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EHJ-ACVC Highlights

Scientific articles from the European Heart Journal - Acute CardioVascular Care (EHJ-ACVC) authored and co-authored by the ACVC.

By Milica Aleksic, EHJ-ACVC Editorial Board Member and Maria Bergami, Young ACVC Member.

Welcome to EHJ-ACVC Highlights, which spotlights articles from the European Heart Journal - Acute Cardiovascular Care that have recently captured the attention of the general cardiology community.

Delve into groundbreaking research and insights driving progress in acute cardiovascular and intensive care medicine.


July 2024 Highlights

Read this month's selection 

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Figure from Maria Bergami - visual is created by Biorender 

  1. Hong et al. present a study where they deal with the importance of residual ischaemia in AMICS undergoing VA-ECMO. In those cases residual ischaemia was associated with increased risk of 1-year mortality. However, further studies are needed to evaluate efficacy and future management of those patients. 
  2. The correlation between hsTnT CV medications and long-term outcomes? –  Can it have an effect on MAE? 
  3. Elevated hs-cTnT levels pose a significant diagnostic hurdle, necessitating tailored diagnostic thresholds for accurate MI diagnosis in CKD patients. This study heralds a paradigm shift towards personalized diagnostic approaches to optimize patient care in this vulnerable population.
  4. Introduction of Killip pLUS scale– integration of Killip class and LUS provides better risk stratification than any of these used alone 
  5. Portal vein dopler- the one and only that can track volume removal in severe TR. Further studies will provide answers if this strategy have a strong effect on patients outcomes. 
  6. In GULLIVE-R prospective study the main focus is on secondary prevention strategies after AMI. Despite high adherence to guideline-recommended medications, only half of the patients receive all key secondary preventative medications, signaling a pressing need for enhanced education and prevention strategies. 
  7. Finally, be prepared to dive deep into non-invasive imaging strategies in HFpEF, the educational paper prepared by Dhont et al. This article may provide you with resources you are looking for to provide your patients the best quality of care possible. 

June 2024 Highlights

From the cost-effectiveness of eCPR, antithrombotic management during MCS and introduction of CShock score to predict cardiogenic shock onset by using AI, to contemporary management of pulmonary embolism and frail patients in ICU.

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Figure from Maria Bergami - visual is created by Biorender 

May 2024 Highlights

What is the best time for tMCS in AMI-CS - earlier the better?

Buda et al. conducted a study comparing early vs. delayed initiation of MCS in AMI-CS. Their findings suggest that early initiation of tMCS is associated with fewer adverse events, lower mortality and fewer readmissions compared to delayed tMCS. 

Future prospective randomised studies are needed to identify patients who would benefit the most from tMCS and to select the adequate type of tMCS for each patient.

read more 

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Figure from Maria Bergami - visual is created by Biorender 

April 2024 Highlights

Nutritional support during ICU stay - a stepwise approach towards better outcomes

Nutritional support plays an important role in management of critically ill patients, especially patients with acute heart failure, acute coronary syndrome, post-cardiac-arrest patients and patients with cardiogenic shock.

Nutritional support in acute heart failure

The nutritional risk and prevalence of malnutrition is high in patients with acute heart failure (up to 40%) due to bowel ischemia, microcirculatory failure, and malabsorption. Although adequate nutrition might play an important role in improving outcomes, studies on this matter are still lacking. 

Nutritional support for these patients is based on general principles- early nutritional assessment, form of administration and assessment of nutritional risk. It is recommended to start enteral feeding in the first 48h upon CICU admission. In the acute phase (<72h) it is best to implement hypocaloric nutrition with adequate substitution of micronutrients.

Parenteral feeding can be associated with higher risk of infection, and it is recommended as first line in case of severe gastrointestinal dysfunction. However, early parenteral feeding is recommended in severely malnourished patients.

Nutritional support in acute coronary syndrome 

Malnutrition is these patients may be associated with worsening outcomes. The same principles apply as for critically ill patients.

Nutritional support after cardiac arrest

Patients after suffering cardiac arrest may require close monitoring, especially if receiving ECLS for refractory cardiac arrest. In those patients’ enteral nutrition should be introduced with caution, as rates of intestinal ischemia are higher. Delayed feeding is associated with better outcomes. Studies on this field are needed to create uniform protocols of management of these patients.

Nutritional support in cardiogenic shock 

As we all know, cardiogenic shock is a low cardiac output state secondary to cardiac dysfunction, leading to end-organ hypoperfusion and tissue hypoxia. During this condition mesenteric arteriolar vasoconstriction plays a major role in trying to maintain systemic blood pressure. Together with venous congestion it leads to decrease in local perfusion and increased risk of bowel ischemia.

If enteral feeding is started in this highly vulnerable hemodynamic state, there is a risk of mesenteric ischemia. Starting early enteral feeding is still controversial. It may be beneficial to do a permissive underfeeding in the first few days, especially in patients who require use of vasopressors. The incidence of proven bowel ischemia using those protocols was <1%.

Having in mind the incidence and severity of cardiovascular diseases requiring CICU admission, comprehensive multidisciplinary approach to nutritional support is needed to optimize care of critically ill patients. Further research is needed to try to obtain uniform and individualized protocols that could improve patient survival, duration of ICU stay and quality of life after CICU admission.

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Figure from Maria Bergami - visual is created by Biorender 

Read the full article

March 2024 Highlights

The light in the end of the tunnel – unrevealing mechanisms of ventricular fibrillation during the first ST elevation myocardial infarction by the use of proteonomics. 

Stampe et al. conducted a study using proteonomics that unrevealed that 26 proteins are associated with ventricular fibrillation. Pending further analysis two of the proteins were strongly associated with VF (ACTBL2, F13A1). The findings of this study represent a groundbreaking moment that points the light towards further investigation of early VF in  ST elevation myocardial infarction.

Read the full article 

Embrace the challenge – the role of ventricular assist device in management of fulminant myocarditis

The study by Takahito Nasu et al. represent a pioneering large-scale registry study using data from Japanese Registry for Percutaneous Ventricular Assist Devices. Use of Impella device showed better success rate in comparison with ECPELLA. Having in mind the high percentage of adverse events further investigation is needed to optimize patient selection and treatment in this matter.

Read the full article 

Deep dive into pulmonary embolism – identifying early predictors affects the outcome?

Zuin et al. deal with “Early predictors of clinical deterioration in intermediate-high risk pulmonary embolism” Their educational paper is complemented by a clinical consensus statement from the Association for Acute Cardiovascular Care that outlines the diagnostic and treatment pathways for acute right ventricular failure secondary to acutely increased right ventricular afterload.

Read the full article

Triglyceride deposit cardiomyovasculopathy (TGCV) – rare or just undiagnosed condition?

Nakano et al. introduce us to TGCV by conducting a study on 400 patients with ACS and 148 patients with diabetes and ACS. The study reports 4.3-5.4% prevalence emphasizing the need for further investigation and risk stratification of these patients, having in mind that they may present with diffuse coronary artery stenosis.

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Figure from Maria Bergami

Read the full article 


February 2024 Highlights

Cardiogenic shock patients on VA-ECMO – individual approach as the solution in prediction and reduction of complications?

VA-ECMO is a well-established method of treating patients with cardiogenic shock. But the risk of complications is still very high. Benedict N. Beer et al. conducted a retrospective multicenter cohort study with the aim to accurately describe the risk of complications and mortality events and to evaluate possible predictors of such events in those patients.

The study showed that the majority of 30-day survival patients treated with VA-ECMO had favorable neurological outcome (CPC 1/2). The presence of AEs, which are more common in women, are strongly associated with worsened neurological outcome and 30-day survival.

Further studies are needed to identify patients that could benefit from this strategy, having in mind the high risk of complications, whose prediction is still challeging and in need for RCTs. One possible solution might be the use of ECMELLA strategy that may reduce typical VA-ECMO complications but the strong evidence is still lacking. Patient selection might be improved by forming the multidisciplinary cardiogenic shock teams worldwide.

Read the full article 

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Figure from Maria Bergami

January 2024 Highlights

Sex-specific 99th percentile high-sensitivity cardiac troponin assays – are we there yet? 

Dr. Maria Rubini Gimenez discusses the diagnostic and prognostic value of sex-specific 99th percentiles in high sensitivity cardiac troponin assays for AMI.

The study by Lehmacher et al. reveals comparable diagnostic accuracy between uniform and sex-specific cutoffs, suggesting no clear advantage for the latter.

The results extend this message to uniform cutoffs for hs-cTnI, but the diagnostic accuracy’s reliance on hs-cTnT concentrations is acknowledged as a limitation which requires futher studies before recommending sex-specific cutoffs in clinical practice.

Read the full article

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Figure from Maria Bergami

Climate change as a global health problem – are we too late to prevent the consequences?

The EHJ-ACVC joins over 200 heart journals and urges the United Nations, political leaders, and health professionals to address climate change and biodiversity loss together as an indivisible global health emergency. 

Recognising the interconnectedness of climate and nature crisis, they emphasise the severe impact on health, from infectious diseases to mental health issues. The call urges the WHO to declare this crisis a global health emergency to be able to restore biodiversity and combat climate change.

Read the full article

Figures from Maria Bergami 

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