Objectives: Meta-analysis was performed to evaluate the effect of staged revascularization with concomitant chronic total occlusion (CTO) in the non-infarct-associated artery (non-IRA) in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (p-PCI).Methods: Various electronic databases were searched for studies published from inception to June, 2021. The primary endpoint was all-cause death, and the secondary endpoint was a composite of major adverse cardiac events (MACEs).Odds ratios (ORs) were pooled with 95% confidence intervals (CIs) for dichotomous data.Results: Seven studies involving 1540 participants were included in the final analysis. Pooled analyses revealed that patients with successful staged revascularization for CTO in non-IRA with STEMI treated with p-PCI had overall lower all-cause death compared with the occluded CTO group (OR, 0.46; 95% CI, 0.23–0.95), cardiac death (OR, 0.43; 95% CI, 0.20–0.91), MACEs (OR, 0.47; 95% CI, 0.32–0.69) and heart failure (OR, 0.57; 95% CI, 0.37–0.89) compared with the occluded CTO group. No significant differences were observed between groups regarding myocardialinfarction and repeated revascularization.Conclusions: Successful revascularization of CTO in the non-IRA was associated with better outcomes in patients with STEMI treated with p-PCI.
{"title":"Staged Revascularization for Chronic Total Occlusion in the Non-IRA in Patients with ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: An Updated Systematic Review and Meta-analysis","authors":"Ping Zhang","doi":"10.15212/cvia.2022.0007","DOIUrl":"https://doi.org/10.15212/cvia.2022.0007","url":null,"abstract":"Objectives: Meta-analysis was performed to evaluate the effect of staged revascularization with concomitant chronic total occlusion (CTO) in the non-infarct-associated artery (non-IRA) in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (p-PCI).Methods: Various electronic databases were searched for studies published from inception to June, 2021. The primary endpoint was all-cause death, and the secondary endpoint was a composite of major adverse cardiac events (MACEs).Odds ratios (ORs) were pooled with 95% confidence intervals (CIs) for dichotomous data.Results: Seven studies involving 1540 participants were included in the final analysis. Pooled analyses revealed that patients with successful staged revascularization for CTO in non-IRA with STEMI treated with p-PCI had overall lower all-cause death compared with the occluded CTO group (OR, 0.46; 95% CI, 0.23–0.95), cardiac death (OR, 0.43; 95% CI, 0.20–0.91), MACEs (OR, 0.47; 95% CI, 0.32–0.69) and heart failure (OR, 0.57; 95% CI, 0.37–0.89) compared with the occluded CTO group. No significant differences were observed between groups regarding myocardialinfarction and repeated revascularization.Conclusions: Successful revascularization of CTO in the non-IRA was associated with better outcomes in patients with STEMI treated with p-PCI.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67305755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Ondansetron and hypothermia are both known to induce bradycardia or QT interval prolongation, thus placing affected patients at risk of cardiac arrest.Case Report: Herein, we report the case of a 97-year-old woman who initially presented with confusion and hypothermia, and experienced severe bradycardia and asystolic cardiac arrest after a 4 mg intravenous ondansetron bolus injection.Conclusion: Ondansetron is associated with bradycardia and QTc prolongation, both of which might be further exacerbatedby hypothermia. Clinicians should be aware that administering ondansetron in patients with hypothermia might further increase the risk of adverse cardiac events and eventual cardiac arrest.
{"title":"Ondansetron and Hypothermia Induced Cardiac Arrest in a 97-Year-Old Woman: A Case Report","authors":"Keith Sai Kit Leung","doi":"10.15212/cvia.2022.0021","DOIUrl":"https://doi.org/10.15212/cvia.2022.0021","url":null,"abstract":"Background: Ondansetron and hypothermia are both known to induce bradycardia or QT interval prolongation, thus placing affected patients at risk of cardiac arrest.Case Report: Herein, we report the case of a 97-year-old woman who initially presented with confusion and hypothermia, and experienced severe bradycardia and asystolic cardiac arrest after a 4 mg intravenous ondansetron bolus injection.Conclusion: Ondansetron is associated with bradycardia and QTc prolongation, both of which might be further exacerbatedby hypothermia. Clinicians should be aware that administering ondansetron in patients with hypothermia might further increase the risk of adverse cardiac events and eventual cardiac arrest.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67306053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The purpose of our study was to assess whether the occurrence of ISR might be associated with plasmaTMAO levels in patients with ACS after DES implantation.Methods: This was a single center retrospective case-control study, in which 64 symptomatic patients with repeatedcoronary angiography after PCI and 15 patients with ISR were included in the ISR group, and 49 patients without ISRwere included in the non-ISR group. High-performance liquid chromatography with tandem mass spectrometry wasused to measure plasma TMAO levels.Results: No significant differences were observed in plasma TMAO between the ISR and non-ISR groups. Plasma TMAO levels showed no significant correlation with ISR, but were significantly positively correlated with diabetes mellitus, serum HbA1c levels and serum creatinine levels; moreover, they were significantly negatively correlated with female sex. ISR was significantly positively correlated with diabetes mellitus, fasting blood glucose levels, the neutrophil to lymphocyte ratio and syntax score; in addition, it was significantly negatively correlated with platelets. Logistic regression analysis indicated that fasting blood glucose was the only independent predictor of ISR.Conclusion: Plasma TMAO may not be associated with ISR and plaque burden in patients with ACS after DES implantation,whereas FBG may predict the development of ISR in these patients.
{"title":"Fasting Blood Glucose but not TMAO is Associated with In-Stent Restenosis in Patients with Acute Coronary Syndrome","authors":"Ping Zhang","doi":"10.15212/cvia.2021.0034","DOIUrl":"https://doi.org/10.15212/cvia.2021.0034","url":null,"abstract":"Background: The purpose of our study was to assess whether the occurrence of ISR might be associated with plasmaTMAO levels in patients with ACS after DES implantation.Methods: This was a single center retrospective case-control study, in which 64 symptomatic patients with repeatedcoronary angiography after PCI and 15 patients with ISR were included in the ISR group, and 49 patients without ISRwere included in the non-ISR group. High-performance liquid chromatography with tandem mass spectrometry wasused to measure plasma TMAO levels.Results: No significant differences were observed in plasma TMAO between the ISR and non-ISR groups. Plasma TMAO levels showed no significant correlation with ISR, but were significantly positively correlated with diabetes mellitus, serum HbA1c levels and serum creatinine levels; moreover, they were significantly negatively correlated with female sex. ISR was significantly positively correlated with diabetes mellitus, fasting blood glucose levels, the neutrophil to lymphocyte ratio and syntax score; in addition, it was significantly negatively correlated with platelets. Logistic regression analysis indicated that fasting blood glucose was the only independent predictor of ISR.Conclusion: Plasma TMAO may not be associated with ISR and plaque burden in patients with ACS after DES implantation,whereas FBG may predict the development of ISR in these patients.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67305056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: This study describes a real-world experience of implanting a novel balloon expandable transcatheteraortic valve replacement (TAVR) compared to devices commonly used in clinical practice. As a secondary objective,the effect of balloon angioplasty (BAV) before TAVR on the transvalvular gradient 1 and 30 days after implantationwas evaluated.Background: For most commercial TAVR valves, the 30-day average mean aortic valve gradients have been reported.Our experience with the Lotus Valve System had indicated higher immediate post-implant gradients than those in the literature. We sought to evaluate both these valves, comparing them to other valves.Methods: We analyzed discharge and 30-day echocardiograms of Lotus valves from 7/5/2019 to 8/27/2020. In responseto higher-than-expected post-implant gradients, patients from 11/4/19 to 8/27/20 underwent BAV before the valve implantation, whereas patients from 7/5/19 to 10/18/19 did not (no-BAV). We compared these samples to each other and to a random sampling of TAVR valves implanted by the same interventionalist.Results: At discharge, 27 patients received Lotus valves. The average mean aortic valve gradient was 16.7 mmHg(SD = 5.5 mmHg) for the no-BAV and 14.7 mmHg (SD = 3.7 mmHg) for the BAV (P = 0.177) cohorts. No-BAV Lotus valve mean gradients were significantly higher (P < 0.001) than those of the Sapien valve (M = 12 mmHg, SD = 4.3)and CoreValve (M = 9.18 mmHg, SD = 3.96). At the 30-day assessment, the mean gradients in the no-BAV and BAV groups were similar to those in the literature (M = 11 mmHg SD 3.5; M = 12 mmHg, SD 4.1 (P = 0.287)) and those ofother valves.Conclusions: The Lotus valve demonstrated higher post-implantation gradients than other valves. This effect wasnot attenuated by BAV. These elevated gradients were not significant at the 30-day follow-up.
{"title":"Comparison of Post-Procedural and 30-day Post-Implantation Transcatheter Aortic Valve Replacement Gradients with and without preimplantation Balloon Valvuloplasty: A Real- World Analysis of Early Results using a Novel Balloon Expandable Transcatheter Aortic Valve","authors":"M. Chandrasekhar","doi":"10.15212/cvia.2022.0009","DOIUrl":"https://doi.org/10.15212/cvia.2022.0009","url":null,"abstract":"Objectives: This study describes a real-world experience of implanting a novel balloon expandable transcatheteraortic valve replacement (TAVR) compared to devices commonly used in clinical practice. As a secondary objective,the effect of balloon angioplasty (BAV) before TAVR on the transvalvular gradient 1 and 30 days after implantationwas evaluated.Background: For most commercial TAVR valves, the 30-day average mean aortic valve gradients have been reported.Our experience with the Lotus Valve System had indicated higher immediate post-implant gradients than those in the literature. We sought to evaluate both these valves, comparing them to other valves.Methods: We analyzed discharge and 30-day echocardiograms of Lotus valves from 7/5/2019 to 8/27/2020. In responseto higher-than-expected post-implant gradients, patients from 11/4/19 to 8/27/20 underwent BAV before the valve implantation, whereas patients from 7/5/19 to 10/18/19 did not (no-BAV). We compared these samples to each other and to a random sampling of TAVR valves implanted by the same interventionalist.Results: At discharge, 27 patients received Lotus valves. The average mean aortic valve gradient was 16.7 mmHg(SD = 5.5 mmHg) for the no-BAV and 14.7 mmHg (SD = 3.7 mmHg) for the BAV (P = 0.177) cohorts. No-BAV Lotus valve mean gradients were significantly higher (P < 0.001) than those of the Sapien valve (M = 12 mmHg, SD = 4.3)and CoreValve (M = 9.18 mmHg, SD = 3.96). At the 30-day assessment, the mean gradients in the no-BAV and BAV groups were similar to those in the literature (M = 11 mmHg SD 3.5; M = 12 mmHg, SD 4.1 (P = 0.287)) and those ofother valves.Conclusions: The Lotus valve demonstrated higher post-implantation gradients than other valves. This effect wasnot attenuated by BAV. These elevated gradients were not significant at the 30-day follow-up.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67305831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Great Wall International Congress of Cardiology 2021 Asian Heart Society Congress 2021","authors":"","doi":"10.15212/cvia.2021.0030","DOIUrl":"https://doi.org/10.15212/cvia.2021.0030","url":null,"abstract":"","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48264481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Acute decompensated heart failure (ADHF) is a life-threatening and costly disease. Controversy remainsregarding the efficacy and renal tolerability of ultrafiltration for treating ADHF. We therefore performed thismeta-analysis to evaluate this clinical issue.Methods: A search of PubMed, EMBASE, and the Cochrane database of controlled trials was performed from inceptionto March 2021 for relevant randomized controlled trials. The quality of the included trials and outcomes wasevaluated with the use of the risk of bias assessment tool and the Grading of Recommendations, Assessment, Developmentand Evaluation (GRADE) approach, respectively. The risk ratio and the standardized mean difference (SMD) or weighted mean difference (WMD) were computed and pooled with fixed-effects or random-effects models.Results: This meta-analysis included 19 studies involving 1281 patients. Ultrafiltration was superior to the controltreatments for weight loss (WMD 1.24 kg, 95% confidence interval [CI] 0.38–2.09 kg, P = 0.004) and fluid removal(WMD 1.55 L, 95% CI 0.51–2.59 l, P = 0.003) and was associated with a significant increase in serum creatinine levelcompared with the control treatments (SMD 0.15 mg/dL, 95% CI 0.00–0.30 mg/dL, P = 0.04). However, no significanteffects were found for serum N-terminal prohormone of brain natriuretic peptide level, length of hospital stay, all-causemortality, or all-cause rehospitalization in the ultrafiltration group.Conclusions: The use of ultrafiltration in patients with ADHF is superior to the use of the control treatments for weight loss and fluid removal, but has adverse renal effects and lacks significant effects on long-term prognosis, indicatingthat this approach to decongestion in ADHF patients is efficient for fluid management but less safe renally.
背景:急性失代偿性心力衰竭(ADHF)是一种危及生命且代价高昂的疾病。关于超滤治疗ADHF的疗效和肾耐受性仍有争议。因此，我们进行了这项荟萃分析来评估这一临床问题。方法:检索PubMed、EMBASE和Cochrane对照试验数据库，从开始到2021年3月检索相关随机对照试验。分别使用偏倚风险评估工具和推荐、评估、发展和评价分级(GRADE)方法对纳入的试验和结果的质量进行评估。计算风险比和标准化平均差(SMD)或加权平均差(WMD)，并采用固定效应或随机效应模型进行合并。结果:本荟萃分析纳入19项研究，涉及1281例患者。超滤组在减重(WMD 1.24 kg, 95%可信区间[CI] 0.38-2.09 kg, P = 0.004)和排液(WMD 1.55 L, 95% CI 0.51-2.59 L, P = 0.003)方面优于对照组，且血清肌酐水平显著高于对照组(SMD 0.15 mg/dL, 95% CI 0.00-0.30 mg/dL, P = 0.04)。超滤组血清脑利钠肽n端激素原水平、住院时间、全因死亡率、全因再住院均无显著影响。结论:ADHF患者超滤治疗优于对照组的减重、排液治疗，但对肾脏有不良影响，且对远期预后影响不显著，提示该方法对ADHF患者去充血的液体管理有效，但对肾脏的安全性较差。
{"title":"Efficacy and Renal Tolerability of Ultrafiltration in Acute Decompensated Heart Failure: A Meta-analysis and Systematic Review of 19 Randomized Controlled Trials","authors":"Ya-jie Liu, Xin Yuan","doi":"10.15212/cvia.2021.0020","DOIUrl":"https://doi.org/10.15212/cvia.2021.0020","url":null,"abstract":"\u0000 Background: Acute decompensated heart failure (ADHF) is a life-threatening and costly disease. Controversy remainsregarding the efficacy and renal tolerability of ultrafiltration for treating ADHF. We therefore performed thismeta-analysis to evaluate this clinical issue.Methods: A search of PubMed, EMBASE, and the Cochrane database of controlled trials was performed from inceptionto March 2021 for relevant randomized controlled trials. The quality of the included trials and outcomes wasevaluated with the use of the risk of bias assessment tool and the Grading of Recommendations, Assessment, Developmentand Evaluation (GRADE) approach, respectively. The risk ratio and the standardized mean difference (SMD) or weighted mean difference (WMD) were computed and pooled with fixed-effects or random-effects models.Results: This meta-analysis included 19 studies involving 1281 patients. Ultrafiltration was superior to the controltreatments for weight loss (WMD 1.24 kg, 95% confidence interval [CI] 0.38–2.09 kg, P = 0.004) and fluid removal(WMD 1.55 L, 95% CI 0.51–2.59 l, P = 0.003) and was associated with a significant increase in serum creatinine levelcompared with the control treatments (SMD 0.15 mg/dL, 95% CI 0.00–0.30 mg/dL, P = 0.04). However, no significanteffects were found for serum N-terminal prohormone of brain natriuretic peptide level, length of hospital stay, all-causemortality, or all-cause rehospitalization in the ultrafiltration group.Conclusions: The use of ultrafiltration in patients with ADHF is superior to the use of the control treatments for weight loss and fluid removal, but has adverse renal effects and lacks significant effects on long-term prognosis, indicatingthat this approach to decongestion in ADHF patients is efficient for fluid management but less safe renally.\u0000","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45710817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Tu, Jiang Li, Z. Fang, Xinqun Hu, Jianjun Tang, Yan‐shu Zhao, Liang Tang, Shenghua Zhou
Background: We report an acute emotional stress–induced in-hospital cardiac arrest in a patient admitted with gastrointestinal symptoms after experiencing chronic anxiety disorder.Case Presentation: The patient was admitted to the Second Xiangya Hospital, Central South University, withgastrointestinal symptoms and chronic anxiety disorder, and experienced cardiac arrest during hospitalization after acute emotional stress. Malignant ventricular tachycardia and cardiogenic shock were evidenced in this patient afterthe acute emotional stress. Severe and extensive coronary spasm was confirmed by emergency coronary angiography, and coronary spasm was relieved by intracoronary injection of nitroglycerin. The patient recovered from myocardial infarction with nonobstructive coronary arteries. However, the patient developed acute kidney dysfunction and severe pulmonary infection and eventually died of respiratory circulatory failure on the ninth day after the successful rescue.Conclusions: Acute emotional stress on top of chronic anxiety disorder in patients hospitalized for noncardiovascularreasons might lead to the development of life-threatening cardiovascular diseases, including coronary artery spasmand myocardial infarction with nonobstructive coronary arteries. Psychological management is of importance to improvethe outcome of these patients.
{"title":"In-Hospital Cardiac Arrest after Emotional Stress in a Patient Hospitalized with Gastrointestinal Symptoms and Chronic Anxiety Disorder","authors":"T. Tu, Jiang Li, Z. Fang, Xinqun Hu, Jianjun Tang, Yan‐shu Zhao, Liang Tang, Shenghua Zhou","doi":"10.15212/cvia.2021.0021","DOIUrl":"https://doi.org/10.15212/cvia.2021.0021","url":null,"abstract":"\u0000 Background: We report an acute emotional stress–induced in-hospital cardiac arrest in a patient admitted with gastrointestinal symptoms after experiencing chronic anxiety disorder.Case Presentation: The patient was admitted to the Second Xiangya Hospital, Central South University, withgastrointestinal symptoms and chronic anxiety disorder, and experienced cardiac arrest during hospitalization after acute emotional stress. Malignant ventricular tachycardia and cardiogenic shock were evidenced in this patient afterthe acute emotional stress. Severe and extensive coronary spasm was confirmed by emergency coronary angiography, and coronary spasm was relieved by intracoronary injection of nitroglycerin. The patient recovered from myocardial infarction with nonobstructive coronary arteries. However, the patient developed acute kidney dysfunction and severe pulmonary infection and eventually died of respiratory circulatory failure on the ninth day after the successful rescue.Conclusions: Acute emotional stress on top of chronic anxiety disorder in patients hospitalized for noncardiovascularreasons might lead to the development of life-threatening cardiovascular diseases, including coronary artery spasmand myocardial infarction with nonobstructive coronary arteries. Psychological management is of importance to improvethe outcome of these patients.\u0000","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44824151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To explore the experience with and complications of extracorporeal membrane oxygenation (ECMO) combined with continuous renal replacement therapy (CRRT) for treatment of critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia.Methods: The data on critically ill COVID-19 patients who received ECMO/CRRT at Tongji Hospital, which is affiliated with Huazhong University of Science and Technology, in February and March 2020 were collected and analyzed. All three patients were male, and the mean age was 50.6 years (range 44‐58 years). The indications for ECMO in critically ill SARS-CoV-2 pneumonia patients at our center were severe acute respiratory distress syndrome with Pao2/Fio2 below 100 mmHg under an effective protective pulmonary ventilation strategy and inflammatory storm accompanied by acute kidney injury. One patient, with severe heart failure, was selected for venoarterial ECMO, and the other two patients were selected for venovenous ECMO.Results: In the three patients who received ECMO combined with bedside CRRT, the mean duration was 9.7 days (range 7‐13 days). Four complications occurred during ECMO/CRRT, especially thrombocytopenia. Laboratory testing showed increased counts of leukocytes and lymphocytes and decreased levels of inflammatory factors. Lung CT was suggestive of significantly absorbed and reduced lesions and interstitial fibrosis.Conclusions: The survival rate of patients with cardiopulmonary failure treated with ECMO/CRRT in whom conventional treatment failed in this group was 100%, which indicates that combined treatment with ECMO and CRRT is an important treatment technique.
{"title":"ECMO/CRRT Combined Support in the Treatment of Critically Ill SARS-CoV-2 Pneumonia Patients","authors":"Hai Zou, Shengqing Li","doi":"10.15212/cvia.2019.1267","DOIUrl":"https://doi.org/10.15212/cvia.2019.1267","url":null,"abstract":"Objective: To explore the experience with and complications of extracorporeal membrane oxygenation (ECMO) combined with continuous renal replacement therapy (CRRT) for treatment of critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia.Methods:\u0000 The data on critically ill COVID-19 patients who received ECMO/CRRT at Tongji Hospital, which is affiliated with Huazhong University of Science and Technology, in February and March 2020 were collected and analyzed. All three patients were male, and the mean age was 50.6 years (range 44‐58\u0000 years). The indications for ECMO in critically ill SARS-CoV-2 pneumonia patients at our center were severe acute respiratory distress syndrome with Pao2/Fio2 below 100 mmHg under an effective protective pulmonary ventilation strategy and inflammatory storm accompanied\u0000 by acute kidney injury. One patient, with severe heart failure, was selected for venoarterial ECMO, and the other two patients were selected for venovenous ECMO.Results: In the three patients who received ECMO combined with bedside CRRT, the mean duration was 9.7 days (range 7‐13\u0000 days). Four complications occurred during ECMO/CRRT, especially thrombocytopenia. Laboratory testing showed increased counts of leukocytes and lymphocytes and decreased levels of inflammatory factors. Lung CT was suggestive of significantly absorbed and reduced lesions and interstitial fibrosis.Conclusions:\u0000 The survival rate of patients with cardiopulmonary failure treated with ECMO/CRRT in whom conventional treatment failed in this group was 100%, which indicates that combined treatment with ECMO and CRRT is an important treatment technique.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45071586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yu Zhang, W. Dai, can-can Lin, Qiao-yuan Li, Chengjun Guo
Subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy has become a viable alternative to conventional transvenous ICD implantation. Patients with congenitally corrected transposition of the great arteries (ccTGA) have a high risk of sudden cardiac death due to malignant arrhythmia. The interaction between the S-ICD system and the transvenous pacemaker system is not fully understood. We report a case of S-ICD implantation in a patient with ccTGA and a DDD pacemaker. The patient was a 30-year-old man with a previously placed pacemaker with diagnoses of congenital heart disease, ccTGA (SLL), left atrioventricular valve insufficiency, and third-degree atrioventricular block. He presented with an out-of-hospital cardiac arrest, and an S-ICD was implanted to prevent sudden cardiac death. Defibrillation checks were performed successfully. We tested the compatibility of the DDD pacemaker with the S-ICD and found that there was no interference between them. In conclusion, an S-ICD system is a reasonable and safe option in patients with ccTGA.
{"title":"Implantation of an S-ICD in a Patient with a DDD Pacemaker and Congenitally Corrected Transposition of the Great Arteries","authors":"Yu Zhang, W. Dai, can-can Lin, Qiao-yuan Li, Chengjun Guo","doi":"10.15212/cvia.2019.0597","DOIUrl":"https://doi.org/10.15212/cvia.2019.0597","url":null,"abstract":"Subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy has become a viable alternative to conventional transvenous ICD implantation. Patients with congenitally corrected transposition of the great arteries (ccTGA) have a high risk of sudden cardiac death due to malignant\u0000 arrhythmia. The interaction between the S-ICD system and the transvenous pacemaker system is not fully understood. We report a case of S-ICD implantation in a patient with ccTGA and a DDD pacemaker. The patient was a 30-year-old man with a previously placed pacemaker with diagnoses of congenital\u0000 heart disease, ccTGA (SLL), left atrioventricular valve insufficiency, and third-degree atrioventricular block. He presented with an out-of-hospital cardiac arrest, and an S-ICD was implanted to prevent sudden cardiac death. Defibrillation checks were performed successfully. We tested the\u0000 compatibility of the DDD pacemaker with the S-ICD and found that there was no interference between them. In conclusion, an S-ICD system is a reasonable and safe option in patients with ccTGA.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41379200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Measuring glycosylated hemoglobin (HbA1c) is a simple way to assess patients with prediabetes ordiabetes mellitus. It has been shown that HbA1c level predicts prognosis in patients with coronary artery disease (CAD)and the incidence of diabetes mellitus. However, the prognostic significance of HbA1c level in Asian patients withprediabetes and CAD is not yet clear. Our study aimed to determine the relationship between HbA1c level and majoradverse cardiovascular events (MACE) in patients with prediabetes and CAD.Methods: We enrolled 1367 patients with prediabetes and CAD in the final analysis, and grouped them according tothe HbA1c level. Primary end points included nonfatal myocardial infarction, hospitalization for unstable angina, andischemia-driven revascularization. Cox proportional-hazards regression analysis was used to determine the relationshipbetween HbA1c level and MACE after our accounting for confounding factors.Results: A total of 1367 patients (age 58.8 ± 10.3 years; 71.6% men) were included. During 43 months of follow-up,197 patients experienced at least one primary end point event. Multivariate Cox proportional-hazards regression analysisshowed in comparison of HbA1c levels that the hazard ratio for primary end points was 4.110, with a 95% confidence interval of 2.097–6.011 (P < 0.001).Conclusions: HbA1c level positively correlated with MACE, demonstrating it is a valuable indicator for independentlypredicting MACE in Asian patients with prediabetes and CAD.
{"title":"Prognostic Significance of HbA1c Level in Asian Patients with Prediabetes and Coronary Artery Disease","authors":"Yu-jie Zhou","doi":"10.15212/cvia.2021.0029","DOIUrl":"https://doi.org/10.15212/cvia.2021.0029","url":null,"abstract":"Background: Measuring glycosylated hemoglobin (HbA1c) is a simple way to assess patients with prediabetes ordiabetes mellitus. It has been shown that HbA1c level predicts prognosis in patients with coronary artery disease (CAD)and the incidence of diabetes mellitus. However, the prognostic significance of HbA1c level in Asian patients withprediabetes and CAD is not yet clear. Our study aimed to determine the relationship between HbA1c level and majoradverse cardiovascular events (MACE) in patients with prediabetes and CAD.Methods: We enrolled 1367 patients with prediabetes and CAD in the final analysis, and grouped them according tothe HbA1c level. Primary end points included nonfatal myocardial infarction, hospitalization for unstable angina, andischemia-driven revascularization. Cox proportional-hazards regression analysis was used to determine the relationshipbetween HbA1c level and MACE after our accounting for confounding factors.Results: A total of 1367 patients (age 58.8 ± 10.3 years; 71.6% men) were included. During 43 months of follow-up,197 patients experienced at least one primary end point event. Multivariate Cox proportional-hazards regression analysisshowed in comparison of HbA1c levels that the hazard ratio for primary end points was 4.110, with a 95% confidence interval of 2.097–6.011 (P < 0.001).Conclusions: HbA1c level positively correlated with MACE, demonstrating it is a valuable indicator for independentlypredicting MACE in Asian patients with prediabetes and CAD.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67304510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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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