European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Correction to: Targeted proteomic profiling of cardiogenic shock in the cardiac intensive care unit.","authors":"","doi":"10.1093/ehjacc/zuaf033","DOIUrl":"10.1093/ehjacc/zuaf033","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"507"},"PeriodicalIF":4.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556260","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":"Machine learning to optimize use of natriuretic peptides in the diagnosis of acute heart failure.","authors":"Dimitrios Doudesis, Kuan Ken Lee, Mohamed Anwar, Adam J Singer, Judd E Hollander, Camille Chenevier-Gobeaux, Yann-Erick Claessens, Desiree Wussler, Dominic Weil, Nikola Kozhuharov, Ivo Strebel, Zaid Sabti, Christopher deFilippi, Stephen Seliger, Evandro Tinoco Mesquita, Jan C Wiemer, Martin Möckel, Joel Coste, Patrick Jourdain, Komukai Kimiaki, Michihiro Yoshimura, Irwani Ibrahim, Shirley Beng Suat Ooi, Win Sen Kuan, Alfons Gegenhuber, Thomas Mueller, Olivier Hanon, Jean-Sébastien Vidal, Peter Cameron, Louisa Lam, Ben Freedman, Tommy Chung, Sean P Collins, Christopher J Lindsell, David E Newby, Alan G Japp, Anoop S V Shah, Humberto Villacorta, A Mark Richards, John J V McMurray, Christian Mueller, James L Januzzi, Nicholas L Mills","doi":"10.1093/ehjacc/zuaf051","DOIUrl":"10.1093/ehjacc/zuaf051","url":null,"abstract":"<p><strong>Aims: </strong>B-type natriuretic peptide (BNP) and mid-regional pro-atrial natriuretic peptide (MR-proANP) testing are guideline-recommended to aid in the diagnosis of acute heart failure. Nevertheless, the diagnostic performance of these biomarkers is uncertain.</p><p><strong>Methods and results: </strong>We performed a systematic review and individual patient-level data meta-analysis to evaluate the diagnostic performance of BNP and MR-proANP. We subsequently developed and externally validated a decision-support tool called CoDE-HF that combines natriuretic peptide concentrations with clinical variables using machine learning to report the probability of acute heart failure. Fourteen studies from 12 countries provided individual patient-level data in 8493 patients for BNP and 3899 patients for MR-proANP, in whom, 48.3% (4105/8493) and 41.3% (1611/3899) had an adjudicated diagnosis of acute heart failure, respectively. The negative predictive value (NPV) of guideline-recommended thresholds for BNP (100 pg/mL) and MR-proANP (120 pmol/L) was 93.6% (95% confidence interval 88.4-96.6%) and 95.6% (92.2-97.6%), respectively, whilst the positive predictive value (PPV) was 68.8% (62.9-74.2%) and 64.8% (56.3-72.5%). Significant heterogeneity in the performance of these thresholds was observed across important subgroups. CoDE-HF was well calibrated with excellent discrimination in those without prior acute heart failure for both BNP and MR-proANP [area under the curve of 0.914 (0.906-0.921) and 0.929 (0.919-0.939), and Brier scores of 0.110 and 0.094, respectively]. CoDE-HF with BNP and MR-proANP identified 30% and 48% as low-probability [NPV of 98.5% (97.1-99.3%) and 98.5% (97.7-99.0%)], and 30% and 28% as high-probability [PPV of 78.6% (70.4-85.0%) and 75.1% (70.9-78.9%)], respectively, and performed consistently across subgroups.</p><p><strong>Conclusion: </strong>The diagnostic performance of guideline-recommended BNP and MR-proANP thresholds for acute heart failure varied significantly across patient subgroups. A decision-support tool that combines natriuretic peptides and clinical variables was more accurate and supports more individualized diagnosis.</p><p><strong>Study registration: </strong>PROSPERO number, CRD42019159407.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"474-488"},"PeriodicalIF":4.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985046","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":"Mechanical ventilation in acute pulmonary embolism: a randomized, experimental, crossover study.","authors":"Cecilie Dahl Baltsen, Mark Stoltenberg Ellegaard, Casper Nørholt, Simone Juel Dragsbaek, Christopher Kabrhel, Asger Andersen, Asger Granfeldt, Mads Dam Lyhne","doi":"10.1093/ehjacc/zuaf036","DOIUrl":"10.1093/ehjacc/zuaf036","url":null,"abstract":"<p><strong>Aims: </strong>Acute intermediate-high-risk pulmonary embolism (PE) causes a pathological increase in pulmonary artery pressure and right ventricle afterload that may progress to right ventricle failure and cardiopulmonary collapse. Patients may require mechanical ventilation, further increasing pulmonary vascular resistance (PVR) and artery pressure. We aimed to investigate the ability of ventilator settings adjustments to reduce pulmonary artery pressure in a porcine model.</p><p><strong>Methods and results: </strong>Eleven Danish female pigs (Landrace/Yorkshire/Duroc) of ≈60 kg were used to perform a randomized, blinded, cross-over, experimental study. Following induction of acute PE, the animals were subject to four randomized interventions with wash-out periods in between: (1) changes in positive end-expiratory pressure (PEEP) (from 5 to 0, 10 and 15 cmH2O), (2) 50 and 100% increase in minute ventilation (hypocapnia), (3) increase in fraction of inspired oxygen (FiO2, from 21 to 40%), and (4) infusion of sodium bicarbonate to induce alkalosis. The main outcome was mean pulmonary artery pressure (mPAP). mPAP was reduced by a reduction in PEEP (28 ± 6 vs. 26 ± 5 mmHg, P = 0.011), hypocapnia (27 ± 6 vs. 23 ± 5 mmHg, P = 0.0004), alkalosis (27 ± 4 vs. 25 ± 5 mmHg, P = 0.003), and increased fraction of inspired oxygen (28 ± 6 vs. 23 ± 5 mmHg, P < 0.0001). Changes in PVR showed similar patterns (P < 0.05 for all).</p><p><strong>Conclusion: </strong>In a porcine model of acute PE reduction of PEEP, permissive hypocapnia through hyperventilation, alkalosis, and increased fraction of inspired oxygen can reduce mPAP.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"455-462"},"PeriodicalIF":4.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566335","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":"The ACVC certification programme: gaining competencies in Acute CardioVascular Care.","authors":"Alessandro Galluzzo, Janine Pöss","doi":"10.1093/ehjacc/zuaf090","DOIUrl":"10.1093/ehjacc/zuaf090","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"502-503"},"PeriodicalIF":4.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526937","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":"Acute heart failure with systolic dysfunction in paediatric patients: aetiology, risk factors, and in-hospital prognosis.","authors":"Kamila Kurkiewicz-Sawczak, Filip Sawczak, Filip Baszkowski, Kinga Walska-Świerc, Malwina Baturo, Weronika Pelczar-Płachta, Dominika Wysocka, Marta Kałużna-Oleksy, Waldemar Bobkowski","doi":"10.1093/ehjacc/zuaf049","DOIUrl":"10.1093/ehjacc/zuaf049","url":null,"abstract":"<p><strong>Aims: </strong>Paediatric acute heart failure (AHF) differs from adult cases, and less numerous population limits research aimed at improving clinical practice and prognosis. We aimed to evaluate outcomes and prognostic factors in the paediatric population of AHF patients with left ventricular ejection fraction (EF) < 50%, or systemic right ventricular fractional area change <40%.</p><p><strong>Methods and results: </strong>This single-centre retrospective cohort study included 162 consecutive paediatric patients hospitalized for new-onset AHF with systolic dysfunction or the first exacerbation with reported systolic dysfunction of chronic heart failure (CHF). Patients were categorized into two subgroups: those with >5% improvement in EF on follow-up echocardiography before discharge (n = 115) and those with EF deterioration, ≤5% EF improvement, or death during hospitalization (n = 47). The study contained 58% males and 42% females. The median age was 1 [interquartile range (IQR) 0-8] year, 14 (IQR 2-101) months. The mortality rate was 12.3%. Acute heart failure aetiologies included congenital heart defects (51.2%), cardiomyopathy (20.4%), infections (14.2%), arrhythmias (11.7%), and others (2.5%). Our study demonstrated independent factors of worse outcomes: cardiomyopathies aetiology [odds ratio (OR) 2.762 (1.210-6.307)], older age [OR 1.006 (1.000-1.011)], and factors of better prognosis: infective aetiology [OR 0.083 (0.010-0.664)], higher EF [OR 0.953 (0.905-0.999)], oxygen saturation (SpO2) [OR 0.951 (0.905-0.992)]. In contrast to CHF exacerbation, de novo AHF had better outcomes (P = 0.014).</p><p><strong>Conclusion: </strong>Acute heart failure with systolic dysfunction in children has an unfavourable prognosis, however most patients improved during hospitalization. In our study, cardiomyopathy aetiology predicted worse outcomes. In turn, infective aetiology, younger age, higher EF, and SpO2 were independent factors of better prognosis.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"443-452"},"PeriodicalIF":4.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763468","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":"Decoding the haemodynamics in sepsis to avoid drowning in salt water.","authors":"Maxwell A Hockstein, Rory J Spiegel","doi":"10.1093/ehjacc/zuaf079","DOIUrl":"10.1093/ehjacc/zuaf079","url":null,"abstract":"<p><p>When a patient is described as 'septic', a clinical cascade occurs to simultaneously attempt to diagnose, risk-stratify, and treat a patient with a presumed infection. Elements of this clinical cascade include laboratory investigations, medication administration, and often specialty service consultations. The clinical consequences of each of these interventions have largely been independently investigated, and their impacts have varied. The primary focus of the management of septic shock has traditionally revolved around resuscitative efforts intended to rapidly restore perfusion to the organs through the use of i.v. fluids, vasopressor, and inotropic support. Such strategies, if deployed carelessly, have the potential to lead to iatrogenic harms. Clinicians should consider the wide variety of haemodynamic phenotypes encountered when treating patients presenting in septic shock and tailor supporting measures to specific physiologic perturbations.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"489-493"},"PeriodicalIF":4.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215258","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: Have the remnographic eye: a rare cause of pericardial effusion after myocardial infarction.","authors":"Alexandra Braillon, Thibault Leclercq, Alain Lalande, Kevin Guillen, Charles Guenancia","doi":"10.1093/ehjacc/zuae127","DOIUrl":"10.1093/ehjacc/zuae127","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"497-498"},"PeriodicalIF":4.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709232","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":"Fifty shades of paediatric heart failure with systolic dysfunction.","authors":"Thomas Salaets, Alexander Van De Bruaene, Bjorn Cools","doi":"10.1093/ehjacc/zuaf083","DOIUrl":"10.1093/ehjacc/zuaf083","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"453-454"},"PeriodicalIF":4.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247061","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":"Failure of standard contemporary ST-elevation myocardial infarction electrocardiogram criteria to reliably identify acute occlusion of the left anterior descending coronary artery.","authors":"H Pendell Meyers, Scott W Sharkey, Robert Herman, José Nunes de Alencar, Gautam R Shroff, William H Frick, Stephen W Smith","doi":"10.1093/ehjacc/zuaf037","DOIUrl":"10.1093/ehjacc/zuaf037","url":null,"abstract":"<p><strong>Aims: </strong>ST-elevation (STE) criteria on the electrocardiogram (ECG) are poorly sensitive for acute coronary occlusion myocardial infarction (ACOMI or OMI). This study evaluates the sensitivity of STE criteria on serial ECGs for total left anterior descending (LAD) coronary artery occlusion. We compared STE criteria with expert interpretation and a validated artificial intelligence (AI) ECG model for diagnosing LAD OMI.</p><p><strong>Methods and results: </strong>This is a retrospective sub-study of the DOMI-ARIGATO case-control study of OMI (808 patients, 265 with OMI). All cases of total (TIMI-0 flow) LAD occlusion were assessed for STE criteria. An OMI ECG expert blindly interpreted all serial ECGs. An AI model (PMCardio Queen of Hearts) was applied to the first available 12-lead ECG. Among the 53 cases of acute LAD OMI with TIMI-0 flow, 20 (38%) did not meet STE myocardial infarction (STEMI) criteria on any pre-angiography ECG; 16/20 had at least two ECGs before angiography. Both the expert and AI model had 100% sensitivity for diagnosing LAD OMI on the first ECG in these 20 cases. Door-to-balloon time (DBT) was significantly shorter for those meeting STEMI criteria. Infarct size, measured by ejection fraction and peak troponin, did not differ between cases with and without STEMI criteria.</p><p><strong>Conclusion: </strong>The STEMI criteria missed 38% of acute total LAD occlusions on all serial ECGs. Both expert interpretation and the AI model demonstrated 100% sensitivity on the first ECG for all cases. Despite the lack of STEMI criteria, these cases had similar infarct sizes but were associated with longer DBTs.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"403-411"},"PeriodicalIF":4.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728940","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: An unexpected cause of left main pattern ST-elevation myocardial infarction.","authors":"Jacqueline Jing Ting Liaw, Lung En Teng, Ella Cockburn","doi":"10.1093/ehjacc/zuaf032","DOIUrl":"10.1093/ehjacc/zuaf032","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"436-437"},"PeriodicalIF":4.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526936","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}