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  • 1
    Online Resource
    Online Resource
    Prognostic value of right atrial pressure‐corrected cardiac power index in cardiogenic shock
    Wiley ; 2022
    In:  ESC Heart Failure Vol. 9, No. 6 ( 2022-12), p. 3920-3930
    Details
    In: ESC Heart Failure, Wiley, Vol. 9, No. 6 ( 2022-12), p. 3920-3930
    Abstract: The pulmonary artery catheter (PAC)‐derived cardiac power index (CPI) has been found of prognostic value in cardiogenic shock (CS) patients. The original CPI equation included the right atrial pressure (RAP), accounting for heart filling pressure as a determinant of systolic myocardial work, but this term was subsequently omitted. We hypothesized that the original CPI formula (CPI RAP ) is superior to current CPI for risk stratification in CS. Methods and results A single‐centre cohort of 80 consecutive Society for Cardiovascular Angiography and Interventions (SCAI) B‐D CS patients with available PAC records was included. Overall in‐hospital mortality was 21.3%. Results showed CPI RAP to be the strongest haemodynamic predictor of in‐hospital death ( p adj  = 0.038), outperforming CPI [area under the receiver operating characteristic (ROC) curves: 0.726 and 0.673, P ‐for‐difference = 0.025]. When the population was stratified according to the identified CPI RAP (0.28 W/m 2 ) and accepted CPI (0.32 W/m 2 ) thresholds, the cohort with discordant indexes (low CPI RAP and high CPI) comprised a group of 13 patients featuring a congested phenotype with frequent right ventricle or biventricular involvement. In this group, in‐hospital mortality was high (30.8%) similar to those with concordant low CPI and CPI RAP . Conclusion Incorporating RAP in CPI calculation (CPI RAP ) improves the prognostic yield in patients with CS SCAI B‐D. A cut‐off of 0.28 W/m 2 identifies patients at higher risk of in‐hospital mortality. The improved prognostic value of CPI RAP may derive from identification of patients with more intravascular congestion who may experience substantial in‐hospital mortality, uncaptured by the commonly used CPI equation.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v9.6
    DOI: 10.1002/ehf2.14093
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2814355-3
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  • 2
    Online Resource
    Online Resource
    Bedside intra‐aortic balloon pump insertion in cardiac intensive care unit: A single‐center experience
    Wiley ; 2022
    In:  Catheterization and Cardiovascular Interventions Vol. 99, No. 7 ( 2022-06), p. 1976-1983
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 99, No. 7 ( 2022-06), p. 1976-1983
    Abstract: In contemporary Cardiac Intensive Care Unit (CICU), bedside intra‐aortic balloon pump (IABP) insertion under echocardiographic guidance may be an attractive option for selected patients with cardiogenic shock (CS). Currently available data on this approach are limited. Aim This study aimed to assess the feasibility and safety of bedside IABP insertion, as compared to fluoroscopic‐guided insertion in the Catheterization Laboratory (CathLab), and to describe the clinical features of patients receiving bedside IABP insertion using a standardized technique in real‐world CICU practice. Methods We prospectively evaluated all patients admitted the CICU who received transfemoral IABP between June 2020 and October 2021. The overall study cohort was divided according to implant strategy in bedside and CathLab groups. The primary outcome was correct radiographic IABP positioning at the first bedside chest X‐ray obtained after insertion. Secondary outcomes included IABP‐related complications. Results Among 115 patients, bedside IABP insertion was performed in 35 (30.4%) cases, mainly presenting with CS‐related to acute decompensated heart failure (ADHF) (68.6 vs 33.8%; p   〈  0.001), with lower LVEF, higher proportion of right ventricular involvement and higher need of inotropes/vasopressors, compared to those receiving CathLab insertion. Bedside IABP insertion resulted feasible and safe, with similar rates of correct IABP positioning (82.9 vs. 82.5%; p  = 0.963) and IABP‐related major vascular complications (5.7 vs. 5.0%; p  = 0.874), as compared to CathLab positioning. Conclusion This study suggests the feasibility and safety of bedside IABP insertion, which could be of relevant interest in patients with ADHF‐related CS who may not need coronary angiography or other urgent CathLab procedures.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v99.7
    DOI: 10.1002/ccd.30197
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2001555-0
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