European Heart Journal: Acute Cardiovascular Care最新文献

{"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}

{"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":"10.1093/ehjacc/zuaf057","url":null,"abstract":"<p><p>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. This collaborative review aims to analyse 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 analyses current evidence to address practical questions posed by acute cardiovascular physicians during the early management of acute, or potentially, myocarditis. 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 aetiological work-up be? Is her/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 the treatment of these patients.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"420-431"},"PeriodicalIF":4.6,"publicationDate":"2025-08-06","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":"Question: 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/zuaf031","DOIUrl":"10.1093/ehjacc/zuaf031","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"434-435"},"PeriodicalIF":4.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495331","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 kidney as sensitive marker of disease severity in cardiogenic shock after myocardial infarction.","authors":"Kevin Damman, Stijn Legtenberg, Jozine M Ter Maaten","doi":"10.1093/ehjacc/zuaf095","DOIUrl":"10.1093/ehjacc/zuaf095","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"392-393"},"PeriodicalIF":4.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612070","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":"Zero-hour thresholds to risk stratify patients for acute myocardial infarction using a point-of-care high-sensitivity troponin assay.","authors":"Jaimi H Greenslade, William Parsonage, Niranjan Gaikwad, Laura Stephensen, Emily Brownlee, Ellyse McCormick, Emma J Hall, Megan Van Niekerk, Maryam Khorramshahi Bayat, Ehsan Mahmoodi, Louise Cullen","doi":"10.1093/ehjacc/zuaf068","DOIUrl":"10.1093/ehjacc/zuaf068","url":null,"abstract":"<p><strong>Aims: </strong>High-sensitivity cardiac troponin (hs-cTn) assays are crucial in assessing suspected myocardial infarction (MI). International recommendations recommend evaluating new assays to identify metrics for clinical use. Our primary aim was to identify patients at low risk of index MI using a point of care hs-cTnI (Abbott i-STAT® hs-TnI) assay at presentation. We also sought to examine the diagnostic accuracy of a single value for identifying patients at high risk for acute MI.</p><p><strong>Methods and results: </strong>This prospective multicentre observational trial enrolled patients with suspected acute coronary syndrome. Nine hundred sixty-seven patients had blood drawn on presentation to the emergency department for hs-cTnI measurement. The primary outcome was index MI including type one or two non-ST segment elevation MI. Diagnostic accuracy statistics were calculated at a range of hs-cTnI values. 5.6% of patients met the criteria for MI. A cut-off <8 ng/L was the highest threshold to achieve an negative predictive value >99.5%. This threshold had a sensitivity of 94.4% (95% CI: 84.6-98.8%). An hs-cTnI concentration of <5 ng/L provided a sensitivity of 100% (95% CI: 93.4-100.0%). For identifying high-risk patients, the positive predictive value (PPV) is the highest at a troponin of >60 ng/L (68.3%, 95% CI: 51.9-81.9%). A PPV of 50% (95% CI: 38.0-62.0%) is achieved at a cut-off of >25 ng/L.</p><p><strong>Conclusion: </strong>This study identified two hs-cTnI thresholds (<5 ng/L or <8 ng/L) to identify patients at low risk and two thresholds (>25 ng/L and >60 ng/L) to identify patients at high risk for MI. Our findings provide promise for improving care in rural and inner-city medical settings.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"412-419"},"PeriodicalIF":4.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974144","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}