The optimal timing of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) who are supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains uncertain. We aimed to evaluate the prognostic impact of shock-to-balloon time (STB) in AMI-CS patients supported with VA-ECMO before revascularization. This study included patient-pooled data from CS-dedicated registries, including the SMART-RESCUE and the SMC-ECMO. A total of 256 patients were included. Patients were stratified according to STB (<120 min, n = 140; ≥120 min, n = 116). Among the study population, all-cause mortality was significantly higher in the ≥120 minutes group compared with the <120 minutes group (65.2% vs. 44.6%; adjusted hazard ratio [HR]: 1.59, 95% confidence interval [CI]: 1.03-2.45, p = 0.037). This association was significant in the ST-segment elevation myocardial infarction (STEMI) subgroup (adjusted HR: 2.22, 95% CI: 1.26-3.93), and in patients with earlier (<60 min) VA-ECMO initiation (adjusted HR: 2.50, 95% CI: 1.42-4.38), whereas in the non-ST-segment elevation myocardial infarction (NSTEMI) subgroup a directionally consistent but nonsignificant trend was observed, without significant interaction (p-for-interaction = 0.164). In AMI-CS patients who underwent VA-ECMO, a prolonged STB was associated with higher all-cause mortality, with a consistent but exploratory trend in NSTEMI. These findings support STB as a prognostic marker and warrant prospective evaluation of coordinated ECMO-revascularization pathways.
Onyou Kim, Ji Hyun Cha, Sang Yoon Lee et al.· ASAIO journal (1992)· 0 citations
BACKGROUND
Because exercise testing is not feasible for a substantial subset of patients with suspected heart failure with preserved ejection fraction (HFpEF), the Heart Failure Association-Pre-test assessment, Echocardiography and natriuretic peptide score, Functional testing in cases of uncertainty, Final etiology (HFA-PEFF) score often leaves many patients in an indeterminate diagnostic category.
OBJECTIVES
The authors aimed to assess whether resting left atrial strain provides incremental diagnostic value beyond the HFA-PEFF score in patients undergoing exercise right heart catheterization.
METHODS
This prospective study enrolled 77 patients with confirmed HFpEF and 37 patients with noncardiac dyspnea (NCD). HFpEF was diagnosed by exercise right heart catheterization demonstrating elevated pulmonary capillary wedge pressure at rest or during exercise. Patients who did not meet HFpEF criteria were classified as NCD. The median HFA-PEFF score was 4 in patients with HFpEF and 2 in those with NCD (P = 0.007).
RESULTS
Left atrial reservoir strain (LARS) was significantly lower in patients with HFpEF compared with those with NCD (26.4% vs 34.7%; P < 0.001). LARS was significantly correlated with exercise mean pulmonary capillary wedge pressure and peak oxygen consumption and declined progressively as more HFpEF criteria were met. The optimal cutoff of LARS for discriminating HFpEF from NCD was 32% (OR: 5.26; 95% CI: 2.30-12.58; P < 0.001). Adding LARS to the HFA-PEFF score improved the area under the curve from 0.65 (0.56-0.74) to 0.75 (0.65-0.85) (P = 0.019) when LARS was analyzed as a continuous variable and to 0.73 (0.63-0.83) (P = 0.026) when using the 32% cutoff.
CONCLUSIONS
LARS provides additive diagnostic value beyond the HFA-PEFF score and may reduce the need for noninvasive and invasive stress testing in patients with suspected HFpEF.
Jihoon Kim, Ji Hyun Cha, K. Choi et al.· JACC: Asia· 1 citation
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