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Réa ABBAC, Mihajlovic V, Vishram-Nielsen JKK, Brahmbhatt DH, Scolari FL, Wang VN, Nisar M, Fung NL, Otsuki M, Billia F, Overgaard CB, Luk A. Pulmonary Artery Catheter Usage and Impact on Mortality in Patients With Cardiogenic Shock: Results From a Canadian Single-Centre Registry. Can J Cardiol 2024; 40:664-673. [PMID: 38092192 DOI: 10.1016/j.cjca.2023.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Hemodynamic assessment for cardiogenic shock (CS) phenotyping in patients has led to renewed interest in the use of pulmonary artery catheters (PACs). METHODS We included patients admitted with CS from January 2014 to December 2020 and compared clinical outcomes among patients who received PACs and those who did not. The primary outcome was the rate of in-hospital mortality. Secondary outcomes included use of advanced heart failure therapies and coronary intensive care unit (CICU) and hospital lengths of stay. RESULTS A total of 1043 patients were analysed and 47% received PACs. Patients selected for PAC-guided management were younger and had lower left ventricular function. They also had higher use of vasopressor and inotropes, and 15.2% of them were already supported with temporary mechanical circulatory support (MCS). In-hospital mortality was lower in patients who received PACs (29.3% vs 36.2%; P = 0.02), mainly driven by a reduction in mortality among those in Society for Cardiovascular Angiography and Interventions (SCAI) stages D and E CS. Patients who received PACs were more likely to receive temporary MCS with Impella, durable ventricular assist devices (VADs), or orthotopic heart transplantation (OHT) (P < 0.001 for all analyses). CICU and hospital lengths of stay were longer in patients who used PACs. CONCLUSIONS Among patients with CS, the use of PACs was associated with lower in-hospital mortality, especially among those in SCAI stages D and E. Patients who received PACs were also more frequently rescued with temporary MCS or received advanced heart failure therapies, such as durable VADs or OHT.
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Affiliation(s)
- Ana Beatriz B A C Réa
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vesna Mihajlovic
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Darshan H Brahmbhatt
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Luis Scolari
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vicki N Wang
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mahrukh Nisar
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Nicole L Fung
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Madison Otsuki
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Filio Billia
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B Overgaard
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Adriana Luk
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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2
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da Silveira AD, Scolari FL, Saadi MP, Brahmbhatt DH, Milani M, Milani JGPO, Junior GC, Sartor ITS, Zavaglia GO, Tonini ML, da Costa MSC, Scotta MC, Stein RT, Rosa RG. Long-term reduced functional capacity and quality of life in hospitalized COVID-19 patients. Front Med (Lausanne) 2024; 10:1289454. [PMID: 38516229 PMCID: PMC10957227 DOI: 10.3389/fmed.2023.1289454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/27/2023] [Indexed: 03/23/2024] Open
Abstract
Background Persistent symptoms and exercise intolerance have been reported after COVID-19, even months after the acute disease. Although, the long-term impact on exercise capacity and health-related quality of life (HRQoL) is still unclear. Research question To assess the long-term functional capacity and HRQoL in patients hospitalized due to COVID-19. Study design and methods This is a prospective cohort study, conducted at two centers in Brazil, that included post-discharge COVID-19 patients and paired controls. The cohort was paired by age, sex, body mass index and comorbidities, using propensity score matching in a 1:3 ratio. Patients were eligible if signs or symptoms suggestive of COVID-19 and pulmonary involvement on chest computed tomography. All patients underwent cardiopulmonary exercise testing (CPET) and a HRQoL questionnaire (SF-36) 6 months after the COVID-19. The main outcome was the percentage of predicted peak oxygen consumption (ppVO2). Secondary outcomes included other CPET measures and HRQoL. Results The study sample comprised 47 post-discharge COVID-19 patients and 141 healthy controls. The mean age of COVID-19 patients was 54 ± 14 years, with 19 (40%) females, and a mean body mass index of 31 kg/m2 (SD, 6). The median follow-up was 7 months (IQR, 6.5-8.0) after hospital discharge. PpVO2 in COVID-19 patients was lower than in controls (83% vs. 95%, p = 0.002) with an effect size of 0.38 ([95%CI], 0.04-0.70). Mean peak VO2 (22 vs. 25 mL/kg/min, p = 0.04) and OUES (2,122 vs. 2,380, p = 0.027) were also reduced in the COVID-19 patients in comparison to controls. Dysfunctional breathing (DB) was present in 51%. HRQoL was significantly reduced in post COVID patients and positively correlated to peak exercise capacity. Interpretation Hospitalized COVID-19 patients presented, 7 months after discharge, with a reduction in functional capacity and HRQoL when compared to historical controls. HRQoL were reduced and correlated with the reduced peak VO2 in our population.
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Affiliation(s)
- Anderson Donelli da Silveira
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Rio de Janeiro, Brazil
| | - Fernando Luis Scolari
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Rio de Janeiro, Brazil
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University of Toronto, Toronto, ON, Canada
- Social Responsibility, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Marina Petersen Saadi
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Rio de Janeiro, Brazil
| | - Darshan H. Brahmbhatt
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University of Toronto, Toronto, ON, Canada
| | - Mauricio Milani
- Hasselt University, REVAL/BIOMED, Hasselt, Belgium
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, Brazil
| | | | - Gerson Cipriano Junior
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, Brazil
| | | | | | - Maiko Luis Tonini
- General Coordination, Chronic and Airborne Disease Surveillance Coordination, Health Surveillance Secretariat, Brazilian Ministry of Health, Brasilia, Brazil
| | - Marcela Santos Correa da Costa
- General Coordination, National Immunization Program, Health Surveillance Secretariat, Brazilian Ministry of Health, Brasilia, Brazil
| | | | - Renato T. Stein
- Social Responsibility, Hospital Moinhos de Vento, Porto Alegre, Brazil
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3
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Trott G, Scolari FL, Rover MM, da Silva MMD, de Souza D, dos Santos RDRM, Schardosim RFDC, Rech GS, de Mesquita J, Estivalete GP, Freitas HJM, Itaqui CR, Kozesinski-Nakatani AC, Biolo A, Marcolino MS, Barreto BB, Schvartzman PR, Antonio ACP, Robinson CC, Falavigna M, Polanczyk CA, Rosa RG. Long-term Health-Related Quality of Life and Outcomes after Hospitalization for COVID-19 in Brazil: Post-COVID Brazil 1 Study Protocol. Arq Bras Cardiol 2023; 120:e20230378. [PMID: 37991122 PMCID: PMC10697686 DOI: 10.36660/abc.20230378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/01/2023] [Accepted: 08/16/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The long-term impact of hospitalization for COVID-19 on patients' physical, mental, and cognitive health still needs further assessment. OBJECTIVES This study aims to evaluate factors associated with quality of life and cardiovascular and non-cardiovascular outcomes 12 months after hospitalization for COVID-19. METHODS This prospective multicenter study intends to enroll 611 patients hospitalized due to COVID-19 (NCT05165979). Centralized telephone interviews are scheduled to occur at three, six, nine, and 12 months after hospital discharge. The primary endpoint is defined as the health-related quality-of-life utility score assessed by the EuroQol-5D-3L (EQ-5D-3L) questionnaire at 12 months. Secondary endpoints are defined as the EQ-5D-3L at three, six and nine months, return to work or education, persistent symptoms, new disabilities in instrumental activities of daily living, cognitive impairment, anxiety, depression, and post-traumatic stress symptoms, major cardiovascular events, rehospitalization, as well as all-cause mortality at 3, 6, 9, and 12 months after SARS-CoV-2 infection. A p-value <0.05 will be assumed as statistically significant for all analyses. RESULTS The primary endpoint will be presented as the frequency of the EQ-5D-3L score 12 months after COVID-19 hospitalization. A sub-analysis to identify possible associations of independent variables with study outcomes will be presented. CONCLUSIONS This study will determine the impact of COVID-19 on the quality of life and cardiovascular and non-cardiovascular outcomes of hospitalized patients 12 months after discharge providing insights to the public health system in Brazil.
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Affiliation(s)
- Geraldine Trott
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Fernando Luis Scolari
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Divisão de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Marciane Maria Rover
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Divisão de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Mariana Motta Dias da Silva
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Denise de Souza
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Rosa da Rosa Minho dos Santos
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Raíne Fogliati de Carli Schardosim
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Gabriela Soares Rech
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Juliana de Mesquita
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Gabriel Pozza Estivalete
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Hellen Jordan Martins Freitas
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Carolina Rothmann Itaqui
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Amanda Christina Kozesinski-Nakatani
- Unidade de Terapia IntensivaHospital Santa Casa de CuritibaCuritibaPRBrasil Unidade de Terapia Intensiva – Hospital Santa Casa de Curitiba , Curitiba , PR – Brasil
| | - Andreia Biolo
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Divisão de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Instituto Nacional de Avaliação de Tecnologias em SaúdeUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasil Instituto Nacional de Avaliação de Tecnologias em Saúde – Universidade Federal do Rio Grande do Sul , Porto Alegre , RS – Brasil
| | - Milena Soriano Marcolino
- Departamento de Medicina InternaFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Medicina Interna da Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Bruna Brandão Barreto
- Departamento de Medicina Interna e Apoio DiagnósticoFaculdade de Medicina da BahiaUniversidade Federal da BahiaSalvadorBABrasil Departamento de Medicina Interna e Apoio Diagnóstico , Faculdade de Medicina da Bahia , Universidade Federal da Bahia , Salvador , BA – Brasil
- Unidade de Terapia IntensivaHospital da Mulher – Maria Luzia Costa dos SantosSalvadorBABrasil Unidade de Terapia Intensiva – Hospital da Mulher – Maria Luzia Costa dos Santos , Salvador , BA – Brasil
| | - Paulo Roberto Schvartzman
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Divisão de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Ana Carolina Peçanha Antonio
- Unidade de Terapia IntensivaHospital de Clínicas de Porto AlegrePorto AlegreRSBrasil Unidade de Terapia Intensiva – Hospital de Clínicas de Porto Alegre , Porto Alegre , RS – Brasil
| | - Caroline Cabral Robinson
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Maicon Falavigna
- Instituto Nacional de Avaliação de Tecnologias em SaúdeUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasil Instituto Nacional de Avaliação de Tecnologias em Saúde – Universidade Federal do Rio Grande do Sul , Porto Alegre , RS – Brasil
- Unidade de PesquisaInova MedicalPorto AlegreRSBrasil Unidade de Pesquisa – Inova Medical , Porto Alegre , RS – Brasil
| | - Carisi Anne Polanczyk
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Divisão de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Instituto Nacional de Avaliação de Tecnologias em SaúdeUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasil Instituto Nacional de Avaliação de Tecnologias em Saúde – Universidade Federal do Rio Grande do Sul , Porto Alegre , RS – Brasil
| | - Regis Goulart Rosa
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Serviço de Medicina InternaHospital Moinhos de VentoPorto AlegreRSBrasil Serviço de Medicina Interna – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
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4
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Rodenas-Alesina E, Luis Scolari F, Wang VN, Brahmbhatt DH, Mihajlovic V, Fung NL, Otsuki M, Billia F, Overgaard CB, Luk A. Improved mortality and haemodynamics with milrinone in cardiogenic shock due to acute decompensated heart failure. ESC Heart Fail 2023. [PMID: 37322827 PMCID: PMC10375068 DOI: 10.1002/ehf2.14379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 01/09/2023] [Accepted: 03/30/2023] [Indexed: 06/17/2023] Open
Abstract
AIMS Studies in cardiogenic shock (CS) often have a heterogeneous population of patients, including those with acute myocardial infarction and acute decompensated heart failure (ADHF-CS). The therapeutic profile of milrinone may benefit patients with ADHF-CS. We compared the outcomes and haemodynamic trends in ADHF-CS receiving either milrinone or dobutamine. METHODS AND RESULTS Patients presenting with ADHF-CS (from 2014 to 2020) treated with a single inodilator (milrinone or dobutamine) were included in this study. Clinical characteristics, outcomes, and haemodynamic parameters were collected. The primary endpoint was 30 day mortality, with censoring at the time of transplant or left ventricular assist device implantation. A total of 573 patients were included, of which 366 (63.9%) received milrinone and 207 (36.1%) received dobutamine. Patients receiving milrinone were younger, had better kidney function, and lower lactate at admission. In addition, patients receiving milrinone received mechanical ventilation or vasopressors less frequently, whereas a pulmonary artery catheter was more frequently used. Milrinone use was associated with a lower adjusted risk of 30 day mortality (hazard ratio = 0.52, 95% confidence interval 0.35-0.77). After propensity-matching, the use of milrinone remained associated with a lower mortality (hazard ratio = 0.51, 95% confidence interval 0.27-0.96). These findings were associated with improved pulmonary artery compliance, stroke volume, and right ventricular stroke work index. CONCLUSIONS The use of milrinone compared with dobutamine in patients with ADHF-CS is associated with lower 30 day mortality and improved haemodynamics. These findings warrant further study in future randomized controlled trials.
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Affiliation(s)
- Eduard Rodenas-Alesina
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Luis Scolari
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Vicki N Wang
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Darshan H Brahmbhatt
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Vesna Mihajlovic
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Nicole L Fung
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Madison Otsuki
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Filio Billia
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B Overgaard
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Adriana Luk
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
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5
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Menegazzo WR, Santos ABS, Foppa M, Scolari FL, Barros FC, Stein R, da Silveira AD. Prognostic value of right ventricular strain and peak oxygen consumption in heart failure with reduced ejection fraction. Int J Cardiovasc Imaging 2023; 39:501-509. [PMID: 36319776 DOI: 10.1007/s10554-022-02747-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/13/2022] [Indexed: 11/12/2022]
Abstract
Our purpose is to evaluate the combined predictive value of cardiopulmonary exercise testing (CPET) and echocardiographic evidence of left ventricular (LV) and right ventricular (RV) strain in predicting mortality and heart transplant (HTx) in a series of outpatients with heart failure with reduced ejection fraction (HFrEF). A retrospective cohort study of 66 patients with HFrEF (median age, 57 years; 51% women) who underwent CPET and echocardiography (up to 90 days apart) to assess prognosis. The primary outcome was a composite of death and need for HTx. At a median follow-up of 27 [20-39] months, 19 patients (29%) experienced the primary outcome. In unadjusted analysis, most echocardiographic and CPET parameters were associated with the primary outcome, including percentage of predicted peak oxygen consumption (ppVO2), VE/VCO2 slope, LV ejection fraction, and LV and RV longitudinal strain. After adjusting for other clinical, echocardiographic and CPET variables, RV free wall longitudinal strain and ppVO2 remained significantly associated with the primary outcome. Kaplan-Meier survival curves for death and HTx, based on the best cutoff values, showed lower survival rates in patients with impairment in both ppVO2 and RV FW-LS than in those with one or neither parameter impaired (p < 0.001). RV dysfunction and low cardiorespiratory fitness were independent markers of death and need for HTx. Impairment of both ppVO2 and RV FW-LS had a strong additive impact on prognostic assessment in this cohort of patients with HFrEF.
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Affiliation(s)
- Willian Roberto Menegazzo
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. .,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Angela Barreto Santiago Santos
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Murilo Foppa
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Fernando Luis Scolari
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Fernando Colares Barros
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ricardo Stein
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Research Group in Exercise Cardiology (Cardio-Ex), Porto Alegre, RS, Brazil
| | - Anderson Donelli da Silveira
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Research Group in Exercise Cardiology (Cardio-Ex), Porto Alegre, RS, Brazil
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6
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Bataiosu R, Scolari FL, Brahmbhatt D, Hoss S, Chow C, Cooper C, Tsoi M, Rowin E, Maron MS, Billia F, Ralph-Edwards A, Rakowski H, Adler A. Left atrial remodelling after septal myectomy is associated with a reduced 5-year risk of atrial fibrillation in hypertrophic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left atrial diameter (LAD) is an established predictor of atrial fibrillation (AF) and adverse outcomes in hypertrophic cardiomyopathy (HCM). However, the impact of LAD remodelling after surgical myectomy on the development of late onset AF is still poorly understood.
Purpose
To investigate the association between LAD remodelling and new occurrence of AF in the first five years after surgical myectomy in a large patient population with HCM.
Methods
1177 HCM patients without a history of AF, subjected to surgical myectomy at two referral centres between 2001 and 2020 were retrospectively reviewed. Paired echocardiographic studies before and shortly after surgical myectomy were available in 894 (76%) patients and 889 (75%) patients had complete LAD measurements, defined as the anteroposterior diameter at end-systole from parasternal long axis view. LAD was considered normal when ≤40mm. Late onset AF was determined as AF documented between one month and 5 years follow up after myectomy. Patients were grouped as having normal LAD pre- and post-myectomy (group 1), enlarged pre-myectomy LAD but normal post-myectomy LAD (group 2), and those with enlarged LAD post-myectomy (group 3). Cox proportional hazards models were applied to evaluate the impact of LAD on late onset AF.
Results
Late onset AF was detected in 63 (7%) patients, 56% male, with an incidence of 1%/year. Patients with AF were older (56±13 vs. 52±14 years, p=0.03), had a larger post-surgery LAD (44±7 vs. 41±6 mm, p<0.001) and a lower left ventricular ejection fraction (58±6 vs. 61±6%, p=0.002) compared to patients without AF. Postoperative left ventricular maximal wall thickness (14±4 mm vs. 15±4mm, p=0.53), left ventricular outflow tract obstruction (6% vs. 8%, p=0.49) or moderate/severe mitral regurgitation (13% vs. 9%, p=0.29) were similar between patients with and without late onset AF. Among the 227 patients in group 1, late onset AF occurred in only 5 (3%), in comparison to 8 (5%) of 182 patients in group 2, and in 36 (10%) of the 480 patients in group 3 (p=0.006). Using group 1 as reference, the hazard ratio for developing AF was 2.1 (95% CI 0.7–6.5, p=0.15) for patients in group 2 and 3.5 (95% CI 1.4–9.4, p=0.005) for patients in group 3.
Conclusion
In our study we were able to show that the overall post-myectomy 5-year risk for developing AF was 1%/year. Normal LAD and reverse LAD remodelling correlated with a lower risk for developing late onset AF, whereas a higher risk was associated with enlarged post-myectomy LAD. These results highlight the possible clinical benefit of LAD remodelling after myectomy in reducing late onset AF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Bataiosu
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - F L Scolari
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - D Brahmbhatt
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - S Hoss
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - C Chow
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - C Cooper
- Tufts Medical Center, Inc., Hypertrophic Cardiomyopathy Centre , Boston , United States of America
| | - M Tsoi
- Tufts Medical Center, Inc., Hypertrophic Cardiomyopathy Centre , Boston , United States of America
| | - E Rowin
- Tufts Medical Center, Inc., Hypertrophic Cardiomyopathy Centre , Boston , United States of America
| | - M S Maron
- Tufts Medical Center, Inc., Hypertrophic Cardiomyopathy Centre , Boston , United States of America
| | - F Billia
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - A Ralph-Edwards
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - H Rakowski
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
| | - A Adler
- Peter Munk Cardiac Centre, Division of Cardiology , Toronto , Canada
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7
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Szekely Y, Brahmbhatt DH, Scolari FL, Doumouras BS, Billia F. Non-invasive assessment of right ventricular function and pulmonary pressures in cardiogenic shock remains challenging: don't pack away the PAC just yet. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiogenic shock (CS) is associated with high levels of morbidity and mortality despite advances in treatment. Patients with right ventricle (RV) dysfunction have been shown to have poorer outcomes. It is suggested that invasive monitoring through pulmonary artery catheter (PAC) placement can assist in guiding management to improve survival, though they are associated with adverse events.
Purpose
This study assessed the utility of non-invasive, echocardiographic assessment of RV performance and pulmonary artery pressures (PAP) in patients with CS.
Methods
Consecutive patients admitted to a North American quaternary cardiac intensive care unit who had PAC placement were recruited into this study. Invasive haemodynamic assessment was followed by transthoracic echocardiography (TTE) performed by a critical care cardiologist, blinded to the invasive measurements. TTE images were later reported by a second cardiologist, blinded to the invasive measurements and the patient. Correlations between RV and pulmonary invasive and non-invasive parameters were evaluated using Pearson's correlation.
Results
Overall, 96 assessments of 60 patients were compared. Patients were predominantly male (73%), aged 58±14 years and SCAI stage C (55%) and D (22%) at the time of assessment. Invasive measurements of right heart and pulmonary function was possible in all patients. Mean RAP was 8.5±4.7 mmHg, systolic PAP 37.5±9.9 mmHg, diastolic PAP 18.1±6.5 mmHg, mean PAP 25.1±7.2 mmHg, pulmonary capillary wedge pressure (PCWP) 16.0±16.4 mmHg, pulmonary vascular resistance (PVR) 157±99dyn s cm–5, RV stroke work index (RVSWI) 7.0±3.9 g min/m2 and PAP index (PAPi) 2.9±4.2. When compared to non-invasive echocardiographic parameters, there was little correlation with invasive values (Table). RVSWI moderately correlated with peak tricuspid regurgitation (TR) velocity, tricuspid annular plane systolic excursion (TAPSE) and estimated systolic PAP; while peak TR velocity was mild-moderately correlated with PAP and PCWP. No single non-invasive parameter demonstrated strong prediction of invasive values.
Conclusion
Non-invasive assessment of right heart and pulmonary haemodynamic parameters is of limited validity when compared with invasive monitoring through PAC in patients with CS. PAC remains the most reliable method of assessing the RV haemodynamic profile in CS. Future studies should evaluate the clinical benefit of invasive haemodynamic monitoring in this population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Szekely
- UHN - University of Toronto, Division of Cardiology, Toronto General Hospital , Toronto , Canada
| | - D H Brahmbhatt
- UHN - University of Toronto, Division of Cardiology, Toronto General Hospital , Toronto , Canada
| | - F L Scolari
- UHN - University of Toronto, Division of Cardiology, Toronto General Hospital , Toronto , Canada
| | - B S Doumouras
- UHN - University of Toronto, Division of Cardiology, Toronto General Hospital , Toronto , Canada
| | - F Billia
- UHN - University of Toronto, Division of Cardiology, Toronto General Hospital , Toronto , Canada
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8
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Brahmbhatt DH, Scolari FL, Doumouras BS, Billia F, Szekely Y. Echocardiographic assessment alone is inadequate for determining elevated left sided filling pressures in patients with cardiogenic shock. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left atrial (LA) filling pressure assessment is of paramount importance in tailoring treatments for patients with cardiogenic shock (CS). ESC guidelines advocate for the use of mitral inflow Doppler and mitral annulus tissue Doppler measurements to predict elevated left atrial pressure in clinical practice. Echocardiographic measurement of LA pressures could reduce the need for invasive monitoring in CS patients, but its utility remains unproven in this population.
Purpose
We assessed the validity of mitral inflow velocity and mitral annulus velocity indices to determine LA pressures, correlating them with invasive measurement of pulmonary capillary wedge pressure (PCWP) in CS patients admitted to the cardiac intensive care unit (CICU).
Methods
We prospectively evaluated consecutive patients who underwent pulmonary artery catheter insertion in the CICU, measuring their haemodynamic parameters, including PCWP. This was immediately followed by a transthoracic echocardiography (TTE) performed by a critical care cardiologist, blinded to the invasive measurements. The early (E) and late (A) mitral inflow velocities were measured using mitral inflow Doppler and septal and lateral mitral annulus velocities (e') were measured using tissue Doppler, all in the apical 4-chamber view. TTE images were later reported by a second cardiologist, blinded to the invasive measurements and the patient. Correlations between E; E/A ratio; E/e' ratio and PCWP were evaluated using Pearson's correlation.
Results
Sixty patients were recruited into the study, aged 58±14 years, 27% female, with 96 assessments undertaken. The majority (55%) of patients were SCAI stage C, with 14% having had a cardiac arrest prior to CICU admission and 27% required mechanical ventilation at the time of assessment. Mean PCWP was 16.0±6.5 mmHg. Full mitral valve Doppler and tissue Doppler profiles were measured in 67 (70%) assessments, limited due to E/A fusion, atrial fibrillation and limited acoustic windows. There was only weak correlation between PCWP and E/A ratio (R=0.33, p=0.01), with no correlation between PCWP and the other measured values (Table 1), including E/e'. The AUC for identifying patients with elevated PCWP (≥15 mmHg) using E/A ratio was 0.67 (p=0.02), although there was no suitable value to use as a cut off with adequate sensitivity and specificity (Figure 1).
Conclusion
Echocardiographic non-invasive assessment of left sided cardiac filling pressures is technically challenging in patients with CS. Even when possible, there is weak correlation between echocardiographic and invasive measurements, suggesting limited value in this technique. Alternative non-invasive modalities, such as lung ultrasound, should be investigated in this population to assist clinical assessment.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D H Brahmbhatt
- UHN - University of Toronto, Division of Cardiology, Toronto General Hospital , Toronto , Canada
| | - F L Scolari
- UHN - University of Toronto, Division of Cardiology, Toronto General Hospital , Toronto , Canada
| | - B S Doumouras
- UHN - University of Toronto, Division of Cardiology, Toronto General Hospital , Toronto , Canada
| | - F Billia
- UHN - University of Toronto, Division of Cardiology, Toronto General Hospital , Toronto , Canada
| | - Y Szekely
- UHN - University of Toronto, Division of Cardiology, Toronto General Hospital , Toronto , Canada
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9
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Szekely Y, Brahmbhatt DH, Scolari FL, Doumouras BS, Billia F. Lung ultrasound predicts left-sided filling pressures in patients with cardiogenic shock admitted to the cardiac intensive care unit. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left and right filling pressures, as well as cardiac output, are key targets in optimising treatment of cardiogenic shock (CS). Invasive pulmonary artery catheters can provide these data but are associated with complications and are not available in all hospital settings. Lung ultrasound (LUS) can detect pulmonary congestion in patients with heart failure (HF) and may be an alternative to invasive monitoring. We assessed the correlation between LUS score and invasive haemodynamic parameters in patients with CS admitted to the cardiac intensive care unit (CICU) of a North American cardiac centre.
Methods
We prospectively evaluated consecutive patients who underwent pulmonary artery catheter insertion in the CICU. Haemodynamic parameters including right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) were measured and cardiac output (CO) was calculated using the thermodilution method. This was immediately followed by an 8-zones LUS done by a critical care cardiologist who was blinded to the invasive hemodynamic measurements. The LUS score was calculated by counting the total number of B-lines in all 8 zones, with a higher score indicating greater congestion. Correlations between LUS score and hemodynamic parameters were evaluated using Pearson's correlation.
Results
Ninety-six measurements from 60 patients were included, aged 58±14 years with 27% female. The most common diagnosis at admission was cardiogenic shock, followed by acute myocardial infarction and HF exacerbation. Most patients were at SCAI stages C and D at the time of assessment. The mean number of B-lines at LUS was 10.1±8.2. Mean RAP was 8.5±4.6 mmHg, PCWP 16.2±6.3 mmHg and CO of 5.0±1.8 L/min. The total number of B-lines was correlated with PCWP (r=0.66, P<0.001, see Figure 1), RAP (r=0.26, P<0.001) and cardiac output (r=−0.23, p=0.02). Due to the correlation of B-lines in LUS with PCWP, we then evaluated the area under the ROC of the LUS to identify patients with PCWP ≥15 mmHg. The number of positive zones (≥3 B-lines) showed an AUC of 0.81 (0.72–0.89), P<0.001. In 36 patients, we had repeated measurement with more than 12 hours apart. The delta change in PCWP was correlated with delta change in the number of B-lines (r=0.59, P<0.001).
Conclusion
Elevated LUS score in patients with CS is associated with worse invasively-measured LV filling pressures, but less so with RAP or CO. LUS can serve as a useful adjunct to the clinical assessment of patients with CS who do not receive invasive hemodynamic monitoring, either at a single timepoint or to detect changes in clinical status over time, to guide ongoing management.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Szekely
- UHN - University of Toronto, Division of Cardiology, Toronto General Hospital , Toronto , Canada
| | - D H Brahmbhatt
- UHN - University of Toronto, Division of Cardiology, Toronto General Hospital , Toronto , Canada
| | - F L Scolari
- UHN - University of Toronto, Division of Cardiology, Toronto General Hospital , Toronto , Canada
| | - B S Doumouras
- UHN - University of Toronto, Division of Cardiology, Toronto General Hospital , Toronto , Canada
| | - F Billia
- UHN - University of Toronto, Division of Cardiology, Toronto General Hospital , Toronto , Canada
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10
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Scolari FL, Machado GP, Pagnoncelli A, Araújo G, Silveira A, Truesdell A, Wainstein M, Wainstein R. TCT-94 Prediction of Mortality in Patients With ST-Segment Elevation Myocardial Infarction Based on Lung Ultrasound and Its Association With SCAI Shock Stages Classification. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Rodenas-Alesina E, Wang VN, Brahmbhatt DH, Scolari FL, Mihajlovic V, Fung NL, Otsuki M, Billia F, Overgaard CB, Luk A. CALL-K score: predicting the need for renal replacement therapy in cardiogenic shock. Eur Heart J Acute Cardiovasc Care 2022; 11:377-385. [PMID: 35303055 DOI: 10.1093/ehjacc/zuac024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
AIMS The clinical predictors and outcomes of patients with cardiogenic shock (CS) requiring renal replacement therapy (RRT) have not been studied previously. This study assesses the impact of RRT on mortality in patients with CS and aims to identify clinical factors that contribute to the need of RRT. METHODS AND RESULTS Consecutive patients presenting with CS were included from a prospective registry of cardiac intensive care unit admissions at a single institution between 2014 and 2020. Of the 1030 patients admitted with CS, 123 (11.9%) received RRT. RRT was associated with higher 1-year mortality [adjusted hazard ratio = 1.62, 95% confidence interval (CI) 1.02-2.14], and a higher in-hospital incidence of sepsis [risk ratio = 2.76, P < 0.001], and pneumonia (risk ratio = 2.9, P = 0.001). Those who received RRT were less likely to receive guideline-directed medical treatment at time of discharge, undergo heart transplantation (2.4% vs. 11.5%, P = 0.002) or receive a durable left ventricular assist device (0.0% vs. 11.6%, P < 0.001). Five variables at admission best predicted the need for RRT (age, lactate, haemoglobin, use of pre-admission loop diuretics, and admission estimated glomerular filtration rate) and were used to generate the CALL-K 9-point risk score, with better discrimination than creatinine alone (P = 0.008). The score was internally validated (area under the curve = 0.815, 95% CI 0.739-0.835) with good calibration (Hosmer-Lemeshow P = 0.827). CONCLUSIONS RRT is associated with worse outcomes, including a lower likelihood to receive advanced heart failure therapies in patients with CS. A risk score comprising five variables routinely collected at admission can accurately estimate the risk of needing RRT.
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Affiliation(s)
- Eduard Rodenas-Alesina
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Vicki N Wang
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Darshan H Brahmbhatt
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada
- National Heart & Lung Institute, Imperial College London, Royal Brompton Campus, Dovehouse Street, London, SW3 6LY, UK
| | - Fernando Luis Scolari
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Vesna Mihajlovic
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Nicole L Fung
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
| | - Madison Otsuki
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
| | - Filio Billia
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Christopher B Overgaard
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada
- Southlake Regional Health Centre, 596 Davis Dr, Newmarket, ON L3Y 2P9, Canada
| | - Adriana Luk
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, 4N 478, Toronto, ON M5G 2N2, Canada
- Ted Rogers Centre for Heart Research, 661 University Avenue, Toronto, ON M5G 1X8, Canada
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12
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Scolari FL, Biolo A. Reply to the letter "Myocardial-derived miR-29a-regulated DNMTs: A novel therapeutic target for myocardial fibrosis". Int J Cardiol 2022; 364:95. [PMID: 35660555 DOI: 10.1016/j.ijcard.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Fernando Luis Scolari
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Ted Rogers Center for Heart Research, Peter Munk Cardiac Center, University of Toronto, Toronto, Canada.
| | - Andreia Biolo
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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13
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Scolari FL, Hastenteufel LCT, Einsfeld L, Bueno J, Orlandin L, Clausell N, Goldraich LA. Impact of COVID-19 Infection Among Heart Transplant Recipients: A Southern Brazilian Experience. Front Med (Lausanne) 2022; 9:814952. [PMID: 35223912 PMCID: PMC8863584 DOI: 10.3389/fmed.2022.814952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose The coronavirus-2019 (COVID-19) infection is associated with a high risk of complications and death among heart transplant recipients. However, most cohorts are from high-income countries, while data from Latin America are sparse. Methods This is a retrospective cohort of heart transplant recipients followed at a hospital in Rio Grande do Sul, Brazil, between March 1st 2020 and October 1st 2021. Results Of the 62 heart transplant recipients on follow-up, 21 (34%) were infected by COVID-19, 58 (36–63) years of age, 67% male, body mass index of 26 (23-29) kg/m2, 48% with hypertension, 43% with chronic kidney disease, 5% with diabetes, within 2 (1–4) years of post-transplant follow-up. At presentation, the main symptoms were fever (62%), myalgia (33%), cough (33%), headache (33%), and dyspnea (19%). Hospitalization was required for 13 (62%) patients, with a time from first symptoms to the admission of 5 (1–12) days. In 38%, supplementary oxygen was needed, 19% required intensive care, and 10% mechanical ventilation. Three (14%) were infected after at least a first dose of COVID-19 vaccine. The main complications were bacterial pneumonia (38%), renal replacement therapy (19%), sepsis (10%) and venous thromboembolism (10%). Immunosuppression therapy was modified in 48%, with a reduction in the majority (89%). Two (10%) patients died in the hospital due to refractory hypoxemia and multiple organ dysfunction. The incidence of COVID-19 among transplant patients was comparable to the general population in the State of Rio Grande do Sul with a peak in December 2020. Conclusion Heart transplant recipients shown a high rate of COVID-19 infection in Southern Brazil, with typical symptom presentation in most cases. There was an elevated rate of hospitalization, supplementary oxygen support, and complications. In-hospital lethality among infected heart transplanted recipients was similar to previously reported data worldwide despite the high rates of infection in Latin America.
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Affiliation(s)
- Fernando Luis Scolari
- Heart Transplant Program, Division of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.,Ted Rogers Center for Heart Research, Peter Munk Cardiac Center, University Health Network, Toronto, ON, Canada
| | | | - Lídia Einsfeld
- Pharmacy Service, Clinical Pharmacy Section, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Julia Bueno
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Letícia Orlandin
- Heart Transplant Program, Division of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Nadine Clausell
- Heart Transplant Program, Division of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.,Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lívia Adams Goldraich
- Heart Transplant Program, Division of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
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14
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Scolari FL, Garbin HI, Mattos BP. Sudden cardiac death risk stratification in hypertrophic cardiomyopathy: discrepancies persist among guidelines. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Differing criteria have been provided on sudden cardiac death (SCD) risk stratification in hypertrophic cardiomyopathy (HCM) by current guidelines. Recently, AHA/ACC proposed an algorithm with novel clinical markers. It remains to be established the impact of this new approach.
Purpose
Evaluate the impact of the 2020 AHA/ACC guideline on the 2014 ESC and 2011 ACCF/AHA criteria regarding SCD risk assessment and primary prevention implantable cardioverter-defibrillator (ICD) in HCM.
Methods
The database of a HCM center non-referred cohort was accessed for SCD risk profile between March 2007 and March 2020. The agreement for primary prevention ICD recommendations among guidelines was assessed with the Cohen's and Fleiss' Kappa coefficient, P<0.05. SCD or appropriate ICD shock were defined as the primary end-point.
Results
A total of 100 patients, age 60±13 years, 55 (55%) females, were followed by 5±3 years. The maximal left ventricular (LV) wall thickness was 18±4 mm, 38 (38%) patients showed a family history of SCD, 22 (22%) syncope, 6 (6%) ejection fraction ≤50%, 2 (2%) LV apical aneurysm, 1 (1%) massive LV hypertrophy, 26 (26%) non-sustained ventricular tachycardia, and 23 (23%) extensive late gadolinium enhancement. An ICD was placed in 17 (17%) patients. According to the 2020 AHA/ACC guideline, 57 (57%) patients met class IIa recommendation, 27 (27%) class IIb, and 16 (16%) class III. The 2014 ESC model classified 14 (14%) in class IIa, 18 (18%) in class IIb, and 68 (68%) in class III. The 2011 ACCF/AHA considered 66 (66%) in class IIa, 6 (6%) in class IIb, and 28 (28%) in class III. The Cohen's Kappa was 0.200 (95% CI 0.292–0.107), P=0.0005, between the 2020 AHA/ACC and the 2014 ESC, and 0.520 (95% CI 0.651–0.388), P=0.0005, between the North American approaches. The Fleiss' Kappa was 0.219 (95% CI 0.303–0.135) P=0.0005 among the three guidelines, whereas it reached 0.221 (95% CI 0.334–0.108) for class IIa, 0.244 (95% CI 0.357–0.131) for class IIb and 0.202 (95% CI 0.315–0.089) for class III, P=0.0005. Figure 1 shows the patient's reclassification with the new guideline. The primary end-points occurred in 7 (7%) patients in a median follow-up of 6 (17–0.4) years. All of them were classified as IIa with the 2011 ACCF/AHA guideline, but only 4 (4%) met this class under the 2020 AHA/ACC, and none in the 2014 ESC model.
Conclusion
A low agreement was found among guidelines, especially between the 2020 AHA/ACC and the 2014 ESC criteria. The North American systems differed moderately, but the new approach has reduced the cases in class IIa and III recommendation for primary prevention ICD. In contrast, the recent 2020 guideline has increased the number of patients in class IIa in relation to the European model, but both strategies have not protected the totality of patients with SCD or appropriate shock.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Hospital de Clínicas de Porto Alegre Figure 1
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Affiliation(s)
- F L Scolari
- Hospital de Clínicas de Porto Alegre, Division of Cardiology, Porto Alegre, Brazil
| | - H I Garbin
- Hospital de Clínicas de Porto Alegre, Division of Cardiology, Porto Alegre, Brazil
| | - B P Mattos
- Hospital de Clínicas de Porto Alegre, Division of Cardiology, Porto Alegre, Brazil
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15
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Luis Scolari F, Biolo A. The Burden of Heart Failure in Brazil: Are we Providing Better Care or Just more Expensive Care? IJCS 2019. [DOI: 10.36660/ijcs.20190160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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