Clinical Research in Cardiology最新文献

{"title":"Impact of mild therapeutic hypothermia on plasma markers of inflammation and apoptosis in non-resuscitated patients with acute myocardial infarction and cardiogenic shock.","authors":"Anne Freund, Petra Büttner, Maria Buske, Janine Pöss, Hans-Josef Feistritzer, Steffen Desch, Georg Fuernau, Holger Thiele","doi":"10.1007/s00392-025-02748-8","DOIUrl":"10.1007/s00392-025-02748-8","url":null,"abstract":"<p><strong>Background: </strong>Patients with cardiogenic shock (CS) following acute myocardial infarction (AMI) are challenged by pro-inflammatory and pro-apoptotic cellular processes. Little is known about the effect of mild therapeutic hypothermia (MTH) on these alterations.</p><p><strong>Methods: </strong>Blood plasma from 40 patients included in the randomized SHOCK-COOL trial, which compared MTH (33 °C) versus no hypothermia in AMI-CS without cardiac arrest, from the first 3 days of hospitalization was used to determine interleukins (IL)-6 and IL-1β, tumor necrosis factor-alpha (TNF-α), intercellular and vascular soluble adhesion molecules (ICAM1 and VCAM1), TNF-receptor 1 (TNF-R1), TNF-related apoptosis-inducing ligand receptor 2 (TRAIL-R2), soluble FAS-ligand (sFASL), and soluble FAS (sFAS). These markers were also determined in 11 healthy controls.</p><p><strong>Results: </strong>All markers except for TNF-R1 and sFASL reached their highest levels on day two or day three in both CS groups. IL-1β and sFAS reached higher maximum levels in the MTH group. IL-1β was higher in the MTH group on day 2 (+ 38%, p = 0.014) and on day 3 (+ 9%, p = 0.047), but the averaged group-wise individual maxima were comparable (24 [17-30] versus 20 [12-25], p = 0.138). The pro-apoptotic marker sFAS was also higher in the MTH group on day 2 (+ 85%, p = 0.004) and day 3 (+ 170%, p < 0.001); the averaged individual maxima were significantly higher in the MTH group (25 [15-38] versus 15 [10-21] ng/ml, p = 0.008).</p><p><strong>Conclusions: </strong>Hypothermia in AMI-CS without cardiac arrest has no moderating effect on the assessed pro-inflammatory cytokines. However, sFAS showed significantly higher individual peak maxima in the MTH group indicating enhancement of pro-apoptotic mechanisms via the soluble FAS/FASL pathway.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1427-1435"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945447","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":"Milrinone versus dobutamine in acute myocardial infarction-related cardiogenic shock; a propensity score matched analysis.","authors":"Sanne Ten Berg, Margriet Bogerd, Elma J Peters, Marijke J C Timmermans, Wim K Lagrand, Luuk C Otterspoor, Alexander P J Vlaar, Annemarie E Engström, José P S Henriques","doi":"10.1007/s00392-025-02742-0","DOIUrl":"10.1007/s00392-025-02742-0","url":null,"abstract":"<p><strong>Background: </strong>Vasopressors and inotropes remain the cornerstone in treatment of acute myocardial infarction-related cardiogenic shock (AMI-CS). Milrinone and dobutamine are both commonly used, yet the optimal inotrope remains unclear. We aimed to identify factors associated with milrinone and dobutamine treatment and assess their effects on 30-day mortality in a large real-world cohort of AMI-CS patients. The Netherlands Heart Registration prospectively records data for percutaneous coronary intervention patients. Between 2017 and 2021, additional retrospective data on CS patients were collected by fourteen Dutch hospitals. Patients who were treated with either milrinone or dobutamine were selected; those treated with both were excluded. Missing data were imputed (30 ×) using multiple imputation, and propensity matched score analysis (PSM) was performed to evaluate the association between milrinone or dobutamine treatment and 30-day mortality.</p><p><strong>Results: </strong>In total, 739 patients were included (milrinone n = 247, dobutamine n = 492). Prior to matching, milrinone-treated patients exhibited more severely ill baseline and treatment characteristics, and higher 30-day mortality (50.6% vs. 41.5%, p = 0.018). After PSM, 198 patients remained in each group for analysis. Baseline characteristics were well balanced and 30-day mortality rates were similar (46.5% vs. 41.9%, p = 0.362).</p><p><strong>Conclusion: </strong>In this real-world propensity-matched cohort of AMI-CS patients, no significant difference in 30-day mortality was observed between patients treated with milrinone and dobutamine. Importantly, milrinone patients were more severely ill at baseline, indicating that the choice of inotrope may be influenced by illness severity. This comprehensive study suggests that the selection of inotrope may continue to be guided by individual patient characteristics.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1414-1426"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945413","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 effect of the combined use of thiazides and loop diuretics at discharge following a hospitalization for acute heart failure.","authors":"Gema Miñana, Joan Carles Trullàs, Rafael de la Espriella, Raquel Núñez-Aragon, Andrea Gasull, Juan-Bosco López-Saez, Jorge Montiel, Miguel Lorenzo-Hernández, Agustín Fernández-Cisnal, Ernesto Valero, Gonzalo Núñez, Vicent Bodí, Òscar Miró, Juan Sanchis, Antoni Bayés-Genis, Julio Núñez","doi":"10.1007/s00392-025-02631-6","DOIUrl":"10.1007/s00392-025-02631-6","url":null,"abstract":"<p><strong>Aims: </strong>There is limited information regarding the clinical impact of the concurrent use of thiazides and loop diuretics (LD) after an episode of acute heart failure (AHF) hospitalization. We aimed to evaluate the impact of thiazide prescription at discharge on top of LD on the short-term risk of AHF readmission.</p><p><strong>Methods: </strong>We included 3384 consecutive patients discharged from January 2008 to September 2021 after an admission for AHF in a single teaching center. The association between thiazides on discharge across the intensity of LD treatment and 30-day AHF readmission was explored by Cox regression analysis. A validation cohort of 622 patients was also examined.</p><p><strong>Results: </strong>The mean age of the patients was 73.8 ± 11.2 years, 1672 (47.5%) were women, and 1733 (51.2%) patients showed left ventricular ejection fraction > 50%. The median (IQR) NT-proBNP was 3409 (1829-6963) pg/mL. At discharge, 754 (22.3%) patients received high LD doses (> 80 mg/day) and 187 (5.5%) thiazides. At 30 days, we registered 76 (2.2%) deaths and 449 (13.3%) AHF readmissions. Thiazides at discharge were not associated with the risk of 30-day AHF readmission (HR = 0.92). However, this association was differentially influenced by the intensity of LD doses (p-value for interaction = 0.030), with a lower AHF-readmission risk in those with LD dose > 80 mg/day (p = 0.038), and a neutral association in those receiving low LD dose (≤ 80 mg/day) (p = 0.541).</p><p><strong>Conclusions: </strong>In patients discharged after an episode of AHF, thiazide prescription was associated with a lower risk of 30-day AHF readmission when they were prescribed in patients receiving high LD doses.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1366-1376"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656029","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":"Safety and efficacy of early use of mineralocorticoid receptor antagonists in cardiogenic shock: a propensity score-matched analysis.","authors":"Miloud Cherbi, François Roubille, Paul Gautier, Etienne Puymirat, Meyer Elbaz, Laurent Bonello, Nicolas Lamblin, Eric Bonnefoy, Clément Delmas","doi":"10.1007/s00392-025-02741-1","DOIUrl":"10.1007/s00392-025-02741-1","url":null,"abstract":"<p><strong>Background: </strong>Despite its high incidence and mortality, the level of evidence for cardiogenic shock (CS) treatments remains very low. This study aims to evaluate the influence of early treatment with mineralocorticoid receptor antagonist (MRA) in CS.</p><p><strong>Methods: </strong>FRENSHOCK is a prospective registry including 772 CS patients from 49 centres. The association between early MRA use and 30-day all-cause mortality was assessed in a 1:3 propensity-matched cohort. Early MRA use was defined as documented use within 24 h of admission.</p><p><strong>Results: </strong>Among the 693 CS patients included, MRAs were used in 91 (13.1%). Patients treated with MRA presented with a more frequent history of cardiac disease (78.0% vs. 56.0%, p < 0.01) and had lower LVEF (20.0% vs. 25.0%, p = 0.01). After matching, 91 patients treated with MRA were compared to 273 patients who did not receive MRA. MRA use was associated with a significant reduction in 30-day mortality, with a matched HR of 0.49 (0.27-0.91), p = 0.02. In subgroup analysis, the benefit of MRA appeared more pronounced in patients with severely reduced LVEF (≤ 20%) or acute myocardial infarction. There were no increased risks of hyperkalaemia or worsening renal function after 24 h of management, albeit with a risk of hypotension.</p><p><strong>Conclusion: </strong>In this prospective, multicentre, nationwide, propensity score-matched study of patients with a broad spectrum of CS aetiologies, early MRA use was associated with a significant reduction in 30-day all-cause mortality. Further randomized trials are needed to confirm its benefit and clarify its role in therapeutic management.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1400-1413"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945423","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":"Risk prediction in heart failure using invasive hemodynamics.","authors":"Martin Joachim Kraus, Aleksandre Veshapeli, Christoph Reich, Hauke Hund, Sonja Hamed, Philip W Raake, Michael M Kreusser, Norbert Frey, Lorenz Lehmann","doi":"10.1007/s00392-025-02690-9","DOIUrl":"10.1007/s00392-025-02690-9","url":null,"abstract":"<p><strong>Aims: </strong>Risk stratification in patients with heart failure patients is crucial. The prognostic value of invasive hemodynamic parameters measured by right heart catheterization compared to established risk scores remains unknown.</p><p><strong>Methods and results: </strong>This retrospective analysis included 883 patients. The combined endpoint was all-cause mortality, heart transplantation or left ventricular assist device implantation. A Cox proportional hazards model assessed the impact of invasive parameters, cardiac biomarkers, and patient characteristics, comparing them with the Seattle Heart Failure Model (SHFM) and the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) Score. A new score was created including mean pulmonary arterial (PA) pressure, mean right atrial pressure, mean pulmonary artery wedge pressure (PAWP), age, N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hsTnT), mixed venous oxygen saturation (SVO2), creatinine, and presence of ischemic cardiomyopathy. Mean, diastolic, and systolic PA pressure, mean right atrial pressure, mean PAWP, SVO2 and cardiac index were significant predictors for the primary endpoint reached by 467/883 (53%) patients, in a multiple Cox proportional hazards model (p < 0.001). The predictive value was diminished in a subgroup of patients with ischemic cardiomyopathy. We used invasive parameters, age, NT-proBNP, hsTnT_, creatinine presence of ischemic cardiomyopathy and sex to develop a new model for risk stratification. This new score showed better performance compared to the SHFM and MAGGIC score in predicting the primary endpoint at 6, 12 and 24 months (area under the curve 0.76, 0.78 and 0.77 vs 0.71/0.69, 0.70/0.68 and 0.70/0.70).</p><p><strong>Conclusion: </strong>Invasive hemodynamics provides valuable measurements for predicting outcome in heart failure with reduced ejection fraction and show better performance than established risk models when combined with cardiac biomarkers and other clinical variables in this particular cohort.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1388-1399"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599589","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":"The relationship between serum potassium levels and cardiac arrhythmias in left ventricular assist device (LVAD) recipients: a comprehensive analysis and prognostic evaluation.","authors":"Gianmarco Lombardi, Alessia Gambaro, Pietro Manuel Ferraro, Elisa De Tomi, Flavio L Ribichini, Giovanni Gambaro","doi":"10.1007/s00392-024-02531-1","DOIUrl":"10.1007/s00392-024-02531-1","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to comprehensively analyze the relationship between serum potassium (K⁺) levels and the risk of de novo cardiac arrhythmias in left ventricular assist device (LVAD) recipients.</p><p><strong>Methods: </strong>We performed a retrospective study using the INTERMACS registry. Data was collected on adult patients with available K⁺ measurements taken 1-month post-LVAD implantation. K⁺ levels were the main exposure of interest and were analyzed as a continuous and categorical variable (quartiles of baseline K⁺ distribution). The main outcome of interest was the occurrence of de novo arrhythmia events, either sustained (ventricular [VA] or supraventricular arrhythmia [SVA]) or not sustained (atrial fibrillation/flutter [AF]). All-cause mortality was evaluated as the secondary outcome. Multivariable adjusted time-dependent Cox regression models and natural splines were used to describe the relationship between the exposure and outcomes of interest.</p><p><strong>Results: </strong>10,570 patients met our inclusion criteria. A significant and consistent relationship was observed between the lowest quartile of longitudinal K⁺ and the risk of arrhythmic events (HR 1.28, 95% CI 1.08, 1.53, p = 0.005) as well as in the highest K⁺ quartile (HR 1.24, 95% CI 1.02, 1.49, p = 0.027). A similar relationship was confirmed in the stratified analysis of arrhythmia types for SVAs and AF. The data were reflected in a U shaped relationship. Similarly, the highest and lowest quartiles of longitudinal K⁺ were independently associated with a significant increase in the HR of death, which was reflected by a U shaped relationship.</p><p><strong>Conclusions: </strong>Our study reveals a significant U shaped relationship between low and high K + levels and cardiac arrhythmias in LVAD patients, particularly SVAs and AF. Both high and low K + levels negatively impacted patient survival.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1300-1310"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079514","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":"Clinical use and predictors of outcome in venoarterial extracorporeal membrane (VA ECMO): insights from VERGE (VA ECMO Registry of Germany).","authors":"Tobias Wengenmayer, Dawid L Staudacher, Alois Philipp, Eike Tigges, Angela Dettling, Hendrik Busse, Marc Kriege, Jan-Sören Padberg, Ingo Voigt, Clemens Scherer, Tobias Graf, Dominik Scharpf, Peter Noack, Simone Britsch, Guido Michels","doi":"10.1007/s00392-025-02650-3","DOIUrl":"10.1007/s00392-025-02650-3","url":null,"abstract":"<p><p>The VA ECMO Registry of Germany (VERGE, http://va-ecmo-register.de/ ) is a prospective, multicenter, investigator-driven registry of Venoarterial Extracorporeal Membrane Oxygenation (VA ECMO) all-comers, free from industrial support. VERGE is Germany's first multicenter registry to systematically gather and analyze data from various centers on the clinical use of VA ECMO. This first report compromises data from 581 VA ECMO patients from 2022. Median age was 60 years, hospital survival was 42% and 25% were female. The leading indication for VA ECMO was extracorporeal cardiopulmonary resuscitation (ECPR) followed by VA ECMO in shock (48.9 and 34.9%, respectively). Hospital survival of ECPR was significantly worse compared to shock (28 and 55%, respectively, p < 0.001). Age, pH, and lactate before cannulation all significantly correlated independently with hospital survival (p < 0.001). In VERGE, no patients with pH below 6.7 or lactate above 25 mmol/l survived.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1377-1387"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981223","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":"The association of heart rate with adverse outcomes and recurrent heart failure hospitalization in peripartum cardiomyopathy.","authors":"Julia Berkowitz, Emilija Sagaityte, Mahnoor Khalid, Diana Lopez, Donya Mohebali, Natalie Bello, Zoltan Arany, Katharine French, Athena Poppas, Marwa Sabe, Wen-Chih Wu, Jacob Joseph, Luc Djousse, Gaurav Choudhary, Tasnim F Imran","doi":"10.1007/s00392-025-02615-6","DOIUrl":"10.1007/s00392-025-02615-6","url":null,"abstract":"<p><strong>Introduction: </strong>Understanding predictors of adverse outcomes in patients with peripartum cardiomyopathy (PPCM) is essential for risk stratification and prognosis. The aim of this study is to examine the relationship between heart rate (HR) at diagnosis and adverse outcomes in PPCM.</p><p><strong>Methods: </strong>We conducted a multi-center cohort study to identify patients with PPCM (1993-2017) who met the inclusion criteria: left ventricular ejection fraction (LVEF) <40%, development of heart failure within the last month of pregnancy or within 5 months of delivery, and no other identifiable cause of heart failure with reduced ejection fraction. The primary composite outcome of major adverse events included recurrent heart failure hospitalization, need for extra-corporeal membrane oxygenation, left ventricular assist device, orthotopic heart transplant, or all-cause death. Using Cox proportional hazards models, we examined the relationship between categories of HR at diagnosis and adverse outcomes.</p><p><strong>Results: </strong>A total of 177 women met criteria (81 with HR <100 bpm, 54 with HR 100-119 bpm, 42 with HR ≥120 bpm) with a mean age of 32 ± 7 years and median follow-up 3.6 years (IQR 1.1-8.2); 48 (27%) experienced the composite outcome. In a multivariable model adjusting for age, race, preeclampsia and hypertension, women with HR ≥ 120 bpm were four times more likely to experience major adverse events compared to women with HR < 100 bpm (HR 4.1, 95% CI 1.6-10.4) at the time of diagnosis. In a second multivariable model adjusting for the above covariates plus LVEF < 30%, QTc, and systolic blood pressure, those with HR ≥ 120 bpm were more likely to experience major adverse events compared to those with HR < 100 bpm (HR 3.31 (1.01-10.9), p = 0.049). Patients with HR <100 bpm were significantly more likely to have survival free from adverse events in survival analysis (p = 0.03).</p><p><strong>Conclusion: </strong>Sinus tachycardia at diagnosis was associated with lower LVEF on presentation and higher rates of major adverse events in PPCM. Tachycardia may be an early prognostic indicator of outcomes in PPCM and could help identify high-risk patients for closer follow-up and earlier intervention.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1358-1365"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482396","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":"Response to the Letter: \"C-reactive protein-to-albumin ratio in transcatheter tricuspid valve repair: methodological concerns and inconsistencies\".","authors":"Karl Finke, Laura Marx, Jan Althoff, Thorsten Gietzen, Matthieu Schäfer, Jan Wrobel, Philipp von Stein, Jennifer von Stein, Maria Isabel Körber, Stephan Baldus, Roman Pfister, Christos Iliadis","doi":"10.1007/s00392-025-02763-9","DOIUrl":"https://doi.org/10.1007/s00392-025-02763-9","url":null,"abstract":"","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184734","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":"Prognostic value of lactate in patients with cardiogenic shock with and without cardiac arrest.","authors":"Uwe Zeymer, Anne Freund, Taoufik Ouarrak, Steffen Schneider, Ibrahim Akin, Daniel Duerschmidt, Steffen Desch, Holger Thiele, Janine Pöss","doi":"10.1007/s00392-025-02762-w","DOIUrl":"https://doi.org/10.1007/s00392-025-02762-w","url":null,"abstract":"<p><strong>Background: </strong>Arterial lactate on admission is a well-established marker of shock severity and prognosis in infarct-related cardiogenic shock (CS). However, it remains unclear whether its prognostic value differs between patients with and without pre-hospital cardiac arrest (CA).</p><p><strong>Methods: </strong>We performed a pooled analysis of three randomized clinical trials on CS (IABP-SHOCK II, CULPRIT-SHOCK, and ECLS-SHOCK). Patients were stratified based on the presence or absence of pre-hospital CA. Admission arterial lactate levels were categorized into tertiles: < 3.6, 3.6-7.1, and > 7.1 mmol/L. The primary endpoint was 1-year all-cause mortality.</p><p><strong>Results: </strong>A total of 1401 patients (804 with CA and 597 without CA) were included. Higher admission lactate levels were associated with a linear increase in 1-year mortality. The prognostic performance of arterial lactate, assessed by the area under the curve (AUC), was 0.65 (95% CI 0.63-0.67). Patients with CA were more frequently represented in the highest lactate tertile compared to those without CA (31.6% vs. 8.8%). Across all tertiles, lactate levels were significantly associated with 1-year mortality, irrespective of CA status: 39.8% vs. 41.4% in the lowest tertile (p = 0.73), 48.6% vs. 50.8% in the intermediate tertile (p = 0.61), and 66.7% vs. 81.8% in the highest tertile (p = 0.0023), for CA and no-CA patients, respectively.</p><p><strong>Conclusions: </strong>Admission arterial lactate is associated with 1-year mortality in infarct-related CS, regardless of pre-hospital CA. Although patients without CA generally had lower lactate levels, those in the highest lactate tertile experienced the highest mortality risk.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184737","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}