European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Development and external validation of a deep learning electrocardiogram model for risk stratification of coronary revascularization need in the emergency department.","authors":"Konstantin A Krychtiuk, Alessandro Sionis","doi":"10.1093/ehjacc/zuaf058","DOIUrl":"10.1093/ehjacc/zuaf058","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"240-242"},"PeriodicalIF":3.9,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794852","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":"End-of-life issues in the intensive therapy unit: 10 important points to remember.","authors":"Jean-Louis Vincent","doi":"10.1093/ehjacc/zuaf011","DOIUrl":"10.1093/ehjacc/zuaf011","url":null,"abstract":"<p><p>End-of-life (EOL) issues have become increasingly common in intensive therapy units (ITUs), largely due to advances in critical care that enable patients to be kept alive for extended periods. Death in the ITU now generally follows an EOL decision, which can pose ethical, emotional, and practical challenges. Our approach to such issues should be based on adherence to the four bioethical principles - autonomy, beneficence, non-maleficence, and distributive justice - as well as the concept of proportionate care, and requires careful and effective communication with the whole ITU team, including the patient and their family. In this article, we discuss 10 key considerations related to EOL care in the ITU, in an attempt to highlight some critical aspects of EOL decision-making for intensivists navigating this sensitive and multifaceted area of practice.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"245-249"},"PeriodicalIF":3.9,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002573","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":"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":"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":"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}

{"title":"Long-term outcomes after acute kidney injury in myocardial infarction complicated by cardiogenic shock - a retrospective, observational study.","authors":"Maria Bjørn, Joakim Bo Kunkel, Ole Helgestad, Jakob Josiassen, Karoline Korsholm Jeppesen, Lene Holmvang, Lisette Okkels Jensen, Henrik Schmidt, Emil Fosbøl, Christian Hassager, Jacob Eifer Møller, Hanne Berg Ravn","doi":"10.1093/ehjacc/zuaf048","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf048","url":null,"abstract":"<p><strong>Background: </strong>The recent DanGer shock trial found reduced mortality, but increased risk of acute kidney injury (AKI) in patients treated with a microaxial flow pump after an acute myocardial infarct with cardiogenic shock. AKI has previously been associated with increased short-term mortality, whereas data on long-term outcomes are sparse. We aimed to describe the frequency of AKI and associated risk factors as well as long-term mortality and morbidity.</p><p><strong>Methods: </strong>A retrospective observational study comprising patients admitted with acute myocardial infarction cardiogenic shock in Denmark between 2010-2017 with data on kidney function from the RETROSHOCK cohort. National health registry data enabled 10-year follow-up to assess mortality and morbidity. Kaplan-Meier estimates and competing risks regression were used to evaluate the association of AKI with the incidence of short- and long-term mortality, chronic kidney disease and dialysis.</p><p><strong>Results: </strong>Among 1473 patients, 44% developed acute kidney injury, 25% required renal replacement therapy. AKI development was associated with increasing age, diabetes, low ejection fraction and high lactate levels on admission (p<0.05).30-days mortality as well as mortality at 1-, 5- and 10-years follow-up was significantly increased in patients with AKI; at 10 years follow-up mortality was increased by more than 30% (p<0.001). The 10-year cumulative incidence of both chronic kidney disease and dialysis, accounting for the competing risk of death, was significantly higher in patients treated with RRT during admission (p< 0.001).</p><p><strong>Conclusions: </strong>Acute kidney injury was associated with increased short- and long-term mortality and morbidity, including chronic kidney disease and dialysis, but not new cardiovascular events.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751158","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}