Manjula Miglani, Manjari Rain, Qadar Pasha, V Samuel Raj, Tashi Thinlas, Ghulam Mohammad, Archana Gupta, Ramendra Pati Pandey, Arpana Vibhuti
High-altitude pulmonary edema (HAPE) is a non-cardiogenic form of pulmonary edema, which is induced upon exposure to hypobaric hypoxia at high-altitude (HA). Hypobaric hypoxia generates reactive oxygen species that may damage telomeres and disturb normal physiological processes. Telomere complex comprises of multiple proteins, of which, tankyrase (TNKS) is actively involved in DNA damage repairs. We hence investigated the association of TNKS and telomeres with HAPE to delineate their potential role at HA. The study was performed in three groups, High altitude pulmonary edema-patients (HAPE-p, n = 200), HAPE-resistant sojourners (HAPE-r, n = 200), and healthy-highlanders (HLs, n = 200)...
September 11, 2020: Human Molecular Genetics
Elham Beheshtian, Jina Pakpoor, Joseph H Huntley, Sadaf Sahraian, Victor Urrutia, Majid K Khan, Oluwatoyin Idowu, David M Yousem
PURPOSE: During acute ischemic stroke evaluations, neurovascular imaging is commonly performed to localize the source of a thromboembolus and to identify vascular stenoses. In this study, we aimed to analyze 1) the usefulness of intracranial and/or cervical CTA and MRA and carotid doppler ultrasound (DUS) for identifying the stroke source and 2) the incidence of vascular stenoses across stroke etiologies. METHODS: We retrospectively reviewed intracranial and/or cervical CTA, DUS and MRA studies to identify the source of the acute stroke by Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria for 200 consecutive patients admitted with a stroke to our tertiary hospital...
July 25, 2020: Clinical Imaging
Christophe Abellan, Christophe Bertin, Thierry Fumeaux, Lionel Carrel
Acute respiratory failure is a complex physiopathological process and the choice of the most appropriate therapy has to be made between standard oxygen therapy (SOT), high-flow oxygen therapy through nasal cannula (High-Flow Nasal Cannula (HFNC)), non- invasive ventilation (NIV) or invasive ventilation. HFNC can deliver a higher and consistent inspired fraction of oxygen than SOT, but has not clearly demonstrated a clinical advantage over other methods. NIV is a therapy of choice in the management of acute exacerbation of chronic obstructive pulmonary disease and acute cardiogenic pulmonary edema, but its effectiveness in other indications is questionable...
September 9, 2020: Revue Médicale Suisse
Krishnaraj Sinhji Rathod, Marco Spagnolo, Mark K Elliott, Anne-Marie Beirne, Elliot J Smith, Rajiv Amersey, Charles Knight, Roshan Weerackody, Andreas Baumbach, Anthony Mathur, Daniel A Jones
Background: More than half of the patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) have multi-vessel coronary artery disease. This is associated with worse outcomes compared with single vessel disease. Whilst evidence now exists to support complete revascularisation for bystander disease the optimal timing is still debated. This study aimed to compare clinical outcomes in patients with STEMI and multi-vessel disease who underwent complete revascularisation as inpatients in comparison to patients who had staged PCI as early outpatients...
2020: Clinical Medicine Insights. Cardiology
Andrew Robson
No abstract text is available yet for this article.
September 10, 2020: Nature Reviews. Cardiology
Amgad Mentias, Saket Girotra, Milind Y Desai, Phillip A Horwitz, James D Rossen, Marwan Saad, Sidakpal Panaich, Samir Kapadia, Mary Vaughan Sarrazin
OBJECTIVES: This study sought to evaluate the incidence and outcomes of endocarditis after transcatheter aortic valve replacement (TAVR). BACKGROUND: Data about endocarditis after TAVR are limited. METHODS: The study investigated Medicare patients who underwent TAVR from 2012 to 2017 and identified patients admitted with endocarditis during follow-up using a validated algorithm. The main study outcome was all-cause mortality. RESULTS: Of 134,717 patients who underwent TAVR, 1868 patients developed endocarditis during follow-up (incidence 0...
September 14, 2020: JACC. Cardiovascular Interventions
Mitchell Padkins, Thomas Breen, Nandan Anavekar, Sean van Diepen, Timothy D Henry, David A Baran, Gregory W Barsness, Kianoush Kashani, David R Holmes, Jacob C Jentzer
AIMS: Age is an important risk factor for mortality among patients with cardiogenic shock and heart failure (HF). We sought to assess the extent to which age modified the performance of the Society for Cardiovascular Angiography and Interventions (SCAI) shock stage for in-hospital and 1 year mortality in cardiac intensive care unit (CICU) patients with and without HF. METHODS AND RESULTS: We retrospectively reviewed unique admissions to the Mayo Clinic CICU during 2007-2015 and stratified patients by age and SCAI shock stage...
September 10, 2020: ESC Heart Failure
Leah Ishmael, Joseph Zalocha
Elevated cardiac enzymes are often seen in the setting of sepsis. The mechanism involves hypoperfusion and possible compromise to myocardial tissue. Electrocardiogram (ECG) changes in the setting of septic shock are less common and can vary widely. Rarely, ST-segment elevations can occur. This case describes a 54-year-old female who presented with septic shock secondary to pyelonephritis and Escherichia coli bacteremia. The patient was admitted to the intensive care unit on norepinephrine and required mechanical ventilation...
2020: Case Reports in Critical Care
Aina Gomila-Grange, M Espasa, E Moglia
Myocarditis is an unusual manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has been associated with increased severity of disease and mortality. The diagnosis of coronavirus disease 2019 (COVID-19) is based on positivity of nucleic acid amplification tests (NAAT) of respiratory samples. We report the case of a patient with cardiogenic shock caused by SARS-CoV-2 myocarditis with serial negative upper and lower respiratory nucleic acid amplification tests. Diagnosis was made by serology (positive IgM + IgA and IgG) from patient's serum sample of day 10 after symptoms' initiation...
August 31, 2020: SN comprehensive clinical medicine
Majed Afana, Mahmoud Altawil, Mir Basir, Mohammad Alqarqaz, Khaldoon Alaswad, Marvin Eng, William W O'Neill, Robert J Lederman, Adam B Greenbaum
OBJECTIVES: The purpose of this study was to describe the feasibility and early outcomes of transcaval access for delivery of emergency mechanical circulatory support (MCS) in cardiogenic shock. BACKGROUND: Vascular access for implantation of MCS in patients with cardiogenic shock is often challenging due to peripheral arterial disease and vasoconstriction. Transcaval delivery of MCS may be an alternative. We describe a series of patients we implanted an Impella 5...
September 9, 2020: Catheterization and Cardiovascular Interventions
Katherine L Thayer, Elric Zweck, Mohyee Ayouty, A Reshad Garan, Jaime Hernandez-Montfort, Claudius Mahr, Kevin J Morine, Sarah Newman, Lena Jorde, Jillian L Haywood, Neil M Harwani, Michele L Esposito, Carlos D Davila, Detlef Wencker, Shashank S Sinha, Esther Vorovich, Jacob Abraham, William O'Neill, James Udelson, Daniel Burkhoff, Navin K Kapur
BACKGROUND: Risk stratifying patients with cardiogenic shock (CS) is a major unmet need. The recently proposed Society for Cardiovascular Angiography and Interventions (SCAI) stages as an approach to identify patients at risk for in-hospital mortality remains under investigation. We studied the utility of the SCAI stages and further explored the impact of hemodynamic congestion on clinical outcomes. METHODS: The CS Working Group registry includes patients with CS from 8 medical centers enrolled between 2016 and 2019...
September 9, 2020: Circulation. Heart Failure
Jacob C Jentzer
No abstract text is available yet for this article.
September 9, 2020: Circulation. Heart Failure
Frederik H Verbrugge, Marco Guazzi, Jeffrey M Testani, Barry A Borlaug
Heart failure is characterized by pathologic hemodynamic derangements, including elevated cardiac filling pressures ("backward" failure), which may or may not coexist with reduced cardiac output ("forward" failure). Even when normal during unstressed conditions such as rest, hemodynamics classically become abnormal during stressors such as exercise in patients with heart failure. This has important upstream and downstream effects on multiple organ systems, particularly with respect to the lungs and kidneys...
September 8, 2020: Circulation
Luis A Baeza-Herrera, Diego Araiza-Garaygordobil, Rodrigo Gopar-Nieto, Grecia I Raymundo-Martínez, Arnoldo Loáisiga-Sáenz, Abraham Villalobos-Flores, Manuel Martínez-Ramos, Laura V Torres-Araujo, Ricardo Pohls-Vázquez, Abraham Luna-Herbert, Arturo Alonso-Vázquez, Itzel V Delgado-Cruz, Alejandro Cabello-López, Pablo Martínez-Amezcua, María A Arias-Mendoza
Objective: The objective of PHASE-MX registry is to validate the efficacy and safety of the pharmacoinvasive strategy in comparison with percutaneous coronary intervention (PCI) in patients with acute myocardial infarction with ST segment elevation (STEMI) in a metropolitan region of Mexico. The primary outcome will consist of the composite of cardiovascular death, re-infarction, stroke and cardiogenic shock. Methods: The PHASE-MX registry will include a prospective cohort of patients with STEMI who received reperfusion treatment (mechanical of pharmacological) in the first 12 h after the onset of symptoms...
2020: Archivos de Cardiología de México
César Jiménez-Méndez, Pablo Díez-Villanueva, Teresa Bastante, Francisco de la Cuerda, Javier Segovia, Fernando Alfonso
No abstract text is available yet for this article.
2020: Archivos de Cardiología de México
Michael Johnson, Arun Kumar, Bradford L Cardonell
A 50-year-old woman underwent coronary artery bypass graft (CABG) for multivessel coronary artery disease. Due to hemodynamic instability, the patient could not be weaned from cardiopulmonary bypass without mechanical support, even after multiple attempts. Subsequently, a right ventricular intramyocardial hematoma (IH) was found during postoperative coronary angiography. The IH was felt to be the main contributing factor leading to right ventricular failure and cardiogenic shock, which, to the authors' knowledge, has not been previously reported after CABG...
August 12, 2020: Journal of Cardiothoracic and Vascular Anesthesia
Toshiki Kuno, Hisato Takagi, Tomo Ando, Masaki Kodaira, Yohei Numasawa, John Fox, Sripal Bangalore
BACKGROUND: Mechanical circulatory support (MCS) with Impella or intra-aortic balloon pump (IABP) is used for high-risk percutaneous coronary intervention (PCI) and/or for cardiogenic shock (CS) due to acute myocardial infarction. We aimed to investigate the efficacy and safety of Impella or IABP when compared with no MCS using a network meta-analysis of randomized controlled trials (RCTs). METHODS: EMBASE and MEDLINE were searched through February 2020 for RCT evaluating efficacy of Impella vs...
September 7, 2020: Catheterization and Cardiovascular Interventions
Marie Hauguel-Moreau, Olvier Barthélémy, Serdar Farhan, Kurt Huber, Stéphanie Rouanet, Michel Zeitouni, Paul Guedeney, Georges Hage, Eric Vicaut, Uwe Zeymer, Steffen Desch, Holger Thiele, Gilles Montalescot
AIMS: Critical culprit lesion locations (CCLL) such as left main (LM) and proximal left anterior descending (LAD) are associated with worse clinical outcome in myocardial infarction without cardiogenic shock (CS). We aimed to assess whether CCLL identifies a subgroup of patients at poorer prognosis when presenting with CS. METHODS AND RESULTS: In the CULPRIT-SHOCK trial, a core-laboratory reviewed all coronary angiograms to identify CCLL. CCLL was defined as a culprit lesion realizing a >70% diameter stenosis of LM, LM equivalent (>70% diameter stenoses of both proximal LAD and proximal circumflex), proximal LAD or, last remaining vessel...
September 8, 2020: EuroIntervention
Michael Salna, James Beck, Josh Willey, Koji Takeda
We describe four cases of spinal cord ischemia resulting in paraplegia after peripheral venoarterial extracorporeal membrane oxygenation for cardiogenic shock. This is an uncommon, but possibly underreported, complication with significant irreversible long-term morbidity. While causes are likely multifactorial, it is possible that thrombosis may occur at the level of the mixing cloud due to turbulent flow. Additional studies will be needed to elucidate the true incidence of this complication and investigate whether flow dynamics may potentiate clot formation...
September 2, 2020: Annals of Thoracic Surgery
Jacob A Doll, Colin I O'Donnell, Meg E Plomondon, Stephen W Waldo
BACKGROUND: Bleeding is a common complication of percutaneous coronary intervention (PCI) that is associated with worse clinical outcomes and increased costs. Improved pre-procedural bleeding risk prediction could promote strategies that have been shown to reduce post-PCI bleeding, including increased adoption of radial access. METHODS: We studied patients in the Veterans Affairs Clinical Assessment, Reporting, and Tracking (VA CART) program receiving PCI in VA hospitals...
July 31, 2020: Cardiovascular Revascularization Medicine: Including Molecular Interventions
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