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المؤلفون: Adham Mohamed, Timothy P. Berry, Julie A Welge, Elizabeth L. Thomas, Larisa Zhurav, Jonathan Kozinn, Michelle M. Haines
المصدر: Journal of Cardiothoracic and Vascular Anesthesia. 36:2439-2445
مصطلحات موضوعية: Male, Extracorporeal Membrane Oxygenation, Anesthesiology and Pain Medicine, Angiotensin II, Shock, Cardiogenic, Humans, Female, Shock, Heart-Assist Devices, Prospective Studies, Middle Aged, Cardiology and Cardiovascular Medicine, Retrospective Studies
الوصف: To describe angiotensin II (ANGII) use in patients on mechanical circulatory support (MCS). To evaluate the efficacy and safety of ANGII in patients with shock on MCS.Retrospective cohort study.A single-center, quaternary care academic medical center.The study comprised critically ill patients on MCS.None.Fourteen patients were included in this retrospective analysis. The median age was 54 years (44.8, 68.3) and 78.6% were men. Six patients were receiving venoarterial extracorporeal membrane oxygenation support, 4 patients were receiving venovenous extracorporeal membrane oxygenation support, and 4 patients were on left ventricular assist devices. Five patients (36%) achieved hemodynamic response to ANGII at 3 hours, defined as a mean arterial pressure (MAP) of ≥65 mmHg or a 10-mmHg increase in MAP with a decrease or no change in total vasopressor dose. Overall, the median MAP increased from 61 mmHg (51, 73) at baseline to 66 mmHg (58, 71) at 3 hours, and the median norepinephrine dose decreased from 0.45 µg/kg/min (0.28, 0.6) at baseline to 0.2 µg/kg/min (0.18, 0.32) at 3 hours. The in-hospital mortality rate was 78.6%. Two patients experienced severe adverse drug events and 1 patient had a sentinel thrombotic event.This study suggested that ANGII may provide a salvage treatment option in patients on MCS with refractory vasodilatory shock. There are several safety considerations with the use of ANGII in these patients. Prospective randomized controlled trials are needed to evaluate the safety and efficacy of ANGII in patients on MCS.
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المصدر: Transplantation Proceedings. 54:1671-1674
مصطلحات موضوعية: Male, Transplantation, Catecholamines, Levetiracetam, Status Epilepticus, Takotsubo Cardiomyopathy, Shock, Cardiogenic, Humans, Stroke Volume, Surgery, Middle Aged, Troponin, Ventricular Function, Left
الوصف: Cardiogenic shock after heart transplant, could be due to acute rejection, cardiac allograft vasculopathy, or myocarditis. Stress cardiomyopathy (CM) in a denervated transplanted heart is unusual. A 56-year-old man with a history of ischemic heart disease and a seizure disorder underwent orthotropic heart transplant. He had breakthrough seizures posttransplant while on levetiracetam (Keppra) and was admitted for status epilepticus. A transthoracic echocardiogram (TTE) was done for hypotension (BP 90/60). TTE showed a severely reduced left ventricular ejection fraction (LVEF) of 15%, hyperkinetic base, and apical ballooning that are consistent with stress CM. Electrocardiogram with T wave inversion in precordial leads. Troponin was elevated to 1.77. The patient had cardiogenic shock and needed an intra-aortic balloon pump and multiple pressors. He was treated for status epilepticus and the LVEF completely recovered in 1 week. The patient had a normal TTE, coronary angiography, and biopsy with no rejection 8 days before admission. Stress CM was the diagnosis of exclusion, confirmed with a complete recovery of the LVEF. There are only 5 case reports of stress CM after heart transplant, with most presenting 9 to 10 years afterwards. We describe an unusual case of cardiogenic shock from stress CM triggered by status epilepticus in a denervated heart only 1 year posttransplant. The mechanism is elusive, and some hypotheses suggest exaggerated sensitivity to a plasma catecholamine surge from parasympathetic denervation. In a denervated heart, autonomic re-innervation can be seen as early as 1 year posttransplant.
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المؤلفون: Jonathan D. Moreno, Druv Bhagavan, Allie Li, Nels C. Gerstner, Evan W. Miller, Nathaniel Huebsch, Sharon Cresci, Jonathan R. Silva
المصدر: Circ Heart Fail
مصطلحات موضوعية: Cardiomyopathy, Dilated, Heart Failure, Male, Young Adult, Heart Rate, Optical Imaging, Shock, Cardiogenic, Humans, Myocytes, Cardiac, Cardiology and Cardiovascular Medicine, Article
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d9912a62a35f8ddaf2a94e250fce2288
https://pubmed.ncbi.nlm.nih.gov/34886677 -
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المؤلفون: Samer Noaman, Sara Vogrin, Diem Dinh, Jeffrey Lefkovits, Angela L. Brennan, Christopher M. Reid, Antony Walton, David Kaye, Jason E. Bloom, Dion Stub, Yang Yang, Craig French, Stephen J. Duffy, Nicholas Cox, William Chan
المصدر: JACC: Cardiovascular Interventions. 15:876-886
مصطلحات موضوعية: Male, Percutaneous Coronary Intervention, Treatment Outcome, Risk Factors, Shock, Cardiogenic, Humans, Female, Hospital Mortality, Registries, Acute Coronary Syndrome, Cardiac Surgical Procedures, Cardiology and Cardiovascular Medicine, Aged
الوصف: This study sought to assess the association between cardiac surgery availability and percutaneous coronary intervention (PCI) volume with clinical outcomes of cardiogenic shock (CS) complicating acute coronary syndrome (ACS).CS remains a grave complication of ACS with high mortality rates despite timely reperfusion and improved heart failure therapies.The study analyzed data from consecutive patients with CS complicating ACS who underwent PCI and were prospectively enrolled in the VCOR (Victorian Cardiac Outcomes Registry) from 26 hospitals in Victoria. We compared patients treated at cardiac surgical centers (CSCs) versus non-CSCs as well as the annual CS PCI volume (stratified into tiers of 10, 10-25, and25 cases) for in-hospital major adverse cardiac and cerebrovascular events (MACCE) and long-term mortality.Of 1,179 patients with CS, the mean age of patients was 65 years; males comprised 74%, and 22% had diabetes mellitus. Cardiac arrest occurred in 38% of patients, while 90% presented with ST-segment elevation myocardial infarction and 26% received intra-aortic balloon pump support. Overall, in-hospital and long-term mortality were 42% and 51%, respectively. There was no difference among patients treated non-CSCs compared with a CSCs for in-hospital MACCE and mortality (both P0.05). Similarly, there was no association between tiers of annual CS PCI volume with in-hospital MACCE and mortality (both P0.05).Comparable short- and long-term mortality rates among patients with ACS complicated by CS treated by PCI irrespective of cardiac surgery availability and CS PCI volume support the emergent treatment of these gravely ill patients at their presenting PCI-capable hospital.
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المؤلفون: Jacob C, Jentzer, Yishay, Szekely, Barry, Burstein, Yashi, Ballal, Edy Y, Kim, Sean, van Diepen, Meir, Tabi, Brandon, Wiley, Kianoush B, Kashani, Patrick R, Lawler
المصدر: Journal of Critical Care. 68:50-58
مصطلحات موضوعية: Male, Neutrophils, Shock, Cardiogenic, Humans, Female, Hospital Mortality, Lymphocytes, Critical Care and Intensive Care Medicine, Risk Assessment, Retrospective Studies
الوصف: To evaluate the association between the neutrophil-to-lymphocyte ratio (NLR) and mortality across the cardiogenic shock (CS) severity spectrum, defined using the Society of Cardiovascular Interventions and Angiography (SCAI) shock stages.We retrospectively analyzed cardiac intensive care unit (CICU) patients between 2007 and 2015. Predictors of in-hospital mortality were analyzed using logistic regression.We included 8280 patients aged 67.3 ± 15.2 years (37.2% females). Elevated NLR (≥7) was present in 45% of patients. NLR increased with worsening SCAI stage and was associated with higher in-hospital mortality in shock stages A to C (all p 0.001). After multivariable adjustment, NLR remained associated with higher in-hospital mortality (adjusted odds ratio 1.05 per 3.5 NLR units, 95% CI 1.03-1.08, p 0.001), with an optimal cut-off of ≥7 (in-hospital mortality 13.1% vs. 4.1%, adjusted odds ratio 1.44, 95% CI 1.14-1.81, p = 0.002). Patients in SCAI stage A or B with NLR ≥7 had higher in-hospital mortality than patients in SCAI stage B or C with NLR7, respectively.Elevated NLR is associated with higher in-hospital mortality in CICU patients with or at risk for CS, emphasizing the importance of systemic inflammation as a determinant of outcomes in CS patients.
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المؤلفون: Jacob Abraham, Lian Wang, Vishesh Kumar, Eric B. Kirker, Kateri J. Spinelli
المصدر: The Journal of Heart and Lung Transplantation. 41:434-437
مصطلحات موضوعية: Aged, 80 and over, Male, Pulmonary and Respiratory Medicine, Transplantation, Shock, Cardiogenic, Aortic Valve Stenosis, Transcatheter Aortic Valve Replacement, Treatment Outcome, Aortic Valve, Humans, Surgery, Heart-Assist Devices, Cardiology and Cardiovascular Medicine, Aged
الوصف: Cardiogenic shock in the setting of severe aortic stenosis is associated with poor outcomes. We describe 5 patients with cardiogenic shock and severe aortic stenosis who received an axillary microaxial pump (Impella) as an extended bridge to transcatheter aortic valve replacement. The median (range) age was 65 (61-87) years old, 80% were male, and 80% presented with stage D or E cardiogenic shock. In most cases, balloon aortic valvuloplasty was performed prior to pump insertion. Stabilization by Impella allowed for heart team evaluation and additional interventions, including percutaneous coronary intervention, MitraClip, and cardioversion. After a median (range) of 7 (5-14) days of Impella support, semi-elective transcatheter aortic valve replacement was successfully performed. All patients survived to discharge. Four patients (80%) were alive beyond 1 year. In these high-risk patients, prolonged support with a microaxial pump allowed for stabilization, ancillary interventions, and multi-disciplinary heart team evaluation prior to transcatheter aortic valve replacement.
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المؤلفون: Angelo Silverio, Guido Parodi, Fernando Scudiero, Eduardo Bossone, Marco Di Maio, Olga Vriz, Michele Bellino, Concetta Zito, Gennaro Provenza, Ilaria Radano, Cesare Baldi, Antonello D'Andrea, Giuseppina Novo, Ciro Mauro, Fausto Rigo, Pasquale Innelli, Jorge Salerno-Uriarte, Matteo Cameli, Carmine Vecchione, Francesco Antonini Canterin, Gennaro Galasso, Rodolfo Citro
المساهمون: Silverio, Angelo, Parodi, Guido, Scudiero, Fernando, Bossone, Eduardo, Di Maio, Marco, Vriz, Olga, Bellino, Michele, Zito, Concetta, Provenza, Gennaro, Radano, Ilaria, Baldi, Cesare, D'Andrea, Antonello, Novo, Giuseppina, Mauro, Ciro, Rigo, Fausto, Innelli, Pasquale, Salerno-Uriarte, Jorge, Cameli, Matteo, Vecchione, Carmine, Antonini Canterin, Francesco, Galasso, Gennaro, Citro, Rodolfo
المصدر: Heart. 108:1369-1376
مصطلحات موضوعية: Male, Outcome Assessment, Adrenergic beta-Antagonists, Shock, Cardiogenic, Health Care, Tin, Takotsubo Cardiomyopathy, Hypertension, Outcome Assessment, Health Care, Humans, Female, Cardiomyopathies, Cardiology and Cardiovascular Medicine, Aged, Shock, Cardiogenic
الوصف: ObjectiveThe advantage of beta-blockers has been postulated in patients with Takotsubo syndrome (TTS) given the pathophysiological role of catecholamines. We hypothesised that beta-blocker treatment after discharge may improve the long-term clinical outcome in this patient population.MethodsThis was an observational, multicentre study including consecutive patients with TTS diagnosis prospectively enrolled in the Takotsubo Italian Network (TIN) register from January 2007 to December 2018. TTS was diagnosed according to the TIN, Heart Failure Association and InterTAK Diagnostic Criteria. The primary study outcome was the occurrence of all-cause death at the longest available follow-up; secondary outcomes were TTS recurrence, cardiac and non-cardiac death.ResultsThe study population included 825 patients (median age: 72.0 (63.0–78.0) years; 91.9 % female): 488 (59.2%) were discharged on beta-blockers and 337 (40.8%) without beta-blockers. The median follow-up was 24.0 months. The adjusted Cox regression analysis showed a significantly lower risk for all-cause death (adjusted HR: 0.563; 95% CI: 0.356 to 0.889) and non-cardiac death (adjusted HR: 0.525; 95% CI: 0.309 to 0.893) in patients receiving versus those not receiving beta-blockers, but no significant differences in terms of TTS recurrence (adjusted HR: 0.607; 95% CI: 0.311 to 1.187) and cardiac death (adjusted HR: 0.699; 95% CI: 0.284 to 1.722). The positive survival effect of beta-blockers was higher in patients with hypertension than in those without (pinteraction=0.014), and in patients who developed cardiogenic shock during the acute phase than in those who did not (pinteraction=0.047).ConclusionsIn this real-world register population, beta-blockers were associated with a significantly higher long-term survival, particularly in patients with hypertension and in those who developed cardiogenic shock during the acute phase.
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المؤلفون: Barry Burstein, Vidhu Anand, Bradley Ternus, Meir Tabi, Nandan S. Anavekar, Barry A. Borlaug, Gregory W. Barsness, Garvan C. Kane, Jae K. Oh, Jacob C. Jentzer
المصدر: American Heart Journal. 245:149-159
مصطلحات موضوعية: Aged, 80 and over, Male, Shock, Cardiogenic, Stroke Volume, Middle Aged, Ventricular Function, Left, Intensive Care Units, Echocardiography, Humans, Female, Hospital Mortality, Cardiology and Cardiovascular Medicine, Aged, Retrospective Studies
الوصف: Low cardiac power output (CPO), measured invasively, can identify critically ill patients at increased risk of adverse outcomes, including mortality. We sought to determine whether non-invasive, echocardiographic CPO measurement was associated with mortality in cardiac intensive care unit (CICU) patients.Patients admitted to CICU between 2007 and 2018 with echocardiography performed within one day (before or after) admission and who had available data necessary for calculation of CPO were evaluated. Multivariable logistic regression determined the relationship between CPO and adjusted hospital mortality.A total of 5,585 patients (age of 68.3 ± 14.8 years, 36.7% female) were evaluated with admission diagnoses including acute coronary syndrome (ACS) in 56.7%, heart failure (HF) in 50.1%, cardiac arrest (CA) in 12.2%, shock in 15.5%, and cardiogenic shock (CS) in 12.8%. The mean left ventricular ejection fraction (LVEF) was 47.3 ± 16.2%, and the mean CPO was 1.04 ± 0.37 W. There were 419 in-hospital deaths (7.5%). CPO was inversely associated with the risk of hospital mortality, an association that was consistent among patients with ACS, HF, and CS. On multivariable analysis, higher CPO was associated with reduced hospital mortality (OR 0.960 per 0.1 W, 95CI 0.0.926-0.996, P = .03). Hospital mortality was particularly high in patients with low CPO coupled with reduced LVEF, increased vasopressor requirements, or higher admission lactate.Echocardiographic CPO was inversely associated with hospital mortality in unselected CICU patients, particularly among patients with increased lactate and vasopressor requirements. Routine calculation and reporting of CPO should be considered for echocardiograms performed in CICU patients.
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المؤلفون: Lene Holmvang, Louise Linde, Henrik Schmidt, Hanna Louise Ratcovich, Christian Hassager, Thomas Engstrøm, Francis R. Joshi, Jacob E. Møller, Hanne Berg Ravn, Ole Kristian Lerche Helgestad, Lisette Okkels Jensen, Jakob Josiassen
المصدر: Ratcovich, H L, Josiassen, J, Helgestad, O K L, Linde, L, Jensen, L O, Ravn, H B, Joshi, F R, Engstrøm, T, Schmidt, H, Hassager, C, Møller, J E & Holmvang, L 2022, ' Outcome in Elderly Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction ', Shock (Augusta, Ga.), vol. 57, no. 3, pp. 327-335 . https://doi.org/10.1097/SHK.0000000000001837
مصطلحات موضوعية: Male, Shock, Cardiogenic/etiology, medicine.medical_specialty, Denmark, Myocardial Infarction, Shock, Cardiogenic, Critical Care and Intensive Care Medicine, Tertiary care, Cohort Studies, Risk Factors, Internal medicine, Heart rate, medicine, Humans, Hospital Mortality, Lactic Acid, Registries, Myocardial infarction, Aged, Aged, 80 and over, Ejection fraction, Myocardial Infarction/complications, business.industry, Cardiogenic shock, Age Factors, Stroke Volume, Lactic Acid/blood, Middle Aged, University hospital, medicine.disease, Current analysis, Hospitalization, Survival Rate, Treatment Outcome, Increased risk, Emergency Medicine, Cardiology, Female, business
الوصف: INTRODUCTION: Despite advances in treatment of patients with cardiogenic shock following acute myocardial infarction (AMICS) in-hospital mortality remains around 50%. Outcome varies among patient subsets and the elderly often have a poor a priori prognosis. We sought to investigate outcome among elderly AMICS patients referred to evaluation and treatment at a tertiary university hospital. METHODS: Current analysis was based on the RETROSHOCK registry comprising consecutive AMICS patients admitted to tertiary care. Patients in the registry were individually identified and validated. RESULTS: Of 1,716 admitted patients, 496 (28.9%) patients were ≥75 years old. Older patients were less likely to be admitted directly to a tertiary centre (59.4% vs. 69.9%, P = 0.003), receive mechanical support devices (i.e., Impella® (8.9% vs. 15.0%, P = 0.003), and undergo revascularization attempt (76.8% vs. 90.2%, P
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::8c1f24781f45bba1fde25fe2e49a2069
https://doi.org/10.1097/shk.0000000000001837 -
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المؤلفون: Marie D Lauridsen, Rasmus Rørth, Jawad H Butt, Morten Schmidt, Peter E Weeke, Søren L Kristensen, Jacob E Møller, Christian Hassager, Jesper Kjærgaard, Christian Torp-Pedersen, Gunnar Gislason, Lars Køber, Emil L Fosbøl
المصدر: Lauridsen, M D, Rørth, R, Butt, J H, Schmidt, M, Weeke, P E, Kristensen, S L, Møller, J E, Hassager, C, Kjærgaard, J, Torp-Pedersen, C, Gislason, G, Køber, L & Fosbøl, E L 2022, ' Return to work after acute myocardial infarction with cardiogenic shock : a Danish nationwide cohort study ', European Heart Journal: Acute Cardiovascular Care, vol. 11, no. 5, pp. 397-406 . https://doi.org/10.1093/ehjacc/zuac040
مصطلحات موضوعية: Male, Myocardial Infarction/complications, Denmark, Myocardial Infarction, Shock, Cardiogenic, Hypoxia, Brain/complications, General Medicine, Middle Aged, Critical Care and Intensive Care Medicine, Denmark/epidemiology, Cohort Studies, Return to Work, Humans, Registries, Hypoxia, Brain, Cardiology and Cardiovascular Medicine, Shock, Cardiogenic/complications
الوصف: Background Physical and mental well-being after critical illness may be objectified by the ability to work. We examined return to work among patients with myocardial infarction (MI) by cardiogenic shock (CS) status. Methods Danish nationwide registries were used to identify patients with first-time MI by CS status between 2005 and 2015, aged 18–63 years, working before hospitalization and discharged alive. Multiple logistic regression models were used to compare groups. Results We identified 19 799 patients with MI of whom 653 had CS (3%). The median age was similar for patients with and without CS (53 years, interquartile range 47–58). One-year outcomes in patients with and without CS were as follows: 52% vs. 83% returned to work, 41% vs. 16% did not and 6% vs. 1% died. The adjusted odds ratio (OR) of returning to work was 0.53 [95% confidence limit (CI): 0.42–0.66]. In patients with CS, males and patients surviving OHCA were more likely to return to work (OR: 1.83, 95% CI: 1.15–2.92 and 1.55, 95% CI: 1.00–2.40, respectively), whereas prolonged hospitalization (OR: 0.38, 95% CI: 0.22–0.65) and anoxic brain damage (OR: 0.36, 95% CI: 0.18–0.72) were associated with lower likelihood of returning to work. Conclusion In patients with MI discharged alive, approximately 80% of those without CS returned to work at 1-year follow-up in contrast to 50% of those with CS. Among patients with CS, male sex and OHCA survivors were markers positively related to return to work, whereas prolonged hospitalization and anoxic brain damage were negatively related markers.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::bbda8ed3013712c0dd6fd452fb63d778
https://vbn.aau.dk/da/publications/370592a7-37ee-4bea-966c-9dbe227760db
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