Echocardiographic assessment of right ventricular (RV) measurements may be challenging. The aim of this study was to develop a formula for calculation of RV volumes and function based on measurements ...of linear dimensions by 2-dimensional (2D) transthoracic echocardiography (TTE) in comparison to cardiovascular magnetic resonance (CMR). 129 consecutive patients with standard TTE and RV analysis by CMR were included. A formula based on the geometric assumptions of a truncated cone minus a truncated rhomboid pyramid was developed for calculations of RV end-diastolic volume (EDV) and RV end-systolic volume (ESV) by using the basal diameter of the RV (Dd and Ds) and the baso-apical length (Ld and Ls) in apical 4-chamber TTE views: RV EDV = 1.21 * Dd.sup.2 * Ld, and RV ESV = 1.21 * Ds.sup.2 * Ls. Calculations of RV EDV (DELTARV EDV = 10.2±26.4 ml to CMR, r = 0.889), RV ESV (DELTARV ESV = 4.5±18.4 ml to CMR, r = 0.921) and RV EF (DELTARV EF = 0.5±4.0% to CMR, r = 0.905) with the cone-pyramid formula (CPF) highly agreed with CMR. Impaired RV function on CMR (n = 52) was identified with a trend to higher accuracy by CPF than by conventional echocardiographic parameters (tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC)). Calculations of RV volumes and RV function by 2D TTE with the newly developed CPF were in high concordance to measurements by CMR. Accuracy for detection of patients with reduced RV function were higher by the proposed 2D TTE CPF method than by conventional echocardiographic parameters of TAPSE and RV FAC.
Background
Out of hospital cardiac arrest (OHCA) is common and associated with low survival rates. Guidelines propose a fast work‐up after OHCA including coronary angiography (CA) but little is known ...about the actual outcome of those patients who undergo immediate CA after OHCA with suspected cardiac origin.
Aim
The aim of this retrospective single‐center study was to evaluate the short‐term outcomes and predictors of in‐hospital mortality in patients who underwent immediate CA after OHCA with suspected cardiac origin.
Methods
We included all consecutive patients with OHCA who underwent immediate CA between January 2011 and December 2015. We defined immediate CA after OHCA as angiography within 2 hr after admission.
Results
Two hundred and nineteen consecutive patients with OHCA were included. Fifty six patients (26%) underwent CA without previous return of spontaneous circulation (ROSC) and with ongoing CPR using the LUCAS‐device. One hundred and forty nine patients (67%) died in hospital. Of the 56 patients with CA with ongoing CPR, 55 died and only 1 patient survived to hospital discharge. In a multivariate analysis, older age (OR = 2.03, 95%CI 1.35–3.03; p = .001), initial shockable rhythm (OR = 0.28, 95%CI 0.07–1.13; p = .076), CA with ongoing CPR (OR = 11.63, 95%CI 1.20–122.55; p = .035), and initial arterial pH (OR = 0.008, 95%CI 0.00–0.228; p < .005) remained as independent predictors for in‐hospital mortality.
Conclusions
In this study older age, metabolic derangement on admission, initial nonshockable rhythm and failure to achieve ROSC before admission predicted in‐hospital mortality. While CA with ongoing CPR with the LUCAS‐device was feasible, mortality in patients without previous ROSC was extremely high, questioning whether this approach is medically useful.
Background
Transcatheter aortic valve implantation (TAVI) has become a well‐established therapeutic option for patients with severe aortic stenosis (AS) at high to intermediate surgical risk. ...Although TAVI is associated with low mortality of 1.2–6.5%, cardiogenic shock (CS) as a peri‐interventional complication remains a challenging problem with very high morbidity and mortality.
Aim
This study evaluated the clinical outcome of the use of Impella ventricular assist device in patients undergoing TAVI.
Methods
Between 11/2015 and 08/2018, all patients undergoing TAVI requiring temporary circulatory during the same index hospitalization were included. Primary endpoint was 30‐day all‐cause mortality. Secondary endpoints were peri‐interventional mortality and 30‐day stroke rate.
Results
Of the 390 patients undergoing TAVI, 13 (3%) required hemodynamic support with an Impella device. Of these, 3 (23%) underwent protected high‐risk PCI before TAVI and 10 patients (77%) needed emergency periprocedural hemodynamic support due to cardiogenic shock. Mortality at 30 days was 0% in Impella‐protected PCI and 40% with Impella use for periprocedural CS. No stroke occurred in the cohort up to 30 days. Insertion of the Impella device in the setting of TAVI was fast with a mean insertion time of 10 min. Eight patients (80%) in the periprocedural CS group required cardiopulmonary resuscitation prior to Impella use. There was only one device‐related complication.
Conclusions
Temporary hemodynamic support with the Impella device in patients with severe aortic valve stenosis or in CS secondary to complicated TAVI was technically doable and allowed stabilization and treatment of salvageable patients.
Transcatheter aortic valve implantation (TAVI) is nowadays the optimal therapeutic strategy in patients with severe aortic valve stenosis (AS). Consequently, percutaneous coronary intervention (PCI) ...of concomitant complex coronary artery disease (CAD) has increased in the last decade to optimize patients with severe AS before TAVI. Although the Impella ventricular assist device (Abiomed) was considered as a relative contraindication in patients with AS, its usage has demonstrated promising results in selected patients.
All consecutive patients with severe AS who underwent staged approach with high-risk PCI of unprotected left main (ULM) using the Impella ventricular assist device before TAVI were retrospectively included. The primary endpoint was 30-day all-cause mortality, and secondary endpoints were peri-interventional mortality, vascular complication, and 30-day stroke rates. Due to the exploratory, observational intent of the study, no statistical analysis was performed.
Twenty-one consecutive patients (14 men; age, 80 ± 6 years; log EuroScore, 17 ± 7; SYNTAX score, 27 ± 10) were included. All patients (21/21) survived to 30-day follow-up exam. Three patients (14%) had PCI of ULM and TAVI at the same session. Eighteen patients (86%) underwent TAVI in a staged approach after previous PCI (10 ± 10 days). No patient suffered from stroke up to 30-day follow-up. One patient (5%) developed Valve Academic Research Consortium-2 major vascular complication after PCI. TAVI was successfully performed in all patients.
Temporary hemodynamic support with the Impella device during staged approach with high-risk protected PCI appears to be safe and technically feasible in patients with severe AS before undergoing TAVI.
Analysis of diastolic function for assessment of myocardial viability has not been evaluated. Strain rate (SR) analysis allows quantitative segmental analysis of myocardial function and has been used ...during dobutamine stimulation for assessment of systolic functional reserve. In 37 patients with ischemic left ventricular dysfunction diastolic function was evaluated at rest and during low-dose dobutamine stimulation (10 mug/kg/min) using SR imaging and related to F18-fluorodeoxyglucose positron emission tomography. Analysis of peak early (E waves) and late (A waves) diastolic myocardial SR was performed using apical views. In all, 317 segments had normal function at rest by 2-dimensional echocardiography. A total of 192 segments with dyssynergy at rest were classified by positron emission tomography as viable in 94 cases and nonviable in 98 cases. Dys-synergic segments had lower E and A waves SR compared with normal contracting segments. There were no significant differences in peak E and A waves SR at rest between dys-synergic viable and nonviable segments. With dobutamine stimulation peak E waves SR increased significantly for viable segments (0.89 +/- 0.51-1.06 +/- 0.51 L/s, P < .01) whereas it was unchanged for nonviable segments (0.77 +/- 0.49-0.78 +/- 0.48 L/s, P = .835). Peak A waves SR increased for viable (0.71 +/- 0.55-1.00 +/- 0.56 L/s, P < .01) and nonviable (0.57 +/- 0.47-0.71 +/- 0.58 L/s, P = .023) segments. However, during dobutamine stimulation peak A waves SR was larger ( P < .001) for viable than for nonviable segments. In conclusion, normal contracting segments at rest have higher E and A waves SR compared with dys-synergic segments. Dys-synergic viable myocardial segments demonstrate an increase in E and A waves SR with dobutamine stimulation whereas nonviable segments are less responsive to dobutamine.
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