European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Lower vs. higher blood pressure targets during intensive care of comatose patients resuscitated from out-of-hospital cardiac arrest-a Bayesian analysis of the BOX trial.","authors":"Johannes Grand, Anders Granholm, Sebastian Wiberg, Henrik Schmidt, Jacob E Møller, Simon Mølstrøm, Martin A S Meyer, Jakob Josiassen, Rasmus P Beske, Jordi S Dahl, Laust E R Obling, Martin Frydland, Britt Borregaard, Vibeke Lind Jørgensen, Jakob Hartvig Thomsen, Søren Aalbæk Madsen, Benjamin Nyholm, Christian Hassager, Jesper Kjaergaard","doi":"10.1093/ehjacc/zuae142","DOIUrl":"10.1093/ehjacc/zuae142","url":null,"abstract":"<p><strong>Aims: </strong>The Blood Pressure and Oxygenation (BOX) targets after out-of-hospital cardiac arrest trial found no statistically significant differences in mortality or neurological outcomes with mean arterial blood pressure targets of 63 vs. 77 mmHg in patients receiving intensive care post-cardiac arrest. In this study, we aimed to evaluate the effect on 1-year mortality and assess heterogeneity in treatment effects (HTEs) using Bayesian statistics.</p><p><strong>Methods and results: </strong>We analyzed 1-year all-cause mortality, 1-year neurological outcomes, and plasma neuron-specific enolase (NSE) at 48 h using Bayesian logistic and linear regressions primarily with weakly informative priors. HTE was assessed according to age, plasma lactate, time to return of spontaneous circulation, primary shockable rhythm, history of hypertension, and ST-segment elevation myocardial infarction. Absolute and relative differences are presented with probabilities of any clinical benefit and harm. All 789 patients in the intention-to-treat cohort were included. The risk difference (RD) for 1-year mortality was 1.5%-points [95% credible interval (CrI): -5.1 to 8.1], with <33% probability of benefit with the higher target. There was 33% probability for a better neurological outcome (RD: 1.5%-points; 95% CrI: -5.3 to 8.3) and 35.1% for lower NSE levels (mean difference: 1.5 µg/L, 95% CrI: -6.0 to 9.1). HTE analyses suggested potential harms of the higher blood pressure target in younger patients.</p><p><strong>Conclusion: </strong>The effects of a higher blood pressure target on overall mortality among comatose patients resuscitated from out-of-hospital cardiac arrest were uncertain. A potential effect modification according to age warrants additional investigation.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov ID NCT03141099.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"14-23"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806711","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":"Shaping the future of acute coronary syndrome management: a look back at 2024.","authors":"Pascal Vranckx, Marco Valgimigli, Milica Aleksic","doi":"10.1093/ehjacc/zuae143","DOIUrl":"10.1093/ehjacc/zuae143","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"40-43"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846305","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":"Novel troponin fragmentation assay to discriminate between takotsubo syndrome and acute myocardial infarction: reply.","authors":"K E Juhani Airaksinen, Saara Wittfooth","doi":"10.1093/ehjacc/zuae139","DOIUrl":"10.1093/ehjacc/zuae139","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"56"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846289","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":"Ghrelin for neuroprotection in post-cardiac arrest coma: a 1-year follow-up of cognitive and psychosocial outcomes.","authors":"Pauline van Gils, Sjoukje Nutma, Karen Meeske, Caroline van Heugten, Walter van den Bergh, Norbert Foudraine, Joost le Feber, Margreet Filius, Michel van Putten, Bert Beishuizen, Jeannette Hofmeijer","doi":"10.1093/ehjacc/zuae119","DOIUrl":"10.1093/ehjacc/zuae119","url":null,"abstract":"<p><strong>Aims: </strong>Effective treatments to improve brain recovery after cardiac arrest are needed. Ghrelin showed efficacy in experimental models and was associated with lower neuron-specific enolase levels in the clinical Ghrelin in Coma (GRECO) trial. Here, we present cognitive and psychosocial outcomes at 1-year follow-up.</p><p><strong>Methods and results: </strong>GRECO was a Phase 2 multicentre, double-blind, randomized, placebo-controlled trial in comatose patients after cardiac arrest. The intervention was intravenous acyl-ghrelin 600 μg twice daily or placebo for 1 week, starting within 12 h after the arrest. Patients were assessed after 1 year using cognitive tests and questionnaires measuring participation, health-related quality of life, mood, and caregiver strain. Composite z-scores of the cognitive tests were computed by comparing the scores with those of a norm population and averaging the tests for memory, attention, and executive functioning separately. Groups were compared based on composite z-scores and cut-off scores for psychosocial outcomes. Of the 160 participants originally included, 66 of the 85 participants who survived to 1 year after OHCA completed the psychosocial and cognitive follow-up. The intervention group scored numerically higher across the cognitive domains compared with the control group, but the differences were not statistically significant (memory median = -0.850 vs. -1.385, U = 424.5, P = 0.587; attention median = -0.733 vs. -0.717, U = 420.5, P = 0.548; and executive functioning median = -0.311 vs. -0.482, U = 408.5, P = 0.323). There were significantly fewer signs of depression in the intervention group (U = 322.5, P = 0.014).</p><p><strong>Conclusion: </strong>This predefined secondary analysis found that ghrelin treatment was associated with non-significantly but consistently better cognitive outcomes and significantly fewer signs of depression. This is in line with the primary outcomes.</p><p><strong>Clinical trial registration: </strong>Clinicaltrialsregister.eu: EUCTR2018-000005-23-NL.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"5-11"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497391","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":"Acute cardiovascular care 2024 in review: acute heart failure.","authors":"Elke Platz, Milica Aleksic, Frederik H Verbrugge","doi":"10.1093/ehjacc/zuae145","DOIUrl":"10.1093/ehjacc/zuae145","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"44-47"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834805","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":"Answer: Rhythmic chaos amidst brain death.","authors":"Akshay Prashanth, Bharath Raj Kidambi, Adhiya Senguttuvan, Vadivelu Ramalingam, Ramesh Sankaran, Nagendra Boopathy Senguttuvan","doi":"10.1093/ehjacc/zuae095","DOIUrl":"10.1093/ehjacc/zuae095","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"53-54"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921274","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":"High VExUS grades are linked to cardiac function in general intensive care unit patients.","authors":"Stefan Andrei, Maxime Nguyen, Belaid Bouhemad, Pierre-Grégoire Guinot","doi":"10.1093/ehjacc/zuae126","DOIUrl":"10.1093/ehjacc/zuae126","url":null,"abstract":"<p><strong>Aims: </strong>Even though initially considered as a new standard in systemic venous congestion assessment, the semi-quantitative Doppler ultrasound-based venous excess ultrasound grading system (VExUS) showed inconsistent associations with outcomes in general intensive care unit (ICU) patients. It is unclear why VExUS is so effective in predicting outcomes in some cohorts and not in others. The determinants of higher VExUS have not been studied in a general ICU cohort. The aim of this study was to determine the factors associated with higher VExUS (≥ 2) in a general ICU cohort.</p><p><strong>Methods and results: </strong>We performed a post-hoc analysis of a prospective, observational cohort, including adult patients within 24 h of ICU admission and expected ICU length of stay longer than 2 days. Collected data included patients' haemodynamic status (including ultrasound evaluation) at several points in time: ICU admission, Day 1, Day 2, Day 5, and the last day of ICU stay. We analysed 514 haemodynamic evaluations in 145 patients. In total, 96/514 (18.7%) had a VExUS grade ≥ 2. The univariable followed by multivariable mixed-effects logistic regression analyses only found a statistically significant association between VExUS ≥ 2 and right ventricle S wave [OR 0.85 (0.74;0.97), P = 0.02] and left ventricle E/A ratio [OR 2.34, 95% CI (1.27;4.33), P = 0.006].</p><p><strong>Conclusion: </strong>The current study has elucidated that higher VExUS is primarily associated with cardiac comorbidities and ultrasound parameters of left- and right-sided cardiac systolic and/or diastolic function in general ICU patients.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"24-30"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616640","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":"Advancing neuroprotective strategies post-anoxic brain injury: the role of ghrelin in cognitive and psychosocial recovery.","authors":"Fabio Silvio Taccone","doi":"10.1093/ehjacc/zuae147","DOIUrl":"10.1093/ehjacc/zuae147","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"12-13"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893117","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":"Question: Rhythmic chaos amidst brain death.","authors":"Akshay Prashanth, Bharath Raj Kidambi, Adhiya Senguttuvan, Vadivelu Ramalingam, Ramesh Sankaran, Nagendra Boopathy Senguttuvan","doi":"10.1093/ehjacc/zuae094","DOIUrl":"10.1093/ehjacc/zuae094","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"51-52"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893126","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":"Delving in the troponin fragmentation and takotsubo syndrome: pathophysiologic implications.","authors":"John E Madias","doi":"10.1093/ehjacc/zuae138","DOIUrl":"10.1093/ehjacc/zuae138","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"55"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846256","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}