Pub Date : 2024-10-01DOI: 10.1016/j.cardfail.2024.07.013
Chirag Mehta MD , Brian Osorio MD , Neel R. Sodha MD , Halley C. Gibson PharmD , Annaliese Clancy PharmD , Athena Poppas MD , Omar N Hyder MD , Marwan Saad MD, PhD , Rachna Kataria MD , J. Dawn Abbott MD , Saraschandra Vallabhajosyula MD, MSc
Cardiogenic shock (CS) is a syndrome of low cardiac output resulting in critical end-organ hypoperfusion and hypoxia. The mainstay of management involves optimizing preload, afterload and contractility. In medically refractory cases, temporary percutaneous mechanical support (MCS) is used as a bridge to recovery, surgical ventricular assist device, or transplant. Anticoagulation is recommended to prevent device-related thromboembolism. However, MCS can be fraught with hemorrhagic complications, compounded by incident multisystem organ failure often complicating CS. Currently, there are limited data on optimal anticoagulation strategies that balance the risk of bleeding and thrombosis, with most centers adopting local antithrombotic stewardship practices. In this review, we detail anticoagulation protocols, including anticoagulation agents, therapeutic monitoring, and complication mitigation in CS requiring MCS. This review is intended to provide an evidence-based framework in this population at high risk for in-hospital bleeding and mortality.
{"title":"Anticoagulation Medications, Monitoring, and Outcomes in Patients with Cardiogenic Shock Requiring Temporary Mechanical Circulatory Support","authors":"Chirag Mehta MD , Brian Osorio MD , Neel R. Sodha MD , Halley C. Gibson PharmD , Annaliese Clancy PharmD , Athena Poppas MD , Omar N Hyder MD , Marwan Saad MD, PhD , Rachna Kataria MD , J. Dawn Abbott MD , Saraschandra Vallabhajosyula MD, MSc","doi":"10.1016/j.cardfail.2024.07.013","DOIUrl":"10.1016/j.cardfail.2024.07.013","url":null,"abstract":"<div><div>Cardiogenic shock (CS) is a syndrome of low cardiac output resulting in critical end-organ hypoperfusion and hypoxia. The mainstay of management involves optimizing preload, afterload and contractility. In medically refractory cases, temporary percutaneous mechanical support (MCS) is used as a bridge to recovery, surgical ventricular assist device, or transplant. Anticoagulation is recommended to prevent device-related thromboembolism. However, MCS can be fraught with hemorrhagic complications, compounded by incident multisystem organ failure often complicating CS. Currently, there are limited data on optimal anticoagulation strategies that balance the risk of bleeding and thrombosis, with most centers adopting local antithrombotic stewardship practices. In this review, we detail anticoagulation protocols, including anticoagulation agents, therapeutic monitoring, and complication mitigation in CS requiring MCS. This review is intended to provide an evidence-based framework in this population at high risk for in-hospital bleeding and mortality.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1343-1354"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cardfail.2024.06.020
SARASCHANDRA VALLABHAJOSYULA MD, MSc , ADEBOLA OGUNSAKIN MD , JACOB C. JENTZER MD , SHASHANK S. SINHA MD, MSc , AJAR KOCHAR MD, MHS , DANA J. GERBERI MLIS , CHRISTOPHER J. MULLIN MD , SUN HO AHN MD , NEEL R. SODHA MD , COREY E. VENTETUOLO MD, MS , DANIEL J. LEVINE MD , BRIAN G. ABBOTT MD , JASON M. ALIOTTA MD , ATHENA POPPAS MD , J. DAWN ABBOTT MD
As cardiovascular care continues to advance and with an aging population with higher comorbidities, the epidemiology of the cardiac intensive care unit has undergone a paradigm shift. There has been increasing emphasis on the development of multidisciplinary teams (MDTs) for providing holistic care to complex critically ill patients, analogous to heart teams for chronic cardiovascular care. Outside of cardiovascular medicine, MDTs in critical care medicine focus on implementation of guideline-directed care, prevention of iatrogenic harm, communication with patients and families, point-of-care decision-making, and the development of care plans. MDTs in acute cardiovascular care include physicians from cardiovascular medicine, critical care medicine, interventional cardiology, cardiac surgery, and advanced heart failure, in addition to nonphysician team members. In this document, we seek to describe the changes in patients in the cardiac intensive care unit, health care delivery, composition, logistics, outcomes, training, and future directions for MDTs involved in acute cardiovascular care. As a part of the comprehensive review, we performed a scoping of concepts of MDTs, acute hospital care, and cardiovascular conditions and procedures.
{"title":"Multidisciplinary Care Teams in Acute Cardiovascular Care: A Review of Composition, Logistics, Outcomes, Training, and Future Directions","authors":"SARASCHANDRA VALLABHAJOSYULA MD, MSc , ADEBOLA OGUNSAKIN MD , JACOB C. JENTZER MD , SHASHANK S. SINHA MD, MSc , AJAR KOCHAR MD, MHS , DANA J. GERBERI MLIS , CHRISTOPHER J. MULLIN MD , SUN HO AHN MD , NEEL R. SODHA MD , COREY E. VENTETUOLO MD, MS , DANIEL J. LEVINE MD , BRIAN G. ABBOTT MD , JASON M. ALIOTTA MD , ATHENA POPPAS MD , J. DAWN ABBOTT MD","doi":"10.1016/j.cardfail.2024.06.020","DOIUrl":"10.1016/j.cardfail.2024.06.020","url":null,"abstract":"<div><div>As cardiovascular care continues to advance and with an aging population with higher comorbidities, the epidemiology of the cardiac intensive care unit has undergone a paradigm shift. There has been increasing emphasis on the development of multidisciplinary teams (MDTs) for providing holistic care to complex critically ill patients, analogous to heart teams for chronic cardiovascular care. Outside of cardiovascular medicine, MDTs in critical care medicine focus on implementation of guideline-directed care, prevention of iatrogenic harm, communication with patients and families, point-of-care decision-making, and the development of care plans. MDTs in acute cardiovascular care include physicians from cardiovascular medicine, critical care medicine, interventional cardiology, cardiac surgery, and advanced heart failure, in addition to nonphysician team members. In this document, we seek to describe the changes in patients in the cardiac intensive care unit, health care delivery, composition, logistics, outcomes, training, and future directions for MDTs involved in acute cardiovascular care. As a part of the comprehensive review, we performed a scoping of concepts of MDTs, acute hospital care, and cardiovascular conditions and procedures.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1367-1383"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cardfail.2024.06.019
WISSAM KHALIFE MD , MANREET K. KANWAR MD , JACOB ABRAHAM MD , SONG LI MD , KEVIN JOHN MD , SHASHANK S. SINHA MD, MSC , ELRIC ZWECK MD , BORUI LI MA , ARTHUR R. GARAN MD , JAIME HERNANDEZ-MONTFORT MD , YIJING ZHANG MA , VAN-KHUE TON MD, PhD , MAYA GUGLIN MD, PhD , RACHNA KATARIA MD , GAVIN W. HICKEY MD , SARASCHANDRA VALLABHAJOSYULA MD , CHLOE KONG MA , MARYJANE FARR MD , JUSTIN FRIED MD , SHELLEY HALL MD , NAVIN K. KAPUR MD
Cardiogenic shock (CS) is a hemodynamic syndrome that can progress to systemic metabolic derangements and end-organ dysfunction. Prior studies have reported hemodynamic parameters at the time of admission to be associated with mortality but hemodynamic trajectories in CS have not been well described. We studied the association between hemodynamic profiles and their trajectories and in-hospital mortality in patients with CS due to heart failure (HF-CS) and acute myocardial infarction (MI-CS). Using data from the large multicenter Cardiogenic Shock Working Group (CSWG) registry, we analyzed hemodynamic data obtained at the time of pulmonary artery catheter (PAC) insertion (dataset at baseline) and at PAC removal or death (dataset at final time point). Univariable regression analyses for prediction of in-hospital mortality were conducted for baseline and final hemodynamic values, as well as the interval change (delta-P). Data was further analyzed based on CS etiology and survival status. A total of 2260 patients with PAC data were included (70% male, age 61 ± 14 years, 61% HF-CS, 27% MI-CS). In-hospital mortality was higher in the MI-CS group (40.1%) compared with HF-CS (22.4%, P < .01). In the HF-CS cohort, survivors exhibited lower right atrial pressure (RAP), pulmonary artery pressure (PAP), cardiac output/index (CO/CI), lactate, and higher blood pressure (BP) than nonsurvivors at baseline. In this cohort, during hospitalization, improvement in metabolic (aspartate transaminase, lactate), BP, hemodynamic (RAP, pulmonary artery pulsatility index [PAPi], pulmonary artery compliance for right-sided profile and CO/CI for left-sided profile), had association with survival. In the MI-CS cohort, a lower systolic BP and higher PAP at baseline were associated with odds of death. Improvement in metabolic (lactate), BP, hemodynamic (RAP, PAPi for right-sided profile and CO/CI for left-sided profile) were associated with survival. In a large contemporary CS registry, hemodynamic trajectories had a strong association with short-term outcomes in both cohorts. These findings suggest the clinical importance of timing and monitoring hemodynamic trajectories to tailor management in patients with CS.
{"title":"Association of Hemometabolic Trajectory and Mortality: Insights From the Cardiogenic Shock Working Group Registry","authors":"WISSAM KHALIFE MD , MANREET K. KANWAR MD , JACOB ABRAHAM MD , SONG LI MD , KEVIN JOHN MD , SHASHANK S. SINHA MD, MSC , ELRIC ZWECK MD , BORUI LI MA , ARTHUR R. GARAN MD , JAIME HERNANDEZ-MONTFORT MD , YIJING ZHANG MA , VAN-KHUE TON MD, PhD , MAYA GUGLIN MD, PhD , RACHNA KATARIA MD , GAVIN W. HICKEY MD , SARASCHANDRA VALLABHAJOSYULA MD , CHLOE KONG MA , MARYJANE FARR MD , JUSTIN FRIED MD , SHELLEY HALL MD , NAVIN K. KAPUR MD","doi":"10.1016/j.cardfail.2024.06.019","DOIUrl":"10.1016/j.cardfail.2024.06.019","url":null,"abstract":"<div><div>Cardiogenic shock (CS) is a hemodynamic syndrome that can progress to systemic metabolic derangements and end-organ dysfunction. Prior studies have reported hemodynamic parameters at the time of admission to be associated with mortality but hemodynamic trajectories in CS have not been well described. We studied the association between hemodynamic profiles and their trajectories and in-hospital mortality in patients with CS due to heart failure (HF-CS) and acute myocardial infarction (MI-CS). Using data from the large multicenter Cardiogenic Shock Working Group (CSWG) registry, we analyzed hemodynamic data obtained at the time of pulmonary artery catheter (PAC) insertion (dataset at baseline) and at PAC removal or death (dataset at final time point). Univariable regression analyses for prediction of in-hospital mortality were conducted for baseline and final hemodynamic values, as well as the interval change (delta-P). Data was further analyzed based on CS etiology and survival status. A total of 2260 patients with PAC data were included (70% male, age 61 ± 14 years, 61% HF-CS, 27% MI-CS). In-hospital mortality was higher in the MI-CS group (40.1%) compared with HF-CS (22.4%, <em>P</em> < .01). In the HF-CS cohort, survivors exhibited lower right atrial pressure (RAP), pulmonary artery pressure (PAP), cardiac output/index (CO/CI), lactate, and higher blood pressure (BP) than nonsurvivors at baseline. In this cohort, during hospitalization, improvement in metabolic (aspartate transaminase, lactate), BP, hemodynamic (RAP, pulmonary artery pulsatility index [PAPi], pulmonary artery compliance for right-sided profile and CO/CI for left-sided profile), had association with survival. In the MI-CS cohort, a lower systolic BP and higher PAP at baseline were associated with odds of death. Improvement in metabolic (lactate), BP, hemodynamic (RAP, PAPi for right-sided profile and CO/CI for left-sided profile) were associated with survival. In a large contemporary CS registry, hemodynamic trajectories had a strong association with short-term outcomes in both cohorts. These findings suggest the clinical importance of timing and monitoring hemodynamic trajectories to tailor management in patients with CS.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1196-1207"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cardfail.2024.08.036
MEGHA PRASAD MD, MS , SRIHARI S. NAIDU MD
{"title":"Easy-on Easy-off: Is the Promise of Intravenous P2Y12 Inhibition Realized in AMI Cardiogenic Shock?","authors":"MEGHA PRASAD MD, MS , SRIHARI S. NAIDU MD","doi":"10.1016/j.cardfail.2024.08.036","DOIUrl":"10.1016/j.cardfail.2024.08.036","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1241-1243"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cardfail.2024.05.019
QUENTIN R. YOUMANS MD, MSc , SARAH CHUZI MD, MSc , MAYRA GUERRERO MD , SRIHARI S. NAIDU MD
{"title":"Procedural Health Equity in Heart Failure: Meeting Patients Where They Are","authors":"QUENTIN R. YOUMANS MD, MSc , SARAH CHUZI MD, MSc , MAYRA GUERRERO MD , SRIHARI S. NAIDU MD","doi":"10.1016/j.cardfail.2024.05.019","DOIUrl":"10.1016/j.cardfail.2024.05.019","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1384-1386"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cardfail.2024.08.037
JULIANN GILCHRIST MD , JENNIFER A. RYMER MD, MBA, MHS
{"title":"The Management and Treatment of Cardiogenic Shock: Is Sex Still a Factor?","authors":"JULIANN GILCHRIST MD , JENNIFER A. RYMER MD, MBA, MHS","doi":"10.1016/j.cardfail.2024.08.037","DOIUrl":"10.1016/j.cardfail.2024.08.037","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1220-1221"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cardfail.2024.07.019
JOSHUA LONGINOW DO , PIETER MARTENS MD, PhD , ZACHARY J. IL'GIOVINE MD , ANDREW HIGGINS MD , LAUREN IVES RN , EDWARD G. SOLTESZ MD , MICHAEL Z. TONG MD , JERRY D. ESTEP MD , RANDALL C. STARLING MD, MPH , W.H. WILSON TANG MD , MAZEN HANNA MD , RAN LEE MD
Background
In those with heart failure-related cardiogenic shock (HF-CS), an intra-aortic balloon pump (IABP) may improve hemodynamics and be useful as a bridge to advanced therapies. We explore whether those with cardiac amyloidosis and HF-CS might experience hemodynamic improvement and describe the hemodynamic response after IABP.
Methods and Results
We retrospectively identified consecutive patients with a diagnosis of cardiac amyloid, either light chain or transthyretin, who were admitted to our intensive care unit with HF-CS. Patients were excluded if an IABP was placed during heart transplant or for shock related to acute myocardial infarction. Invasive hemodynamics before and after IABP placement were assessed. We identified 23 patients with cardiac amyloid who had an IABP placed for HF-CS. The 1-year survival rate was 74% and most (65%) were bridged to heart transplant, although 1 patient was bridged to destination left ventricular assist device. After IABP, the mean arterial pressure, cardiac index, and cardiac power index were significantly increased, whereas mean right atrial pressure, mean pulmonary artery pressure, and pulmonary capillary wedge pressure were all significantly decreased. A smaller left ventricular end-diastolic diameter (per cm) was associated with a higher likelihood of a cardiac index of <2.2 L/min/m2 after IABP (odds ratio 0.16, 95% confidence interval 0.01–0.93, P = .04).
Conclusions
IABP significantly improved cardiac index while decreasing right atrial pressure, mean pulmonary artery pressure, and pulmonary capillary wedge pressure in cardiac amyloidosis patients with HF-CS.
{"title":"Hemodynamic Response after Intra-aortic Balloon Counter-Pulsation in Cardiac Amyloidosis and Cardiogenic Shock","authors":"JOSHUA LONGINOW DO , PIETER MARTENS MD, PhD , ZACHARY J. IL'GIOVINE MD , ANDREW HIGGINS MD , LAUREN IVES RN , EDWARD G. SOLTESZ MD , MICHAEL Z. TONG MD , JERRY D. ESTEP MD , RANDALL C. STARLING MD, MPH , W.H. WILSON TANG MD , MAZEN HANNA MD , RAN LEE MD","doi":"10.1016/j.cardfail.2024.07.019","DOIUrl":"10.1016/j.cardfail.2024.07.019","url":null,"abstract":"<div><h3>Background</h3><div>In those with heart failure-related cardiogenic shock (HF-CS), an intra-aortic balloon pump (IABP) may improve hemodynamics and be useful as a bridge to advanced therapies. We explore whether those with cardiac amyloidosis and HF-CS might experience hemodynamic improvement and describe the hemodynamic response after IABP.</div></div><div><h3>Methods and Results</h3><div>We retrospectively identified consecutive patients with a diagnosis of cardiac amyloid, either light chain or transthyretin, who were admitted to our intensive care unit with HF-CS. Patients were excluded if an IABP was placed during heart transplant or for shock related to acute myocardial infarction. Invasive hemodynamics before and after IABP placement were assessed. We identified 23 patients with cardiac amyloid who had an IABP placed for HF-CS. The 1-year survival rate was 74% and most (65%) were bridged to heart transplant, although 1 patient was bridged to destination left ventricular assist device. After IABP, the mean arterial pressure, cardiac index, and cardiac power index were significantly increased, whereas mean right atrial pressure, mean pulmonary artery pressure, and pulmonary capillary wedge pressure were all significantly decreased. A smaller left ventricular end-diastolic diameter (per cm) was associated with a higher likelihood of a cardiac index of <2.2 L/min/m<sup>2</sup> after IABP (odds ratio 0.16, 95% confidence interval 0.01–0.93, <em>P</em> = .04).</div></div><div><h3>Conclusions</h3><div>IABP significantly improved cardiac index while decreasing right atrial pressure, mean pulmonary artery pressure, and pulmonary capillary wedge pressure in cardiac amyloidosis patients with HF-CS.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1255-1264"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cardfail.2024.09.005
Jennifer Rymer MD, MBA, MHS, Srihari S. Naidu MD
{"title":"Guests in Your Field and Guest Editors in Your Journal: Celebrating the Nexus of Heart Failure and Interventional Cardiology","authors":"Jennifer Rymer MD, MBA, MHS, Srihari S. Naidu MD","doi":"10.1016/j.cardfail.2024.09.005","DOIUrl":"10.1016/j.cardfail.2024.09.005","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1193-1195"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cardfail.2024.08.030
BALIMKIZ SENMAN MD , ARUSHI SINGH MD , BERNARD S. KADOSH MD , JASON N. KATZ MD, MHS
{"title":"How Steep is Your Slide? I Really Mean to Learn","authors":"BALIMKIZ SENMAN MD , ARUSHI SINGH MD , BERNARD S. KADOSH MD , JASON N. KATZ MD, MHS","doi":"10.1016/j.cardfail.2024.08.030","DOIUrl":"10.1016/j.cardfail.2024.08.030","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1208-1210"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cardfail.2024.07.014
ABDELRAHMAN ABUSHOUK MD , HABIB LAYOUN MD , SERGE C. HARB MD , RHONDA MIYASAKA MD , CHONYANG ALBERT MD , RANDALL C. STARLING MD, MPH , GRANT W. REED MD, MSc , AMAR KRISHNASWAMY MD , JAMES J. YUN MD, PhD , SAMIR R. KAPADIA MD , RISHI PURI MD, PhD
Novel transcatheter therapies for tricuspid regurgitation (TR) appear promising, yet their applicability to an all-comer TR population remains unclear. We aimed to assess the feasibility of emerging transcatheter tricuspid therapies in a real-world population with greater than or equal to moderate symptomatic TR. A total of 178 patients were referred to our center between January 2019 and December 2021 for greater than or equal to moderate symptomatic TR and were classified into 4 groups: Investigative (patients eligible for enrollment in the Triluminate, Clasp TR, and TRISCEND trials), off-label clipping, surgery, and medical treatment. A total of 10.7% of the population were deemed eligible for investigative therapies, 20.2% and 19.7% of patients were offered off-label clipping and surgery, respectively, and 49.4% received medical treatment. Common reasons for investigative therapy–related ineligibility were unsuitable anatomy (large tricuspid annulus or wide leaflet coaptation gap) and the presence of significant comorbidities. Compared with the other groups, the investigative group was less likely to harbor concomitant ≥moderate mitral regurgitation, greater than or equal to moderate right ventricular dysfunction or severe pulmonary hypertension (P < .05). At 1 year, there remained a significant reduction in TR severity in the investigative group (P < .001) in comparison with the medical treatment group. However, the results were comparable to off-label clipping (P = .60) and inferior to surgery (P =.04). Exploratory analyses failed to show evidence of differences in the rates of all-cause mortality (P =.40) and heart failure hospitalizations (P = .94) between all groups. Current real-world eligibility of TR patients for emerging transcatheter therapies remains limited, underscoring the need for continued innovative efforts to offer device therapies to a broader TR cohort.
{"title":"Real-World Patient Eligibility and Feasibility of Transcatheter Edge-to-Edge Repair or Replacement Interventions for Tricuspid Regurgitation","authors":"ABDELRAHMAN ABUSHOUK MD , HABIB LAYOUN MD , SERGE C. HARB MD , RHONDA MIYASAKA MD , CHONYANG ALBERT MD , RANDALL C. STARLING MD, MPH , GRANT W. REED MD, MSc , AMAR KRISHNASWAMY MD , JAMES J. YUN MD, PhD , SAMIR R. KAPADIA MD , RISHI PURI MD, PhD","doi":"10.1016/j.cardfail.2024.07.014","DOIUrl":"10.1016/j.cardfail.2024.07.014","url":null,"abstract":"<div><div>Novel transcatheter therapies for tricuspid regurgitation (TR) appear promising, yet their applicability to an all-comer TR population remains unclear. We aimed to assess the feasibility of emerging transcatheter tricuspid therapies in a real-world population with greater than or equal to moderate symptomatic TR. A total of 178 patients were referred to our center between January 2019 and December 2021 for greater than or equal to moderate symptomatic TR and were classified into 4 groups: Investigative (patients eligible for enrollment in the Triluminate, Clasp TR, and TRISCEND trials), off-label clipping, surgery, and medical treatment. A total of 10.7% of the population were deemed eligible for investigative therapies, 20.2% and 19.7% of patients were offered off-label clipping and surgery, respectively, and 49.4% received medical treatment. Common reasons for investigative therapy–related ineligibility were unsuitable anatomy (large tricuspid annulus or wide leaflet coaptation gap) and the presence of significant comorbidities. Compared with the other groups, the investigative group was less likely to harbor concomitant ≥moderate mitral regurgitation, greater than or equal to moderate right ventricular dysfunction or severe pulmonary hypertension (<em>P</em> < .05). At 1 year, there remained a significant reduction in TR severity in the investigative group (<em>P</em> < .001) in comparison with the medical treatment group. However, the results were comparable to off-label clipping (<em>P</em> = .60) and inferior to surgery (<em>P</em> =.04). Exploratory analyses failed to show evidence of differences in the rates of all-cause mortality (<em>P</em> =.40) and heart failure hospitalizations (<em>P</em> = .94) between all groups. Current real-world eligibility of TR patients for emerging transcatheter therapies remains limited, underscoring the need for continued innovative efforts to offer device therapies to a broader TR cohort.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1265-1272"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号