1,720,972 research outputs found
[Post-cardiac arrest syndrome: definition, pathophysiology, and management]
No full text: The post-cardiac arrest syndrome is a delicate, critical and complex condition that involves most patients resuscitated by a cardiac arrest. The main pathophysiological mechanism of this syndrome is a widespread ischemia-reperfusion damage, then there are other pathological alterations involving various organs which, if untreated, can evolve into multiorgan dysfunction. For this reason, a series of diagnostic-therapeutic actions (bundles) are necessary to ensure a correct management of the post-cardiac arrest syndrome: adequate oxygenation and ventilation, hemodynamic stabilization, temperature control, early prediction of neurological outcome, optimization of metabolic aspects, indication and timing of coronary angiography. The management of the post-cardiac arrest syndrome, the fifth link in the chain of survival, consists of a set of early, complex and multidisciplinary interventions, which must be promptly started, immediately after a return of spontaneous circulation, regardless of the location of cardiac arrest presentation, and it aims to obtain a good hemodynamic and neurological recovery. In this review, we will address the most recent scientific recommendations in the various areas of management of post-cardiac arrest syndrome that have led in recent years to a change in the practical approach to the comatose patient after cardiac arrest
[Approach to the diagnosis and management of patients with cardiac amyloidosis. A consensus document by the Tuscan section of the Italian Association of Hospital Cardiologists (ANMCO) and the Tusco-Umbrian section of the Italian Society of Cardiology (SIC)]
No full text: The diagnosis of cardiac amyloidosis (CA) is challenging because of its phenotypic heterogeneity, multi-organ involvement often requiring the interaction among experts in different specialties and subspecialties, the lack of a single non-invasive diagnostic tool, and limited awareness in the medical community. Recent studies have challenged the dogma of CA as a rare, incurable disease, and have redefined the epidemiology and therapeutic options for this condition. Missing or delaying the diagnosis may have a profound impact on patient outcome, as potentially life-saving treatments may be omitted or delayed, particularly chemotherapy in the case of amyloid light-chain amyloidosis. For a timely identification, clinical cardiologists should be able to recognize the "red flags" prompting a dedicated diagnostic work-up. Cardiologists could also face the challenge of making decisions about drug and device therapies for patients with known CA. The present consensus document aims to provide a practical guide and an organizational framework for professionals belonging to the Tuscan network of hospital cardiologists
Thousand Registries Are Not Worth a Randomized Trial: Also True for Chronic Total Occlusions?
No full textBlood lactate predicts survival after percutaneous implantation of extracorporeal life support for refractory cardiac arrest or cardiogenic shock complicating acute coronary syndrome: insights from the CareGem registry
No full textRefractory cardiogenic shock (RCS) or refractory cardiac arrest (RCA) complicating acute coronary syndrome (ACS) is associated with extremely high mortality rate. Veno-arterial extracorporeal life support (VA-ECLS) represents a valuable therapeutic option to stabilize patients' condition before or at the time of emergency revascularization. We analyzed 29 consecutive patients with RCS or RCA complicating ACS, and implanted with VA-ECLS in two centers who have adopted a similar, structured approach to ECLS implantation. Data were collected from January 2010 to December 2015 and ECLS had to be percutaneously implanted either before (within 48 h) or at the time of attempted percutaneous coronary revascularization (PCI). We investigated in-hospital outcome and factors associated with survival. Twenty-one (72%) were implanted for RCA, whereas 8 (28%) were implanted on ECLS for RCS. All RCA were witnessed and no-flow time was shorter than 5 min in all cases but one. All patients underwent attempted emergency PCI, using radial access in ten cases (34.5%), whereas in three patients a subsequent CABG was performed. Overall, ten patients (34.5%) survived, nine of them with a good neurological outcome. Life threatening complications, including stroke (4 pts), leg ischemia (4 pts), intestinal ischemia (5 pts), and deep vein thrombosis 2 pts), occurred frequently, but were not associated with in-hospital death. Main cause of death was multi-organ failure. PCI variables did not predict survival. Survivors were younger, with shorter low-flow time, and with ECLS mainly implanted for RCS. At multivariate analysis, levels of lactate at ECLS implantation (OR 4.32, 95%CI 1.01-18.51,p = 0.049) emerged as the only variable that independently predicted survival. In patients with RCA or RCS complicating ACS who are percutaneously implanted with ECLS before or at the time of coronary revascularization, in hospital survival rate is higher than 30%. Level of lactate at ECLS implantation appears to be the most important factor to predict survival
Identifying Cardiogenic Shock Sub-Phenotypes with Machine Learning: A Multicenter Study Combining Clinical and Echocardiographic Data
No full textBackground: Subphenotyping cardiogenic shock (CS) patients using nontraditional clustering methods represent a step toward precision medicine, potentially improving outcomes in this heterogeneous and high-mortality condition. Objectives: This study aimed to apply an unsupervised machine learning approach to integrate clinical and advanced echocardiographic data, identifying CS subphenotypes associated with different outcomes and features, beyond etiology. Methods: This multicenter observational study prospectively analyzed 172 patients admitted to cardiac intensive care units with overt CS, from 2021. An exploratory statistical analysis preceded patient clustering using the Elbow Method and K-Means algorithm, based on clinical presentation. Dimensionality reduction was performed with principal component analysis. Phenotypes were further stratified according to the Society for Cardiovascular Angiography and Interventions stages. Results: Five distinct phenotypes (I–V) were identified, showing progressively increasing in-hospital mortality rates: 25% (I), 32% (II), 39% (III), 41% (IV), and 60% (V). Kaplan-Meier analysis demonstrated a stepwise increase in mortality risk. Phenotypes IV and V had significantly higher mortality than phenotype I (HR: 2.78 [95% CI: 1.07-7.19] and HR: 2.80 [95% CI: 1.10-7.14]; P < 0.05). Mortality prediction remained independent after adjustment for confounding factors, and independently of Society for Cardiovascular Angiography and Interventions stage. Phenotype I had the lowest mortality, with higher arterial pressure and moderate left ventricular (LV) dysfunction, whereas phenotype II exhibited marked LV failure. Oppositely, phenotypes IV and V had severe congestion despite only mild LV impairment. Conclusions: Machine learning, newly integrating echocardiographic data, identified 5 distinct CS phenotypes, each with unique clinical/echocardiographic features and mortality risks. These insights could support personalized treatment strategies in CS patients, pending further validation
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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