European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"The intersection of obesity and acute heart failure: cardiac structure and function and congestion across BMI categories.","authors":"Sofie Bøgh-Sørensen, Ross T Campbell, Brian L Claggett, Eldrin F Lewis, Kieran F Docherty, Matthew M Y Lee, Moritz Lindner, Tor Biering-Sørensen, Scott D Solomon, Elke Platz","doi":"10.1093/ehjacc/zuaf067","DOIUrl":"10.1093/ehjacc/zuaf067","url":null,"abstract":"<p><strong>Aims: </strong>Overweight/obesity are important risk factors for heart failure (HF), however, the pathophysiologic consequences of obesity in patients with acute HF (AHF) are incompletely understood.</p><p><strong>Methods and results: </strong>We examined cardiac structure and function, and congestion-related markers in adults hospitalized for AHF across three body mass index (BMI) groups: 18.5-24.9 kg/m2 (normal weight), 25-29.9 kg/m2 (overweight), ≥ 30 kg/m2 (obese), and based on left ventricular ejection fraction (LVEF) > 40% [HF with mildly reduced/preserved EF (HFmrEF/HFpEF)] vs. ≤ 40% [HF with reduced EF (HFrEF)]. Echocardiography, 4-zone lung ultrasound, and patient-reported symptoms were assessed at baseline, and 6-month outcomes (HF hospitalizations and all-cause death) were collected. Among 354 participants (median age 75, 59% men), 36% were normal weight, 29% overweight and 35% obese. Higher BMI was associated with younger age, more comorbidities, a higher proportion of prior HF, and worse patient-reported symptoms. Patients with HFmrEF/HFpEF were older, more likely female, had a higher BMI and higher proportions of hypertension and atrial fibrillation. Both patients with HFmrEF/HFpEF and HFrEF had greater biventricular volumes/area and LV mass, similar degrees of elevated LV filling pressure and lower degrees of pulmonary congestion with higher BMI. The risk of the composite outcome was similar across BMI groups both in the overall cohort and when stratified by LVEF.</p><p><strong>Conclusion: </strong>Among patients with AHF, those with overweight/obesity had greater biventricular volumes/area and LV mass, similar sonographic evidence of haemodynamic congestion and less pulmonary congestion than those with normal weight. The risk of 6-month HF hospitalization or death was similar across BMI groups.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"540-551"},"PeriodicalIF":4.6,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986914","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":"Life is worth more than survival: beyond surviving after out-of-hospital cardiac arrest.","authors":"Emilie P Belley-Côté, Jessica D Spence","doi":"10.1093/ehjacc/zuaf108","DOIUrl":"10.1093/ehjacc/zuaf108","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"520-521"},"PeriodicalIF":4.6,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844982","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":"DAPT-SHOCK-AMI: does faster and more complete platelet inhibition translate to improved clinical outcomes?","authors":"Johannes Grand, Pascal Vranckx, Sean van Diepen","doi":"10.1093/ehjacc/zuaf117","DOIUrl":"10.1093/ehjacc/zuaf117","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"562-564"},"PeriodicalIF":4.6,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029292","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":"A Multicentre Observational Study on Landiolol Use, Efficacy, and Safety in European Patients with Supraventricular Arrhythmia (Landi-UP).","authors":"Al-Medina Dizdarevic, Marek Šramko, Norman Mangner, Béla Merkely, Endre Zima, Nikolaou Nikolaos, Daniel Scherr, Johann Knotzer, Paul Köglberger, Zoi Nouvaki, Martin Martinek, Tomas Hnat, Carina Bethlehem, Zlatko Fras, Waldemar Goździk, Anastasia Kotanidou, Wojciech Dąbrowski, Maciej Lesiak, Karina Stefanska-Wronka, Martin Unger, Jan Sus, Christoph Klade, Kurt Krejcy, Olivier Bouvet, Eva Oravec, Günther Krumpl, Jolanta Siller-Matula","doi":"10.1093/ehjacc/zuaf129","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf129","url":null,"abstract":"<p><strong>Background and aims: </strong>Landiolol is an ultrashort-acting, highly cardio-selective beta1-adrenergic receptor blocker used for short-term control of tachyarrhythmias. While its real-world use has been described in Japan, data from European clinical practice are lacking. This study aimed to collect real-world data on landiolol use, effectiveness, and safety across diverse clinical settings in Europe.</p><p><strong>Methods: </strong>This multicentre, observational study included adult patients with supraventricular arrhythmias treated with landiolol. Patient characteristics, drug utilization patterns, efficacy, and safety were assessed.</p><p><strong>Results: </strong>In total, 450 patients were enrolled and 449 analysed (median age: 72 years, IQR 63-78) from 17 sites across eight European countries. Most patients (73.1%) received landiolol for atrial fibrillation. Median (IQR) duration of infusion was 8.9 (2.3. - 34.0) hours, with starting, minimum, and maximum doses of 5.3 (2.5 - 10.0), 4.0 (1.7-10) and 10.0 (6.0-30.0) µg/kg/min, respectively. Heart rate (HR) control, defined as HR ≤110 bpm or a reduction of >20% from baseline, was achieved in 74.2% of patients within 4 hours after treatment discontinuation, with 36.9% of arrhythmia patients restoring sinus rhythm. Blood pressure (BP) remained stable throughout treatment. A total of 123 adverse events and 113 major adverse cardiac events were reported, none related to landiolol.</p><p><strong>Conclusions: </strong>In European clinical practice, landiolol dosing adhered to product information recommendations. Landiolol was effective in controlling HR with minimal impact on BP. The treatment was well tolerated, and no new safety signals were identified. These findings support the efficacy and safety of landiolol across diverse clinical settings in Europe.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237885","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":"Translating the Latest 2025 ESC Guidelines and Consensus Statement into Acute Cardiovascular Care Practice.","authors":"Tharusan Thevathasan, Jeanette Schulz-Menger, Jan Gröschel, Julie De Backer, Michael A Borger, Sofie Gevaert, Ulrich Laufs, Janine Pöss","doi":"10.1093/ehjacc/zuaf126","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf126","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228557","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":"Hemodynamic Monitoring and Management of the Hypotensive Out-of-Hospital Cardiac Arrest Patient in the Adult Intensive Care Unit.","authors":"Johannes Grand, Alessandro Sionis, Christian Hassager, Pablo Jorge Perez, Janine Poess, Hannah Schaubroeck, Steffen Desch, Konstantin A Krychtiuk, Jan Belohlavek, Alexandre Mebazaa, Kurt Huber, Sean van Diepen, Christophe Vandenbriele, David Morrow, Guido Tavazzi","doi":"10.1093/ehjacc/zuaf125","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf125","url":null,"abstract":"<p><p>Out-of-hospital cardiac arrest (OHCA) represents a major public health challenge, with high mortality and significant neurological impairments among survivors. Hemodynamic instability, particularly hypotension (a mean arterial blood pressure <65mmHg), may be a key contributor to post-resuscitation morbidity and mortality. After return of spontaneous circulation, hypotension can result from various causes, including arrhythmias, mechanical complications, thromboembolism, or different types of shock, as well as sedation, temperature control and positive pressure ventilation. Differentiating between hypotension with vs. without hypoperfusion is critical to avoid unnecessary interventions while ensuring adequate cerebral and myocardial perfusion. Clinical assessment and repeated echocardiography should be routine in all patients. Therapeutic targets should include evidence of preserved end-organ function, including urine output, and normal or decreasing lactate. In selected cases, advanced hemodynamic monitoring with pulmonary artery catheters may be necessary to diagnose the shock-type and monitor treatment effects. Causal treatment of the precipitating cause of hypotension is crucial as well as symptomatic treatment with fluids, vasopressors and inotropes if needed. Mechanical circulatory support may be employed for refractory shock unresponsive to other treatment. This clinical consensus statement by the Association for Acute CardioVascular Care (ACVC) of the European Society of Cardiology (ESC) provides clinical guidance for the hemodynamic monitoring and management of hypotension in OHCA patients in intensive care. The document advocates for a multidisciplinary approach that integrates clinical assessment, imaging, and hemodynamic parameters to guide treatment, with the overarching goal of improving survival rates and neurological outcomes.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181938","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":"Mild Induced Hypothermia in Patients with Infarct-Related Cardiogenic Shock and Cardiac Arrest: Insights from the CULPRIT-SHOCK Trial.","authors":"Daniel Zeymer-von Metnitz, Taoufik Ouarrak, Kurt Huber, Marko Noc, Steffen Desch, Anne Freund, Uwe Zeymer, Holger Thiele, Janine Pöss","doi":"10.1093/ehjacc/zuaf124","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf124","url":null,"abstract":"<p><strong>Background: </strong>Mild induced hypothermia (MIH) is often applied in patients with cardiac arrest (CA), but its impact on patients with infarct-related cardiogenic shock (CS) and CA remains unclear.</p><p><strong>Objectives: </strong>To evaluate the characteristics and outcomes of patients with infarct-related CS and CA who received MIH versus those who did not in the randomized CULPRIT-SHOCK trial and the accompanying registry.</p><p><strong>Methods: </strong>We included patients with CS and CA from the CULPRIT-SHOCK trial and registry. The primary endpoint was 1-year mortality. Secondary endpoints included death or renal replacement therapy within 30 days. A multivariate regression analysis was performed for 1-year mortality, adjusted for relevant baseline parameters.</p><p><strong>Results: </strong>Among 550 patients with CA, 288 (52.4%) received MIH. Patients treated with MIH were younger (64 vs. 67 years, P=0.03), had higher rates of mechanical ventilation (94.5% vs. 78.8%, p<0.01), and higher mean arterial pressure (82 vs. 76 mmHg, P=0.002). The unadjusted hazard ratio (HR) for 1-year mortality favored MIH (HR: 0.77, 95% confidence interval [CI]: 0.61-0.97, P=0.024); however, after multivariate adjustment, this effect was not statistically significant (HR: 0.83, 95% CI: 0.64-1.09, P=0.18). MIH was associated with a higher need for renal replacement therapy (15.2% vs. 7.5%, P=0.005) and less use of mechanical circulatory support (21.2% vs. 34.2%, P<0.001).</p><p><strong>Conclusions: </strong>In this retrospective analysis MIH was not significantly associated with lower 1-year mortality in patients with infarct-related CS and CA. Because of the numerically lower mortality rate, further research is necessary to clarify the role of MIH in this patient population.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT01927549.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130068","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":"Cardiogenic shock as a complication of acute myocardial infarction: a nationwide cohort study.","authors":"Jarle Jortveit, Peder L Myhre, Geir Øystein Andersen, Sigrun Halvorsen","doi":"10.1093/ehjacc/zuaf118","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf118","url":null,"abstract":"<p><strong>Background and aims: </strong>Cardiogenic shock (CS) is a life-threatening complication of acute myocardial infarction (AMI). This study aimed to assess real-world incidence, characteristics, and outcomes in relation to age among patients with AMI complicated by CS (AMI-CS) compared to those without CS in a nationwide cohort.</p><p><strong>Methods: </strong>Cohort study of all patients <85 years with AMI registered in the Norwegian Myocardial Infarction Registry 2013-2022. Outcomes were short- and long-term all-cause mortality. Mortality was assessed by Kaplan-Meier survival curves, Life Tables, and multivariable Cox regression models.</p><p><strong>Results: </strong>Among 86,730 AMI patients (40% women), 1,645 (2.7%) patients <75 years and 969 (3.9%) patients 75-84 years developed CS. Regardless of age, patients with AMI-CS were more likely to have previous heart failure, diabetes, renal failure, and ST-elevation AMI compared to patients without CS. In-hospital mortality was 47.5% in AMI-CS patients <75 years and 71.4% in patients 75-84 years, and the estimated one year cumulative mortality rates were 54.7% (95% CI: 52.3-57.1%) and 79.8% (95% CI: 77.2-82.3), respectively. Patients with AMI-CS who survived to hospital discharge remained at a higher long-term mortality risk compared to patients without CS (<75 years: adjusted HR 1.91 (95% CI 1.67-2.18), 75-84 years: adjusted HR 1.65 (95% CI: 1.41-1.93)).</p><p><strong>Conclusion: </strong>The in-hospital mortality rates for AMI-related CS remain high, especially in patients ≥75 years. However, long-term mortality in CS patients surviving to hospital discharge was only moderately higher compared to AMI patients without CS.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091281","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":"A prospective study on the impact of high-grade atrioventricular block (HAVB) on outcomes in patients with acute myocardial infarction (AMI).","authors":"Nicola Olivito, Fabienne Foster Witassek, Hans Rickli, Marco Roffi, Dragana Radovanovic, Giovanni Pedrazzini","doi":"10.1093/ehjacc/zuaf123","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf123","url":null,"abstract":"<p><strong>Background: </strong>Contemporary data on the impact of high-grade atrioventricular blocks (HAVB) in acute myocardial infarction (AMI) are scarce. Therefore, we investigated this in the Swiss national AMI registry (AMIS Plus) cohort.</p><p><strong>Methods: </strong>We included all AMI patients enrolled from January 2005 to September 2024 with available ECG information. Primary outcome was in-hospital mortality; secondary outcomes included in-hospital major adverse cardiac or cerebrovascular events (MACCE) defined as cardiogenic shock, stroke, re-infarction or death.</p><p><strong>Results: </strong>Among 50'279 AMI patients, 747 (1.5%) patients presented with HAVB and 407 (0.8%) developed HAVB during hospitalisation. Patients presenting with HAVB had increased in-hospital mortality (15% vs. 4.9%; p<0.001) and MACCE (17% vs. 6.0%; p<0.001) compared with those without HAVB. HAVB on admission was an independent predictor for in-hospital mortality (OR 1.89;95% CI, 1.42-2.49; p<0.001), with a stronger impact on mortality in the setting of anterior compared to non-anterior AMI (OR 3.69; 95% CI, 1.99-6.81; pinteraction=0.02). Independent predictors for HAVB on admission included STEMI and female sex. Rates of permanent pacemaker implantation during hospitalisation in patients with HAVB on admission were higher in NSTEMI than STEMI patients (20% vs. 4.4%; p< 0.001). HAVB occurring during hospital stay was associated with higher mortality (20% vs. 15%; p=0.031) and higher permanent pacemaker rate (25% vs. 8%; p< 0.001) than HAVB on admission.</p><p><strong>Conclusion: </strong>HAVB in AMI was associated with high in-hospital mortality, especially in anterior AMI or if occurring during hospitalisation. Permanent pacemaker implantation was more frequent in the setting of NSTEMI and among patients developing HAVB during hospital stay.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091292","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":"Development and external validation of a prognostic model for new-onset atrial fibrillation complicating acute myocardial infarction: insights from the NOAFCAMI-China registry.","authors":"Jiachen Luo, Xiaoming Qin, Yuan Fang, Xingxu Zhang, Yiwei Zhang, Jieyun Liu, Yaoxin Wang, Guojun Zhao, Lili Xiao, Wentao Shi, Lei Qin, Baoxin Liu, Yidong Wei","doi":"10.1093/ehjacc/zuaf122","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf122","url":null,"abstract":"<p><strong>Background: </strong>There is no specifically developed model to predict the risk of major adverse cardiac events (MACEs) in patients with new-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI). We aimed to develop and validate a prediction model for 5-year risk of MACE in patients with post-MI NOAF.</p><p><strong>Methods: </strong>The derivation cohort comprised 457 patients, and the external validation cohort consisted of 206 patients between January 2014 and January 2022. Stepwise multivariable Cox regression analysis was used to identify candidate predictors and to establish the model for 5-year MACE prediction. Model performance was assessed using time-dependent area under the receiver-operating characteristic curve (AUC), C-index, and calibration curves.</p><p><strong>Results: </strong>According to the stepwise multivariable Cox regression analysis, 7 variables were included in the prediction model (NOAFCAMI score): age, prior HF, Killip class, undergoing percutaneous coronary intervention, peak level of NT-pro BNP, AF burden, and symptomatic AF. The 5-year AUC was 0.83 (95% confidence interval [CI]: 0.77 to 0.88). Internal validation by optimism bootstrap-corrected C-index was 0.72 (95% CI: 0.68 to 0.76). External validation showed a 5-year AUC of 0.79 (95% CI: 0.69 to 0.89). The calibration of the NOAFCAMI score for 5-year MACE prediction was acceptable in the derivation (Brier score: 0.17 [95%CI: 0.15 to 0.19]) and the external validation (Brier score: 0.19 [95%CI: 0.16 to 0.22]) cohorts, respectively.</p><p><strong>Conclusions: </strong>The NOAFCAMI score is the first externally validated prediction model to personalize MACE risk assessment in patients with post-MI NOAF, offering actionable insights for tailored management.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091297","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}