Canadian Journal of Cardiology最新文献

{"title":"ECLS-SHOCK and DanGer Shock: Implications for Optimal Temporary Mechanical Circulatory Support Use for Cardiogenic Shock Due to Acute Myocardial Infarction","authors":"Adriana Luk MD, MSc ,&nbsp;Madeleine Barker MD ,&nbsp;Phyllis Billia MD, PhD ,&nbsp;Christopher B. Fordyce MD ,&nbsp;Derek So MD ,&nbsp;Michael Tsang MD ,&nbsp;Brian J. Potter MDCM, SM","doi":"10.1016/j.cjca.2025.01.007","DOIUrl":"10.1016/j.cjca.2025.01.007","url":null,"abstract":"<div><div>Despite concerted efforts to rapidly identify patients with cardiogenic shock complicating acute myocardial infarction (AMI-CS) and provide timely revascularization, early mortality remains stubbornly high. Although artificially augmenting systemic flow by using temporary mechanical circulatory support (tMCS) devices would be expected to reduce the rate of progression to multiorgan dysfunction and thereby enhance survival, reliable evidence for benefit has remained elusive with lingering questions regarding the appropriate selection of both patients and devices, as well as the timing of device implantation relative to other critical interventions. Further complicating matters are the resource-intensive multidisciplinary systems of care that must be brought to bear in this complex patient population. Until recently, studies of tMCS were extremely heterogeneous in design, populations treated, and timing of device implantation with regard to shock onset and revascularization. Attempts at summarizing the available data had resulted in a lack of clear benefit for any type of tMCS modality. On this background, 2 landmark trials of tMCS in the setting of AMI-CS---ECLS-SHOCK and DanGer Shock---have recently been published with divergent results that deserve detailed consideration. Thus, we provide a detailed narrative review of the current state of knowledge regarding tMCS for AMI-CS. The most common types of tMCS and related evidence are presented, as well as evidence for organizational considerations, such as the shock team. We also provide some insight into how this new evidence may be incorporated into practice and influence future research.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 4","pages":"Pages 691-704"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000897","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 Role of a Cardiogenic Shock Team in Decision Making Surrounding Mechanical Circulatory Support","authors":"Derek Y.F. So MD, FRCPC,&nbsp;Rene Boudreau MD, FRCPC,&nbsp;Sharon Chih MBBS, PhD, FRACP","doi":"10.1016/j.cjca.2025.02.002","DOIUrl":"10.1016/j.cjca.2025.02.002","url":null,"abstract":"<div><div>Cardiogenic shock (CS) confers high mortality rates and remains a challenge for cardiovascular specialists. The difficulty in treating CS lies in its complexity, phenotypic heterogeneity, and the need for expedient treatment. Emerging evidence suggests that cardiogenic shock teams (CS teams), consisting of multiple specialists working in tandem with set protocols and care pathways to offer standardized team-based care, may reduce mortality and morbidity in patients with CS. A key reason for improved outcomes may be the team’s decisions surrounding the use of temporary mechanical support devices (tMCS). CS teams expedite the identification of patients who require tMCS and determine the most appropriate device based on patient factors, including shock phenotype. The CS team ensures that tMCS best practices are followed and assists in determining the timing of device escalation or de-escalation. This article will discuss the rationale and role of CS teams. The evidence behind CS teams and their impact on tMCS decision making will be reviewed. Recent trial evidence for the use of tMCS in CS secondary to acute myocardial infarction (AMI) will be examined. Considerations for creating and optimizing an AMI-CS team will be highlighted. Finally, we will examine the current use of CS teams, potential challenges, and future directions for establishing CS teams in Canada.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 4","pages":"Pages 682-690"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373853","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":"Differences in Care and Outcomes in Cardiogenic Shock in Cardiac Intensive Care Units in the United States and Canada: CCCTN Registry Insights","authors":"Madeleine Barker MD MPH ,&nbsp;Sean van Diepen MD, MSc ,&nbsp;Christopher B. Granger MD ,&nbsp;Graham C. Wong MD, MPH ,&nbsp;Vivian M. Baird-Zars MPH ,&nbsp;Jeong-Gun Park PhD ,&nbsp;Michael J. Goldfarb MD, MSc ,&nbsp;Patrick Lawler MD ,&nbsp;Adriana Luk MD ,&nbsp;ShuangBo Liu MD ,&nbsp;Brian J. Potter MD ,&nbsp;Michael A. Solomon MD, MBA ,&nbsp;Sammy Zakaria MD, MPH ,&nbsp;David A. Morrow MD, MPH ,&nbsp;Christopher B. Fordyce MD, MHS, MSc","doi":"10.1016/j.cjca.2025.01.012","DOIUrl":"10.1016/j.cjca.2025.01.012","url":null,"abstract":"<div><h3>Background</h3><div>Mortality in cardiogenic shock (CS) remains high. Significant interhospital heterogeneity in critical care therapies has been described, which reflects the lack of high-quality evidence to guide optimal treatment. We aimed to describe differences in practices and clinical outcomes among patients with CS in the United States and Canada.</div></div><div><h3>Methods</h3><div>The Critical Care Cardiology Trials Network (CCCTN) is a research network of tertiary cardiac intensive care units (CICUs). Data collection spanned from 2017 to 2022. The analysis included 34 American and 8 Canadian sites. The outcomes of interest included baseline clinical differences, use of critical care monitoring and therapies, and all-cause in-hospital mortality between patients with CS in the United States and Canada admitted to CICUs.</div></div><div><h3>Results</h3><div>Among 23,299 admissions, 19% had CS (n = 4336, 88% United States vs 12% Canada). The proportion of patient who received invasive hemodynamics (United States: 80.8% vs Canada: 74.8%, <em>P</em> = 0.0015), vasoactive medications (United States: 88.9% vs Canada: 82.1%, <em>P</em> &lt; 0.0001), temporary mechanical circulatory support (tMCS) (United States: 39.4% vs Canada: 23.1%, <em>P</em> &lt; 0.0001) were more frequent in US centres. Intra-aortic balloon pump was the most common tMCS device in both countries. After multivariable adjustment, in-hospital mortality was higher in Canada vs United States (37.1% vs 29.4%, odds ratio [OR]: 1.47; 95% confidence interval [CI], 1.18-1.83).</div></div><div><h3>Conclusions</h3><div>In a contemporary registry, management of CS was heterogenous between the United States and Canada, with higher use of invasive monitoring and MCS in the US. Although adjusted mortality was lower in the United States, the effects of these treatments cannot be reliably determined without randomized trial data.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 4","pages":"Pages 718-727"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022200","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":"Editorial Commentary to When Shock Hits the Border: Comparing US and Canadian Management of Cardiogenic Shock","authors":"Jean Deschamps MD ,&nbsp;Rakesh C. Arora MD, PhD","doi":"10.1016/j.cjca.2025.01.028","DOIUrl":"10.1016/j.cjca.2025.01.028","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 4","pages":"Pages 728-729"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073997","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":"Extracorporeal Membrane Oxygenation in Pediatric Patients With Congenital Heart Disease: Surgical Considerations","authors":"Rachel D. Vanderlaan MD, PhD,&nbsp;David J. Barron MD","doi":"10.1016/j.cjca.2024.12.035","DOIUrl":"10.1016/j.cjca.2024.12.035","url":null,"abstract":"<div><div>The use of extracorporeal membrane oxygenation (ECMO) in the paediatric population has increased over time, with the ability to rescue pulmonary and cardiovascular deterioration. ECMO can be utilised by neonates and children with congenital heart disease in both preoperative and postoperative settings to improve survival and minimise morbidity. ECMO cannulation strategy must be tailored to the age, weight, and physiologic state of the patient. Careful patient selection and rapid deployment of ECMO may improve survival and morbidity in patients with congenital heart disease.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 4","pages":"Pages 613-620"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963839","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":"Five Years of the One Heart Team – A Milestone Worth Celebrating","authors":"","doi":"10.1016/j.cjca.2025.02.030","DOIUrl":"10.1016/j.cjca.2025.02.030","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 4","pages":"Pages 561-562"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807687","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 Role of Echocardiography in Monitoring Patients Supported With Extracorporeal Membrane Oxygenation","authors":"E. Caroline Bullen MBBS, BSc ,&nbsp;Filio Billia MD, PhD ,&nbsp;Ghislaine Douflé MD, MME","doi":"10.1016/j.cjca.2024.10.024","DOIUrl":"10.1016/j.cjca.2024.10.024","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 4","pages":"Pages 775-778"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615275","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":"Factors Associated With Shock at Presentation in Kawasaki Disease Versus Multisystem Inflammatory Syndrome in Children Associated With Covid-19","authors":"Supriya S. Jain MD ,&nbsp;Ashraf S. Harahsheh MD ,&nbsp;Simon Lee MD ,&nbsp;Geetha Raghuveer MD ,&nbsp;Nagib Dahdah MD, MBA ,&nbsp;Michael Khoury MD ,&nbsp;Michael A. Portman MD ,&nbsp;Melissa Wehrmann MD ,&nbsp;Arash A. Sabati MD ,&nbsp;Marianna Fabi MD, PhD ,&nbsp;Deepika Thacker MD ,&nbsp;Nilanjana Misra MBBS ,&nbsp;Mark D. Hicar MD, PhD ,&nbsp;Nadine F. Choueiter MD ,&nbsp;Matthew D. Elias MD ,&nbsp;Audrey Dionne MD ,&nbsp;William B. Orr MD ,&nbsp;Jacqueline R. Szmuszkovicz MD ,&nbsp;Seda Selamet Tierney MD ,&nbsp;Luis Martin Garrido-Garcia MD, MSc ,&nbsp;Varsha Zadokar MBBS","doi":"10.1016/j.cjca.2024.11.027","DOIUrl":"10.1016/j.cjca.2024.11.027","url":null,"abstract":"<div><h3>Background</h3><div>While clinical overlap between Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) has been evident, information regarding those presenting with shock has been limited. We sought to determine associations with shock within and between diagnosis groups.</div></div><div><h3>Methods</h3><div>The International KD Registry enrolled contemporaneous patients with either KD or MIS-C from 39 sites in 7 countries from January 1, 2020, to January 1, 2023. Demographics, clinical features and presentation, management, laboratory values, and outcomes were compared between the diagnosis and shock groups.</div></div><div><h3>Results</h3><div>Shock at presentation was noted for 19 of 672 KD patients (2.8%) and 653 of 1472 MIS-C patients (44%; <em>P</em> &lt; 0.001). Within both groups, patients with shock were significantly more likely to be admitted to the intensive care unit, to receive inotropes, and to have greater laboratory abnormalities indicative of hyperinflammation and organ dysfunction, including abnormal cardiac biomarkers. Patients with KD and shock had a greater maximum coronary artery <em>z</em> score (median +2.62) vs KD patients without shock (+1.36; <em>P</em> &lt; 0.001) and MIS-C patients with shock (+1.45 [vs +1.32 for MIS-C patients without shock]; <em>P</em> &lt; 0.001). They were also more likely to have large coronary artery aneurysms. In contrast, MIS-C patients with shock had lower left ventricular ejection fraction (mean 51.6%) vs MIS-C patients without shock (56.6%; <em>P</em> &lt; 0.001) and KD patients with shock (56.7% [vs 62.8% for KD patients without shock]; <em>P</em> = 0.04).</div></div><div><h3>Conclusions</h3><div>Although patients with KD presenting with shock are clinically similar to patients with MIS-C, especially those with shock, they have more severe coronary artery involvement, whereas MIS-C patients with shock have lower left ventricular ejection fraction.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 4","pages":"Pages 740-748"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766546","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":"Double Sequential External Defibrillation for Refractory Ventricular Fibrillation: A Perspective on the Canadian Cardiovascular Society Practice Update","authors":"Sheldon Cheskes MD,&nbsp;Paul Dorian MD, MSc,&nbsp;Ian R. Drennan ACP, PhD,&nbsp;Damon C. Scales MD, PhD","doi":"10.1016/j.cjca.2024.05.011","DOIUrl":"10.1016/j.cjca.2024.05.011","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 4","pages":"Page 792"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141330434","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":"Life-Saving Combination of Extracorporeal Membrane Oxygenation, Percutaneous Aspiration, and Valvuloplasty in a Pulmonary Prosthetic Valve Endocarditis","authors":"Daniel Tébar Márquez MD ,&nbsp;Santiago Jiménez-Valero MD ,&nbsp;Alfonso Jurado-Román MD, PhD ,&nbsp;Guillermo Galeote MD, PhD ,&nbsp;Pablo Meras-Colunga MD ,&nbsp;Ángel Aroca MD, PhD ,&nbsp;Fernando Leyra MD, PhD ,&nbsp;Isabel Higuera MD ,&nbsp;José Ruíz Cantador MD ,&nbsp;Raúl Moreno MD, PhD","doi":"10.1016/j.cjca.2024.08.267","DOIUrl":"10.1016/j.cjca.2024.08.267","url":null,"abstract":"","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 4","pages":"Pages 761-763"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995365","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}