Clinical Research in Cardiology最新文献

{"title":"Mechanical circulatory support for cardiogenic shock in takotsubo syndrome.","authors":"Victoria L Cammann, Victor Schweiger, Konrad A Szawan, Davide Di Vece, David Niederseer, Michael Würdinger, Alexander Schönberger, Maximilian Schönberger, Iva Koleva, Julien C Mercier, Rodolfo Citro, Carmine Vecchione, Eduardo Bossone, Sebastiano Gili, Michael Neuhaus, Jennifer Franke, Benjamin Meder, Miłosz Jaguszewski, Michel Noutsias, Maike Knorr, Thomas Jansen, Fabrizio D'Ascenzo, Wolfgang Dichtl, Dirk von Lewinski, Christof Burgdorf, Behrouz Kherad, Ahmed Elsanhoury, Carsten Tschöpe, Vivian Alice Nelki, Annahita Sarcon, Jerold Shinbane, Lawrence Rajan, Guido Michels, Roman Pfister, Alessandro Cuneo, Claudius Jacobshagen, Mahir Karakas, Wolfgang Koenig, Alexander Pott, Philippe Meyer, Marco Roffi, Adrian Banning, Mathias Wolfrum, Florim Cuculi, Richard Kobza, Thomas A Fischer, Tuija Vasankari, K E Juhani Airaksinen, L Christian Napp, Rafal Dworakowski, Philip MacCarthy, Christoph Kaiser, Stefan Osswald, Leonarda Galiuto, Christina Chan, Paul Bridgman, Daniel Beug, Stephan B Felix, Clément Delmas, Olivier Lairez, Ekaterina Gilyarova, Alexandra Shilova, Mikhail Gilyarov, Ibrahim El-Battrawy, Ibrahim Akin, Karolina Poledniková, Petr Toušek, David E Winchester, Michael Massoomi, Jan Galuszka, Christian Ukena, Gregor Poglajen, Pedro Carrilho-Ferreira, Christian Hauck, Carla Paolini, Claudio Bilato, Yoshio Kobayashi, Ken Kato, Iwao Ishibashi, Toshiharu Himi, Jehangir Din, Ali Al-Shammari, Abhiram Prasad, Charanjit S Rihal, Kan Liu, P Christian Schulze, Matteo Bianco, Lucas Jörg, Hans Rickli, Gonçalo Pestana, Thanh H Nguyen, Michael Böhm, Lars S Maier, Fausto J Pinto, Petr Widimský, Ruediger C Braun-Dullaeus, Wolfgang Rottbauer, Gerd Hasenfuß, Burkert M Pieske, Heribert Schunkert, Monika Budnik, Grzegorz Opolski, Holger Thiele, Johann Bauersachs, John D Horowitz, Carlo Di Mario, William Kong, Mayank Dalakoti, Yoichi Imori, Laura Wehling, Norman Mangner, Ulrich Gerk, Thomas Münzel, Filippo Crea, Thomas F Lüscher, Jeroen J Bax, Burkhardt Seifert, Jelena R Ghadri, Christian Templin","doi":"10.1007/s00392-025-02832-z","DOIUrl":"10.1007/s00392-025-02832-z","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock complicates takotsubo syndrome (TTS) in approximately 10% of cases. The effectiveness of mechanical circulatory support (MCS) for managing cardiogenic shock in TTS remains unknown.</p><p><strong>Methods: </strong>We assessed outcomes in TTS patients with cardiogenic shock who received MCS compared to medical therapy only by using data from the International Takotsubo Registry. Two independent propensity scores were computed to investigate outcomes of patients with an intra-aortic balloon pump (IABP) vs. medical therapy only (1:2 propensity score matched cohort) and patients with an Impella vs. medical therapy only (1:1 propensity score matched cohort). The primary endpoint was in-hospital mortality and the secondary outcomes included MCS-related complications.</p><p><strong>Results: </strong>Among 3740 eligible patients, 309 (8.3%) patients had cardiogenic shock, of whom 112 (36.2%) had MCS and 197 (63.8%) had medical therapy only. After propensity-score matching, the use of an IABP was found to be associated with a lower in-hospital mortality rate than medical therapy only (14.5% vs. 35.5%, P = 0.002), while mortality rates in the Impella group and medical therapy only group were comparable (25.0% vs. 29.2%, P = 0.75). MCS-related complications occurred in 6.0% of the IABP cohort and in 31.3% of Impella cohort.</p><p><strong>Conclusion: </strong>Active MCS has been increasingly used for the management of cardiogenic shock in patients with TTS. This observational study could not demonstrate an association with improved mortality with an Impella device, but possibly with an IABP when compared to patients with medical management only. MCS-related complications occurred more frequently in the Impella cohort than in the IABP cohort. Further data are required to confirm results of the present study.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1944-1958"},"PeriodicalIF":3.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146103982","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}

{"title":"Association of prior beta-blocker treatment and outcome in patients with out-of-hospital cardiac arrest.","authors":"Fardin Hamidi, Fabian Muhler, Gisela Skopp, Jonas Rusnak, Claudius Speer, Guido Michels, Norbert Frey, Thomas A Zelniker, Michael R Preusch","doi":"10.1007/s00392-026-02968-6","DOIUrl":"10.1007/s00392-026-02968-6","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hospital cardiac arrest (OHCA) is associated with poor outcomes and presents a considerable treatment challenge. Here, we investigated the association of prior beta-blocker treatment with outcomes in patients with OHCA.</p><p><strong>Methods: </strong>We enrolled consecutive OHCA patients with return of spontaneous circulation (ROSC). Beta-blocker plasma concentrations were measured upon admission and analyzed in relation to the number of defibrillations required to achieve ROSC, initial cardiac rhythm and in-hospital mortality.</p><p><strong>Results: </strong>Among 207 enrolled patients (median age 68 years, 71% male, 45% shockable rhythm), 65 (31.4%) had detectable beta-blocker plasma concentrations. Detectable beta-blocker concentrations were not associated with the likelihood of an initial shockable rhythm (adjusted odds ratio [OR] 0.99 [95% confidence interval [CI], 0.52-1.91]; P = 0.99), number of defibrillations (adjusted incidence rate ratio 0.93 [95% CI 0.63-1.37], P = 0.72) or doses of epinephrine (adjusted mean 7.4 vs. 6.7 mg, P = 0.29) and amiodarone (adjusted mean 99.3 vs. 93.9 mg, P = 0.83) administered to achieve ROSC. When analyzed as a continuous variable, beta-blocker concentration on admission was not associated with in-hospital death (adjusted OR 0.85 [95% CI 0.67-1.08]; P = 0.18). However, patients with plasma concentrations above the median had lower odds of death compared to those with undetectable levels or those below the median (adjusted OR 0.36 [95% CI 0.13-0.96]; P = 0.042).</p><p><strong>Conclusion: </strong>In OHCA patients with ROSC, detectable beta-blocker plasma concentrations on admission were not associated with defibrillation requirements or initial cardiac rhythm. While any detectable beta-blocker level was not associated with overall mortality, levels above the median were associated with lower odds of death in this cohort. These results are hypothesis-generating and warrant confirmation in larger independent cohorts.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"2038-2047"},"PeriodicalIF":3.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293636","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}

{"title":"Invasive ventilation and association with outcomes in heart failure-related cardiogenic shock.","authors":"Lisa Besch, Caroline Kellner, Jonas Sundermeyer, Benedikt N Beer, Angela Dettling, Marvin Kriz, Carsten Skurk, Peter Lüdike, Tienush Rassaf, Stefan Kluge, Holger Thiele, Alastair Proudfoot, Tobias Graf, Enzo Lüsebrink, Paulus Kirchhof, Stefan Blankenberg, Benedikt Schrage","doi":"10.1007/s00392-026-02953-z","DOIUrl":"10.1007/s00392-026-02953-z","url":null,"abstract":"<p><strong>Background: </strong>Respiratory failure occurs frequently in cardiogenic shock but with varying severity. It is unknown whether invasive ventilation should be used strictly, reserved for severe respiratory failure, or liberally, reducing stress and increasing compliance with intensive care procedures. Aim of this study was to evaluate the impact of invasive ventilation on outcomes in patients with heart failure-related cardiogenic shock across the severity of respiratory failure.</p><p><strong>Methods: </strong>Patients with heart failure-related cardiogenic shock treated 2010-2021 in 16 tertiary care centers in five countries were enrolled. Cox regression models were constructed to assess the impact of overall invasive ventilation and invasive ventilation stratified by PaO₂/FiO₂ ≤ 100, 101-200, and > 200 on 30-day mortality, adjusted for relevant confounders.</p><p><strong>Results: </strong>Of N = 1010 patients (median age 64 years, 724 (71.7%) male), 659 patients (65.2%) received invasive ventilation. In patients receiving invasive ventilation, 30-day mortality was 1.67 times higher (95% confidence interval (CI) 1.26-2.22, p < 0.001) than in patients without invasive ventilation. Although patients with a worse PaO₂/FiO₂ of ≤ 100 and 101-200 had the highest mortality risk (hazard ratio (HR) 1.74, 95% CI 1.19-2.53, p = 0.004 and HR 1.82, 95% CI 1.29-2.56, p < 0.001), the same trend towards increased mortality persisted even in patients with preserved gas exchange and PaO₂/FiO₂ > 200 (HR 1.39, 95% CI 0.99-1.97, p = 0.06).</p><p><strong>Conclusions: </strong>In patients with cardiogenic shock, invasive ventilation was associated with higher mortality, with a non-significant trend towards higher mortality even in patients with preserved gas exchange. The results call for further analyses on this topic, specifically to clarify whether dedicated ventilator settings or weaning strategies may improve outcomes for affected patients.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"2015-2023"},"PeriodicalIF":3.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249475","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}

{"title":"Diagnostic and prognostic utility of bone morphogenetic protein 10 in acute dyspnea: a cohort study.","authors":"Justas Simonavicius, Desiree Wussler, Maria Belkin, Karoline Luening, Pedro Lopez-Ayala, Ivo Strebel, Samyut Shrestha, Albina Nowak, Eleni Michou, Androniki Papachristou, Codruta Popescu, Nikola Kozhuharov, Zaid Sabti, Zora Reiffer, Elisa Hennings, Tobias Zimmermann, Matthias Diebold, Tobias Breidthardt, Christian Mueller","doi":"10.1007/s00392-024-02584-2","DOIUrl":"10.1007/s00392-024-02584-2","url":null,"abstract":"<p><strong>Background and aim: </strong>The possible clinical utility of Bone Morphogenetic Protein 10 (BMP10), a novel atrial-specific biomarker, is incompletely understood. We aimed to test the hypothesis that BMP10 has high diagnostic and prognostic accuracy in patients presenting with acute dyspnea.</p><p><strong>Methods and results: </strong>In a multicenter diagnostic study, BMP10, high-sensitivity cardiac troponin T (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations were determined in patients presenting with acute dyspnea to the emergency department. The final diagnosis was centrally adjudicated by two independent cardiologists blinded to BMP10. Diagnostic accuracy for acute heart failure (AHF) was quantified using the area under the receiver operating characteristic curve (AUC). 720-day all-cause mortality and the composite of all-cause mortality or AHF rehospitalization were prognostic endpoints. Among 933 consecutive patients, 54% were adjudicated to have AHF. Patients with AHF had higher BMP10 concentrations (median 3.34 [IQR 2.55-4.35] ng/mL) compared to patients with other causes of acute dyspnea (2.04 [1.74-2.45] ng/mL, p < 0.001). The AUC of BMP10 was 0.85 (95%CI, 0.82-0.87), versus 0.79 (95%CI, 0.76-0.82, p < 0.001) for hs-cTnT and 0.91 (95%CI, 0.90-0.93, p < 0.001) for NT-proBNP. The combination of BMP10 with NT-proBNP (AUC 0.92, 95%CI, 0.90-0.94) did not significantly increase the AUC versus NT-proBNP alone. BMP10 was a powerful predictor of death and AHF rehospitalization, but did not provide incremental value to models including NT-proBNP.</p><p><strong>Conclusion: </strong>BMP10 had a high diagnostic accuracy for AHF and high prognostic accuracy for death and AHF rehospitalization. However, it did not provide relevant incremental value to the current gold standard NT-proBNP.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1897-1909"},"PeriodicalIF":3.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806363","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}

{"title":"Letter to the Editor: 250th cardiac arrest center certification in Germany.","authors":"N Rott, H J Busch, N Frey, M Kelm, L Reinsch, K H Scholz, H Thiele, B W Böttiger","doi":"10.1007/s00392-025-02777-3","DOIUrl":"10.1007/s00392-025-02777-3","url":null,"abstract":"","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"2077-2079"},"PeriodicalIF":3.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279033","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}

{"title":"Beyond the protocol: adherence to ECPR selection criteria and outcomes after Out-of-Hospital Cardiac Arrest (OHCA)-insights from the German Cardiac Arrest Registry (G-CAR).","authors":"A Springer, M Rossberg, C Sinning, I Voigt, A Freund, N Hösler, G Michels, S Ewen, F Voss, P Wohlmuth, H Thiele, U Zeymer, J Pöss, E Tigges","doi":"10.1007/s00392-026-02930-6","DOIUrl":"10.1007/s00392-026-02930-6","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal cardiopulmonary resuscitation (ECPR) is a potential treatment for selected patients with refractory out-of-hospital cardiac arrest (OHCA). Randomized controlled trials (RCTs) emphasize the importance of appropriate patient selection. Expert consensus statements recommend six criteria for ECPR suitability: age ≤ 75 years, witnessed OHCA, bystander cardiopulmonary resuscitation (CPR), no-flow time ≤ 5 min (min), low-flow time ≤ 60 min, and an initial shockable rhythm. Although widely accepted, these items are not supported by robust data and adherence varies greatly. We present an analysis from the German Cardiac Arrest Registry (G-CAR) describing the current state of ECPR across participating centers.</p><p><strong>Results: </strong>Of 1,644 patients in G-CAR, 576 patients (34.6%) were admitted with ongoing CPR. Of these, 162 (28.0%) were treated with ECPR. Only 18 patients (11.0%) met all six ECPR criteria, with the majority displaying five (37.0%) or four (25.9%) characteristics. Overall, rates of favorable neurological survival at 30 days did not differ between patients treated with ECPR and those treated conventionally (8.6% vs. 5.6%, p = 0.25). When stratified according to the number of criteria, the probability of survival was higher in patients meeting all six or five compared to those meeting one to four criteria (20.0% vs. 11.9% vs. 1.4%; p = 0.028). A similar gradient in survival according to the number of fulfilled criteria was observed in conventionally treated patients.</p><p><strong>Conclusions: </strong>Adherence to proposed ECPR selection criteria was low in this real-world cohort, potentially contributing to lower survival rates compared with results from RCTs. However, when all criteria were fulfilled, survival rates were significantly higher, underscoring the importance of stringent patient selection.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1983-1992"},"PeriodicalIF":3.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834503","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}

{"title":"Prevalence and prognostic relevance of abnormal liver function tests in critically ill patients with cardiac arrest.","authors":"Nam Gyu Im, Sarah K Stegmann, Julius Hollnberger, Gabriel Allo, Julia Lang-Meli, Sascha Macherey-Meyer, Sebastian Heyne, Christoph Adler, Guido Michels, Stephan Baldus, Christoph Neumann-Haefelin, Philipp Kasper","doi":"10.1007/s00392-026-02919-1","DOIUrl":"10.1007/s00392-026-02919-1","url":null,"abstract":"<p><strong>Background: </strong>Patients with out-of-hospital cardiac arrest and in-hospital cardiac arrest have a poor prognosis. Laboratory biomarkers that are frequently altered in critically ill patients with cardiac arrest are liver function tests. However, the predictive value of abnormal liver function tests in the cardiac arrest setting remains unclear.</p><p><strong>Methods: </strong>Four hundred seven patients who were treated after cardiac arrest in an intensive care unit at a tertiary-care hospital were included in the analysis. To classify LFT abnormalities, we used established upper limit of normal values and multiples thereof according to the NIH Common Terminology Criteria for Adverse Events (CTCAE). Kaplan-Meier estimates and cox proportional hazard models combined with the CardShock risk score were performed to investigate the association between liver function abnormalities and patient outcomes.</p><p><strong>Results: </strong>Thirty-nine different combinations of elevated liver function tests have been observed in the study cohort. The most common abnormalities included an increase in aspartate aminotransferase (AST) levels, followed by an increase in alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) levels. Kaplan-Meier estimates showed significant differences in 90-day survival rates depending on severity of AST, ALT, bilirubin, and INR elevations. A cox proportional hazard model analysis demonstrated that a combined increase in bilirubin and INR together with the CardShock risk score allowed the highest mortality prediction.</p><p><strong>Conclusions: </strong>Abnormal liver function tests can be frequently observed after cardiac arrest, with different patterns of damage having different prognostic relevance. The combination of elevated bilirubin and INR offers important prognostic information regarding 90-day mortality, particularly when added to validated risk tools, and can be used to identify patients at risk.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1959-1972"},"PeriodicalIF":3.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764699","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}

{"title":"Timing of IABP initiation and its impact on outcomes in acute myocardial infarction with cardiogenic shock: insights from a bi-center retrospective study.","authors":"Istvan Bojti, Sarolta Bojtine Kovacs, David Kovacs, Antonia Ziegler, Alexander Maier, Dirk Westermann, Miroslaw Ferenc, Attila Csaba Nagy, Kalman Racz, Zsolt Koszegi, Gabor Tamas Szabo","doi":"10.1007/s00392-026-02951-1","DOIUrl":"10.1007/s00392-026-02951-1","url":null,"abstract":"<p><strong>Background: </strong>The optimal timing of intra-aortic balloon pump (IABP) initiation in cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains uncertain. Contemporary ESC guidance and the recent EACTS/STS/AATS MCS guideline highlight gaps regarding timing, patient selection, and ischemic burden. In this study, the association between IABP timing, myocardial area at risk (AAR), and survival in AMI-CS was evaluated.</p><p><strong>Methods: </strong>We retrospectively analyzed 399 AMI-CS patients treated with primary PCI at two tertiary centers. Patients were categorized as no IABP (n = 124), non-rescue IABP (started during PCI; n = 216), or rescue IABP (inserted after PCI; n = 59). Clinical and angiographic parameters, including AAR quantified by a coronary anatomy-based algorithm, were assessed. Multivariable logistic regression identified predictors of in-hospital and 1-year mortality.</p><p><strong>Results: </strong>Non-rescue IABP was independently associated with lower in-hospital mortality vs. no IABP (OR 0.29, 95% CI 0.16-0.52). Rescue IABP showed a weaker association with lower in-hospital mortality (OR 0.41, 95% CI 0.19-0.89). At 1 year, mortality was higher in both no IABP (OR 3.27, 95% CI 1.86-5.76) and rescue IABP groups (OR 2.04, 95% CI 1.04-3.98) compared with non-rescue IABP. An augmented inverse-probability weighted (AIPW) analysis confirmed these findings, demonstrating a significant reduction in 1-year mortality with early IABP use compared with no IABP (ATE - 0.24, 95% CI - 0.375 to - 0.104), whereas no significant effect was observed for rescue IABP. A significant interaction between AAR and timing indicated that early IABP offered the greatest benefit in patients with moderate AAR (30-55%), whereas no benefit was observed with extensive AAR (> 80%).</p><p><strong>Conclusions: </strong>In AMI-CS, early IABP initiation was associated with improved in-hospital and long-term survival, particularly in patients with a moderate AAR. These findings support the need for refining IABP use based on both ischemic burden and the timing of hemodynamic support.</p><p><strong>Trial registration number and date of registration: </strong>DRKS00038637, 03.12.2025.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"2005-2014"},"PeriodicalIF":3.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197669","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}

{"title":"Prognostic impact of body mass index in acute myocardial infarction complicated by cardiogenic Shock: an ECLS-SHOCK subanalysis.","authors":"Tobias Schupp, Holger Thiele, Tienush Rassaf, Amir Abbas Mahabadi, Ralf Lehmann, Ingo Eitel, Carsten Skurk, Peter Clemmensen, Marcus Hennersdorf, Ingo Voigt, Axel Linke, Eike Tigges, Peter Nordbeck, Christian Jung, Philipp Lauten, Hans-Josef Feistritzer, Maria Buske, Janine Pöss, Taoufik Ouarrak, Steffen Schneider, Michael Behnes, Daniel Duerschmied, Steffen Desch, Anne Freund, Uwe Zeymer, Ibrahim Akin","doi":"10.1007/s00392-025-02717-1","DOIUrl":"10.1007/s00392-025-02717-1","url":null,"abstract":"<p><strong>Background: </strong>The prognostic impact of overweight and obesity in patients with cardiogenic shock (CS) following acute myocardial infarction (AMI) is still a matter of debate. The present subanalysis of the ECLS-SHOCK trial sought to investigate the association between body mass index (BMI) and outcomes in patients with AMI-CS.</p><p><strong>Methods: </strong>Patients with AMI-CS enrolled in the multicenter, randomized ECLS-SHOCK trial between 2019 and 2022 were included. The prognostic impact of BMI was investigated stratified by BMI 18.5-24.9 kg/m², 25.0-29.9 kg/m² and ≥ 30.0 kg/m² with regard to the primary endpoint 30-day all-cause mortality.</p><p><strong>Results: </strong>Overall, 407 patients with AMI-CS were included with a median BMI of 27.7 kg/m² (interquartile range 24.8-30.8 kg/m²). Patients with a BMI ≥ 30.0 kg/m² (n = 115) were less likely males, had a higher burden of cardiovascular risk factors and higher rates of TIMI flow 0 before revascularization than patients with lower BMI values. The primary endpoint of all-cause mortality at 30 days occurred in 53.9%, 45.3% and 47.7% of patients with BMI ≥ 30.0 kg/m², 25.0-29.9 kg/m² and 18.5-24.9 kg/m², respectively. Using patients with a BMI 18.5-24.9 kg/m² as a reference, neither a BMI ≥ 30.0 kg/m² (OR = 1.28; 95% CI 0.76-2.16; p = 0.35) nor a BMI of 25.0-29.9 kg/m² (OR = 0.91; 95% CI 0.56-1.46; p = 0.68) were associated with an increased risk of all-cause mortality. Similar results were obtained regardless of allocation to extracorporeal life support (ECLS) or medical treatment only for all BMI groups. Safety endpoints did not differ across the different BMI groups.</p><p><strong>Conclusion: </strong>In this well-defined cohort of patients with AMI-CS, BMI was not associated with the risk of all-cause mortality, nor were we able to identify BMI subgroups who derived more benefit or less harm from ECLS therapy.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1910-1920"},"PeriodicalIF":3.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728448","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}

{"title":"Urinary sodium and right ventricular function in acute heart failure.","authors":"Pedro Caravaca-Pérez, Carmen Jiménez López-Guarch, Ignacio Fernández-Herrero, Zorba Blázquez-Bermejo, Joan Guzman-Bofarull, Ilana Forado-Benatar, Angela Rodriguez-Eguren, Elena Sandoval, Laura Morán-Fernández, María Dolores García Cosio, Ana García Alvarez, Marta Farrero, Juan F Delgado","doi":"10.1007/s00392-026-02965-9","DOIUrl":"10.1007/s00392-026-02965-9","url":null,"abstract":"<p><strong>Aims: </strong>Urinary sodium (UNa) is a powerful predictor of adverse events in acute heart failure (AHF), although its etiopathogenic mechanism remains poorly understood. Previous studies highlight the importance of venous congestion on renal function in AHF. Our objective was to evaluate the relationship between right ventricular (RV) function and UNa, as well as their prognostic interaction in AHF.</p><p><strong>Methods: </strong>We prospectively analyzed 101 patients hospitalized for AHF, divided into high or low natriuresis groups based on the median natriuretic response to a furosemide stress test. We performed a comprehensive echocardiographic assessment of RV size and function. The clinical outcome was a 6-month composite of all-cause mortality, heart failure rehospitalization, or heart transplantation.</p><p><strong>Results: </strong>The median age was 65 (56-80) years, with 63.4% of male patients. Subjects with low natriuresis showed greater RV dilation (p = 0.008), right atrial dilation (p = 0.006), inferior vena cava dilation (p = 0.004), higher prevalence of RV dysfunction (p = 0.019), and moderate-to-severe tricuspid regurgitation (p < 0.001). RV dysfunction was associated with a higher likelihood of low natriuresis (OR 3.93 [1.72-9.02]; p = 0.001), poorer diuretic response during hospitalization (p = 0.037), and a higher risk of adverse events during follow-up (p = 0.002). Patients with combined RV dysfunction and low natriuresis had the worst prognosis during follow-up (HR = 38.67 [5.21-286.88]; p < 0.001).</p><p><strong>Conclusions: </strong>Low natriuresis is associated with a phenotype of AHF characterized by more advanced right-sided remodelling, higher prevalence of RV dysfunction, and an increased risk of diuretic resistance and adverse outcomes. RV function assessment may enhance prognostic stratification in AHF patients with impaired natriuretic response.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"2024-2037"},"PeriodicalIF":3.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618074","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}