Pub Date : 2024-10-01DOI: 10.1016/j.cardfail.2024.04.032
Jonathan R. Dalzell MBChB, MD
{"title":"VA-ECMO for Infarct-Related Cardiogenic Shock Following the ECLS-SHOCK Trial: More Questions than Answers?","authors":"Jonathan R. Dalzell MBChB, MD","doi":"10.1016/j.cardfail.2024.04.032","DOIUrl":"10.1016/j.cardfail.2024.04.032","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1391-1394"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400404","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.2024.08.032
ANTONIO LEWIS MD , DAVID A. BARAN MD
{"title":"A Gator in Every Pond: The Ever-present Risk of Right Ventricular Failure","authors":"ANTONIO LEWIS MD , DAVID A. BARAN MD","doi":"10.1016/j.cardfail.2024.08.032","DOIUrl":"10.1016/j.cardfail.2024.08.032","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1285-1286"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400377","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.2024.07.012
ATUL D. BALI MD , TANYA SHARMA MD , MIGUEL ALVAREZ VILLELA MD , SRIHARI S. NAIDU MD , JOSHUA GOLDBERG MD
Acute pulmonary embolism (PE) represents the third leading cause of cardiovascular mortality, with most PE-related mortality associated with acute right ventricular (RV) failure. Despite an increase in attention to acute PE with new endovascular devices for therapy and the adoption of multidisciplinary clinical treatment teams, mortality rates remain high in patients who present with PE-related hemodynamic compromise. Currently, the advanced treatment modalities for acute high-risk and intermediate high-risk PE are limited to several interventional modalities—open surgical embolectomy and systemic fibrinolytic agents. The purpose of this state-of-the-art review is to describe modern therapeutic techniques and strategies (both interventional and surgical) and the role of mechanical circulatory support (MCS) for hemodynamic compromise in PE.
急性肺栓塞（PE）是导致心血管疾病死亡的第三大原因，与 PE 相关的死亡率大多与急性右心室（RV）衰竭有关。尽管新型血管内治疗设备和多学科临床治疗团队的采用提高了对急性肺栓塞的关注度，但出现与肺栓塞相关的血流动力学损害的患者死亡率仍然很高。目前，急性高风险和中度高风险 PE 的先进治疗方法仅限于几种介入方法--开放性外科栓子切除术和全身性纤溶药物。这篇最新综述旨在介绍现代治疗技术和策略（包括介入治疗和手术治疗）以及机械循环支持（MCS）在 PE 血流动力学损害中的作用。
{"title":"Interventional Therapies and Mechanical Circulatory Support for Acute Pulmonary Embolism","authors":"ATUL D. BALI MD , TANYA SHARMA MD , MIGUEL ALVAREZ VILLELA MD , SRIHARI S. NAIDU MD , JOSHUA GOLDBERG MD","doi":"10.1016/j.cardfail.2024.07.012","DOIUrl":"10.1016/j.cardfail.2024.07.012","url":null,"abstract":"<div><div>Acute pulmonary embolism (PE) represents the third leading cause of cardiovascular mortality, with most PE-related mortality associated with acute right ventricular (RV) failure. Despite an increase in attention to acute PE with new endovascular devices for therapy and the adoption of multidisciplinary clinical treatment teams, mortality rates remain high in patients who present with PE-related hemodynamic compromise. Currently, the advanced treatment modalities for acute high-risk and intermediate high-risk PE are limited to several interventional modalities—open surgical embolectomy and systemic fibrinolytic agents. The purpose of this state-of-the-art review is to describe modern therapeutic techniques and strategies (both interventional and surgical) and the role of mechanical circulatory support (MCS) for hemodynamic compromise in PE.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1319-1329"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400391","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.2024.08.001
KARL-PHILIPP ROMMEL MD , GUILLAUME BONNET MD, PhD , LAVANYA BELLUMKONDA MD , ALEXANDRA J. LANSKY MD , DUZHI ZHAO MS , JULIA B. THOMPSON MS , YIRAN ZHANG MS , BJÖRN REDFORS MD, PhD , PHILIPP C. LURZ MD, PhD , JUAN F. GRANADA MD , ADITYA S. BHARADWAJ MD , M. BABAR BASIR DO , WILLIAM W. O'NEILL MD , DANIEL BURKHOFF MD, PhD
Background
Right ventricular dysfunction (RVD) is an important prognostic factor in several cardiac conditions, including acute and chronic heart failure. The impact of baseline RVD on clinical outcomes of patients undergoing high-risk percutaneous coronary intervention (HRPCI) supported by Impella is unknown.
Methods
Patients from the single-arm, multicenter PROTECT III study of Impella-supported HRPCI were stratified based on the presence or absence of RVD. RVD was quantitatively assessed by an echocardiography core laboratory and was defined as fractional area change < 35%, tricuspid annular plane systolic excursion < 17 mm or pulsed-wave Doppler S-wave of the lateral tricuspid annulus < 9.5 cm/s. Procedural outcomes, 90-day major adverse cardiac and cerebrovascular events (MACCE: the composite of all-cause mortality, myocardial infarction, stroke/TIA, and repeat revascularization), and 1-year mortality were assessed.
Results
Of the 239 patients who underwent RV function assessment, 124 were found to have RVD. Lower left ventricular ejection fraction, higher blood urea nitrogen levels, and more severe RV dilation were independently associated with RVD. The incidence of hypotensive episodes during PCI, the proportion of patients requiring prolonged Impella support, the completeness of revascularization, and the rate of in-hospital mortality did not differ significantly between patients with vs without RVD. However, 90-day MACCE rates were higher in those with RVD, and RVD was a robust predictor of 1-year mortality in multivariable Cox-regression analyses.
Conclusion
In patients undergoing HRPCI with Impella, RVD was associated with more advanced biventricular failure. The use of Impella support during HRPCI facilitated effective revascularization, even in those with concomitant RVD. Nevertheless, RVD was associated with unfavorable long-term prognoses.
{"title":"Right Ventricular Dysfunction in Patients Undergoing High-Risk PCI with Impella","authors":"KARL-PHILIPP ROMMEL MD , GUILLAUME BONNET MD, PhD , LAVANYA BELLUMKONDA MD , ALEXANDRA J. LANSKY MD , DUZHI ZHAO MS , JULIA B. THOMPSON MS , YIRAN ZHANG MS , BJÖRN REDFORS MD, PhD , PHILIPP C. LURZ MD, PhD , JUAN F. GRANADA MD , ADITYA S. BHARADWAJ MD , M. BABAR BASIR DO , WILLIAM W. O'NEILL MD , DANIEL BURKHOFF MD, PhD","doi":"10.1016/j.cardfail.2024.08.001","DOIUrl":"10.1016/j.cardfail.2024.08.001","url":null,"abstract":"<div><h3>Background</h3><div>Right ventricular dysfunction (RVD) is an important prognostic factor in several cardiac conditions, including acute and chronic heart failure. The impact of baseline RVD on clinical outcomes of patients undergoing high-risk percutaneous coronary intervention (HRPCI) supported by Impella is unknown.</div></div><div><h3>Methods</h3><div>Patients from the single-arm, multicenter PROTECT III study of Impella-supported HRPCI were stratified based on the presence or absence of RVD. RVD was quantitatively assessed by an echocardiography core laboratory and was defined as fractional area change < 35%, tricuspid annular plane systolic excursion < 17 mm or pulsed-wave Doppler S-wave of the lateral tricuspid annulus < 9.5 cm/s. Procedural outcomes, 90-day major adverse cardiac and cerebrovascular events (MACCE: the composite of all-cause mortality, myocardial infarction, stroke/TIA, and repeat revascularization), and 1-year mortality were assessed.</div></div><div><h3>Results</h3><div>Of the 239 patients who underwent RV function assessment, 124 were found to have RVD. Lower left ventricular ejection fraction, higher blood urea nitrogen levels, and more severe RV dilation were independently associated with RVD. The incidence of hypotensive episodes during PCI, the proportion of patients requiring prolonged Impella support, the completeness of revascularization, and the rate of in-hospital mortality did not differ significantly between patients with vs without RVD. However, 90-day MACCE rates were higher in those with RVD, and RVD was a robust predictor of 1-year mortality in multivariable Cox-regression analyses.</div></div><div><h3>Conclusion</h3><div>In patients undergoing HRPCI with Impella, RVD was associated with more advanced biventricular failure. The use of Impella support during HRPCI facilitated effective revascularization, even in those with concomitant RVD. Nevertheless, RVD was associated with unfavorable long-term prognoses.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1244-1254"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cardfail.2024.07.016
MIR B. BASIR DO , DANA BENTLEY BA , ALEXANDER G. TRUESDELL MD , KATHERINE KUNKEL MD , ALEJANDRO LEMOR MD , MICHAEL MEGALY MD , MOHAMMAD ALQARQAZ MD , KHALDOON ALASWAD MD , AKSHAY KHANDEWAL MD , ELISE JORTBERG MS , SANJOG KALRA MD , AMIR KAKI MD , DANIEL BURKHOFF MD , JEFFREY W. MOSES MD , DUANE S. PINTO MD , GREGG W. STONE MD , WILLIAM W. O'NEILL MD
Background
Patients experiencing loss of pulse pressure (LOPP) during high-risk percutaneous coronary intervention (HR-PCI) are transiently dependent on mechanical circulatory support devices. We sought to define the frequency and clinic outcomes of patients who experience LOPP during HR-PCI.
Methods and Results
Patients enrolled in the PROTECT III study and had automated Impella controller logs capturing real-time hemodynamics were included in this analysis. A LOPP event was defined as a mean pulse pressure on Impella of <20 mm Hg for ≥5 seconds during PCI. Clinical characteristics and outcomes were then compared between those with and without LOPP. Logistic regression identified clinical and hemodynamic predictors of LOPP. We included 302 patients, of whom 148 patients (49%) experienced LOPP. Age, sex, and comorbidities were similar in patients with and without LOPP. Mean baseline systolic blood pressure (118.6 mm Hg vs 129.8 mm Hg; P < .001) and mean arterial pressure (86.9 mm Hg vs 91.6 mm Hg; P = .011) were lower in patients with LOPP, whereas heart rate (78 bpm vs 73 bpm; P = .012) was higher. Anatomical complexity was similar between groups. Patients with LOPP were more likely to experience major adverse cardiac and cerebrovascular events (23.5% vs 8.8%; P = .002), acute kidney injury (10.1% vs 2.6%; P = .030), and death (20.2% vs 7.9%; P = .008) within 90 days. A low baseline systolic blood pressure and cardiomyopathy were the strongest predictors of LOPP (P = .003 and P = .001, respectively).
Conclusions
LOPP on Impella during HR-PCI was common and occurred more frequently in patients with cardiomyopathy and a low systolic blood pressure. LOPP was strongly associated with higher 90-day major adverse cardiac and cerebrovascular events, acute kidney injury, and mortality.
Condensed Abstract
We sought to define the frequency and clinic outcomes of patients who experience LOPP during high-risk percutaneous coronary intervention (HR-PCI). We included 302 patients, of whom 148 (49%) experienced LOPP. Patients with LOPP were more likely to experience major adverse cardiac and cerebrovascular events (23.5% vs 8.8%; P = .002), acute kidney injury (10.1% vs 2.6%; P = .030), and death (20.2% vs 7.9%; P = .008) within 90 days. A low baseline systolic blood pressure and cardiomyopathy were the strongest predictors of LOPP (P = .003 and P = .001, respectively).
背景：在高风险经皮冠状动脉介入治疗（HR-PCI）过程中出现脉搏失压（LOPP）的患者会暂时依赖于机械循环支持装置。我们试图确定在 HR-PCI 过程中出现 LOPP 的患者的频率和临床结果：参加 PROTECT III 研究并有 Impella 控制器自动日志记录实时血流动力学的患者被纳入本次分析。LOPP事件定义为Impella上的平均脉压达到结论：HR-PCI 期间 Impella 的 LOPP 很常见，在心肌病和收缩压较低的患者中发生得更频繁。LOPP 与较高的 90 天主要不良心脑血管事件、急性肾损伤和死亡率密切相关。摘要 我们试图确定在高风险经皮冠状动脉介入治疗（HR-PCI）过程中出现 LOPP 的患者的频率和临床结果。我们纳入了 302 名患者，其中 148 人（49%）经历过 LOPP。LOPP 患者更有可能在 90 天内发生重大不良心脑血管事件（23.5% vs 8.8%；P = .002）、急性肾损伤（10.1% vs 2.6%；P = .030）和死亡（20.2% vs 7.9%；P = .008）。低基线收缩压和心肌病是预测 LOPP 的最有力因素（分别为 P = .003 和 P = .001）。
{"title":"Clinical Outcomes of Patients Experiencing Transient Loss of Pulse Pressure During High-Risk PCI with Impella","authors":"MIR B. BASIR DO , DANA BENTLEY BA , ALEXANDER G. TRUESDELL MD , KATHERINE KUNKEL MD , ALEJANDRO LEMOR MD , MICHAEL MEGALY MD , MOHAMMAD ALQARQAZ MD , KHALDOON ALASWAD MD , AKSHAY KHANDEWAL MD , ELISE JORTBERG MS , SANJOG KALRA MD , AMIR KAKI MD , DANIEL BURKHOFF MD , JEFFREY W. MOSES MD , DUANE S. PINTO MD , GREGG W. STONE MD , WILLIAM W. O'NEILL MD","doi":"10.1016/j.cardfail.2024.07.016","DOIUrl":"10.1016/j.cardfail.2024.07.016","url":null,"abstract":"<div><h3>Background</h3><div>Patients experiencing loss of pulse pressure (LOPP) during high-risk percutaneous coronary intervention (HR-PCI) are transiently dependent on mechanical circulatory support devices. We sought to define the frequency and clinic outcomes of patients who experience LOPP during HR-PCI.</div></div><div><h3>Methods and Results</h3><div>Patients enrolled in the PROTECT III study and had automated Impella controller logs capturing real-time hemodynamics were included in this analysis. A LOPP event was defined as a mean pulse pressure on Impella of <20 mm Hg for ≥5 seconds during PCI. Clinical characteristics and outcomes were then compared between those with and without LOPP. Logistic regression identified clinical and hemodynamic predictors of LOPP. We included 302 patients, of whom 148 patients (49%) experienced LOPP. Age, sex, and comorbidities were similar in patients with and without LOPP. Mean baseline systolic blood pressure (118.6 mm Hg vs 129.8 mm Hg; <em>P</em> < .001) and mean arterial pressure (86.9 mm Hg vs 91.6 mm Hg; <em>P</em> = .011) were lower in patients with LOPP, whereas heart rate (78 bpm vs 73 bpm; <em>P</em> = .012) was higher. Anatomical complexity was similar between groups. Patients with LOPP were more likely to experience major adverse cardiac and cerebrovascular events (23.5% vs 8.8%; <em>P</em> = .002), acute kidney injury (10.1% vs 2.6%; <em>P</em> = .030), and death (20.2% vs 7.9%; <em>P</em> = .008) within 90 days. A low baseline systolic blood pressure and cardiomyopathy were the strongest predictors of LOPP (<em>P</em> = .003 and <em>P</em> = .001, respectively).</div></div><div><h3>Conclusions</h3><div>LOPP on Impella during HR-PCI was common and occurred more frequently in patients with cardiomyopathy and a low systolic blood pressure. LOPP was strongly associated with higher 90-day major adverse cardiac and cerebrovascular events, acute kidney injury, and mortality.</div><div><strong>Condensed Abstract</strong></div><div>We sought to define the frequency and clinic outcomes of patients who experience LOPP during high-risk percutaneous coronary intervention (HR-PCI). We included 302 patients, of whom 148 (49%) experienced LOPP. Patients with LOPP were more likely to experience major adverse cardiac and cerebrovascular events (23.5% vs 8.8%; P = .002), acute kidney injury (10.1% vs 2.6%; P = .030), and death (20.2% vs 7.9%; P = .008) within 90 days. A low baseline systolic blood pressure and cardiomyopathy were the strongest predictors of LOPP (P = .003 and P = .001, respectively).</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1287-1299"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400382","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.2024.08.035
Jason Grady NRP , Allison Dupont MD, FACC, FSCAI
{"title":"Navigating High-Risk Percutaneous Coronary Interventions: Predicting Loss of Pulse Pressure and the Role of Mechanical Circulatory Support","authors":"Jason Grady NRP , Allison Dupont MD, FACC, FSCAI","doi":"10.1016/j.cardfail.2024.08.035","DOIUrl":"10.1016/j.cardfail.2024.08.035","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1300-1301"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400394","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.2024.05.018
WILLARD N. APPLEFELD MD , ANN GAGE MD , SARASCHANDRA VALLABHAJOSYULA MD, MSc , M. IMRAN ASLAM MD
Dual training in Interventional Cardiology (IC) with other cardiac subspecialties such as Advanced Heart Failure and Transplant Cardiology (AHFTC) and Critical Care Cardiology (CCC) is becoming a pathway for trainees to acquire a needed skill set to deliver comprehensive care for increasingly complex patients in the intensive care unit and catheterization laboratory settings. The makeup of these training pathways varies depending on several factors, with the resultant role of the specialist reflecting this reality. Herein, we review the merits to combined fellowship training for the Interventional Cardiologist, the ideal structure of programs to facilitate this, and how the faculty position for such a unique specialist can enhance a program.
{"title":"Dual Training in Interventional Cardiology: The Next Frontier","authors":"WILLARD N. APPLEFELD MD , ANN GAGE MD , SARASCHANDRA VALLABHAJOSYULA MD, MSc , M. IMRAN ASLAM MD","doi":"10.1016/j.cardfail.2024.05.018","DOIUrl":"10.1016/j.cardfail.2024.05.018","url":null,"abstract":"<div><div>Dual training in Interventional Cardiology (IC) with other cardiac subspecialties such as Advanced Heart Failure and Transplant Cardiology (AHFTC) and Critical Care Cardiology (CCC) is becoming a pathway for trainees to acquire a needed skill set to deliver comprehensive care for increasingly complex patients in the intensive care unit and catheterization laboratory settings. The makeup of these training pathways varies depending on several factors, with the resultant role of the specialist reflecting this reality. Herein, we review the merits to combined fellowship training for the Interventional Cardiologist, the ideal structure of programs to facilitate this, and how the faculty position for such a unique specialist can enhance a program.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1395-1398"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400383","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.2024.07.015
SARAH GORGIS MD , KARTIK GUPTA MD , ALEJANDRO LEMOR MD , DANA BENTLEY MWC , CHRISTIAN MOYER PhD , THOMAS McRAE MD , MATHEEN KHUDDUS MD , RAHUL SHARMA MD , MICHAEL LIM MD , ALI NSAIR MD , DAVID WOHNS MD , ADITYA MEHRA MD , LANG LIN MD , ADITYA BHARADWAJ MD , RYAN TEDFORD MD , NAVIN KAPUR MD , JENNIFER COWGER MD , WILLIAM O'NEILL MD , MIR B. BASIR DO
Background
Right ventricular dysfunction (RVD) complicates 30%–40% of cases in acute myocardial infarction (AMI) and cardiogenic shock (CS). There are sparse data on the effects of RVD on outcomes and the impact of providing early left ventricular (LV) mechanical circulatory support (MCS) on RV function and hemodynamics.
Methods and Results
Between July 2016 and December 2020, 80 sites participated in the study. All centers agreed to treat patients with AMI-CS using a standard protocol emphasizing invasive hemodynamic monitoring and rapid initiation of LV-MCS. RVD was defined as a right atrial (RA) pressure of >12 mm Hg and a pulmonary artery pulsatility index (PAPI) of <1 within 24 hours of the index procedure. The primary outcome was survival to discharge. In a subgroup analysis, data available from the Automated Impella Controller console was used to analyze diastolic suction alarms from LV placement signal and its relation to RVD. A total of 361 patients were included in the analysis, of whom 28% had RVD. The median age was 64 years (interquartile range 55–72 years), 22.7% were female and 75.7% were White. There was no difference in age, sex, or comorbidities between those with or without RVD. Patients with RVD had a higher probability of active CPR during LV-MCS implant (14.7% vs 6.3%), Society for Cardiovascular Angiography and Interventions stage E shock (39.2% vs 23.2%), and higher admission lactate levels (5.1 mg/dL vs 3.0 mg/dL). Survival to discharge was significantly lower among those with RVD (61.8% vs 73.4%, odds ratio 0.89, 95% confidence interval 0.36–0.95, P = .031). This association remained significant in the multivariate analysis. There was no significant difference in hemodynamic variables within 24 hours of LV-MCS support among those with or without RVD. At 24 hours, patients with a CPO of >0.6 W and a PAPi of >1 had a trend toward better survival to discharge compared with those with a CPO of ≤0.6 W and a PAPi of ≤1 (77.1% vs 54.6%, P = .092). Patients with RVD were significantly more likely to have diastolic suction alarms within 24 hours of LV-MCS initiation.
Conclusions
RVD in AMI-CS is common and associated with worse survival to discharge. Early LV-MCS decreases filling pressures rapidly within the first 24 hours and decreases the rate of RVD. Achieving a CPO of >0.6 W and a PAPi of >1 within 24 hours is associated with high survival. Diastolic suction alarms may have usefulness as an early marker of RVD.
{"title":"Impact of Right Ventricular Dysfunction on Outcomes in Acute Myocardial Infarction and Cardiogenic Shock: Insights from the National Cardiogenic Shock Initiative","authors":"SARAH GORGIS MD , KARTIK GUPTA MD , ALEJANDRO LEMOR MD , DANA BENTLEY MWC , CHRISTIAN MOYER PhD , THOMAS McRAE MD , MATHEEN KHUDDUS MD , RAHUL SHARMA MD , MICHAEL LIM MD , ALI NSAIR MD , DAVID WOHNS MD , ADITYA MEHRA MD , LANG LIN MD , ADITYA BHARADWAJ MD , RYAN TEDFORD MD , NAVIN KAPUR MD , JENNIFER COWGER MD , WILLIAM O'NEILL MD , MIR B. BASIR DO","doi":"10.1016/j.cardfail.2024.07.015","DOIUrl":"10.1016/j.cardfail.2024.07.015","url":null,"abstract":"<div><h3>Background</h3><div>Right ventricular dysfunction (RVD) complicates 30%–40% of cases in acute myocardial infarction (AMI) and cardiogenic shock (CS). There are sparse data on the effects of RVD on outcomes and the impact of providing early left ventricular (LV) mechanical circulatory support (MCS) on RV function and hemodynamics.</div></div><div><h3>Methods and Results</h3><div>Between July 2016 and December 2020, 80 sites participated in the study. All centers agreed to treat patients with AMI-CS using a standard protocol emphasizing invasive hemodynamic monitoring and rapid initiation of LV-MCS. RVD was defined as a right atrial (RA) pressure of >12 mm Hg and a pulmonary artery pulsatility index (PAPI) of <1 within 24 hours of the index procedure. The primary outcome was survival to discharge. In a subgroup analysis, data available from the Automated Impella Controller console was used to analyze diastolic suction alarms from LV placement signal and its relation to RVD. A total of 361 patients were included in the analysis, of whom 28% had RVD. The median age was 64 years (interquartile range 55–72 years), 22.7% were female and 75.7% were White. There was no difference in age, sex, or comorbidities between those with or without RVD. Patients with RVD had a higher probability of active CPR during LV-MCS implant (14.7% vs 6.3%), Society for Cardiovascular Angiography and Interventions stage E shock (39.2% vs 23.2%), and higher admission lactate levels (5.1 mg/dL vs 3.0 mg/dL). Survival to discharge was significantly lower among those with RVD (61.8% vs 73.4%, odds ratio 0.89, 95% confidence interval 0.36–0.95, <em>P</em> = .031). This association remained significant in the multivariate analysis. There was no significant difference in hemodynamic variables within 24 hours of LV-MCS support among those with or without RVD. At 24 hours, patients with a CPO of >0.6 W and a PAPi of >1 had a trend toward better survival to discharge compared with those with a CPO of ≤0.6 W and a PAPi of ≤1 (77.1% vs 54.6%, <em>P</em> = .092). Patients with RVD were significantly more likely to have diastolic suction alarms within 24 hours of LV-MCS initiation.</div></div><div><h3>Conclusions</h3><div>RVD in AMI-CS is common and associated with worse survival to discharge. Early LV-MCS decreases filling pressures rapidly within the first 24 hours and decreases the rate of RVD. Achieving a CPO of >0.6 W and a PAPi of >1 within 24 hours is associated with high survival. Diastolic suction alarms may have usefulness as an early marker of RVD.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1275-1284"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400389","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.2024.06.018
Manish Vinayak MD , Francesca R. Prandi MD , Lucy Safi DO , Anupam Sharma MD , Gilbert H.L. Tang MD, MSc, MBA , Stamatios Lerakis MD PhD , Annapoorna S. Kini MD , Samin K. Sharma MD , Sean Pinney MD , Anuradha Lala MD , Sahil Khera MD, MPH
Secondary mitral regurgitation (SMR) is associated with increased mortality and heart failure hospitalizations. The management of heart failure patients with SMR is complex and requires a multidisciplinary Heart Team approach. Guideline-directed medical therapies remain fundamental, yet in a proportion of patients SMR persists. In the past decade, transcatheter edge-to-edge repair (TEER) has been shown to improve survival in patients with SMR who remain symptomatic despite medical therapy. Technical advancements across newer generations of devices, improved imaging, and greater operator expertise have collectively contributed to the increased safety and efficacy of this procedure over time. Various emerging transcatheter mitral valve repair and replacement devices are currently under investigation and may offer superior, complementary or synergistic treatment options in patients ineligible for TEER. This review provides a state-of-the-art overview regarding the diagnosis of SMR, and currently available transcatheter mitral valve interventions and describes a contemporary approach to the management of SMR.
{"title":"Secondary Mitral Regurgitation: Updated Review with Focus on Percutaneous Interventional Management","authors":"Manish Vinayak MD , Francesca R. Prandi MD , Lucy Safi DO , Anupam Sharma MD , Gilbert H.L. Tang MD, MSc, MBA , Stamatios Lerakis MD PhD , Annapoorna S. Kini MD , Samin K. Sharma MD , Sean Pinney MD , Anuradha Lala MD , Sahil Khera MD, MPH","doi":"10.1016/j.cardfail.2024.06.018","DOIUrl":"10.1016/j.cardfail.2024.06.018","url":null,"abstract":"<div><div>Secondary mitral regurgitation (SMR) is associated with increased mortality and heart failure hospitalizations. The management of heart failure patients with SMR is complex and requires a multidisciplinary Heart Team approach. Guideline-directed medical therapies remain fundamental, yet in a proportion of patients SMR persists. In the past decade, transcatheter edge-to-edge repair (TEER) has been shown to improve survival in patients with SMR who remain symptomatic despite medical therapy. Technical advancements across newer generations of devices, improved imaging, and greater operator expertise have collectively contributed to the increased safety and efficacy of this procedure over time. Various emerging transcatheter mitral valve repair and replacement devices are currently under investigation and may offer superior, complementary or synergistic treatment options in patients ineligible for TEER. This review provides a state-of-the-art overview regarding the diagnosis of SMR, and currently available transcatheter mitral valve interventions and describes a contemporary approach to the management of SMR.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"30 10","pages":"Pages 1302-1318"},"PeriodicalIF":6.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400400","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}
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