American heart journal plus : cardiology research and practice最新文献

{"title":"Management of non-Cardiac Organ Failure in cardiogenic shock","authors":"Chirag Mehta ,&nbsp;Abraham Shin ,&nbsp;Brian Osorio ,&nbsp;Daniel DePolo ,&nbsp;Irene Vargas ,&nbsp;Emily Hao ,&nbsp;Ali Khan ,&nbsp;Sahas Chandragiri ,&nbsp;Sandipan Shringi ,&nbsp;Paige O. McLean Diaz ,&nbsp;Nicholas S. Potter ,&nbsp;Mark Godding ,&nbsp;Athena Poppas ,&nbsp;Rachna Kataria ,&nbsp;Marwan Saad ,&nbsp;Omar Hyder ,&nbsp;Neel R. Sodha ,&nbsp;J. Dawn Abbott ,&nbsp;Saraschandra Vallabhajosyula","doi":"10.1016/j.ahjo.2025.100549","DOIUrl":"10.1016/j.ahjo.2025.100549","url":null,"abstract":"<div><div>Cardiogenic shock (CS) is a syndrome of low cardiac output leading to systemic hypoperfusion. The mainstay of management involves optimizing preload, afterload, and contractility to restore central hemodynamics. However, CS is frequently complicated by non-cardiac organ failure, for which there is limited guidance. Herein, we review the pathophysiology, assessment, and management of respiratory, renal, hepatic, and neurological failure in the context of CS. This review is intended to provide an evidence-based framework for the management of extracardiac sequelae for the patients in the cardiac and medical intensive care unit.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"55 ","pages":"Article 100549"},"PeriodicalIF":1.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractory angina in women with ischemia and no obstructive coronary artery disease — A report from the Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study","authors":"Judy M. Luu ,&nbsp;Janet Wei ,&nbsp;Chrisandra Shufelt ,&nbsp;Anum Asif ,&nbsp;Benita Tjoe ,&nbsp;Galen Cook-Wiens ,&nbsp;Eileen M. Handberg ,&nbsp;Puja K. Mehta ,&nbsp;Jenna Maughan ,&nbsp;Daniel S. Berman ,&nbsp;Louise E.J. Thomson ,&nbsp;Carl J. Pepine ,&nbsp;C. Noel Bairey Merz","doi":"10.1016/j.ahjo.2025.100547","DOIUrl":"10.1016/j.ahjo.2025.100547","url":null,"abstract":"<div><h3>Background</h3><div>Women with suspected ischemia and no obstructive coronary artery disease (INOCA) are often challenging to manage. We aimed to understand mechanisms and treatable pathways of refractory angina.</div></div><div><h3>Methods</h3><div>The Women's Ischemia Syndrome Evaluation – Coronary Vascular Dysfunction (<span><span>NCT00832702</span><svg><path></path></svg></span>) recruited women between 2008 and 2015. In a pre-defined subgroup (<em>n</em> = 198) with repeat cardiac magnetic resonance imaging (CMRI) at 1-year, we investigated severity of angina (Seattle Angina Questionnaire-7) in relation to risk factors, baseline invasive coronary function testing, and CMRI parameters. Refractory angina was defined as SAQ-7 score &lt; 75 at baseline and &lt; 10-point improvement at 1-year.</div></div><div><h3>Results</h3><div>Women with refractory angina (<em>n</em> = 60, 30 %), compared to those without, had lower incomes, and higher proportion of hypertension and nitrate use at 1-year (<em>p</em> &lt; 0.05). They also had significantly lower baseline coronary blood flow (CBF) response to acetylcholine (<em>p</em> &lt; 0.01). Myocardial perfusion reserve index was not different at baseline or follow-up. At 1-year, changes in SAQ domain scores significantly differed between groups, with persistent lack of improvement in physical limitation, disease perception, angina stability, and angina frequency (<em>p</em> &lt; 0.05) in the refractory group. In an age-adjusted regression model, hypertension (OR 4.48; 95 % CI 1.23–16.25; <em>p</em> = 0.02) and abnormal CBF (OR 3.34; 95 % CI 1.04–10.72; <em>p</em> = 0.04) were associated with refractory angina.</div></div><div><h3>Conclusions</h3><div>Refractory angina is common in women with INOCA. Hypertension and endothelial-dependent microvascular dysfunction are independently associated with a 4- and 3-fold increase in refractory angina at 1-year, respectively. These findings may identify potential treatment targets to reduce angina burden in INOCA.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"54 ","pages":"Article 100547"},"PeriodicalIF":1.3,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epicardial adipose tissue in patients with and without COVID-19 infection","authors":"Alexander J. Küng ,&nbsp;Iryna Dykun ,&nbsp;Matthias Totzeck ,&nbsp;Raluca Mincu ,&nbsp;Lars Michel ,&nbsp;Clemens Kill ,&nbsp;Oliver Witzke ,&nbsp;Jan Buer ,&nbsp;Tienush Rassaf ,&nbsp;Amir A. Mahabadi","doi":"10.1016/j.ahjo.2025.100548","DOIUrl":"10.1016/j.ahjo.2025.100548","url":null,"abstract":"<div><h3>Background</h3><div>Acute COVID-19 infection frequently affects the cardiovascular system and causes acute myocardial injury. Epicardial Adipose Tissue (EAT), a visceral adipose tissue surrounding the myocardium and coronary arteries, has unique paracrine and endocrine effects, modulating the heart's inflammatory environment. Systemic inflammation stimulates TNF-α and Interleukin-6 secretion from EAT, contributing to cytokine storms and intensifying systemic responses. We aimed to determine whether EAT amount differs in patients with and without acute COVID-19 infection and myocardial injury.</div></div><div><h3>Methods</h3><div>This study analyzed the CoV-COR registry cohort, conducted at the University Hospital Essen, including patients with symptoms suggestive of COVID-19 infection. The infection was confirmed by PCR. EAT thickness was measured by two-dimensional TTE.</div></div><div><h3>Results</h3><div>A total of 296 patients (mean age 63.6 ± 17.26 years, 55.4 % male) were included. Patients with confirmed COVID-19 infection were younger, more frequently treated with antihypertensive medication, and had higher BMI and systolic blood pressures. Univariate logistic regression showed no association between EAT and myocardial injury 0.97 (0.74; 1.28, <em>p</em> = 0.82). A trend towards an association was observed between increasing EAT thickness and COVID-19 infection 1.25 (0.99; 1.59, <em>p</em> = 0.060). Adjusting for age and gender strengthened the association, with a 48 % (1.14; 1.93, <em>p</em> = 0.004) increased odds of COVID-19 infection per increase in EAT thickness. Multivariable regression yielded consistent effect sizes 1.47 (1.01; 2.16, <em>p</em> = 0.047).</div></div><div><h3>Conclusion</h3><div>EAT thickness is associated with the presence of an acute COVID-19 infection but not with a myocardial injury. Further research is needed to assess if systemic viral infection induces dynamic changes in EAT.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"54 ","pages":"Article 100548"},"PeriodicalIF":1.3,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143858730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Air pollution and cardiovascular disease: a systematic review of the effects of air pollution, including bushfire smoke, on cardiovascular disease","authors":"Fariha Islam,&nbsp;Sai Keerthana Nukala,&nbsp;Pallavi Shrestha,&nbsp;Tim Badgery-Parker,&nbsp;Fiona Foo","doi":"10.1016/j.ahjo.2025.100546","DOIUrl":"10.1016/j.ahjo.2025.100546","url":null,"abstract":"<div><h3>Objective</h3><div>Particulate matter (PM) with diameter ≤ 2.5 μm (PM_2.5) and ≤ 10 μm (PM₁₀), including from bushfire smoke, is associated with cardiovascular disease (CVD) morbidity and mortality. This systematic review assesses how CVD morbidity and mortality is affected by type, duration, and level of air pollution exposure.</div></div><div><h3>Data sources</h3><div>A search was conducted on Ovid Medline, Embase and Scopus, spanning across 1 January 2012 to 30 July 2022. Primary quantitative studies exploring the effect of PM_2.5, PM₁₀ or bushfire smoke on CVD were included. Studies without adjustment for confounding factors were excluded. The Newcastle-Ottawa Scale was used to assess the risk of bias (ROB) in the studies, and meta-analysis was conducted on relevant outcomes.</div></div><div><h3>Findings</h3><div>A total 275 studies were obtained, and 80 studies were analysed with diseases ranging from ICD-10 I00-I99. For CVD morbidity, increased PM_2.5 and PM₁₀ was associated with 1.92 (95 % CI: 0.58,3.26) years of life lost per 10 μg/m³ increase in exposure. Increased PM_2.5 and PM₁₀ was associated with a 0.52 % (95 % CI: 0.37,0.68) increase in mortality per 10 μg/m³ increase in exposure. Bushfire smoke also presented similar trends. Two studies had high ROB, 42 had medium ROB, and 36 had low ROB. There was high heterogeneity between the studies, with I² values ranging between 88.09 % and 94.25 %.</div></div><div><h3>Conclusion</h3><div>Air pollution including bushfire smoke is associated with increased CVD morbidity and mortality. This effect ranges across different types, durations, and levels of air pollution exposure, making stringent climate change and air pollution mitigation strategies imperative.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"54 ","pages":"Article 100546"},"PeriodicalIF":1.3,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143858731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and outcomes of different mechanical circulatory support modalities for refractory cardiogenic shock in Takotsubo cardiomyopathy","authors":"Shafaqat Ali ,&nbsp;Manoj Kumar ,&nbsp;Yehya Khlidj ,&nbsp;Faryal Farooq ,&nbsp;Thannon Alsaeed ,&nbsp;Muhammad Sultan ,&nbsp;Pramod Kumar Ponna ,&nbsp;Laxman Byreddi ,&nbsp;Pratik Agrawal ,&nbsp;Vijaywant Brar ,&nbsp;Tarek Helmy ,&nbsp;Taher Tayeb","doi":"10.1016/j.ahjo.2025.100545","DOIUrl":"10.1016/j.ahjo.2025.100545","url":null,"abstract":"<div><h3>Background</h3><div>The use of mechanical circulatory support (MCS) devices in cardiogenic shock is growing. We aim to study trends and compare different MCS modalities in this population.</div></div><div><h3>Methods</h3><div>The National Readmission Database (2016-2020) was queried to identify TTC-CS requiring MCS. Cohorts were stratified as ECMO (extracorporeal membrane oxygenation) compared to other short-term percutaneous left ventricular assist devices (Impella). The propensity score matching (PSM) was used to remove confounders. Pearson’s x2 test was applied to PSM-matched cohorts to compare outcomes. Additionally, we used multivariate regression and reported predictive margins for adjusted trend analysis.</div></div><div><h3>Results</h3><div>Among 2,025 TTC-CS hospitalizations requiring MCS, 1,790 required Impella vs. 235 on ECMO. ECMO was more common in metropolitan teaching hospitals (72.2 % vs 56.1 %, p &lt; 0.05). On PSM cohorts (N = 131), ECMO had higher in-hospital mortality (38.9 % vs. 20.6 %, p &lt; 0.001), major bleeding (15.3 % vs. 2.3 %, p &lt; 0.001), acute blood loss anemia (48.9 % vs. 19.1 %, p &lt; 0.001) among others. Our subgroup analysis comparing ECMO when Left ventricular (LV) unloading was provided by either IABP or Impella, and Impella alone showed no difference in the short-term mortality (42.2 % vs. 33.3 %, p: 0.384). However, the rates of major bleeding (17.8 % vs. 0.0 %, p: 0.003) and acute blood loss anemia (55.6 % vs. 22.2 %, p: 0.001) were higher for ECMO cohort.</div></div><div><h3>Conclusion</h3><div>In the absence of LV unloading, the ECMO utilization in TTC-CS had higher mortality and adverse events than Impella. The mortality difference was nonsignificant when concomitant LV unloading was provided with Impella or IABP in these patients.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"54 ","pages":"Article 100545"},"PeriodicalIF":1.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison of magnetocardiography with noninvasive cardiac testing in the evaluation of patients with chest pain","authors":"Sharon E. Mace ,&nbsp;Christopher Baugh ,&nbsp;Margarita E. Pena ,&nbsp;Robert Takla","doi":"10.1016/j.ahjo.2025.100541","DOIUrl":"10.1016/j.ahjo.2025.100541","url":null,"abstract":"<div><h3>Objectives</h3><div>Chest pain is a common complaint of outpatients and emergency department patients. These patients are often referred for noninvasive cardiac imaging (NCI). Problems with NCI include limited availability, lengthy test delays, test duration, radiation exposure, adverse events, NPO (holding medications, caffeine/food/liquids/tobacco), exercise requirement, limitations for certain populations, inability to assess for ischemia with no obstructive coronary artery disease (INOCA), contrast/medication/needlestick-intravenous (IV) line needed.</div><div>Magnetocardiography (MCG) advantages include faster, easier test administration, radiation avoidance, less resource utilization, safer, no needlestick/IV requirement, no NPO for caffeine/food/liquids/tobacco, and no holding medications. By avoiding medications and/or exercise, MCG avoids risk of provoking myocardial injury and dangerous events (arrhythmias). No contrast or pharmacologic agents are needed with MCG, eliminating side effects/complications: tissue necrosis from extravasation, contrast-induced nephropathy, allergic reactions including life threatening anaphylaxis.</div></div><div><h3>Design</h3><div>MCG comparison with NCI: exercise stress test, stress echo, dobutamine stress echocardiogram, myocardial perfusion imaging: single photon emission computed tomography (SPECT) or positron emission tomography (PET), cardiac magnetic resonance imaging (cMRI), coronary computed tomography angiography (CCTA).</div></div><div><h3>Outcome measures</h3><div>Literature review: NCI versus MCG.</div></div><div><h3>Conclusion</h3><div>MCG is a rapid, safe, effective, painless and radiation-free test, does not require contrast/medication administration. MCG by avoiding provocative medications and/or exercise eliminates the risk of provoking myocardial injury and causing dangerous events such as arrhythmias. MCG avoids testing delays, has higher patient satisfaction, no NPO requirement, no holding medications or caffeine/food/liquids/tobacco, with similar sensitivity and specificity. Additional clinical research is needed to validate its utility. MCG may be a complementary modality alongside current NCI.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"54 ","pages":"Article 100541"},"PeriodicalIF":1.3,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143828352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel and established biomarkers to complement risk scores in patients with acute decompensated heart failure – a pilot study","authors":"Valentin Hähnel ,&nbsp;Victoria Meretz ,&nbsp;Christian Butter ,&nbsp;Vera Paar ,&nbsp;Christoph Edlinger ,&nbsp;Michael Lichtenauer ,&nbsp;Ronald Biemann ,&nbsp;Berend Isermann ,&nbsp;Meike Hoffmeister ,&nbsp;Michael Haase ,&nbsp;Anja Haase-Fielitz ,&nbsp;Marwin Bannehr","doi":"10.1016/j.ahjo.2025.100544","DOIUrl":"10.1016/j.ahjo.2025.100544","url":null,"abstract":"<div><h3>Study Objective</h3><div>There are several risk scores for mortality in patients with acute decompensated heart failure (ADHF) such as the European Collaboration on Acute Decompensated Heart Failure Score (ELAN-HF Score), the ADHF/NT-proBNP-Score or A2B-Score (age, anemia, BNP). The aim of this study was to evaluate the predictive value of such risk scores with and without addition of novel cardiorenal biomarkers.</div></div><div><h3>Design &amp; Setting</h3><div>Single-center, exploratory prospective cohort study at the University Hospital Heart Centre Brandenburg.</div></div><div><h3>Participants</h3><div>Forty-four adult patients hospitalized for ADHF.</div></div><div><h3>Interventions</h3><div>Measurement of established and novel biomarkers at hospital admission including N-terminal-pro brain natriuretic peptide (NT-pro-BNP), troponin T, creatinine, cystatin C, soluble suppression of tumorigenicity 2 (sST2), Neprilysin, Dickkopf-3 (DKK3), interleukin-6 (IL-6), growth differentiation factor-15 (GDF-15), Galectin-3, Progranulin and urine neutrophil gelatinase-associated lipocalin (uNGAL).</div></div><div><h3>Main Outcome Measures</h3><div>Analysis of predictive indices of ELAN-HF, ADHF/NT-proBNP and A2B-Scores for 90-day mortality with and without adding biomarkers. AUC &lt;0.8 was considered as fair, ≥0.8 as good and &gt; 0.9 as excellent predictive value.</div></div><div><h3>Results</h3><div>Median age was 78.0 (25th–75th percentiles 69.3–83.8) years, 50 % (22/44) were female. Twelve patients (27.3 %) died within 90 days after discharge. All three risk scores were higher in non-survivors and showed fair AUC for 90-day mortality (ELAN-HF: 0.792 [0.639–0.901], p = 0.003; ADHF-NT-proBNP score: 0.749 [0.559–0.938], p = 0.012; A2B score: 0.734 [0.541–0.927], p = 0.017). Adding troponin T, cystatin C-based estimated glomerular filtration rate (eGFR) or uNGAL to risk scores was associated with an area under the curve (AUC) &gt;0.80 for all models. Combination of troponin T, cystatin C-based eGFR and uNGAL increased risk scores to AUC &gt;0.91.</div></div><div><h3>Conclusion</h3><div>These findings imply that further evaluation of the addition of a panel of cardiorenal biomarkers to ADHF risk scores is warranted.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"53 ","pages":"Article 100544"},"PeriodicalIF":1.3,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of the EggNest complete shielding system to standard shielding in the Cath lab","authors":"Robert F. Riley ,&nbsp;Jacob Kamen ,&nbsp;Ashley Tao ,&nbsp;Daniel Gomez-Cardona","doi":"10.1016/j.ahjo.2025.100543","DOIUrl":"10.1016/j.ahjo.2025.100543","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluated the effectiveness of scatter radiation reduction with the EggNest Complete shielding system compared to standard catheterization laboratory shielding.</div></div><div><h3>Methods</h3><div>Vertical poles with mounted radiation survey meters were positioned at six points around a catheterization laboratory imaging table where procedural staff usually stand. Meters were mounted on vertical tracks where the sensor could be raised on the track with stops every 20 cm (up to 200 cm). Fluoroscopy (15 frames per second) was then performed on an anthropomorphic phantom with a cardiac silhouette in PA and four quadrant angulations using a Toshiba Infinx fixed C-arm X-ray system with a 12″ detector. Scatter radiation measurements were reported in μSv/h under three radiation shielding conditions: no shielding, standard catheterization laboratory lead shielding, and the EggNest Complete system.</div></div><div><h3>Results</h3><div>Average scatter radiation levels in all angulations were significantly higher below the x-ray table and at the positions near the head of the table (1862 ± 340 μSv/h at the head vs. 605 ± 316 μSv/h below the phantom waist, p &lt; 0.05). Using the EggNest Complete system compared to standard shielding, average radiation exposure in all x-ray angulations and positions was reduced by 92.5 ± 3.9 % (83 ± 103 compared to 1087 ± 898 μS/h, p &lt; 0.01). At the Operator and Assistant positions, scatter radiation averaged 9 ± 4 μSv/h using the EggNest Complete (98 ± 1 % reduction compared to no shielding, p &lt; 0.01), 147 ± 101 μSv/h using Standard Shielding (75 ± 8 % reduction compared to no shielding, p &lt; 0.01), and 605 ± 316 μSv/h without shielding.</div></div><div><h3>Conclusion</h3><div>Compared to standard shielding, the EggNest Complete system significantly reduced radiation levels at all positions around the x-ray table. At the operator and Assistant positions, EggNest complete provided 98 % reduction in scatter radiation dose.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"54 ","pages":"Article 100543"},"PeriodicalIF":1.3,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous atrial septostomy for left ventricular unloading in patients on peripheral venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis","authors":"Mohammed AlGhamdi ,&nbsp;Gabriel Saiydoun ,&nbsp;Guillaume Lebreton ,&nbsp;Jean-Philippe Mazzucotelli","doi":"10.1016/j.ahjo.2025.100542","DOIUrl":"10.1016/j.ahjo.2025.100542","url":null,"abstract":"<div><h3>Background</h3><div>This study systematically reviewed the safety and efficacy of atrial septostomy as a left ventricular (LV) unloading intervention in paediatric and adult patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO).</div></div><div><h3>Methods</h3><div>The PubMed, Cochrane, and Google Scholar online databases were searched, and studies describing patients who received VA-ECMO for refractory cardiogenic shock and underwent atrial septostomy for LV unloading were included. Laboratory experiments, animal studies, and patients who received ECMO with a method other than atrial septostomy for LV unloading were excluded.</div></div><div><h3>Results</h3><div>From the 12 studies analysed, data were collected on 197 patients, including 97 (49 %) males and 75 (38 %) females (data unavailable for 25 patients) with ages ranging from 3.65 days to 70 years. VA-ECMO duration was 1.71 to 40 days (<em>P</em> &lt; 0.001). Weaning from VA-ECMO with LV discharge was achieved successfully in 126 (64 %) patients, with 60 (30.5 %) in recovery (<em>P</em> = 0.006) and 66 (33.5 %) converted to a ventricular assistant device or transplantation. Additionally, 54 (27.4 %) patients experienced unsuccessful weaning. During atrial septostomy for LV unloading, 14 (7.1 %) patients experienced complications, whereas 180 (91.4 %) did not (<em>P</em> = 0.250). After LV unloading in patients receiving VA-ECMO, 60 (30.5 %) experienced early mortality (<em>P</em> = 0.286).</div></div><div><h3>Conclusion</h3><div>VA-ECMO-assisted percutaneous atrial septostomy is a viable, safe, and successful alternative for LV unloading in both children and adults with refractory cardiogenic shock. However, further studies with larger sample sizes are required to comprehensively assess the morbidity and mortality associated with this approach.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"54 ","pages":"Article 100542"},"PeriodicalIF":1.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143828351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world interventional outcomes for cardiogenic shock complicating acute myocardial infarction","authors":"John E. Brush Jr. ,&nbsp;Ann M. Harper ,&nbsp;Luke C. Kohan ,&nbsp;Zachary Bouker ,&nbsp;Kaivalya Dandamudi ,&nbsp;Deepak R. Talreja","doi":"10.1016/j.ahjo.2025.100540","DOIUrl":"10.1016/j.ahjo.2025.100540","url":null,"abstract":"<div><div>Acute myocardial infarction with cardiogenic shock (AMICS) carries high mortality and remains a major concern. This concern drives use of interventions with marginal benefit and some evidence of harm. The configuration of hospital care and allocation of interventions for AMICS in our health system created a natural experiment to analyze interventional outcomes for patients with AMICS.</div></div><div><h3>Objective</h3><div>To compare clinical outcomes among AMICS patients treated with mechanical circulatory support (MCS) using a micro-axial left ventricular assist device and intra-aortic balloon counter-pulsation (IABP).</div></div><div><h3>Design, setting, participants, outcome measures</h3><div>In this observational study in a large health system, we used clinical registry data augmented with data from other sources to analyze 30-day and 180-day mortality as well as complications including major bleeding, and access site injury.</div></div><div><h3>Results</h3><div>Of 505 patients with AMICS, 73 were treated with MCS and 160 with IABP. Baseline characteristics were similar between treatment groups except infarct location. Multivariable logistic regression showed that MCS was associated with 1.92 (CI = 1.10–3.37) times higher 30-day mortality risk and 2.03 (CI = 1.17–3.57) times higher 180-day mortality risk. In MCS-inclined hospitals as compared with IABP-inclined hospitals, patients had significantly higher 180-day mortality (45.3 % versus 33.9 %, <em>p</em> = 0.017), and bleeding rates (15.1 % versus 1.3 %, <em>p</em> &lt; 0.001), with trends toward higher 30-day mortality (41.4 % versus 32.6 %, <em>p</em> = 0.064) and access site injury (4.7 % versus 1.3 %, <em>p</em> = 0.063).</div></div><div><h3>Conclusion</h3><div>In this real-world setting, MCS use for AMICS was associated with higher complication rates. Before using this device for AMICS, clinicians should consider tight selection criteria to minimize harm and maximize overall benefit.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"53 ","pages":"Article 100540"},"PeriodicalIF":1.3,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}