Consensus guidelines for the use and interpretation of angiogenesis assays

The formation of new blood vessels, or angiogenesis, is a complex process that plays important roles in growth and development, tissue and organ regeneration, as well as numerous pathological conditions. Angiogenesis undergoes multiple discrete steps that can be individually evaluated and quantified by a large number of bioassays. These independent assessments hold advantages but also have limitations. This article describes in vivo, ex vivo, and in vitro bioassays that are available for the evaluation of angiogenesis and highlights critical aspects that are relevant for their execution and proper interpretation. As such, this collaborative work is the first edition of consensus guidelines on angiogenesis bioassays to serve for current and future reference

Acute lung injury after mechanical circulatory support implantation in patients on extracorporeal life support: an unrecognized problem

OBJECTIVES: We observed early acute lung injury (ALI) after a switch from veno-arterial extracorporeal life support (VA-ECLS) to long-term mechanical circulatory support (MCS). The aim of our study was to analyse the frequency, impact on mortality and characteristics of patients presenting ALI after MCS implantation in the bridge-to-bridge (BTB) strategy. METHODS: We retrospectively analysed data from 55 consecutive cardiogenic shock patients who underwent a BTB strategy between January 2004 and March 2012 in our centre. ALI was defined as severe acute respiratory failure (PaO2/FiO2 <200) with or without need for iterative VA-ECLS or veno-venous (VV)-exracorporeal membrane oxygenation (ECMO) occurring within 48 h of MCS implantation. RESULTS: ALI was observed in 15 of 55 (27%) patients. Eleven patients required VV-ECMO or VA-ECLS and 4 were treated medically. The median (interquartile range) duration of support under a long-term device was 47.5 (168.8) days. Mortality while on long-term support was significantly higher in patients who developed ALI (13 of 15, 87%) than in those who did not (21 of 40, 53%; P = 0.03). Hazard ratio for death while on support in patients who developed ALI when compared with those who did not was 3.390 (95% confidence interval, 1.636\u20137.026, P = 0.001). Univariate risk factors for postimplant ALI included: signs of pulmonary oedema while under extracorporeal life support (ECLS) during the week preceding long-term device implantation; mechanical ventilation, the incomplete recovery of renal and hepatic functions and the number of red blood cell units transfused at the time of long-term device implantation, and use of pulsatile, biventricular support. CONCLUSIONS: Implantation of a long-term MCS device in patients on ECLS can result in severe ALI, which is associated with ominous outcomes. Various preimplant risk factors for ALI have been identified and might allow devising strategies to prevent this complication

Impact of early respiratory failure after mechanical circulatory support implantation in patients assisted by veno-arterial extracorporeal membrane oxygenation

Objectives: We observed early onset of severe respiratory failure (ESRF) after switching from veno-arterial extracorporeal membrane oxygenation (VA ECMO) to mechanical circulatory support (MCS), i.e. \u201cbridge to bridge\u201d strategy. The aim of our study was to analyse the frequency, impact on mortality and characteristics of patients presenting with ESFR after MCS implantation in bridge-to-bridge strategy. Methods: We retrospectively analysed data from 55 consecutive patients who underwent bridge-to-bridge strategy for refractory cardiogenic shock between January 2004 and March 2012 in our centre. ESRF was defined as acute respiratory syndrome with or without requirement for ECMO within 48 hours after MCS implantation. Results: ESRF was observed in 15/55 (27%) patients; 11 required veno-venous or VA ECMO and 4 were medically treated. Mean follow-up after MCS implantation was 450\ub1728 days. Mortality after MCS implantation was increased among patients who developed ESRF (ESRF patients) compared with others (87% vs 53%, P=0.03). The rate of acute pulmonary oedema within seven days before MCS implantation was higher in ESRF patients (47% vs 8%, P=0.02), whereas spontaneous ventilation at the time of MCS implantation was lower in the ESRF group (0% vs 48%, P=0.01). The duration of VA ECMO and duration of mechanical ventilation before MCS implantation were not different between ESRF patients and others (respectively 11.2\ub17.4 vs 11.8 \ub113.9 days, P=0.88 and 8.2\ub15.8 vs 7.0\ub111 days, P=0.7). Conclusions: Early severe respiratory failure after MCS implantation in bridge-to-bridge strategy is frequent and increases mortality. Mechanical ventilation and recent pulmonary oedema at the time of MCS implantation could predict early onset of severe respiratory failure after implantation

Late Diastolic Strain Index Is a Marker of Right Ventricular Fibrosis Content in Precapillary Pulmonary Hypertension

status: publishe