Shock Cardiogenic Publications (11974)


Shock Cardiogenic Publications

Hellenic J Cardiol
Hellenic J Cardiol 2016 Nov 16. Epub 2016 Nov 16.
Department of Radiology, Nuclear Medicine and Medical Physics, Vilnius University, Lithuania.

The natural history, management, and outcome of Takotsubo (stress) cardiomyopathy (TTC) is not clear. The aim of this study was to investigate clinical features, define prognostic predictors, and assess the clinical course and outcomes of patients with TTC.
We analyzed 64 patients (52 women) meeting the proposed Mayo Clinic diagnostic criteria for TTC. Read More

All patients were treated at Vilnius University Hospital Santariskiu Klinikos from 2001-01-01 to 2014-11-27. Data were collected on the basis of medical records and follow-up data was collected by phone.
The mean age of analyzed patients was 63.4 ± 14.6 years; the mean follow-up was 2.9 years. More than half of the patients (52%) did not have any clear stressful triggers. During admission, symptoms such as chest pain (64%) and general weakness (45%) were reported more often than other symptoms. Almost all patients (94%) had the classical TTC form; the remaining 6% of patients had "inverted" TTC. The mean left ventricular ejection fraction (LVEF) on admission was 37.7% (± 8.2%). A pseudonormal or restrictive pattern of LV filling, moderate to severe mitral regurgitation (MR), and right ventricular involvement were uncommon in the patients. The in-hospital course showed cardiogenic shock in 23% of the cases, resulting in the death of 5 (8%) patients. We discovered that only peak concentration of troponin I was a significant predictor of in-hospital mortality (HR 1.067, 95%CI 1.022-1.113, p=0.003). At the end of the follow-up period, 45 (87%) women and 8 (67%) men were alive. This makes the overall observed mortality at 3 years approximately 17.2%. Using multivariate analysis, elevation of BNP (HR for increase by 10 ng/l 1.002, 95%CI 1-1.003, p=0.022) and cardiogenic shock on admission (HR 8.696, 95%CI 1.198-63.124, p=0.032) were significant predictors of overall mortality. Other prognostic factors assessed on admission were nonsignificant predictors of overall mortality.
Our analysis shows that in-hospital mortality is influenced by the peak concentration of troponin I, and overall mortality is affected by cardiogenic shock and the elevation of BNP during admission. The assessment of troponin I and BNP can help with the prognostication of TTC patients in our daily clinical practice.

J Crit Care
J Crit Care 2016 Dec 29. Epub 2016 Dec 29.
Department of Cardiology, Dr. Siyami Ersek Cardiovascular Surgery Research and Training Hospital, Istanbul, 34773, Turkey.
Int J Artif Organs
Int J Artif Organs 2017 Jan 12. Epub 2017 Jan 12.
Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA - USA.

Idiopathic infantile arterial calcification is a rare cause of infantile ischemic cardiac failure with extremely poor prognosis. We present the first case report of successful extracorporeal membrane oxygenation support and outcome in a child with idiopathic infantile arterial calcification (IIAC). This 6-week-old infant presented with cardiogenic shock and circulatory collapse. Read More

The patient underwent extracorporeal cardiopulmonary resuscitation, allowing stabilization, diagnosis, and treatment with etidronate, followed by successful discharge to home.

Asian Cardiovasc Thorac Ann
Asian Cardiovasc Thorac Ann 2017 Jan 1:218492316689177. Epub 2017 Jan 1.
1 Department of Cardiovascular Diseases, Clínica Dávila, Santiago, Chile.

Background Durable mechanical support devices are prohibitively expensive in our health system and may be unsuitable for critically ill patients. CentriMag is an alternative bridge to transplantation or recovery. Methods We retrospectively reviewed 28 patients (23 males) aged 13-60 years who received CentriMag support. Read More

The etiology was ischemic in 13 (46%), dilated cardiomyopathy in 8 (29%), and others in 7 (25%). All patients were in Interagency Registry for Mechanically Assisted Circulatory Support class I, and 27 (96%) had multiorgan failure; 2 (7%) were post-cardiotomy and 12 (43%) had a previous cardiac arrest (mean arrest time 21 ± 17 min). Results Thirty-day post-implant survival was 79% (22 patients). Twenty (71%) patients were successfully bridged to transplantation or recovery. The mean support time was 40 days; 12 (43%) patients had >4-weeks' support (longest was 292 days). Eight (29%) patients died on support. Complications included bleeding in 10 (36%) cases, immediate stroke in 4 (14%), and dialysis in 8 (29%). There was no stroke during subsequent support. Eighteen (64%) patients underwent transplantation, and 17 of them were discharged. Two (7%) patients recovered and were discharged. Two-year survival was 62% ± 10%. Mean follow-up was 21 months (total follow-up 579 months). Two (7%) patients died during follow-up. All survivors were in New York Heart Association class I. Conclusions CentriMag is useful for medium-term support for cardiogenic shock in a developing country. Support for >4 weeks is feasible. The stroke rate is low during support. The major drawback is prolonged intensive care unit stay.

Turk J Med Sci
Turk J Med Sci 2016 Dec 20;46(6):1688-1693. Epub 2016 Dec 20.
Department of Cardiology, Koşuyolu Heart Education and Research Hospital, İstanbul, Turkey.

The aim of this study was to evaluate if the modified ACEF (age, creatinine, and ejection fraction) score is a predictor of major adverse cardiac and cerebrovascular events during 1 year of follow-up in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).
We retrospectively enrolled 1632 consecutive patients who were admitted to our emergency department diagnosed with STEMI within 12 h of chest pain and treated with primary PCI. The modified ACEF score, determined with a simplified scoring system, was calculated. Read More

The patients were grouped into tertiles according to this score (group I mACEF < 1.03, group II mACEF 1.03-1.37, group III > 1.37) . The clinical and angiographic data were compared among the tertiles.
In patients with the highest mACEF tertile, out-of-hospital cardiac arrest (1.3%, 1.8%, and 4.1% consecutively; P = 0.003), Killip class ≥ II (P < 0.001), and cardiogenic shock were more common and ejection fraction was lower (P < 0.001). Moreover, in the 1-year follow-up, there was a statistically significant difference between cardiac mortality, target vessel revascularization, stroke, reinfarction, and major adverse cardiac and cerebrovascular events of the groups, while the rates of stent thrombosis were similar.
The modified ACEF score is a predictor of cardiac mortality and morbidity during 1-year follow-up.

Br J Anaesth
Br J Anaesth 2016 Oct 17;117(4):458-463. Epub 2016 Oct 17.
Anesthesiology & Critical Care, Clinica Universidad de Navarra, Avenida Pio 12, 36, 31008 Pamplona, Spain.

Recent trials have shown hydroxyethyl starch (HES) solutions increase the risk of acute kidney injury (AKI) in critically ill patients. It is uncertain whether these adverse effects also affect surgical patients. We sought to determine the renal safety of modern tetrastarch (6% HES 130/0. Read More

4) use in cardiac surgical patients.
In this multicentre prospective cohort study, 1058 consecutive patients who underwent cardiac surgery from 15th September 2012 to 15th December 2012 were recruited in 23 Spanish hospitals.
We identified 350 patients (33%) administered 6% HES 130/0.4 intraoperatively and postoperatively, and 377 (36%) experienced postoperative AKI (AKI Network criteria). In-hospital death occurred in 45 (4.2%) patients. Patients in the non-HES group had higher Euroscore and more comorbidities including unstable angina, preoperative cardiogenic shock, preoperative intra-aortic balloon pump use, peripheral arterial disease, and pulmonary hypertension. The non-HES group received more intraoperative vasopressors and had longer cardiopulmonary bypass times. After multivariable risk-adjustment, 6% HES 130/0.4 use was not associated with significantly increased risks of AKI (adjusted odds ratio 1.01, 95% CI 0.71-1.46, P=0.91). These results were confirmed by propensity score-matched pairs analyses.
The intraoperative and postoperative use of modern hydroxyethyl starch 6% HES 130/0.4 was not associated with increased risks of AKI and dialysis after cardiac surgery in our multicentre cohort.

Ann Card Anaesth
Ann Card Anaesth 2017 Jan;20(Supplement):S11-S18
Department of Anesthesiology, Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Arizona, USA.
Circ Cardiovasc Qual Outcomes
Circ Cardiovasc Qual Outcomes 2017 Jan;10(1)
From the Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Y.Y., H.S., H.Y., S.S., K.O., T.K.), Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Tenri, Japan (Y.N.); Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (K.A.); Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K.K.); Division of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (M.A.); and Division of Cardiology, Osaka Red Cross Hospital, Osaka, Japan (K.N.).

In patients with ST-segment-elevation acute myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention, long-term risks for cardiac and noncardiac death beyond acute phase of STEMI have not been thoroughly evaluated yet.
We identified 3942 STEMI patients who had primary percutaneous coronary intervention within 24 hours after onset between January 2005 and December 2007 in the CREDO-Kyoto AMI registry (Coronary Revascularization Demonstrating Outcome study in Kyoto Acute Myocardial Infarction) and evaluated their short-term (within 6-month) and long-term (beyond 6-month) incidences and causes of deaths. The cumulative 5-year incidence of all-cause death in the current study population was 20. Read More

4% (cardiac death, 12.2% and noncardiac death, 9.4%, respectively). The vast majority of deaths were cardiac in origin within 6-month (cardiac death, 8.0% and noncardiac death, 0.9%), whereas noncardiac death accounted for nearly two thirds of all-cause death beyond 6-month (cardiac death, 4.6% and noncardiac death, 8.5%). In the stratified analysis according to age, the proportion of noncardiac death was similar regardless of age although the absolute mortality rate was higher with increasing age. By the multivariable Cox regression models, the independent risk factors of all-cause death were advanced age, cardiogenic shock, renal dysfunction, large infarct size, and anterior wall infarction within 6 months after STEMI, and advanced age, previous heart failure, renal dysfunction, and liver cirrhosis beyond 6 months after STEMI, respectively.
In STEMI patients who underwent primary percutaneous coronary intervention, the long-term risk for cardiac death was relatively low compared with that for noncardiac death, which accounted for nearly two thirds of all-cause death beyond 6 months.

Medicine (Baltimore)
Medicine (Baltimore) 2017 Jan;96(1):e5688
aDepartment of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College bDepartment of Pathology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Techology, PR China.

Ventricular septal defect is a lethal complication after an acute myocardial infarction which have become infrequent with the advent of reperfusion strategies however; they remain a major contributor to mortality.
We identified patients using the ICD-9CM procedure codes from the Nationwide Inpatient Sample between the years 2001 and 2013. A multivariate hierarchical logistic regression model was used to identify significant predictors of in-hospital mortality. Read More

We identified 3,373,206 ST-elevation myocardial infarctions, out of which 10,012 (0.3%) were complicated with ventricular septal defect s. Most of the patients (60%) were older than 65, male (55%), and white (63%). Inferior (49.7%) and anterior (41.1%) myocardial infarctions were more commonly implicated with the development of VSDs. The median (IQR) hospitalization length was 7 days (3.0-13.5). Only 7.65% of patients underwent some intervention with 7% surgical and 0.65% minimally invasive. Mechanical support devices were used in 36.5% of patients, with intra-aortic balloon pump (96%) being the most common. In-hospital mortality remained high at 30.5% (downward trending from 41.6% in 2001 to 23.3% in 2013). Age, cardiogenic shock, and in-hospital cardiac arrest were statistically significant predictors of in-hospital mortality. The utilization of corrective procedures significantly declined. The use of mechanical support devices and performing a corrective procedure were associated with higher mortality, length of stay and cost.
Ventricular septal defects after acute myocardial infarctions remain associated with significantly high mortality rates. Highly specialized regional centers with individual expertise in the management of septal ruptures are required to improve outcomes of these patients.