New ICCUs – a Modern Perspective on Acute Cardiac Care

<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Background:</bold> Acute ST-elevation myocardial infarction (STEMI) is an uncommon diagnosis in patients less than 40 years of age. Over the last two decades, there is an increase in the frequency of cardiovascular events among young adults. However, at present there is only limited clinical data on the clinical characteristics and outcomes of STEMI in young patients who were treated with primary percutaneous coronary intervention (pPCI). Plaque erosion is the underlying pathological mechanism leading to STEMI in the vast majority of young adults. Thrombi that complicate superficial erosion seem more platelet-rich than the fibrinous clots precipitated by plaque rupture. Mean platelet volume (MPV) is recognized as a marker of the platelet activation process and may be a better indicator of short-term prognosis than the inflammatory markers in young patients with STEMI. Therefore, we aimed to investigate clinical and angiographic characteristics, risk factors and the independent value of MPV on predicting short-term major adverse cardiovascular events (MACEs) in young adults with STEMI. <bold>Methods:</bold> A total of 349 patients aged 40 years or younger who underwent pPCI at our center between 2010–2015 with the diagnosis of STEMI were retrospectively analyzed. <bold>Results:</bold> The mean age of the patients was 36.4 ± 3.6 years and 90% of them were men. Smoking was by far the most frequent cardiovascular risk factor. MACEs were observed in 23 patients (6.6%), and according to the multivariate regression analysis, Killip IIIIV (OR 7.52, 95% CI 1.25–45.24, p = 0.03), lower admission SBP (OR 0.94, 95% CI 0.90–0.98, p &lt;0.01) and increased MPV (OR 1.67, 95% CI 1.05–2.67, p = 0.03) were found to be independently correlated with MACE in the study population. <bold>Conclusion:</bold> Our results indicate that MPV is an independent predictor of MACEs at the short-term follow-up in young patients with STEMI undergoing pPCI. Accordingly, we suggested that MPV, a marker of platelet activation, could play a significant role in predicting clinical evolution in young patients with STEMI.</abstract>

Mean Platelet Volume Predicts Short-term Prognosis in Young Patients with St-segment Elevation Myocardial Infarction

<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Background:</bold> There is no known therapy with proven efficacy for improving clinical outcomes in elderly patients with heart failure (HF) and preserved ejection fraction (HFpEF). In this study, we aimed to evaluate the efficacy of tolvaptan (TLV) in elderly HFpEF patients. <bold>Methods:</bold> This retrospective observational study involved 100 consecutive elderly HFpEF patients hospitalized at the Nagoya Heart Center, Japan. Inclusion criteria were: (1) patients aged ≥75 years; (2) first hospitalization secondary to HF; (3) received medical therapy for HF, without invasive treatment; and (4) clinical follow-up for >6 months after discharge. The primary endpoint was rehospitalization due to worsening HF, and the secondary endpoint was worsening renal function (WRF) during hospitalization and at 6 months after discharge. Sixty background-matched HFpEF patients were divided into 2 groups: with TLV therapy (TLV (+), n = 29) and without TLV therapy (TLV (–), n = 31). In the TLV (+) group, TLV therapy was continued after discharge. Clinical outcomes of these patients were evaluated. <bold>Results:</bold> Bed rest period and length of hospital stay were significantly shorter in the TLV (+) group than in the TLV (−) group. The dose of loop diuretics, mean serum creatinine levels, and incidence of WRF development were significantly lower in the TLV (+) group. Incidence of rehospitalization was also significantly lower in the TLV (+) group (log-rank test; p = 0.018). The multivariate logistic regression analysis demonstrated that TLV therapy reduces the incidence of rehospitalization in elderly patients with HFpEF. <bold>Conclusions:</bold> TLV therapy reduced the bed rest period, length of hospital stay, and rate of rehospitalization without WRF in elderly HFpEF patients, suggesting that TLV could represent an effective therapy for this group of patients.</abstract>

Efficacy of Tolvaptan in Elderly Patients with Heart Failure and Preserved Ejection Fraction

<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Background:</bold> A significant proportion of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel coronary artery disease (MVD), and they are at high risk for recurrent cardiac events. The <bold>aim</bold> of the present study was to analyze the impact of MVD on long-term cardiovascular mortality in STEMI patients treated with primary percutaneous coronary intervention (pPCI). <bold>Method:</bold> This study included 3,115 consecutive STEMI patients hospitalized in the Coronary Care Unit of the Clinical Centre of Serbia, between November 2005 and January 2012. Patients were divided in two groups: MVD and no MVD. MVD disease was defined as stenosis greater than 50% by visual assessment in more than one major coronary artery. Primary PCI was limited to the infarct-related artery (IRA). Cardiovascular mortality was defined as any death from cardiovascular reason (myocardial reinfarction, low-output heart failure, and sudden death). Patients presenting with cardiogenic shock were excluded. Patients were followed-up for 6 years after enrollment. <bold>Results:</bold> Among 3,115 analyzed patients, 1,352 (43.4%) patients had no MVD and 1,763 (56.6%) had MVD; among patients with MVD, 926 (52.6%) had two-vessel disease and 837 (47.4%) had three-vessel disease. Compared with patients with single-vessel disease, patients with MVD were older, had longer pain duration, and presented more often with heart failure; they were more likely to have previous coronary artery disease, diabetes, hypertension, and chronic kidney disease; post-procedural flow TIMI &lt;3 was more frequently observed in patients with MVD than in patients with no MVD (5.9% vs. 3.1%, p &lt;0.001). Patients with MVD had lower left ventricular ejection fraction than patients with single-vessel disease: 45% (interquartile range [IQR] 40¬–55%) vs. 50% (IQR 43–55%), p &lt;0.001. Revascularization of non-IRA lesions was performed at index hospitalization in 1,075 (61%) patients, and in 602 (34.1%) patients revascularization was performed in the first few months after pPCI (median 1.5 months, IQR 1–2.5 months); coronary artery bypass grafting was performed in 291 (18.4%) patients and PCI (with stent implantation) in 1,368 (81.6%) patients. Six-year cardiovascular mortality was significantly higher in patients with MVD than in patients with single-vessel disease (10.4% vs. 4.6%, p &lt;0.001). In multivariate Cox regression analysis, MVD remained an independent predictor for 6-year cardiovascular mortality (HR 1.55, 95% CI 1.11–2.06, p = 0.041). <bold>Conclusion:</bold> In STEMI patients treated with pPCI, the presence of MVD remained an independent predictor for higher long-term cardiovascular mortality despite early revascularization of the remaining stenosis in non-IRA.</abstract>

Impact of Multivessel Coronary Artery Disease on Long Term Prognosis in Patients with ST-segment Elevation Myocardial Infarction

<abstract xmlns="http://www.w3.org/1999/xhtml">Electrical storm is defined by at least three episodes of sustained ventricular tachyarrhythmias or appropriate shocks given by implantable cardiac defibrillator devices (ICD), occurring within a period of 24 hours. In the present manuscript, we present the case of a 69-year-old female patient with previous aortocoronary bypass, who was admitted from the Emergency Department after presenting several episodes of syncope in prehospital settings and presented 4 episodes of sustained ventricular tachycardia which required electrical cardioversion. The arrhythmia disappeared after percutaneous revascularization of a chronic occlusion in the right coronary artery. In this case, the implantation of an ICD was avoided, as a reversible cause of ES has been identified and treated.</abstract>

University of Medicine, Pharmacy, Science and Technology

Electrical Storm Due to Active Myocardial Ischemia in the Right Coronary Artery Territory – Case Report

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Journal of Cardiovascular Emergencies

 The Journal of Cardiovascular Emergencies aims to publish top quality papers related to acute conditions in any cardiovascular pathology. The journal will mainly focus on recent advances in the field of diagnosis and treatment of the most common causes of cardiovascular emergencies, including acute coronary syndromes, acute heart failure, acute aortic diseases, pulmonary embolism, peripheral arterial diseases or cardiac arrhythmia. Interdisciplinary approaches will be extremely welcomed, presenting new advances in the approach of different other pathologies (i.e. stroke) from the cardiovascular perspective.  The Journal of Cardiovascular Emergencies will publish high-quality basic and clinical research related to these topics, in a common approach that will integrate the clinical studies with the pre-clinical work dedicated to discovery of new mechanisms involved in the development and progression of acute cardiovascular conditions.  Especially in the case of acute coronary syndromes, the journal will try to provide the entire cardiology community with the perspective of the regional cardiology networks in Central and Eastern European countries, reflecting the regional model of care in cardiovascular acute conditions.  The journal will primarily focus on publishing original research papers, but also other types of materials (such as review articles, case reports, state of the art papers, comments to editor, etc) will be extremely welcomed.  Rejection Rate   30%   Archiving  Sciendo archives the contents of this journal in Portico - digital long-term preservation service of scholarly books, journals and collections.  Plagiarism Policy  The editorial board is participating in a growing community of Similarity Check System's users in order to ensure that the content published is original and trustworthy. Similarity Check is a medium that allows for comprehensive manuscripts screening, aimed to eliminate plagiarism and provide a high standard and quality peer-review process. 