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Am J Cardiol 2019 Jan 25. Epub 2019 Jan 25.

Department of Cardiology, Henry Ford Hospital, Detroit, Michigan.

The outcomes for patients transferred with cardiogenic shock and later treated with revascularization and Impella support have not previously been studied. To evaluate these outcomes, patients in cardiogenic shock were recruited from the catheter-based ventricular assist device registry, a prospective registry enrolling patients who underwent percutaneous coronary intervention with hemodynamic support using Impella 2.5 or CP. Read More

Cardiovasc Revasc Med 2018 Dec 27. Epub 2018 Dec 27.

Department of Cardiovascular Science, University of Sheffield, UK; Department of Cardiology, Northern General Hospital, Sheffield, UK.

Background: Primary percutaneous coronary intervention (PPCI) is the default treatment for patients with ST elevation myocardial infarction (STEMI) and carries a higher risk of adverse outcomes when compared with elective and urgent PCI. Conventional PCI risk scores tend to be complex and may underestimate the risk associated with PPCI due to under-representation of patients with STEMI in their datasets. This study aimed to develop a simple, practical and contemporary risk model to provide risk stratification in PPCI. Read More

Am J Cardiol 2019 Jan 24. Epub 2019 Jan 24.

Department of Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, Louisiana.

We reviewed 54,044 adult cases of cardiogenic shock (CS) accompanying acute coronary syndrome from the 2005 to 2014 Nationwide Inpatient Sample. We evaluated outcomes among patients who were nonobese, obese (body mass index 30.0 to 39. Read More

Kyobu Geka 2019 Feb;72(2):120-123

Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan.

A 73-year-old male was referred to our hospital for acute congestive heart failure. His cardiac and respiratory conditions were worsening with cardiogenic shock requiring intubation. Coronary angiography revealed severe triple vessel disease, and echocardiography showed severe left ventricular dysfunction. Read More

J Cardiothorac Vasc Anesth 2019 Jan 22. Epub 2019 Jan 22.

Department of Anesthesiology, Division of Critical Care, Kansas University Medical Center, Kansas City, KS. Electronic address:

Objective: Activated recombinant factor VII (rFVIIa) has been used to treat cardiac surgical bleeding in an off-label manner. This observational report analyzes the outcomes with use of a low dose and early administration of rFVIIa for cardiac surgical bleeding.

Design: A retrospective, observational study. Read More

Catheter Cardiovasc Interv 2019 Feb;93(3):434-435

Interventional Cardiology, Lankenau Heart Institute, Wynnewood, Pennsylvania.

The use of percutaneous mechanical support devices is becoming more embedded within the therapeutic armamentarium for patients presenting with decompensated heart failure, cardiogenic shock, and patients undergoing high risk PCI. The Aortix device offers a new approach to percutaneous support that appears to be safe to implement and overcomes some of the drawbacks of the extant devices. Further investigation remains warranted to evaluate its ultimate utility and place among the approach to the patient in need of circulatory support. Read More

J Am Coll Cardiol 2019 Feb;73(6):698-716

Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.

Venoarterial extracorporeal membrane oxygenation (ECMO) is a rescue therapy that can stabilize patients with hemodynamic compromise, with or without respiratory failure, for days or weeks. In cardiology, the main indications for ECMO include cardiac arrest, cardiogenic shock, post-cardiotomy shock, refractory ventricular tachycardia, and acute management of complications of invasive procedures. The fundamental premise underlying ECMO is that it is a bridge-to recovery, to a more durable bridge, to definitive treatment, or to decision. Read More

J Am Coll Cardiol 2019 Feb;73(6):663-666

Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.

J Am Coll Cardiol 2019 Feb;73(6):654-662

University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address:

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a widely used form of mechanical circulatory support in patients with refractory cardiogenic shock. A common drawback of this modality is a resultant increase in left ventricular afterload.

Objectives: The purpose of this meta-analysis was to examine the efficacy and safety of left ventricular unloading strategies during VA-ECMO in adult patients with cardiogenic shock. Read More

Can J Cardiol 2019 Feb 7;35(2):229.e7-229.e9. Epub 2018 Dec 7.

Department of Cardiovascular Sciences, University of South Florida, Morsani College of Medicine, Tampa, Florida, USA. Electronic address:

We describe the case of a 68-year-old woman presenting with stress cardiomyopathy (SCM), with concomitant cardiogenic shock, left ventricular outflow tract obstruction, and ventricular septal rupture. These complications have not simultaneously been reported in a single SCM case. The importance of early diagnosis of serial complications of SCM and using mechanical circulatory support as a treatment strategy are highlighted. Read More

Eur Heart J Acute Cardiovasc Care 2019 Feb 14:2048872619830609. Epub 2019 Feb 14.

3 Department of Cardiology, Radboud University Medical Center, The Netherlands.

Background:: Conflicting evidence is available on the efficacy and safety of early intravenous beta-blockers before primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. We performed a patient-pooled meta-analysis of trials comparing early intravenous beta-blockers with placebo or routine care in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

Aim:: The aim of this study was to evaluate the clinical and safety outcomes of intravenous beta-blockers in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Read More

Cardiology 2019 Feb 13;141(4):190-198. Epub 2019 Feb 13.

Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.

Objectives: We aimed to examine the relations of very high levels of serum uric acid (sUA) with features of culprit lesion plaque morphology determined by optical coherence tomography (OCT) and adverse clinical outcomes in patients with acute coronary syndrome (ACS).

Methods: We retrospectively compared ACS patients according to sUA levels of > 8.0 mg/dL (n = 169), 7. Read More

Eur J Case Rep Intern Med 2018 31;5(1):000742. Epub 2018 Jan 31.

Department of Internal Medicine, St. Marienhospital, Oberhausen, Germany.

A 46-year-old woman presented to the emergency room with acute onset of nausea, vomiting and prostration. She appeared ill and was poorly responsive to verbal stimuli. Physical examination showed a systolic blood pressure of 60 mmHg and a pulse of 40 bpm. Read More

Am Surg 2018 Nov;84(11):e483-e484

Int Heart J 2019 Feb 8. Epub 2019 Feb 8.

Division of Cardiology, Gunma Prefectural Cardiovascular Center.

A 28-year-old female presented with fulminant lymphocytic myocarditis. She developed cardiogenic shock, frequent sustained ventricular tachycardia, and fibrillation (VT and VF). The left ventricular ejection fraction improved from 5% to 40% after medical therapy, but the right ventricular systolic dysfunction and enlargement persisted. Read More

Rev Port Cardiol 2019 Jan 30;38(1):67-68. Epub 2018 Jun 30.

Cardiology Department, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.

Circ Cardiovasc Imaging 2019 Feb;12(2):e008736

Department of Cardiovascular, Nephrologic, Anesthesiologic and Geriatric Sciences, La Sapienza University of Rome (A.F., C.C.).

Am J Cardiol 2019 Jan 25. Epub 2019 Jan 25.

Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia. Electronic address:

Percutaneous coronary intervention (PCI) in patients with angiographic evidence of intracoronary thrombus is associated with in-hospital and 30-day adverse clinical outcomes. Cangrelor, a direct, rapid-onset acting intravenous P2Y receptor inhibitor, has been proved to be effective by reducing peri-PCI ischemic complications in subjects who underwent PCI. This study aimed to assess the angiographic and in-hospital clinical outcomes in all-comer patients receiving cangrelor immediately before PCI at a tertiary care center. Read More

J Intensive Care 2019 31;7. Epub 2019 Jan 31.

1Department of Visceral and Thoracic Surgery, Asklepios Klinik Langen, Röntgenstr 20, 63220 Langen, Germany.

[This corrects the article DOI: 10.1186/s40560-018-0352-2.]. Read More

J Intensive Care Med 2019 Feb 7:885066619828959. Epub 2019 Feb 7.

12 Critical Care Department, Hospital Sant Joan Despi Moisès Broggi, Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain.

Background:: Cardiogenic shock (CS) is the most life-threatening manifestation of acute heart failure. Its complexity and high in-hospital mortality may justify the need for invasive monitoring with a pulmonary artery catheter (PAC).

Methods:: Patients with CS included in the CardShock Study, an observational, prospective, multicenter, European registry, were analyzed, aiming to describe the real-world use of PAC, evaluate its impact on 30-day mortality, and the ability of different hemodynamic parameters to predict outcomes. Read More

Curr Treat Options Cardiovasc Med 2019 Feb 7;21(1). Epub 2019 Feb 7.

The Cardiovascular Center, Tufts Medical Center, Boston, MA, 02111, USA.

Purpose Of Review: Ischemic heart disease is the most common cause of heart failure with systolic dysfunction. The progressive course of heart failure characterized by increasing levels of care and worsening quality of life often indicates an advanced stage. Similarly, cardiogenic shock remains a major clinical problem with prohibitively high mortality rates despite major advances in clinical care. Read More

Eur J Clin Invest 2019 Feb 6:e13078. Epub 2019 Feb 6.

First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.

Background: Previous studies revealed that patients with Takotsubo syndrome (TTS) have a higher mortality rate than the general population and a comparable mortality to acute coronary syndrome (ACS). Repolarization abnormalities, namely T-wave amplitude, may provide incremental prognostic information, in addition to traditional risk factors in ACS. This study was performed to determine the short- and long-term prognostic impact of inverted T-waves in TTS patients, as compared to ACS patients. Read More

Shock 2019 Feb 1. Epub 2019 Feb 1.

Department of Cardio-Thoracic Surgery, Drum Tower Hospital Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, China.

Purpose: In contrast to arterial lactate, previous studies have proposed central venous-to-arterial CO2 difference (P (v-a)CO2) as a more useful guide for categorizing patients at risk of developing septic shock. It is worthwhile studying P (v-a)CO2 in determining whether it could serve as a useful predictor for poor postoperative outcomes in patients undergoing cardiac surgery. We investigated the ability of P(v-a)CO2 to predict poor outcomes of patients with postoperative cardiogenic shock. Read More

Circ Cardiovasc Interv 2019 Feb;12(2):e007425

Department of Internal Medicine II, University Medical Center Regensburg, Germany.

Rev Esp Anestesiol Reanim 2019 Feb 1. Epub 2019 Feb 1.

Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España; Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España.

Intracardiac thrombosis is a rare complication in patients receiving haemodynamic support with venous-arterial extracorporeal membrane oxygenation (VA-ECMO), but it has a high risk of mortality. This case report describes a patient who suffered cardiogenic shock after a ST-segment elevation myocardial infarction (STEMI) and who presented with intracardiac thrombosis during VA-ECMO support on two occasions after mitral valve replacement. The first one was after the insertion of a mechanical prosthesis, and the second, after replacing it with a biological valve. Read More

Medicina (Kaunas) 2019 Feb 1;55(2). Epub 2019 Feb 1.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.

We aimed to demonstrate the clinical utility of CHA2DS2-VASc score in risk assessment of patients with STEMI regarding adverse clinical outcomes particularly no-reflow phenomenon. We designed a retrospective cohort study using the data of Tehran Heart Center registry for acute coronary syndrome. The study included 1331 consecutive patients with STEMI who underwent primary angioplasty. Read More

Heart Vessels 2019 Feb 4. Epub 2019 Feb 4.

JCS Shock Registry Scientific Committee, Tokyo, Japan.

Cardiogenic shock frequently leads to death even with intensive treatment. Although the leading cause of cardiogenic shock is acute coronary syndrome (ACS), the clinical characteristics and the prognosis of ACS with cardiogenic shock in the present era still remain to be elucidated. We analyzed clinical characteristics and predictors of 30-day mortality in ACS with cardiogenic shock in Japan. Read More

QJM 2019 Jan 31. Epub 2019 Jan 31.

First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.

Disclosures: There is no potential conflict of interest to disclose for any of the co-authors.

Objectives: Takotsubo Syndrome (TTS) is an acute reversible left ventricular (LV) dysfunction. Recently published studies have highlighted a similar mortality rate as acute coronary syndrome (ACS). Read More

Eur J Heart Fail 2019 Feb 4. Epub 2019 Feb 4.

Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy.

Aim: To evaluate the long-term outcome of patients with Takotsubo syndrome (TTS) and severely reduced left ventricular ejection fraction (LVEF ≤ 35%) at presentation.

Methods And Results: The study population included 326 patients (mean age 69.5 ± 10. Read More

Perfusion 2019 Feb 2:267659119826822. Epub 2019 Feb 2.

1 Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK.

Central venoarterial extracorporeal membrane oxygenation has been used since the 1970s to support patients with cardiogenic shock following cardiac surgery. Despite this, in-hospital mortality is still high, and although rare, thrombus within the cardiac chambers or within the extracorporeal membrane oxygenation circuit is often fatal. Aprotinin is an antifibrinolytic available in Europe and Canada, though not currently in the United States. Read More

Clin Respir J 2019 Feb 3. Epub 2019 Feb 3.

Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.

Introduction And Objectives: Prior studies demonstrated that plasma osmolality may have a predictive value for in-hospital mortality in patients with heart failure and acute coronary syndrome. In addition, plasma glucose and blood urea nitrogen (BUN) levels, the components of plasma osmolality, have been shown to be an important contributor for in-hospital mortality in acute pulmonary embolism (APE) patients. Hence, the objective of the current study is to evaluate the effect of plasma osmolality upon admission with in-hospital mortality in patients with APE. Read More

JACC Cardiovasc Interv 2019 Jan 25. Epub 2019 Jan 25.

Division of Cardiovascular Diseases and Cardiac Surgery, Robert Wood Johnson University Hospital, Rutgers University, New Brunswick, New Jersey. Electronic address:

JACC Cardiovasc Interv 2019 Jan 25. Epub 2019 Jan 25.

Intensive Cardiac Care Unit, Advanced Heart failure and Mechanical Circulatory Support Program, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.

Int J Cardiol 2019 Jan 25. Epub 2019 Jan 25.

Department of Internal Medicine, University of Nevada School of Medicine, Reno, NV, USA.

Background: We aimed to analyze the burden and predictors of arrhythmias and in-hospital mortality in chronic obstructive pulmonary disease (COPD)-related hospitalizations using the nationwide cohort.

Methods: We queried the National Inpatient Sample (NIS) (2010-2014) databases to identify adult COPD hospitalizations with arrhythmia. Categorical and continuous variables were compared using Chi-square and Student's t-test/ANOVA. Read More

J Forensic Leg Med 2019 Jan 18;62:92-96. Epub 2019 Jan 18.

Institute of Legal Medicine, Department of Medicine and Surgery, University of Parma, Italy.

The aim of this study was to collect all available data from 2009 to 2016 focusing on the epidemiological, clinical and pharmacological issues only related to acute intoxication fatalities in the Unit of Legal Medicine of the Department of Medicine and Surgery at the University of Parma. All death certificates and autopsy reports were retrieved from the archives and evaluated to identify cases in which only acute intoxication from xenobiotics could be defined as the cause of death, however statistical and descriptive analyses were applied to all the data. A more comprehensive analysis on all causes of death showed that out of 1005 total cases the most common is haemorrhagic shock/traumatic shock (36. Read More

Ann Intensive Care 2019 Feb 1;9(1):24. Epub 2019 Feb 1.

Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France.

Background: Few data are available on the impact of levosimendan in refractory cardiogenic shock patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO). The aim of this study was to evaluate the impact of levosimendan on VA-ECMO weaning in patients hospitalized in intensive care unit (ICU).

Methods: This retrospective cohort study was conducted in a French university hospital from 2010 to 2017. Read More

JACC Heart Fail 2019 Feb;7(2):176-178

JACC Heart Fail 2019 Feb;7(2):175-176

JACC Heart Fail 2019 Feb;7(2):174-175

Am J Respir Crit Care Med 2019 Feb 1. Epub 2019 Feb 1.

Mahidol University Faculty of Medicine Siriraj Hospital, 65106, Office of Research and Development, Bangkok, Thailand.

Rationale: Recent retrospective evidence suggests the efficacy of early norepinephrine administration during resuscitation; however, prospective data to support this assertion are scarce.

Objectives: To conduct a Phase II trial evaluating the hypothesis that early low-dose norepinephrine in adults sepsis with hypotension increases shock control by six hours compared with standard care.

Methods: This single-center, randomized, double-blind, placebo-controlled clinical trial was conducted at Siriraj Hospital, Bangkok, Thailand. Read More

IEEE Trans Biomed Eng 2019 Jan 28. Epub 2019 Jan 28.

Objective: Limitations in available diagnostic metrics restrict the efficacy of managing therapies for cardiogenic shock. In current clinical practice, cardiovascular state is inferred through measurement of pulmonary capillary wedge pressure and reliance on linear approximations between pressure and flow to estimate peripheral vascular resistance. Mechanical circulatory support devices residing within the left ventricle and aorta provide an opportunity for both determining cardiac and vascular state and offering therapeutic benefit. Read More

J Invasive Cardiol 2019 Feb;31(2):E23-E29

Montrose Memorial Hospital, 801 South 3rd Street, Montrose, CO 81401 USA.

Aims: Impella 2.5 and Impella CP (Abiomed) are percutaneous left ventricular assist devices that can be easily deployed in the cardiac catheterization laboratory without need for surgery and provide effective hemodynamic support. The utility of Impella devices for management of acute myocardial infarction complicated by cardiogenic shock (AMI-CS) at a rural community hospital without on-site surgical back-up has not been reported. Read More

Interact Cardiovasc Thorac Surg 2019 Jan 28. Epub 2019 Jan 28.

Department of Cardiovascular Surgery, Sana-Herzzentrum Cottbus, Cottbus, Germany.

Objectives: Although percutaneous edge-to-edge mitral valve repair with the MitraClip system is becoming widely adopted in clinical practice, surgical experience on how to correct failed MitraClip therapy is limited. We aimed to analyse the surgical and pathological outcomes after surgical revision of the failed MitraClip therapy.

Methods: Between January 2011 and January 2018, 25 patients (age 73 ± 9 years; men 48%; New York Heart Association class 3. Read More

J Heart Lung Transplant 2019 Feb;38(2):114-126

Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.

Background: The Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs), a joint effort among the National Heart, Lung, and Blood Institute, the Food and Drug Administration, the Centers for Medicare and Medicaid Services, and others, was established in 2005 at the University of Alabama at Birmingham. The registry examined clinical outcomes and quality-of-life metrics of patients who received an Food and Drug Administration-approved durable mechanical circulatory support (MCS) device to treat advanced heart failure. On January 1, 2018, the Intermacs Database became part of The Society of Thoracic Surgeons National Database, providing additional resources for quality assessment and improvement and scientific advancement. Read More

Ann Thorac Surg 2019 Feb;107(2):341-353

Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.

Background: The Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs), a joint effort among the National Heart, Lung, and Blood Institute, the Food and Drug Administration, the Centers for Medicare and Medicaid Services, and others, was established in 2005 at the University of Alabama at Birmingham. The registry examined clinical outcomes and quality-of-life metrics of patients who received an Food and Drug Administration-approved durable mechanical circulatory support (MCS) device to treat advanced heart failure. On January 1, 2018, the Intermacs Database became part of The Society of Thoracic Surgeons National Database, providing additional resources for quality assessment and improvement and scientific advancement. Read More

Catheter Cardiovasc Interv 2019 Jan 28. Epub 2019 Jan 28.

Department of Cardiology, Zucker School of Medicine at Hofstra Northwell, North Shore University Hospital, Manhasset, New York.

Left ventricular free wall rupture is a feared complication of acute myocardial infarction typically presenting with cardiogenic shock. We present a case of spontaneous coronary artery dissection with free wall rupture and cardiac tamponade in an uncommon demographic. Friable myocardial tissue frequently precludes suture technique making biological glue repair a suitable option. Read More

North Clin Istanb 2018 Sep;5(3):264-267

Department of Cardiology, Health Sciences University, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey.

Spontaneous and simultaneous multivessel coronary artery spasm may present with multisite myocardial ischemia, atrioventricular block, acute lung edema, cardiogenic shock, or ventricular fibrillation. In a case of syncope caused by vasospasm, the underlying mechanism may be complex, such as atrioventricular block and/or ventricular arrhythmia. Dual implantable cardioverter defibrillator (ICD) placement should be considered along with optimal medical treatment. Read More

Hellenic J Cardiol 2019 Jan 21. Epub 2019 Jan 21.

Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN. Electronic address:

Cardiogenic shock develops in up to 10% of patients with acute myocardial infarction and continues to have high mortality, often >50%. Early invasive treatment is the default therapeutic approach in these patients. Based on the results of the CULPRIT-SHOCK trial, culprit only revascularization during the acute phase is preferred over multivessel revascularization. Read More

Catheter Cardiovasc Interv 2019 Jan 24. Epub 2019 Jan 24.

Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado.

Background: Patients with severe mitral regurgitation (MR) and cardiogenic shock are typically too high risk for immediate surgery; however, percutaneous edge-to-edge mitral valve repair (pMVr) may be reasonable in select patients.

Aim: Describe characteristics and outcomes of patients who underwent pMVr with and without shock at a single center.

Methods: Chart review of all patients who underwent non-investigational pMVr from November 2013 to October 2018. Read More