European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Comparison of cardiac troponin assays reveals assay-specific sensitivities in a clinical model of very acute myocardial injury.","authors":"Julius Obergassel, Marc D Lemoine, Laura C Sommerfeld, Jan L Rieß, Salah Al-Aqili, Sandro J Jäckle, Laura Rottner, Andreas Rillig, Andreas Metzner, Nils A Sörensen, Larissa Fabritz, Thomas Renné, Raphael Twerenbold, Stefan Blankenberg, Tanja Zeller, Paulus Kirchhof, Johannes T Neumann","doi":"10.1093/ehjacc/zuaf064","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf064","url":null,"abstract":"<p><strong>Background: </strong>High-sensitivity cardiac troponin (hs-cTn) assays indicating myocardial injury are critical for the diagnosis of acute myocardial infarction (AMI), but their use to differentiate between acute and chronic myocardial injury is limited. This study aimed to assess the differential utility of three hs-cTn assays, targeting different troponin epitopes (proximal and/or central), to detect myocardial injury in a clinical model of acute myocardial injury by left-atrial ablation.</p><p><strong>Methods: </strong>First, pre- and post-procedural serum samples were prospectively collected from 158 patients undergoing pulmonary vein isolation in a standardised setting. cTn-concentrations were measured using the high-sensitive Architect-cTnI-, Atellica-IM-cTnI-, and Elecsys-cTnT-assays. cTnI/T-concentrations and -ratios were compared, also to established AMI rule-in-thresholds. Second, 48 patients in which hs-cTn measurements were performed in clinical routine after ablation with a clinical indication were assessed for correlations between hs-cTn-levels, symptoms and electrocardiogram changes.</p><p><strong>Results: </strong>The Atellica-assessed cTnI showed a doubled relative pre-to-post-procedural concentration-increase compared to Architect-cTnI (39.6-fold versus 20.5-fold; p=0.0036). The Atellica-hs-cTnI/T-ratio had a 2.5 [95%-CI 1.1,5.2] relative increase, while the Architect-cTnI-to-Elecsys-cTnT-ratio showed a 6.9 [95%-CI 2.3,11.8] relative increase (p<0.0001). In 78% of patients, at least one post-procedural cTn-concentration exceeded AMI rule-in-thresholds. Chronic kidney disease predicted higher pre-to-post-increases. In retrospectively analyzed routine cTn-assessments after ablation, cTn-levels after ablation did not correlate with neither symptoms, electrocardiogram changes nor angiography findings.</p><p><strong>Conclusions: </strong>The Atellica-assay demonstrated enhanced sensitivity for very acute myocardial injury, likely via its additional recognition of the proximally located cTnI epitope. This suggests its potential to improve differentiation of acute from chronic myocardial injury, warranting further investigation to confirm its clinical utility in that setting.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987498","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":"Model for End-Stage Liver Disease incorporating albumin score is associated with short- and long-term all-cause mortality in patients with acute myocardial infarction complicated by cardiogenic shock.","authors":"Zakaria Alaoui-Ismaili, Joakim Bo Kunkel, Anika Klein, Jakob Josiassen, Ole Kristian Lerche Helgestad, Karoline Korsholm Jeppesen, Henrik Schmidt, Lene Holmvang, Peter Laursen Graversen, Emil Fosbøl, Hanne Berg Ravn, Lisette Okkels Jensen, Jacob Eifer Møller, Christian Hassager","doi":"10.1093/ehjacc/zuaf063","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf063","url":null,"abstract":"<p><strong>Background: </strong>Liver injury is a frequent complication in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS). The Model for End-Stage Liver Disease incorporating albumin (MELD-albumin) quantifies liver injury. This study assesses the association between MELD-albumin score and all-cause mortality among patients with AMICS.</p><p><strong>Methods and results: </strong>From a retrospective cohort of 1716 consecutive AMICS patients admitted between 2010 and 2017, we included patients who survived until day 3 and had complete laboratory data available (N=717). MELD-albumin was calculated using 0 to 72-hour peak s-bilirubin and s-creatinine values and the lowest s-albumin value. Patients were stratified into tertiles low, intermediate, and high MELD-albumin. The primary outcome was all-cause mortality with a follow-up of up to 14 years.Patients in the high score group were more often female, had lower left ventricular ejection fraction, higher lactate levels, and less suffered out-of-hospital cardiac arrest. The high score group had a significantly higher all-cause mortality rate than the intermediate and low score group at 30 days (49 vs. 35 vs. 26%, p<0.001) and 10 years for 30-day survivors (58 vs. 46 vs. 37%, p<0.001). Adjusted hazard ratios for mortality in the high score group were 2.02 at 30 days (95% CI: 1.49-2.74, p<0.001) and 1.86 at 10 years (95% CI: 1.18-2.92, p<0.001). The MELD-albumin score demonstrated an area under the receiver operating curve of 0.63 (95% CI: 0.59-0.67) for predicting 30-day mortality.</p><p><strong>Conclusions: </strong>Liver injury, quantified as MELD-albumin score, was significantly associated with short- and long-term all-cause mortality among AMICS patients.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988819","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":"Decongestion strategies in Acute Heart Failure: contrasting opinions from two leading experts.","authors":"Alessandro Galluzzo, Janine Pöss, Frederik H Verbrugge","doi":"10.1093/ehjacc/zuaf059","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf059","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958920","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":"Rapid Response Letter.","authors":"Colin Berry, Richard Good","doi":"10.1093/ehjacc/zuaf061","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf061","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964871","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":"Machine learning to optimise 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":"https://doi.org/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: </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.</p><p><strong>Results: </strong>Fourteen studies from 12 countries provided individual patient-level data in 8,493 patients for BNP and 3,899 patients for MR-proANP, in whom, 48.3% (4,105/8,493) and 41.3% (1,611/3,899) 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 individualised diagnosis.</p><p><strong>Study registration: </strong>PROSPERO number, CRD42019159407.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Management of Acute myocarditis in daily practice: an expert practical view.","authors":"Mathieu Kerneis, Enrico Ammirati, Clément Delmas, Ward Heggermont, Stephane Heymans, Max Lenz, Rosalinda Madonna, Marco Morosin, Hannah Schaubroeck, Alessandro Sionis, Gal Tsaban, Jamol Uzokov, Katarine Vardanyan, Christophe Vandenbriele, François Roubille","doi":"10.1093/ehjacc/zuaf057","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf057","url":null,"abstract":"<p><strong>Background: </strong>Acute Myocarditis (AM) encompasses a broad spectrum of clinical presentations and causes. Despite the recent advances in cardiovascular imaging, pathology, virology and genetics, specific therapies are still lacking.</p><p><strong>Purpose: </strong>This collaborative review aims to analyze the current evidence to answer practical questions that physicians may face during the early management of patients presenting with an acute form of the disease, complicated or not.This review analyzes current evidence to address practical questions posed by acute cardiovascular physicians during the early management of acute, often fulminant, myocarditis.</p><p><strong>Methods and results: </strong>Based on the current literature, this review provides a step-by-step approach to treat AM patients from their admission in the cardiac intensive care unit (CICU) to discharge, by answering 10 clinical questions: Might this patient be suffering from an AM? Should I hospitalize this patient and, if so, where? Which cardiac imaging exam should I perform and what can I learn from it? Is this patient requiring an EMB? What should the non-invasive etiological work-up be? Is his episode of AM of viral, toxic, or other origin? Does this patient need specific treatments or mechanical circulatory support? Is there an indication for guideline-directed medical heart failure treatment? When can the patient be discharged and resume physical activity? Notably, this review highlights the need to build a multidisciplinary response team to address the many diagnostic and therapeutic challenges of AM patients. It also points out the lack of evidence to guide treatment of these patients.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810866","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":"Bringing Heart Care Home: Management of Acute Cardiovascular Pathologies in the Home Hospital.","authors":"Abraham M Cherukara, Lawrence Rudski, Michelle Grinman, David M Levine","doi":"10.1093/ehjacc/zuaf053","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf053","url":null,"abstract":"<p><p>The Home Hospital (HH) model delivers hospital-level acute care in patients' homes, offering a scalable, patient-centered alternative to traditional brick-and-mortar (BAM) facilities. By integrating multidisciplinary teams, remote monitoring, and tailored interventions, HH reduces hospital length of stay, enhances patient satisfaction, and lowers healthcare costs. Despite these benefits, universally established diagnosis-specific management guidelines remain limited, leading to variability in care delivery. Current practices rely on clinical experience and governing protocols, but structured HH pathways must be developed based on system-dependent resources and infrastructure. Standardizing care in HH will allow to ensure patient safety, optimize clinical outcomes, and expand access to acute care beyond conventional hospital settings. This article outlines a blueprint for acute cardiac care in HH, focusing on heart failure, atrial arrhythmias, and venous thromboembolism while emphasizing the critical role of patient selection, recruitment strategies, management protocols, and escalation criteria.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771612","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: 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/zuae130","DOIUrl":"https://doi.org/10.1093/ehjacc/zuae130","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763471","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":"Letter to the Editor related to \"An uncommon electrocardiogram pattern in a case of acute chest pain\" by Gulbadin Mufti, Shahid H. Shali, and A. Shaheer Ahmed.","authors":"Gheorghe-Andrei Dan","doi":"10.1093/ehjacc/zuaf050","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf050","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763476","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":"https://doi.org/10.1093/ehjacc/zuaf049","url":null,"abstract":"<p><strong>Background: </strong>Paediatric acute heart failure (AHF) differs from adult cases, and less numerous population limits research aimed at improving clinical practice and prognosis.</p><p><strong>Aims: </strong>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: </strong>This single-centre retrospective cohort study included 162 consecutive paediatric patients hospitalised 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 either EF deterioration, ≤5% EF improvement, or death during hospitalisation (n=47).</p><p><strong>Results: </strong>The study contained 58% males and 42% females. The median age was 1 (IQR 0-8) year, 14 (IQR 2-101) months. The mortality rate was 12.3%. AHF 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 [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)], 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>Conclusions: </strong>AHF with systolic dysfunction in children has an unfavourable prognosis, however most patients improved during hospitalisation. 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":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-02","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}