, Jäntti T, Kataja A, Hongisto M, Køber L, Sionis A, Parissis J, Tarvasmäki T, Harjola VP, Jurkko R. Prognostic impact of angiographic findings, procedural success, and timing of percutaneous coronary intervention in cardiogenic shock. ESC Heart Fail 2020; 7:768-773. [PMID: 32163675 PMCID: PMC7160464 DOI: 10.1002/ehf2.12637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/15/2020] [Accepted: 01/21/2020] [Indexed: 01/20/2023] Open
Abstract
Aims Urgent revascularization is the mainstay of treatment in acute coronary syndrome (ACS) related cardiogenic shock (CS). The aim was to investigate the association of angiographic results with 90‐day mortality. Procedural complications of percutaneous coronary intervention (PCI) were also examined. Methods and results This CardShock (NCT01374867) substudy included 158 patients with ACS aetiology and data on coronary angiography and complications during PCI procedure. Survival analysis was conducted with Kaplan–Meier curves and Cox regression analysis. Median age was 67 ± 11 years, and 77% were men. During 90‐day follow‐up, 66 (42%) patients died. Patients with one‐vessel disease (n = 49) had lower mortality than patients with two‐vessel (n = 59) or three‐vessel (n = 50) disease (25% vs. 48% vs. 52%, P = 0.011). Successful revascularization [Thrombolysis in Myocardial Infarction (TIMI) Flow 3 post‐PCI) was achieved more often in survivors than non‐survivors (81% vs. 60%, P = 0.019). The median symptom‐to‐balloon time was 340 (196–660) minutes, with no difference between survivors and non‐survivors. In multivariable mortality analysis, multivessel disease (HR 2.59, CI95% 1.29–5.18) and TIMI flow <3 post‐PCI (HR 2.41, CI95% 1.4–4.15) were associated with 90‐day mortality. Procedural PCI complications were recorded in 51 (35%) patients, arrhythmic complications being the most common (n = 32, 63%). The incidence of complications was similar between survivors and non‐survivors (31% vs. 42%, P = 0.21). Conclusions Multivessel disease is associated with worse survival in ACS‐related CS. In patients undergoing PCI, arrhythmic complications were common, but not associated with excess mortality. Successful revascularization of the IRA had positive effect on outcome despite delay from symptom onset.
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Affiliation(s)
- Tuija Sabell
- Heart and Lung Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Marek Banaszewski
- Intensive Cardiac Therapy Clinic, Institute of Cardiology, Warsaw, Poland
| | - Johan Lassus
- Heart and Lung Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Markku S Nieminen
- Heart and Lung Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Heli Tolppanen
- Heart and Lung Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Toni Jäntti
- Heart and Lung Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Anu Kataja
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Mari Hongisto
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alessandro Sionis
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - John Parissis
- ER and Heart Failure Clinic, Attikon University Hospital, Athens, Greece
| | - Tuukka Tarvasmäki
- Heart and Lung Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Veli-Pekka Harjola
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Raija Jurkko
- Heart and Lung Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
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7
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Hongisto M, Kataja A, Tarvasmäki T, Holopainen A, Javanainen T, Jurkko R, Jäntti T, Kimmoun A, Levy B, Mebazaa A, Pulkki K, Sionis A, Tolppanen H, Wollert KC, Harjola VP, Lassus J. Levels of Growth Differentiation Factor 15 and Early Mortality Risk Stratification in Cardiogenic Shock. J Card Fail 2019; 25:894-901. [PMID: 31310811 DOI: 10.1016/j.cardfail.2019.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/09/2019] [Accepted: 07/05/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to assess the levels, kinetics, and prognostic value of growth differentiation factor 15 (GDF-15) in cardiogenic shock (CS). METHODS AND RESULTS Levels of GDF-15 were determined in serial plasma samples (0-120 h) from 177 CS patients in the CardShock study. Kinetics of GDF-15, its association with 90-day mortality, and incremental value for risk stratification were assessed. The median GDF-150h level was 9647 ng/L (IQR 4500-19,270 ng/L) and levels above median were significantly associated with acidosis, hyperlactatemia, renal dysfunction, and higher 90-day mortality (56% vs 28%, P < .001). Serial sampling showed that non-survivors had significantly higher GDF-15 levels at all time points (P < .001 for all). Furthermore, non-survivors displayed increasing and survivors declining GDF-15 levels during the first days in CS. Higher levels of GDF-15 were independently associated with mortality. A GDF-1512h cutoff >7000 ng/L was identified as a strong predictor of death (OR 5.0; 95% CI 1.9-3.8, P = .002). Adding GDF-1512h >7000 ng/L to the CardShock risk score improved discrimination and risk stratification for 90-day mortality. CONCLUSIONS GDF-15 levels are highly elevated in CS and associated with markers of systemic hypoperfusion and end-organ dysfunction. GDF-15 helps to discriminate survivors from non-survivors very early in CS.
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Affiliation(s)
- Mari Hongisto
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Anu Kataja
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Tuukka Tarvasmäki
- Cardiology, Helsinki University and Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Anu Holopainen
- Department of Clinical Chemistry, Institute of Clinical Medicine, University of Eastern Finland and ISLAB, Kuopio, Finland
| | - Tuija Javanainen
- Cardiology, Helsinki University and Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Raija Jurkko
- Cardiology, Helsinki University and Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Toni Jäntti
- Cardiology, Helsinki University and Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Antoine Kimmoun
- Medical Intensive Care Unit Brabois, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, INSERM U1116, Université de Lorraine, Nancy, France
| | - Bruno Levy
- Service de Réanimation Médicale Brabois, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, 54511 Vandoeuvre-les-Nancy, INSERM U1116, Faculté de Médecine, 54511Vandoeuvre-les-Nancy and Université de Lorraine, Nancy, France
| | - Alexandre Mebazaa
- INSERM U942, APHP, Hôpitaux Universitaires Saint Louis Lariboisière and University Paris Diderot, Paris, France
| | - Kari Pulkki
- Department of Clinical Chemistry, University of Turku and Turku University Hospital, Turku, Finland
| | - Alessandro Sionis
- Acute and Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, CIBER-CV, Universitat Autonoma de Barcelona, Spain
| | - Heli Tolppanen
- Cardiology, Helsinki University and Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Kai C Wollert
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany; Division of Molecular and Translational Cardiology, Hannover Medical School, Hannover, Germany
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Johan Lassus
- Cardiology, Helsinki University and Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
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Jäntti T, Tarvasmäki T, Harjola VP, Parissis J, Pulkki K, Javanainen T, Tolppanen H, Jurkko R, Hongisto M, Kataja A, Sionis A, Silva-Cardoso J, Banaszewski M, Spinar J, Mebazaa A, Lassus J. Hypoalbuminemia is a frequent marker of increased mortality in cardiogenic shock. PLoS One 2019; 14:e0217006. [PMID: 31095609 PMCID: PMC6522037 DOI: 10.1371/journal.pone.0217006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/02/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The prevalence of hypoalbuminemia, early changes of plasma albumin (P-Alb) levels, and their effects on mortality in cardiogenic shock are unknown. MATERIALS AND METHODS P-Alb was measured from serial blood samples in 178 patients from a prospective multinational study on cardiogenic shock. The association of hypoalbuminemia with clinical characteristics and course of hospital stay including treatment and procedures was assessed. The primary outcome was all-cause 90-day mortality. RESULTS Hypoalbuminemia (P-Alb < 34g/L) was very frequent (75%) at baseline in patients with cardiogenic shock. Patients with hypoalbuminemia had higher mortality than patients with normal albumin levels (48% vs. 23%, p = 0.004). Odds ratio for death at 90 days was 2.4 [95% CI 1.5-4.1] per 10 g/L decrease in baseline P-Alb. The association with increased mortality remained independent in regression models adjusted for clinical risk scores developed for cardiogenic shock (CardShock score adjusted odds ratio 2.0 [95% CI 1.1-3.8], IABP-SHOCK II score adjusted odds ratio 2.5 [95%CI 1.2-5.0]) and variables associated with hypoalbuminemia at baseline (adjusted odds ratio 2.9 [95%CI 1.2-7.1]). In serial measurements, albumin levels decreased at a similar rate between 0h and 72h in both survivors and nonsurvivors (ΔP-Alb -4.6 g/L vs. 5.4 g/L, p = 0.5). While the decrease was higher for patients with normal P-Alb at baseline (p<0.001 compared to patients with hypoalbuminemia at baseline), the rate of albumin decrease was not associated with outcome. CONCLUSIONS Hypoalbuminemia was a frequent finding early in cardiogenic shock, and P-Alb levels decreased during hospital stay. Low P-Alb at baseline was associated with mortality independently of other previously described risk factors. Thus, plasma albumin measurement should be part of the initial evaluation in patients with cardiogenic shock. TRIAL REGISTRATION NCT01374867 at ClinicalTrials.gov.
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Affiliation(s)
- Toni Jäntti
- Cardiology, University of Helsinki and Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
- * E-mail:
| | - Tuukka Tarvasmäki
- Cardiology, University of Helsinki and Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - John Parissis
- Heart Failure Clinic and Secondary Cardiology Department, Attikon University Hospital, Athens, Greece
| | - Kari Pulkki
- Laboratory Division, Turku University Hospital and Department of Clinical Chemistry, University of Turku, Turku, Finland
| | - Tuija Javanainen
- Cardiology, University of Helsinki and Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Heli Tolppanen
- Cardiology, University of Helsinki and Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Raija Jurkko
- Cardiology, University of Helsinki and Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Mari Hongisto
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Anu Kataja
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB‐SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jose Silva-Cardoso
- Department of Cardiology, CINTESIS, Porto Medical School, São João Hospital Center, University of Porto, Porto, Portugal
| | - Marek Banaszewski
- Intensive Cardiac Therapy Clinic, Institute of Cardiology, Warsaw, Poland
| | - Jindrich Spinar
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
| | - Alexandre Mebazaa
- INSERM U942, University Paris Diderot and Department of Anesthesia and Critical Care, Hôpital Lariboisière, APHP, Paris, France
| | - Johan Lassus
- Cardiology, University of Helsinki and Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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Affiliation(s)
- A. Kataja
- Emergency Medicine; University of Helsinki; Helsinki University Hospital; Helsinki Finland
| | - V.-P. Harjola
- Emergency Medicine; University of Helsinki; Helsinki University Hospital; Helsinki Finland
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Kataja A, Tarvasmäki T, Lassus J, Køber L, Sionis A, Spinar J, Parissis J, Carubelli V, Cardoso J, Banaszewski M, Marino R, Nieminen MS, Mebazaa A, Harjola VP. Altered mental status predicts mortality in cardiogenic shock – results from the CardShock study. European Heart Journal: Acute Cardiovascular Care 2017; 7:38-44. [DOI: 10.1177/2048872617702505] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Altered mental status is among the signs of hypoperfusion in cardiogenic shock, the most severe form of acute heart failure. The aim of this study was to investigate the prevalence of altered mental status, to identify factors associating with it, and to assess the prognostic significance of altered mental status in cardiogenic shock. Methods: Mental status was assessed at presentation of shock in 215 adult cardiogenic shock patients in a multinational, prospective, observational study. Clinical picture, biochemical variables, and short-term mortality were compared between patients presenting with altered and normal mental status. Results: Altered mental status was detected in 147 (68%) patients, whereas 68 (32%) patients had normal mental status. Patients with altered mental status were older (68 vs. 64 years, p=0.04) and more likely to have an acute coronary syndrome than those with normal mental status (85% vs. 74%, p=0.04). Altered mental status was associated with lower systolic blood pressure (76 vs. 80 mmHg, p=0.03) and lower arterial pH (7.27 vs. 7.35, p<0.001) as well as higher levels of blood lactate (3.4 vs. 2.3 mmol/l, p<0.001) and blood glucose (11.4 vs. 9.0 mmol/l, p=0.01). Low arterial pH (adjusted odds ratio 1.6 (1.1–2.2), p=0.02) was the only factor independently associated with altered mental status. Ninety-day mortality was significantly higher (51% vs. 22%, p<0.001) among patients with altered mental status. Conclusions: Altered mental status is a common clinical sign of systemic hypoperfusion in cardiogenic shock and is associated with poor outcome. It is also associated with several biochemical findings that reflect inadequate tissue perfusion, of which low arterial pH is independently associated with altered mental status.
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Affiliation(s)
- Anu Kataja
- Division of Emergency Medicine, University of Helsinki, Helsinki University Hospital, Finland
| | - Tuukka Tarvasmäki
- Division of Emergency Medicine, University of Helsinki, Helsinki University Hospital, Finland
| | - Johan Lassus
- Cardiology, University of Helsinki, Heart and Lung Centre, Helsinki University Hospital, Finland
| | - Lars Køber
- Rigshospitalet, Copenhagen University Hospital, Division of Heart Failure, Pulmonary Hypertension and Heart Transplantation, Denmark
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universitat de Barcelona, Spain
| | - Jindrich Spinar
- Internal Cardiology Department, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - John Parissis
- Heart Failure Clinic, Attikon University Hospital, Athens, Greece
| | - Valentina Carubelli
- Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Italy
| | - Jose Cardoso
- CINTESIS – Centre for Health Technology and Services Research, Department of Cardiology, Faculty of Medicine, University of Porto, São João Medical Centre, Portugal
| | - Marek Banaszewski
- Intensive Cardiac Therapy Clinic, Institute of Cardiology, Warsaw, Poland
| | - Rossella Marino
- Department of Medical Sciences and Translational Medicine, University of Rome Sapienza, Emergency Department, Sant’ Andrea Hospital, Italy
| | - Markku S Nieminen
- Cardiology, University of Helsinki, Heart and Lung Centre, Helsinki University Hospital, Finland
| | - Alexandre Mebazaa
- INSERM U942, Hopital Lariboisiere, APHP and University Paris Diderot, France
| | - Veli-Pekka Harjola
- Division of Emergency Medicine, University of Helsinki, Helsinki University Hospital, Finland
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Kataja A, Tarvasmäki T, Lassus J, Cardoso J, Mebazaa A, Køber L, Sionis A, Spinar J, Carubelli V, Banaszewski M, Marino R, Parissis J, Nieminen MS, Harjola VP. The association of admission blood glucose level with the clinical picture and prognosis in cardiogenic shock - Results from the CardShock Study. Int J Cardiol 2016; 226:48-52. [PMID: 27788389 DOI: 10.1016/j.ijcard.2016.10.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/09/2016] [Accepted: 10/14/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Critically ill patients often present with hyperglycemia, regardless of previous history of diabetes mellitus (DM). Hyperglycemia has been associated with adverse outcome in acute myocardial infarction and acute heart failure. We investigated the association of admission blood glucose level with the clinical picture and short-term mortality in cardiogenic shock (CS). METHODS Consecutively enrolled CS patients were divided into five categories according to plasma glucose level at the time of enrolment: hypoglycemia (glucose <4.0mmol/L), normoglycemia (4.0-7.9mmol/L), mild (8.0-11.9mmol/L), moderate (12.0-15.9mmol/L), and severe (≥16.0mmol/L) hyperglycemia. Clinical presentation, biochemistry, and short-term mortality were compared between the groups. RESULTS Plasma glucose level of 211 CS patients was recorded. Glucose levels were distributed equally between normoglycemia (26% of patients), mild (27%), moderate (19%) and severe (25%) hyperglycemia, while hypoglycemia (2%) was rare. Severe hyperglycemia was associated with higher blood leukocyte count (17.3 (5.8) E9/L), higher lactate level (4.4 (3.3-8.4) mmol/L) and lower arterial pH (7.23 (0.14)) compared with normoglycemia or mild to moderate hyperglycemia (p<0.001 for all). In-hospital mortality was highest among hypoglycemic (60%) and severely hyperglycemic (56%) patients, compared with 22% in normoglycemic group (p<0.01). Severe hyperglycemia was an independent predictor of in-hospital mortality (OR 3.7, 95% CI 1.19-11.7, p=0.02), when adjusted for age, gender, LVEF, lactate, and DM. CONCLUSIONS Admission blood glucose level has prognostic significance in CS. Mortality is highest among patients with severe hyperglycemia or hypoglycemia. Severe hyperglycemia is independently associated with high in-hospital mortality in CS. It is also associated with biomarkers of systemic hypoperfusion and stress response.
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Affiliation(s)
- Anu Kataja
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
| | - Tuukka Tarvasmäki
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Johan Lassus
- Cardiology, University of Helsinki, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Jose Cardoso
- CINTESIS - Center for Health Technology and Services Research, Department of Cardiology, Faculty of Medicine, University of Porto, São João Medical Center, Porto, Portugal
| | - Alexandre Mebazaa
- INSERM U942, Hopital Lariboisiere, APHP and University Paris Diderot, Paris, France
| | - Lars Køber
- Rigshospitalet, Copenhagen University Hospital, Division of Heart Failure, Pulmonary Hypertension and Heart Transplantation, Copenhagen, Denmark
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universitat de Barcelona, Barcelona, Spain
| | - Jindrich Spinar
- Internal Cardiology Department, University Hospital Brno and Masaryk University, Brno, Czech republic
| | - Valentina Carubelli
- Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Brescia, Italy
| | - Marek Banaszewski
- Intensive Cardiac Therapy Clinic, Institute of Cardiology, Warsaw, Poland
| | - Rossella Marino
- Department of Medical Sciences and Translational Medicine, University of Rome Sapienza, Emergency Department, Sant''Andrea Hospital, Rome, Italy
| | - John Parissis
- Heart Failure Clinic, Attikon University Hospital, Athens, Greece
| | - Markku S Nieminen
- Cardiology, University of Helsinki, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
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