Intra-Aortic Balloon Pump in Heart Failure-Related Cardiogenic Shock: A Meta-Analysis of Randomized Clinical Trials.

Pathophysiologic assumptions and clinical data frame a promising role for intra-aortic balloon pump (IABP) in heart failure-related cardiogenic shock (HF-CS). Currently, two randomized clinical trials (RCT) exploring this hypothesis have been published, yielding inconclusive results. We thus designed this meta-analysis to assess the efficacy of IABP in HF-CS.

Comprehensive Cardiac Imaging Before and During Microaxial Flow Pump Support for Cardiogenic Shock.

The increasing use of microaxial flow pumps (mAFP) underpins the need for a comprehensive approach to manage critically ill patients in an effort to maximize the benefits of this temporary mechanical circulatory support (tMCS) while minimizing its potential complications. Multimodality cardiac imaging offers an irreplaceable array of tools to address device position, device-heart hemodynamic interaction, myocardial recovery assessment, and identification of complications. This review provides a comprehensive and pragmatic summary of the cardiovascular imaging modalities currently available throughout the pathway of care of mAFP-supported patients, from device insertion, to intensive cardiac care hemodynamic monitoring, weaning guidance, and myocardial recovery assessment.

Trade-Off Between Bleeding and Ischemic Events From Left Ventricular Assist Devices: A EUROMACS Registry Analysis.

Background: A fully magnetically levitated centrifugal-flow pump (HeartMate 3 [HM3]) has significantly reduced thromboembolic events in left ventricular assist device (LVAD) patients, potentially modifying the trade-off of ischemic and bleeding events with current management strategies.

Objectives: The authors sought to characterize the opposing risk of ischemic and bleeding hemocompatibility-related adverse events (HRAEs) in LVAD carriers with contemporary practice.

Methods: We included 4,320 patients undergoing centrifugal-flow LVAD implantation (HeartWare [HVAD] cohort: 2,088, HM3 cohort: 2,232) in EUROMACS (European Registry for Patients with Mechanical Circulatory Support).

Detection of subclinical atherosclerosis by image-based deep learning on chest X-ray.

Aims: To develop a deep-learning-based system for recognition of subclinical atherosclerosis on a plain frontal chest X-ray.

Methods And Results: A deep-learning algorithm to predict coronary artery calcium (CAC) score (the AI-CAC model) was developed on 460 chest X-ray (80% training cohort, 20% internal validation cohort) of primary prevention patients [58.4% male, median age 63 (51-74) years] with available paired chest X-ray and chest computed tomography (CT) indicated for any clinical reason and performed within 3 months.

Safety and efficacy of P2Y12 inhibitors in acute coronary syndromes patients with KDIGO stage IV-V renal disfunction not on dialysis: a subanalysis of the CORALYS registry.

Background: The impact of the most potent P2Y12i ticagrelor and prasugrel after acute coronary syndrome in patients with chronic kidney disease (CKD) remains unclear. Most evidence on dual antiplatelet therapy (DAPT) comes from real-world study but is limited to glomerular filtration rate (GFR) under 60 ml/min.

Methods: Consecutive patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) and severe CKD defined as GFR under 30 ml/min not on dialysis from the CORALYS registry were included.

Invasive Hemodynamic Monitoring in Acute Heart Failure and Cardiogenic Shock.

Invasive hemodynamic monitoring provides essential information for managing acute heart failure (AHF) and cardiogenic shock (CS) patients, aiding circulatory shock phenotyping and in individualized and hemodynamically-based therapeutic management. The hemodynamic trajectory after the initial care bundle has been provided refines prognostication and anticipates hospital outcomes. Invasive hemodynamic monitoring also tracks the clinical response to supportive measures, providing objective background for therapeutic escalation/de-escalation, facilitating titration of vasoactive/temporary mechanical circulatory support (tMCS) to achieve an optimal balance between native heart function and device assistance, and allowing for a repeated reassessment of hemodynamics during the support weaning phase.

Impact of Hemolysis During Microaxial Flow Pump Support on Early Outcomes After Durable Left Ventricular Assist Device Implantation.

The impact of hemolysis during microaxial flow pump (mAFP; Impella, Danvers, Massachusetts, US) support on early outcomes after durable left ventricular assist device (d-LVAD) implantation is unknown. Three hundred and eleven consecutive patients undergoing d-LVAD implantation after mAFP support (Impella 5.0/5.

Echo and Hemodynamic-Guided Ramp Test in a Left Ventricular Assist Device Carrier With Right Ventricular Failure and Aortic Regurgitation.

The clinical outcomes of patients with left ventricular assist devices (LVAD) have steadily improved, unveiling late right ventricular failure (RVF) and aortic regurgitation (AR) as drivers of long-term mortality. The continuous-flow LVAD physiology and the patient's pre-existing features predispose to these complications, recently labeled hemodynamic-related events (HDREs). We present the case of an LVAD carrier complicated by both late RVF and AR, in which a comprehensive hemodynamic and echo-guided ramp test was carried out.

Rationale and design of the CT-STEMI study (Cardiac Computed Tomography for comprehensive risk stratification of arrhythmic, atherothrombotic and heart failure events following reperfused ST-segment Elevation Myocardial Infarction).

Background: ST-segment elevation myocardial infarction (STEMI) remains a major cause of morbidity and mortality, with survivors facing high risk of heart failure, recurrent ischemia, and arrhythmias. Risk stratification traditionally relies on echocardiography, while cardiac magnetic resonance (CMR) is the most effective tool for predicting adverse outcomes. However, its routine use is limited by accessibility, cost, and logistical constraints.

Afterload mismatch after transcatheter edge-to-edge repair in functional mitral regurgitation: A propensity-score matched analysis.

Background: Transcatheter edge-to-edge repair (TEER) for severe functional mitral regurgitation (FMR) in patients with reduced left ventricular ejection fraction (LVEF) may lead to an acute increase in left ventricular afterload, termed afterload mismatch (AM). This study aimed to redefine AM clinically, analyse its determinants, and assess its prognostic impact post-TEER in FMR patients.

Methods: A multicenter case-control study was conducted, involving FMR patients with LVEF ≤35% undergoing TEER.

Stroke in Heart Failure With Reduced Ejection Fraction: Systematic Review and Meta-Analysis of Randomized Trials.

Background: Patients with heart failure with reduced ejection fraction (HFrEF) have a heightened stroke risk. However, stroke as an endpoint in heart failure trials remains under-reported.

Objectives: The authors sought to define the incidence, characteristics, predictors, modifier treatments, and prognostic impact of stroke in patients with HFrEF who were enrolled in randomized controlled trials (RCTs).

Organ perfusion pressure predicts outcomes in cardiogenic shock patients.

Aims: The diagnosis of cardiogenic shock (CS) relies upon signs and/or symptoms of end-organ hypoperfusion. The combination of hypoperfusion and systemic congestion identifies patients at particularly high risk. This study evaluated organ perfusion pressure (OPP), calculated as mean arterial pressure minus invasive central venous pressure, as a predictor of outcomes in CS.

Mechanisms and Prognosis of Intolerance to Angiotensin Receptor-Neprilysin Inhibitors in Advanced Heart Failure: Insights From Vasodilator Challenge.

Background: Angiotensin receptor-neprilysin inhibitor (ARNI) intolerance is common in patients with advanced heart failure (AdHF) and may be associated with worse prognosis. During right heart catheterization (RHC), afterload reduction induced by vasodilator challenge may reproduce the hemodynamic effects of ARNI. Through sodium nitroprusside (NTP) infusion, we characterized the hemodynamic mechanisms of ARNI intolerance and explored its prognostic relevance in AdHF.

Differential Prognosis of True Bifurcation Lesions According to Left Main Versus Non-Left Main Location and Treatment Strategy.

Background: Although true bifurcation lesions are associated with a high risk of procedural complications, the differential prognostic implications of percutaneous coronary intervention for true bifurcations according to lesion location are unclear. This study aimed to identify whether clinical outcomes of true bifurcation lesions differed between left main coronary artery (LM) and non-LM bifurcations and to determine the optimal treatment strategy for subtypes of bifurcation lesions in the current-generation drug-eluting stent era.

Methods: The ULTRA-BIFURCAT (Combined Insights From the Unified COBIS III, RAIN, and ULTRA Registries) was created by merging 3 bifurcation-dedicated registries from Korea and Italy.

Diagnostic accuracy of late iodine enhancement on cardiac CT for myocardial tissue characterization: a systematic review and meta-analysis.

Purpose: to evaluate the diagnostic accuracy of late iodine enhancement (LIE) in cardiac computed tomography (CCT) compared to late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) for myocardial tissue characterization.

Materials And Methods: EMBASE, PubMed/MEDLINE, and CENTRAL were searched for studies reporting the accuracy of LIE with LGE as the gold standard of reference. QUADAS-2 tool was used to assess the risk of bias.

Impact of concomitant aortic valve replacement in patients with mild-to-moderate aortic valve regurgitation undergoing left ventricular assist device implantation: EUROMACS analysis.

Introduction: Left ventricular assist device (LVAD) therapy may lead to an aortic regurgitation, limiting left ventricular unloading and causing adverse events. Whether concomitant aortic valve replacement may improve outcomes in patients with preoperative mild-to-moderate aortic regurgitation remains unclear.

Methods: A retrospective propensity score-matched analysis of adult patients with preoperative mild-to-moderate aortic regurgitation undergoing durable LVAD implantation between 01/01/2011 and 30/11/2021 was performed.

Sex Differences in Procedural Characteristics and Clinical Outcomes Among Patients Undergoing Bifurcation PCI.

Background And Objectives: The risk profiles, procedural characteristics, and clinical outcomes for women undergoing bifurcation percutaneous coronary intervention (PCI) are not well defined compared to those in men.

Methods: COronary BIfurcation Stenting III (COBIS III) is a multicenter, real-world registry of 2,648 patients with bifurcation lesions treated with second-generation drug-eluting stents. We compared the angiographic and procedural characteristics and clinical outcomes based on sex.

Mitral Transcatheter Edge-to-Edge Repair in INTERMACS 3-4 Profile Patients with Severe Mitral Regurgitation.

Background: Heart transplantation and left ventricular assist device (LVAD) implementation are effective treatments for advanced heart failure (HF), although their use is limited by organ availability and the high incidence of adverse events. The efficacy of mitral transcatheter edge-to-edge repair (TEER) as a bridge to transplantation or as a destination therapy in advanced HF is still debated.

Methods: A total of 63 patients with INTERMACS class 3 or 4 with contraindications for LVAD and severe functional mitral regurgitation (FMR) were evaluated for TEER implantation eligibility.

Non-invasive physiological assessment of intermediate coronary stenoses from plain angiography through artificial intelligence: the STARFLOW system.

Background: Despite evidence supporting use of fractional flow reserve (FFR) and instantaneous waves-free ratio (iFR) to improve outcome of patients undergoing coronary angiography (CA) and percutaneous coronary intervention, such techniques are still underused in clinical practice due to economic and logistic issues.

Objectives: We aimed to develop an artificial intelligence (AI)-based application to compute FFR and iFR from plain CA.

Methods And Results: Consecutive patients performing FFR or iFR or both were enrolled.

Comprehensive non-invasive haemodynamic assessment in acute decompensated heart failure-related cardiogenic shock: a step towards echodynamics.

Aims: Haemodynamic assessment can be determinant in phenotyping cardiogenic shock (CS) and guiding patient management. Aim of this study was to evaluate the correlation between echocardiographic and invasive assessment of haemodynamics in acute decompensated heart failure-related CS (ADHF-CS).

Methods And Results: All consecutive ADHF-CS patients (SCAI shock stage ≥B) undergoing right heart catheterization (RHC) between 2020 and 2022 were prospectively enrolled.