Pub Date : 2024-07-15DOI: 10.1016/j.hjc.2024.07.005
Magdi Zordok, Sourbha S Dani, Mariam Tawadros, Hady T Lichaa, Jimmy L Kerrigan, Babar Basir, Khaldoon Alaswad, Michael Miedema, Michael Megaly
{"title":"Morbidity and mortality trends in patients with inflammatory bowel disease presenting with ST elevation myocardial infarction.","authors":"Magdi Zordok, Sourbha S Dani, Mariam Tawadros, Hady T Lichaa, Jimmy L Kerrigan, Babar Basir, Khaldoon Alaswad, Michael Miedema, Michael Megaly","doi":"10.1016/j.hjc.2024.07.005","DOIUrl":"10.1016/j.hjc.2024.07.005","url":null,"abstract":"","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Unrecognized myocardial infarction (UMI) on delayed-enhancement cardiac magnetic resonance imaging (DE-CMR) and coronary computed tomography angiography (CCTA) derived high-risk features provide prognostic information in patients with chronic coronary syndrome (CCS). The study aimed to assess the prognostic value of UMI and predictors of UMI using CCTA in patients with CCS who underwent elective percutaneous coronary intervention (PCI).
Methods: This study enrolled 181 patients with CCS who underwent DE-CMR and CCTA before elective PCI. The CCTA-derived predictors of UMI and the association of baseline clinical characteristics, CCTA findings, and CMR-derived factors, including UMI, with MACEs, defined as death, nonfatal myocardial infarction, unplanned late revascularization, hospitalization for congestive heart failure, and stroke, were investigated.
Results: UMI was detected in 57 (31.5%) patients. ROC analysis revealed that the optimal cut-off values of Agatston score and mean peri-coronary fat attenuation index (FAI) for predicting the presence of UMI were 397 and -69.8, respectively. The multivariable logistic regression analysis revealed that left ventricular mass, Agatston score >397, mean FAI >-69.8, positive remodeling of the target lesion, and CCTA-derived stenosis severity were independent predictors of UMI. Kaplan-Meier analysis revealed that patients with UMI were associated with increased risk of MACEs. The Cox proportional hazards analysis showed post-PCI minimum lumen diameter and the presence of UMI were independent predictors of MACEs. The risk of MACEs significantly increased according to the number of four preprocedural CCTA-relevant features of UMI.
Conclusion: Preprocedural comprehensive CCTA analysis may help predict the presence of UMI and provide prognostic information in patients with CCS who underwent PCI.
{"title":"Predictors and prognostic value of coronary computed tomography angiography for unrecognized myocardial infarction in patients with chronic coronary syndrome.","authors":"Yun Teng, Masahiro Hoshino, Yoshihisa Kanaji, Tomoyo Sugiyama, Toru Misawa, Masahiro Hada, Tatsuhiro Nagamine, Kai Nogami, Hiroki Ueno, Kodai Sayama, Kazuki Matsuda, Taishi Yonetsu, Tetsuo Sasano, Tsunekazu Kakuta","doi":"10.1016/j.hjc.2024.07.004","DOIUrl":"10.1016/j.hjc.2024.07.004","url":null,"abstract":"<p><strong>Objective: </strong>Unrecognized myocardial infarction (UMI) on delayed-enhancement cardiac magnetic resonance imaging (DE-CMR) and coronary computed tomography angiography (CCTA) derived high-risk features provide prognostic information in patients with chronic coronary syndrome (CCS). The study aimed to assess the prognostic value of UMI and predictors of UMI using CCTA in patients with CCS who underwent elective percutaneous coronary intervention (PCI).</p><p><strong>Methods: </strong>This study enrolled 181 patients with CCS who underwent DE-CMR and CCTA before elective PCI. The CCTA-derived predictors of UMI and the association of baseline clinical characteristics, CCTA findings, and CMR-derived factors, including UMI, with MACEs, defined as death, nonfatal myocardial infarction, unplanned late revascularization, hospitalization for congestive heart failure, and stroke, were investigated.</p><p><strong>Results: </strong>UMI was detected in 57 (31.5%) patients. ROC analysis revealed that the optimal cut-off values of Agatston score and mean peri-coronary fat attenuation index (FAI) for predicting the presence of UMI were 397 and -69.8, respectively. The multivariable logistic regression analysis revealed that left ventricular mass, Agatston score >397, mean FAI >-69.8, positive remodeling of the target lesion, and CCTA-derived stenosis severity were independent predictors of UMI. Kaplan-Meier analysis revealed that patients with UMI were associated with increased risk of MACEs. The Cox proportional hazards analysis showed post-PCI minimum lumen diameter and the presence of UMI were independent predictors of MACEs. The risk of MACEs significantly increased according to the number of four preprocedural CCTA-relevant features of UMI.</p><p><strong>Conclusion: </strong>Preprocedural comprehensive CCTA analysis may help predict the presence of UMI and provide prognostic information in patients with CCS who underwent PCI.</p>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Twin circumflex arteries in a patient with lateral STEMI: Which is the culprit artery?","authors":"Nikitas Katsillis, Antonios Dimopoulos, Sarantos Linardakis, Nikolaos Papakonstantinou, Nikolaos Patsourakos","doi":"10.1016/j.hjc.2024.06.012","DOIUrl":"10.1016/j.hjc.2024.06.012","url":null,"abstract":"","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-06DOI: 10.1016/j.hjc.2024.06.007
Eleonora Moccia, Harshil Dhutia, Aneil Malhotra, Efstathios Papatheodorou, Elijah Behr, Rajan Sharma, Michael Papadakis, Sanjay Sharma, Gherardo Finocchiaro
Objective: The aim of the study was to explore the individual impact of BMI and height on LV size and geometry in a cohort of healthy athletes.
Methods: From a total cohort of 1857 healthy élite athletes (21 ± 5 years, males 70%) investigated with ECG and echocardiogram, we considered three groups: Group 1 n = 50: BMI ≥ 30 and height < 1.90 m; Group 2 n = 87: height ≥ 1.95 m and BMI < 30; control Group 3 n = 243: height < 1.90 m and BMI = 20-29.
Results: BSA was ≤2.3 m2 in 52% of athletes in group 1 and 47% of athletes in group 2. Athletes in group 1 and in group 2 showed an enlarged LV end-diastolic diameter (LVEDD) (57 ± 6 vs 57 ± 4 vs 53 ± 4 mm in Group 3); 50% of athletes in group 1 and 38% of athletes in group 2 exhibited a LVEDD > 57 mm (p = 0.23). LV wall thickness was higher in group 1 (11 ± 1 vs 10 ± 2 mm in Group 2, p = 0.001). Concentric hypertrophy or concentric remodelling was found in 20% of athletes in group 1 vs 7% of athletes in group 2 (p = 0.04). Athletes of group 1 with BSA ≤ 2.3 m2 showed lower LVEDD (53 ± 5 vs 60 ± 5 mm, p < 0.001), similar LV wall thickness (10 ± 1 vs 11 ± 1 mm, p = 0.128) and higher prevalence of concentric hypertrophy or concentric remodelling (31% vs 8%, p = 0.04) compared to those with BSA > 2.3 m2.
Conclusion: Athletes with high BMI have similar LV dimensions but greater wall thickness and higher prevalence of concentric remodelling compared to very tall athletes. Athletes with high BMI and large BSA have the widest LV dimensions.
{"title":"Left ventricular morphology and geometry in élite athletes characterised by extreme anthropometry.","authors":"Eleonora Moccia, Harshil Dhutia, Aneil Malhotra, Efstathios Papatheodorou, Elijah Behr, Rajan Sharma, Michael Papadakis, Sanjay Sharma, Gherardo Finocchiaro","doi":"10.1016/j.hjc.2024.06.007","DOIUrl":"10.1016/j.hjc.2024.06.007","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to explore the individual impact of BMI and height on LV size and geometry in a cohort of healthy athletes.</p><p><strong>Methods: </strong>From a total cohort of 1857 healthy élite athletes (21 ± 5 years, males 70%) investigated with ECG and echocardiogram, we considered three groups: Group 1 n = 50: BMI ≥ 30 and height < 1.90 m; Group 2 n = 87: height ≥ 1.95 m and BMI < 30; control Group 3 n = 243: height < 1.90 m and BMI = 20-29.</p><p><strong>Results: </strong>BSA was ≤2.3 m<sup>2</sup> in 52% of athletes in group 1 and 47% of athletes in group 2. Athletes in group 1 and in group 2 showed an enlarged LV end-diastolic diameter (LVEDD) (57 ± 6 vs 57 ± 4 vs 53 ± 4 mm in Group 3); 50% of athletes in group 1 and 38% of athletes in group 2 exhibited a LVEDD > 57 mm (p = 0.23). LV wall thickness was higher in group 1 (11 ± 1 vs 10 ± 2 mm in Group 2, p = 0.001). Concentric hypertrophy or concentric remodelling was found in 20% of athletes in group 1 vs 7% of athletes in group 2 (p = 0.04). Athletes of group 1 with BSA ≤ 2.3 m<sup>2</sup> showed lower LVEDD (53 ± 5 vs 60 ± 5 mm, p < 0.001), similar LV wall thickness (10 ± 1 vs 11 ± 1 mm, p = 0.128) and higher prevalence of concentric hypertrophy or concentric remodelling (31% vs 8%, p = 0.04) compared to those with BSA > 2.3 m<sup>2</sup>.</p><p><strong>Conclusion: </strong>Athletes with high BMI have similar LV dimensions but greater wall thickness and higher prevalence of concentric remodelling compared to very tall athletes. Athletes with high BMI and large BSA have the widest LV dimensions.</p>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141556000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-06DOI: 10.1016/j.hjc.2024.07.001
Lara-Marie Yamagata, Kentaro Yamagata, Alexander Borg, Mark Abela
Hypertrophic cardiomyopathy (HCM) is traditionally associated with exercise restriction due to potential risks, yet recent evidence and guidelines suggest a more permissive stance for low-risk individuals. The aim of this comprehensive review was to examine existing research on the impact of exercise on cardiovascular outcomes, safety, and quality of life in this population and to consider implications for clinical practice. Recent studies suggest that regular exercise and physical activity in low-risk individuals with HCM are associated with positive outcomes in functional capacity, haemodynamic response, and quality of life, with consistent safety. Various studies highlight the safety of moderate-intensity exercise, showing improvements in exercise capacity without adverse cardiac remodelling or significant arrhythmias. Psychological benefits, including reductions in anxiety and depression, have been also reported following structured exercise programmes. These findings support the potential benefits of integrating individualised exercise regimens in the management of low-risk individuals with HCM, with the aim of improving their overall well-being and cardiovascular health. Adoption of the FITT (frequency, intensity, time, and type of exercise) principle, consideration of individual risk profiles, and shared decision-making are recommended. Future research is warranted to clarify the definition of 'low risk' for exercise participation and investigate the influence of physical activity on disease progression in HCM. Innovation in therapeutic strategies and lifestyle interventions, alongside improved patient and provider education, will help advance the care and safety of individuals with HCM engaging in exercise.
{"title":"Shifting paradigms in hypertrophic cardiomyopathy: the role of exercise in disease management.","authors":"Lara-Marie Yamagata, Kentaro Yamagata, Alexander Borg, Mark Abela","doi":"10.1016/j.hjc.2024.07.001","DOIUrl":"10.1016/j.hjc.2024.07.001","url":null,"abstract":"<p><p>Hypertrophic cardiomyopathy (HCM) is traditionally associated with exercise restriction due to potential risks, yet recent evidence and guidelines suggest a more permissive stance for low-risk individuals. The aim of this comprehensive review was to examine existing research on the impact of exercise on cardiovascular outcomes, safety, and quality of life in this population and to consider implications for clinical practice. Recent studies suggest that regular exercise and physical activity in low-risk individuals with HCM are associated with positive outcomes in functional capacity, haemodynamic response, and quality of life, with consistent safety. Various studies highlight the safety of moderate-intensity exercise, showing improvements in exercise capacity without adverse cardiac remodelling or significant arrhythmias. Psychological benefits, including reductions in anxiety and depression, have been also reported following structured exercise programmes. These findings support the potential benefits of integrating individualised exercise regimens in the management of low-risk individuals with HCM, with the aim of improving their overall well-being and cardiovascular health. Adoption of the FITT (frequency, intensity, time, and type of exercise) principle, consideration of individual risk profiles, and shared decision-making are recommended. Future research is warranted to clarify the definition of 'low risk' for exercise participation and investigate the influence of physical activity on disease progression in HCM. Innovation in therapeutic strategies and lifestyle interventions, alongside improved patient and provider education, will help advance the care and safety of individuals with HCM engaging in exercise.</p>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-06DOI: 10.1016/j.hjc.2024.07.002
Vasileios Anastasiou, Stylianos Daios, Dimitrios V Moysidis, Alexandros C Liatsos, Andreas S Papazoglou, Matthaios Didagelos, Christos Savopoulos, Jeroen J Bax, Antonios Ziakas, Vasileios Kamperidis
Background: The tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio is a non-invasive surrogate for right ventricular-pulmonary arterial (RV-PA) coupling, studied in chronic RV pressure overload syndromes. However, its prognostic utility in patients with acute myocardial infarction (AMI), which may cause acute RV pressure overload, remains unexplored.
Objective: This study aimed to determine predictors of RV-PA uncoupling in patients with first AMI and examine whether it could improve risk stratification for cardiovascular in-hospital mortality after revascularization.
Methods: Three-hundred consecutive patients with first AMI were prospectively studied (age 61.2 ± 11.8, 24% females). Echocardiography was performed 24 h after successful revascularization, and TAPSE/PASP was evaluated. Cardiovascular in-hospital mortality was recorded.
Results: The optimal cutoff value of TAPSE/PASP to determine cardiovascular in-hospital mortality was 0.49 mm/mmHg. RV-PA uncoupling was considered for patients with TAPSE/PASP ≤0.49 mm/mmHg. Left ventricular ejection fraction (LVEF) was independently associated with RV-PA uncoupling. A total of 23 (7.7%) patients died in hospital despite successful revascularization. TAPSE/PASP was independently associated with in-hospital mortality after adjustment for Global Registry of Acute Coronary Events (GRACE) risk score and LVEF (odds ratio 0.14 [95% confidence interval 0.03-0.56], P = 0.007). The prognostic value of a baseline model including the GRACE risk score and NT-pro-BNP (χ2 26.55) was significantly improved by adding LVEF ≤40% (χ2 44.71, P < 0.001), TAPSE ≤ 17 mm (χ2 75.42, P < 0.001) and TAPSE/PASP ≤ 0.49 mm/mmHg (χ2 101.74, P < 0.001) for predicting cardiovascular in-hospital mortality.
Conclusion: RV-PA uncoupling, assessed by echocardiographic TAPSE/PASP ≤ 0.49 mm/mmHg 24 h after revascularization, may improve risk stratification for cardiovascular in-hospital mortality after first AMI.
{"title":"Right ventricular-pulmonary arterial coupling in patients with first acute myocardial infarction: an emerging post-revascularization triage tool.","authors":"Vasileios Anastasiou, Stylianos Daios, Dimitrios V Moysidis, Alexandros C Liatsos, Andreas S Papazoglou, Matthaios Didagelos, Christos Savopoulos, Jeroen J Bax, Antonios Ziakas, Vasileios Kamperidis","doi":"10.1016/j.hjc.2024.07.002","DOIUrl":"10.1016/j.hjc.2024.07.002","url":null,"abstract":"<p><strong>Background: </strong>The tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio is a non-invasive surrogate for right ventricular-pulmonary arterial (RV-PA) coupling, studied in chronic RV pressure overload syndromes. However, its prognostic utility in patients with acute myocardial infarction (AMI), which may cause acute RV pressure overload, remains unexplored.</p><p><strong>Objective: </strong>This study aimed to determine predictors of RV-PA uncoupling in patients with first AMI and examine whether it could improve risk stratification for cardiovascular in-hospital mortality after revascularization.</p><p><strong>Methods: </strong>Three-hundred consecutive patients with first AMI were prospectively studied (age 61.2 ± 11.8, 24% females). Echocardiography was performed 24 h after successful revascularization, and TAPSE/PASP was evaluated. Cardiovascular in-hospital mortality was recorded.</p><p><strong>Results: </strong>The optimal cutoff value of TAPSE/PASP to determine cardiovascular in-hospital mortality was 0.49 mm/mmHg. RV-PA uncoupling was considered for patients with TAPSE/PASP ≤0.49 mm/mmHg. Left ventricular ejection fraction (LVEF) was independently associated with RV-PA uncoupling. A total of 23 (7.7%) patients died in hospital despite successful revascularization. TAPSE/PASP was independently associated with in-hospital mortality after adjustment for Global Registry of Acute Coronary Events (GRACE) risk score and LVEF (odds ratio 0.14 [95% confidence interval 0.03-0.56], P = 0.007). The prognostic value of a baseline model including the GRACE risk score and NT-pro-BNP (χ<sup>2</sup> 26.55) was significantly improved by adding LVEF ≤40% (χ<sup>2</sup> 44.71, P < 0.001), TAPSE ≤ 17 mm (χ<sup>2</sup> 75.42, P < 0.001) and TAPSE/PASP ≤ 0.49 mm/mmHg (χ<sup>2</sup> 101.74, P < 0.001) for predicting cardiovascular in-hospital mortality.</p><p><strong>Conclusion: </strong>RV-PA uncoupling, assessed by echocardiographic TAPSE/PASP ≤ 0.49 mm/mmHg 24 h after revascularization, may improve risk stratification for cardiovascular in-hospital mortality after first AMI.</p>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Atavism as a cause of dilative cardiomyopathy.","authors":"Fabian Fastenrath, Anoshirwan Tavakoli, Daniel Duerschmied, Dariusch Haghi, Isabelle Ayx, Theano Papavassiliu","doi":"10.1016/j.hjc.2024.03.015","DOIUrl":"10.1016/j.hjc.2024.03.015","url":null,"abstract":"","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-02DOI: 10.1016/j.hjc.2024.06.011
Grigoris V Karamasis, Effie Polyzogopoulou, Charalampos Varlamos, Frantzeska Frantzeskaki, Vassiliki-Maria Dragona, Antonios Boultadakis, Vasiliki Bistola, Katerina Fountoulaki, Christos Pappas, Fotios Kolokathis, Dionysios Pavlopoulos, Ioannis K Toumpoulis, Vasilios D Kollias, Dimitrios Farmakis, Loukianos S Rallidis, Dimitrios C Angouras, Iraklis Tsangaris, John T Parissis, Gerasimos Filippatos
Objective: Observational studies have shown that the management of patients with cardiogenic shock (CS) by dedicated multidisciplinary teams improves clinical outcomes. Nevertheless, these studies reflect a specific organizational setting with most patients being transferred from referring hospitals, hospitalized in cardiac intensive care units (ICU), or treated with mechanical circulatory support (MCS) devices. The purpose of this study was to document the organization and outcomes of a CS team offering acute care in an all-comer population.
Methods: A CS team was developed in a large academic tertiary institution. The team consisted of emergency care physicians, critical care cardiologists, interventional cardiologists, cardiac surgeons, ICU physicians, and heart failure specialists and was supported by a predefined operating protocol, a dedicated communication platform, and regular team meetings.
Results: Over 12 months, 70 CS patients (69 ± 13 years old, 67% males) were included. Acute myocardial infarction (AMI-CS) was the most common cause (64%); 31% of the patients presented post-resuscitated cardiac arrest and 56% needed invasive mechanical ventilation (IMV). Coronary angiography was performed in 70% and 53% had percutaneous coronary intervention. MCS was used in 10% and 6% were referred for urgent cardiac surgery. The in-hospital mortality in our center was 40% with 39% of the patients dying within 24 h from presentation. Overall, 76% of the live patients were discharged home.
Conclusion: Across an all-comer population, AMI was the most common cause of CS. A significant number of patients presented post-cardiac arrest, and the majority required IMV. Mortality was high with a significant number dying within hours of presentation.
{"title":"Implementation of a cardiogenic shock team in a tertiary academic center.","authors":"Grigoris V Karamasis, Effie Polyzogopoulou, Charalampos Varlamos, Frantzeska Frantzeskaki, Vassiliki-Maria Dragona, Antonios Boultadakis, Vasiliki Bistola, Katerina Fountoulaki, Christos Pappas, Fotios Kolokathis, Dionysios Pavlopoulos, Ioannis K Toumpoulis, Vasilios D Kollias, Dimitrios Farmakis, Loukianos S Rallidis, Dimitrios C Angouras, Iraklis Tsangaris, John T Parissis, Gerasimos Filippatos","doi":"10.1016/j.hjc.2024.06.011","DOIUrl":"10.1016/j.hjc.2024.06.011","url":null,"abstract":"<p><strong>Objective: </strong>Observational studies have shown that the management of patients with cardiogenic shock (CS) by dedicated multidisciplinary teams improves clinical outcomes. Nevertheless, these studies reflect a specific organizational setting with most patients being transferred from referring hospitals, hospitalized in cardiac intensive care units (ICU), or treated with mechanical circulatory support (MCS) devices. The purpose of this study was to document the organization and outcomes of a CS team offering acute care in an all-comer population.</p><p><strong>Methods: </strong>A CS team was developed in a large academic tertiary institution. The team consisted of emergency care physicians, critical care cardiologists, interventional cardiologists, cardiac surgeons, ICU physicians, and heart failure specialists and was supported by a predefined operating protocol, a dedicated communication platform, and regular team meetings.</p><p><strong>Results: </strong>Over 12 months, 70 CS patients (69 ± 13 years old, 67% males) were included. Acute myocardial infarction (AMI-CS) was the most common cause (64%); 31% of the patients presented post-resuscitated cardiac arrest and 56% needed invasive mechanical ventilation (IMV). Coronary angiography was performed in 70% and 53% had percutaneous coronary intervention. MCS was used in 10% and 6% were referred for urgent cardiac surgery. The in-hospital mortality in our center was 40% with 39% of the patients dying within 24 h from presentation. Overall, 76% of the live patients were discharged home.</p><p><strong>Conclusion: </strong>Across an all-comer population, AMI was the most common cause of CS. A significant number of patients presented post-cardiac arrest, and the majority required IMV. Mortality was high with a significant number dying within hours of presentation.</p>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.hjc.2024.06.010
Ioannis Merinopoulos, U Bhalraam, Bahman Kasmai, David Hewson, Richard Greenwood, Simon C Eccleshall, James Smith, Vasiliki Tsampasian, Vassilios Vassiliou
Objective: It is well established that inflammation plays a central role in the sequelae of percutaneous coronary intervention (PCI). Most of the studies to date have focused on the inflammatory reaction affecting the vessel wall after angioplasty. However, there are data to suggest that the main foci of inflammation are in fact in the myocardium beyond the vessel wall. The main aim of our study was to investigate the myocardial inflammation after elective, uncomplicated angioplasty with cardiovascular magnetic resonance (CMR) enhanced by ultrasmall superparamagnetic particles of iron oxide (USPIO) and also blood biomarkers. This is the first study to report such findings after elective angioplasty.
Methods: We assessed patients undergoing elective angioplasty for stable angina with USPIO-enhanced CMR two weeks after the procedure and compared the results with those of healthy volunteers who constituted the control group. We excluded patients with previous myocardial infarction, previous PCI, or any significant inflammatory condition. All patients also underwent blood biomarker testing at baseline (pre-PCI), 4 h, and two weeks later.
Results: A total of five patients and three controls were scanned. There was a small absolute increase, although statistically insignificant, in R2∗ values in the PCI area compared with either remote myocardium from the same patient (PCI area [left anterior descending artery (LAD)] vs remote myocardium [circumflex area]: 19.3 ± 10.8 vs 9.2 ± 7.9, p = 0.1) or healthy myocardium from healthy volunteers (PCI area [LAD] vs healthy myocardium [LAD]: 19.3 ± 10.8 vs 12.2 ± 4.0, p = 0.2). PTX3 and IL-6 were the only biomarkers that changed significantly from baseline to 4 h and 2 weeks. Both biomarkers peaked at 4 h.
Conclusion: We used USPIO-enhanced CMR for the first time to assess myocardial inflammation after elective, uncomplicated PCI. We have demonstrated a small numerical increase in inflammation, which was not statistically significant. This study opens the way for future studies to use this method as a means to target inflammation.
{"title":"Myocardial inflammation after elective percutaneous coronary intervention.","authors":"Ioannis Merinopoulos, U Bhalraam, Bahman Kasmai, David Hewson, Richard Greenwood, Simon C Eccleshall, James Smith, Vasiliki Tsampasian, Vassilios Vassiliou","doi":"10.1016/j.hjc.2024.06.010","DOIUrl":"10.1016/j.hjc.2024.06.010","url":null,"abstract":"<p><strong>Objective: </strong>It is well established that inflammation plays a central role in the sequelae of percutaneous coronary intervention (PCI). Most of the studies to date have focused on the inflammatory reaction affecting the vessel wall after angioplasty. However, there are data to suggest that the main foci of inflammation are in fact in the myocardium beyond the vessel wall. The main aim of our study was to investigate the myocardial inflammation after elective, uncomplicated angioplasty with cardiovascular magnetic resonance (CMR) enhanced by ultrasmall superparamagnetic particles of iron oxide (USPIO) and also blood biomarkers. This is the first study to report such findings after elective angioplasty.</p><p><strong>Methods: </strong>We assessed patients undergoing elective angioplasty for stable angina with USPIO-enhanced CMR two weeks after the procedure and compared the results with those of healthy volunteers who constituted the control group. We excluded patients with previous myocardial infarction, previous PCI, or any significant inflammatory condition. All patients also underwent blood biomarker testing at baseline (pre-PCI), 4 h, and two weeks later.</p><p><strong>Results: </strong>A total of five patients and three controls were scanned. There was a small absolute increase, although statistically insignificant, in R2∗ values in the PCI area compared with either remote myocardium from the same patient (PCI area [left anterior descending artery (LAD)] vs remote myocardium [circumflex area]: 19.3 ± 10.8 vs 9.2 ± 7.9, p = 0.1) or healthy myocardium from healthy volunteers (PCI area [LAD] vs healthy myocardium [LAD]: 19.3 ± 10.8 vs 12.2 ± 4.0, p = 0.2). PTX3 and IL-6 were the only biomarkers that changed significantly from baseline to 4 h and 2 weeks. Both biomarkers peaked at 4 h.</p><p><strong>Conclusion: </strong>We used USPIO-enhanced CMR for the first time to assess myocardial inflammation after elective, uncomplicated PCI. We have demonstrated a small numerical increase in inflammation, which was not statistically significant. This study opens the way for future studies to use this method as a means to target inflammation.</p>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.hjc.2023.08.005
Background
The association of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) on myocardial function, as reflected in myocardial work (MyW) parameters, in patients with ischemic cardiomyopathy and heart failure (HF) is unknown.
Methods
We analyzed data from 68 patients who were hospitalized with chronic HF due to ischemic cardiomyopathy and stratified them according to the mode of revascularization. All patients underwent a 2D speckle tracking echocardiography exam performed by the same expert sonographer and had complete MyW data including global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE).
Results
The mean age of patients was 70 ± 10 years and 86.8% were men. The mean left ventricular ejection fraction (LVEF) in overall cohort was 31.6 ± 9.5%. Both subgroups did not significantly differ in terms of baseline LVEF, comorbidities, and pharmacotherapy. Compared with those who received PCI, patients revascularized with CABG had significantly greater GWI (821 vs. 555 mmHg%, p = 0.002), GCW (1101 vs. 794 mmHg%, p = 0.001), GWE (78 vs. 72.6%, p = 0.025), and global longitudinal strain (−8.7 vs. −6.7%, p = 0.004). Both patient subgroups did not significantly differ with respect to GWW (273 vs. 245 mmHg%, p = 0.410 for CABG and PCI, respectively) and survival during the median follow-up of 18 months (log-rank p = 0.813).
Conclusion
Patients with HF and ischemic cardiomyopathy revascularized with CABG had greater myocardial work performance when compared with those revascularized with PCI. This might suggest a higher degree of functional myocardial revascularization associated with the CABG procedure.
背景:缺血性心肌病合并心力衰竭(HF)患者经皮冠状动脉介入治疗(PCI)或冠状动脉旁路移植术(CABG)对心肌功能(反映在心肌功(MyW)参数上)的影响尚不清楚:我们分析了 68 名因缺血性心肌病导致慢性心力衰竭住院患者的数据,并根据血管重建方式对他们进行了分层。所有患者都接受了由同一位超声专家进行的二维斑点追踪超声心动图检查,并获得了完整的 MyW 数据,包括全局工作指数(GWI)、全局建设性工作(GCW)、全局浪费工作(GWW)和全局工作效率(GWE):患者的平均年龄为 70±10 岁,86.8% 为男性。总体组群的平均左心室射血分数(LVEF)为(31.6 ± 9.5%)。两个亚组在基线左心室射血分数、合并症和药物治疗方面没有明显差异。与接受 PCI 的患者相比,接受 CABG 血管再通的患者的 GWI(821 vs. 555 mmHg%,p = 0.002)、GCW(1101 vs. 794 mmHg%,p = 0.001)、GWE(78 vs. 72.6%,p = 0.025)和整体纵向应变(-8.7 vs. -6.7%,p = 0.004)均明显增加。在中位随访18个月期间,两组患者的GWW(CABG和PCI分别为273 vs. 245 mmHg%,p = 0.410)和存活率(log-rank p = 0.813)没有明显差异:结论:与采用 PCI 进行血管重建的患者相比,采用 CABG 进行血管重建的心房颤动和缺血性心肌病患者的心肌工作性能更高。结论:与 PCI 血管再通术相比,接受 CABG 血管再通术的 HF 和缺血性心肌病患者的心肌工作性能更高,这可能表明 CABG 手术的心肌功能性血管再通程度更高。
{"title":"Myocardial work in patients with heart failure and ischemic cardiomyopathy according to the mode of coronary revascularization","authors":"","doi":"10.1016/j.hjc.2023.08.005","DOIUrl":"10.1016/j.hjc.2023.08.005","url":null,"abstract":"<div><h3>Background</h3><p>The association of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) on myocardial function, as reflected in myocardial work (MyW) parameters, in patients with ischemic cardiomyopathy and heart failure (HF) is unknown.</p></div><div><h3>Methods</h3><p>We analyzed data from 68 patients who were hospitalized with chronic HF due to ischemic cardiomyopathy and stratified them according to the mode of revascularization. All patients underwent a 2D speckle tracking echocardiography exam performed by the same expert sonographer and had complete MyW data including global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE).</p></div><div><h3>Results</h3><p>The mean age of patients was 70 ± 10 years and 86.8% were men. The mean left ventricular ejection fraction (LVEF) in overall cohort was 31.6 ± 9.5%. Both subgroups did not significantly differ in terms of baseline LVEF, comorbidities, and pharmacotherapy. Compared with those who received PCI, patients revascularized with CABG had significantly greater GWI (821 <em>vs.</em> 555 mmHg%, p = 0.002), GCW (1101 <em>vs.</em> 794 mmHg%, p = 0.001), GWE (78 <em>vs.</em> 72.6%, p = 0.025), and global longitudinal strain (−8.7 <em>vs.</em> −6.7%, p = 0.004). Both patient subgroups did not significantly differ with respect to GWW (273 <em>vs.</em> 245 mmHg%, p = 0.410 for CABG and PCI, respectively) and survival during the median follow-up of 18 months (log-rank p = 0.813).</p></div><div><h3>Conclusion</h3><p>Patients with HF and ischemic cardiomyopathy revascularized with CABG had greater myocardial work performance when compared with those revascularized with PCI. This might suggest a higher degree of functional myocardial revascularization associated with the CABG procedure.</p></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1109966623001422/pdfft?md5=1892041827f918e4fe06e4b0d53e20c9&pid=1-s2.0-S1109966623001422-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10133568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}