Cardiac magnetic resonance predictors of left ventricular remodelling following acute ST elevation myocardial infarction: The VavirimS study

Left ventricular (LV) remodelling (REM) ensuing after ST-elevation myocardial infarction (STEMI), has typically been studied by echocardiography, which has limitations, or cardiac magnetic resonance (CMR) in early phase that may overestimate infarct size (IS) due to tissue edema and stunning. This prospective, multicenter study investigated LV-REM performing CMR in the subacute phase, and 6 months after STEMI

Intra-Aortic Balloon Pumping in Acute Decompensated Heart Failure With Hypoperfusion: From Pathophysiology to Clinical Practice

Trials on intra-aortic balloon pump (IABP) use in cardiogenic shock related to acute myocardial infarction have shown disappointing results. The role of IABP in cardiogenic shock treatment remains unclear, and new (potentially more potent) mechanical circulatory supports with arguably larger device profile are emerging. A reappraisal of the physiological premises of intra-aortic counterpulsation may underpin the rationale to maintain IABP as a valuable therapeutic option for patients with acute decompensated heart failure and tissue hypoperfusion. Several pathophysiological features differ between myocardial infarction- and acute decompensated heart failure-related hypoperfusion, encompassing cardiogenic shock severity, filling status, systemic vascular resistances rise, and adaptation to chronic (if preexisting) left ventricular dysfunction. IABP combines a more substantial effect on left ventricular afterload with a modest increase in cardiac output and would therefore be most suitable in clinical scenarios characterized by a disproportionate increase in afterload without profound hemodynamic compromise. The acute decompensated heart failure syndrome is characterized by exquisite afterload-sensitivity of cardiac output and may be an ideal setting for counterpulsation. Several hemodynamic variables have been shown to predict response to IABP within this scenario, potentially guiding appropriate patient selection. Finally, acute decompensated heart failure with hypoperfusion may frequently represent an end stage in the heart failure history: IABP may provide sufficient hemodynamic support and prompt end-organ function recovery in view of more definitive heart replacement therapies while preserving ambulation when used with a transaxillary approach

Cat Scratch Endocarditis

We reported a case of blood culture–negative infective endocarditis on a native valve, where the clinical presentation was exclusively related to extensive cerebral ischemia secondary to multiple systemic septic cardioembolic events. The cause was ascribed to subacute Bartonella henselae infection, presumably transmitted by cat scratch, documented by positive serologic findings

Impact of in-Hospital Left Ventricular Ejection Fraction Recovery on Long-Term Outcomes in Patients Who Underwent Impella Support for HR PCI or Cardiogenic Shock: A Sub-Analysis from the IMP-IT Registry

: (1) Background: Percutaneous left ventricle assist devices (pLVADs) demonstrated an improvement in mid-term clinical outcomes in selected patients with severely depressed left ventricular ejection fraction (LVEF) undergoing percutaneous coronary interventions. However, the prognostic impact of in-hospital LVEF recovery is unclear. Accordingly, the present sub-analysis aims to evaluate the impact of LVEF recovery in both cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR PCI) supported with pLVADs in the IMP-IT registry. (2) Methods: A total of 279 patients (116 patients in CS and 163 patients in HR PCI) treated with Impella 2.5 or CP in the IMP-IT registry were included in this analysis, after excluding those who died while in the hospital or with missing data on LVEF recovery. The primary study objective was a composite of all-cause death, rehospitalisation for heart failure, left ventricle assist device (LVAD) implantation, or heart transplantation (HT), overall referred to as the major adverse cardiac events (MACE) at 1 year. The study aimed to evaluate the impact of in-hospital LVEF recovery on the primary study objective in patients treated with Impella for HR PCI and CS, respectively. (3) Results: The mean in-hospital change in LVEF was 10 ± 1% (p 3%) was not associated with lower MACE at multivariable analysis (HR 0.73, CI 0.31-1.72, p = 0.17). Conversely, the completeness of revascularisation was found to be a protective factor for MACE (HR 0.11, CI 0.02-0.62, p = 0.02) (4) Conclusions: Significant LVEF recovery was associated with improved outcomes in CS patients treated with PCI during mechanical circulatory support with Impella, whereas complete revascularisation showed a significant clinical relevance in HR PCI

Prevalence and clinical implications of hyperhomocysteinaemia in patients with hypertrophic cardiomyopathy and MTHFR C6777T polymorphism.

The aim of this pilot study was to evaluate the prevalence and clinical implications of hyperhomocysteinaemia in a cohort of patients with HCM and MTHFR C677T polymorphism. A total of 65 consecutive patients with a diagnosis of HCM1 and MTHFR C677T polymorphism were retrospectively evaluated at the Cardiomyopathies and Heart Failure Clinic of the University of Campania ‘Luigi Vanvitelli’ between January 2008 and January 2019. The primary endpoint was a composite of all-cause death, decompensated heart failure, syncope, arrhythmia, implantable cardioverter-defibrillator implantation, or all-cause hospitalization. Secondary endpoints were the individual components of the primary endpoint. The mean age at HCM diagnosis of the total cohort was 30.519.2 years. Out of 65 participants, 52% had a mutation in sarcomeric genes and 49% showed plasma homocysteine levels >12 mmol/L hyperhomocysteinaemia). In patients with hyperhomocysteinaemia, plasma homocysteine levels were higher compared with those without (20.68 vs. 9.11.9, p-value<0.001), while mean age at HCM diagnosis, family history of HCM and SCD, genetic variants and degree of hypertrophy or left ventricular outflow tract obstruction did not differ statistically significantly between the two groups. homocysteine levels >12 mmol/L (hyperhomocysteinaemia). In patients with hyperhomocysteinaemia, plasma homocysteine levels were higher compared with those without (20.68 vs. 9.11.9, p-value<0.001), while mean age at HCM diagnosis, family history of HCM and SCD, genetic variants and degree of hypertrophy or left ventricular outflow tract obstruction did not differ statistically significantly between the two groups

Device-related complications after Impella mechanical circulatory support implantation: an IMP-IT observational multicentre registry substudy

none25To report the incidence, the predictors and clinical impact of device-related complications (DRCs) in the IMP-IT (IMPella Mechanical Circulatory Support Device in Italy) registry. Impella is percutaneous left ventricular assist devices, which provides mechanical circulatory support both in cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR-PCI). The IMP-IT registry is a multicentre registry evaluating the trends in use and clinical outcomes of Impella in Italy.noneAncona, Marco B; Montorfano, Matteo; Masiero, Giulia; Burzotta, Francesco; Briguori, Carlo; Pagnesi, Matteo; Pazzanese, Vittorio; Trani, Carlo; Piva, Tommaso; De Marco, Federico; Di Biasi, Maurizio; Pagnotta, Paolo; Casu, Gavino; Garbo, Roberto; Preti, Gerlando; Nicolini, Elisa; Sclafani, Rocco; Colonna, Giuseppe; Mojoli, Marco; Siviglia, Massimo; Denurra, Cristiana; Caprioglio, Francesco; Scandroglio, Anna Mara; Tarantini, Giuseppe; Chieffo, AlaideAncona, Marco B; Montorfano, Matteo; Masiero, Giulia; Burzotta, Francesco; Briguori, Carlo; Pagnesi, Matteo; Pazzanese, Vittorio; Trani, Carlo; Piva, Tommaso; De Marco, Federico; Di Biasi, Maurizio; Pagnotta, Paolo; Casu, Gavino; Garbo, Roberto; Preti, Gerlando; Nicolini, Elisa; Sclafani, Rocco; Colonna, Giuseppe; Mojoli, Marco; Siviglia, Massimo; Denurra, Cristiana; Caprioglio, Francesco; Scandroglio, Anna Mara; Tarantini, Giuseppe; Chieffo, Alaid

Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation

International audienceBackground: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality. Methods: Data from 686 consecutive patients with cardiogenic shock treated with VA-ECMO with or without left ventricular unloading using an Impella at 16 tertiary care centers in 4 countries were collected. The association between left ventricular unloading and 30-day mortality was assessed by Cox regression models in a 1:1 propensity score–matched cohort. Results: Left ventricular unloading was used in 337 of the 686 patients (49%). After matching, 255 patients with left ventricular unloading were compared with 255 patients without left ventricular unloading. In the matched cohort, left ventricular unloading was associated with lower 30-day mortality (hazard ratio, 0.79 [95% CI, 0.63–0.98]; P =0.03) without differences in various subgroups. Complications occurred more frequently in patients with left ventricular unloading: severe bleeding in 98 (38.4%) versus 45 (17.9%), access site–related ischemia in 55 (21.6%) versus 31 (12.3%), abdominal compartment in 23 (9.4%) versus 9 (3.7%), and renal replacement therapy in 148 (58.5%) versus 99 (39.1%). Conclusions: In this international, multicenter cohort study, left ventricular unloading was associated with lower mortality in patients with cardiogenic shock treated with VA-ECMO, despite higher complication rates. These findings support use of left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO and call for further validation, ideally in a randomized, controlled trial