Impella versus extracorporal life support in cardiogenic shock: a propensity score adjusted analysis

Aims: The mortality in cardiogenic shock (CS) is high. The role of specific mechanical circulatory support (MCS) systems is unclear. We aimed to compare patients receiving Impella versus ECLS (extracorporal life support) with regard to baseline characteristics, feasibility, and outcomes in CS. Methods and results: This is a retrospective cohort study including CS patients over 18 years with a complete follow-up of the primary endpoint and available baseline lactate level, receiving haemodynamic support either by Impella 2.5 or ECLS from two European registries. The decision for device implementation was made at the discretion of the treating physician. The primary endpoint of this study was all-cause mortality at 30 days. A propensity score for the use of Impella was calculated, and multivariable logistic regression was used to obtain adjusted odds ratios (aOR). In total, 149 patients were included, receiving either Impella (n = 73) or ECLS (n = 76) for CS. The feasibility of device implantation was high (87%) and similar (aOR: 3.14; 95% CI: 0.18–56.50; P = 0.41) with both systems. The rates of vascular injuries (aOR: 0.95; 95% CI: 0.10–3.50; P = 0.56) and bleedings requiring transfusions (aOR: 0.44; 95% CI: 0.09–2.10; P = 0.29) were similar in ECLS patients and Impella patients. The use of Impella or ECLS was not associated with increased odds of mortality (aOR: 4.19; 95% CI: 0.53–33.25; P = 0.17), after correction for propensity score and baseline lactate level. Baseline lactate level was independently associated with increased odds of 30 day mortality (per mmol/L increase; OR: 1.29; 95% CI: 1.14–1.45; P < 0.001). Conclusions: In CS patients, the adjusted mortality rates of both ECLS and Impella were high and similar. The baseline lactate level was a potent predictor of mortality and could play a role in patient selection for therapy in future studies. In patients with profound CS, the type of device is likely to be less important compared with other parameters including non-cardiac and neurological factors

Clinical correlates and prognostic impact of neurologic disorders in Takotsubo syndrome

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Cardiac alterations are frequently observed after acute neurological disorders. Takotsubo syndrome (TTS) represents an acute heart failure syndrome and is increasingly recognized as part of the spectrum of cardiac complications observed after neurological disorders. A systematic investigation of TTS patients with neurological disorders has not been conducted yet. The aim of the study was to expand insights regarding neurological disease entities triggering TTS and to investigate the clinical profile and outcomes of TTS patients after primary neurological disorders. The International Takotsubo Registry is an observational multicenter collaborative effort of 45 centers in 14 countries (ClinicalTrials.gov, identifier NCT01947621). All patients in the registry fulfilled International Takotsubo Diagnostic Criteria. For the present study, patients were included if complete information on acute neurological disorders were available. 2402 patients in whom complete information on acute neurological status were available were analyzed. In 161 patients (6.7%) an acute neurological disorder was identified as the preceding triggering factor. The most common neurological disorders were seizures, intracranial hemorrhage, and ischemic stroke. Time from neurological symptoms to TTS diagnosis was ≤ 2 days in 87.3% of cases. TTS patients with neurological disorders were younger, had a lower female predominance, fewer cardiac symptoms, lower left ventricular ejection fraction, and higher levels of cardiac biomarkers. TTS patients with neurological disorders had a 3.2-fold increased odds of in-hospital mortality compared to TTS patients without neurological disorders. In this large-scale study, 1 out of 15 TTS patients had an acute neurological condition as the underlying triggering factor. Our data emphasize that a wide spectrum of neurological diseases ranging from benign to life-threatening encompass TTS. The high rates of adverse events highlight the need for clinical awareness.The International Takotsubo Registry was supported by the Biss Davies Charitable Trust. Dr. Scheitz has been supported by the Corona Foundation. Dr. Templin has been supported by the H.H. Sheikh Khalifa bin Hamad Al-Thani Research Programme and the Swiss Heart Foundation.info:eu-repo/semantics/publishedVersio

Ethnic comparison in takotsubo syndrome : novel insights from the International Takotsubo Registry

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Background: Ethnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes. Methods: TTS patients in Japan were enrolled from 10 hospitals and TTS patients in Europe were enrolled from 32 hospitals participating in the International Takotsubo Registry. Clinical characteristics and in-hospital outcomes were compared between Japanese and European patients. Results: A total of 503 Japanese and 1670 European patients were included. Japanese patients were older (72.6 ± 11.4 years vs. 68.0 ± 12.0 years; p < 0.001) and more likely to be male (18.5 vs. 8.4%; p < 0.001) than European TTS patients. Physical triggering factors were more common (45.5 vs. 32.0%; p < 0.001), and emotional triggers less common (17.5 vs. 31.5%; p < 0.001), in Japanese patients than in European patients. Japanese patients were more likely to experience cardiogenic shock during the acute phase (15.5 vs. 9.0%; p < 0.001) and had a higher in-hospital mortality (8.2 vs. 3.2%; p < 0.001). However, ethnicity itself did not appear to have an impact on in-hospital mortality. Machine learning approach revealed that the presence of physical stressors was the most important prognostic factor in both Japanese and European TTS patients. Conclusion: Differences in clinical characteristics and in-hospital outcomes between Japanese and European TTS patients exist. Ethnicity does not impact the outcome in TTS patients. The worse in-hospital outcome in Japanese patients, is mainly driven by the higher prevalence of physical triggers.Open Access funding provided by Universität Zürich. CT has been supported by the H.H. Sheikh Khalifa bin Hamad Al-Thani Research Programme and the Swiss Heart Foundation. L.S.M. has been supported by EU HORIZON 2020 (SILICOFCM ID777204). J.R.G has received a grant “Filling the gap” from the University of Zurich. The InterTAK Registry is supported by The Biss Davies Charitable Trust.info:eu-repo/semantics/publishedVersio

Ethnic comparison in takotsubo syndrome: novel insights from the International Takotsubo Registry

Background Ethnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes.Methods TTS patients in Japan were enrolled from 10 hospitals and TTS patients in Europe were enrolled from 32 hospitals participating in the International Takotsubo Registry. Clinical characteristics and in-hospital outcomes were compared between Japanese and European patients.Results A total of 503 Japanese and 1670 European patients were included. Japanese patients were older (72.6 +/- 11.4 years vs. 68.0 +/- 12.0 years; p < 0.001) and more likely to be male (18.5 vs. 8.4%; p< 0.001) than European TTS patients. Physical triggering factors were more common (45.5 vs. 32.0%; p < 0.001), and emotional triggers less common (17.5 vs. 31.5%; p < 0.001), in Japanese patients than in European patients. Japanese patients were more likely to experience cardiogenic shock during the acute phase (15.5 vs. 9.0%; p < 0.001) and had a higher in-hospital mortality (8.2 vs. 3.2%; p< 0.001). However, ethnicity itself did not appear to have an impact on in-hospital mortality. Machine learning approach revealed that the presence of physical stressors was the most important prognostic factor in both Japanese and European TTS patients.Conclusion Differences in clinical characteristics and in-hospital outcomes between Japanese and European TTS patients exist. Ethnicity does not impact the outcome in TTS patients. The worse in-hospital outcome in Japanese patients, is mainly driven by the higher prevalence of physical triggers.Cardiolog

Ethnic comparison in takotsubo syndrome: novel insights from the International Takotsubo Registry

Background Ethnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes.Methods TTS patients in Japan were enrolled from 10 hospitals and TTS patients in Europe were enrolled from 32 hospitals participating in the International Takotsubo Registry. Clinical characteristics and in-hospital outcomes were compared between Japanese and European patients.Results A total of 503 Japanese and 1670 European patients were included. Japanese patients were older (72.6 +/- 11.4 years vs. 68.0 +/- 12.0 years; p Conclusion Differences in clinical characteristics and in-hospital outcomes between Japanese and European TTS patients exist. Ethnicity does not impact the outcome in TTS patients. The worse in-hospital outcome in Japanese patients, is mainly driven by the higher prevalence of physical triggers.</p

Sudden Cardiac Death during Mountain Sports Activities

Sudden cardiac death (SCD) is an unanticipated and dramatic event resulting from cardiac causes. First reports on SCDs during mountain sports activities date back to the 1970s and 1980s of the last century. Relatively large datasets have been collected in Austria from 1985 onwards initiating systematic recordings and analyses of risk factors and triggers of SCDs during mountain sports activities. The results presented in this publication are derived from a literature search on reported SCDs that occurred during selected mountaineering activities with particular regard to study findings based on data collected in Austria. We found a relatively low SCD risk during mountaineering activities, amounting to about 1 SCD per 1 million activity days when hiking, trekking or ski touring, which is even lower during downhill skiing but higher in competitive cross-country skiing. The risk is much higher in men than in women and increases sharply above the age of 34. Main risk factors include prior myocardial infarction, coronary artery disease, arterial hypertension, hypercholesterolaemia and diabetes mellitus type 2, but regular and sport-specific activities turned out to be important protective factors. Unaccustomed physical exertion, in particular on the first days in the mountains (altitude), prolonged activities without rest and insufficient energy and fluid intake represent important SCD triggers. Besides considering these potential triggers during mountaineering activities, sports medical examination, appropriate pharmacological therapy of risk factors and physical preparation represent preventive key elements. Key Words: Exercise, Mountains, Cardiovascular, Risk, Triggers, Prevention = Der plötzliche Herztod (PHT) ist ein unerwartetes aber dramatisches Ereignis. Die PHT-Inzidenz in der Gesamtbevölkerung variiert zwischen 50 und 100 pro 100.000. Sie ist deutlich höher für Männer als für Frauen und steigt mit zunehmendem Alter, bei Personen mit Vorerkrankungen und bei ungewohnter körperlicher Belastung markant an. Erste PHT-Berichte bei Bergsportaktivitäten stammen aus den 70er und 80er Jahren des vorigen Jahrhunderts und ab 1985 starteten in Österreich systematische Erhebung über Häufigkeit, Risikopersonen, Risikofaktoren und Trigger für den PHT. Die im Folgenden präsentierten Ergebnisse basieren auf einer Literaturerhebung zu PHT-Daten beim alpinen und nordischen Skilauf, auf Skitouren, beim Bergwandern und Trekking unter besonderer Berücksichtigung der langjährigen Erhebungen und Analysen in Österreich. Es zeigte sich, dass Bergsport mit einem relativ niedrigen PHT-Risiko verbunden ist, in einer Größenordnung von etwa 1 PHT pro 1 Million Aktivitätstage beim Bergwandern, Trekking und auf Skitouren. Dieses Risiko ist beim alpinen Skilauf sogar noch niedriger aber beim Skilanglaufen (besonders bei Wettkämpfen) allerdings höher. Das Risiko ist für Männer weitaus höher als für Frauen und steigt mit zunehmendem Alter steil an. Hauptrisikofaktoren sind ein bereits vorangegangener Myokardinfarkt, eine bestehende koronare Herzkrankheit, Bluthochdruck, ein erhöhter Cholesterinspiegel und Diabetes Typ 2. Regelmäßige und sportartspezifische Sportausübung sind die wichtigsten Schutzfaktoren. Ungewohnte körperliche Belastung (bei niedriger Fitness), besonders am ersten Tag der Bergsportaktivität sowie lange Belastungen ohne Pausen mit Energie- und Flüssigkeitszufuhr sind als Trigger zu nennen. Neben der Berücksichtigung dieser Trigger bei der Bergsportausübung stellen die vorangehende sportmedizinische Untersuchung, eine wirkungsvolle pharmakologische Therapie bestehender Risikofaktoren und besonders auch die rechtzeitige körperliche Vorbereitung wichtige Präventivmaßnahmen dar. Schlüsselwörter: Sport, Berge, Herzkreislauf, Risiko, Trigger, Vorbeugun

Mountain &amp; Alpine Medicine

Sudden cardiac death (SCD) is an unanticipated and dramatic event resulting from cardiac causes. First reports on SCDs during mountain sports activities date back to the 1970s and 1980s of the last century. Relatively large datasets have been collected in Austria from 1985 onwards initiating systematic recordings and analyses of risk factors and triggers of SCDs during mountain sports activities. The results presented in this publication are derived from a literature search on reported SCDs that occurred during selected mountaineering activities with particular regard to study findings based on data collected in Austria.We found a relatively low SCD risk during mountaineering activities, amounting to about 1 SCD per 1 million activity days when hiking, trekking or ski touring, which is even lower during downhill skiing but higher in competitive cross-country skiing. The risk is much higher in men than in women and increases sharply above the age of 34. Main risk factors include prior myocardial infarction, coronary artery disease, arterial hypertension, hypercholesterolaemia and diabetes mellitus type 2, but regular and sport-specific activities turned out to be important protective factors. Unaccustomed physical exertion, in particular on the first days in the mountains (altitude), prolonged activities without rest and insufficient energy and fluid intake represent important SCD triggers. Besides considering these potential triggers during mountaineering activities, sports medical examination, appropriate pharmacological therapy of risk factors and physical preparation represent preventive key elements.Key Words: Exercise, Mountains, Cardiovascular, Risk, Triggers, Preventio

Hypertensive Response to Exercise in Athletes: Unremarkable Finding or Relevant Marker for Future Cardiovascular Complications?

Background. In the general population, hypertensive response to exercise (HRE) predicts new-onset resting hypertension or other cardiovascular diseases. Methods. PubMed was searched for English articles published between January 1st 2000 and April 30th 2020. Additional studies were identified via reference lists of included studies. 92 papers were selected for full text analysis, finally 30 studies were included. Results. The results from 5 follow-up studies suggested an association between HRE and the risk of developing hypertension, while 10 studies reported a link with adverse cardiovascular events in the general population. Another study showed an association between HRE and future hypertension in athletes after a follow-up of 7 years. HRE in athletes was associated with left ventricular hypertrophy in three studies. Two other studies showed a link between HRE and focal myocardial fibrosis in triathletes and myocardial injury, respectively. One study found lower Apoliprotein-1 serum levels in athletes with HRE leading to a higher risk for cardiovascular disease. Only in one study no association with cardiovascular dysfunction in athletes with HRE was found. Conclusions. Based on current evidence, HRE is not a normal finding in athletes. If detected, it should be interpreted as a risk factor for future cardiovascular complications. Future research should address the adequate follow-up and management of athletes with HRE

The cardiovascular response to interval exercise is modified by the contraction type and training in proportion to metabolic stress of recruited muscle groups

Background: Conventional forms of endurance training based on shortening contractions improve aerobic capacity but elicit a detriment of muscle strength. We hypothesized that eccentric interval training, loading muscle during the lengthening phase of contraction, overcome this interference and potentially adverse cardiovascular reactions, enhancing both muscle metabolism and strength, in association with the stress experienced during exercise. Methods: Twelve healthy participants completed an eight-week program of work-matched progressive interval-type pedaling exercise on a soft robot under predominately concentric or eccentric load. Results: Eccentric interval training specifically enhanced the peak power of positive anaerobic contractions (+28%), mitigated the strain on muscle\u2019s aerobic metabolism, and lowered hemodynamic stress during interval exercise, concomitant with a lowered contribution of positive work to the target output. Concentric training alone lowered blood glucose concentration during interval exercise and mitigated heart rate and blood lactate concentration during ramp exercise. Training-induced adjustments for lactate and positive peak power were independently correlated (p 0.7) with indices of metabolic and mechanical muscle stress during exercise. Discussion: Task-specific improvements in strength and muscle\u2019s metabolic capacity were induced with eccentric interval exercise lowering cardiovascular risk factors, except for blood glucose concentration, possibly through altered neuromuscular coordination