RESUMO

Constrictive pericarditis (CP) is an infrequent complication following heart transplantation (HTx) and arises from diverse postoperative occurrences, including mediastinitis, pericardial effusion, or allograft rejection. Indeed, this rare clinical entity can be misdiagnosed as a rejection episode or restrictive cardiomyopathy. In this report, we present the case of a 43-year-old male who underwent HTx 1.5 years prior and was subsequently admitted to our center due to the gradual onset of symptoms indicative of right congestive heart failure, with an initial diagnosis of constrictive pericarditis.

La pericarditis constrictiva (PC) representa una complicación rara después de un trasplante de corazón (TC), derivada de diversos eventos posoperatorios como mediastinitis, derrame pericárdico o rechazo del injerto. De hecho, esta entidad clínica poco común puede ser diagnosticada erróneamente como un episodio de rechazo o miocardiopatía restrictiva. En este informe presentamos el caso de un hombre de 43 años que se sometió a un TC 1,5 años antes y que fue ingresado posteriormente a nuestra institución debido al inicio gradual de síntomas indicativos de insuficiencia cardíaca congestiva derecha, con diagnóstico inicial de pericarditis constrictiva.

RESUMO

Venoarterial extracorporeal membrane oxygenation (VA ECMO) is a form of temporary mechanical circulatory support and simultaneous extracorporeal gas exchange for acute cardiorespiratory failure, including refractory cardiogenic shock (CS) and cardiac arrest (CA). Few studies have assessed predictors of successful weaning (SW) from VA ECMO. This systematic review and meta-analysis aimed to identify a multiparameter strategy associated with SW from VA ECMO. PubMed and the Cochrane Library and the International Clinical Trials Registry Platform were searched. Studies reporting adult patients with CS or CA treated with VA ECMO published from the year 2000 onwards were included. Primary outcomes were hemodynamic, laboratory, and echocardiography parameters associated with a VA ECMO SW. A total of 11 studies (n=653) were included in this review. Pooled VA ECMO SW was 45% (95%CI: 39-50%, I2 7%) and in-hospital mortality rate was 46.6% (95%CI: 33-60%; I2 36%). In the SW group, pulse pressure [MD 12.7 (95%CI: 7.3-18) I2 = 0%] and mean blood pressure [MD 20.15 (95%CI: 13.8-26.4 I2 = 0) were higher. They also had lower values of creatinine [MD -0.59 (95%CI: -0.9 to -0.2) I2 = 7%], lactate [MD -3.1 (95%CI: -5.4 to -0.7) I2 = 89%], and creatine kinase [-2779.5 (95%CI: -5387 to -171) I2 = 38%]. And higher left and right ventricular ejection fraction, MD 17.9% (95%CI: -0.2-36.2) I2 = 91%, and MD 15.9% (95%CI 11.9-20) I2 = 0%, respectively. Different hemodynamic, laboratory, and echocardiographic parameters were associated with successful device removal. This systematic review demonstrated the relationship of multiparametric assessment on VA ECMO SW.

Assuntos

Assuntos

RESUMO

Background: SCAI classification in cardiogenic shock is simple and suitable for rapid assessment. Its predictive behavior in patients with primary acute heart failure (AHF) is not fully known. We aimed to evaluate the ability of the SCAI classification to predict in-hospital and long-term mortality in AHF. Methods: We conducted a single-center study and performed a retrospective analysis of prospectively collected data of consecutive patients admitted with AHF between 2015 and 2020. The primary end points were in-hospital and long-term mortality from all causes. Results: In total, 856 patients were included. The unadjusted in-hospital mortality was as follows: A, 0.6%; B, 2.7%; C, 21.5%; D 54.3%; and E, 90.6% (log rank, P < .0001), and long-term mortality was as follows: A, 24.9%; B, 24%; C, 49.6%; D, 62.9%; and E, 95.5% (log rank, P < .0001). After multivariable adjustment, each SCAI SHOCK stage remained associated with increased mortality (all P < .001 compared with stage A). With the exception of the long-term end point, there were no differences between stages A and B for adjusted mortality (P = .1). Conclusions: In a cohort of patients with AHF, SCAI cardiogenic shock classification was associated with in-hospital and long-term mortality. This finding supports the rationale of the classification in this setting.