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Right ventricle dysfunction does not predict mortality in patients with SARS-CoV-2-related acute respiratory distress syndrome on extracorporeal membrane oxygenation support

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World Journal of Cardiology 2023年第4期15卷 165-173页

作者： Chiara Lazzeri Manuela Bonizzoli Stefano Batacchi Giovanni Cianchi Andrea Franci Filippo Socci marco chiostri Adriano Peris ICU and ECMO Center Florence 50134Italy

BACKGROUND The prognostic role of right ventricle dilatation and dysfunction(RVDD)has not been elucidated in patients with coronavirus disease(COVID)-related respiratory failure refractory to standard treatment needing extracorporeal membrane oxygenation(ECMO)*** To assess whether pre veno-venous(VV)ECMO RVDD were related to inintensive care unit(ICU)*** We enrolled 61 patients with COVID-related acute respiratory distress syndrome refractory to conventional treatment submitted to VV ECMO and consecutively admitted to our ICU(an ECMO referral center)from 31th March 2020 to 31th August *** echocardiographic exam was performed immediately before VV ECMO *** Males were prevalent(73.8%)and patients with a body mass index>30 kg/m^(2) were the majority(46/61,75%).The overall in-ICU mortality rate was 54.1%(33/61).RVDD was detectable in more than half of the population(34/61,55.7%)and associated with higher simplified organ functional assessment(SOFA)values(P=0.029)and a longer mechanical ventilation duration prior to ECMO support(P=0.046).Renal replacement therapy was more frequently needed in RVDD patients(P=0.002).A higher in-ICU mortality(P=0.024)was observed in RVDD *** echo variables were independent predictors of in-ICU *** In patients with COVID-related respiratory failure on ECMO support,RVDD(dilatation and dysfunction)is a common finding and identifies a subset of patients characterized by a more severe disease(as indicated by higher SOFA values and need of renal replacement therapy)and by a higher in-ICU ***(also when considered separately)did not result independently associated with in-ICU mortality in these patients.

关键词： Right ventricle Echocardiography Mortality COVID Acute respiratory distress syndrome Right ventricle-pulmonary circulation coupling

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Hemodynamic changes acutely determined by primary PCI in STEMI patients evaluated with a minimally invasive method

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World Journal of Cardiovascular Diseases 2013年第4期3卷 69-72页

作者： Cristina Giglioli Omar Tujjar Emanuele Cecchi Daniele Landi marco chiostri Serafina Valente Giorgio Jacopo Baldereschi Francesco Meucci Gian Franco Gensini Salvatore Mario Romano Department of Critical Care and Surgery Unit of Internal Medicine and Cardiology University of Florence Italy Department of Heart and Vessels Azienda Ospedaliero-Universitaria Careggi Florence Italy

Objective: Few studies are available on the hemodynamic changes acutely determined by Primary Percutaneous Coronary Intervention (PCI) in ST-Elevation Myocardial Infarction (STEMI) patients, probably for the difficult evaluation of hemodynamic variables in this acute setting. Therefore, the paper is to evaluate the variations of several hemodynamic parameters determined by PCI using PRAM (Pressure Recording Analytical Method), minimally invasive hemodynamic monitoring. Methods: We analyzed in 20 STEMI patients submitted to PCI several hemodynamic variables, assessed with PRAM from radial/ femoral artery, 3-minute before PCI and at endprocedure. Variables measures were: systolic, diastolic, dicrotic and mean arterial pressures;heart rate (HR);stroke volume (SV);systemic vascular resistance (SVR);dP/dtmax;cardiac cycle efficiency (CCE). Results: In our patients HR, SVR and dP/dtmax decreased significantly (85 ± 6.3 to 77 ± 4.5, p = 0.002;1738 ± 241 to 1450 ± 253, p = 0.022;1.22 ± 0.11 to 1.11 ± 0.12, p = 0.007, respectively) while CCE and SV increased significantly (?0.25 ± 0.23 to ?0.01 ± 0.12,

关键词： STEMI Primary PCI Hemodynamic Monitoring Cardiac Output

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Clinical significance of lactate in acute cardiac patients

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World Journal of Cardiology 2015年第8期7卷 483-489页

作者： Chiara Lazzeri Serafina Valente marco chiostri Gian Franco Gensini Intensive Cardiac Care Unit Heart and Vessel Department Azienda Ospedaliero-Universitaria Careggi Department of Experimental and Clinical Medicine University of Florence

Lactate, as a metabolite of easy and quick assessment, has been studied over time in critically ill patients in order to evaluate its prognostic ability. The present review is focused on the prognostic role of lactate levels in acute cardiac patients(that is with acute coronary syndrome, cardiogenic shock, cardiac arrest, non including post cardiac surgery patients). In patients with STelevation myocardial infarction treated with mechanical revascularization, hyperlactatemia identified a subset of patients at higher risk for early death and in-hospital complications, being strictly related mainly to hemodynamic derangement. The prognostic impact of hyperlactatemia on mortality has been documented in patients with cardiogenic shock and in those with cardiac arrest even if there is no cut-off value of lactate to be associated with worse outcome or to guide resuscitation or hemodynamic management. Therapeutic hypothermia seems to affect per se lactate values which have been shown to progressively decrease during hypothermia. The mechanism(s) accounting for lactate levels during hypothemia seem to be multiple ranging from the metabolic effects of reduced temperatures to the hemodynamic effects of hypothermia(i.e., reduced need of vasopressor agents). Serial lactate measurements over time, or lactate clearance, have been reported to be clinically more reliable than lactate absolute value also in acute cardiac patients. Despite differences in study design, timing of lactate measurements and type of acute cardiac conditions(i.e., cardiogenic shock, cardiac arrest, refractory cardiac arrest), available evidence strongly suggests that higher lactate levels can be observed on admission in non-survivors and that higher lactate clearance is associated with better outcome.

关键词： Lactate Acute coronary syndrome Cardio-genic shock Cardiac arrest Therapeutic hypothermia Extracorporeal membrane oxygenation Prognosis

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Clinical significance of glycated hemoglobin in the acute phase of ST elevation myocardial infarction

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World Journal of Cardiology 2014年第4期6卷 140-147页

作者： Chiara Lazzeri Serafina Valente marco chiostri Maria Grazia D'Alfonso Gian Franco Gensini Intensive Cardiac Care Unit Heart and Vessel DepartmentAzienda OspedalieroUniversitaria Careggi

In population-based studies,including diabetic and nondiabetic cohorts,glycated hemoglobin A1c(HbA1c) has been reported as an independent predictor of allcause and cardiovascular disease *** on the prognostic role of HbA1c in patients with acute myocardial infarction(MI) are not univocal since they stem from studies which mainly differ in patients' selection criteria,therapy(thrombolysis vs mechanical revascularization) and number *** present review is focused on available evidence on the prognostic significance of HbA1c measured in the acute phase in patients with ST-elevation myocardial infarction(STEMI) submitted to primary percutaneous coronary intervention(PCI).We furthermore highlighted the role of HbA1c as a screening tool for glucose intolerance in patients with *** to available evidence,in contemporary cohorts of STEMI patients submitted to mechanical revascularization,HbA1c does not seem to be associated with short and long term mortality ***,HbA1c may represent a screening tool for glucose intolerance from the early phase on in STEMI *** a pragmatic ground,an HbA1c testhas several advantages over fasting plasma glucose or an oral glucose tolerance test in an acute *** test can be performed in the non-fasting state and reflects average glucose concentration over the preceding 2-3 *** therefore proposed an algorithm based on pragmatic grounds which could be applied in STEMI patients without known diabetes in order to detect glucose intolerance abnormalities from the early *** main advantage of this algorithm is that it may help in tailoring the follow-up program,by helping in identifying patients at risk for the development of glucose intolerance after *** validation of this algorithm in prospective studies may be required in the contemporary STEMI population to resolve some of these uncertainties around HbA1c screening cutoff points.

关键词： Glycated hemoglobin ST-elevation myocardial infarction Prognosis Hyperglycemia Glucose intolerance

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