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Long B, Brady WJ, Gottlieb M. Emergency medicine updates: Sympathetic crashing acute pulmonary edema. Am J Emerg Med 2025; 90:35-40. [PMID: 39799613 DOI: 10.1016/j.ajem.2024.12.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Revised: 12/11/2024] [Accepted: 12/19/2024] [Indexed: 01/15/2025] Open
Abstract
INTRODUCTION Patients with heart failure exacerbation can present in a variety of ways, including sympathetic crashing acute pulmonary edema (SCAPE). Emergency physicians play a key role in the diagnosis and management of this condition. OBJECTIVE This narrative review evaluates key evidence-based updates concerning the diagnosis and management of SCAPE for the emergency clinician. DISCUSSION SCAPE is a subset of acute heart failure, defined as a patient with sudden, severe pulmonary edema and hypertension, resulting respiratory distress, and hypoxemia. This is associated with significantly elevated afterload with fluid maldistribution into the pulmonary system. Evaluation and resuscitation should occur concurrently. Laboratory assessment, electrocardiogram, and imaging should be obtained. Point-of-care ultrasound is a rapid and reliable means of confirming pulmonary edema. Management focuses on respiratory support and vasodilator administration. Noninvasive positive pressure ventilation (NIPPV) with oxygen support is associated with reduced need for intubation, improved survival, and improved respiratory indices. If the patient does not improve or decompensates on NIPPV, endotracheal intubation is recommended. Rapid reduction in afterload is necessary, with the first-line medication including nitroglycerin. High-dose bolus nitroglycerin is safe and effective, followed by an infusion. If hypertension is refractory to NIPPV and high-dose nitroglycerin, other agents may be administered including clevidipine or nicardipine. Angiotensin-converting enzyme inhibitors such as enalaprilat are an option in those with normal renal function and resistant hypertension. Diuretics may be administered in those with evidence of systemic volume overload (e.g., cardiomegaly, peripheral edema, weight gain), but should not be routinely administered in patients with SCAPE in the absence of fluid overload. Caution is recommended in utilizing opioids and beta blockers in those with SCAPE. CONCLUSION An understanding of the current literature concerning SCAPE can assist emergency clinicians and improve the care of these patients.
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Affiliation(s)
- Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - William J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
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Shchekochikhin D, Charaya K, Shilova A, Nesterov A, Pershina E, Sherashov A, Panov S, Ibraimov S, Bogdanova A, Suvorov A, Trushina O, Bguasheva Z, Rozina N, Klimenko A, Mareyeva V, Voinova N, Dukhnovskaya A, Konchina S, Zakaryan E, Kopylov P, Syrkin A, Andreev D. Prognostic Markers of Adverse Outcomes in Acute Heart Failure: Use of Machine Learning and Network Analysis with Real Clinical Data. J Clin Med 2025; 14:1934. [PMID: 40142741 PMCID: PMC11943172 DOI: 10.3390/jcm14061934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 02/28/2025] [Accepted: 03/10/2025] [Indexed: 03/28/2025] Open
Abstract
Background: Acute heart failure (AHF) is one of the leading causes of admissions to the emergency department (ED). There is a need to develop an easy-to-use score that can be used in the ED to risk-stratify patients with AHF and in hospitalization decisions regarding cardiac wards or intensive care units (ICUs). Methods: A retrospective observational study was conducted at a city hospital. The data from the presentation of AHF patients at the ED were collected. The combined primary endpoint included death from any cause during hospitalization or transfer to an intensive care unit (ICU) for using inotropes/vasopressors. Feature selection was performed using artificial intelligence. Results: From August 2020 to August 2021, 908 patients were enrolled (mean age: 71.6 ± 13 years; 500 (55.1%) men). We found significant predictors of in-hospital mortality and ICU transfers for inotrope/vasopressor use and built two models to assess the need for ICU admission of patients from the ED. The first model included SpO2 < 90%, QTc duration, prior diabetes mellitus and HF diagnosis, serum chloride concentration, respiratory rate and atrial fibrillation on admission, blood urea nitrogen (BUN) levels, and any implanted devices. The second model included left ventricular end-diastolic size, systolic blood pressure, pulse blood pressure, BUN levels, right atrium size, serum chloride, sodium and uric acid concentrations, prior loop diuretic use, and pulmonary artery systolic blood pressure. Conclusions: We developed two models that demonstrated a high negative predictive value, which allowed us to distinguish patients with low risk and determine patients who can be hospitalized and sent from the ED to the floor. These easy-to-use models can be used at the ED.
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Affiliation(s)
- Dmitri Shchekochikhin
- Functional and Ultrasound Diagnostics, Department of Cardiology, Sechenov University, 8 Trubetskaya Str., Moscow 119991, Russia; (D.S.); (E.P.); (S.P.); (S.I.); (A.B.); (S.K.); (E.Z.); (P.K.); (A.S.); (D.A.)
- City Clinical Hospital No.1, 8 Leninsky Ave., Moscow 119049, Russia; (A.S.); (A.N.); (O.T.); (Z.B.); (N.R.); (A.K.); (N.V.); (A.D.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., Moscow 119991, Russia;
- Ministry of Health of Russia, N.I. Pirogov Russian National Research Medical University, 1 Ostrovitianova St., Moscow 117513, Russia;
| | - Kristina Charaya
- Functional and Ultrasound Diagnostics, Department of Cardiology, Sechenov University, 8 Trubetskaya Str., Moscow 119991, Russia; (D.S.); (E.P.); (S.P.); (S.I.); (A.B.); (S.K.); (E.Z.); (P.K.); (A.S.); (D.A.)
| | - Alexandra Shilova
- City Clinical Hospital No.1, 8 Leninsky Ave., Moscow 119049, Russia; (A.S.); (A.N.); (O.T.); (Z.B.); (N.R.); (A.K.); (N.V.); (A.D.)
| | - Alexey Nesterov
- City Clinical Hospital No.1, 8 Leninsky Ave., Moscow 119049, Russia; (A.S.); (A.N.); (O.T.); (Z.B.); (N.R.); (A.K.); (N.V.); (A.D.)
| | - Ekaterina Pershina
- Functional and Ultrasound Diagnostics, Department of Cardiology, Sechenov University, 8 Trubetskaya Str., Moscow 119991, Russia; (D.S.); (E.P.); (S.P.); (S.I.); (A.B.); (S.K.); (E.Z.); (P.K.); (A.S.); (D.A.)
- City Clinical Hospital No.1, 8 Leninsky Ave., Moscow 119049, Russia; (A.S.); (A.N.); (O.T.); (Z.B.); (N.R.); (A.K.); (N.V.); (A.D.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., Moscow 119991, Russia;
| | - Andrei Sherashov
- City Clinical Hospital No.1, 8 Leninsky Ave., Moscow 119049, Russia; (A.S.); (A.N.); (O.T.); (Z.B.); (N.R.); (A.K.); (N.V.); (A.D.)
| | - Sergei Panov
- Functional and Ultrasound Diagnostics, Department of Cardiology, Sechenov University, 8 Trubetskaya Str., Moscow 119991, Russia; (D.S.); (E.P.); (S.P.); (S.I.); (A.B.); (S.K.); (E.Z.); (P.K.); (A.S.); (D.A.)
| | - Shevket Ibraimov
- Functional and Ultrasound Diagnostics, Department of Cardiology, Sechenov University, 8 Trubetskaya Str., Moscow 119991, Russia; (D.S.); (E.P.); (S.P.); (S.I.); (A.B.); (S.K.); (E.Z.); (P.K.); (A.S.); (D.A.)
| | - Alexandra Bogdanova
- Functional and Ultrasound Diagnostics, Department of Cardiology, Sechenov University, 8 Trubetskaya Str., Moscow 119991, Russia; (D.S.); (E.P.); (S.P.); (S.I.); (A.B.); (S.K.); (E.Z.); (P.K.); (A.S.); (D.A.)
| | - Alexander Suvorov
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., Moscow 119991, Russia;
| | - Olga Trushina
- City Clinical Hospital No.1, 8 Leninsky Ave., Moscow 119049, Russia; (A.S.); (A.N.); (O.T.); (Z.B.); (N.R.); (A.K.); (N.V.); (A.D.)
| | - Zarema Bguasheva
- City Clinical Hospital No.1, 8 Leninsky Ave., Moscow 119049, Russia; (A.S.); (A.N.); (O.T.); (Z.B.); (N.R.); (A.K.); (N.V.); (A.D.)
| | - Nina Rozina
- City Clinical Hospital No.1, 8 Leninsky Ave., Moscow 119049, Russia; (A.S.); (A.N.); (O.T.); (Z.B.); (N.R.); (A.K.); (N.V.); (A.D.)
| | - Alesya Klimenko
- City Clinical Hospital No.1, 8 Leninsky Ave., Moscow 119049, Russia; (A.S.); (A.N.); (O.T.); (Z.B.); (N.R.); (A.K.); (N.V.); (A.D.)
- Ministry of Health of Russia, N.I. Pirogov Russian National Research Medical University, 1 Ostrovitianova St., Moscow 117513, Russia;
| | - Varvara Mareyeva
- Ministry of Health of Russia, N.I. Pirogov Russian National Research Medical University, 1 Ostrovitianova St., Moscow 117513, Russia;
| | - Natalia Voinova
- City Clinical Hospital No.1, 8 Leninsky Ave., Moscow 119049, Russia; (A.S.); (A.N.); (O.T.); (Z.B.); (N.R.); (A.K.); (N.V.); (A.D.)
| | - Alexandra Dukhnovskaya
- City Clinical Hospital No.1, 8 Leninsky Ave., Moscow 119049, Russia; (A.S.); (A.N.); (O.T.); (Z.B.); (N.R.); (A.K.); (N.V.); (A.D.)
| | - Svetlana Konchina
- Functional and Ultrasound Diagnostics, Department of Cardiology, Sechenov University, 8 Trubetskaya Str., Moscow 119991, Russia; (D.S.); (E.P.); (S.P.); (S.I.); (A.B.); (S.K.); (E.Z.); (P.K.); (A.S.); (D.A.)
| | - Eva Zakaryan
- Functional and Ultrasound Diagnostics, Department of Cardiology, Sechenov University, 8 Trubetskaya Str., Moscow 119991, Russia; (D.S.); (E.P.); (S.P.); (S.I.); (A.B.); (S.K.); (E.Z.); (P.K.); (A.S.); (D.A.)
| | - Philipp Kopylov
- Functional and Ultrasound Diagnostics, Department of Cardiology, Sechenov University, 8 Trubetskaya Str., Moscow 119991, Russia; (D.S.); (E.P.); (S.P.); (S.I.); (A.B.); (S.K.); (E.Z.); (P.K.); (A.S.); (D.A.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., Moscow 119991, Russia;
| | - Abram Syrkin
- Functional and Ultrasound Diagnostics, Department of Cardiology, Sechenov University, 8 Trubetskaya Str., Moscow 119991, Russia; (D.S.); (E.P.); (S.P.); (S.I.); (A.B.); (S.K.); (E.Z.); (P.K.); (A.S.); (D.A.)
| | - Denis Andreev
- Functional and Ultrasound Diagnostics, Department of Cardiology, Sechenov University, 8 Trubetskaya Str., Moscow 119991, Russia; (D.S.); (E.P.); (S.P.); (S.I.); (A.B.); (S.K.); (E.Z.); (P.K.); (A.S.); (D.A.)
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Ge X, Brittain B, Dawson L, Dwivedi G, Kaye DM, Morahan G. A Genetic Test to Identify People at High Risk of Heart Failure. Int J Mol Sci 2025; 26:1782. [PMID: 40004245 PMCID: PMC11855781 DOI: 10.3390/ijms26041782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Revised: 02/10/2025] [Accepted: 02/12/2025] [Indexed: 02/27/2025] Open
Abstract
Earlier intervention may delay or prevent heart failure (HF), a widespread health problem. However, it is not currently possible to identify those who are most at risk, especially before the appearance of any clinical signs. This study presents the development and subsequent validation of a novel genetic test for predicting the risk of HF, utilizing data from three independent cohorts of Australian and US subjects. We developed a first-phase test using the Baker Biobank case-control cohort, identifying 41 genetic variants indicative of HF risk through genome-wide interaction and association analyses. Subsequently, a second-phase test was designed. This identified 29 additional single-nucleotide polymorphisms. The combination of these two tests resulted in an aggregate test with a high predictive accuracy, achieving an Area Under the Curve of 0.93 and a balanced accuracy of 0.89. High genetic risk subjects in the Baker Biobank cohort had an odds ratio of 533.2. The test's robustness was validated by applying it to data from the Busselton Health Study and the Atherosclerosis Risk in Communities cohorts, yielding, respectively, Areas Under the Curve of 0.83 and 0.72, a balanced accuracy of 0.76 and 0.67, and Odds Ratios of 12.3 and 4.6. These results highlight the critical role of genetic factors in the development of heart failure and demonstrate this test's potential as a significant tool for clinical HF risk prediction.
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Affiliation(s)
- Xintian Ge
- Centre for Diabetes Research, Harry Perkins Institute of Medical Research, Nedlands, WA 6009, Australia; (X.G.); (B.B.); (G.D.)
- Stroke Research Centre, Perron Institute for Neurological and Translational Science, Nedlands, WA 6009, Australia
| | - Bek Brittain
- Centre for Diabetes Research, Harry Perkins Institute of Medical Research, Nedlands, WA 6009, Australia; (X.G.); (B.B.); (G.D.)
| | - Luke Dawson
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; (L.D.); (D.M.K.)
| | - Girish Dwivedi
- Centre for Diabetes Research, Harry Perkins Institute of Medical Research, Nedlands, WA 6009, Australia; (X.G.); (B.B.); (G.D.)
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA 6150, Australia
| | - David M. Kaye
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; (L.D.); (D.M.K.)
| | - Grant Morahan
- Centre for Diabetes Research, Harry Perkins Institute of Medical Research, Nedlands, WA 6009, Australia; (X.G.); (B.B.); (G.D.)
- Advanced Genetic Diagnostics, Nedlands, WA 6009, Australia
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He Z, Wang Z, Dong B, Long Q. Ventricular Septal Rupture as a Complication of Acute Myocardial Infarction: Clinical Characteristics and Prognostic Comparison of Different Treatment Methods. Anatol J Cardiol 2025:132-138. [PMID: 39763315 PMCID: PMC11904253 DOI: 10.14744/anatoljcardiol.2024.4674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2025] Open
Abstract
BACKGROUND This research aimed to investigate the clinical features exhibited by individuals diagnosed with acute myocardial infarction (AMI) complicated by ventricular septal rupture (VSR) and to compare the prognostic outcomes of different treatment modalities. METHODS A retrospective study on a cohort of 200 patients who were diagnosed with AMI complicated by VSR at a specialized medical facility from 2018 to 2023 was conducted. The patients were categorized into 3 different treatment groups: group A received medical management, group B underwent surgical repair, and group C underwent percutaneous device closure. Our primary objective was to assess the overall mortality rate within 1 year, while secondary objectives included evaluating in-hospital mortality, mortality within 30 days, and occurrence of major adverse cardiovascular events within 1 year. RESULTS Group A showed the highest in-hospital mortality rate of 37.3%. The rate for group B was only 20.6%, while group C exhibited the lowest rate of 17.4%. A similar tendency was observed for the 30-day and 1-year mortality rates. The 30-day mortality rate for group A, group B, and group C was 56.9%, 20.6%, and 22.1%, respectively. The 1-year mortality rate for group A, group B, and group C was as follows: 31.4%, 28.6%, and 25.6%. In addition, the incidence of major adverse cardiovascular events at 1 year was highest in group A (56.9%), followed by group B (28.6%) and group C (32.6%). CONCLUSION Both surgical repair and percutaneous device closure were associated with significantly better survival outcomes compared to medical management alone in patients with AMI complicated by VSR.
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Affiliation(s)
- Zhongchun He
- Department of Cardiovascular Internal Medicine, Changsha First Hospital, Changsha, China
| | - Zhaofei Wang
- Department of Cardiovascular Internal Medicine, Changsha First Hospital, Changsha, China
| | - Bo Dong
- Department of Cardiovascular Internal Medicine, Changsha First Hospital, Changsha, China
| | - Qiuxiang Long
- Department of Introduction, Changsha First Hospital, Changsha, China
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Heyman ET, Ashfaq A, Ekelund U, Ohlsson M, Björk J, Khoshnood AM, Lingman M. A novel interpretable deep learning model for diagnosis in emergency department dyspnoea patients based on complete data from an entire health care system. PLoS One 2024; 19:e0311081. [PMID: 39729465 DOI: 10.1371/journal.pone.0311081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 09/12/2024] [Indexed: 12/29/2024] Open
Abstract
BACKGROUND Dyspnoea is one of the emergency department's (ED) most common and deadly chief complaints, but frequently misdiagnosed and mistreated. We aimed to design a diagnostic decision support which classifies dyspnoeic ED visits into acute heart failure (AHF), exacerbation of chronic obstructive pulmonary disease (eCOPD), pneumonia and "other diagnoses" by using deep learning and complete, unselected data from an entire regional health care system. METHODS In this cross-sectional study, we included all dyspnoeic ED visits of patients ≥ 18 years of age at the two EDs in the region of Halland, Sweden, 07/01/2017-12/31/2019. Data from the complete regional health care system within five years prior to the ED visit were analysed. Gold standard diagnoses were defined as the subsequent in-hospital or ED discharge notes, and a subsample was manually reviewed by emergency medicine experts. A novel deep learning model, the clinical attention-based recurrent encoder network (CareNet), was developed. Cohort performance was compared to a simpler CatBoost model. A list of all variables and their importance for diagnosis was created. For each unique patient visit, the model selected the most important variables, analysed them and presented them to the clinician interpretably by taking event time and clinical context into account. AUROC, sensitivity and specificity were compared. FINDINGS The most prevalent diagnoses among the 10,315 dyspnoeic ED visits were AHF (15.5%), eCOPD (14.0%) and pneumonia (13.3%). Median number of unique events, i.e., registered clinical data with time stamps, per ED visit was 1,095 (IQR 459-2,310). CareNet median AUROC was 87.0%, substantially higher than the CatBoost model´s (81.4%). CareNet median sensitivity for AHF, eCOPD, and pneumonia was 74.5%, 92.6%, and 54.1%, respectively, with a specificity set above 75.0, slightly inferior to that of the CatBoost baseline model. The model assembled a list of 1,596 variables by importance for diagnosis, on top were prior diagnoses of heart failure or COPD, daily smoking, atrial fibrillation/flutter, life management difficulties and maternity care. Each patient visit received their own unique attention plot, graphically displaying important clinical events for the diagnosis. INTERPRETATION We designed a novel interpretable deep learning model for diagnosis in emergency department dyspnoea patients by analysing unselected data from a complete regional health care system.
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Affiliation(s)
- Ellen T Heyman
- Department of Emergency Medicine, Halland Hospital, Region Halland, Sweden
- Emergency Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Awais Ashfaq
- Halland Hospital, Region Halland, Sweden
- Center for Applied Intelligent Systems Research (CAISR), Halmstad University, Halmstad, Sweden
| | - Ulf Ekelund
- Emergency Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Skåne University Hospital, Lund, Sweden
| | - Mattias Ohlsson
- Center for Applied Intelligent Systems Research (CAISR), Halmstad University, Halmstad, Sweden
- Centre for Environmental and Climate Science, Lund University, Lund, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Ardavan M Khoshnood
- Emergency Medicine, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Skåne University Hospital, Malmö, Sweden
| | - Markus Lingman
- Halland Hospital, Region Halland, Sweden
- Center for Applied Intelligent Systems Research (CAISR), Halmstad University, Halmstad, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Cohen A, Li T, Bielawa N, Nello A, Gold A, Gorlin M, Nelson M, Carlin E, Rolston D. Right Ventricular "Bubble Time" to Identify Patients With Right Ventricular Dysfunction. Ann Emerg Med 2024; 84:182-194. [PMID: 38597847 DOI: 10.1016/j.annemergmed.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 01/10/2024] [Accepted: 02/08/2024] [Indexed: 04/11/2024]
Abstract
STUDY OBJECTIVE We propose a novel method of evaluating right ventricular (RV) dysfunction in the emergency department (ED) using RV "bubble time"-the duration of time bubbles from a saline solution flush are visualized in the RV on echocardiography. The objective was to identify the optimal cutoff value for RV bubble time that differentiates patients with RV dysfunction and report on its diagnostic test characteristics. METHODS This prospective diagnostic accuracy study enrolled a convenience sample of hemodynamically stable patients in the ED. A sonographer administered a 10-mL saline solution flush into the patient's intravenous catheter, performed a bedside echocardiogram, and measured RV bubble time. Subsequently, the patient underwent a comprehensive cardiologist-interpreted echocardiogram within 36 hours, which served as the gold standard. Patients with RV strain or enlargement of the latter found on an echocardiogram were considered to have RV dysfunction. Bubble time was evaluated by a second provider, blinded to the initial results, who reviewed the ultrasound clips. The primary outcome measure was the optimal cutoff value of RV bubble time that identifies patients with and without RV dysfunction. RESULTS Of 196 patients, median age was 67 year, and half were women, with 69 (35.2%) having RV dysfunction. Median RV bubble time among patients with RV dysfunction was 62 seconds (interquartile range [IQR]: 52, 93) compared with 21 seconds (IQR: 12, 32) among patients without (P<.0001). The optimal cutoff value of RV bubble time for identifying patients with RV dysfunction was 40 or more seconds, with a sensitivity of 0.97 (95% CI 0.93 to 1.00) and specificity of 0.87 (95% CI 0.82 to 0.93). CONCLUSION In patients in the ED, an RV bubble time of 40 or more seconds had high sensitivity in identifying patients with RV dysfunction, whereas an RV bubble time of less than 40 seconds had good specificity in identifying patients without RV dysfunction. These findings warrant further investigation in undifferentiated patient populations and by emergency physicians without advanced ultrasound training.
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Affiliation(s)
- Allison Cohen
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY.
| | - Timmy Li
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY
| | - Nicholas Bielawa
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY
| | - Alexander Nello
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY
| | - Allen Gold
- Department of Emergency Medicine, St. Barnabas Hospital, Bronx, NY
| | - Margaret Gorlin
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New Hyde Park, NY
| | - Mathew Nelson
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY
| | - Edward Carlin
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY
| | - Daniel Rolston
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY
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Khan AA, Saeed H, Haque IU, Iqbal A, Du D, Koratala A. Point-of-care ultrasonography spotlight: Could venous excess ultrasound serve as a shared language for internists and intensivists? World J Crit Care Med 2024; 13:93206. [PMID: 38855280 PMCID: PMC11155496 DOI: 10.5492/wjccm.v13.i2.93206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/24/2024] [Accepted: 05/11/2024] [Indexed: 06/03/2024] Open
Abstract
Point-of-care ultrasonography (POCUS), particularly venous excess ultrasound (VExUS) is emerging as a valuable bedside tool to gain real-time hemodynamic insights. This modality, derived from hepatic vein, portal vein, and intrarenal vessel Doppler patterns, offers a scoring system for dynamic venous congestion assessment. Such an assessment can be crucial in effective management of patients with heart failure exacerbation. It facilitates diagnosis, quantification of congestion, prognostication, and monitoring the efficacy of decongestive therapy. As such, it can effectively help to manage cardiorenal syndromes in various clinical settings. Extended or eVExUS explores additional veins, potentially broadening its applications. While VExUS demonstrates promising outcomes, challenges persist, particularly in cases involving renal and liver parenchymal disease, arrhythmias, and situations of pressure and volume overload overlap. Proficiency in utilizing spectral Doppler is pivotal for clinicians to effectively employ this tool. Hence, the integration of POCUS, especially advanced applications like VExUS, into routine clinical practice necessitates enhanced training across medical specialties.
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Affiliation(s)
- Anosh Aslam Khan
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ 07740, United States
| | - Hasham Saeed
- Department of Internal Medicine, Trinitas Regional Medical Center, Elizabeth, NJ 07202, United States
| | - Ibtehaj Ul Haque
- Department of Anesthesiology, Dr. Ruth K M Pfau Civil Hospital, Karachi 74400, Pakistan
| | - Ayman Iqbal
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Doantrang Du
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ 07740, United States
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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Dimopoulos S, Antonopoulos M. Portal vein pulsatility: An important sonographic tool assessment of systemic congestion for critical ill patients. World J Cardiol 2024; 16:221-225. [PMID: 38817642 PMCID: PMC11135329 DOI: 10.4330/wjc.v16.i5.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/19/2024] [Accepted: 04/01/2024] [Indexed: 05/23/2024] Open
Abstract
In this editorial we comment on the article by Kuwahara et al, published in the recent issue of the World Journal of Cardiology. In this interesting paper, the authors showed a correlation between portal vein pulsatility ratio, examined by bedside ultrasonography, and prognosis of hospitalized patients with acute heart failure. Systemic congestion is being notoriously underdetected in the acutely ill population with conventional methods like clinical examination, biomarkers, central venous pressure estimation and X-rays. However, congestion should be a key therapeutic target due to its deleterious effects to end organ function and subsequently patient prognosis. Doppler flow assessment of the abdominal veins is gaining popularity worldwide, as a valuable tool in estimating comprehensively congestion and giving a further insight into hemodynamics and patient management.
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Affiliation(s)
- Stavros Dimopoulos
- Cardiac Surgery ICU, Onassis Cardiac Surgery Center, Kallithea 17674, Greece.
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Gamiño-Gutiérrez JA, Terán-Hernández IM, Castellar-Lopez J, Villamizar-Villamizar W, Osorio-Llanes E, Palacios-Cruz M, Rosales W, Chang AY, Díaz-Ariza LA, Ospino MC, Mendoza-Torres E. Novel Insights into the Cardioprotective Effects of the Peptides of the Counter-Regulatory Renin-Angiotensin System. Biomedicines 2024; 12:255. [PMID: 38397857 PMCID: PMC10887066 DOI: 10.3390/biomedicines12020255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 02/25/2024] Open
Abstract
Currently, cardiovascular diseases are a major contributor to morbidity and mortality worldwide, having a significant negative impact on both the economy and public health. The renin-angiotensin system contributes to a high spectrum of cardiovascular disorders and is essential for maintaining normal cardiovascular homeostasis. Overactivation of the classical renin-angiotensin system is one of the most important pathophysiological mechanisms in the progression of cardiovascular diseases. The counter-regulatory renin-angiotensin system is an alternate pathway which favors the synthesis of different peptides, including Angiotensin-(1-7), Angiotensin-(1-9), and Alamandine. These peptides, via the angiotensin type 2 receptor (AT2R), MasR, and MrgD, initiate multiple downstream signaling pathways that culminate in the activation of various cardioprotective mechanisms, such as decreased cardiac fibrosis, decreased myocardial hypertrophy, vasodilation, decreased blood pressure, natriuresis, and nitric oxide synthesis. These cardioprotective effects position them as therapeutic alternatives for reducing the progression of cardiovascular diseases. This review aims to show the latest findings on the cardioprotective effects of the main peptides of the counter-regulatory renin-angiotensin system.
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Affiliation(s)
| | - Ivana María Terán-Hernández
- Grupo de Investigación Avanzada en Biomedicina, Faculty of Health Sciences, Universidad Libre Seccional Barranquilla, Barranquilla 081001, Colombia; (I.M.T.-H.); (W.V.-V.); (L.A.D.-A.); (M.C.O.)
| | - Jairo Castellar-Lopez
- Grupo de Investigación Avanzada en Biomedicina, Faculty of Exact and Natural Sciences, Universidad Libre Seccional Barranquilla, Barranquilla 081001, Colombia; (J.C.-L.); (E.O.-L.); (W.R.)
| | - Wendy Villamizar-Villamizar
- Grupo de Investigación Avanzada en Biomedicina, Faculty of Health Sciences, Universidad Libre Seccional Barranquilla, Barranquilla 081001, Colombia; (I.M.T.-H.); (W.V.-V.); (L.A.D.-A.); (M.C.O.)
| | - Estefanie Osorio-Llanes
- Grupo de Investigación Avanzada en Biomedicina, Faculty of Exact and Natural Sciences, Universidad Libre Seccional Barranquilla, Barranquilla 081001, Colombia; (J.C.-L.); (E.O.-L.); (W.R.)
| | | | - Wendy Rosales
- Grupo de Investigación Avanzada en Biomedicina, Faculty of Exact and Natural Sciences, Universidad Libre Seccional Barranquilla, Barranquilla 081001, Colombia; (J.C.-L.); (E.O.-L.); (W.R.)
| | - Aileen Y. Chang
- School of Medicine and Health Sciences, The George Washington University, Washington, DC 20052, USA;
| | - Luis Antonio Díaz-Ariza
- Grupo de Investigación Avanzada en Biomedicina, Faculty of Health Sciences, Universidad Libre Seccional Barranquilla, Barranquilla 081001, Colombia; (I.M.T.-H.); (W.V.-V.); (L.A.D.-A.); (M.C.O.)
| | - María Clara Ospino
- Grupo de Investigación Avanzada en Biomedicina, Faculty of Health Sciences, Universidad Libre Seccional Barranquilla, Barranquilla 081001, Colombia; (I.M.T.-H.); (W.V.-V.); (L.A.D.-A.); (M.C.O.)
| | - Evelyn Mendoza-Torres
- Grupo de Investigación Avanzada en Biomedicina, Faculty of Health Sciences, Universidad Libre Seccional Barranquilla, Barranquilla 081001, Colombia; (I.M.T.-H.); (W.V.-V.); (L.A.D.-A.); (M.C.O.)
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10
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Yu S, Wei D, Shi N. Comprehensive nursing intervention improves quality of life and reduces hospitalization time and expense in elderly patients with severe heart failure undergoing rh-BNP treatment. Am J Transl Res 2023; 15:5239-5248. [PMID: 37692925 PMCID: PMC10492075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE This study was designed to explore the efficacy of comprehensive nursing intervention in elderly patients with severe heart failure (SHF) treated by recombinant human brain natriuretic peptide (rh-BNP). METHODS A retrospective analysis was made on 131 patients with SHF treated with rh-BNP in Wuhan Asia Cardiology Hospital from May 2019 to May 2022. Of them, 71 patients who received routine nursing care between May 2019 and December 2021 were assigned to the control group, and 60 patients who received comprehensive nursing between January 2022 and May 2022 were assigned to the observation group. The changes in quality of life (QoL) before and after nursing and the occurrence of adverse events after nursing were counted and compared between the two groups. The two groups were compared reagarding changes in anxiety and depression scores before and after nursing, as well as hospitalization expenses and hospitalization time. The left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) of patients were determined. The nursing satisfaction of the two groups was evaluated. Additionally, logistic regression was carried out to analyze the risk factors for adverse events. RESULTS The control group had lower QoL scores than the observation group after nursing (P < 0.0001). The control group got significantly higher self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores than the observation group (P < 0.0001). The control group showed lower levels of LVEDV and LVEF than the observation group (P < 0.0001). The control group experienced greatly longer hospitalization time than the observation group, and also had a higher hospitalization expense than the observation group (P < 0.001). The observation group expressed much higher nursing satisfaction than the control group (P=0.007). Additionally, according to multivariate logistic regression analysis, age, hypertension, and diabetes mellitus were independent risk factors for adverse events (P < 0.05). CONCLUSION For elderly SHF patients treated by rh-BNP, comprehensive nursing intervention can contribute to higher QoL, shorter hospitalization time, lower hospitalization expense, and milder negative emotions, but did not correlate with short-term adverse cardiovascular events.
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Affiliation(s)
- Sujun Yu
- CCU, Wuhan Asia Cardiology HospitalWuhan, Hubei, China
| | - Dan Wei
- CCU, Wuhan Asia Cardiology HospitalWuhan, Hubei, China
| | - Nian Shi
- PICU, Wuhan Asia Cardiology HospitalWuhan, Hubei, China
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11
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Turk M, Robertson T, Koratala A. Point-of-care ultrasound in diagnosis and management of congestive nephropathy. World J Crit Care Med 2023; 12:53-62. [PMID: 37034023 PMCID: PMC10075049 DOI: 10.5492/wjccm.v12.i2.53] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/08/2023] [Accepted: 02/17/2023] [Indexed: 03/07/2023] Open
Abstract
Congestive nephropathy is kidney dysfunction caused by the impact of elevated venous pressures on renal hemodynamics. As a part of cardiorenal syndrome, the diagnosis is usually made based on history and physical examination, with findings such as jugular venous distension, a third heart sound, and vital signs as supporting findings. More recently, however, these once though objective measures have come under scrutiny for their accuracy. At the same time, bedside ultrasound has increased in popularity and is routinely being used by clinicians to take some of the guess work out of making the diagnosis of volume overload and venous congestion. In this mini-review, we will discuss some of the traditional methods used to measure venous congestion, describe the role of point-of-care ultrasound and how it can ameliorate a clinician’s evaluation, and offer a description of venous excess ultrasound score, a relatively novel scoring technique used to objectively quantify congestion. While there is a paucity of published large scale clinical trials evaluating the potential benefit of ultrasonography in venous congestion compared to gold standard invasive measurements, more study is underway to solidify the role of this objective measure in daily clinical practice.
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Affiliation(s)
- Michael Turk
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA 15222, United States
| | - Thomas Robertson
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA 15222, United States
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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12
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Nogueira MA, Calcagno S, Campbell N, Zaman A, Koulaouzidis G, Jalil A, Alam F, Stankovic T, Szabo E, Szabo AB, Kecskes I. Detecting heart failure using novel bio-signals and a knowledge enhanced neural network. Comput Biol Med 2023; 154:106547. [PMID: 36696813 DOI: 10.1016/j.compbiomed.2023.106547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/02/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND Clinical decisions about Heart Failure (HF) are frequently based on measurements of left ventricular ejection fraction (LVEF), relying mainly on echocardiography measurements for evaluating structural and functional abnormalities of heart disease. As echocardiography is not available in primary care, this means that HF cannot be detected on initial patient presentation. Instead, physicians in primary care must rely on a clinical diagnosis that can take weeks, even months of costly testing and clinical visits. As a result, the opportunity for early detection of HF is lost. METHODS AND RESULTS The standard 12-Lead ECG provides only limited diagnostic evidence for many common heart problems. ECG findings typically show low sensitivity for structural heart abnormalities and low specificity for function abnormalities, e.g., systolic dysfunction. As a result, structural and functional heart abnormalities are typically diagnosed by echocardiography in secondary care, effectively creating a diagnostic gap between primary and secondary care. This diagnostic gap was successfully reduced by an AI solution, the Cardio-HART™ (CHART), which uses Knowledge-enhanced Neural Networks to process novel bio-signals. Cardio-HART reached higher performance in prediction of HF when compared to the best ECG-based criteria: sensitivity increased from 53.5% to 82.8%, specificity from 85.1% to 86.9%, positive predictive value from 57.1% to 70.0%, the F-score from 56.4% to 72.2%, and area under curve from 0.79 to 0.91. The sensitivity of the HF-indicated findings is doubled by the AI compared to the best rule-based ECG-findings with a similar specificity level: from 38.6% to 71%. CONCLUSION Using an AI solution to process ECG and novel bio-signals, the CHART algorithms are able to predict structural, functional, and valve abnormalities, effectively reducing this diagnostic gap, thereby allowing for the early detection of most common heart diseases and HF in primary care.
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Affiliation(s)
- Marta Afonso Nogueira
- Consultant Cardiologist Heart Failure and Cardiomyopathies, Department of Cardiology, Cascais Hospital, Lusíadas Saúde - UnitedHealth Group, Lisbon, Portugal
| | - Simone Calcagno
- Division of Cardiology, Santa Maria Goretti Hospital, Via Canova Snc, 04100, Latina, Italy
| | - Niall Campbell
- Manchester University NHS Foundation Trust, Department of Cardiology, Manchester, UK
| | - Azfar Zaman
- Freeman Hospital, Newcastle University, and Newcastle upon Tyne Hospitals NHS Trust, Newcastle, UK
| | | | - Anwar Jalil
- Cardiology of Karachi, Hill Park General Hospital, Karachi, Pakistan
| | - Firdous Alam
- Cardiology of Karachi, Hill Park General Hospital, Karachi, Pakistan
| | - Tatjana Stankovic
- Division of Cardiology, Regional Hospital Dr Radivoj Simonovic Sombor, Sombor, Serbia
| | - Erzsebet Szabo
- Division of Cardiology, General Hospital Senta, Senta, Serbia
| | - Aniko B Szabo
- Division of Cardiology, General Hospital Senta, Senta, Serbia
| | - Istvan Kecskes
- Dir. Cardiology Research and Scientific Advancements, UVA Research Corp., 24000, Subotica, Henrike Sjenkjevica 14, Serbia.
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13
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Dao L, Huang M, Lin X, Li L, Feng X, Wei C, Guo M, Yang Y, Xu F, Weng X. A systemic review and meta-analysis comparing the ability of diagnostic of the third heart sound and left ventricular ejection fraction in heart failure. Front Cardiovasc Med 2022; 9:918051. [PMID: 36277783 PMCID: PMC9582155 DOI: 10.3389/fcvm.2022.918051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/12/2022] [Indexed: 11/22/2022] Open
Abstract
Objective This study aimed to compare the sensitivity and specificity of diagnosis between the third heart sound (S3) and left ventricular ejection fraction (LVEF) in heart failure (HF). Methods Relevant studies were searched in PubMed, SinoMed, China National Knowledge Infrastructure, and the Cochrane Trial Register until February 20, 2022. The sensitivity, specificity, likelihood ratio (LR), and diagnostic odds ratio (DOR) were pooled. The symmetric receiver operator characteristic curve (SROC) and Fagan’s nomogram were drawn. The source of heterogeneity was explored by meta-regression and subgroup analysis. Results A total of 19 studies, involving 5,614 participants, were included. The combined sensitivity of S3 was 0.23 [95% confidence interval (CI) (0.15–0.33), specificity was 0.94 [95% CI (0.82–0.98)], area under the SROC curve was 0.49, and the DOR was 4.55; while the sensitivity of LVEF was 0.70 [95% CI (0.53–0.83)], specificity was 0.79 [95% CI (0.75–0.82)], area under the SROC curve was 0.79, and the DOR was 8.64. No publication bias was detected in Deeks’ funnel plot. The prospective design, partial verification bias, and blind contributed to the heterogeneity in specificity, while adequate description of study participants contributed to the heterogeneity in sensitivity. In Fagan’s nomogram, the post-test probability was 48% when the pre-test probability was set as 20%, while in LVEF, the post-test probability was 45% when the pre-test probability was set as 20%. Conclusion The use of S3 alone presented lower sensitivity in diagnosing HF compared with LVEF, whereas it was useful in early pathological assessment.
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Affiliation(s)
- Lin Dao
- Department of Clinic Medicine, Chengdu Medical College, Chengdu, Sichuan, China
| | - Min Huang
- Department of Physiology, Chengdu Medical College, Chengdu, Sichuan, China
| | - Xinghong Lin
- Department of Clinic Medicine, Chengdu Medical College, Chengdu, Sichuan, China
| | - Liuyin Li
- Department of Chinese Medicine Heart Disease, Zigong City First People’s Hospital, Zigong, Sichuan, China
| | - Xixi Feng
- Department of Public Health, Chengdu Medical College, Chengdu, Sichuan, China
| | - Changyou Wei
- Department of Public Health, Chengdu Medical College, Chengdu, Sichuan, China
| | - Mingjin Guo
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yifan Yang
- Department of Pain Medicine, Peking University Peoples Hospital, Beijing, China
| | - Fan Xu
- Department of Public Health, Chengdu Medical College, Chengdu, Sichuan, China,*Correspondence: Fan Xu,
| | - Xiechuan Weng
- Department of Neuroscience, Beijing Institute of Basic Medical Sciences, Beijing, China,Xiechuan Weng,
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14
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Magidson PD. The Aged Heart. Emerg Med Clin North Am 2022; 40:637-649. [DOI: 10.1016/j.emc.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Evaluation and Management of Asthma and Chronic Obstructive Pulmonary Disease Exacerbation in the Emergency Department. Emerg Med Clin North Am 2022; 40:539-563. [DOI: 10.1016/j.emc.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hou M, Lu L, Wu X, Liu H. LCZ696 Ameliorates Isoproterenol-Induced Acute Heart Failure in Rats by Activating the Nrf2 Signaling Pathway. Appl Bionics Biomech 2022; 2022:6077429. [PMID: 35528528 PMCID: PMC9076311 DOI: 10.1155/2022/6077429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022] Open
Abstract
Objective LCZ696 (sacubitril/valsartan) is an angiotensin II (Ang II) type 1 receptor-neprilysin inhibitor, with effects of immunosuppression, anti-inflammation, antiapoptosis, and antioxidation. The present study was aimed at determining whether LCZ696 has a protective effect against isoproterenol-induced acute heart failure (AHF) in rats. Methods SD rats were randomly divided into four groups: control group, HF group, LCZ696 group, and enalapril group. The cardiac function of rats was evaluated using echocardiographic parameters, heart weight (HW), serum levels of cardiac troponin I (cTnI), and lactate dehydrogenase (LDH). HE is staining, which was used to determine the pathological damage of rat myocardial tissue. Also, we measured oxidative stress markers including reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT). Finally, the expression of Nrf2 signaling pathway-related proteins was determined using Western blot. Results Compared with the HF group, LCZ696 could significantly improve cardiac function and myocardial injury in rats and reduce AHF-induced oxidative stress. In addition, the results of Western blot confirmed that LCZ696 could upregulate the expression of Nrf2 and HO-1 while decreasing Keap1 expression. Conclusion LCZ696 ameliorates isoproterenol-induced AHF in rats by alleviating oxidative stress injury and activating the Nrf2 signaling pathway.
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Affiliation(s)
- Min Hou
- Department of Emergency, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Linxin Lu
- Department of Emergency, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiaobo Wu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Department of Lymphoma, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
| | - Hongxuan Liu
- Department of Emergency, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Vasti E, Tabas JA, Hoffman A, Pletcher M. Use and diagnostic value of liver enzyme tests in the emergency department and subsequent heart failure diagnosis: a retrospective cohort study. BMJ Open 2022; 12:e055216. [PMID: 35354618 PMCID: PMC8968565 DOI: 10.1136/bmjopen-2021-055216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To determine (1) if liver function tests (LFTs) are ordered in the emergency department (ED) in patients with suspected acute decompensated heart failure (ADHF) and (2) if the pattern of LFT abnormalities are meaningfully associated with a discharge diagnosis of ADHF among patients for whom these tests were ordered. SETTING We conducted a single-centre retrospective cohort study of patients with suspected ADHF who were seen in an academic tertiary ED using electronic medical records. PARTICIPANTS All ED patients admitted with suspected ADHF from January 2017 to May 2018, defined as any patient who had a brain natriuretic peptide (BNP) ordered. PRIMARY OUTCOME The primary outcome was ADHF diagnosis at discharge. RESULTS In 5323 ED patients with suspected ADHF, 60% (n=3184) had LFTs ordered; 34.6% were abnormal. Men comprised 56% of patients with abnormal LFTs and the average age was 67 years. The odds of a final diagnosis of ADHF in the univariate analysis was 59% higher in patients with abnormal LFTs (OR=1.59, (95% CI 1.35 to 1.87) p<0.001) and remained significant though attenuated after adjusting for BNP, race and ethnicity and age (ORadj=1.31 (95% CI 1.09 to 1.57), p=0.004). Likelihood ratios for abnormal and normal LFTs were 1.2 (95% CI 1.21 to 1.28) and 0.76 (95% CI 0.68 to 0.84), respectively. CONCLUSIONS A significant proportion (40%) of patients with suspected ADHF was missing LFTs in their ED workup. Among patients with LFTs, abnormal LFTs are associated with discharge diagnosis of ADHF after accounting for potential confounders, but their diagnostic value was relatively low. Future prospective studies are warranted to explore the role of LFTs in the workup of ADHF.
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Affiliation(s)
- Elena Vasti
- Department of Medicine, Stanford Health Care, Stockton, California, USA
| | - Jeffrey A Tabas
- Department of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ari Hoffman
- University of California San Francisco, San Francisco, California, USA
| | - Mark Pletcher
- Department of Internal Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, USA
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18
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Jin Y, Wei S, Yao L. Diagnostic performance of miR-214, BNP, NT-proBNP and soluble ST2 in acute heart failure. Int J Clin Pract 2021; 75:e14643. [PMID: 34310833 DOI: 10.1111/ijcp.14643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aimed to investigate the potential diagnostic value of miR-214, B-type natriuretic peptide (BNP), N terminal-pro BNP (NT-proBNP) and soluble ST2 (sST2) in acute heart failure (AHF). METHOD This study included 176 patients as the AHF group and 60 healthy subjects as the control group from February 2018 to February 2020. Patients in the AHF group were classified according to the New York Heart Association (NYHA) functional classification, including 60 level II patients, 59 level III patients and 57 level IV patients. The expression level of miR-214, BNP, NT-proBNP and sST2 of both groups were recorded and analysed. RESULTS The morbidity of cardiovascular diseases was significantly higher in the AHF group than in the control group (P < .05). The expression level of miR-214, BNP, NT-proBNP and sST2 in the AHF group were all significantly higher than in the control group (P < .05). Besides, the expression level of all the molecules in level IV was significantly higher than that of level III and level II, respectively (P < .001, P < .001). In addition, the expression level of all the molecules in level III was significantly higher than that of level II (P < .001). The area under the ROC curve of miR-214, BNP, NT-proBNP and sST2 were 0.913, 0.836, 0.849 and 0.855, respectively, indicating good diagnostic value. CONCLUSION MiR-214, BNP, NT-proBNP and sST2 can be used as effective biomarkers for AHF, providing a new strategy for diagnosis and for judging the severity of AHF.
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Affiliation(s)
- Yinsheng Jin
- Department of Cardiology, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Shuang Wei
- Department of Cardiology, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Lingling Yao
- Department of Cardiology, Renmin Hospital, Hubei University of Medicine, Shiyan, China
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19
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Wang T, Han Y, Song Y. Comparison of continuous infusion and intermittent boluses of furosemide in acute heart failure: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27108. [PMID: 34664834 PMCID: PMC8448006 DOI: 10.1097/md.0000000000027108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Acute heart failure (HF) is a common cause of hospital admission. This study aims to compare continuous infusion and intermittent boluses of furosemide in treating acute HF. METHODS This protocol of systematic review and meta-analysis has been drafted under the guidance of the preferred reporting items for systematic reviews and meta-analyses protocols. Electronic databases including Web of Science, Embase, PubMed, Wanfang, Data, Scopus, Science Direct, and Cochrane Library will be searched in June 2021 by 2 independent reviewers. The main outcomes are post-treatment daily urine output, weight, length of stay, serum sodium, potassium, and creatinine. Two researchers conducted a quality assessment in strict accordance with the risk bias assessment tool recommended by the Cochrane Handbook Version5.3. We performed the meta-analysis by Stata version 10.0 software. RESULTS The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. CONCLUSION The choice of furosemide regime in acute HF remains physician preference. Both bolus and continuous infusion yields satisfactory outcomes.
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20
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Iovino P, Rebora P, Occhino G, Zeffiro V, Caggianelli G, Ausili D, Alvaro R, Riegel B, Vellone E. Effectiveness of motivational interviewing on health-service use and mortality: a secondary outcome analysis of the MOTIVATE-HF trial. ESC Heart Fail 2021; 8:2920-2927. [PMID: 34085763 PMCID: PMC8318502 DOI: 10.1002/ehf2.13373] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/25/2021] [Accepted: 04/01/2021] [Indexed: 01/10/2023] Open
Abstract
Aims Intense health‐care service use and high mortality are common in heart failure (HF) patients. This secondary analysis of the MOTIVATE‐HF trial investigates the effectiveness of motivational interviewing (MI) in reducing health‐care service use (e.g. emergency service use and hospitalizations) and all‐cause mortality. Methods and results This study used a randomized controlled trial. Patients and caregivers were randomized to Arm 1 (MI for patients), Arm 2 (MI for patients and caregivers), or Arm 3 (control group). Data were collected at baseline and at 3, 6, 9, and 12 months. Face‐to‐face MI plus three telephone calls were performed in Arms 1 and 2. The sample consisted of 510 patient (median age 74 years, 58% male patients) and caregiver dyads (median age 55 years, 75% female patients). At 12 months, 16.1%, 17%, and 11.2% of patients used health‐care services at least once in Arms 1, 2, and 3, respectively, without significant difference. At 3 months, 1.9%, 0.6%, and 5.1% of patients died in Arms 1, 2, and 3, respectively. Mortality was lower in Arm 2 vs. Arm 3 at 3 months [hazard ratio (HR) = 0.112, 95% CI: 0.014–0.882, P = 0.04]; no difference was found at subsequent follow‐ups. Mortality was lower in Arm 1 vs. Arm 3 at 3 months but did not reach statistical significance (HR = 0.38, 95% CI: 0.104–1.414, P = 0.15). Conclusion This study suggests that MI reduces mortality in patients with HF if caregivers are included in the intervention. Further studies with a stronger intervention and longer follow‐up are needed to clarify the benefits of MI on health‐care service use and mortality.
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Affiliation(s)
- Paolo Iovino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,School of Nursing, Midwifery and Paramedicine Faculty of Health Science, Australian Catholic University, Melbourne, Australia
| | - Paola Rebora
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre - B4 School of Medicine and Surgery, University of Milano-Bicocca, Italy
| | - Giuseppe Occhino
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre - B4 School of Medicine and Surgery, University of Milano-Bicocca, Italy
| | - Valentina Zeffiro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gabriele Caggianelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Eileen O'Connor Institute of Nursing Research, Australian Catholic University
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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21
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Sekma A, Bel Haj Ali K, Jeddi C, Ben Brahim N, Bzeouich N, Gannoun I, Trabelssi I, Laouiti K, Grissa MH, Beltaief K, Zohra D, Asma Z, Lotfi B, Rym Y, Ben Soltane H, Zied M, Mariem K, Msolli MA, Riadh B, Bouida W, Boubaker H, Nouira S. Value of nitroglycerin test in the diagnosis of heart failure in emergency department patients with undifferentiated dyspnea. Clin Cardiol 2021; 44:932-937. [PMID: 34076282 PMCID: PMC8259157 DOI: 10.1002/clc.23615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 01/06/2023] Open
Abstract
Background Rapid diagnosis of heart failure (HF) in acutely dyspneic patients can be challenging for emergency department (ED) physicians. Hypothesis Cardiac output (CO) change with sublingual nitroglycerin (NTG) could be helpful in the diagnosis of HF in patients with acute undifferentiated dyspnea. Materials and Methods A prospective study of patients >18 years admitted to the ED for acute dyspnea. Using thoracic bioimpedance, we measured CO change at baseline and after sublingual administration of 0.6 mg of NTG. HF was defined on the basis of clinical examination, pro‐brain natriuretic peptide levels, and echocardiographic findings. Diagnostic performance of delta CO was calculated by sensitivity, specificity, likelihood ratio and receiver operating characteristic (ROC) curve. Results This study included 184 patients with mean age of 64 years. Baseline CO was comparable between the HF group and the non‐HF group. At its best cutoff (29%), delta CO showed good accuracy in the diagnosis of HF with a sensitivity, specificity, positive and negative likelihood ratios of 80%, 44%, 57%, and 66% respectively. Area under ROC curve was 0.701 [95% CI 0.636–0.760]. The decrease of CO with sublingual NTG was significantly higher in patients with HFpEF compared with those with HFrEF. Multivariate analysis, showed that delta CO was an independent factor associated with HF diagnosis [OR 0.19 (95% CI 0.11–0.29); p < .001]. Conclusions Our study showed that CO change with sublingual nitroglycerin is a simple tool that may be helpful for the diagnosis of HF in ED patients with undifferentiated dyspnea.
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Affiliation(s)
- Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Khaoula Bel Haj Ali
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Camilia Jeddi
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Nadia Ben Brahim
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Nasri Bzeouich
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Imen Gannoun
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Imen Trabelssi
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Kamel Laouiti
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Kaouthar Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Dridi Zohra
- Cardiology Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Zorgati Asma
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.,Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Boukadida Lotfi
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.,Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Youssef Rym
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.,Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Houda Ben Soltane
- Emergency Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mezgar Zied
- Emergency Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Khrouf Mariem
- Emergency Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mohamed Amine Msolli
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Boukef Riadh
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.,Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Wahid Bouida
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Hamdi Boubaker
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
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22
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Radhachandran A, Garikipati A, Zelin NS, Pellegrini E, Ghandian S, Calvert J, Hoffman J, Mao Q, Das R. Prediction of short-term mortality in acute heart failure patients using minimal electronic health record data. BioData Min 2021; 14:23. [PMID: 33789700 PMCID: PMC8010502 DOI: 10.1186/s13040-021-00255-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/21/2021] [Indexed: 12/15/2022] Open
Abstract
Background Acute heart failure (AHF) is associated with significant morbidity and mortality. Effective patient risk stratification is essential to guiding hospitalization decisions and the clinical management of AHF. Clinical decision support systems can be used to improve predictions of mortality made in emergency care settings for the purpose of AHF risk stratification. In this study, several models for the prediction of seven-day mortality among AHF patients were developed by applying machine learning techniques to retrospective patient data from 236,275 total emergency department (ED) encounters, 1881 of which were considered positive for AHF and were used for model training and testing. The models used varying subsets of age, sex, vital signs, and laboratory values. Model performance was compared to the Emergency Heart Failure Mortality Risk Grade (EHMRG) model, a commonly used system for prediction of seven-day mortality in the ED with similar (or, in some cases, more extensive) inputs. Model performance was assessed in terms of area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. Results When trained and tested on a large academic dataset, the best-performing model and EHMRG demonstrated test set AUROCs of 0.84 and 0.78, respectively, for prediction of seven-day mortality. Given only measurements of respiratory rate, temperature, mean arterial pressure, and FiO2, one model produced a test set AUROC of 0.83. Neither a logistic regression comparator nor a simple decision tree outperformed EHMRG. Conclusions A model using only the measurements of four clinical variables outperforms EHMRG in the prediction of seven-day mortality in AHF. With these inputs, the model could not be replaced by logistic regression or reduced to a simple decision tree without significant performance loss. In ED settings, this minimal-input risk stratification tool may assist clinicians in making critical decisions about patient disposition by providing early and accurate insights into individual patient’s risk profiles. Supplementary Information The online version contains supplementary material available at 10.1186/s13040-021-00255-w.
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Affiliation(s)
| | - Anurag Garikipati
- Dascena, Inc, 12333 Sowden Rd Ste B PMB 65148, Houston, TX, 77080-2059, USA
| | - Nicole S Zelin
- Dascena, Inc, 12333 Sowden Rd Ste B PMB 65148, Houston, TX, 77080-2059, USA
| | - Emily Pellegrini
- Dascena, Inc, 12333 Sowden Rd Ste B PMB 65148, Houston, TX, 77080-2059, USA.
| | - Sina Ghandian
- Dascena, Inc, 12333 Sowden Rd Ste B PMB 65148, Houston, TX, 77080-2059, USA
| | - Jacob Calvert
- Dascena, Inc, 12333 Sowden Rd Ste B PMB 65148, Houston, TX, 77080-2059, USA
| | - Jana Hoffman
- Dascena, Inc, 12333 Sowden Rd Ste B PMB 65148, Houston, TX, 77080-2059, USA
| | - Qingqing Mao
- Dascena, Inc, 12333 Sowden Rd Ste B PMB 65148, Houston, TX, 77080-2059, USA
| | - Ritankar Das
- Dascena, Inc, 12333 Sowden Rd Ste B PMB 65148, Houston, TX, 77080-2059, USA
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23
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Zhang K, Wu M, Qin X, Wen P, Wu Y, Zhuang J. Asporin is a Potential Promising Biomarker for Common Heart Failure. DNA Cell Biol 2021; 40:303-315. [PMID: 33605799 DOI: 10.1089/dna.2020.5995] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Heart failure (HF) is the end-stage of various diseases, especially ischemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM). We aimed to investigate the common molecular mechanism of ICM and DCM. Differentially expressed genes (DEGs) of ICM or DCM samples compared with control were identified in GSE1869, GSE5406, GSE57338, GSE79962, GSE116250, and GSE46224 datasets. Functional enrichment analysis and protein-protein network analysis of the coregulated DEGs in at least four datasets were performed using the online tools of DAVID, the Metascape database, and the STRING database. Hub genes of HF were identified and validated by western blotting (WB) and immunohistochemistry in our tissue microarray (TMA). Seventy-four coregulated ICM and 126 coregulated DCM relevant DEGs were identified. Moreover, 59 common genes between ICM and DCM relevant DEGs were obtained, which were mainly involved in cardiac fibrosis and several signal pathways, such as Wnt signal pathway, PI3K-Akt signal pathway, and HIF-1A signal pathway. Among the six hub genes with top degrees, asporin (ASPN) had a relatively higher correlation with LVEF. Finally, TMA and WB results revealed that the ASPN protein was significantly increased in ICM and DCM left ventricular samples. The present study revealed some common molecular mechanisms of HF with different causes. Furthermore, ASPN may be a potential promising biomarker for HF.
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Affiliation(s)
- Kai Zhang
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Min Wu
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xianyu Qin
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Pengju Wen
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yueheng Wu
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jian Zhuang
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
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24
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Hongo T, Naito H, Fujiwara T, Inaba M, Fujisaki N, Nakao A. Incidence and related factors of hypoxia associated with elderly femoral neck fractures in the emergency department setting. Acute Med Surg 2020; 7:e618. [PMID: 33364038 PMCID: PMC7750023 DOI: 10.1002/ams2.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/01/2020] [Accepted: 11/29/2020] [Indexed: 11/17/2022] Open
Abstract
Aim Femoral neck fractures in elderly patients needing oxygen therapy are often encountered in the emergency department. This single‐center, retrospective, observational study aimed to examine the frequency, cause, and factors related to hypoxia in elderly patients with femoral neck fractures. Methods We analyzed data from 241 patients admitted to Okayama Saiseikai General Hospital (Okayama, Japan) from April 2016 to March 2019. Hypoxia was defined as PaO2 / FiO2 ratio under 300. The independent factors for hypoxia were determined by multiple logistic regression analysis. Results There were 194 patients who met the study inclusion criteria, 148 in the non‐hypoxia group and 46 in the hypoxia group. The hypoxia group included patients with pneumonia (n = 3), chronic obstructive pulmonary disease (n = 2), pulmonary edema (n = 1), and pulmonary embolization (n = 1). The cause of hypoxia was undetermined in 39 cases. However, occult fat embolism syndrome was suspected in 29 of these 39 cases based on Gurd and Wilson criteria after considering clinical examination results. Barthel indexes were significantly lower in the hypoxia group on discharge. Age (adjusted odds ratio [OR] 1.07; 95% confidence interval [CI], 1.00–1.14; P = 0.038), D‐dimer (adjusted OR 1.02; 95% CI, 1.00–1.03; P = 0.005), and transtricuspid pressure gradient (adjusted OR 1.03; 95% CI, 1.00–1.07; P = 0.015) were independently associated with the hypoxia. Conclusion We found that hypoxia, including undetermined hypoxia, was commonly encountered in the emergency department. Hypoxia in elderly patients with femoral neck fractures was associated with age, D‐dimer, and transtricuspid pressure gradient and needs further investigation.
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Affiliation(s)
- Takashi Hongo
- Emergency Department Okayama Saiseikai General Hospital Okayama Japan.,Department of Emergency Critical Care, and Disaster Medicine Dentistry, and Pharmaceutical Sciences Okayama University Graduate School of Medicine Okayama Japan
| | - Hiromichi Naito
- Department of Emergency Critical Care, and Disaster Medicine Dentistry, and Pharmaceutical Sciences Okayama University Graduate School of Medicine Okayama Japan
| | | | - Mototaka Inaba
- Department of Emergency Critical Care, and Disaster Medicine Dentistry, and Pharmaceutical Sciences Okayama University Graduate School of Medicine Okayama Japan
| | - Noritomo Fujisaki
- Department of Emergency Critical Care, and Disaster Medicine Dentistry, and Pharmaceutical Sciences Okayama University Graduate School of Medicine Okayama Japan
| | - Atsunori Nakao
- Department of Emergency Critical Care, and Disaster Medicine Dentistry, and Pharmaceutical Sciences Okayama University Graduate School of Medicine Okayama Japan
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25
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Daly M, Long B, Koyfman A, Lentz S. Identifying cardiogenic shock in the emergency department. Am J Emerg Med 2020; 38:2425-2433. [PMID: 33039227 DOI: 10.1016/j.ajem.2020.09.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Cardiogenic shock is difficult to diagnose due to diverse presentations, overlap with other shock states (i.e. sepsis), poorly understood pathophysiology, complex and multifactorial causes, and varied hemodynamic parameters. Despite advances in interventions, mortality in patients with cardiogenic shock remains high. Emergency clinicians must be ready to recognize and start appropriate therapy for cardiogenic shock early. OBJECTIVE This review will discuss the clinical evaluation and diagnosis of cardiogenic shock in the emergency department with a focus on the emergency clinician. DISCUSSION The most common cause of cardiogenic shock is a myocardial infarction, though many causes exist. It is classically diagnosed by invasive hemodynamic measures, but the diagnosis can be made in the emergency department by clinical evaluation, diagnostic studies, and ultrasound. Early recognition and stabilization improve morbidity and mortality. This review will focus on identification of cardiogenic shock through clinical examination, laboratory studies, and point-of-care ultrasound. CONCLUSIONS The emergency clinician should use the clinical examination, laboratory studies, electrocardiogram, and point-of-care ultrasound to aid in the identification of cardiogenic shock. Cardiogenic shock has the potential for significant morbidity and mortality if not recognized early.
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Affiliation(s)
- Madison Daly
- Division of Emergency Medicine, The University of Vermont Medical Center, United States of America
| | - Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, United States of America
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, United States of America
| | - Skyler Lentz
- Division of Emergency Medicine, Department of Surgery, The University of Vermont Larner College of Medicine, United States of America.
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26
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Long B, Long DA, Tannenbaum L, Koyfman A. An emergency medicine approach to troponin elevation due to causes other than occlusion myocardial infarction. Am J Emerg Med 2020; 38:998-1006. [DOI: 10.1016/j.ajem.2019.12.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/18/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
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