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.

Clinical Prediction Score for Successful Liberation from Temporary Mechanical Circulatory Support in Cardiogenic Shock Patients.

Background: In cardiogenic shock (CS) patients requiring temporary mechanical circulatory support (tMCS), assessing cardiac recovery vs the need for heart replacement therapy is critical. We developed and validated a new clinical score aimed at predicting successful tMCS liberation.

Methods: A cohort of 80 CS patients treated with Impella support between January 2018 and December 2020 was analyzed.

Myocardial viability assessment during Impella support with 18-fluorodesoxyglucose PET imaging.

Formal assessment of myocardial viability (MV) is challenging in acute myocardial infarction-related cardiogenic shock (AMI-CS) patients receiving Impella mechanical circulatory support, as the cardiac magnetic resonance gold standard technique is not feasible due to the metallic components of the device. 18-fluorodesoxyglucose metabolic myocardial positron emission tomography (FDG-PET) may represent a valid and feasible alternative to obtain semi-quantitative and objective evidence of MV during Impella support. We hereby report the first series of sequential AMI-CS patients who received FDG-PET scanning to assess MV during Impella support to demonstrate the safety and feasibility of this approach.

The intelligent Impella: Future perspectives of artificial intelligence in the setting of Impella support.

Aims: Artificial intelligence (AI) has emerged as a potential useful tool to support clinical treatment of heart failure, including the setting of mechanical circulatory support (MCS). Modern Impella pumps are equipped with advanced technology (SmartAssist), enabling real-time acquisition and display of data related to both pump performance and the patient's haemodynamic status. These data emerge as an 'ideal' source for data-driven AI applications to predict the clinical course of an ongoing therapeutic protocol.

Cat Scratch Endocarditis.

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

Longitudinal analysis of pump parameters over long-term support with the HeartMate 3 left ventricular assist device.

Aims: Recurrence of heart failure emerged as the main cause of long-term mortality in patients implanted with the HeartMate 3 (HM3) left ventricular assist device (LVAD). We aimed at deriving a possible mechanistic rationale of clinical outcomes and analyzed longitudinal changes in pump parameters over prolonged HM3 support to investigate long-term effects of pump settings on left ventricular mechanics.

Methods: Data on pump parameters (i.

Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy.

Background: It is currently unclear if active left ventricular (LV) unloading should be used as a primary treatment strategy or as a bailout in patients with cardiogenic shock (CS) treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO).

Objectives: This study sought to evaluate the association between timing of active LV unloading and implantation of VA-ECMO with outcomes of patients with CS.

Methods: Data from 421 patients with CS treated with VA-ECMO and active LV unloading at 18 tertiary care centers in 4 countries were analyzed.

Effects of Intra-Aortic Balloon Pump delayed deflation timing on carotid blood flow and cardiac mechanics: An ultrasound and haemodynamic study.

Intra-Aortic Balloon Pump (IABP) efficacy is critically affected by the inflation/deflation timing. Balloon deflation may cause a sucking effect, and a steal phenomenon on carotid flow. Delaying IABP deflation reduces the degree of this flow reversal, but at the same time exposes patients to the risk of increased proto-systolic afterload with detrimental effects on the LV.

A simplified echocardiographic formula to estimate cardiac index in the intensive care unit.

Background And Aim: Measurement of cardiac index (CI) is crucial in the hemodynamic assessment of critically ill patients in the intensive care unit (ICU). The most reliable trans-thoracic echocardiography (TTE) technique for CI estimation is the left ventricular outflow tract (LVOT) Doppler method that requires, among other parameters, the LVOT cross-sectional area (CSA) measurement. However, inherent and practical disadvantages, mostly related to the ICU setting, hamper LVOT-CSA assessment.

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

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

Methods And Results: patients with first STEMI undergoing successful primary angioplasty were consecutively enrolled.

Prognostic value of right atrial pressure-corrected cardiac power index in cardiogenic shock.

Aim: The pulmonary artery catheter (PAC)-derived cardiac power index (CPI) has been found of prognostic value in cardiogenic shock (CS) patients. The original CPI equation included the right atrial pressure (RAP), accounting for heart filling pressure as a determinant of systolic myocardial work, but this term was subsequently omitted. We hypothesized that the original CPI formula (CPI ) is superior to current CPI for risk stratification in CS.

Bedside intra-aortic balloon pump insertion in cardiac intensive care unit: A single-center experience.

Background: In contemporary Cardiac Intensive Care Unit (CICU), bedside intra-aortic balloon pump (IABP) insertion under echocardiographic guidance may be an attractive option for selected patients with cardiogenic shock (CS). Currently available data on this approach are limited.

Aim: This study aimed to assess the feasibility and safety of bedside IABP insertion, as compared to fluoroscopic-guided insertion in the Catheterization Laboratory (CathLab), and to describe the clinical features of patients receiving bedside IABP insertion using a standardized technique in real-world CICU practice.

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

Trials on intra-aortic balloon pump (IABP) use in cardiogenic shock related to acute myocardial infarction have shown disappointing results. The role of IABP in cardiogenic shock treatment remains unclear, and new (potentially more potent) mechanical circulatory supports with arguably larger device profile are emerging. A reappraisal of the physiological premises of intra-aortic counterpulsation may underpin the rationale to maintain IABP as a valuable therapeutic option for patients with acute decompensated heart failure and tissue hypoperfusion.