European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Lactate dynamics and metabolic differences in cardiogenic shock across clinical contexts.","authors":"Johannes Grand","doi":"10.1093/ehjacc/zuaf074","DOIUrl":"10.1093/ehjacc/zuaf074","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"432-433"},"PeriodicalIF":4.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093203","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":"Left ventricular-arterial coupling and mortality in the cardiac intensive care unit.","authors":"Luca Fazzini, Mitchell R Padkins, Kristoffer Berg-Hansen, Mauro Gori, Garvan C Kane, Dustin B Hillerson, Guido Tavazzi, Yogesh N V Reddy, Oh K Jae, Barry Borlaug, Jacob C Jentzer","doi":"10.1093/ehjacc/zuaf038","DOIUrl":"10.1093/ehjacc/zuaf038","url":null,"abstract":"<p><strong>Aims: </strong>Left ventricular (LV) ventricular-arterial coupling (VAC) refers to the ratio of afterload (effective arterial elastance) to contractility (end-systolic elastance) as an integrated marker of cardiac performance. We sought to determine whether the echocardiographic VAC ratio, defined using the ratio of LV end-systolic volume (LVESV) to stroke volume (SV), predicted mortality in the cardiac intensive care unit (CICU).</p><p><strong>Methods and results: </strong>Mayo Clinic CICU patients from 2007 and 2018 were included. Ventricular-arterial coupling ratio was calculated as the Teichholz LVESV divided by the SV calculated from LV outflow tract Doppler. The primary outcome was in-hospital mortality and the secondary outcome was all-cause 1-year mortality. A total of 4685 patients were included with a median age of 69 (58, 79) years (37.2% females), with acute coronary syndrome in 54.9% and heart failure in 49.0%. A higher VAC ratio was associated with greater severity of illness, worse echocardiographic findings, and more use of critical care therapies. A total of 329 (7%) patients died during hospitalization. Patients with a higher VAC ratio had higher in-hospital mortality overall and in each admission diagnosis subgroup. After multivariable adjustment, patients with a VAC ratio >2 were at higher risk of in-hospital mortality (adjusted odds ratio 1.63, 95% confidence interval 1.17-2.28, P = 0.010). One-year mortality was higher for patients with a higher VAC ratio, especially VAC >2.</p><p><strong>Conclusion: </strong>Ventricular-arterial uncoupling was associated with worse outcomes in an unselected CICU cohort. The echocardiographic VAC ratio is a simple non-invasive bedside measure that can be used for risk prediction in the CICU.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"394-402"},"PeriodicalIF":4.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613969","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":"10.1093/ehjacc/zuaf048","url":null,"abstract":"<p><strong>Aims: </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 and results: </strong>A retrospective observational study comprising patients admitted with acute myocardial infarction cardiogenic shock in Denmark between 2010 and 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 (CKD) and dialysis. Among 1473 patients, 44% developed AKI, 25% required renal replacement therapy (RRT). AKI development was associated with increasing age, diabetes, low ejection fraction and high lactate levels on admission (P < 0.05). Thirty-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 CKD 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>Conclusion: </strong>AKI was associated with increased short- and long-term mortality and morbidity, including CKD and dialysis, but not new cardiovascular events.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"385-391"},"PeriodicalIF":4.6,"publicationDate":"2025-08-06","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}

{"title":"First chapter of the 2025 ACVC Clinical Decision-Making Toolkit: pulmonary embolism-an interview with Ass. Prof. Umit Yasar Sinan and Prof. Stavros Konstantinides.","authors":"Alessandro Galluzzo, Janine Pöss","doi":"10.1093/ehjacc/zuaf076","DOIUrl":"10.1093/ehjacc/zuaf076","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"438-439"},"PeriodicalIF":4.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157464","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":"Bright days, critical decisions: evolving strategies in cardiogenic shock and OMI.","authors":"Pascal Vranckx, David Morrow, Sean van Diepen, Frederik H Verbrugge","doi":"10.1093/ehjacc/zuaf091","DOIUrl":"10.1093/ehjacc/zuaf091","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"383-384"},"PeriodicalIF":4.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658759","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":"Hypertensive vs normotensive blood pressure response to advanced conduction disorders -comparison of baseline non-invasive hemodynamic evaluation.","authors":"Katia Orvin, Shelly Vons, Alon Barsheshet, Ciel Zehavi, Gregory Golovchiner, Georgy Rusadze, Ori Rahat, Ran Kornowski, Tsahi T Lerman, Aharon Erez","doi":"10.1093/ehjacc/zuaf103","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf103","url":null,"abstract":"<p><strong>Aims: </strong>Patients with advanced conduction disorders exhibit diverse hemodynamic profiles, from cardiogenic shock to severe hypertension. Peripheral vascular resistance (PVR) significantly contributes to compensatory mechanisms during bradycardia. This study aimed to assess the hemodynamic responses of patients presenting with high-degree atrioventricular (AV) block.</p><p><strong>Methods and results: </strong>We retrospectively analyzed 261 consecutive patients with advanced conduction disorders who underwent pacemaker implantation from October 2020 to December 2022. Patients were classified into three groups: normotensive (<160 mmHg), hypertensive (≥160 mmHg), and unstable (requiring emergent temporary pacing). Additionally, 73 stable patients underwent non-invasive hemodynamic assessment. Of 261 patients, 99 (37.9%) were normotensive, 118 (45.2%) hypertensive, and 44 (16.9%) unstable. Hypertensive patients frequently had hypertension history (77.1%), presented with higher escape rhythms (39.1± 6.7 vs 31.5± 10.4 and 38.1± 9.9 in unstable and normotensive patients respectively) and exhibited higher ejection fractions (58.2±8 vs 53.2±12 and 53.9±11 respectively). They demonstrated fewer low cardiac output signs, including acute kidney injury and elevated lactate levels. PVR was significantly elevated in the hypertensive group. The unstable group experienced the highest 30-day mortality and higher 1-year mortality, though the latter did not reach statistical significance. Factors independently associated with a hypertensive response included higher heart rate, higher ejection fraction, and calcium channel blocker pretreatment.</p><p><strong>Conclusion: </strong>Hemodynamic presentations in high-degree AV block are heterogeneous. A hypertensive response represents a distinct clinical phenotype characterized by preserved cardiac function, higher escape rhythms, increased PVR, and fewer end-organ hypoperfusion signs.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783818","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 of recurrent myocardial infarction: a nationwide Danish study.","authors":"Daniel Mølager Christensen, Deewa Zahir, Caroline Hartwell Garred, Nina Nouhravesh, Mariam Elmegaard, Morten Malmborg, Caroline Sindet-Pedersen, Abdullahi Ahmed Mohamed, Mohamad El-Chouli, Emil Fosbøl, Charlotte Andersson, Marc A Pfeffer, Lars Køber, Morten Schou","doi":"10.1093/ehjacc/zuaf101","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf101","url":null,"abstract":"<p><strong>Background: </strong>During the past decades outcomes of first-time myocardial infarction (MI) have improved substantially. However, it is unknown if the prognosis following a recurrent MI has also improved similarly.</p><p><strong>Methods: </strong>We conducted a nationwide registry-based study including all patients with first-time recurrent MI in Denmark during 2003 to 2022. Cumulative incidences and standardized risk ratios (sRR) of mortality, hospitalization for heart failure (HHF), and subsequent recurrent MI were reported along with stratified analyses by age, sex, and HF status at baseline.</p><p><strong>Results: </strong>A total of 24,799 patients with recurrent MI were identified. Between 2003-07 (N=7,368) and 2018-22 (N=4,928), their median age decreased from 75 to 73 years. The prevalence of non-cardiovascular comorbidities increased. The use of lipid-lowering treatment at baseline increased (53.7% to 76.6%), as well as procedures performed in relation to recurrent MI (coronary angiogram, 41.2% to 77.4%; percutaneous coronary intervention, 26.8% to 54.0%). 5-year mortality decreased from 54.1% to 37.3% (sRR: 0.78 [0.74-0.82]), 5-year incidence of HHF decreased from 13.6% to 11.7% (sRR: 0.76 [0.68-0.84]), and 5-year incidence of subsequent recurrent MI decreased from 23.4% to 17.7% (sRR: 0.65 [0.52-0.78]). While mortality and subsequent recurrent MI decreased consistently across subgroups, stratified analyses revealed that the 5-year incidence of HHF increased from 23.9% to 26.2% in patients with previous HF and from 14.3% to 15.9% in males aged ≥75 years.</p><p><strong>Conclusions: </strong>Mortality has decreased in parallel with intensified pharmacologic and invasive management of patients with recurrent MI. However, there has been little improvement in heart failure hospitalizations, underscoring that directed preventive strategies are needed to mitigate the heart failure risk in patients with recurrent MI.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759525","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":"Prevalence and prognostic impact of subclinical venous congestion in patients hospitalized for acute heart failure.","authors":"Sara Lozano-Jiménez, Cristina García Sebastian, Paula Vela Martín, Belén García Magallón, Alba Martín Centellas, Daniel de Castro, Cristina Mitroi, Susana Del Prado Díaz, Francisco José Hernández-Pérez, Marta Jiménez-Blanco Bravo, Marta Cobo-Marcos, Manuel Gómez-Bueno, José Luis Zamorano Gómez, Javier Segovia Cubero, Jesús Álvarez-García, Mercedes Rivas-Lasarte","doi":"10.1093/ehjacc/zuaf097","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf097","url":null,"abstract":"<p><strong>Background: </strong>Congestion is a major cause of hospitalisation in patients with heart failure (HF) and the persistence of congestive signs at discharge is a robust predictor of early readmission. Currently, there is increasing interest in the comprehensive assessment of subclinical congestion, as it can increase residual risk in individuals who appear to be euvolemic. Our aim was to investigate the prevalence and prognostic impact of subclinical venous congestion assessed by ultrasound.</p><p><strong>Methods: </strong>This is a two-centre, prospective observational study. Patients admitted for HF between June 2021 and March 2023 were selected. Clinical (physical examination) and subclinical venous congestion [Venous Excess Ultrasound score (VExUS)] were assessed. The prognostic impact was assessed through a composite endpoint of death from any cause, HF readmissions, or unscheduled visits requiring intravenous diuretic administration at 6-month follow-up.</p><p><strong>Results: </strong>120 patients were included (62% male, mean age 75±15 years). Congestion parameters decreased during hospitalisation but tended to worsen at the first outpatient visit. At discharge, 24% showed subclinical venous congestion. This group had a significantly higher incidence of adverse outcomes, comparable to those with overt clinical congestion. Subclinical congestion was an independent predictor of the composite endpoint (HR 2.84; 95% CI: 1.01-8.01, p value=0.048) after adjustment for age, chronic kidney disease, NYHA class at admission, and NT-proBNP level at discharge.</p><p><strong>Conclusions: </strong>Clinical and subclinical congestion decreased during hospitalisation but worsened shortly after discharge. A quarter of patients had residual venous congestion which was associated with a worse prognosis at 6 months.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689654","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":"Artificial intelligence-enhanced ECG detection of acute coronary occlusion in chest pain patients with ST-elevation in lead aVR - A direct comparison to conventional ECG criteria.","authors":"Johannes Terporten, Max Maria Meertens, Sebastian Heyne, Victor Mauri, Karl Finke, Stephan Baldus, Christoph Adler, Samuel Lee, Sascha Macherey-Meyer","doi":"10.1093/ehjacc/zuaf096","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf096","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590761","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":"Cardiovascular and non-cardiovascular mortality at 5 years in patients with type 1 and type 2 myocardial infarction.","authors":"Caelan Taggart, Alexander J F Thurston, Deepak Harry, Yong Yong Tew, Ryan Wereski, Michael McDermott, Kuan Ken Lee, Atul Anand, Nicholas L Mills, Annemarie Docherty, Andrew R Chapman","doi":"10.1093/ehjacc/zuaf085","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf085","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575099","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}