European Heart Journal: Acute Cardiovascular Care最新文献

Aims: Refractory ventricular tachycardia (VT) is a rare but lethal condition in the early phase of acute myocardial infarction (AMI). Its intracardiac mechanism and role of catheter ablation is under-determined. The current study aims to evaluate the feasibility and safety of catheter ablation for refractory ventricular tachycardia in early AMI.

Methods and results: Between 2022 and 2024, 12 835 consecutive patients with AMI were screened, and VT/ventricular fibrillation (VF) was developed in 261 (2.0%) patients; among them 51 (19.5%) were identified as refractory VT storm necessitating intensive intervention, and finally 19 patients received bailout ablation for incessant VT. Their clinical and electrophysiological characteristics and outcomes were collected and analysed. For these, 19 patients underwent rescue ablation, VT was developed at a median of 4 days after the onset of AMI and became incessant 2 days after the first VT occurrence, despite revascularization, anti-arrhythmic agents, sedation, and haemodynamic support. Through intracardiac mapping, VTs were all identified as scar-related reentry within the territory of the culprit artery. The endocardial mappable cycle length (CL) was 65.3 ± 7.6% to the total CL. Energy delivery at either component of critical isthmus from the endocardium successfully eliminated VT, and no foci trigger was observed after VT termination. Subsequent substrate modification was performed around the termination site. After the index procedure, recurrent sustained VT was documented in two, and one patient received repeated ablation. After a total of 20 procedures, VTs were all well subsided after the index procedure in all except for one patient who died of cerebral haemorrhage. The remaining patients were discharged alive. After a median of 18-month follow-up, one patient developed recurrent VF, and no sudden cardiac death occurred.

Conclusion: Scar-related reentry is responsible for refractory VT early after AMI, and ablation at critical isthmus is effective in VT suppression. Its indication and optimal timing of catheter ablation should be evaluated in prospective analysis.

Aims: While the aging cardiac intensive care unit (CICU) population has been well studied, young adults represent a distinct and under-explored subgroup. We aimed to characterize the demographics, clinical presentations, resource utilization, and outcomes of young adults admitted to contemporary CICUs.

Methods and results: We analyzed consecutive adult CICU admissions from 2018 to 2023 within the Critical Care Cardiology Trials Network (CCCTN), a multicenter registry of advanced CICUs in North America. Patients aged 18 to 39 years were classified as "young adults" and compared with those aged ≥40 years. Among 29,035 CICU admissions, 6.7% (n=1,959) were aged 18-39 years. Young adults were more likely to be female (40.0% vs. 36.4%, p=0.001) and non-white (55.3% vs. 43.0%, p<0.001), with fewer traditional cardiovascular risk factors. Heart failure was the leading admission diagnosis among young adults (26.4% vs. 19.5%, p<0.001). Compared to older adults, young patients were more likely to present with cardiogenic shock (22.4% vs. 18.7%, p<0.001) and cardiac arrest (12.7% vs. 10.6%, p=0.003). Utilization of critical care therapies was higher, including mechanical circulatory support (13.1% vs. 11.4%, p=0.02), with ECMO comprising a greater share (29.3% vs. 9.9%, p<0.001). Young admissions had longer CICU stays (2.7 [1.2-5.8] vs. 2.2 [1.1-4.6] days, p<0.001). CICU mortality (6.5% vs 10.5%, p<0.001) and hospital mortality (9.5% vs 14.4%, p<0.001) were significantly lower in the young.

Conclusion: Young adults admitted to the CICU represent a clinically distinct population, with higher rates of high acuity presentations and intensive resource use, yet lower short-term mortality.

Background: D-dimer, degradation product of cross-linked fibrin, has been described as the prognostic marker in some cardiovascular diseases. However, the association between D-dimer levels and prognosis has not been fully evaluated in patients with takotsubo syndrome (TTS).

Methods: We retrospectively analysed data of 580 patients with TTS from the Tokyo Cardiovascular Care Unit Network registry. The primary endpoint was in-hospital all-cause death. Logistic regression analysis was used to investigate the relationship between D-dimer level and mortality. The additive effect of D-dimer level on the conventional prognostic risk score (InterTAK) was assessed using C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

Results: In the entire sample (median age, 77 years; 79.5% women), 174 (30.0%) patients had an emotional trigger, while 177 (30.5%) patients had a physical trigger, causing 28 (4.8%) deaths (cardiac death [n=13, 46.4%], non-cardiac death [n=15, 53.6%]). D-dimer levels on admission were significantly higher in those who died than in those who survived (6.4 [3.9-18.3] versus 1.1 [0.7-2.9] µg/mL, P<0.001). On multivariable logistic regression analysis, the odds ratio (OR) for in-hospital mortality significantly increased with D-dimer levels ≥3.5 µg/mL (OR: 7.06 [95% confidence interval: 2.90-17.16], P<0.001). The InterTAK Prognostic Score was 17 (11-24), and NRI and IDI were improved by incorporating D-dimer levels (NRI: 1.08, P<0.001; IDI: 0.05, P<0.001).

Conclusions: Elevated D-dimer levels may serve as an additional predictor of increased in-hospital mortality in patients with TTS. Patients with higher D-dimer levels may warrant intensified monitoring and management.