European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Mechanical ventilation in acute pulmonary embolism: A randomised, 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":"https://doi.org/10.1093/ehjacc/zuaf036","url":null,"abstract":"<p><strong>Background: </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 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: </strong>Eleven Danish female pigs (Landrace/Yorkshire/Duroc) of ≈60 kg were used to perform a randomised, 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 (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.</p><p><strong>Results: </strong>Mean pulmonary artery pressure was reduced by reduction in positive end-expiratory pressure (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 pulmonary vascular resistance showed similar patterns (p<0.05 for all).</p><p><strong>Conclusion: </strong>In a porcine model of acute PE reduction of positive end-expiratory pressure, permissive hypocapnia through hyperventilation, alkalosis and increased fraction of inspired oxygen can reduce mean pulmonary artery pressure.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-05","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":"Femoral versus Radial Approach for Primary Percutaneous Intervention in Cardiogenic Shock: A Subanalysis from the ECLS-SHOCK Trial.","authors":"Mohammad Abumayyaleh, 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, Janine Pöss, Taoufik Ouarrak, Steffen Schneider, Michael Behnes, Daniel Duerschmied, Steffen Desch, Anne Freund, Uwe Zeymer, Ibrahim Akin","doi":"10.1093/ehjacc/zuaf035","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf035","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock (CS) is a life-threatening complication of acute coronary syndromes (ACS). Early revascularization with treating the culprit lesion improves survival. Nevertheless, the impact of access site (femoral vs. radial) on outcomes in infarct-related CS also in conjunction with extracorporeal life support (ECLS) remains unclear.</p><p><strong>Methods: </strong>This subanalysis of the ECLS-SHOCK trial included patients with infarct-related CS treated with or without ECLS, divided into femoral and radial access groups. The primary endpoint was 30-day mortality. Secondary endpoints included renal replacement therapy (RRT), repeat revascularization, reinfarction, rehospitalization for congestive heart failure, and poor neurological outcome (Cerebral Performance Category [CPC] 3-5) within 30 days. Safety outcomes included bleeding and peripheral vascular complications.</p><p><strong>Results: </strong>Among 415 patients, percutaneous coronary intervention (PCI) was initially intended through femoral (N=304; 72.9%) or radial (N=111; 26.6%) access. In the intended access site analysis, 25 patients (22.5%) in the radial group switched to femoral access, while 3 patients (1%) in the femoral group switched to radial access prior to or after coronary angiography. At 30 days, the overall mortality rate was higher in the femoral group compared to the radial group (52.0% vs. 37.8%) with a relative risk (RR) of 1.37; 95%-confidence interval [CI], 1.06-1.78; p=0.011 with no significant differences in the crude rates of secondary and safety endpoint. In the analysis based on the actual access site (as opposed to intended access site used), 7.8% of patients in the ECLS arm switched from radial to femoral, while 7.5% of patients in the conservative arm switched from radial to femoral for or after coronary angiography. Mortality rates were higher in the femoral group for both ECLS (52.7% vs. 26.8%; p=0.003; RR 1.96 [95% CI, 1.16-3.32]) and conservative arms (52.2% vs. 37.5%; p=0.074; RR 1.39 [95% CI, 0.94-2.06]). In a multivariate analysis, femoral access was associated with a trend for predicting adjusted 30-day mortality (RR 1.22; 95% CI, 0.95-1.55; p=0.11).</p><p><strong>Conclusions: </strong>In myocardial infarction related CS, nearly one-fifth of patients with intended radial access switched to femoral. In multivariate analysis, femoral access was associated with a trend to adversely affect 30-day mortality.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556264","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: Triphasic radial pulse in a patient with abdominal pain.","authors":"Jonathan Chun-Hei Cheung, Geoffrey Chi Chun Tang, Albert Kam Ming Chan","doi":"10.1093/ehjacc/zuae129","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae129","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556228","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 characteristics, management and predictors of mortality: results from national prospective cardiogenic shock registry (CZECH-SHOCK).","authors":"Michal Pazdernik, Petr Ostadal, Jiri Seiner, Jan Pudil, Anna Chaloupka, Martin Novak, Eva Lichnerova, Radek Pelouch, Dagmar Vondrakova, Aneta Dvorakova, David Foral, Ales Kovarik, Tomas Hnat, Ahmad Zohoor, Adam Pocarovsky, Aneta Hainzova, Jan Matejka, Ondrej Sirotek, Anna Valerianova, Martin Vojtisek, Jan Precek, Peter Misun, Marek Sramko, Jan Mares, Jan Belohlavek","doi":"10.1093/ehjacc/zuaf034","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf034","url":null,"abstract":"<p><strong>Background: </strong>Only limited epidemiological data exist from national or international prospective multicentre registries covering the whole spectrum of cardiogenic shock (CS) aetiologies.</p><p><strong>Methods: </strong>CZECH-SHOCK was a national prospective multicentre observational study conducted in 15 main tertiary care centres in Czechia over a 12-month period from March 2023 to February 2024.</p><p><strong>Results: </strong>A total of 418 patients with a median age of 70 (IQR 59-76) years were enrolled. The majority of patients were male (69.6%). A newly developed heart failure was observed in 76.8% patients, and acute myocardial infarction complicated by CS (AMI-CS) was the most frequent cause of a CS episode (56.7%). Mechanical circulatory support devices were utilised in 28.2% of cases. A 30-day mortality was 39.5%. In a multivariate analysis, six independent factors were associated with a higher 30-day mortality: age (OR per 10 year increase: 1.78, 95% CI: 1.45-2.19), history of coronary artery disease (OR: 2.38, 95% CI: 1.41-4.30), history of chronic obstructive pulmonary disease (OR: 2.58, 95% CI: 1.27-5.25), SCAI class on admission (OR per one class increase: 1.64, 95% CI: 1.27-2.11), renal replacement therapy during in-hospital stay (OR: 2.46, 95% CI: 1.32-4.59) and new mechanical ventilation after admission (OR: 4.58, 95% CI: 2.50-8.39).</p><p><strong>Conclusions: </strong>AMI-CS still represents the most frequent cause of CS episodes. The in-hospital mortality of patients with CS remains high, despite frequent utilization of hemodynamic support and organ replacement therapies.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556230","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":"Moving forward one loss at a time.","authors":"Jonas Sundermeyer, Benedikt Schrage","doi":"10.1093/ehjacc/zuaf028","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf028","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482448","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":"Outcomes of Patients with Cancer Admitted with Heart Failure-Associated Cardiogenic Shock.","authors":"Olivia Liu, Steven Soo, Michelle Bloom, Jose Alvarez-Cardona, Jason N Katz, Richard K Cheng, Eric H Yang, Orly Leiva","doi":"10.1093/ehjacc/zuaf027","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf027","url":null,"abstract":"<p><strong>Background: </strong>Acute decompensated heart failure (HF) can progress to cardiogenic shock, and patients with cancer are at an increased risk of HF compared to patients without cancer. However, limited data exist on outcomes of patients admitted for HF-related cardiogenic shock (HF-CS) with cancer versus without cancer.</p><p><strong>Methods: </strong>Adult patients admitted for HF-CS between 2014-2020 were identified using the National Readmission Database. Propensity score matching (PSM) was used to match 1 patient with cancer to 10 patients without cancer. Primary outcomes were in-hospital death, major bleeding, and thrombotic complications. Exploratory outcomes were 90-day readmission rates among patients who survived initial hospitalization. Temporal trends were also explored.</p><p><strong>Results: </strong>Of 137,316 admissions for HF-CS, 7,306 (5.3%) had active cancer. After PSM, patients with cancer had increased odds of in-hospital death (OR 1.12, 95% CI 1.06 - 1.18), thrombotic complications (OR 1.12, 95% CI 1.03 - 1.21), and major bleeding (OR 1.23, 95% CI 1.17 - 1.31) compared to patients without cancer, with risks differing by cancer type. In exploratory analyses, rates of readmission were similar for patients with and without cancer. From 2014-2020, patients with cancer had no significant change in in-hospital mortality (ptrend = 0.43), while patients without cancer had decreased mortality over time (ptrend < 0.001).</p><p><strong>Conclusions: </strong>Among patients admitted for HF-CS, patients with cancer are at increased risk of in-hospital death, thrombotic complications, and major bleeding compared to patients without cancer. Future studies are needed to guide nuanced evaluation and management of this population to improve outcomes.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491386","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: Triphasic radial pulse in a patient with abdominal pain.","authors":"Jonathan Chun-Hei Cheung, Geoffrey Chi Chun Tang, Albert Kam Ming Chan","doi":"10.1093/ehjacc/zuae128","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae128","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482449","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":"EHJ ACVC where translational science meets care.","authors":"Pascal Vranckx, David Morrow, Sean van Diepen, Frederik H Verbrugge","doi":"10.1093/ehjacc/zuaf006","DOIUrl":"10.1093/ehjacc/zuaf006","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"57-58"},"PeriodicalIF":3.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964272","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: A mysterious cause of myocardial infarction: look beyond his coronary vessels.","authors":"Grace H T Kwok, Kevin K H Kam","doi":"10.1093/ehjacc/zuae117","DOIUrl":"10.1093/ehjacc/zuae117","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"123-125"},"PeriodicalIF":3.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046056","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":"Deep learning model for identifying acute heart failure patients using electrocardiography in the emergency room.","authors":"Jose Moon, Jong-Ho Kim, Soon Jun Hong, Cheol Woong Yu, Yong Hyun Kim, Eung Ju Kim, Jung-Joon Cha, Hyung Joon Joo","doi":"10.1093/ehjacc/zuaf001","DOIUrl":"10.1093/ehjacc/zuaf001","url":null,"abstract":"<p><strong>Aims: </strong>Acute heart failure (AHF) poses significant diagnostic challenges in the emergency room (ER) because of its varied clinical presentation and limitations of traditional diagnostic methods. This study aimed to develop and evaluate a deep learning model using electrocardiogram (ECG) data to enhance AHF identification in the ER.</p><p><strong>Methods and results: </strong>In this retrospective cohort study, we analysed the ECG data of 19 285 patients who visited ERs of three hospitals between 2016 and 2020; 9119 with available left ventricular ejection fraction and N-terminal prohormone of brain natriuretic peptide level data and who were diagnosed with AHF were included in the study. We extracted morphological and clinical parameters from ECG data to train and validate four machine learning models: baseline linear regression and more advanced models including XGBoost, Light GBM, and CatBoost. The CatBoost algorithm outperformed other models, showing superior area under the receiver operating characteristic and area under the precision-recall curve diagnostic accuracy across both internal (0.89 ± 0.01 and 0.89 ± 0.01) and external (0.90 and 0.89) validation data sets, respectively. The model demonstrated high accuracy, precision, recall, and f1 score, indicating robust performance in AHF identification.</p><p><strong>Conclusion: </strong>The developed machine learning model significantly enhanced AHF detection in the ER using conventional 12-lead ECGs combined with clinical data. These findings suggest that ECGs, a common tool in the ER, can effectively help screen for AHF.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"74-82"},"PeriodicalIF":3.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946763","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}