1
|
Golino M, Morello M, Marazzato J, Blasi F, Chierchia V, Oliva CA, Zappa M, Ageno W, Passi A, Angeli F, De Ponti R. Sex-related differences in non-ischemic myocardial injury in the emergency department: A real-world perspective. Int J Cardiol 2024; 395:131394. [PMID: 37748523 DOI: 10.1016/j.ijcard.2023.131394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/28/2023] [Revised: 07/27/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Myocardial injury is associated with adverse outcomes. No data are reported about sex differences in incidence and factors associated with myocardial injury in an emergency department (ED) setting from a real-world perspective. We aimed to assess whether sex plays a major role in the diagnosis of myocardial injury in the ED. METHODS In this subanalysis of a retrospective study, patients presenting at the ED with at least one high-sensitivity cardiac troponin T (hs-cTnT) value and without acute coronary syndromes diagnosis were compared. RESULTS 31,383 patients were admitted to the ED, 4660 had one hs-cTnT value, and 3937 were enrolled: 1943 females (49.4%) and 1994 males (50.6%). The diagnosis of myocardial injury was higher among men (36.8% vs. 32.9%, p < 0.01). Male sex was independently associated with myocardial injury. An older age, an elevated NT-proB-type Natriuretic Peptide and a lower estimated glomerular filtrate rate were independently associated with myocardial injury in both sexes. CONCLUSIONS In the ED, from a real-world perspective, myocardial injury occurred more frequently in males, and it was associated with older age and the presence of cardiac, lung, and kidney disease but not higher hs-cTnT values.
Collapse
Affiliation(s)
- Michele Golino
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
| | - Matteo Morello
- Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy; School of Cardiology, University of Brescia, 25121 Brescia, Italy
| | - Jacopo Marazzato
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Federico Blasi
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Valentina Chierchia
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Carlo-Agostino Oliva
- Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy; School of Cardiology, University of Brescia, 25121 Brescia, Italy
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049 Tradate, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy
| | - Alberto Passi
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy
| | - Fabio Angeli
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049 Tradate, Italy; Department of Medicine and Technological Innovation (DiMIT), University of Insubria, 21100 Varese, Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; Ospedale di Circolo, ASST Settelaghi, 21100 Varese, Italy
| |
Collapse
|
2
|
Avula V, Karacsonyi J, Kostantinis S, Simsek B, Rangan BV, Gutierrez AA, Burke MN, Garcia S, Mooney M, Sorajja P, Traverse JH, Poulose A, Chavez I, Wang Y, Goessl M, Brilakis ES. Incidence, Treatment, and Outcomes of Coronary Artery Perforation During Percutaneous Coronary Intervention. J Invasive Cardiol 2022; 34:E499-E504. [PMID: 35714223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To examine the incidence, treatment and outcomes of perforation during percutaneous coronary intervention (PCI). BACKGROUND Coronary perforation is a potentially life-threatening PCI complication. METHODS We examined the clinical, angiographic, and procedural characteristics, management, and outcomes of coronary perforation at a tertiary care institution. RESULTS Between 2014 and 2019, perforation occurred in 70 of 10,278 PCIs (0.7%). Patient age was 71 ± 12 years, 66% were men, and 30% had prior coronary artery bypass graft surgery. Among perforation cases, the prevalence of chronic total occlusions was 33%, moderate/severe calcification was 66% and moderate/severe tortuosity was 41%. The frequency of Ellis class 1, 2, and 3 perforations was 14%, 50%, and 36%, respectively. Most (n = 51; 73%) were large vessel perforations, 16 (23%) were distal vessel perforations and 3 (4%) were collateral vessel perforations (1 septal and 2 epicardial). Hypotension occurred in 26%, pericardial effusion in 36% and tamponade in 13%; 47% of perforations did not have clinical consequences. Perforations were most often treated with prolonged balloon inflation (63%), reversal of anticoagulation (39%), and covered stent implantation (33%). Technical and procedural success were 73% and 60%, respectively, and major periprocedural adverse cardiac events occurred in 21% of the patients. Three patients (4%) required emergent CABG surgery and four (6%) died. CONCLUSIONS Coronary perforation is an infrequent complication of PCI. Most perforations are large vessel perforations and often require further intervention. The incidence of death or emergent cardiac surgery is low.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emmanouil S Brilakis
- Emmanouil S. Brilakis, MD, PhD, Minneapolis Heart Institute, 920 E 28th Street #300, Minneapolis, MN 55407 USA.
| |
Collapse
|
3
|
Weber B, Siddiqi H, Zhou G, Vieira J, Kim A, Rutherford H, Mitre X, Feeley M, Oganezova K, Varshney AS, Bhatt AS, Nauffal V, Atri DS, Blankstein R, Karlson EW, Di Carli M, Baden LR, Bhatt DL, Woolley AE. Relationship Between Myocardial Injury During Index Hospitalization for SARS-CoV-2 Infection and Longer-Term Outcomes. J Am Heart Assoc 2022; 11:e022010. [PMID: 34970914 PMCID: PMC9075193 DOI: 10.1161/jaha.121.022010] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/15/2021] [Indexed: 12/15/2022]
Abstract
Background Myocardial injury in patients with COVID-19 is associated with increased mortality during index hospitalization; however, the relationship to long-term sequelae of SARS-CoV-2 is unknown. This study assessed the relationship between myocardial injury (high-sensitivity cardiac troponin T level) during index hospitalization for COVID-19 and longer-term outcomes. Methods and Results This is a prospective cohort of patients who were hospitalized at a single center between March and May 2020 with SARS-CoV-2. Cardiac biomarkers were systematically collected. Outcomes were adjudicated and stratified on the basis of myocardial injury. The study cohort includes 483 patients who had high-sensitivity cardiac troponin T data during their index hospitalization. During index hospitalization, 91 (18.8%) died, 70 (14.4%) had thrombotic complications, and 126 (25.6%) had cardiovascular complications. By 12 months, 107 (22.2%) died. During index hospitalization, 301 (62.3%) had cardiac injury (high-sensitivity cardiac troponin T≧14 ng/L); these patients had 28.6%, 32.2%, and 33.2% mortality during index hospitalization, at 6 months, and at 12 months, respectively, compared with 4.1%, 4.9%, and 4.9% mortality for those with low-level positive troponin and 0%, 0%, and 0% for those with undetectable troponin. Of 392 (81.2%) patients who survived the index hospitalization, 94 (24%) had at least 1 readmission within 12 months, of whom 61 (65%) had myocardial injury during the index hospitalization. Of 377 (96%) patients who were alive and had follow-up after the index hospitalization, 211 (56%) patients had a documented, detailed clinical assessment at 6 months. A total of 78 of 211 (37.0%) had ongoing COVID-19-related symptoms; 34 of 211 (16.1%) had neurocognitive decline, 8 of 211 (3.8%) had increased supplemental oxygen requirements, and 42 of 211 (19.9%) had worsening functional status. Conclusions Myocardial injury during index hospitalization for COVID-19 was associated with increased mortality and may predict who are more likely to have postacute sequelae of COVID-19. Among patients who survived their index hospitalization, the incremental mortality through 12 months was low, even among troponin-positive patients.
Collapse
Affiliation(s)
- Brittany Weber
- Division of Cardiovascular MedicineDepartment of Medicine, Heart and Vascular CenterBrigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Hasan Siddiqi
- Division of Cardiovascular MedicineDepartment of Medicine, Heart and Vascular CenterBrigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Guohai Zhou
- Center for Clinical InvestigationBrigham and Women's HospitalBostonMA
| | - Jefferson Vieira
- Division of Cardiovascular MedicineDepartment of Medicine, Heart and Vascular CenterBrigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Andy Kim
- Division of Infectious Diseases, Brigham and Women’s HospitalBostonMA
| | - Henry Rutherford
- Division of Infectious Diseases, Brigham and Women’s HospitalBostonMA
| | - Xhoi Mitre
- Division of Infectious Diseases, Brigham and Women’s HospitalBostonMA
| | - Monica Feeley
- Division of Infectious Diseases, Brigham and Women’s HospitalBostonMA
| | - Karina Oganezova
- Division of Infectious Diseases, Brigham and Women’s HospitalBostonMA
| | - Anubodh S. Varshney
- Division of Cardiovascular MedicineDepartment of Medicine, Heart and Vascular CenterBrigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Ankeet S. Bhatt
- Division of Cardiovascular MedicineDepartment of Medicine, Heart and Vascular CenterBrigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Victor Nauffal
- Division of Cardiovascular MedicineDepartment of Medicine, Heart and Vascular CenterBrigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Deepak S. Atri
- Division of Cardiovascular MedicineDepartment of Medicine, Heart and Vascular CenterBrigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Ron Blankstein
- Division of Cardiovascular MedicineDepartment of Medicine, Heart and Vascular CenterBrigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Elizabeth W. Karlson
- Division of Rheumatology, Inflammation, and ImmunityBrigham and Women’s Hospital Harvard Medical SchoolBostonMA
| | - Marcelo Di Carli
- Division of Cardiovascular MedicineDepartment of Medicine, Heart and Vascular CenterBrigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Lindsey R. Baden
- Division of Infectious Diseases, Brigham and Women’s HospitalBostonMA
| | - Deepak L. Bhatt
- Division of Cardiovascular MedicineDepartment of Medicine, Heart and Vascular CenterBrigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Ann E. Woolley
- Division of Infectious Diseases, Brigham and Women’s HospitalBostonMA
| |
Collapse
|
4
|
Chew MS, Puelacher C, Patel A, Hammarskjöld F, Lyckner S, Kollind M, Jawad M, Andersson U, Fredrikson M, Sperber J, Johnsson P, Elander L, Zeuchner J, Linhardt M, De Geer L, Rolander WG, Gagnö G, Didriksson H, Pearse R, Mueller C, Andersson H. Identification of myocardial injury using perioperative troponin surveillance in major noncardiac surgery and net benefit over the Revised Cardiac Risk Index. Br J Anaesth 2021; 128:26-36. [PMID: 34857357 DOI: 10.1016/j.bja.2021.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 09/12/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients with perioperative myocardial injury are at risk of death and major adverse cardiovascular and cerebrovascular events (MACCE). The primary aim of this study was to determine optimal thresholds of preoperative and perioperative changes in high-sensitivity cardiac troponin T (hs-cTnT) to predict MACCE and mortality. METHODS Prospective, observational, cohort study in patients ≥50 yr of age undergoing elective major noncardiac surgery at seven hospitals in Sweden. The exposures were hs-cTnT measured before and days 0-3 after surgery. Two previously published thresholds for myocardial injury and two thresholds identified using receiver operating characteristic analyses were evaluated using multivariable logistic regression models and externally validated. The weighted comparison net benefit method was applied to determine the additional value of hs-cTnT thresholds when compared with the Revised Cardiac Risk Index (RCRI). The primary outcome was a composite of 30-day all-cause mortality and MACCE. RESULTS We included 1291 patients between April 2017 and December 2020. The primary outcome occurred in 124 patients (9.6%). Perioperative increase in hs-cTnT ≥14 ng L-1 above preoperative values provided statistically optimal model performance and was associated with the highest risk for the primary outcome (adjusted odds ratio 2.9, 95% confidence interval 1.8-4.7). Validation in an independent, external cohort confirmed these findings. A net benefit over RCRI was demonstrated across a range of clinical thresholds. CONCLUSIONS Perioperative increases in hsTnT ≥14 ng L-1 above baseline values identifies acute perioperative myocardial injury and provides a net prognostic benefit when added to RCRI for the identification of patients at high risk of death and MACCE. CLINICAL TRIAL REGISTRATION NCT03436238.
Collapse
Affiliation(s)
- Michelle S Chew
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Christian Puelacher
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University Basel, Basel, Switzerland
| | - Akshaykumar Patel
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Fredrik Hammarskjöld
- Department of Anesthesiology and Intensive Care, Ryhov County Hospital, Jönköping, Sweden
| | - Sara Lyckner
- Department of Anesthesiology, Mälarsjukhuset, Centre for Clinical Research Sörmland, Eskilstuna, Sweden
| | - Malin Kollind
- Department of Anaesthesia and Intensive Care, Centralsjukhuset Kristianstad, Kristianstad, Sweden
| | - Monir Jawad
- Department of Anaesthesia and Intensive Care, Centralsjukhuset Kristianstad, Kristianstad, Sweden; Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Ulrika Andersson
- Department of Clinical Sciences Lund, Anaesthesiology and Intensive Care, Skåne University Hospital Lund, Lund University, Sweden
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Health, Linköping University, Linköping, Sweden
| | - Jesper Sperber
- Department of Anesthesiology, Mälarsjukhuset, Centre for Clinical Research Sörmland, Eskilstuna, Sweden
| | - Patrik Johnsson
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Skåne University Hospital Malmö, Lund University, Sweden
| | - Louise Elander
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Vrinnevi Hospital, Norrköping, Sweden
| | - Jakob Zeuchner
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Vrinnevi Hospital, Norrköping, Sweden
| | - Michael Linhardt
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lina De Geer
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Wictor Gääw Rolander
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Gagnö
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Helén Didriksson
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Rupert Pearse
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Christian Mueller
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University Basel, Basel, Switzerland
| | - Henrik Andersson
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
5
|
Zhu H, Zhang Y, Pei Z, Guo Y, Yang C, Song Y, Guo X, Wang F. Manifestation of cardiac injury in hospitalised patients with COVID-19. Int J Clin Pract 2021; 75:e14197. [PMID: 33792126 PMCID: PMC8250309 DOI: 10.1111/ijcp.14197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 03/27/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND COVID-19 has been sweeping the world since it emerged in late December 2019. However, little is known about cardiac injury in hospitalised COVID-19 patients. This study is to investigate the incidence and characteristics of myocardial injury in COVID-19 patients admitted in hospital. METHODS Fifty-four COVID-19 patients were enrolled in one ward in Tongji Hospital, Wuhan, China, and 5 were excluded caused by missing cardiac troponin I levels. Forty-nine participants were included in the final analysis. The clinical manifestations of hospitalised patients were analysed. Patients were divided into two groups, cardiac injury group and non-cardiac injury group, based on whether cardiac troponin I was elevated. Epidemic characteristics and laboratory test results were analysed in these two group. RESULTS The average age of patients in the cardiac injury group was older (68.0 years old) than that in the non-cardiac injury group (61.5 years old). The percentages of patients with diabetes and critically severe pneumonia in the cardiac injury group were 38.5% and 38.5% respectively. Lymphocytes were decreased in 53.1% of all enrolled patients, but this decrease was more prominent (76.9%) in the cardiac injury group than the non-cardiac injury group (44.4%). Patients in the cardiac injury group also had lower platelet counts. CONCLUSIONS COVID-19 can cause cardiac injury in many patients. It is more common in older patients and patients with diabetes and is associated with a significant decrease in lymphocytes.
Collapse
Affiliation(s)
- Huolan Zhu
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing HospitalChinese Academy of Medical SciencesBeijingChina
- Peking Union Medical CollegeChinese Academy of Medical ScienceBeijingChina
| | - Yanfei Zhang
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing HospitalChinese Academy of Medical SciencesBeijingChina
| | - Zuowei Pei
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing HospitalChinese Academy of Medical SciencesBeijingChina
| | - Ying Guo
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing HospitalChinese Academy of Medical SciencesBeijingChina
| | - Chenguang Yang
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing HospitalChinese Academy of Medical SciencesBeijingChina
| | - Yan Song
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing HospitalChinese Academy of Medical SciencesBeijingChina
- Tongji HospitalWuhanChina
| | | | - Fang Wang
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing HospitalChinese Academy of Medical SciencesBeijingChina
- Tongji HospitalWuhanChina
| |
Collapse
|
6
|
González-Hadad A, Ordoñez CA, Parra MW, Caicedo Y, Padilla N, Millán M, García A, Vidal-Carpio JM, Pino LF, Herrera MA, Quintero L, Hernández F, Flórez G, Rodríguez-Holguín F, Salcedo A, Serna JJ, Franco MJ, Ferrada R, Navsaria PH. Damage control in penetrating cardiac trauma. Colomb Med (Cali) 2021; 52:e4034519. [PMID: 34188321 PMCID: PMC8216058 DOI: 10.25100/cm.v52i2.4519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/20/2020] [Accepted: 03/18/2021] [Indexed: 11/15/2022] Open
Abstract
Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients.
Collapse
Affiliation(s)
- Adolfo González-Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
| | - Carlos A Ordoñez
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL, USA
| | - Yaset Caicedo
- Fundacion Valle del Lili, Centro de Investigaciones Clinicas (CIC), Cali, Colombia
| | - Natalia Padilla
- Fundacion Valle del Lili, Centro de Investigaciones Clinicas (CIC), Cali, Colombia
| | - Mauricio Millán
- Universidad Icesi, Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Transplant Surgery, Cali, Colombia
| | - Alberto García
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Jenny Marcela Vidal-Carpio
- Hospital General Teofilo Davila, Servicio de Emergencias, Cuenca, Ecuador
- Universidad de Cuenca, Department of Surgery, Cuenca, Ecuador
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Laureano Quintero
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
| | - Fabian Hernández
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Guillermo Flórez
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Alexander Salcedo
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - José Julián Serna
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - María Josefa Franco
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Ricardo Ferrada
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
| | - Pradeep H Navsaria
- University of Cape Town, Faculty of Health Sciences, Groote Schuur Hospital, Trauma Center, Anzio Road, Observatory, Cape Town, South Africa
| |
Collapse
|
7
|
He X, Wang L, Wang H, Xie Y, Yu Y, Sun J, Yan J, Du Y, Shen Y, Zeng H. Factors associated with acute cardiac injury and their effects on mortality in patients with COVID-19. Sci Rep 2020; 10:20452. [PMID: 33235220 PMCID: PMC7686361 DOI: 10.1038/s41598-020-77172-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 07/24/2020] [Accepted: 10/19/2020] [Indexed: 12/15/2022] Open
Abstract
To determine the incidence of acute cardiac injury (ACI), the factors associated with ACI and the in-hospital mortality in patients with COVID-19, especially in severe patients. All consecutive in-patients with laboratory-confirmed COVID-19 from Tongji Hospital in Wuhan during February 1 and March 29, 2020 were included. The demographic, clinical characteristics, laboratory, radiological and treatment data were collected. Univariate and Firth logistic regression analyses were used to identify factors associated with ACI and in-hospital mortality, and Kaplan-Meier method was used to estimate cumulative in-hospital mortality. Among 1031 patients included, 215 (20.7%) had ACI and 501 (48.6%) were severe cases. Overall, 165 patients died; all were from the severe group, and 131 (79.39%) had ACI. ACI (OR = 2.34, P = 0.009), male gender (OR = 2.58, P = 0.001), oximeter oxygen saturation (OR = 0.90, P < 0.001), lactate dehydrogenase (OR = 3.26, P < 0.001), interleukin-6 (IL-6) (OR = 8.59, P < 0.001), high sensitivity C-reactive protein (hs-CRP) (OR = 3.29, P = 0.016), N-terminal pro brain natriuretic peptide (NT-proBNP) (OR = 2.94, P = 0.001) were independent risk factors for the in-hospital mortality in severe patients. The mortality was significantly increased among severe patients with elevated hs-CRP, IL-6, hs-cTnI, and/or NT-proBNP. Moreover, the mortality was significantly higher in patients with elevation of both hs-cTnI and NT proBNP than in those with elevation of either of them. ACI develops in a substantial proportion of patients with COVID-19, and is associated with the disease severity and in-hospital mortality. A combination of hs-cTnI and NT-proBNP is valuable in predicting the mortality.
Collapse
Affiliation(s)
- Xingwei He
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Luyan Wang
- Heart Center, Peking University Peoples Hospital, Beijing, China
| | - Hongjie Wang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yang Xie
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yongfu Yu
- Department of Clinical Epidemiology, Aarhus University Hospital, Arhus, Denmark
| | - Jianhua Sun
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jiangbo Yan
- Medical Research Institute, Wuhan University Renmin Hospital, Wuhan University, Wuhan, 430060, China
| | - Yuxin Du
- Medical Research Institute, Wuhan University Renmin Hospital, Wuhan University, Wuhan, 430060, China
| | - Yin Shen
- Medical Research Institute, Wuhan University Renmin Hospital, Wuhan University, Wuhan, 430060, China.
| | - Hesong Zeng
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| |
Collapse
|
8
|
Naeem KB, Hachim MY, Hachim IY, Chkhis A, Quadros R, Hannawi H, Al Salmi I, Alokaily F, Hannawi S. Acute cardiac injury is associated with adverse outcomes, including mortality in COVID-19 patients. A single-center experience. Saudi Med J 2020; 41:1204-1210. [PMID: 33130840 PMCID: PMC7804230 DOI: 10.15537/smj.2020.11.25466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To evaluate acute cardiac injury in COVID-19 patients and its association with adverse outcomes including mortality in the United Arab Emirates (UAE) population. METHODS A retrospective study conducted between February and June 2020 in Dubai, UAE, for all laboratory-confirmed Coronavirus disease-19 patients. Demographic, clinical, laboratory, radiological, and clinical outcomes were compared between patients with and without acute cardiac injury. RESULTS During the study period, 203 patients were included, of which, 44 (21.7%) had evidence of acute cardiac injury. Compared with patients without acute cardiac injury, patients with acute cardiac injury were: older, had more shortness of breath, diabetes, hypertension, and more bilateral airspace shadowing on admission chest radiography. These patients also had a higher neutrophil count, C-reactive protein, procalcitonin, ferritin, D-dimers and lactate dehydrogenase but lower lymphocyte count. Regarding outcomes, these patients had higher intensive care admissions; a higher rate of complications including acute kidney and liver injury, acidosis, septic shock, acute respiratory distress syndrome, needed more mechanical ventilation, and had a significantly higher risk of death. CONCLUSION Acute cardiac injury is common among Coronavirus disease-19 patients. These patients present with higher comorbidities, have high inflammatory markers and have greater risk for in-hospital multi-organ damage, need for mechanical ventilation, and death. Prompt full assessment and intervention are recommended.
Collapse
Affiliation(s)
- Kashif B Naeem
- Ministry of Health and Prevention, Mohammed bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates. E-mail.
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Karbalai Saleh S, Oraii A, Soleimani A, Hadadi A, Shajari Z, Montazeri M, Moradi H, Talebpour M, Sadat Naseri A, Balali P, Akhbari M, Ashraf H. The association between cardiac injury and outcomes in hospitalized patients with COVID-19. Intern Emerg Med 2020; 15:1415-1424. [PMID: 32772283 PMCID: PMC7415198 DOI: 10.1007/s11739-020-02466-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/31/2020] [Indexed: 02/06/2023]
Abstract
In this study, we aimed to assess the association between development of cardiac injury and short-term mortality as well as poor in-hospital outcomes in hospitalized patients with COVID-19. In this prospective, single-center study, we enrolled hospitalized patients with laboratory-confirmed COVID-19 and highly suspicious patients with compatible chest computed tomography features. Cardiac injury was defined as a rise of serum high sensitivity cardiac Troponin-I level above 99th percentile (men: > 26 ng/mL, women: > 11 ng/mL). A total of 386 hospitalized patients with COVID-19 were included. Cardiac injury was present among 115 (29.8%) of the study population. The development of cardiac injury was significantly associated with a higher in-hospital mortality rate compared to those with normal troponin levels (40.9% vs 11.1%, p value < 0.001). It was shown that patients with cardiac injury had a significantly lower survival rate after a median follow-up of 18 days from symptom onset (p log-rank < 0.001). It was further demonstrated in the multivariable analysis that cardiac injury could possibly increase the risk of short-term mortality in hospitalized patients with COVID-19 (HR = 1.811, p-value = 0.023). Additionally, preexisting cardiovascular disease, malignancy, blood oxygen saturation < 90%, leukocytosis, and lymphopenia at presentation were independently associated with a greater risk of developing cardiac injury. Development of cardiac injury in hospitalized patients with COVID-19 was significantly associated with higher rates of in-hospital mortality and poor in-hospital outcomes. Additionally, it was shown that development of cardiac injury was associated with a lower short-term survival rate compared to patients without myocardial damage and could independently increase the risk of short-term mortality by nearly two-fold.
Collapse
Affiliation(s)
- Shahrokh Karbalai Saleh
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Oraii
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Soleimani
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azar Hadadi
- Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Shajari
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Montazeri
- Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hedieh Moradi
- Department of Pathology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Talebpour
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Sadat Naseri
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pargol Balali
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Akhbari
- Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Haleh Ashraf
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Hasan-Abad Sq., Imam Khomeini St., Tehran, 1136746911, Iran.
- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
10
|
Zhang K, Alfirevic A, Ramos D, Liang C, Soltesz EG, Duncan AE. Neither Preoperative Pulse Pressure nor Systolic Blood Pressure Is Associated With Cardiac Complications After Coronary Artery Bypass Grafting. Anesth Analg 2020; 131:1491-1499. [PMID: 33079872 DOI: 10.1213/ane.0000000000005124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Increased pulse pressure has been associated with adverse cardiovascular events, cardiac and all-cause mortality in surgical and nonsurgical patients. Whether increased pulse pressure worsens myocardial injury and dysfunction after cardiac surgery, however, has not been fully characterized. We examined whether cardiac surgical patients with elevated pulse pressure are more susceptible to myocardial injury, dysfunction, cardiac-related complications, and mortality. Secondarily, we examined whether pulse pressure was a stronger predictor of the outcomes than systolic blood pressure. METHODS This retrospective observational study included adult cardiac surgical patients having elective isolated on-pump coronary artery bypass grafting (CABG) between 2010 and 2017 at the Cleveland Clinic. The association between elevated pulse pressure and (1) perioperative myocardial injury, measured by postoperative troponin-T concentrations, (2) perioperative myocardial dysfunction, assessed by the requirement for perioperative inotropic support using the modified inotropic score (MIS), and (3) cardiovascular complications assessed by the composite outcome of postoperative mechanical circulatory assistance or in-hospital mortality were assessed using multivariable linear regression models. Secondarily, the association between pulse pressure versus systolic blood pressure and the outcomes were compared. RESULTS Of 2704 patients who met the inclusion/exclusion criteria, complete data were available for 2003 patients. Increased pulse pressure over 40 mm Hg was associated with elevated postoperative troponin-T level, estimated to be 1.05 (97.5% confidence interval [CI], 1.02-1.09; P < .001) times higher per 10 mm Hg increase in pulse pressure. The association between pulse pressure and myocardial dysfunction and the composite outcome of cardiovascular complications and death were not significant. There was no difference in the association with pulse pressure versus systolic blood pressure and troponin-T concentrations. CONCLUSIONS Elevated preoperative pulse pressure was associated with a modest increase in postoperative troponin-T concentrations, but not postoperative cardiovascular complications or in-hospital mortality in patients having CABG. Pulse pressure was not a better predictor than systolic blood pressure.
Collapse
Affiliation(s)
| | | | | | - Chen Liang
- Departments of Quantitative Health Sciences and Outcomes Research
| | | | - Andra E Duncan
- Department of Cardiothoracic Anesthesia and Outcomes Research, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
11
|
Liang L, Tang R, Xie Q, Han J, Li W. The clinical effect of recombinant human brain natriuretic peptide on asymptomatic peri-procedural myocardial injury after percutaneous transluminal coronary angioplasty. Sci Rep 2020; 10:15902. [PMID: 32985551 PMCID: PMC7522987 DOI: 10.1038/s41598-020-72710-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 09/04/2020] [Indexed: 01/22/2023] Open
Abstract
To determine the effect of intravenous injection of recombinant human brain natriuretic peptide (rhBNP) on lowering the incidence of asymptomatic peri-procedural myocardial injury (PMI) in patients who underwent coronary stent implantation. In this retrospective observational study, data pooled from a tertiary hospital electronic medical records were used to quantify the troponin enzyme change after patients with coronary artery disease (CAD) were pretreated with rhBNP infusion one day prior to percutaneous coronary intervention (PCI). The primary end point was to analyze the incidence of the elevated high-sensitivity cardiac troponin I serum levels above the upper normal limit after PCI. A total of 156 CAD patients were enrolled into rhBNP group (n = 76) and control group (n = 80). The incidence of asymptomatic PMI was 33% in the rhBNP group versus 51% in the control group (P = 0.02) after PCI. At eight months, the incidences of composite endpoints were 25.3% in the control group and 13% in the rhBNP group (difference, 12.3 percentage points; 95% confidence interval (CI), 0.197 to 1.048; P = 0.061). There were 7 visits in the rhBNP group and 15 visits in the control group for recurrent angina (difference, 10 percentage points; 95% CI 0.168-1.147; P = 0.087). A time-to-event analysis of the composite clinical endpoints and the recurrent angina between the control group and rhBNP group showed that the hazard ratios were 2.566 (95% CI 1.187-5.551; P = 0.017) and 2.607 (95% CI 1.089-6.244; P = 0.032) respectively. The decreased incidence of asymptomatic PMI after PCI and the reduced episodes of recurrent angina at eight months follow-up were associated with the administration of rhBNP infusion prior to PCI.
Collapse
Affiliation(s)
- Ling Liang
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, People's Republic of China
- Department of Cardiology, First Clinical Medical College, Fujian Medical University, Fuzhou, People's Republic of China
| | - Rong Tang
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, People's Republic of China
- Department of Cardiology, First Clinical Medical College, Fujian Medical University, Fuzhou, People's Republic of China
| | - Qiang Xie
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, People's Republic of China
- Department of Cardiology, First Clinical Medical College, Fujian Medical University, Fuzhou, People's Republic of China
| | - Junyu Han
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, People's Republic of China
| | - Weihua Li
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, People's Republic of China.
- Department of Cardiology, First Clinical Medical College, Fujian Medical University, Fuzhou, People's Republic of China.
| |
Collapse
|
12
|
Lala A, Johnson KW, Januzzi JL, Russak AJ, Paranjpe I, Richter F, Zhao S, Somani S, Van Vleck T, Vaid A, Chaudhry F, De Freitas JK, Fayad ZA, Pinney SP, Levin M, Charney A, Bagiella E, Narula J, Glicksberg BS, Nadkarni G, Mancini DM, Fuster V. Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection. J Am Coll Cardiol 2020; 76:533-546. [PMID: 32517963 PMCID: PMC7279721 DOI: 10.1016/j.jacc.2020.06.007] [Citation(s) in RCA: 509] [Impact Index Per Article: 127.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The degree of myocardial injury, as reflected by troponin elevation, and associated outcomes among U.S. hospitalized patients with coronavirus disease-2019 (COVID-19) are unknown. OBJECTIVES The purpose of this study was to describe the degree of myocardial injury and associated outcomes in a large hospitalized cohort with laboratory-confirmed COVID-19. METHODS Patients with COVID-19 admitted to 1 of 5 Mount Sinai Health System hospitals in New York City between February 27, 2020, and April 12, 2020, with troponin-I (normal value <0.03 ng/ml) measured within 24 h of admission were included (n = 2,736). Demographics, medical histories, admission laboratory results, and outcomes were captured from the hospitals' electronic health records. RESULTS The median age was 66.4 years, with 59.6% men. Cardiovascular disease (CVD), including coronary artery disease, atrial fibrillation, and heart failure, was more prevalent in patients with higher troponin concentrations, as were hypertension and diabetes. A total of 506 (18.5%) patients died during hospitalization. In all, 985 (36%) patients had elevated troponin concentrations. After adjusting for disease severity and relevant clinical factors, even small amounts of myocardial injury (e.g., troponin I >0.03 to 0.09 ng/ml; n = 455; 16.6%) were significantly associated with death (adjusted hazard ratio: 1.75; 95% CI: 1.37 to 2.24; p < 0.001) while greater amounts (e.g., troponin I >0.09 ng/dl; n = 530; 19.4%) were significantly associated with higher risk (adjusted HR: 3.03; 95% CI: 2.42 to 3.80; p < 0.001). CONCLUSIONS Myocardial injury is prevalent among patients hospitalized with COVID-19; however, troponin concentrations were generally present at low levels. Patients with CVD are more likely to have myocardial injury than patients without CVD. Troponin elevation among patients hospitalized with COVID-19 is associated with higher risk of mortality.
Collapse
Affiliation(s)
- Anuradha Lala
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Kipp W Johnson
- The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James L Januzzi
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Baim Institute for Clinical Research, Cardiometabolic Trials, Boston, Massachusetts
| | - Adam J Russak
- The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ishan Paranjpe
- The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York
| | - Felix Richter
- The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shan Zhao
- The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York; Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sulaiman Somani
- The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York
| | - Tielman Van Vleck
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Akhil Vaid
- The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Fayzan Chaudhry
- The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York
| | - Jessica K De Freitas
- The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zahi A Fayad
- The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sean P Pinney
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthew Levin
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York; Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexander Charney
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; The Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emilia Bagiella
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jagat Narula
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Benjamin S Glicksberg
- The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Girish Nadkarni
- The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Donna M Mancini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
13
|
Friedman DJ, Pokorney SD, Khanna R, Goldstein L, Atwater BD, Bahnson TD, Daubert JP, Jackson KP, Heist EK, Singh JP, Calkins H, Piccini JP. Catheter Ablation of Atrial Fibrillation With and Without On-Site Cardiothoracic Surgery. J Am Coll Cardiol 2020; 73:2487-2489. [PMID: 31076234 DOI: 10.1016/j.jacc.2019.02.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/01/2019] [Accepted: 02/04/2019] [Indexed: 11/19/2022]
|
14
|
KhabazianZadeh F, Kazemi T, Nakhaee S, Ng PC, Mehrpour O. Acetaminophen poisoning-induced heart injury: a case-based review. Daru 2019; 27:839-851. [PMID: 31713183 PMCID: PMC6895290 DOI: 10.1007/s40199-019-00307-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/11/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Acetaminophen (Paracetamol, APAP) poisoning is frequently implicated in self-harm. Cases of acetaminophen-associated cardiotoxicity are rare in relation to the number of patients with acetaminophen poisoning. A review of acetaminophen cardiotoxicity in 1996 concluded that there was no decisive evidence demonstrating that acetaminophen overdose has a cardiotoxic effect. This review study aimed to determine whether acetaminophen could induce heart injury. METHODS We searched for keywords of acetaminophen, paracetamol, cardiotoxicity, heart injury, heart damage, myocarditis, pericarditis, myocardial infarction, and myocardial ischemia in Web of Science, PubMed, Scopus, Embase, Google Scholar, and Persian databases. The search included articles published from January 1950 to October 2018 with no language restrictions. RESULTS The search yielded 64 citations in English; 36 of the articles were excluded as they were not relevant; 5 articles were excluded since they were duplicates, leaving 23 articles. Full-text articles of the 23 citations were obtained and reviewed. Myocardial infarction, heart dysfunction and failure, cardiac arrhythmias, pericarditis, heart cell necrosis, and sudden cardiac death were reported in acetaminophen overdose. CONCLUSIONS Ddysrhythmias, heart failure, and various other cardiac effects could occur following acetaminophen induced hepatic failure. However, the evidence for direct injury on cardiac tissue is weak. Graphical abstract Potential mechanisms for cardiotoxicity of acetaminophen.
Collapse
Affiliation(s)
- Fatemeh KhabazianZadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran
| | - Tooba Kazemi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran
| | - Patrick C Ng
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran.
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA.
| |
Collapse
|
15
|
Miller KR, Benns MV, Bozeman MC, Franklin GA, Harbrecht BG, Nash NA, Smith JW, Smock WS, Richardson JD. Operative Management of Thoracic Gunshot Wounds: More Aggressive Treatment Has Been Required over Time. Am Surg 2019; 85:1205-1208. [PMID: 31775959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Our department has a database of thoracic gunshot wounds (GSWs), which has cataloged these injury patterns over the past five decades. Prevailing wisdom on the management of these injuries suggested operative treatment beyond tube thoracostomy is not commonly required. It was our clinical impression that the operative treatment required beyond chest tube placement has greatly increased over the past several decades, whereas the operative management of cardiac GSWs seemed to be increasingly infrequent events. To test these observations, we analyzed the treatment of GSWs to the chest and heart in four distinct time periods, categorized as "historical" (1973-1975 and 1988-1990) and "modern" (2005-2007 and 2015-2017). There was a significant increase in emergent thoracotomy, delayed thoracic operations, overall operative interventions, and pulmonary resections from the historical period to the modern era. There was a decline in cardiac injuries treated, whereas the number of injuries remained constant. Mortality was unchanged between the early and later periods. Operative treatment beyond tube thoracostomy was much more prevalent for noncardiac thoracic GSWs in the past two decades than in the prior decades, whereas the number of cardiac wounds treated decreased by half.
Collapse
|
16
|
Stipinovic M, Percin L, Radonic V, Jerkic H, Jurin I, Letilovic T. Periprocedural myocardial and renal injury in patients undergoing elective percutaneous coronary interventions - is there an association? Medicine (Baltimore) 2019; 98:e16989. [PMID: 31651833 PMCID: PMC6824666 DOI: 10.1097/md.0000000000016989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Periprocedural myocardial injury (PMI) and contrast-induced nephropathy (CIN) are frequent complications of percutaneous coronary intervention (PCI) associated with early and late major adverse cardiovascular events. Both conditions are associated with similar risk factors, which could imply their possible association. The aim of our study was to assess the correlation of PMI and early postprocedural creatinine shift (ECS) as a marker of renal injury.A total of 209 hospitalized patients with stable coronary artery disease (CAD) were enrolled, who underwent an elective PCI in a period of 12 months. All patients had their serum high-sensitivity troponin I (hsTnI) measured at baseline and 16 hours after the PCI. PMI was defined according to the elevation of postprocedural hsTnI using criteria provided by both the most recent consensus documents as well as evidence-based data. Renal injury was evaluated using the ECS concept. Serum creatinine (SCr) was also measured at baseline and at 16 hours. ECS was defined as SCr >5% at 16 hours compared to baseline.Although incidence of both PMI (77.5%) and ECS (44.5%) were high, no association of these 2 conditions could be found. Further analyses of our data showed that diabetes is associated with a higher incidence of ECS, while patients on beta-blocker therapy had a lower incidence of ECS.In our study, no association between PMI and ECS was found. Additional studies with a larger number of patients and longer patient observation are needed to assess the correlation between PMI and CIN as well as to validate the attractive, but controversial, concept of ECS as an early marker of CIN.
Collapse
Affiliation(s)
- Mario Stipinovic
- Division of Cardiology, Department of Medicine, University Hospital Merkur, Zagreb
| | - Luka Percin
- Department of Emergency Medicine of the Primorje-Gorski Kotar Country, Rijeka
| | - Vedran Radonic
- Division of Cardiology, Department of Medicine, University Hospital Merkur, Zagreb
| | - Helena Jerkic
- Division of Cardiology, Department of Medicine, University Hospital Merkur, Zagreb
- Division of Cardiology, Department of Medicine, University Hospital Dubrava, Zagreb
| | - Ivana Jurin
- School of Medicine, University of Osijek, Osijek
| | - Tomislav Letilovic
- Division of Cardiology, Department of Medicine, University Hospital Merkur, Zagreb
- School of Medicine, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
17
|
Kinnaird T, Kwok CS, Davies R, Calvert PA, Anderson R, Gallagher S, Sirker A, Ludman P, deBelder M, Stables R, Johnson TW, Kontopantelis E, Curzen N, Mamas M. Coronary perforation complicating percutaneous coronary intervention in patients presenting with an acute coronary syndrome: An analysis of 1013 perforation cases from the British Cardiovascular Intervention Society database. Int J Cardiol 2019; 299:37-42. [PMID: 31253528 DOI: 10.1016/j.ijcard.2019.06.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 11/11/2018] [Revised: 05/15/2019] [Accepted: 06/12/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The evidence base for coronary perforation occurring during percutaneous coronary intervention in patients presenting with an acute coronary syndrome (ACS-PCI) is limited and the specific role of acute pharmacology in its clinical presentation unclear. METHODS AND RESULTS Using the BCIS PCI database, data were analysed on all ACS-PCI procedures performed in England and Wales between 2007 and 2014. Multiple regressions were used to identify predictors of coronary perforation and its association with outcomes. Propensity score matching was used to evaluate the association between differing P2Y12 inhibitors or glycoprotein inhibitors (GPI) and CP. During 270,329 ACS-PCI procedures, 1013 coronary perforations were recorded (0.37%) with a stable annual incidence. In multiple regression analysis, covariates associated with increased frequency of coronary perforation included age, female gender, CTO intervention, number and length of stents used, and rotational atherectomy use, whilst differing P2Y12 inhibitors were not predictive. Using propensity score matching, use of a GPI was independently associated with tamponade (OR 1.50, [1.08-2.06], p = 0.014). The adjusted odds ratios for all clinical outcomes were adversely affected by coronary perforation. CONCLUSIONS Coronary perforation is an infrequent event during ACS-PCI but is closely associated with adverse clinical outcomes. GPI use was associated with higher rates of tamponade.
Collapse
Affiliation(s)
- Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, UK; Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, UK.
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, UK; Royal Stoke Hospital, UHNM, Stoke-on-Trent, UK
| | - Rhodri Davies
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Patrick A Calvert
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust Cambridge, UK
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Sean Gallagher
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Alex Sirker
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - Peter Ludman
- Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Mark deBelder
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
| | - Rod Stables
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital NHS Foundation Trust, UK
| | | | - Evan Kontopantelis
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, UK
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton NHS Trust, School of Medicine, University of Southampton, Southampton, UK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, UK; Royal Stoke Hospital, UHNM, Stoke-on-Trent, UK
| |
Collapse
|
18
|
Rahim Khan HA, Gilani JA, Pervez MB, Hashmi S, Hasan S. Penetrating cardiac trauma: A retrospective case series from Karachi. J PAK MED ASSOC 2018; 68:1285-1287. [PMID: 30108408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Penetrating cardiac trauma is a medical emergency that commonly affects young men throughout the world. A retrospective review of the records of all patients presenting with cardiac injury was done from January 2000 to December 2015 at our institute. There were 10 cases of such trauma, all of whom were males, 17 to 48 years of age. The most common mechanism of injury was gunshot wounds followed by stab wounds. The Mean Revised Trauma Score was 7.23±0.855. Only 2 out of the total 10 patients died (20% mortality). The Right Ventricle followed by the Left Ventricle was the most common site of injury. Median Sternotomy was the surgical procedure of choice in managing these patients. Pericardial tamponade and Haemothorax were common intra-operative findings. Patients having penetrating cardiac injury presenting with detectable signs of life on arrival to the hospital can be rescued by early surgical intervention.
Collapse
Affiliation(s)
| | | | | | - Shiraz Hashmi
- Section of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi
| | - Sulaiman Hasan
- Section of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi
| |
Collapse
|
19
|
Bohnen M, Biskup E. [CME: Post-Cardiac Injury Syndrome – a Special Form of Acute Pericarditis.]. Praxis (Bern 1994) 2018; 107:61-67. [PMID: 29338630 DOI: 10.1024/1661-8157/a002874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Angesichts der zunehmenden Anzahl kardialer Interventionen steigt auch die Inzidenz eines «Post-Cardiac Injury Syndrome» (PCIS). Dies stellt eine Form einer akuten Perikarditis dar und schliesst verschiedene pleuroperikardiale Syndrome ein, welche durch eine initiale Verletzung des Perikards/Myokards auftreten können. Klinisch präsentieren diese sich in einer Bandbreite von einer unkomplizierten Perikarditis bis hin zu komplexen Pleuroperikarditiden, Perikardtamponaden oder massiven Pleuraergüssen. Es wird eine immunvermittelte Pathogenese bei prädisponierten Patienten angenommen. Die Therapie basiert auf einer empirischen antiinflammatorischen Behandlung, inklusive Colchizin zur Prävention von Rezidiven.
Collapse
Affiliation(s)
| | - Ewelina Biskup
- 1 Klinik Innere Medizin, Universitätsspital Basel
- 2 Shanghai University of Medicine and Health Sciences, College of Basic and Clinical Sciences, Shanghai
| |
Collapse
|
20
|
Jerkic H, Letilovic T, Stipinovic M, Pocanic D, Catic J, Knotek M. Association of chronic kidney disease with periprocedural myocardial injury after elective stent implantation: A single center prospective cohort study. Medicine (Baltimore) 2016; 95:e5381. [PMID: 27828870 PMCID: PMC5106076 DOI: 10.1097/md.0000000000005381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of mortality in patients with chronic kidney disease (CKD). Patients with CKD who undergo percutaneous coronary intervention (PCI) may have more ischemic events than patients without CKD. The aim of our study was to determine the incidence of periprocedural myocardial injury (PMI) after elective stent implantation in patients with CKD using the Third Joint ESC/ACCF/AHA/WHF PMI definition.In a single center prospective cohort study, we enrolled 344 consecutive patients who underwent elective PCI in a period of 39 months. Serum troponin I (cTnI) concentrations were measured at baseline and at 8 and 16 hours after PCI. Periprocedural increase of cTnI, according to the most recent PMI definition, was used to define both the presence and intensity of PMI. Patients were further stratified according to the estimated glomerular filtration rate (eGFR) using 4 variable Modification of Diet in Renal Disease (MDRD) equation: control group with eGFR >90 mL/min/1.73 m and the CKD group with eGFR < 90 mL/min/1.73 m, with further subdivision according to the CKD stage.We found no significant difference in the incidence as well as intensity of the PMI in the control (>90 mL/min/1.73 m) and the CKD group (<90 mL/min/1.73 m) both 8 and 16 hours after PCI. When the CKD patients were further subdivided according to their CKD stage, there was again no difference in the intensity or incidence of PMI compared to the control group. Further analyses of our data showed angina pectoris CCS IV, bare metal stent (BMS) implantation, and treatment with angiotensin-converting enzyme inhibitors (ACEI) as independent predictors of PMI. Furthermore, the presence of hypertension was inversely related to the occurrence of PMI.Applying the new guidelines for PMI and using the eGFR equation most suitable for our patients, we found no association between PMI and CKD. Further analyses showed other factors that could potentially influence the occurrence of PMI.
Collapse
Affiliation(s)
- Helena Jerkic
- Division of Cardiology
- Correspondence: Helena Jerkic, Division of Cardiology, Department of Medicine, University Hospital Merkur, Zajceva 19, Zagreb, Croatia (e-mail: )
| | - Tomislav Letilovic
- Division of Cardiology
- University of Zagreb Medical School, Zagreb, Croatia
| | | | | | - Jasmina Catic
- Division of Cardiology, Department of Medicine, University Hospital Dubrava
| | - Mladen Knotek
- Division of Nephrology, Department of Medicine, University Hospital Merkur
- University of Zagreb Medical School, Zagreb, Croatia
| |
Collapse
|
21
|
Hao J, Du H, Li WW, Zhao ZF, Liu F, Lu JC, Yang XC, Cui W. Effects of atorvastatin combined with trimetazidine on myocardial injury and inflammatory mediator in unstable angina patients during perioperative of percutaneous coronary intervention. Eur Rev Med Pharmacol Sci 2015; 19:4642-4646. [PMID: 26698263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the effects of atorvastatin combined with trimetazidine on periprocedural myocardial injury and serum inflammatory mediators in unstable angina pectoris (UAP) patients following percutaneous coronary intervention (PCI) treatment. PATIENTS AND METHODS 90 patients with UAP treated with conventional medications and PCI were recruited and were randomly divided into the control group and the experimental group. The control group had 42 patients were treated with atorvastatin alone, while the experimental group had 48 cases treated with atorvastatin combined with trimetazidine. All the patients were checked the preoperative 24h and postoperative 24h PCI concentrations of cardiac troponin I (cTnI), hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), serum interferon-γ (IFN-γ) and interlukin-10 (IL-10). RESULTS At the pre-PCI stage, every serum factors was no significant difference. 24 hours after the PCI intervention, the occurence of abnormal cTnI level in the experimental group was remarkable reduced than the control group. In the experimental group, the serum levels of TNF-α and IFN-γ significantly decreased (p < 0.05); while IL-10 was increased. In the control group, all the mediators were increased significantly except the hs-CRP (p < 0.05). CONCLUSIONS No unexpected symptom was found in patients with large dose atorvastatin combined with large dose trimetazidine. The administration of conventional medications together with the atorvastatin plus trimetazidine were able to reduce the prevalence of postoperative myocardial injury.
Collapse
Affiliation(s)
- J Hao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Zhang D, Xu B, Yin D, Li Y, He Y, You S, Qiao S, Wu Y, Yan H, Yang Y, Gao R, Dou K. Predictors and Periprocedural Myocardial Injury Rate of Small Side Branches Occlusion in Coronary Bifurcation Intervention. Medicine (Baltimore) 2015; 94:e992. [PMID: 26107685 PMCID: PMC4504653 DOI: 10.1097/md.0000000000000992] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Occlusion of small side branch (SB) may result in significant adverse clinical events. We aim to characterize the predictors of small SB occlusion and incidence of periprocedural myocardial injury (PMI) in coronary bifurcation intervention.Nine hundred twenty-five consecutive patients with 949 bifurcation lesions (SB ≤ 2.0 mm) treated with percutaneous coronary intervention (PCI) were studied. All clinical characteristics, coronary angiography findings, PCI procedural factors, and quantitative coronary angiographic analysis data were collected. SB occlusion after main vessel (MV) stenting was defined as no blood flow or any thrombolysis in myocardial infarction (TIMI) flow grade decrease in SB after MV stenting. Multivariate logistic regression analysis was performed to identify independent predictors of small SB occlusion. Creatine kinase-myocardial band activity was determined by using an immunoinhibition assay and confirmed by mass spectrometry. Incidence of PMI between no SB occlusion group and SB occlusion group was compared.SB occlusion occurred in 86 (9.1%) of 949 bifurcation lesions. Of SB occlusion, total occlusion occurred in 64 (74.4%) lesions and a decrease in TIMI flow occurred in 22 (25.6%) lesions. True bifurcation lesion, irregular plaque, predilation in SB, preprocedural SB TIMI flow grade, preprocedural diameter stenosis of distal MV, preprocedural diameter stenosis of bifurcation core, bifurcation angle, diameter ratio between MV and SB, diameter stenosis of SB before MV stenting, and MV lesion length were independent risk factors of SB occlusion. We observed a significantly higher incidence of PMI in each cutoff level in patients with SB occlusion compared with those without SB occlusion.True bifurcation lesion, irregular plaque, and 8 other predictors were independent predictors of SB occlusion. Patients with small SB occlusion had significant higher incidence of PMI.
Collapse
Affiliation(s)
- Dong Zhang
- From Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Khorsandi M, Skouras C, Prasad S, Shah R. Major cardiothoracic trauma: Eleven-year review of outcomes in the North West of England. Ann R Coll Surg Engl 2015; 97:298-303. [PMID: 26263939 PMCID: PMC4473869 DOI: 10.1308/003588415x14181254789169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Up to 15% of patients with cardiothoracic trauma require emergency surgery, and death can be prevented in a substantial proportion of this group. UK reports have emphasised the need for improvement in this field. We assessed major cardiothoracic trauma (MCT) outcomes in North West England over 11 years. METHODS The database from the Trauma Audit and Research Network was used to retrieve data for all patients who had suffered MCT between 2000 and 2011 in North West England and the findings analysed. Trauma that led to thoracotomy/thoracoscopy or sternotomy was defined as MCT. RESULTS A total of 146 patients were identified, and a considerable male predominance (88.4%) noted. A total of 54.1% had sustained penetrating cardiothoracic trauma. Also, 53.4% had been admitted to tertiary-care hospitals for trauma (TCHT) and 46.6% had been admitted to non-TCHT. Overall prevalence of mortality was 35.6%. No significant difference was found in mortality between TCHT vs non-TCHT. Prevalence of mortality was significantly higher in the subgroup of patients cared for exclusively in non-TCHT compared with patients transferred from non-TCHT to TCHT (41% vs 13.8%, p<0.05). CONCLUSIONS No significant difference was demonstrated in length of stay in hospital/length of stay in the intensive treatment unit and prevalence of mortality between patients originally presenting in TCHT and those presenting in non-TCHT. However, patients transferred from non-TCHT to TCHT had a lower prevalence of mortality. These findings may constitute a valuable benchmark for comparison with results arising after introduction of trauma centres in the UK.
Collapse
Affiliation(s)
- M Khorsandi
- Department of Cardio-Thoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh
| | - C Skouras
- Department of Clinical Surgery, Edinburgh University, Edinburgh
| | - S Prasad
- Department of Cardio-Thoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh
| | - R Shah
- Department of Cardio-Thoracic Surgery, University Hospital of South Manchester (Wythenshawe hospital)
| |
Collapse
|
24
|
Soto JR, Murry JS, Truitt MS, Dunn EL. Penetrating cardiac injuries at a Level II trauma center: a 15-year review. Am Surg 2015; 81:324-325. [PMID: 25760212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
25
|
Lin YS, Hung SP, Chen PR, Yang CH, Wo HT, Chang PC, Wang CC, Chou CC, Wen MS, Chung CM, Chen TH. Risk factors influencing complications of cardiac implantable electronic device implantation: infection, pneumothorax and heart perforation: a nationwide population-based cohort study. Medicine (Baltimore) 2014; 93:e213. [PMID: 25501080 PMCID: PMC4602772 DOI: 10.1097/md.0000000000000213] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
As the number of cardiac implantable electronic devices (CIEDs) is increasing annually, CIED-related complications are becoming increasingly important. The aim of the study was to assess the risks associated with CIEDs by a nationwide database. Patients were selected from the Taiwan National Health Insurance Database. Admissions for CIED implantation, replacement, and revision were evaluated and the evaluation period was 14 years. Endpoints included CIED-related infection, pneumothorax, and heart perforation. The study included 40,608 patients with a mean age of 71.8 ± 13.3 years. Regarding infection, the incidence rate was 2.45 per 1000 CIED-years. Male gender, younger age, device replacement, and previous infection were risks for infection while old age and high-volume centers (>200 per year) were protectors. The incidence of pneumothorax was 0.6%, with an increased risk in individuals who had chronic obstructive lung disease (COPD) and cardiac resynchronized therapy (CRT). The incidence of heart perforation was 0.09%, with an increased risk in individuals who had pre-operation temporal pacing and steroid use. High-volume center was found to decrease infection rate while male gender, young people, and individuals who underwent replacements were associated with an increased risk of infection. Additionally, pre-operation temporal pacing and steroid use should be avoided if possible. Furthermore, COPD patients or those who accept CRTs should be monitored closely.
Collapse
Affiliation(s)
- Yu-Sheng Lin
- From the Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan (YSL, CMC); Chang Gung University College of Medicine, Taoyuan, Taiwan (SPH, PRC); Division of Cardiology, Chang-Gung Memorial Hospital, Linkou, Taiwan (CHY, HTW, PCC, CCW, CCC, MSW, THC); Department of Cardiology, Chang-Gung Memorial Hospital, Xiamen, China (THC); and Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University (YSL)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Bahar AM, Nouri M, Alizadeh L, Namvar F, Asadi M. Estimated incidence of cardiac contusion using transthoracic echocardiography in patients suffering from severe blunt trauma to the chest. Acta Chir Belg 2014; 114:105-109. [PMID: 25073207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Cardiac contusion (CC) is a known complication of blunt trauma to the chest. There have been debates about its true incidence and there are different reports which claim that it occurs in less than 10% to more than 70% of patients. The goal of this study is to estimate the incidence of CC in patients with severe blunt chest trauma (SBCT) using transthoracic echocardiography (TTE). METHODS After defining inclusion and exclusion criteria, all cases with clinical evidences of SBCT from February 2010 until October 2011 were included in this study. Patients were assessed using electrocardiography (ECG) and transthoracic echocardiography (TTE). Transient echocardiographic changes, including wall motion abnormalities, valvular or papillary muscle dysfunction, pericardial effusion or tamponade, free wall rupture and interatrial/interventricular septum defects, were considered to be abnormal and trauma-related. RESULTS A total of 210 patients were assessed for CC. Fifty-two trauma-related echocardiographic changes in 47 patients were observed, in which 34 cases had simultaneous transient ECG changes. The estimated incidence of CC in these subjects was calculated to be 23.38% and 16.19%, respectively. There was a statistically significant relationship between the presence of both echocardiographic changes and ECG abnormalities, and those subjects without ECG changes (P = 0.03). As we evaluated stable patients without any cardiac-related clinical manifestations and TTE was chosen as our diagnostic modality, we claim that the true incidence must be higher. CONCLUSIONS We believe that a comparison of our findings with those presented in the literature shows that the actual incidence of CC in blunt chest trauma is underestimated.
Collapse
|
27
|
Oyetunji TA, Jackson HT, Obirieze AC, Moore D, Branche MJ, Greene WR, Cornwell EE, Siram SM. Associated injuries in traumatic sternal fractures: a review of the National Trauma Data Bank. Am Surg 2013; 79:702-705. [PMID: 23816003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sternal fractures occur infrequently with blunt force trauma. The demographics and epidemiology of associated injuries have not been well characterized from a national trauma database. The National Trauma Data Bank was queried for patients with closed sternal fractures. The demographics were analyzed by age, gender, mechanism and indicators of anatomic and physiologic injuries. Types of commonly associated injuries were also determined. A total of 23,985 records were analyzed. Males accounted for 68.3 per cent and whites 70.9 per cent. Motor vehicle crash was the leading mechanism. More than 56 per cent had severe injuries based on Injury Severity Score (greater than 15) and 17 per cent with Glasgow Coma Score 8 or less. Crude mortality was 7.9 per cent. The majority (57.8%) and approximately one-third (33.7%) of the patients had rib fractures and lung contusions, respectively, 22.0 per cent with closed pneumothorax, 21.6 per cent had a closed thoracic vertebra fracture, 16.9 per cent with lumbar spine fracture, 3.9 per cent with concussion, and blunt cardiac injury in 3.6 per cent. Sternal fractures are usually associated with severe blunt trauma. Lung contusion remains the leading associated injury followed by vertebral spine fractures. Cardiac injuries are less frequent and vascular injuries less so. Mechanism of injury and presence of sternal fractures should alert providers to these potential associated injuries.
Collapse
Affiliation(s)
- Tolulope A Oyetunji
- Department of Surgery, Howard University College of Medicine, Washington, DC 20060, USA.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Carrabba N, Valenti R, Migliorini A, Vergara R, Parodi G, Antoniucci D. Prognostic value of myocardial injury following transcatheter aortic valve implantation. Am J Cardiol 2013; 111:1475-81. [PMID: 23465097 DOI: 10.1016/j.amjcard.2013.01.301] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 01/17/2013] [Accepted: 01/17/2013] [Indexed: 11/27/2022]
Abstract
There is a lack of clarity concerning the clinical implications of myocardial injury occurring after transcatheter aortic valve implantation (TAVI) procedures. The aim of this study was to determine the incidence, degree, and timing of myocardial injury associated with TAVI procedures and to evaluate its 1-year prognostic value. Among 68 consecutive patients (mean age 80.9 ± 6.4 years) treated with TAVI, 3 patients who died within 24 hours, precluding cardiac biomarker measurements, and 3 patients with major procedural complications were excluded. Cardiac troponin I, creatine kinase-MB, and creatinine levels were determined at baseline and 6, 12, 24, 48, and 72 hours after TAVI. All complications were defined according to the Valve Academic Research Consortium. Myocardial injury was observed in all patients (n = 62), as determined by an increase in cardiac troponin I (median peak at 12 hours 3.8 μg/L, interquartile range 1.8 to 25.67), and a higher degree of myocardial injury was observed in patients (n = 9) who developed acute kidney injury (AKI) (p = 0.026). Periprocedural myocardial infarction was not found. At 1-year follow-up, 5 patients had died, and 7 patients had been hospitalized for heart failure. The development of AKI, not the degree of peak cardiac troponin I (p = 0.348), was identified as the only strong independent predictor of 1-year mortality from any cause (including heart failure) after TAVI (hazard ratio 4.74, 95% confidence interval 1.12 to 20.03, p = 0.034). In conclusion, TAVI was systematically associated with myocardial injury, occurring with a higher degree in patients who developed AKI. However, the simultaneous development of AKI occurring after TAVI is the strongest predictor of 1-year mortality.
Collapse
|
29
|
Onan B, Demirhan R, Öz K, Onan IS. Cardiac and great vessel injuries after chest trauma: our 10-year experience. ULUS TRAVMA ACIL CER 2011; 17:423-429. [PMID: 22090328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Cardiovascular injuries after trauma present with high mortality. The aim of the study was to present our experience in cardiac and great vessel injuries after chest trauma. METHODS During the 10-year period, 104 patients with cardiac (n=94) and great vessel (n=10) injuries presented to our hospital. The demographic data, mechanism of injury, location of injury, other associated injuries, timing of surgical intervention, surgical approach, and clinical outcome were reviewed. RESULTS Eighty-eight (84.6%) males presented after chest trauma. The mean age of the patients was 32.5±8.2 years (range: 12-76). Penetrating injuries (62.5%) were the most common cause of trauma. Computed tomography was performed in most cases and echocardiography was used in some stable cases. Cardiac injuries mostly included the right ventricle (58.5%). Great vessel injuries involved the subclavian vein in 6, innominate vein in 1, vena cava in 1, and descending aorta in 2 patients. Early operations after admission to the emergency were performed in 75.9% of the patients. Thoracotomy was performed in 89.5% of the patients. Operative mortality was significantly high in penetrating injuries (p=0.01). CONCLUSION Clinicians should suspect cardiac and great vessel trauma in every patient presenting to the emergency unit after chest trauma. Computed tomography and echocardiography are beneficial in the management of chest trauma. Operative timing depends on hemodynamic status, and a multidisciplinary team approach improves the patient's prognosis.
Collapse
Affiliation(s)
- Burak Onan
- Department of Thoracic Surgery, Dr. Lütfi Kırdar Kartal Training And Research Hospital, İstanbul, Turkey.
| | | | | | | |
Collapse
|
30
|
Kamalı S, Aydın MT, Akan A, Karatepe O, Sarı A, Yüney E. Penetrating cardiac injury: factors affecting outcome. ULUS TRAVMA ACIL CER 2011; 17:225-230. [PMID: 21935800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Penetrating cardiac injuries are rare but represent a high mortality. Early recognition of the injury and rapid intervention are necessary. We analyzed the characteristics of patients with penetrating injury and the factors affecting the outcome, including the experience of the general surgeon. METHODS Twenty-three patients suffering penetrating cardiac injury were retrospectively evaluated in the Istanbul Okmeydanı Training and Research Hospital, Department of General Surgery between 1995 and 2009. Patients with no sign of life on admission were excluded. RESULTS All patients were male, and the median age was 25 years. Fifteen patients had left ventricular, 4 had right ventricular and 4 had right atrial injuries; in addition, 2 patients had accompanying intra-abdominal injuries. No coronary vascular injury was reported, and pericardial tamponade did not statistically influence the outcome. Ten of 23 patients suffering of penetrating cardiac injury were lost, and in 6 of the 10 cases, the patient represented the first experience for the operating surgeon. CONCLUSION The characteristics of the penetrating cardiac injuries seen in our institution are consistent with the literature. However, we believe that the surgeon's experience is another prognostic factor. Dedicated level 1 emergency services and trained trauma surgeons are invaluable.
Collapse
Affiliation(s)
- Sedat Kamalı
- Department of General Surgery, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | | | | | | | | | | |
Collapse
|
31
|
Korolev MP, Urakcheev SK, Pastukhova NK, Sagatinov RS, Starkov GE. [On the question of heart injuries]. Vestn Khir Im I I Grek 2011; 170:75-76. [PMID: 21848244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The work is devoted to an analysis of hospitalized patients to the specialized department of injuries of the chest and abdomen of the Mariinskaja hospital at the period from 1993 through 2010. The diagnosis of injury of the pericardium and heart had 280 patients, during the operative treatment heart injuries were detected in 156 (55.71%) patients. Penetration to the heart chambers was found in 132 (84.61%) of them, with perforating and multiple injuries there were 24 (15.39%) patients. Operations were performed during 20 minutes after admission on 65 (28.9%), and during the following two hours on 160 (71.1%) patients. Expectant management and conservative treatment were used in treatment of 34 patients (12.14%), three patients were admitted in the state of apparent death and died during 15 minutes. The lethality of 41 patients was 26.28%. mainly it was those who were operated at the period from 80 to 100 minutes from the moment of injury. The success of treatment depends on the early hospitalization, correct diagnosis and emergent surgery.
Collapse
|
32
|
Aliyev F, Celiker C, Türkoğlu C, Karadağ B, Yıldız A. Perforations of right heart chambers associated with electrophysiology catheters and temporary transvenous pacing leads. Turk Kardiyol Dern Ars 2011; 39:16-22. [PMID: 21358226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVES Perforation of heart chambers is one of the rare complications observed during electrophysiological studies and placement of pacemaker leads. In this study, we performed a retrospective evaluation of patients with catheter-related right heart perforation, aiming to determine its incidence and clinical course. STUDY DESIGN We reviewed cases with catheter-related cardiac perforations observed at our institution from June 2002 to November 2007. RESULTS During the study period, a total of 2,385 procedures were performed (1,287 electrophysiologic studies, 1,098 temporary nonballoon-floating pacing lead placements). Eight cardiac perforations were diagnosed, with the overall procedure-based and catheter-based incidences of 0.34% (8/2,385) and 0.14% (8/5,603), respectively. Three of these perforations were related to diagnostic electrophysiology catheters, and five were related to temporary (1 permanent) transvenous pacemaker leads. Seven perforations involved the right ventricle and one involved the right atrium. Three patients in whom right ventricular perforation was detected at a late stage died suddenly after pacemaker lead implantation. One patient underwent surgical exploration because of right atrial perforation. Two patients underwent coronary bypass operation and, in one of these patients, perforation was detected during surgery. Two patients were managed conservatively. CONCLUSION Although right ventricular perforations detected early have a relatively benign course, those detected late and right atrial perforations require emergent surgical exploration and may have catastrophic consequences.
Collapse
Affiliation(s)
- Farid Aliyev
- Department of Cardiology, Division of Pacing and Electrophysiology, İstanbul University Institute of Cardiology, İstanbul, Turkey.
| | | | | | | | | |
Collapse
|
33
|
Mataraci I, Polat A, Cevirme D, Büyükbayrak F, Saşmazel A, Tuncer E, Songur M, Erentuğ V, Kirali K, Yakut C. Increasing numbers of penetrating cardiac trauma in a new center. ULUS TRAVMA ACIL CER 2010; 16:54-58. [PMID: 20209397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Our aim was to express the importance of emergency diagnosis and surgical approach in penetrating cardiac trauma patients. METHODS Koşuyolu Heart and Research Hospital moved to its new location in Cevizli Kartal in June 2005. Due to its close proximity to the main roads of the city, the number of trauma cases has increased tremendously. We have retrospectively examined our penetrating cardiac trauma cases treated between June 2005 and September 2008. RESULTS Twenty-six trauma cases were admitted to our clinic with penetrating cardiac trauma. Twenty of them were operated on an emergency basis. One (5%) had a gunshot wound while the other 19 (95%) had stab wounds. Four were female (20%) and 16 were male (80%). Average age of the patients was 24.9+/-10.1 (12-49) years. Telecardiography and transthoracic echocardiography were used for diagnosis. Surgical approaches were median sternotomy in 14 and left anterolateral thoracotomy in 6 cases. The right ventricle was damaged in 12, left ventricle in 7 and pulmonary artery in 1. Additionally, 5 patients had lung injury, 1 had brachiocephalic vein injury and 1 had coronary artery injury. One patient was re-explored for bleeding. There were two mortalities (10%) postoperatively. CONCLUSION Rapid transfer to the emergency department, accurate and quick diagnosis and aggressive surgical approach will increase survival in penetrating cardiac trauma.
Collapse
MESH Headings
- Adolescent
- Adult
- Child
- Female
- Heart Injuries/diagnosis
- Heart Injuries/epidemiology
- Heart Injuries/mortality
- Heart Injuries/surgery
- Humans
- Male
- Middle Aged
- Postoperative Complications
- Prevalence
- Retrospective Studies
- Trauma Centers/statistics & numerical data
- Treatment Outcome
- Wounds, Gunshot/diagnosis
- Wounds, Gunshot/epidemiology
- Wounds, Gunshot/mortality
- Wounds, Gunshot/surgery
- Wounds, Penetrating/diagnosis
- Wounds, Penetrating/epidemiology
- Wounds, Penetrating/mortality
- Wounds, Penetrating/surgery
- Wounds, Stab/diagnosis
- Wounds, Stab/epidemiology
- Wounds, Stab/mortality
- Wounds, Stab/surgery
- Young Adult
Collapse
Affiliation(s)
- Ilker Mataraci
- Kartal Koşuyolu High Graduate Education and Research Hospital, Istanbul, Turkey.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Hosono M, Shibata T, Sasaki Y, Hirai H, Bito Y, Takahashi Y, Suehiro S. Left ventricular rupture after mitral valve replacement: risk factor analysis and outcome of resuscitation. J Heart Valve Dis 2008; 17:42-47. [PMID: 18365568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Left ventricular (LV) rupture is a rare but lethal complication after mitral valve replacement (MVR). Hence, the occurrence of LV rupture after MVR and the outcome of resuscitation was assessed. METHODS Between January 1991 and June 2005, a total of 258 patients underwent MVR at the authors' institution. Thirteen preoperative factors and 13 surgical factors were analyzed to assess the incidence of LV rupture after MVR. RESULTS Among the patients, there were six cases of LV rupture (2.3%). Age >69 years (p = 0.0174), hemodialysis (p = 0.0119), echocardiographic end-diastolic left ventricular diameter (Dd) <50 mm (p = 0.0104), resection of the basal chorda of the posterior leaflet (p = 0.0086), mitral annular reconstruction (p = 0.009), and additional left atrial plication (p = 0.0269) were each considered as significant risk factors for LV rupture following MVR. All ruptures were type III. There were two hospital deaths (mortality 33%). At more than one year after surgery, all surviving patients were in reasonable health. CONCLUSION Older age, hemodialysis, and Dd <50 mm are significant risk factors for LV rupture after MVR. Preservation of the basal chordae of the posterior leaflet was important to prevent LV rupture, while endocardial patch repair with elective intraaortic balloon pumping was suggested as an effective treatment for type III rupture.
Collapse
Affiliation(s)
- Mitsuharu Hosono
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan.
| | | | | | | | | | | | | |
Collapse
|
35
|
Hirschl DA, Jain VR, Spindola-Franco H, Gross JN, Haramati LB. Prevalence and characterization of asymptomatic pacemaker and ICD lead perforation on CT. Pacing Clin Electrophysiol 2007; 30:28-32. [PMID: 17241311 DOI: 10.1111/j.1540-8159.2007.00575.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Pacemakers and implantable cardiac defibrillators (ICDs) are widely used for the management of cardiac arrhythmias and congestive heart failure (CHF). Acute implantation complication rates range from 3% to 7%. The aim of this study is to describe the incidence of lead perforation on computed tomography (CT), and correlate these findings with electrophysiologic data. METHODS Images of 100 consecutive patients with permanent pacemakers (n = 72) or ICDs (n = 28) who underwent multidetector CTs of the chest were identified. Cases were reviewed by 2 cardiothoracic radiologists, and a third if there was disagreement. Each CT was reviewed for device and fixation type, tip position, and presence of pericardial effusion. Results were correlated with lead impedance and pacing threshold, when available [79% (79/100)]. A cardiac electrophysiologist interpreted device data. RESULTS All 100 patients had right ventricular leads (58 passive, 42 active) and 61 had right atrial leads (12 passive, 49 active). 15% (15/100) of patients had a lead perforation. Perforation rates were 15% (9/61) for atrial and 6% (6/100) for ventricular leads (P < 0.05, chi square). Four of 28 (14%) right ventricular ICD leads and 2 of 72 (3%)right ventricular pacemaker leads were perforated (P < 0.05, chi square). 12% (6/49) of active right atrial leads, and 25% (3/12) of passive right atrial leads perforated (P = NS, chi square). 7% (3/42) of active right ventricular leads, and 5% (3/58) of passive ventricular leads perforated (P = NS, chi square). Electrophysiologic parameters did not differ significantly between perforated and nonperforated leads. CONCLUSION Asymptomatic perforation is a common phenomenon and rarely resulting in electrophysiologic consequences. Atrial leads perforated more frequently than ventricular leads, and ventricular ICD leads perforated more frequently than ventricular pacemaker leads.
Collapse
Affiliation(s)
- David A Hirschl
- Department of Radiology, Division of Cardiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | | | | | | | | |
Collapse
|
36
|
Bailey B. Risk Factors for Cardiac Injury Following an Electrical Exposure. Ann Emerg Med 2007; 50:92; author reply 92-3. [PMID: 17572296 DOI: 10.1016/j.annemergmed.2007.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Revised: 01/15/2007] [Accepted: 01/19/2007] [Indexed: 11/26/2022]
|
37
|
Uludağ M, Yetkin G, Celayir F, Citgez B, Başaran C, Baykan A. [Penetrating cardiac injuries]. ULUS TRAVMA ACIL CER 2007; 13:199-204. [PMID: 17978894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND The aim of this study was to evaluate our clinical findings and results of cardiac injuries. METHODS We reviewed the records of patients who were admitted to our clinic between 1996 and 2005 and operated due to penetrating cardiac injury. RESULTS Eighteen patients (17 male, one female; mean age 25.9; range 17-45 years) (all penetrating stab wounds) with cardiac injuries were operated. The clinical aspects were: agonal status in 5 patients (27.8%), profound shock in 7 patients (38.9%). The remaining 6 patients (33.3%) were in mild shock (hypotension 60-90 mmHg) and 3 of them (16.7%) had a diagnosis of cardiac tamponade preoperatively. Emergency room thoracotomy was made in 2 patients (11.1%). Mortality rate was %80 in agonal patients whereas overall mortality was 44.5%. CONCLUSION Cardiac injuries have high mortality. The mortality rate of the patients, who can arrive to the hospital alive, is closely related to the vital signs and general condition. The mortality can be reduced by quick evaluation and prompt surgical intervention.
Collapse
Affiliation(s)
- Mehmet Uludağ
- Department of 2nd General Surgery, Sişli Etfal Training and Research Hospital, Istanbul, Turkey.
| | | | | | | | | | | |
Collapse
|
38
|
Conroy C, Hoyt DB, Eastman AB, Holbrook TL, Pacyna S, Erwin S, Vaughan T, Sise M, Kennedy F, Velky T. Motor Vehicle-Related Cardiac and Aortic Injuries Differ From Other Thoracic Injuries. ACTA ACUST UNITED AC 2007; 62:1462-7. [PMID: 17563667 DOI: 10.1097/01.ta.0000221271.76676.2e] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Traumatic cardiac and thoracic aortic injuries are hypothesized to result from rapid deceleration of occupants during a motor vehicle crash. The purpose of this study was to identify potential risk factors for motor vehicle-related cardiac and thoracic aortic (HTA) injury using the Crash Injury Research Engineering Network (CIREN) database. METHODS CIREN data were used to test the hypothesis that there is no difference between occupants with HTA injury and occupants with thoracic injury other than the heart or aorta (non-HTA). Occupant variables (restraint use, airbag deployment, Glasgow Coma Scale score, Injury Severity Score, concomitant injuries, driver versus passenger status, height, and comorbidity) and crash variables (principal direction of force, change in velocity, vehicle crush, intrusion, and vehicle type) were compared for these two groups. Odds ratios were used to quantify the potential risk factors for HTA injury compared with non-HTA injury. RESULTS There were 168 occupants with an HTA injury and 731 with a non-HTA injury. Greater crash severity (based on vehicle crush and change in velocity), improper safety belt use, and lack of safety belt use were significantly associated with HTA injury. Unrestrained occupants had almost three times the chance of having an HTA injury (odds ratio = 2.86; p < 0.05). For restrained drivers, 41.4% of HTA injuries were caused by vehicle interior components. When not protected by both safety belts and air bags, 45.7% of driver HTA injuries were caused by the steering wheel. For passengers, the vehicle interior (armrests, side interior, and B-pillars) accounted for most HTA injuries regardless of safety system status. More than half of all occupants wearing safety belts who sustained an HTA injury were improperly wearing their safety belts. CONCLUSION The high mortality associated with cardiac and aortic injuries supports the need to prevent these injuries from occurring during motor vehicle crashes. These results suggest proper use of safety belts is necessary to prevent cardiac and thoracic aortic injuries. However, other important potential risk factors, such as motor vehicle size and crash severity, might continue to present a challenge to motor vehicle safety professionals.
Collapse
Affiliation(s)
- Carol Conroy
- Department of Surgery, University of California, San Diego, California 92103-8896, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
OBJECTIVE We evaluated the cardiovascular injury induced by ischemia and reperfusion (I/R) of the liver by measuring changes in blood levels of cardiac troponin I (cTNI), an index of cardiovascular injury, as well as levels of selected indicators of an inflammatory response. MATERIALS AND METHODS Ischemia was induced in the rat liver by clamping the common hepatic artery and portal vein for 40 minutes, after which flow was restored, and the liver reperfused for 90 minutes. Blood samples were collected prior to ischemia and after reperfusion. cTNI as well as levels of tumor necrosis factor alpha (TNFalpha), hydroxyl radical (.OH), nitric oxide (NO), and alanine transferase (ALT) were measured. RESULTS I/R of the liver induced a significant increase in ALT (P<.001). Increased cTNI levels (P<.05) were associated with inflammatory responses, such as elevated levels of TNFalpha (P<.001), . OH (P<.001), and NO (P<.001). After administration of 3-aminobenzamide, a poly(ADP-ribose) polymerase (PARP) inhibitor, liver and heart injuries were significantly attenuated (P<.05). CONCLUSIONS I/R-induced liver injury was associated with cardiovascular injury, perhaps resulting from inflammatory responses triggered by elevated levels of reactive radical species of nitric oxide, superoxide, and peroxynitrite, by which PARP was activated. 3-Aminobenzamide, significantly attenuated I/R-induced liver and heart injuries.
Collapse
Affiliation(s)
- C F Chen
- Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan, Republic of China
| | | | | | | | | | | |
Collapse
|
40
|
Aksöyek A, Tütün U, Babaroğlu S, Parlar AI, Ulus AT, Katircioğlu SF. Penetrating cardiac injuries. ULUS TRAVMA ACIL CER 2007; 13:135-41. [PMID: 17682956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND This study was planned to evaluate patients with penetrating cardiac injury. METHODS Twenty-two patients had cardiac injury among twenty-five patients who had been referred to our hospital with a suspicion of this diagnosis. Data of the patients were retrospectively evaluated. RESULTS Echocardiography could be performed in 11 patients with stable haemodynamics and pericardial effusion was established in all of them with one false positive result. The patient with false positive result had left internal thoracic artery and venous injury. Cardiac tamponade was seen in 17 (77%) patients. Injury sites were right ventricle 10 (45.5%), left ventricle 7 (31.8%), left ventricle consisting left anterior descending artery 2 (9.1%), right atrium 1 (4.5%) and pericardial injuries and hematoma 2 (9.1%). The mean physiologic index (PI) of the patients was 10.68+/-5.63, penetrating cardiac trauma index was (PCTI) 14.09+/-6.3, penetrating thoracic trauma index (PTTI) was 17+/-8.84 and organ injury scale according to the American Association for the Surgery of Trauma (AAST/OIS) was 3.86+/-1.25. Mortality rate was 27.3% with 6 out of 22 patients. PI, PCTI, PTTI and AAST/OIS scores of the non-survivors were significantly higher than those of the survivors (p<0.05). While there was no difference between survivors and non-survivors regarding the presence of tamponade and the frequency of the associated abdominal injury, left ventricular and left anterior descending artery injuries and associated lung injuries were more common in non-survivors (p<0.05). CONCLUSION Non-survivors with penetrating cardiac injury have higher PI, PCTI, PTTI and AAST/OIS scores and they are more severely injured patients comparing to the survivors.
Collapse
Affiliation(s)
- Ayşen Aksöyek
- Department of Cardiovascular Surgery, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
Cardiac contusion following blunt chest trauma is not rare, and the works in the literature report incidence rates between 5 and 50%. Traffic accidents are the most frequent cause of cardiac contusion followed by violent fall impacts, aggressions and the practice of risky sports. The spectrum of post-traumatic cardiac lesions varies greatly, ranging from no symptoms to decrease in cardiac function. Cardiogenic shock is a rarely encountered manifestation of blunt cardiac contusion. We review our experience of cardiac contusion after blunt chest trauma, and we describe two very severe cases that manifested as cardiogenic shock. We emphasize an early diagnosis by continuous electrocardiographic monitoring, serial electrocardiograms, echocardiography, serum determination of biochemical cardiac markers, radionuclide imaging and coronary angiography. The treatment includes continuous monitoring of cardiac rhythm, use of inotropic drugs, insertion of a catheter in the pulmonary artery for continuous assessment of cardiac output and, in extreme cases, the insertion of a contrapulsation balloon to maintain haemodynamics until improvement of cardiac function.
Collapse
Affiliation(s)
- María S Holanda
- Department of Intensive Care Medicine, Unit of Multisystem Trauma, The Marqués de Valdecilla Hospital of Santander, Cantabria, Spain.
| | | | | | | | | | | |
Collapse
|
42
|
Patti G, Chello M, Pasceri V, Colonna D, Nusca A, Miglionico M, D'Ambrosio A, Covino E, Di Sciascio G. Protection From Procedural Myocardial Injury by Atorvastatin Is Associated With Lower Levels of Adhesion Molecules After Percutaneous Coronary Intervention. J Am Coll Cardiol 2006; 48:1560-6. [PMID: 17045888 DOI: 10.1016/j.jacc.2006.06.061] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 06/19/2006] [Accepted: 06/26/2006] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The goal of this work was to investigate whether protection from myocardial injury during percutaneous coronary intervention (PCI) by atorvastatin is related to reduction of endothelial inflammatory response. BACKGROUND In the randomized ARMYDA (Atorvastatin for Reduction of MYocardial Damage during Angioplasty) trial, 7-day pre-treatment with atorvastatin before PCI significantly reduced procedural myocardial injury; mechanisms underlying this effect are not characterized. METHODS In a planned subanalysis of the ARMYDA trial, a subgroup of 76 patients was blind-tested for measurement of plasma levels of vascular cell adhesion molecule-1 (VCAM-1), intercellular cell adhesion molecule-1 (ICAM-1), and E-selectin: 38 patients belonged to atorvastatin (40 mg/day) and 38 to the placebo arm. Adhesion molecules were evaluated 7 days before intervention, immediately before PCI, and after 8 and 24 h. RESULTS Reduction of procedural myocardial injury after statin pre-treatment was also confirmed in this subgroup. Intercellular cell adhesion molecule-1, E-selectin, and VCAM-1 levels were not different at randomization and before intervention in either arm. At 8 h, increase of ICAM-1 levels was similar in the 2 arms, whereas 24-h levels were significantly lower in the atorvastatin versus placebo group (282 +/- 56 vs. 325 +/- 70 ng/ml; p = 0.007). Attenuation of E-selectin elevation occurred at 8 h in the atorvastatin group (50 +/- 8 vs. 59 +/- 13 ng/ml; p = 0.002) and became even more significant at 24 h (57 +/- 9 vs. 73 +/- 18 ng/ml; p = 0.0008). Vascular cell adhesion molecule-1 levels were not different at any time point in the 2 arms. CONCLUSIONS In patients undergoing PCI, reduction of procedural myocardial injury after 7-day pre-treatment with atorvastatin is paralleled by concomitant attenuation of post-procedural increase of ICAM-1 and E-selectin levels; thus, reduction of endothelial inflammatory response may explain this protective effect of statins.
Collapse
Affiliation(s)
- Giuseppe Patti
- Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Rome, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Shah PJ, Buxton BF, Seevanayagam S. Coronary artery bypass surgery in undiagnosed traumatic pericardial rupture--25 years later. Heart Lung Circ 2005; 14:116-7. [PMID: 16352266 DOI: 10.1016/j.hlc.2005.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2004] [Revised: 01/19/2005] [Accepted: 01/28/2005] [Indexed: 10/25/2022]
Abstract
A 55-year-old man was electively admitted for coronary artery bypass surgery. His admission chest X-ray showed an abnormal cardiac silhouette with complete leftward displacement. He had a past history of blunt thoracic trauma due to a motor vehicle accident treated conservatively. We present our findings and surgical difficulty during an operation on a patient with a previously undiagnosed pericardial rupture. This is the first reported case of its kind in the cardiac surgical literature.
Collapse
Affiliation(s)
- Pallav J Shah
- Department of Cardiac Surgery, Austin Hospital, Studley Road, Austin Hospital, Melbourne, Heidelberg, Vic. 3084, Australia
| | | | | |
Collapse
|
44
|
Ramana RK, Arab D, Joyal D, Steen L, Cho L, Lewis B, Liu J, Loeb H, Leya F. Coronary artery perforation during percutaneous coronary intervention: incidence and outcomes in the new interventional era. J Invasive Cardiol 2005; 17:603-5. [PMID: 16264206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Coronary artery perforation (CP) is a serious complication of percutaneous coronary intervention (PCI). We sought to define the incidence and outcome of CP given the advance in interventional techniques, devices and use of glycoprotein inhibitors (GP IIb/IIIa). METHODS We retrospectively reviewed the records of patients who underwent PCI at our institution over a four-year period. The incidence of CP was derived from patient records and then confirmed by reviewing the angiogram. Perforations were classified as Type 1, 2, or 3, as previously defined. RESULTS A total of 4,886 patients underwent PCI. Atherectomy devices were used in 329 patients and GP IIb/IIIa in 2,200 patients. Twenty-five CP were identified (0.5% incidence). Six were Type 1 (24%), 10 were Type 2 (40%), and 9 were Type 3 (36%). 13/25 (52%) of the CP were Type C Lesions, and 12/25 (48%) occurred in calcified vessels. All Type 1 perforations were caused by coronary wires and 4/6 CP occurred with the use of hydrophilic and extra stiff wires. Type 2 perforations were caused by coronary wires in 8/10 CP, and by stent deployment in 2/10. Two patients with Type 2 CP sustained a non-ST-elevation myocardial infarction. Type 3 perforations were caused by stent placement in 4/9 CP, 2/9 by atherectomy devices, and 3/9 by coronary wires. Four patients with Type 3 CP underwent pericardial drainage, 5 patients had a myocardial infarction and 2 patients died. CONCLUSION Type 1 and 2 perforations are predominately caused by hydrophilic and stiff wires and do not require pericardial drainage or surgical intervention. Type 3 perforations are more often associated with stent and device use. A majority of Type 3 perforations can be initially managed by percutaneous methods.
Collapse
Affiliation(s)
- Ravi K Ramana
- Division of Cardiology, Loyola University Medical Center, Hines V.A. Hospital, Maywood, Illinois, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Roguin A, Beyar R. Coronary perforation 2006--watch for the wire. J Invasive Cardiol 2005; 17:606-8. [PMID: 16264207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Ariel Roguin
- Division of Interventional Cardiology, Rambam Human Health Campus, The Ruth and Baruch Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | |
Collapse
|
46
|
Findlay JY, Keegan MT, Pellikka PP, Rosen CB, Plevak DJ. Preoperative dobutamine stress echocardiography, intraoperative events, and intraoperative myocardial injury in liver transplantation. Transplant Proc 2005; 37:2209-13. [PMID: 15964381 DOI: 10.1016/j.transproceed.2005.03.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The appropriate method of screening for coronary artery disease in patients who present for liver transplantation is currently uncertain. METHODS We assessed the utility of a screening protocol using dobutamine stress echocardiography (DSE) in 119 patients who underwent liver transplantation. Patients with cardiac risk factors had DSE performed, and those with positive results were referred for coronary angiography. Outcome was myocardial injury during liver transplantation determined by an elevation of cardiac troponin T measured after transplantation. RESULTS Seventy-three patients had DSE performed; eight were reported as positive for inducible ischemia. Seven of these patients underwent coronary angiography, and one had significant coronary artery disease. Postoperative troponin elevation occurred in 14 patients. There was no significant difference in the prevalence of troponin elevation in those patients with positive DSE versus those with negative DSE. No significant difference was identified in the prevalence of troponin elevation when comparing those patients with cardiac risk factors who underwent DSE with those patients with no risk factors and no DSE performed. DSE had a sensitivity of 0.2 and a specificity of 0.9 for myocardial injury. The prevalence of intraoperative hemodynamic instability was significantly higher in patients who had evidence of myocardial injury, but hemodynamic instability was no more common in patients who had a positive DSE. CONCLUSION When used in accordance with our protocol a positive DSE does not reliably identify patients at high cardiac risk during liver transplantation, but a negative DSE is strongly predictive of no myocardial injury.
Collapse
Affiliation(s)
- J Y Findlay
- Department of Anesthesiology, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 Second Street SW, Rochester, MN 55905, USA
| | | | | | | | | |
Collapse
|
47
|
Abstract
BACKGROUND Blunt injury of the pericardium with strangulation of the heart is a rare clinical injury. METHODS We conducted a review of clinical records and performed prospective collection of forensic data from a large urban medical examiner's office. RESULTS Ten cases of blunt injury to the pericardium were identified. All were secondary to blunt trauma. Nine of the 10 cases had associated chest wall injuries and 5 of the 10 cases had cardiac strangulation. CONCLUSION Pericardial lacerations are common findings at autopsy. Clinically, those that survive to the hospital have a confusing presentation. They are often diagnosed during emergent thoracotomy for hemodynamic instability. Hemodynamic deterioration associated with change in patient position may be a clue to cardiac strangulation.
Collapse
Affiliation(s)
- Matthew J Wall
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
| | | | | |
Collapse
|
48
|
Rollins MD, Koehler RP, Stevens MH, Walsh KJ, Doty DB, Price RS, Allen TL. Traumatic Ventricular Septal Defect: Case Report and Review of the English Literature since 1970. ACTA ACUST UNITED AC 2005; 58:175-80. [PMID: 15674170 DOI: 10.1097/01.ta.0000066147.57530.2e] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Michael D Rollins
- Department of Surgery, LDS Hospital, Salt Lake City, Utah 84143, USA
| | | | | | | | | | | | | |
Collapse
|
49
|
Ulusoy Bozbuğa N, Erentuğ V, Göksedef D, Toker ME, Güzelmeriç F, Kaymaz C, Kirali K, Akinci E, Yakut C. [Surgical treatment of iatrogenic cardiac traumas induced by heart catheterization]. ULUS TRAVMA ACIL CER 2004; 10:22-7. [PMID: 14752682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND A retrospective evaluation was made on iatrogenic cardiac traumas requiring surgical treatment, that were induced by cardiac catheterizations and interventions performed within a 17-year period. METHODS A total of 64,911 patients underwent cardiac catheterizations and interventions from 1985 to 2002. Complications of iatrogenic cardiac traumas induced by these interventions were examined together with the surgical treatment performed within 24 hours after catheterization. RESULTS Iatrogenic cardiac trauma requiring prompt surgical intervention was documented in 20 patients (6 females, 14 males; mean age 51 years; range 31 to 69 years). These were due to coronary angiography/balloon angioplasty-stenting in 14 (70%), percutaneous mitral balloon valvuloplasty in four (20%), and to heart catheterization in two patients (10%). Acute cardiac tamponade was detected in 10 patients (50%) resulting from perforations to the cardiac chambers in six, coronary arteries in two, and major vessels in two patients. Surgical interventions included coronary artery by-pass in 14, mitral valve surgery in four, and repair of major vessels in two patients. Perioperative mortality occurred in two patients. Six patients developed complications contributing to morbidity, including perioperative myocardial infarction (3 patients), infection (2 patients), and prolonged intubation (1 patient). CONCLUSION In case of major cardiac complications induced during cardiac catheterizations, early diagnosis and prompt surgical intervention are of vital importance regardless of considerably high risks.
Collapse
Affiliation(s)
- Nilgun Ulusoy Bozbuğa
- Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
In summary, the incidence of BCI following blunt thoracic trauma patients has been reported between 20% and 76%, and no gold standard exists to diagnose BCI. Diagnostic tests should be limited to identify those patients who are at risk of developing cardiac complications as a result of BCI. Therapeutic interventions should be directed to treat the complications of BCI. Finally, the prognosis and outcome of BCI patients is encouraging
Collapse
Affiliation(s)
- Jess M Schultz
- Department of Surgery, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, L223, Portland, OR 97239, USA
| | | |
Collapse
|