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Leick J, Gjata A, Pulz J, Weisbarth T, Richter K, Krause T, Saad L, Zayat R, Kolat P, Haneya A, Sinning JM, Werner N. Evaluation of LVEDP Change During High-Risk PCI With and Without Impella Support (ELVIS)-A Pilot Trial. J Clin Med 2025; 14:824. [PMID: 39941495 PMCID: PMC11818807 DOI: 10.3390/jcm14030824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 01/19/2025] [Accepted: 01/23/2025] [Indexed: 02/16/2025] Open
Abstract
Background: The decision-making process to use percutaneous mechanical circulatory support in the context of elective high-risk percutaneous coronary intervention (HRPCI) is complex and evolving. The aim of this study is to evaluate the left ventricular end-diastolic pressure (LVEDP) as a parameter to identify patients that may benefit from a protected HRCPI (pHRPCI) procedure. Methods: Overall, 62 patients (pHRPCI n = 31 vs. non-pHRPCI n = 31) with a complex coronary artery disease and a left ventricular ejection fraction (LVEF) ≤35% were included. The primary endpoint was defined as a change in LVEDP and its correlation with laboratory measurements. The secondary safety endpoint was a composite of the incidence of major in-hospital adverse cardiac and cerebrovascular events (MACCE). Results: Baseline characteristics were similar, including age (pHRPCI 72.8 ± 8.8 vs. non-pHRPCI 75.0 ± 10.4; p = 0.408), male (pHRPCI 83.9% vs. non-pHRPCI 96.8; p = 0.195), pre-PCI Syntax Score (pHRPCI 33.9 ± 13.1 vs. non-pHRPCI 35.4 ± 12; p = 0.643), post-PCI Syntax Score (pHRPCI 7.4 ± 6.2 vs. non-pHRPCI 9.6 ± 8.4; p = 0.239) and baseline LVEDP between the groups (pHRPCI 18.5 ± 10.5 mmHg vs. non-pHRPCI 15.7 ± 8.1 mmHg; p = 0.237). There was a trend to a lower LVEF in the pHRPCI group (26.4 ± 6.7% vs. 29.4 ± 5%; p = 0.051). The primary endpoint analysis revealed a significant change in LVEDP (pHRPCI -4.7 ± 9 mmHg vs. non-pHRPCI +3.1 ± 7.5 mmHg; p < 0.001) that did not correlate with changes in creatinine (p = 0.285), NT-proBNP (p = 0.383) or troponin (p = 0.639) concentrations within 24 h. Overall, low rates of in-hospital (pHRPCI 6.5% vs. non-pHRPCI 3.2%; p = 0.999) and 90-days (pHRPCI 12.9% vs. non-pHRPCI 12.9%; p = 0.999) MACCE were observed in both groups. Conclusions: Protected HRPCI leads to a significant reduction in LVEDP without influencing biomarkers of myocardial damage. There was no difference in MACCE rates between the groups.
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Affiliation(s)
- Juergen Leick
- Heart Center Trier, Department of Cardiology, Barmherzige Brueder Hospital, Nordallee 1, 54296 Trier, Germany; (A.G.); (T.K.); (L.S.); (N.W.)
| | - Anida Gjata
- Heart Center Trier, Department of Cardiology, Barmherzige Brueder Hospital, Nordallee 1, 54296 Trier, Germany; (A.G.); (T.K.); (L.S.); (N.W.)
| | - Jan Pulz
- Department of Cardiology, Cellitinnen Hospital St. Vinzenz Cologne, Merheimer Straße 221-223, 50733 Cologne, Germany; (J.P.); (T.W.); (K.R.); (J.-M.S.)
| | - Tobias Weisbarth
- Department of Cardiology, Cellitinnen Hospital St. Vinzenz Cologne, Merheimer Straße 221-223, 50733 Cologne, Germany; (J.P.); (T.W.); (K.R.); (J.-M.S.)
| | - Kristof Richter
- Department of Cardiology, Cellitinnen Hospital St. Vinzenz Cologne, Merheimer Straße 221-223, 50733 Cologne, Germany; (J.P.); (T.W.); (K.R.); (J.-M.S.)
| | - Tobias Krause
- Heart Center Trier, Department of Cardiology, Barmherzige Brueder Hospital, Nordallee 1, 54296 Trier, Germany; (A.G.); (T.K.); (L.S.); (N.W.)
| | - Louai Saad
- Heart Center Trier, Department of Cardiology, Barmherzige Brueder Hospital, Nordallee 1, 54296 Trier, Germany; (A.G.); (T.K.); (L.S.); (N.W.)
| | - Rashad Zayat
- Heart Center Trier, Department of Cardiothoracic Surgery, Barmherzige Brueder Hospital, Nordallee 1, 54296 Trier, Germany; (R.Z.); (P.K.); (A.H.)
| | - Philipp Kolat
- Heart Center Trier, Department of Cardiothoracic Surgery, Barmherzige Brueder Hospital, Nordallee 1, 54296 Trier, Germany; (R.Z.); (P.K.); (A.H.)
| | - Assad Haneya
- Heart Center Trier, Department of Cardiothoracic Surgery, Barmherzige Brueder Hospital, Nordallee 1, 54296 Trier, Germany; (R.Z.); (P.K.); (A.H.)
| | - Jan-Malte Sinning
- Department of Cardiology, Cellitinnen Hospital St. Vinzenz Cologne, Merheimer Straße 221-223, 50733 Cologne, Germany; (J.P.); (T.W.); (K.R.); (J.-M.S.)
| | - Nikos Werner
- Heart Center Trier, Department of Cardiology, Barmherzige Brueder Hospital, Nordallee 1, 54296 Trier, Germany; (A.G.); (T.K.); (L.S.); (N.W.)
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Tamis-Holland JE, Abbott JD, Al-Azizi K, Barman N, Bortnick AE, Cohen MG, Dehghani P, Henry TD, Latif F, Madjid M, Yong CM, Sandoval Y. SCAI Expert Consensus Statement on the Management of Patients With STEMI Referred for Primary PCI. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:102294. [PMID: 39649824 PMCID: PMC11624394 DOI: 10.1016/j.jscai.2024.102294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2024]
Abstract
ST-elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality in the United States. Timely reperfusion with primary percutaneous coronary intervention is associated with improved outcomes. The Society for Cardiovascular Angiography & Interventions puts forth this expert consensus document regarding best practices for cardiac catheterization laboratory team readiness, arterial access with an algorithm to help determine proper arterial access in STEMI, and diagnostic angiography. This consensus statement highlights the strengths and limitations of various diagnostic and therapeutic interventions to access and treat a patient with STEMI in the catheterization laboratory, reviews different options to manage large thrombus burden during STEMI, and reviews the management of STEMI across the spectrum of various anatomical and clinical circumstances.
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Affiliation(s)
| | - J. Dawn Abbott
- Lifespan Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Karim Al-Azizi
- Baylor Scott & White The Heart Hospital – Plano, Plano, Texas
| | | | - Anna E. Bortnick
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | | | - Payam Dehghani
- University of Saskatchewan College of Medicine, Regina, Saskatchewan, Canada
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
| | - Faisal Latif
- SSM Health St. Anthony Hospital and University of Oklahoma, Oklahoma City, Oklahoma
| | - Mohammad Madjid
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Celina M. Yong
- Stanford University School of Medicine, Stanford, California
- Palo Alto Veterans Affairs Healthcare System, Palo Alto, California
| | - Yader Sandoval
- Minneapolis Heart Institute, Abbott Northwestern Hospital, and Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
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Denicolai M, Morello M, Del Buono MG, Sanna T, Agatiello CR, Abbate A. Cardiac rupture as a life-threatening outcome of Takotsubo syndrome: A systematic review. Int J Cardiol 2024; 412:132336. [PMID: 38964548 DOI: 10.1016/j.ijcard.2024.132336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/17/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Takotsubo syndrome (TS) is a reversible cause of heart failure; however, a minority of patients can develop serious complications, including cardiac rupture (CR). OBJECTIVES Analyze case reports of CR related to TS, detailing patient characteristics to uncover risk factors and prognosis for this severe complication. METHODS We conducted a systematic search of MEDLINE and Embase databases to identify case reports of patients with TS complicated by CR, from inception to October 2023. RESULTS We included 44 subjects (40 females; 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity. An emotional trigger was present in 15 (34%) subjects and an apical ballooning pattern was observed in all cases (100%). ST-segment elevation was reported in 39 (93%) of 42 cases, with the anterior myocardial segments (37 [88%]) being the most compromised, followed by lateral (26 [62%]) and inferior (14 [33%]) segments. The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery was attempted in 16 (36%) cases, and 28 (64%) patients did not survive. CONCLUSIONS CR related to TS is a rare complication associated with high mortality and affecting elderly females, specially from White/Caucasian or East Asian/Japanese descent, presenting with anterior or lateral ST-segment elevation, and an apical ballooning pattern. Although data is limited and additional prospective studies are needed, the awareness of this life-threatening complication is crucial to early identify high-risk patients. CONDENSED ABSTRACT Cardiac rupture is a rare complication of Takotsubo syndrome. We conducted a systematic review of cases complicated by cardiac rupture, and we identified 44 subjects (40 females and 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity, all with an apical ballooning pattern (100%). The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery treatment was attempted in 16 (36%) cases, and 28 (64%) patients did not survive.
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Affiliation(s)
- Martin Denicolai
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States; Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Matteo Morello
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States
| | - Marco G Del Buono
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tommaso Sanna
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carla R Agatiello
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States; Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, United States
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Pahlevan NM, Alavi R, Liu J, Ramos M, Hindoyan A, Matthews RV. Detecting elevated left ventricular end diastolic pressure from simultaneously measured femoral pressure waveform and electrocardiogram. Physiol Meas 2024; 45:085005. [PMID: 39084642 DOI: 10.1088/1361-6579/ad69fd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/31/2024] [Indexed: 08/02/2024]
Abstract
Objective.Instantaneous, non-invasive evaluation of left ventricular end-diastolic pressure (LVEDP) would have significant value in the diagnosis and treatment of heart failure. A new approach called cardiac triangle mapping (CTM) has been recently proposed, which can provide a non-invasive estimate of LVEDP. We hypothesized that a hybrid machine-learning (ML) method based on CTM can instantaneously identify an elevated LVEDP using simultaneously measured femoral pressure waveform and electrocardiogram (ECG).Approach.We studied 46 patients (Age: 39-90 (66.4 ± 9.9), BMI: 20.2-36.8 (27.6 ± 4.1), 12 females) scheduled for clinical left heart catheterizations or coronary angiograms at University of Southern California Keck Medical Center. Exclusion criteria included severe mitral/aortic valve disease; severe carotid stenosis; aortic abnormalities; ventricular paced rhythm; left bundle branch and anterior fascicular blocks; interventricular conduction delay; and atrial fibrillation. Invasive LVEDP and pressure waveforms at the iliac bifurcation were measured using transducer-tipped Millar catheters with simultaneous ECG. LVEDP range was 9.3-40.5 mmHg. LVEDP = 18 mmHg was used as cutoff. Random forest (RF) classifiers were trained using data from 36 patients and blindly tested on 10 patients.Main results.Our proposed ML classifier models accurately predict true LVEDP classes using appropriate physics-based features, where the most accurate demonstrates 100.0% (elevated) and 80.0% (normal) success in predicting true LVEDP classes on blind data.Significance.We demonstrated that physics-based ML models can instantaneously classify LVEDP using information from femoral waveforms and ECGs. Although an invasive validation, the required ML inputs can be potentially obtained non-invasively.
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Affiliation(s)
- Niema M Pahlevan
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, CA, United States of America
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Rashid Alavi
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, CA, United States of America
| | - Jing Liu
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, CA, United States of America
| | - Melissa Ramos
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Antreas Hindoyan
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Ray V Matthews
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
- Cardiac and Vascular Institute, University of Southern California, Los Angeles, CA, United States of America
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Benenati S, Montorfano M, Pica S, Crimi G, Ancona M, Montone RA, Rinaldi R, Gramegna M, Esposito A, Palmisano A, Tavano D, Monizzi G, Bartorelli A, Porto I, Ambrosio G, Camici PG. Coronary physiology thresholds associated with microvascular obstruction in myocardial infarction. Heart 2024; 110:271-280. [PMID: 37879880 DOI: 10.1136/heartjnl-2023-323169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/15/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES To ascertain whether invasive assessment of coronary physiology soon after recanalisation of the culprit artery by primary percutaneous coronary intervention is associated with the development of microvascular obstruction by cardiac magnetic resonance in patients with ST-segment elevation myocardial infarction (STEMI). METHODS Between November 2020 and December 2021, 102 consecutive patients were prospectively enrolled in five tertiary centres in Italy. Coronary flow reserve (CFR) and index of microvascular resistance (IMR) were measured in the culprit vessel soon after successful primary percutaneous coronary intervention. Optimal cut-off points of IMR and CFR to predict the presence of microvascular obstruction were estimated, stratifying the population accordingly in four groups. A comparison with previously proposed stratification models was carried out. RESULTS IMR>31 units and CFR≤1.25 yielded the best accuracy. Patients with IMR>31 and CFR≤1.25 exhibited higher microvascular obstruction prevalence (83% vs 38%, p<0.001) and lower left ventricular ejection fraction (45±9% vs 52±9%, p=0.043) compared with those with IMR≤31 and CFR>1.25, and lower left ventricular ejection fraction compared with patients with CFR≤1.25 and IMR≤31 (45±9% vs 54±7%, p=0.025). Infarct size and area at risk were larger in the former, compared with other groups. CONCLUSIONS IMR and CFR are associated with the presence of microvascular obstruction in STEMI. Patients with an IMR>31 units and a CFR≤1.25 have higher prevalence of microvascular obstruction, lower left ventricular ejection fraction, larger infarct size and area at risk. TRIAL REGISTRATION NUMBER NCT04677257.
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Affiliation(s)
- Stefano Benenati
- Cardiovascular Disease Chair, Department of Internal Medicine (Di.M.I.), University of Genova, Genova, Liguria, Italy
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Matteo Montorfano
- Interventional Cardiology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Silvia Pica
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Gabriele Crimi
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Marco Ancona
- Cardiology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rocco A Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Rinaldi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Antonio Esposito
- Diagnostic Radiology, IRCCS San Raffaele Hospital and Vita University San Raffaele, Milan, Italy
- Radiology, Università Vita e Salute San Raffaele, Milan, Italy
| | | | - Davide Tavano
- Cardiology, IRCCS MultiMedica, Sesto San Giovanni, Italy
| | | | | | - Italo Porto
- Cardiovascular Disease Chair, Department of Internal Medicine (Di.M.I.), University of Genova, Genova, Liguria, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Giuseppe Ambrosio
- Cardiology, University of Perugia School of Medicine, Perugia, Italy
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Hanson L, Vogrin S, Noaman S, Goh CY, Zheng W, Wexler N, Jumaah H, Al-Mukhtar O, Bloom J, Haji K, Schneider D, Kadhmawi A, Stub D, Cox N, Chan W. Left Ventricular End-Diastolic Pressure for the Prediction of Contrast-Induced Nephropathy and Clinical Outcomes in Patients With ST-Elevation Myocardial Infarction Who Underwent Primary Percutaneous Intervention (the ELEVATE Study). Am J Cardiol 2023; 203:219-225. [PMID: 37499602 DOI: 10.1016/j.amjcard.2023.06.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/10/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023]
Abstract
Contrast-induced nephropathy (CIN) is an important complication of percutaneous coronary intervention (PCI). We investigated whether left ventricular end-diastolic pressure (LVEDP) in patients who underwent PCI might be additive to current risk stratification of CIN. Data from consecutive patients who underwent primary PCI for ST-elevation myocardial infarction between 2013 and 2018 at Western Health in Victoria, Australia were analyzed. CIN was defined as a 25% increase in serum creatinine from baseline or 44 µmol/L increase in absolute value within 48 hours of contrast administration. Compared with patients without CIN (n = 455, 93%), those who developed CIN (n = 35, 7%) were older (64 vs 58 years, p = 0.006), and had higher peak creatine kinase (2,862 [1,258 to 3,952] vs 1,341 U/L [641 to 2,613], p = 0.02). The CIN group had higher median LVEDP (30 [21-33] vs 25 mm Hg [20-30], p = 0.013) and higher median Mehran risk score (MRS) (5 [2-8] vs 2 [1-5], p <0.001). Patients with CIN had more in-hospital major adverse cardiovascular and cerebrovascular events (composite end point of death, new or recurrent myocardial infarction or stent thrombosis, target vessel revascularization or stroke) (23% vs 8.6%, p = 0.01), but similar 30-day major adverse cardiovascular and cerebrovascular events (20% vs 15%, p = 0.46). An LVEDP >30 mm Hg independently predicted CIN (odds ratio 3.4, 95% confidence interval 1.46 to 8.03, p = 0.005). The addition of LVEDP ≥30 mm Hg to MRS marginally improved risk prediction for CIN compared with MRS alone (area-under-curve, c-statistic = 0.71 vs c-statistic = 0.63, p = 0.08). In conclusion, elevated LVEDP ≥30 mm Hg during primary PCI was an independent predictor of CIN in patients treated for ST-elevation myocardial infarction. The addition of LVEDP to the MRS may improve risk prediction for CIN.
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Affiliation(s)
- Laura Hanson
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Samer Noaman
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Cheng Yee Goh
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Cardiology, University of Ottawa Heart Institute Ottawa, Ontario, Canada
| | - Wayne Zheng
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Noah Wexler
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Haider Jumaah
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Omar Al-Mukhtar
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Jason Bloom
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Kawa Haji
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Daniel Schneider
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ahmed Kadhmawi
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - William Chan
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
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Impact of Left Ventricular End-Diastolic Pressure on the Outcomes of Patients Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2022; 185:107-114. [DOI: 10.1016/j.amjcard.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/19/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022]
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Castaldi G, Benfari G, Zivelonghi C. Risk stratification in patients with STEMI: is it finally time to look at the left atrium? THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:2115-2116. [PMID: 37726475 DOI: 10.1007/s10554-022-02650-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/14/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Gianluca Castaldi
- Hartcentrum - Middeleheim Ziekenhuis Netwerk Antwerp (ZNA), Lindendreef 1, 2020, Antwerp, Belgium
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Carlo Zivelonghi
- Hartcentrum - Middeleheim Ziekenhuis Netwerk Antwerp (ZNA), Lindendreef 1, 2020, Antwerp, Belgium.
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Martonová D, Holz D, Brackenhammer D, Weyand M, Leyendecker S, Alkassar M. Support Pressure Acting on the Epicardial Surface of a Rat Left Ventricle—A Computational Study. Front Cardiovasc Med 2022; 9:850274. [PMID: 35872914 PMCID: PMC9299250 DOI: 10.3389/fcvm.2022.850274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
The present computational study investigates the effects of an epicardial support pressure mimicking a heart support system without direct blood contact. We chose restrictive cardiomyopathy as a model for a diseased heart. By changing one parameter representing the amount of fibrosis, this model allows us to investigate the impairment in a diseased left ventricle, both during diastole and systole. The aim of the study is to determine the temporal course and value of the support pressure that leads to a normalization of the cardiac parameters in diseased hearts. These are quantified via the end-diastolic pressure, end-diastolic volume, end-systolic volume, and ejection fraction. First, the amount of fibrosis is increased to model diseased hearts at different stages. Second, we determine the difference in the left ventricular pressure between a healthy and diseased heart during a cardiac cycle and apply for the epicardial support as the respective pressure difference. Third, an epicardial support pressure is applied in form of a piecewise constant step function. The support is provided only during diastole, only during systole, or during both phases. Finally, the support pressure is adjusted to reach the corresponding parameters in a healthy rat. Parameter normalization is not possible to achieve with solely diastolic or solely systolic support; for the modeled case with 50% fibrosis, the ejection fraction can be increased by 5% with purely diastolic support and 14% with purely systolic support. However, the ejection fraction reaches the value of the modeled healthy left ventricle (65.6%) using a combination of diastolic and systolic support. The end-diastolic pressure of 13.5 mmHg cannot be decreased with purely systolic support. However, the end-diastolic pressure reaches the value of the modeled healthy left ventricle (7.5 mmHg) with diastolic support as well as with the combination of the diastolic and systolic support. The resulting negative diastolic support pressure is −4.5 mmHg, and the positive systolic support pressure is 90 mmHg. We, thereby, conclude that ventricular support during both diastole and systole is beneficial for normalizing the left ventricular ejection fraction and the end-diastolic pressure, and thus it is a potentially interesting therapy for cardiac insufficiency.
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Affiliation(s)
- Denisa Martonová
- Institute of Applied Dynamics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- *Correspondence: Denisa Martonová
| | - David Holz
- Institute of Applied Dynamics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dorothea Brackenhammer
- Institute of Applied Dynamics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Weyand
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sigrid Leyendecker
- Institute of Applied Dynamics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Muhannad Alkassar
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Mathew R, Fernando SM, Hu K, Parlow S, Di Santo P, Brodie D, Hibbert B. Optimal Perfusion Targets in Cardiogenic Shock. JACC. ADVANCES 2022; 1:100034. [PMID: 38939320 PMCID: PMC11198174 DOI: 10.1016/j.jacadv.2022.100034] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 06/29/2024]
Abstract
Cardiology shock is a syndrome of low cardiac output resulting in end-organ dysfunction. Few interventions have demonstrated meaningful clinical benefit, and cardiogenic shock continues to carry significant morbidity with mortality rates that have plateaued at upwards of 40% over the past decade. Clinicians must rely on clinical, biochemical, and hemodynamic parameters to guide resuscitation. Several features, including physical examination, renal function, serum lactate metabolism, venous oxygen saturation, and hemodynamic markers of right ventricular function, may be useful both as prognostic markers and to guide therapy. This article aims to review these targets, their utility in the care of patients with cardiology shock, and their association with outcomes.
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Affiliation(s)
- Rebecca Mathew
- Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Shannon M. Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kira Hu
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Parlow
- Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, New York, USA
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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11
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Lee SH, Choi KH, Yang JH, Song YB, Lee JM, Park TK, Hahn JY, Choi JH, Choi SH, Gwon HC. Association Between Preexisting Elevated Left Ventricular Filling Pressure and Clinical Outcomes of Future Acute Myocardial Infarction. Circ J 2022; 86:660-667. [PMID: 34321375 DOI: 10.1253/circj.cj-21-0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Because no data were available regarding the effect of preexisting left ventricular filling pressure (LVFP) on clinical outcomes in patients with acute myocardial infarction (AMI), we evaluated whether preexisting high LVFP can determine outcomes of subsequent AMI events. METHODS AND RESULTS Among 399,613 subjects who underwent echocardiography for various reason from August 2004 to June 2019, 231 had experienced subsequent AMI and were stratified according to preexisting LVFP: low LVFP (E/e' ≤14) and high LVFP (E/e' >14). The primary outcome was cardiac death at 30 days and 1 year after AMI. Overall, 19.5% had high LVFP prior to AMI events. Preexisting high LVFP was associated with an increased risk of cardiac death at 30 days (3.8% vs. 11.6%; adjusted hazard ratio (HR) 4.56, 95% confidence interval (CI) 1.20-17.24, P=0.026) and 1 year after AMI (7.9% vs. 35.9%; adjusted HR 4.14, 95% CI 1.79-9.57, P<0.001). Preexisting E/e' as a continuous value was significantly associated with 1-year risk of cardiac death (adjusted HR 1.08, 95% CI 1.02-1.15, P=0.007). Follow-up echocardiography showed that patients with high LVFP did not show improvement in systolic or diastolic function. CONCLUSIONS Preexisting high LVFP was associated with poor clinical course and 1-year cardiac death after subsequent AMI, as well as no improvement in systolic or diastolic function.
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Affiliation(s)
- Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Chonnam National University Hospital
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jin-Ho Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
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12
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Yu H, Ahn J. Effect of systolic dysfunction and elevated left ventricular end diastolic pressure on 3-year clinical outcomes in patients with atrial fibrillation. Echocardiography 2021; 38:1787-1794. [PMID: 34672009 DOI: 10.1111/echo.15216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/23/2021] [Accepted: 09/25/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Systolic and diastolic dysfunctions are related to adverse clinical outcomes in patients with sinus rhythm. The aim of this study was to clarify the prognostic significance of systolic and diastolic dysfunctions in patients with persistent atrial fibrillation (AF). METHODS We evaluated the data of 114 consecutive patients with persistent AF who underwent measurement of LVEDP at our hospital between March 1, 2011 and December 31, 2014. The patients were divided into two groups according to the left ventricular ejection fraction (LVEF): LVEF < 50 (reduced ejection fraction, REF group) and LVEF ≥50 (preserved EF, PEF group). The PEF group was further divided into two subgroups according to the left ventricular end-diastolic filling pressure (LVEDP): LVEDP > 15 mm Hg and LVEDP ≤ 15 mm Hg subgroups. The 3-year clinical outcomes were compared between the PEF and REF groups and the LVEDP ≥15 mm Hg and LVEDP < 15 mm Hg groups. RESULTS During the 3-year follow-up period, the rate of heart failure (HF) hospitalization and incidence of AF with rapid ventricular rhythm (RVR) were higher in the REF group than in the PEF group. Multivariate analysis revealed that REF was the only significant predictor of HF hospitalization (hazard ratio, 4.71; 95% confidence interval, 1.48-15.02; p = 0.009). CONCLUSIONS Our mid-term follow-up data demonstrated that systolic dysfunction was an important predictor of HF hospitalization in patients with AF. However, elevated LVEDP may not be associated with adverse mid-term clinical outcomes in patients without systolic dysfunction.
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Affiliation(s)
- HyeYon Yu
- School of Nursing, College of Medicine, Soonchunhyang University, Asan, Korea
| | - JiHun Ahn
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University, Daejeon, South Korea
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13
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Millo L, McKenzie A, De la Paz A, Zhou C, Yeung M, Stouffer GA. Usefulness of a Novel Risk Score to Predict In-Hospital Mortality in Patients ≥ 60 Years of Age with ST Elevation Myocardial Infarction. Am J Cardiol 2021; 154:1-6. [PMID: 34261591 DOI: 10.1016/j.amjcard.2021.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
Numerous algorithms are available to predict short-term mortality in ST elevation myocardial infarction (STEMI) but none are focused on elderly patients or include invasive hemodynamics. A simplified risk score (LASH score) including left ventricular end diastolic pressure > 20 mm Hg, age > 75 years, systolic blood pressure < 100 mm Hg and heart rate > 100 bpm was tested in a retrospective, single-center study of 346 patients ≥ 60 years old who underwent primary percutaneous coronary intervention (PPCI). The median age was 70 years [IQR: 64, 79], 60.1% were men, and 77.8% identified as White. In-hospital all-cause mortality was 10.1%. Patients with a LASH score ≥ 3 (n = 34) had an in-hospital mortality rate of 44.1% compared to 6.4% for LASH score ≤ 2 (p < 0.0001). The odds ratio for in-hospital mortality for patients with LASH score ≥ 3 was 13.2 (95% CI 5.3-33.1) compared to patients with a LASH score ≤ 2 when adjusted for sex, cardiac arrest, heart failure, and prior cerebrovascular event. The LASH score had an area under the ROC curve for predicting in-hospital mortality of 0.795 [CI 0.716-0.872], as compared to TIMI-STEMI (0.881, CI 0.829-0.931; p = 0.01), GRACE (0.849, CI 0.778-0.920; p = 0.19), shock index (0.769, CI 0.667-0.871; p = 0.51) and modified shock index (0.765, CI 0.716-0.873; p = 0.48). In summary, a simplified, easy to calculate risk score that incorporates age and invasive hemodynamics predicts in-hospital mortality in patients ≥ 60 years old undergoing PPCI for STEMI.
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Affiliation(s)
- Lorena Millo
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Alexander McKenzie
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Andrew De la Paz
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Cynthia Zhou
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Michael Yeung
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - George A Stouffer
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
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14
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McKenzie A, Zhou C, Svendsen C, Anketell R, Behroozi A, Jessa D, Piehl C, Rayson R, Yeung M, Stouffer GA. Ability of a novel shock index that incorporates invasive hemodynamics to predict mortality in patients with ST-elevation myocardial infarction. Catheter Cardiovasc Interv 2021; 98:87-94. [PMID: 33421279 DOI: 10.1002/ccd.29460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/08/2020] [Accepted: 12/28/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine whether the use of invasively measured hemodynamics improves the prognostic ability of a shock index (SI). BACKGROUND SI such as Admission-SI, Age-SI, Modified SI (MSI), and Age-MSI predict short-term mortality in ST-elevation myocardial infarction (STEMI). METHODS Single-center study of 510 patients who underwent primary percutaneous coronary intervention. STEMI SI was defined as age × heart rate (HR) divided by coronary perfusion pressure (CPP). RESULTS The mean age was 62 ± 14 years, 66% were males with hypertension (69%), tobacco use (38%), diabetes (28%) and chronic kidney disease (6%). The mean HR, systolic blood pressure (SBP), and CPP were 81 ± 18 bpm, 124 ± 28 mmHg, and 52.8 ± 16.3 mmHg, respectively. Patients with STEMI SI ≥182 (n = 51) were more likely to experience a cardiac arrest in the catheterization laboratory (9.8% vs. 2.0%; p = .001), require mechanical circulatory support (47.1% vs. 8.5%; p < .0001) and be treated with vasopressors (56.9% vs. 10.7%; p < .0001) compared to STEMI SI < 182 (n = 459). After multivariate adjustment, patients with STEMI SI ≥182 were 10, 10.1 and 4.8 times more likely to die during hospitalization, at 30 days and at 5 years, respectively. The C statistic of STEMI SI was 0.870, similar to GRACE score (AUC = 0.902; p = .29) and TIMI STEMI score (AUC = 0.895; p = .36). CONCLUSION STEMI SI is an easy to calculate risk score that identifies STEMI patients at high risk of in-hospital death.
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Affiliation(s)
- Alexander McKenzie
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Cynthia Zhou
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Christopher Svendsen
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Lillington, North Carolina, USA
| | - Rebecca Anketell
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Lillington, North Carolina, USA
| | - Arash Behroozi
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Lillington, North Carolina, USA
| | - Dafe Jessa
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Lillington, North Carolina, USA
| | | | - Robert Rayson
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael Yeung
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - George A Stouffer
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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15
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Tarantini G, Fabris T, Rodinò G, Fraccaro C. Improvement of symptoms and coronary perfusion gradient with mechanical left ventricular unloading in flow-limiting complex spontaneous coronary artery dissection, without revascularization. Catheter Cardiovasc Interv 2021; 98:E581-E585. [PMID: 34128584 PMCID: PMC8518797 DOI: 10.1002/ccd.29836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/20/2021] [Accepted: 06/05/2021] [Indexed: 11/12/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) can lead to acute coronary syndrome and sudden cardiac death, particularly in young women. Observational data show that, in SCAD patients, both percutaneous coronary intervention and coronary artery bypass grafting seem to be hampered by higher technical complexity, lower success rates, and worse outcomes. As spontaneous healing is a common occurrence, expert consensus advices medical management of the acute phase, when feasible. We present the case of a young woman with SCAD of left anterior descending artery causing myocardial infarction with ST-segment elevation. High-anatomical complexity and unstable conditions of the patient made both medical management and immediate revascularization unfeasible options. Therefore, we decided to implant a percutaneous off-loading mechanical support device to improve coronary perfusion pressure by unloading the left ventricle and preserve cardiac function, preventing worse complications of acute myocardial infarction. This strategy was successful in stabilizing the patient, until the definitive revascularization treatment became an option.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Tommaso Fabris
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giulio Rodinò
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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16
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Aortic Pulsatility Index: A Novel Hemodynamic Variable for Evaluation of Decompensated Heart Failure. J Card Fail 2021; 27:1045-1052. [PMID: 34048919 DOI: 10.1016/j.cardfail.2021.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/26/2021] [Accepted: 05/04/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Right heart catheterization for invasive hemodynamics has shown only modest correlation with clinical outcomes. We designed a novel hemodynamic variable that incorporates ventricular output and filling pressure. We anticipated that the aortic pulsatility index (API) would correlate with clinical outcomes in patients with heart failure. METHODS AND RESULTS We retrospectively analyzed consecutive patients undergoing right heart catheterization with milrinone drug study at our institution (February 2013 to November 2019). The API was calculated as (systolic blood pressure - diastolic blood pressure)/pulmonary capillary wedge pressure. The primary outcome was freedom from advanced therapies, defined as the need for inotropes, temporary mechanical circulatory support, a left ventricular assist device, or orthotopic heart transplantation, or death at 30 days. A total of 224 patient encounters, age 57 years (48-66 years; 34% women; 31% ischemic cardiomyopathy) were included. In univariable analysis, lower baseline API was significantly associated with progression to advanced therapies or death at 30-days (odds ratio 0.43, 95% confidence interval 0.30-0.61; P < .001) compared with those on continued medical management. Receiver operator characteristic analysis specified an optimal cutpoint of 1.45 for API. A Kaplan-Meier analysis indicated an association of API with the primary outcome (79% for API ≥ 1.45 vs 48% for API < 1.45). In multivariable analysis, higher API was strongly associated with freedom from advanced therapies or death (odds ratio 0.38, 95% confidence interval 0.22-0.65, P ≤ .001), even when adjusted for baseline characteristics and routine right heart catheterization measurements. CONCLUSIONS The API is a novel invasive hemodynamic measurement that is associated independently with freedom from advanced therapies or death at 30-day follow-up.
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17
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Khan AA, Al-Omary MS, Collins NJ, Attia J, Boyle AJ. Natural history and prognostic implications of left ventricular end-diastolic pressure in reperfused ST-segment elevation myocardial infarction: an analysis of the thrombolysis in myocardial infarction (TIMI) II randomized controlled trial. BMC Cardiovasc Disord 2021; 21:243. [PMID: 34001032 PMCID: PMC8130170 DOI: 10.1186/s12872-021-02046-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background The aim of the current study is to assess the natural history and prognostic value of elevated left ventricular end-diastolic pressure (LVEDP) in patients with ST-segment elevation myocardial infarction (STEMI) after reperfusion with thrombolysis; we utilize data from the Thrombolysis in Myocardial Infarction (TIMI) II study.
Methods A total of 3339 patients were randomized to either an invasive (n = 1681) or a conservative (n = 1658) strategy in the TIMI II study following thrombolysis. To make the current cohort as relevant as possible to modern pharmaco-invasively managed cohorts, patients in the invasive arm with TIMI flow grade ≥ 2 (N = 1201) at initial catheterization are included in the analysis. Of these, 259 patients had a second catheterization prior to hospital discharge, and these were used to define the natural history of LVEDP in reperfused STEMI. Results The median LVEDP for the whole cohort was 18 mmHg (IQR: 12–23). Patients were divided into quartiles by LVEDP measured during the first cardiac catheterization. During a median follow up of 3 (IQR: 2.1–3.2) years, quartile 4 (highest LVEDP) had the highest incidence of mortality and heart failure admissions. In the cohort with paired catheterization data, the LVEDP dropped slightly from 18 mmHg (1QR: 12–22) to 15 mmHg (IQR: 10–20) (p = 0.01) from the first to the pre-hospital discharge catheterization. Conclusions LVEDP remains largely stable during hospitalisation post-STEMI. Elevated LVEDP is a predictor of death and heart failure hospitalization in STEMI patients undergoing successful thrombolysis. Graphic abstract ![]()
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Affiliation(s)
- Arshad A Khan
- Department of Cardiovascular Medicine, John Hunter Hospital, Locked Bag 1, HRMC, Newcastle, NSW, 2310, Australia.,The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Mohammed S Al-Omary
- Department of Cardiovascular Medicine, John Hunter Hospital, Locked Bag 1, HRMC, Newcastle, NSW, 2310, Australia.,The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Nicholas J Collins
- Department of Cardiovascular Medicine, John Hunter Hospital, Locked Bag 1, HRMC, Newcastle, NSW, 2310, Australia.,The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - John Attia
- Department of Cardiovascular Medicine, John Hunter Hospital, Locked Bag 1, HRMC, Newcastle, NSW, 2310, Australia.,The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Andrew J Boyle
- Department of Cardiovascular Medicine, John Hunter Hospital, Locked Bag 1, HRMC, Newcastle, NSW, 2310, Australia. .,The University of Newcastle, Newcastle, Australia. .,Hunter Medical Research Institute, Newcastle, Australia.
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18
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Szekely Y, Borohovitz A, Hochstadt A, Topilsky Y, Konigstein M, Halkin A, Bazan S, Banai S, Finkelstein A, Arbel Y. Long-term Implications of Post-Procedural Left Ventricular End-Diastolic Pressure in Patients Undergoing Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 146:62-68. [PMID: 33539862 DOI: 10.1016/j.amjcard.2021.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/29/2022]
Abstract
Current risk models have only limited accuracy in predicting transcatheter aortic valve Implantation (TAVI) outcomes and there is a paucity of clinical variables to guide patient management after the procedure. The prognostic impact of elevated left ventricular end-diastolic pressure (LVEDP) in TAVI patients is unknown. The aim of the present study was to evaluate the prognostic value of after-procedural LVEDP in patients who undewent TAVI. Consecutive patients with severe symptomatic aortic stenosis who undewent TAVI were divided into 2 groups according to after-procedural LVEDP above and below or equal 12 mm Hg. Collected data included baseline clinical, laboratory and echocardiographic variables. We evaluated the impact of elevated vs. normal LVEDP on in-hospital outcomes, short- and long-term mortality. Eight hundred forty-five patients were included in the study with complete in-hospital and late mortality data available for all survivors (median follow-up 29.5 months [IQR 16.5 to 48.0]). The mean age (±SD) was 82.3±6.2 years and mean Society of Thoracic Surgery score was 4.0%±3.0%. Patients with LVEDP>12 mm Hg (n = 591, 70%) and LVEDP≤12 mm Hg (n = 254, 30%) had a 6-months mortality rate of 6.8% and 2%, respectively (P=0.004) and a 1-year mortality rate of 10.1% vs 4.9%, respectively (p = 0.017). By multivariable analysis, after-procedural LVEDP>12 mm Hg was independently associated with all-cause mortality (HR 2.45, 95% CI 1.58 to 3.76, p <0.001) during long-term follow-up. In conclusion, elevated after-procedural LVEDP in patients who undewent TAVI is an independent predictor of mortality following TAVI. Further research regarding the use of LVEDP as a tool for after-procedural medical management is warranted.
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Affiliation(s)
- Yishay Szekely
- From the Department of Cardiology, Tel Aviv Medical Center, Tel Aviv; affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Israel.
| | - Ariel Borohovitz
- From the Department of Cardiology, Tel Aviv Medical Center, Tel Aviv; affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Israel
| | - Aviram Hochstadt
- From the Department of Cardiology, Tel Aviv Medical Center, Tel Aviv; affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Israel
| | - Yan Topilsky
- From the Department of Cardiology, Tel Aviv Medical Center, Tel Aviv; affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Israel
| | - Maayan Konigstein
- From the Department of Cardiology, Tel Aviv Medical Center, Tel Aviv; affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Israel
| | - Amir Halkin
- From the Department of Cardiology, Tel Aviv Medical Center, Tel Aviv; affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Israel
| | - Samuel Bazan
- From the Department of Cardiology, Tel Aviv Medical Center, Tel Aviv; affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Israel
| | - Shmuel Banai
- From the Department of Cardiology, Tel Aviv Medical Center, Tel Aviv; affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Israel
| | - Ariel Finkelstein
- From the Department of Cardiology, Tel Aviv Medical Center, Tel Aviv; affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Israel
| | - Yaron Arbel
- From the Department of Cardiology, Tel Aviv Medical Center, Tel Aviv; affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Israel
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19
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Araujo GN, Beltrame R, Pinheiro Machado G, Luchese Custodio J, Zimerman A, Donelli da Silveira A, Scolari FL, Corsetti Bergoli LC, Gonçalves SC, Pereira Lima Marques F, Fuchs FC, Vugman Wainstein M, Vugman Wainstein R. Comparison of Admission Lung Ultrasound and Left Ventricular End-Diastolic Pressure in Patients Undergoing Primary Percutaneous Coronary Intervention. Circ Cardiovasc Imaging 2021; 14:e011641. [PMID: 33866795 DOI: 10.1161/circimaging.120.011641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Gustavo Neves Araujo
- Universidade Federal do Rio Grande do Sul, Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Porto Alegre, Brazil (G.N.d.A., R.B., G.P.M., J.L.C., A.Z., A.D.d.S., F.L.S., L.C.C.B., S.C.G., F.P.L.M., F.C.F., M.V.W., R.V.W.)
- Imperial Hospital de Caridade, Florianópolis, Brazil (G.N.d.A.)
- Hospital SOS Cardio, Florianópolis, Brazil (G.N.d.A.)
| | - Rafael Beltrame
- Universidade Federal do Rio Grande do Sul, Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Porto Alegre, Brazil (G.N.d.A., R.B., G.P.M., J.L.C., A.Z., A.D.d.S., F.L.S., L.C.C.B., S.C.G., F.P.L.M., F.C.F., M.V.W., R.V.W.)
| | - Guilherme Pinheiro Machado
- Universidade Federal do Rio Grande do Sul, Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Porto Alegre, Brazil (G.N.d.A., R.B., G.P.M., J.L.C., A.Z., A.D.d.S., F.L.S., L.C.C.B., S.C.G., F.P.L.M., F.C.F., M.V.W., R.V.W.)
| | - Julia Luchese Custodio
- Universidade Federal do Rio Grande do Sul, Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Porto Alegre, Brazil (G.N.d.A., R.B., G.P.M., J.L.C., A.Z., A.D.d.S., F.L.S., L.C.C.B., S.C.G., F.P.L.M., F.C.F., M.V.W., R.V.W.)
| | - Andre Zimerman
- Universidade Federal do Rio Grande do Sul, Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Porto Alegre, Brazil (G.N.d.A., R.B., G.P.M., J.L.C., A.Z., A.D.d.S., F.L.S., L.C.C.B., S.C.G., F.P.L.M., F.C.F., M.V.W., R.V.W.)
| | - Anderson Donelli da Silveira
- Universidade Federal do Rio Grande do Sul, Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Porto Alegre, Brazil (G.N.d.A., R.B., G.P.M., J.L.C., A.Z., A.D.d.S., F.L.S., L.C.C.B., S.C.G., F.P.L.M., F.C.F., M.V.W., R.V.W.)
- Hospital de Clinicas de Porto Alegre, Division of Cardiology, Brazil (A.D.d.S., L.C.C.B., S.C.G., F.C.F., M.V.W., R.V.W.)
| | - Fernado Luís Scolari
- Universidade Federal do Rio Grande do Sul, Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Porto Alegre, Brazil (G.N.d.A., R.B., G.P.M., J.L.C., A.Z., A.D.d.S., F.L.S., L.C.C.B., S.C.G., F.P.L.M., F.C.F., M.V.W., R.V.W.)
| | - Luiz Carlos Corsetti Bergoli
- Universidade Federal do Rio Grande do Sul, Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Porto Alegre, Brazil (G.N.d.A., R.B., G.P.M., J.L.C., A.Z., A.D.d.S., F.L.S., L.C.C.B., S.C.G., F.P.L.M., F.C.F., M.V.W., R.V.W.)
- Hospital de Clinicas de Porto Alegre, Division of Cardiology, Brazil (A.D.d.S., L.C.C.B., S.C.G., F.C.F., M.V.W., R.V.W.)
| | - Sandro Cadaval Gonçalves
- Universidade Federal do Rio Grande do Sul, Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Porto Alegre, Brazil (G.N.d.A., R.B., G.P.M., J.L.C., A.Z., A.D.d.S., F.L.S., L.C.C.B., S.C.G., F.P.L.M., F.C.F., M.V.W., R.V.W.)
- Hospital de Clinicas de Porto Alegre, Division of Cardiology, Brazil (A.D.d.S., L.C.C.B., S.C.G., F.C.F., M.V.W., R.V.W.)
| | - Felipe Pereira Lima Marques
- Universidade Federal do Rio Grande do Sul, Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Porto Alegre, Brazil (G.N.d.A., R.B., G.P.M., J.L.C., A.Z., A.D.d.S., F.L.S., L.C.C.B., S.C.G., F.P.L.M., F.C.F., M.V.W., R.V.W.)
| | - Felipe Costa Fuchs
- Universidade Federal do Rio Grande do Sul, Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Porto Alegre, Brazil (G.N.d.A., R.B., G.P.M., J.L.C., A.Z., A.D.d.S., F.L.S., L.C.C.B., S.C.G., F.P.L.M., F.C.F., M.V.W., R.V.W.)
- Hospital de Clinicas de Porto Alegre, Division of Cardiology, Brazil (A.D.d.S., L.C.C.B., S.C.G., F.C.F., M.V.W., R.V.W.)
| | - Marco Vugman Wainstein
- Universidade Federal do Rio Grande do Sul, Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Porto Alegre, Brazil (G.N.d.A., R.B., G.P.M., J.L.C., A.Z., A.D.d.S., F.L.S., L.C.C.B., S.C.G., F.P.L.M., F.C.F., M.V.W., R.V.W.)
- Hospital de Clinicas de Porto Alegre, Division of Cardiology, Brazil (A.D.d.S., L.C.C.B., S.C.G., F.C.F., M.V.W., R.V.W.)
| | - Rodrigo Vugman Wainstein
- Universidade Federal do Rio Grande do Sul, Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Porto Alegre, Brazil (G.N.d.A., R.B., G.P.M., J.L.C., A.Z., A.D.d.S., F.L.S., L.C.C.B., S.C.G., F.P.L.M., F.C.F., M.V.W., R.V.W.)
- Hospital de Clinicas de Porto Alegre, Division of Cardiology, Brazil (A.D.d.S., L.C.C.B., S.C.G., F.C.F., M.V.W., R.V.W.)
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20
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Henry TD, Tomey MI, Tamis-Holland JE, Thiele H, Rao SV, Menon V, Klein DG, Naka Y, Piña IL, Kapur NK, Dangas GD. Invasive Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e815-e829. [DOI: 10.1161/cir.0000000000000959] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cardiogenic shock (CS) remains the most common cause of mortality in patients with acute myocardial infarction. The SHOCK trial (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) demonstrated a survival benefit with early revascularization in patients with CS complicating acute myocardial infarction (AMICS) 20 years ago. After an initial improvement in mortality related to revascularization, mortality rates have plateaued. A recent Society of Coronary Angiography and Interventions classification scheme was developed to address the wide range of CS presentations. In addition, a recent scientific statement from the American Heart Association recommended the development of CS centers using standardized protocols for diagnosis and management of CS, including mechanical circulatory support devices (MCS). A number of CS programs have implemented various protocols for treating patients with AMICS, including the use of MCS, and have published promising results using such protocols. Despite this, practice patterns in the cardiac catheterization laboratory vary across health systems, and there are inconsistencies in the use or timing of MCS for AMICS. Furthermore, mortality benefit from MCS devices in AMICS has yet to be established in randomized clinical trials. In this article, we outline the best practices for the contemporary interventional management of AMICS, including coronary revascularization, the use of MCS, and special considerations such as the treatment of patients with AMICS with cardiac arrest.
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21
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De Maria GL, Garcia-Garcia HM, Scarsini R, Finn A, Sato Y, Virmani R, Bhindi R, Ciofani JL, Nuche J, Ribeiro HB, Mathias W, Yerasi C, Fischell TA, Otterspoor L, Ribichini F, Ibañez B, Pijls NHJ, Schwartz RS, Kapur NK, Stone GW, Banning AP. Novel device-based therapies to improve outcome in ST-segment elevation myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:687-697. [PMID: 33760016 DOI: 10.1093/ehjacc/zuab012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 12/17/2022]
Abstract
Primary percutaneous coronary intervention (PPCI) has dramatically changed the outcome of patients with ST-elevation myocardial infarction (STEMI). However, despite improvements in interventional technology, registry data show little recent change in the prognosis of patients who survive STEMI, with a significant incidence of cardiogenic shock, heart failure, and cardiac death. Despite a technically successful PPCI procedure, a variable proportion of patients experience suboptimal myocardial reperfusion. Large infarct size and coronary microvascular injury, as the consequence of ischaemia-reperfusion injury and distal embolization of atherothrombotic debris, account for suboptimal long-term prognosis of STEMI patients. In order to address this unmet therapeutic need, a broad-range of device-based treatments has been developed. These device-based therapies can be categorized according to the pathophysiological pathways they target: (i) techniques to prevent distal atherothrombotic embolization, (ii) techniques to prevent or mitigate ischaemia/reperfusion injury, and (iii) techniques to enhance coronary microvascular function/integrity. This review is an overview of these novel technologies with a focus on their pathophysiological background, procedural details, available evidence, and with a critical perspective about their potential future implementation in the clinical care of STEMI patients.
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Affiliation(s)
- Giovanni Luigi De Maria
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, UK
| | - Hector M Garcia-Garcia
- MedStar Washington Hospital Centre-Interventional Cardiology Department, 110 Irving St NW, Washington, DC, USA
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Aloke Finn
- CVPath Institute, Gaithersburg, 19 Firstfield Rd, Gaithersburg, MD 20878, USA.,School of Medicine, University of Maryland, Baltimore, 655 W Baltimore St, Baltimore, MD 21201, USA
| | - Yu Sato
- CVPath Institute, Gaithersburg, 19 Firstfield Rd, Gaithersburg, MD 20878, USA
| | - Renu Virmani
- CVPath Institute, Gaithersburg, 19 Firstfield Rd, Gaithersburg, MD 20878, USA
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Reserve Road, ST. Leonard 2065, Sydney, Australia
| | - Jonathan L Ciofani
- Department of Cardiology, Royal North Shore Hospital, Reserve Road, ST. Leonard 2065, Sydney, Australia
| | - Jorge Nuche
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Calle Melchor Fernández Almagro 3, 28029, Madrid, Spain.,Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Cordoba avenue, 28041, Madrid, Spain.,CIBERCV, Av. Monforte de Lemos, 3-5. Pabellón, 11. Planta 0 28029, Madrid, Spain
| | - Henrique B Ribeiro
- Heart Institute (InCor), Clinic Hospital, The University of Sao Paulo School of Medicine, Sao Paulo, State of Sao Paulo 05403-000, Brazil
| | - Wilson Mathias
- Heart Institute (InCor), Clinic Hospital, The University of Sao Paulo School of Medicine, Sao Paulo, State of Sao Paulo 05403-000, Brazil
| | - Charan Yerasi
- MedStar Washington Hospital Centre-Interventional Cardiology Department, 110 Irving St NW, Washington, DC, USA
| | - Tim A Fischell
- Michigan State University, 426 Auditorium Road, East Lansing, MI 48824, USA
| | - Luuk Otterspoor
- Department of Cardiology, Catharina Hospital, Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Borja Ibañez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Calle Melchor Fernández Almagro 3, 28029, Madrid, Spain.,CIBERCV, Av. Monforte de Lemos, 3-5. Pabellón, 11. Planta 0 28029, Madrid, Spain.,IIS-Fundación Jiménez Díaz, Calle Isaac Peral, 28015 Madrid, Spain
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
| | - Robert S Schwartz
- Minneapolis Heart Institute, 920 E 28th St Ste 100, Minneapolis, MN 55407, USA
| | - Navin K Kapur
- The Cardiovascular Centre, Tufts Medical Centre, 800 Washington St, Boston, MA 02111, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, New York, NY 10029, USA
| | - Adrian P Banning
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, UK
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22
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Maznyczka AM, McCartney PJ, Oldroyd KG, Lindsay M, McEntegart M, Eteiba H, Rocchiccioli JP, Good R, Shaukat A, Robertson K, Malkin CJ, Greenwood JP, Cotton JM, Hood S, Watkins S, Collison D, Gillespie L, Ford TJ, Weir RAP, McConnachie A, Berry C. Risk Stratification Guided by the Index of Microcirculatory Resistance and Left Ventricular End-Diastolic Pressure in Acute Myocardial Infarction. CIRCULATION. CARDIOVASCULAR INTERVENTIONS 2021; 14:e009529. [PMID: 33591821 DOI: 10.1161/circinterventions.120.009529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The index of microcirculatory resistance (IMR) of the infarct-related artery and left ventricular end-diastolic pressure (LVEDP) are acute, prognostic biomarkers in patients undergoing primary percutaneous coronary intervention. The clinical significance of IMR and LVEDP in combination is unknown. METHODS IMR and LVEDP were prospectively measured in a prespecified substudy of the T-TIME clinical trial (Trial of Low Dose Adjunctive Alteplase During Primary PCI). IMR was measured using a pressure- and temperature-sensing guidewire following percutaneous coronary intervention. Prognostically established thresholds for IMR (>32) and LVEDP (>18 mm Hg) were predefined. Contrast-enhanced cardiovascular magnetic resonance imaging (1.5 Tesla) was acquired 2 to 7 days and 3 months postmyocardial infarction. The primary end point was major adverse cardiac events, defined as cardiac death/nonfatal myocardial infarction/heart failure hospitalization at 1 year. RESULTS IMR and LVEDP were both measured in 131 patients (mean age 59±10.7 years, 103 [78.6%] male, 48 [36.6%] with anterior myocardial infarction). The median IMR was 29 (interquartile range, 17-55), the median LVEDP was 17 mm Hg (interquartile range, 12-21), and the correlation between them was not statistically significant (r=0.15; P=0.087). Fifty-three patients (40%) had low IMR (≤32) and low LVEDP (≤18), 18 (14%) had low IMR and high LVEDP, 31 (24%) had high IMR and low LVEDP, while 29 (22%) had high IMR and high LVEDP. Infarct size (% LV mass), LV ejection fraction, final myocardial perfusion grade ≤1, TIMI (Thrombolysis In Myocardial Infarction) flow grade ≤2, and coronary flow reserve were associated with LVEDP/IMR group, as was hospitalization for heart failure (n=18 events; P=0.045) and major adverse cardiac events (n=21 events; P=0.051). LVEDP>18 and IMR>32 combined was associated with major adverse cardiac events, independent of age, estimated glomerular filtration rate, and infarct-related artery (odds ratio, 5.80 [95% CI, 1.60-21.22] P=0.008). The net reclassification improvement for detecting major adverse cardiac events was 50.6% (95% CI, 2.7-98.2; P=0.033) when LVEDP>18 was added to IMR>32. CONCLUSIONS IMR and LVEDP in combination have incremental value for risk stratification following primary percutaneous coronary intervention. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02257294.
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Affiliation(s)
- Annette M Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Peter J McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Hany Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - J Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Christopher J Malkin
- Leeds University and Leeds Teaching Hospitals NHS Trust, United Kingdom (C.J.M., J.P.G.)
| | - John P Greenwood
- Leeds University and Leeds Teaching Hospitals NHS Trust, United Kingdom (C.J.M., J.P.G.)
| | - James M Cotton
- Wolverhampton University Hospital NHS Trust, United Kingdom (J.M.C.)
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Damien Collison
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Lynsey Gillespie
- Project Management Unit, Greater Glasgow and Clyde Health Board, United Kingdom (L.G.)
| | - Thomas J Ford
- Faculty of Medicine, University of Newcastle, Callaghan NSW, Australia (T.J.F.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Robin A P Weir
- University Hospital Hairmyres, East Kilbride, United Kingdom (R.A.P.W.)
| | - Alex McConnachie
- Robertson Centre for Biostatistics (A.M.), University of Glasgow, United Kingdom
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
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23
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Wakaki T, Ishibashi N, Yamao H. Increased left ventricular end-diastolic pressure after left ventriculography is associated with subsequent congestive heart failure-related hospitalization. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2021. [DOI: 10.4103/ijca.ijca_56_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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24
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Khan AA, Davies AJ, Whitehead NJ, McGee M, Al-Omary MS, Baker D, Bhagwandeen R, Renner I, Majeed T, Hatton R, Collins NJ, Attia J, Boyle AJ. Targeting elevated left ventricular end-diastolic pressure following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction – a phase one safety and feasibility study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:758-763. [DOI: 10.1177/2048872618819657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Elevated left ventricular end diastolic pressure (LVEDP) is an independent predictor of mortality and heart failure in patients with ST-segment elevation myocardial infarction (STEMI). Whether lowering elevated LVEDP improves outcomes remains unknown.
Methods:
This non-randomized, single blinded study with prospective enrolment and sequential group allocation recruited patients undergoing primary percutaneous coronary intervention for STEMI with LVEDP ⩾ 20 mmHg measured immediately after primary percutaneous coronary intervention. The intervention arm (n=10) received furosemide 40 mg intravenous bolus plus escalating doses of glyceryl trinitrate (100 µg per min to a maximum of 1000 µg) during simultaneous measurement of LVEDP. The control group (n=10) received corresponding normal saline boluses with simultaneous measurement of LVEDP (10 readings over 10 min). Efficacy endpoints were final LVEDP achieved, and the dose of glyceryl trinitrate needed to reduce LVEDP by ⩾ 20%. Safety endpoint was symptomatic hypotension (systolic blood pressure < 90 mmHg).
Results:
From 1 April 2017 to 23 August 2017 we enrolled 20 patients (age: 64±9 years, males: 60%, n=12, anterior STEMI: 65%, n=13). The mean LVEDP for the whole cohort (n=20) was 29±4 mmHg (intervention group: 28±3 mmHg vs. control group: 31±5 mmHg; p=0.1). The LVEDP dropped from 28±3 to 16±2 mmHg in the glyceryl trinitrate + furosemide group (p <0.01) but remained unchanged in the control group. The median dose of glyceryl trinitrate required to produce ⩾ 20% reduction in LVEDP in the intervention group was 200 µg (range: 100–800). One patient experienced asymptomatic decline in systolic blood pressure to below 90 mmHg. There was no correlation between LVEDP and left ventricular ejection fraction.
Conclusion:
The administration of glyceryl trinitrate plus furosemide in patients with elevated LVEDP following primary percutaneous coronary intervention for STEMI safely reduces LVEDP.
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Affiliation(s)
- Arshad A Khan
- John Hunter Hospital, Newcastle, Australia
- The University of Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | | | | | | | - Mohammed S Al-Omary
- John Hunter Hospital, Newcastle, Australia
- The University of Newcastle, Australia
| | | | | | | | - Tazeen Majeed
- The University of Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | | | - Nicholas J Collins
- John Hunter Hospital, Newcastle, Australia
- The University of Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | - John Attia
- John Hunter Hospital, Newcastle, Australia
- The University of Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | - Andrew J Boyle
- John Hunter Hospital, Newcastle, Australia
- The University of Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
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25
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Tehrani BN, Basir MB, Kapur NK. Acute myocardial infarction and cardiogenic shock: Should we unload the ventricle before percutaneous coronary intervention? Prog Cardiovasc Dis 2020; 63:607-622. [PMID: 32920027 DOI: 10.1016/j.pcad.2020.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 12/22/2022]
Abstract
Despite early reperfusion and coordinated systems of care, cardiogenic shock (CS) remains the number one cause of morbidity and in-hospital mortality following acute myocardial infarction (AMI). CS is a complex clinical syndrome that begins with hemodynamic instability and can progress to multi-organ failure and profound hemo-metabolic compromise. To improve outcomes, a clear understanding of the treatment objectives in CS and developing time-sensitive management strategies aimed at stabilizing hemodynamics and restoring myocardial perfusion are critical. Left ventricular (LV) load has been identified as an independent predictor of heart failure and mortality following AMI. Decades of preclinical and clinical research have identified several effective LV unloading strategies. Recent initiatives from single and multi-center registries and more recently the Door to Unload (DTU)-STEMI pilot study have provided valuable insight to developing a standardized treatment approach to AMI, based on early invasive hemodynamics and tailored circulatory support to unload the LV. To follow is a review of the pathophysiology and prevalence of shock, limitations of current therapies, and the pre-clinical and translational basis for incorporating LV unloading into contemporary AMI and shock care.
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Affiliation(s)
- Behnam N Tehrani
- Inova Heart and Vascular Institute, Falls Church, VA, United States of America
| | - Mir B Basir
- Henry Ford Medical Center, Detroit, MI, United States of America
| | - Navin K Kapur
- The CardioVascular Center, Tufts Medical Center, Boston, MA, United States of America.
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The association of left ventricular end-diastolic pressure with global longitudinal strain and scintigraphic infarct size in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Int J Cardiovasc Imaging 2020; 37:359-366. [PMID: 32761496 DOI: 10.1007/s10554-020-01945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
Left ventricular end-diastolic pressure (LVEDP) is an independent predictor for prognosis in ST-elevation myocardial infarction (STEMI) patients. We aimed to investigate the relationship of admission LVEDP measured after a successful primary percutaneous coronary intervention (pPCI) with scintigraphic infarct size (IS) and global longitudinal strain (GLS), a strong predictor of IS, in STEMI patients. A total of 62 consecutive patients with STEMI were enrolled in the study. LVEDP measurements were performed after pPCI in patients who had TIMI-3 flow. Echocardiography was performed 24 h after pPCI and repeated 3 months later. GLS was calculated as an average peak strain from the 3 apical projections. IS was evaluated at the third month by technetium 99m sestamibi. The mean age was 56 ± 8 years in the study population. The mean LVEDP was found 19.4 ± 4.4 mmHg. Median IS was 4% (0-11.7 IQR).The mean GLS at the 24th hour and the third month were found to be - 15.4 ± 2.8 and - 16.7 ± 2.5 respectively. There was a moderate negative correlation between LVEDP and GLS (24th-hour p < 0.001 r = - 0.485 and third-month p < 0.001 r = - 0.489). LVEDP had a moderate positive correlation with scintigraphic IS (p < 0.001 r = 0.545). In the multivariable model, we found that LVEDP was significantly associated with scintigraphic IS (β coefficient = 0.570, p = 0.008) but was not associated with the 24th hour (β coefficient = 0.092, p = 0.171) and third month GLS (β coefficient = 0.037, p = 0.531). This study demonstrated that there was a statistically significant relationship between LVEDP and scintigraphic IS, and IS was increased with high LVEDP values. However, there was not a relationship between LVEDP and GLS.
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Liu C, Caughey MC, Smith SC, Dai X. Elevated left ventricular end diastolic pressure is associated with increased risk of contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention. Int J Cardiol 2020; 306:196-202. [PMID: 32033785 DOI: 10.1016/j.ijcard.2020.01.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/09/2020] [Accepted: 01/27/2020] [Indexed: 01/19/2023]
Abstract
AIMS To study the correlation between intra-procedural left ventricular end-diastolic pressure (LVEDP) and the development of contrast-induced acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS A single center retrospective observational study compared clinical and hemodynamic characteristics of patients who developed post-PCI CI-AKI with those did not. CI-AKI was defined as an absolute increase in serum creatinine ≥0.5 mg/dl or an increase ≥25% from baseline 48-72 h after the administration of contrast medium. Among 1301 consecutive patients who underwent PCI, 125 patients (9.6%) developed CI-AKI. The CI-AKI group had a higher average LVEDP (18.4 ± 8.7 vs 14.4 ± 6.6 mm Hg; p < .0001) and higher prevalence of elevated LVEDP (≥20 mm Hg) than those without CI-AKI (47.2% vs 23.3%, p < .0001). After adjustments, elevated LVEDP remained independently associated with CI-AKI (OR 2.21; 95% CI 1.40-3.50). LVEDP predicted the development of CI-AKI with a receiver operating characteristic area under curve (AUC) of 0.64. The association between elevated LVEDP and the risk of CI-AKI was stronger in patients with reduced ejection fraction (EF ≤ 40%) (OR = 4.08; 95% CI: 1.68-9.91) than those with preserved EF (OR = 1.69; 95% CI: 0.94-3.04) (p value for interaction = .0003). Patients who had LVEDP ≥ 20 mm Hg and LVEF ≤ 40% had a post-PCI incidence rate of developing CI-AKI of 36.5%. CONCLUSIONS Elevated intra-procedural LVEDP (≥20 mm Hg) is independently associated with increased risk of CI-AKI for patients undergoing cardiac catheterization and PCI, especially in the setting of reduced LVEF (≤40%).
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Affiliation(s)
- Changqing Liu
- Division of Cardiology, McAllister Heart Institute University of North Carolina at Chapel Hill, 160 Dental Circle, Chapel Hill, NC 27514, United States of America; Department of Cardiology, Tangshan Central Hospital, Tangshan 063000, China
| | - Melissa C Caughey
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, NC, United States of America
| | - Sidney C Smith
- Division of Cardiology, McAllister Heart Institute University of North Carolina at Chapel Hill, 160 Dental Circle, Chapel Hill, NC 27514, United States of America.
| | - Xuming Dai
- Division of Cardiology, McAllister Heart Institute University of North Carolina at Chapel Hill, 160 Dental Circle, Chapel Hill, NC 27514, United States of America; Division of Cardiology, Lang Research Center, New York Presbyterian Medical Group - Queens Hospital, 56-45 Main Street, Flushing, NY 11355, United States of America.
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Leistner DM, Dietrich S, Erbay A, Steiner J, Abdelwahed Y, Siegrist PT, Schindler M, Skurk C, Haghikia A, Sinning D, Riedel M, Landmesser U, Stähli BE. Association of left ventricular end‐diastolic pressure with mortality in patients undergoing percutaneous coronary intervention for acute coronary syndromes. Catheter Cardiovasc Interv 2020; 96:E439-E446. [DOI: 10.1002/ccd.28839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/03/2020] [Accepted: 02/25/2020] [Indexed: 11/06/2022]
Affiliation(s)
- David M. Leistner
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
- Berlin Institute of Health (BIH) Berlin Germany
| | - Steven Dietrich
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
| | - Aslihan Erbay
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
| | - Julia Steiner
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
| | - Youssef Abdelwahed
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
| | - Patrick T. Siegrist
- Department of Cardiology University Heart Center, University Hospital Zurich Zurich Switzerland
| | - Matthias Schindler
- Department of Cardiology University Heart Center, University Hospital Zurich Zurich Switzerland
| | - Carsten Skurk
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
| | - Arash Haghikia
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
- Berlin Institute of Health (BIH) Berlin Germany
| | - David Sinning
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
| | - Matthias Riedel
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
| | - Ulf Landmesser
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
- Berlin Institute of Health (BIH) Berlin Germany
| | - Barbara E. Stähli
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
- Department of Cardiology University Heart Center, University Hospital Zurich Zurich Switzerland
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Watanabe I, Saito D, Noike R, Yabe T, Okubo R, Nakanishi R, Amano H, Toda M, Ikeda T. Measurement of left ventricular end-diastolic pressure improves the prognostic utility of the Global Registry of Acute Coronary Events score in patients with ST-segment elevation myocardial infarction. ASIAINTERVENTION 2019; 5:134-140. [PMID: 36483524 PMCID: PMC9706761 DOI: 10.4244/aij-d-18-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 05/02/2019] [Indexed: 06/17/2023]
Abstract
AIMS This study aimed to evaluate the clinical significance of measuring left ventricular end-diastolic pressure (LVEDP) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS We retrospectively analysed clinical data from 277 patients with STEMI between October 2006 and June 2014. LVEDP and left ventricular ejection fraction (LVEF) were perioperatively measured during percutaneous coronary intervention (PCI). The primary endpoint was a major adverse cardiac event (MACE) such as cardiac death, non-fatal myocardial infarction, or hospitalisation due to heart failure during the observation period. The independent predictors were identified by Cox proportional hazards regression analysis. Continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) were conducted to assess the incremental prognostic value of adding cardiovascular parameters, including LVEDP, to the Global Registry of Acute Coronary Events (GRACE) score. The mean follow-up period was 44±31 months. A MACE occurred in 33 patients (12.0%). In the Cox proportional hazards regression model, after adjusting for confounding factors, LVEDP was an independent predictor of a MACE (hazard ratio [HR] 1.11, 95% confidence interval [CI]: 1.06-1.17, p<0.001). In addition, the predictive value of the GRACE score for a MACE was significantly improved by LVEDP (NRI 0.66, 95% CI: 0.32-1.01, p<0.001; IDI 0.06, 95% CI: 0.02-0.11, p=0.001), but not by LVEF (NRI 0.14, 95% CI: -0.22-0.50, p=0.44; IDI 0.01, 95% CI: 0.00-0.03, p=0.11). CONCLUSIONS The results of this study demonstrated that evaluating LVEDP provides an additive prognostic value over conventional risks estimated by the GRACE score among STEMI patients.
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Affiliation(s)
- Ippei Watanabe
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Daiga Saito
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Ryota Noike
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Takayuki Yabe
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Ryo Okubo
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Hideo Amano
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Mikihito Toda
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
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Ndrepepa G, Cassese S, Hashorva D, Kufner S, Xhepa E, Hasimi E, Fusaro M, Laugwitz K, Schunkert H, Kastrati A. Relationship of left ventricular end‐diastolic pressure with extent of myocardial ischemia, myocardial salvage and long‐term outcome in patients with ST‐segment elevation myocardial infarction. Catheter Cardiovasc Interv 2019; 93:901-909. [DOI: 10.1002/ccd.28098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/20/2018] [Accepted: 01/03/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Gjin Ndrepepa
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
| | - Salvatore Cassese
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
| | - Desard Hashorva
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
| | - Sebastian Kufner
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
| | - Erion Xhepa
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
| | - Endri Hasimi
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
| | - Massimiliano Fusaro
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
| | - Karl‐Ludwig Laugwitz
- 1. Medizinische Klinik, Klinikum rechts der IsarTechnische Universität Munich Germany
- DZHK (German Centre for Cardiovascular Research)partner site Munich Heart Alliance Munich Germany
| | - Heribert Schunkert
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
- DZHK (German Centre for Cardiovascular Research)partner site Munich Heart Alliance Munich Germany
| | - Adnan Kastrati
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
- DZHK (German Centre for Cardiovascular Research)partner site Munich Heart Alliance Munich Germany
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31
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Ndrepepa G, Cassese S, Emmer M, Mayer K, Kufner S, Xhepa E, Fusaro M, Laugwitz KL, Schunkert H, Kastrati A. Relation of Ratio of Left Ventricular Ejection Fraction to Left Ventricular End-Diastolic Pressure to Long-Term Prognosis After ST-Segment Elevation Acute Myocardial Infarction. Am J Cardiol 2019; 123:199-205. [PMID: 30424868 DOI: 10.1016/j.amjcard.2018.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 10/28/2022]
Abstract
Risk stratification of patients with ST-segment elevation acute myocardial infarction (STEMI) is suboptimal. We assessed the prognostic value of the left ventricular ejection fraction to left ventricular end-diastolic pressure (LVEF/LVEDP) ratio in patients with STEMI who underwent primary percutaneous coronary intervention (PPCI). The study included 1,283 patients with STEMI. LVEF and LVEDP were measured at the time of PPCI. The primary outcome was 8-year cardiac mortality. Patients were divided into 3 groups: a group with a LVEF/LVEDP ratio within the first tertile (LVEF/LVEDP ratio <2; n = 437 patients), a group with a LVEF/LVEDP ratio within the second tertile (LVEF/LVEDP ratio 2 to 3; n = 422 patients), and a group with a LVEF/LVEDP ratio within third tertile (LVEF/LVEDP ratio >3; n = 424 patients). There were 109 cardiac deaths during the follow-up: 55 (17.1%), 36 (10.9%), and 18 (6.5%) deaths occurring in patients of the first, second, and third LVEF/LVEDP ratio tertiles, respectively (adjusted hazard ratio = 0.80, 95% confidence interval 0.66 to 0.97, p = 0.022 for 1 unit increment in the LVEF/LVEDP ratio). LVEF/LVEDP ratio (p = 0.035) but not LVEF (p = 0.290) or LVEDP (p = 0.145) alone improved the risk prediction of the models for cardiac mortality (p values show the difference in C-statistics between the models without and with LVEF/LVEDP ratio, LVEF or LVEDP). In conclusion, in patients with STEMI who underwent PPCI, a lower LVEF/LVEDP ratio was independently associated with increased risk of cardiac mortality up to 8 years after PPCI. The LVEF/LVEDP ratio, but not LVEF or LVEDP alone improved predictivity of multivariable models with respect to long-term cardiac mortality.
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32
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Goins AE, Rayson R, Caughey MC, Sola M, Venkatesh K, Dai X, Yeung M, Stouffer GA. Correlation of infarct size with invasive hemodynamics in patients with ST-elevation myocardial infarction. Catheter Cardiovasc Interv 2018; 92:E333-E340. [PMID: 29577589 DOI: 10.1002/ccd.27625] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/10/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To identify invasive hemodynamic parameters that correlate with infarction size in patients with ST-elevation myocardial infarction (STEMI). BACKGROUND Invasive hemodynamics obtained during primary percutaneous coronary intervention (PPCI) are predictive of mortality in STEMI, but which parameters correlate best with the size of the infarction are unknown. METHODS This is a single-center study of 405 adult patients with STEMI who had left ventricular end-diastolic pressure (LVEDP) measured during PPCI. Size of infarction was estimated by peak troponin I level and ejection fraction (LVEF) determined by echocardiography. RESULTS The average (±SD) age was 61 ± 14 years, TIMI STEMI risk score was 3.5 ± 2.7 and Grace score was 157 ± 42. Hemodynamic parameters that correlated best with EF were LVEDP (r = -0.40), PP (r = 0.24), and SBP/LVEDP ratio (r = 0.22) and with peak troponin were SBP/LVEDP ratio (r = -0.41), LVEDP (r = 0.31), and PP (r = -0.29). SBP/LVEDP (AUC = 0.76) and SBP (AUC = 0.77) had a stronger association with in-hospital mortality than did LVEDP (AUC = 0.66) or PP (AUC = 0.64). Door-to-balloon time did not affect the correlations between hemodynamic parameters and infarct size. CONCLUSIONS In this sample of 405 patients undergoing PPCI, SBP/LVEDP ratio had the strongest correlation with peak troponin levels and LVEDP with EF, whereas SBP/LVEDP and SBP had a strong association with in-hospital mortality. These results suggest that measurement of LVEDP as well as SBP may help risk stratify patients during PPCI.
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Affiliation(s)
- Allie E Goins
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina
| | - Robert Rayson
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina
| | - Melissa C Caughey
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina
| | - Michael Sola
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina
| | - Kiran Venkatesh
- Division of Cardiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Xuming Dai
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina.,McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina
| | - Michael Yeung
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina
| | - George A Stouffer
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina.,McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina
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Goins AE, Rayson R, Yeung M, Stouffer GA. The use of hemodynamics to predict mortality in patients undergoing primary PCI for ST-elevation myocardial infarction. Expert Rev Cardiovasc Ther 2018; 16:551-557. [DOI: 10.1080/14779072.2018.1497484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Allie E Goins
- Division of Cardiology and McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Robert Rayson
- Division of Cardiology and McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Michael Yeung
- Division of Cardiology and McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA
| | - George A Stouffer
- Division of Cardiology and McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA
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34
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Khan AA, Boyle AJ. Letter by Khan and Boyle Regarding Article, "Early Use of N-Acetylcysteine (NAC) With Nitrate Therapy in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction Reduces Myocardial Infarct Size (The NACIAM Trial [ N-Acetylcysteine in Acute Myocardial Infarction])". Circulation 2018; 137:1418-1419. [PMID: 29581372 DOI: 10.1161/circulationaha.117.032281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Arshad A Khan
- John Hunter Hospital, Newcastle, Australia. University of Newcastle, Australia. Hunter Medical Research Institute, Newcastle, Australia
| | - Andrew J Boyle
- John Hunter Hospital, Newcastle, Australia. University of Newcastle, Australia. Hunter Medical Research Institute, Newcastle, Australia
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Brienesse SC, Davies AJ, Khan A, Boyle AJ. Prognostic Value of LVEDP in Acute Myocardial Infarction: a Systematic Review and Meta-Analysis. J Cardiovasc Transl Res 2017; 11:33-35. [DOI: 10.1007/s12265-017-9776-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/07/2017] [Indexed: 10/18/2022]
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Combined assessment of left ventricular end-diastolic pressure and ejection fraction by left ventriculography predicts long-term outcomes of patients with ST-segment elevation myocardial infarction. Heart Vessels 2017; 33:453-461. [DOI: 10.1007/s00380-017-1080-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/10/2017] [Indexed: 11/26/2022]
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Cahill TJ, Kharbanda RK. Heart failure after myocardial infarction in the era of primary percutaneous coronary intervention: Mechanisms, incidence and identification of patients at risk. World J Cardiol 2017; 9:407-415. [PMID: 28603587 PMCID: PMC5442408 DOI: 10.4330/wjc.v9.i5.407] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/20/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
Myocardial infarction (MI) remains the most common cause of heart failure (HF) worldwide. For almost 50 years HF has been recognised as a determinant of adverse prognosis after MI, but efforts to promote myocardial repair have failed to translate into clinical therapies. Primary percutaneous coronary intervention (PPCI) has driven improved early survival after MI, but its impact on the incidence of downstream HF is debated. The effects of PPCI are confounded by the changing epidemiology of MI and HF, with an ageing patient demographic, an increasing proportion of non-ST-elevation myocardial infarction, and the recognition of HF with preserved ejection fraction. Herein we review the mechanisms of HF after MI and discuss contemporary data on its incidence and outcomes. We review current and emerging strategies for early detection of patients at risk of HF after MI, with a view to identification of patient cohorts for novel therapeutic agents.
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38
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Sola M, Venkatesh K, Caughey M, Rayson R, Dai X, Stouffer GA, Yeung M. Ratio of systolic blood pressure to left ventricular end-diastolic pressure at the time of primary percutaneous coronary intervention predicts in-hospital mortality in patients with ST-elevation myocardial infarction. Catheter Cardiovasc Interv 2017; 90:389-395. [PMID: 28303647 DOI: 10.1002/ccd.26963] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 01/09/2017] [Accepted: 01/16/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Michael Sola
- University of North Carolina School of Medicine, University of North Carolina; Chapel Hill NC
| | - Kiran Venkatesh
- Department of Medicine; Division of Cardiology, University of Massachusetts Medical School; Worcester MA
| | - Melissa Caughey
- Department of Medicine; Division of Cardiology and McAllister Heart Institute, University of North Carolina; Chapel Hill NC
| | - Robert Rayson
- Department of Medicine; Division of Cardiology and McAllister Heart Institute, University of North Carolina; Chapel Hill NC
| | - Xuming Dai
- Department of Medicine; Division of Cardiology and McAllister Heart Institute, University of North Carolina; Chapel Hill NC
| | - George A. Stouffer
- Department of Medicine; Division of Cardiology and McAllister Heart Institute, University of North Carolina; Chapel Hill NC
| | - Michael Yeung
- Department of Medicine; Division of Cardiology and McAllister Heart Institute, University of North Carolina; Chapel Hill NC
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Ahmed N, Carberry J, Teng V, Carrick D, Berry C. Risk assessment in patients with an acute ST-elevation myocardial infarction. J Comp Eff Res 2016; 5:581-593. [PMID: 27580675 PMCID: PMC5985500 DOI: 10.2217/cer-2016-0017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
ST-elevation myocardial infarction (STEMI) is one of the leading causes of mortality and morbidity worldwide. While the survival after acute STEMI has considerably improved, mortality rate still remains high, especially in high-risk patients. Survival after acute STEMI is influenced by clinical characteristics such as age as well as the presence of comorbidities. However, during emergency care increasing access to tools such as the electrocardiogram, chest x-ray and echocardiography can provide additional information helping to further risk stratify patients. In the invasive setting, this can also include coronary angiography, invasive hemodynamic recordings and angiographic assessments of coronary flow and myocardial perfusion. We outline the common investigations used in STEMI and their role in risk assessment of patients with an acute STEMI.
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Affiliation(s)
- Nadeem Ahmed
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Golden Jubilee National Hospital, Clydebank, UK
| | - Jaclyn Carberry
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Golden Jubilee National Hospital, Clydebank, UK
| | - Vannesa Teng
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Golden Jubilee National Hospital, Clydebank, UK
| | - David Carrick
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Golden Jubilee National Hospital, Clydebank, UK
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Golden Jubilee National Hospital, Clydebank, UK
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Tesak M, Kala P, Jarkovsky J, Poloczek M, Bocek O, Jerabek P, Kubková L, Manousek J, Spinar J, Mebazaa A, Parenica J, Cohen-Solal A. The value of novel invasive hemodynamic parameters added to the TIMI risk score for short-term prognosis assessment in patients with ST segment elevation myocardial infarction. Int J Cardiol 2016; 214:235-40. [PMID: 27077540 DOI: 10.1016/j.ijcard.2016.03.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 03/04/2016] [Accepted: 03/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND We compared the prognostic capacity of conventional and novel invasive parameters derived from the slope of the preload recruitable stroke work relationship (PRSW) in STEMI patients and assessed their contribution to the TIMI risk score. METHODS Left ventricular end-diastolic pressure (EDP), ejection fraction (EF), pressure adjusted maximum rate of pressure change in the left ventricle (dP/dt/P), aortic systolic pressure to EDP ratio (SBP/EDP) and end-diastolic volume adjusted stroke work (EW), derived from the slope of the PRSW relationship, were obtained during the emergency cardiac catheterization in 523 STEMI patients. The predictive power of the analyzed parameters for 30-day and 1-year mortality was evaluated using C-statistics and reclassification analysis was adopted to assess the improvement in TIMI score. RESULTS The highest area under the curve (AUC) values for 30-day mortality were observed for EW (0.872(95% confidence interval 0.801-0.943)), SBP/EDP (0.843(0.758-0.928)) and EF (0.833(0.735-0.931)); p<0.001 for all values. For 1-year mortality the best predictive value was found for EW (0.806(0.724-0.887) and EF (0.793(0.703-0.883)); p<0.001 for both. The addition of EDP, SBP/EDP ratio and EW to TIMI score significantly increased the AUC according to De Long's test. For 30-day mortality, increased discriminative power following addition to the TIMI score was observed for EW and SBP/EDP (Integrated Discrimination Improvement was 0.086(0.033-0.140), p=0.002 and 0.078(0.028-0.128), p=0.002, respectively). CONCLUSIONS EW and SBP/EDP are prognostic markers with high predictive value for 30-day and 1-year mortality. Both parameters, easily obtained during emergency catheterization, improve the discriminatory capacity of the TIMI score for 30-day mortality.
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Affiliation(s)
- Martin Tesak
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; Hospital Trebic, Trebic, Czech Republic
| | - Petr Kala
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Poloczek
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Otakar Bocek
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Jerabek
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
| | - Lenka Kubková
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
| | - Jan Manousek
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
| | - Jindrich Spinar
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, Department of Cardiovascular Disease, University Hospital St Anne's, Brno, Czech Republic
| | - Alexandre Mebazaa
- INSERM UMR-S 942, Department of Anaesthesiology and Critical Care Medicine, Lariboisière University Hospital, AP-HP University Paris Diderot, Paris, France; Cardiac Diseases and Biomarkers Unit, INSERM UMR-S 942, Department of Cardiology, Lariboisière University Hospital Paris, France
| | - Jiri Parenica
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, Department of Cardiovascular Disease, University Hospital St Anne's, Brno, Czech Republic.
| | - Alain Cohen-Solal
- INSERM UMR-S 942, Department of Anaesthesiology and Critical Care Medicine, Lariboisière University Hospital, AP-HP University Paris Diderot, Paris, France; Cardiac Diseases and Biomarkers Unit, INSERM UMR-S 942, Department of Cardiology, Lariboisière University Hospital Paris, France
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Kobayashi A, Misumida N, Fox JT, Kanei Y. Prognostic Value of Left Ventricular End-Diastolic Pressure in Patients With Non-ST-Segment Elevation Myocardial Infarction. Cardiol Res 2015; 6:301-305. [PMID: 28197246 PMCID: PMC5295567 DOI: 10.14740/cr406w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 01/10/2023] Open
Abstract
Background Elevated left ventricular end-diastolic pressure (LVEDP) has been reported to predict an increased mortality in patients with ST-segment elevation myocardial infarction. However, its prognostic value in patients with non-ST-segment elevation myocardial infarction (NSTEMI) remains unclear. Methods We performed a retrospective analysis of NSTEMI patients who underwent coronary angiography between January 2013 and June 2014. We excluded patients who did not undergo LVEDP measurements. Baseline and angiographic characteristics, in-hospital heart failure as well as in-hospital mortality were recorded. Results After exclusion, 367 patients were included in the final analysis. The median (interquartile range) LVEDP was 19 mm Hg (14 - 24 mm Hg). By receiver operating characteristic curve analysis, the optimal cutoff value for predicting in-hospital mortality was 22 mm Hg (area under the curve 0.80, sensitivity 80%, and specificity 71%). Of 367 patients, 109 patients (29.7%) had LVEDP > 22 mm Hg. Patients with LVEDP > 22 mm Hg had a greater number of comorbidities. There was no statistically significant difference in the rate of multi-vessel disease. Patients with LVEDP > 22 mm Hg had a significantly higher rate of in-hospital heart failure (22.0% vs. 13.2%, P = 0.03) and in-hospital mortality (3.7% vs. 0.4%, P = 0.03) than those with LVEDP ≤ 22 mm Hg. Conclusion Elevated LVEDP was significantly associated with a higher in-hospital mortality in patients with NSTEMI.
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Affiliation(s)
- Akihiro Kobayashi
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, USA
| | - Naoki Misumida
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, USA
| | - John T Fox
- Department of Cardiology, Mount Sinai Beth Israel, New York, USA
| | - Yumiko Kanei
- Department of Cardiology, Mount Sinai Beth Israel, New York, USA
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Redfors B, Shao Y, Ali A, Sun B, Omerovic E. Rat models reveal differences in cardiocirculatory profile between Takotsubo syndrome and acute myocardial infarction. J Cardiovasc Med (Hagerstown) 2015; 16:632-8. [DOI: 10.2459/jcm.0000000000000088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Andersen MJ, Ersbøll M, Bro-Jeppesen J, Møller JE, Hassager C, Køber L, Borlaug BA, Goetze JP, Gustafsson F. Relationships between biomarkers and left ventricular filling pressures at rest and during exercise in patients after myocardial infarction. J Card Fail 2014; 20:959-67. [PMID: 25285749 DOI: 10.1016/j.cardfail.2014.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/19/2014] [Accepted: 09/29/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increased pulmonary capillary wedge pressure (PCWP) is an independent prognostic predictor after myocardial infarction (MI), but PCWP is difficult to assess noninvasively in subjects with preserved ejection fraction (EF). We hypothesized that biomarkers would provide information regarding PCWP at rest and during exercise in subjects with preserved EF after MI. METHODS AND RESULTS Seventy-four subjects with EF >45% and recent MI underwent right heart catheterization at rest and during a symptom-limited semisupine cycle exercise test with simultaneous echocardiography. Plasma samples were collected at rest for assessment of midregional pro-A-type natriuretic peptide (MR-proANP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), galectin-3 (Gal-3), copeptin, and midregional pro-adrenomedullin (MR-proADM). Plasma levels of MR-proANP and PCWP were associated at rest (r = 0.33; P = .002) and peak exercise (r = 0.35; P = .002) as well as with changes in PCWP (r = 0.26; P = .03). Plasma levels of NT-proBNP and PCWP were weakly associated at rest (r = 0.23; P = .03) and peak exercise (r = 0.28; P = .02) but not with changes in PCWP (r = 0.20; P = .09). In a multivariable analysis, plasma levels of MR-proANP remained associated with rest and exercise PCWP (P < .01), whereas NT-proBNP did not. Plasma levels of Gal-3, copeptin, and MR-proADM were not associated with PCWP at rest or peak exercise. CONCLUSIONS In subjects recovering from an acute MI with preserved EF, plasma levels of natriuretic peptides, particularly MR-proANP, are associated with filling pressures at rest and during exercise.
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Affiliation(s)
- Mads J Andersen
- Department of Cardiology, Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark; Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Mads Ersbøll
- Department of Cardiology, Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Jacob E Møller
- Department of Cardiology, Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Barry A Borlaug
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jens P Goetze
- Department of Biochemistry, Rigshospitalet and University of Aarhus, Aarhus, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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Prognostic implications of left ventricular end-diastolic pressure during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: Findings from the Assessment of Pexelizumab in Acute Myocardial Infarction study. Am Heart J 2013; 166:913-9. [PMID: 24176448 DOI: 10.1016/j.ahj.2013.08.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 08/16/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Left ventricular end-diastolic pressure (LVEDP) is frequently measured during primary percutaneous coronary intervention (PCI). However, little is known of this measurement's utility in predicting outcomes or informing treatment decisions. We sought to determine the prognostic value of LVEDP measured during primary PCI for ST-segment elevation myocardial infarction (STEMI). METHODS We studied 1,909 (33.2%) of 5,745 STEMI patients in whom LVEDP was measured during primary PCI in the APEX-AMI trial. Cox regression analysis was used to evaluate whether LVEDP was an independent predictor of mortality and the composite of death, cardiogenic shock, or congestive heart failure (CHF) at 90 days. RESULTS The median (25th, 75th percentiles) LVEDP level was 22 mm Hg (16, 29); compared with patients with LVEDP ≤ 22 mm Hg, those with LVEDP > 22 mm Hg had higher rates of CHF (7.3% vs 3.1%, P < .001), cardiogenic shock (4.6% vs 1.7%, P < .001), and death (4.1% vs 2.2%, P = .014) at 90 days. After multivariable adjustment, LVEDP was associated with increased risk of mortality through 90 days (adjusted hazard ratio 1.22, 95% CI 1.02-1.46, per 5-mmHg increase, P = .044) and the composite of death, cardiogenic shock, or CHF within the first 2 days (adjusted hazard ratio 1.40, 95% CI 1.23-1.59, per 5-mm Hg increase, P < .001), but not from day 3 to 90 (P = .25). CONCLUSIONS Left ventricular end-diastolic pressure measured during primary PCI for STEMI is an independent predictor of inhospital and longer term cardiovascular outcomes. Measuring LVEDP may be useful to stratify patient risk and guide postinfarct treatment.
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Abnormal P-wave terminal force in lead V1 is associated with cardiac death or hospitalization for heart failure in prior myocardial infarction. Heart Vessels 2012; 28:690-5. [DOI: 10.1007/s00380-012-0307-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 11/02/2012] [Indexed: 10/27/2022]
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