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From medical therapy to mechanical support: strategies for device selection and implantation techniques. 从药物治疗到机械支持：设备选择和植入技术策略。
IF 1.6 4区 医学
European Heart Journal Supplements Pub Date : 2023-12-13 eCollection Date: 2023-12-01 DOI: 10.1093/eurheartjsupp/suad128
Letizia F Bertoldi, Andrea Montisci, Dirk Westermann, Mario Iannaccone, Vasileios Panoulas, Nikos Werner, Norman Mangner
{"title":"From medical therapy to mechanical support: strategies for device selection and implantation techniques.","authors":"Letizia F Bertoldi, Andrea Montisci, Dirk Westermann, Mario Iannaccone, Vasileios Panoulas, Nikos Werner, Norman Mangner","doi":"10.1093/eurheartjsupp/suad128","DOIUrl":"https://doi.org/10.1093/eurheartjsupp/suad128","url":null,"abstract":"<p><p>Cardiogenic shock (CS) is a complex clinical syndrome with a high risk of mortality. The recent, rapid development of temporary mechanical circulatory support (tMCS) has altered CS treatment. While catecholamines remain the cornerstone of CS therapy, tMCS usage has increased. According to shock severity, different treatment strategies including catecholamines alone, catecholamines and tMCS, or multiple tMCS might be used. State-of-the-art implantation techniques are necessary to avoid complications linked to the invasive nature of tMCS. In particular, bleeding and access-site complications might counteract the potential haemodynamic benefit of a percutaneous ventricular assist device. In this review, we describe the role of catecholamines in CS treatment and present the different tMCS devices with an explanation on how to use them according to CS aetiology and severity. Finally, an overview of the best practice for device implantation is provided.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"25 Suppl I","pages":"I11-I18"},"PeriodicalIF":1.6,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138799241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Glimpse into the future. 未来一瞥
IF 1.7 4区 医学
European Heart Journal Supplements Pub Date : 2023-12-13 eCollection Date: 2023-12-01 DOI: 10.1093/eurheartjsupp/suad133
Jacob Eifer Moller, Norman Mangner, Federico Pappalardo, Holger Thiele
{"title":"Glimpse into the future.","authors":"Jacob Eifer Moller, Norman Mangner, Federico Pappalardo, Holger Thiele","doi":"10.1093/eurheartjsupp/suad133","DOIUrl":"10.1093/eurheartjsupp/suad133","url":null,"abstract":"<p><p>Randomized studies attempting to prove benefit of mechanical circulatory support in cardiogenic shock have failed to reduce the risk of death. Further, both registry and randomized data suggest increased rates of serious complications associated with these devices. This last review in the supplement discusses current evidence and provides a perspective on how the scientific community could advance cardiogenic shock research focused on mechanical circulatory support.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"25 Suppl I","pages":"I44-I48"},"PeriodicalIF":1.7,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138799245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Recognizing patients as candidates for temporary mechanical circulatory support along the spectrum of cardiogenic shock. 根据心源性休克的不同阶段，识别出适合使用临时机械循环支持的患者。
IF 1.6 4区 医学
European Heart Journal Supplements Pub Date : 2023-12-13 eCollection Date: 2023-12-01 DOI: 10.1093/eurheartjsupp/suad127
Andrea Montisci, Vasileios Panoulas, Alaide Chieffo, Carsten Skurk, Andreas Schäfer, Nikos Werner, Luca Baldetti, Nicoletta D'Ettore, Federico Pappalardo
{"title":"Recognizing patients as candidates for temporary mechanical circulatory support along the spectrum of cardiogenic shock.","authors":"Andrea Montisci, Vasileios Panoulas, Alaide Chieffo, Carsten Skurk, Andreas Schäfer, Nikos Werner, Luca Baldetti, Nicoletta D'Ettore, Federico Pappalardo","doi":"10.1093/eurheartjsupp/suad127","DOIUrl":"https://doi.org/10.1093/eurheartjsupp/suad127","url":null,"abstract":"<p><p>A growing body of evidence indicates that the benefits of temporary mechanical circulatory support (tMCS) in patients with cardiogenic shock (CS) is dependent on its aetiology and timing of implantation. As such, appropriate diagnosis, screening, selection, and treatment is crucial to achieving good outcomes with tMCS. Here, the latest guidance on CS phenotypes and diagnostics for correctly identifying tMCS candidates is discussed. This includes comprehensive overviews of patient screening with attention given to differences in CS presentation between the sexes, and contraindications for mechanical circulatory support.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"25 Suppl I","pages":"I3-I10"},"PeriodicalIF":1.6,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138799262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Timing and treatment strategies according to SCAI classification in cardiogenic shock. 根据 SCAI 分级确定心源性休克的时机和治疗策略。
IF 1.6 4区 医学
European Heart Journal Supplements Pub Date : 2023-12-13 eCollection Date: 2023-12-01 DOI: 10.1093/eurheartjsupp/suad129
Giuseppe Tarantini, Giulia Masiero, Holger Thiele, Mario Iannaccone, Benedikt Schrage, Christian Hassager, Felix Woitek, Alaide Chieffo, Jacob Eifer Møller
{"title":"Timing and treatment strategies according to SCAI classification in cardiogenic shock.","authors":"Giuseppe Tarantini, Giulia Masiero, Holger Thiele, Mario Iannaccone, Benedikt Schrage, Christian Hassager, Felix Woitek, Alaide Chieffo, Jacob Eifer Møller","doi":"10.1093/eurheartjsupp/suad129","DOIUrl":"https://doi.org/10.1093/eurheartjsupp/suad129","url":null,"abstract":"<p><p>In patients with cardiogenic shock (CS), particularly those with acute myocardial infarction (AMI), evidence suggests that timely diagnosis and treatment interventions are critical in the prevention of haemo-metabolic compromise. Temporary mechanical circulatory support (tMCS) has shown potential in facilitating revascularization and recovery of patients with acute myocardial infarction cardiogenic shock (AMI-CS). Timing of treatment strategies for CS patients needs to be optimized for use of tMCS devices that are applicable to this heterogeneous patient population. Here, the latest evidence as well as the gaps in knowledge surrounding the role of time in the management of patients with CS is summarized.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"25 Suppl I","pages":"I19-I23"},"PeriodicalIF":1.6,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138799263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
From escalation to weaning strategies: how to integrate the ECMELLA concept. 从升级策略到断奶策略：如何整合ECMELLA概念。
IF 1.7 4区 医学
European Heart Journal Supplements Pub Date : 2023-12-13 eCollection Date: 2023-12-01 DOI: 10.1093/eurheartjsupp/suad132
Benedikt Schrage, Alexander Bernhardt, Evgenij Potapov, Letizia F Bertoldi, Norman Mangner
{"title":"From escalation to weaning strategies: how to integrate the ECMELLA concept.","authors":"Benedikt Schrage, Alexander Bernhardt, Evgenij Potapov, Letizia F Bertoldi, Norman Mangner","doi":"10.1093/eurheartjsupp/suad132","DOIUrl":"10.1093/eurheartjsupp/suad132","url":null,"abstract":"<p><p>The additional implantation of a micro-axial flow pump (mAFP) in patients receiving extracorporeal life support by a veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for cardiogenic shock (CS) has gained interest in recent years. Thus far, retrospective propensity score-matched studies, case series, and meta-analyses have consistently shown an improved survival in patients treated with the so-called ECMELLA concept. The pathophysiological context is based on the modification of V-A ECMO-related side effects and the additive benefit of myocardial unloading. From this point of view, knowledge and detection of these pathophysiological mechanisms are of utmost importance to successfully manage mechanical circulatory support in CS. In this article, we describe best practices for the indication of the two devices as well as escalation and de-escalation approaches including implantation and explantation strategies that are key for success.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"25 Suppl I","pages":"I39-I43"},"PeriodicalIF":1.7,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138799237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Monitoring MCS patients on the intensive care unit: integrating haemodynamic assessment, laboratory data, and imaging techniques for timely detection of deterioration and recovery. 监测重症监护室中的多发性硬化症患者：整合血液动力学评估、实验室数据和成像技术，及时发现病情恶化和恢复情况。
IF 1.6 4区 医学
European Heart Journal Supplements Pub Date : 2023-12-13 eCollection Date: 2023-12-01 DOI: 10.1093/eurheartjsupp/suad130
Christophe Vandenbriele, Luca Baldetti, Alessandro Beneduce, Jan Belohlavek, Christian Hassager, Marina Pieri, Amin Polzin, Anna Mara Scandroglio, Jacob Eifer Møller
{"title":"Monitoring MCS patients on the intensive care unit: integrating haemodynamic assessment, laboratory data, and imaging techniques for timely detection of deterioration and recovery.","authors":"Christophe Vandenbriele, Luca Baldetti, Alessandro Beneduce, Jan Belohlavek, Christian Hassager, Marina Pieri, Amin Polzin, Anna Mara Scandroglio, Jacob Eifer Møller","doi":"10.1093/eurheartjsupp/suad130","DOIUrl":"https://doi.org/10.1093/eurheartjsupp/suad130","url":null,"abstract":"<p><p>Monitoring of the patient supported with a temporary mechanical circulatory support (tMCS) is crucial in achieving the best possible outcome. Monitoring is a continuous and labour-intensive process, as cardiogenic shock (CS) patients can rapidly deteriorate and may require new interventions within a short time period. Echocardiography and invasive haemodynamic monitoring form the cornerstone of successful tMCS support. During monitoring, it is particularly important to ensure that adequate end-organ perfusion is achieved and maintained. Here, we provide a comprehensive overview of best practices for monitoring the CS patient supported by a micro-axial flow pump, veno-arterial extracorporeal membrane oxygenation, and both devices simultaneously (ECMELLA approach). It is a complex process that encompasses device control, haemodynamic control and stabilization, monitoring of interventions, and assessment of end-organ function. The combined, continuous, and preferably protocol-based approach of echocardiography, evaluation of biomarkers, end-organ assessment, and haemodynamic parameters is crucial in assessing this critically ill CS patient population.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"25 Suppl I","pages":"I24-I31"},"PeriodicalIF":1.6,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138799257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Appropriate application of diagnostics for identifying patients in need of pacemaker therapy. 适当应用诊断学来识别需要起搏器治疗的患者。
IF 1.6 4区 医学
European Heart Journal Supplements Pub Date : 2023-12-01 DOI: 10.1093/eurheartjsupp/suad123
Mazen Tawfik, Mohamed Mousa, Apichai Pokawattana, Surachat Jaroonpipatkul, Kieu Ngoc Dung
{"title":"Appropriate application of diagnostics for identifying patients in need of pacemaker therapy.","authors":"Mazen Tawfik, Mohamed Mousa, Apichai Pokawattana, Surachat Jaroonpipatkul, Kieu Ngoc Dung","doi":"10.1093/eurheartjsupp/suad123","DOIUrl":"10.1093/eurheartjsupp/suad123","url":null,"abstract":"<p><p>Pacemaker therapy is the cornerstone in treatment of bradycardia and conduction disorders. Several diagnostic tools are utilized to diagnose and guide the physicians for appropriate management and accordingly proper utilization of pacemaker therapy. The current article is discussing the different diagnostics used for appropriate evaluation and diagnosis of bradyarrhythmias and the suggested solutions to improve bradycardia diagnosis and pacemaker therapy utilization in underpenetrated areas.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"25 Suppl H","pages":"H8-H12"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138477116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Improving implant training for physicians and their teams in under-represented regions. 改善代表性不足地区医生及其团队的植入物培训。
IF 1.7 4区 医学
European Heart Journal Supplements Pub Date : 2023-12-01 DOI: 10.1093/eurheartjsupp/suad134
Mohamed Jeilan, Mohamed Hasham Varwani, Abdul Raqib, Emin Evren Ozcan
{"title":"Improving implant training for physicians and their teams in under-represented regions.","authors":"Mohamed Jeilan, Mohamed Hasham Varwani, Abdul Raqib, Emin Evren Ozcan","doi":"10.1093/eurheartjsupp/suad134","DOIUrl":"10.1093/eurheartjsupp/suad134","url":null,"abstract":"<p><p>The burden of cardiovascular disease is increasing globally, with low- and middle-income countries (LMICs) absorbing most of the burden while lacking the necessary healthcare infrastructure to combat the increase. In particular, the disparity in pacemaker implants between high-income countries and LMICs is glaring, partially spurned by reduced numbers of physicians and supporting staff who are trained in pacemaker implant technique. Herein, we will discuss current pacemaker implant training models, outline training frameworks that can be applied to underserved regions, and review adjunctive training techniques that can help supplement traditional training models in LMICs.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"25 Suppl H","pages":"H13-H21"},"PeriodicalIF":1.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138477119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Burden of bradycardia and barriers to accessing bradycardia therapy in underserved countries. 服务不足国家的心动过缓负担和获得心动过缓治疗的障碍。
IF 1.6 4区 医学
European Heart Journal Supplements Pub Date : 2023-12-01 DOI: 10.1093/eurheartjsupp/suad125
Diego Egas, Francisco Rodriguez, Aparna Jaswal, Mohamed Jeilan, Goran Milasinovic, Ahmed Al Fagih
{"title":"Burden of bradycardia and barriers to accessing bradycardia therapy in underserved countries.","authors":"Diego Egas, Francisco Rodriguez, Aparna Jaswal, Mohamed Jeilan, Goran Milasinovic, Ahmed Al Fagih","doi":"10.1093/eurheartjsupp/suad125","DOIUrl":"10.1093/eurheartjsupp/suad125","url":null,"abstract":"<p><p>Bradycardia, a condition characterized by an abnormally slow heart rate, poses significant challenges in terms of diagnosis and treatment. While it is a concern world-wide, low- and middle-income countries (LMICs) face substantial barriers in accessing appropriate bradycardia therapy. This article aims to explore the global aetiology and incidence of bradycardia, compare the prevalence and management of the condition in high-income countries versus LMICs, identify the key reasons behind the disparities in access to bradycardia therapy in LMICs, and emphasize the urgent need to address these disparities to ensure equitable healthcare on a global scale.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"25 Suppl H","pages":"H1-H17"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138477117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Complementary role of governments, non-governmental organizations, industry, and medical societies in expanding bradycardia therapy access. 政府、非政府组织、行业和医学协会在扩大获得心动过缓治疗方面的互补作用。
IF 1.6 4区 医学
European Heart Journal Supplements Pub Date : 2023-12-01 DOI: 10.1093/eurheartjsupp/suad124
Jitendra Singh Makkar, Goran Milasinovic, Chi Keong Ching
{"title":"Complementary role of governments, non-governmental organizations, industry, and medical societies in expanding bradycardia therapy access.","authors":"Jitendra Singh Makkar, Goran Milasinovic, Chi Keong Ching","doi":"10.1093/eurheartjsupp/suad124","DOIUrl":"10.1093/eurheartjsupp/suad124","url":null,"abstract":"<p><p>As the aging population continues to grow, so has the incidence of cardiovascular diseases, including bradycardia, with much of the burden falling on low- and middle-income countries (LMICs). Pacemaker therapy remains the only guideline-recommended therapy for symptomatic bradycardia, but due to the cost and expertise required for pacemaker implants, patients in LMICs have less access to pacemaker therapies. However, with the concerted effort of organizations (governments, non-governmental organizations, industry, and medical societies) strides can continue to be made in improving access to care. Governments play a role in extending health coverage to its citizens and improving their physical and digital healthcare infrastructure. Non-governmental organizations promote access and awareness through charity and advocacy programs. Industries can continue innovating technology that is both affordable and accessible. Medical societies provide guidelines for treatment and necessary educational and networking opportunities for physicians who serve in LMICs. All of these organizations have individual responsibilities and goals in expanding access to bradycardia therapy, which can be more easily realized by their continued collaboration.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"25 Suppl H","pages":"H22-H26"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138477118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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