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New Insights in Critical Care Cardiology
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New Insights in Critical Care Cardiology

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 20 September 2024 | Viewed by 2419

Special Issue Editors

Dr. Dirk Bandorski

E-Mail Website
Guest Editor
1. Asklepios Neurological Clinic Bad Salzhausen, 63667 Nidda, Germany
2. Campus Hamburg, Medical Faculty, Semmelweis University, 22291 Hamburg, Germany
Interests: echocardiography; atrial fibrillation; heart failure; critical care medicine; electrocardiography; hypertension; pulmonary hypertension; myocardial infarction; cardiomyopathies; cardiac function; clinical cardiology
Dr. Reinhard Hoeltgen

E-Mail Website
Guest Editor
Department of Cardiology and Electrophysiology, Medical Clinic 1, St. Agnes-Hospital Bocholt Rhede, Klinikum Westmünsterland, 46397 Bocholt, Germany
Interests: atrial fibrillation; heart failure; electrocardiography; hypertension; critical care medicine; invasive electrophysiology; EP-studies; ablation procedures; pacemakers; ICD; resynchronisation devices; angiology

Special Issue Information

Dear Colleagues,

Due to the ageing population and the high incidence of cardiovascular diseases, the number of cardiological intensive care patients is increasing. New diagnostic and therapeutic options lead to a better survival rate of patients in cardiac intensive care.

Promising innovative approaches in the treatment of cardiogenic shock with and without myocardial infarction found entrance into clinical routine and are available in the majority of clinical institutions caring for this patient population.

CRP apheresis shows new possibilities for the treatment and reduction of tissue damage by the selective immunoadsorption of CRP from blood plasma.

High heart rates are prognostically unfavorable in shock situations, forming an indicator of inefficient hemodynamics, impaired perfusion and organ function. Moreover, most drugs that lower heart rate also lower blood pressure, thus requiring a qualified differentiated heart rate control and non-critical blood pressure reduction. Ultrafast ß1-selective beta blockers such as landiolol allow selected and precise short temporally focused influence on frequency levels.

Differentiated coronary interventional tools and additive strategies like coronary rotablation, coronary lithotripsy procedures and the use of cooling catheters are among other advanced therapies. Therapy for cardiogenic shock using temporary mechanical circulatory support has improved in the last decades. These technologies could be used for acute-phase stabilization and bridging to long-term therapies. Lately, in patients with severe cardiogenic shock, the use of venoarterial extracorporeal life-support systems and the Impella left ventricular assist device (ECMELLA approach) has been described.

Innovative strategies became increasingly common, not only for patients requiring intensive care medicine. Interventional techniques of aortic, mitral and meanwhile even tricuspid valve repair are already established, and offer alternative strategies to the surgical correction of vitia.

In addition to the surgical treatment of patients with chronic thromboembolic pulmonary hypertension, interventional therapy using a balloon angioplasty has shown good results. Differentiated electroanatomical high-density mapping procedures to clarify complex arrhythmogenic substrates, both in the left and right atria and ventricles, and innovative ablation techniques such as pulsed-field ablation systems allow the cure of an increasing number of critical tachyarrhythmias.

The current Special Issue, “New Insights in Critical Care Cardiology”, invites authors focusing on cardiology intensive care and associated strategies for long-term therapy procedures. This Issue is focused on drug therapy, interventional therapy and mechanical circulatory support systems. We hope that these topics generate your interest to contribute to our journal.

Dr. Dirk Bandorski
Dr. Reinhard Hoeltgen
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • atrial fibrillation
  • arrhythmia surgery
  • CIEDs therapy
  • valvular surgery (including TAVR)
  • risk stratification of cardiovascular surgery
  • interventional valve therapy
  • pulmonary hypertension
  • balloon angioplasty

Published Papers (2 papers)

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Research

11 pages, 692 KiB  
Article
Clinical Course and Management of Patients with Emergency Surgery Treated with Direct Oral Anticoagulants or Vitamin K Antagonists—Results of the German Prospective RADOA-Registry
by Jana Last, Eva Herrmann, Ingvild Birschmann, Simone Lindau, Stavros Konstantinides, Oliver Grottke, Ulrike Nowak-Göttl, Barbara Zydek, Christian von Heymann, Ariane Sümnig, Jan Beyer-Westendorf, Sebastian Schellong, Patrick Meybohm, Andreas Greinacher and Edelgard Lindhoff-Last
J. Clin. Med. 2024, 13(1), 272; https://doi.org/10.3390/jcm13010272 - 3 Jan 2024
Viewed by 861
Abstract
(1) Background: The clinical management of anticoagulated patients treated with direct oral anticoagulants (DOAC) or Vitamin K antagonists (VKA) needing emergency surgery is challenging. (2) Methods: The prospective German RADOA registry investigated treatment strategies in DOAC- or VKA-treated patients needing emergency surgery within [...] Read more.
(1) Background: The clinical management of anticoagulated patients treated with direct oral anticoagulants (DOAC) or Vitamin K antagonists (VKA) needing emergency surgery is challenging. (2) Methods: The prospective German RADOA registry investigated treatment strategies in DOAC- or VKA-treated patients needing emergency surgery within 24 h after admission. Effectiveness was analysed by clinical endpoints including major bleeding. Primary observation endpoint was in hospital mortality until 30 days after admission. (3) Results: A total of 78 patients were included (DOAC: 44; VKA: 34). Median age was 76 years. Overall, 43% of the DOAC patients and 79% of the VKA patients were treated with prothrombin complex concentrates (PCC) (p = 0.002). Out of the DOAC patients, 30% received no hemostatic treatment compared to 3% (1/34) of the VKA patients (p = 0.002), and 7% of the DOAC patients and 21% of the VKA patients developed major or clinically relevant non-major bleeding at the surgical site (p = 0.093). In-hospital mortality was 13% with no significant difference between the two treatment groups (DOAC: 11%, VKA: 15%; p > 0.20). (4) Conclusions: The 30-day in-hospital mortality rate was comparable between both patient groups. VKA patients required significantly more hemostatic agents than DOAC patients in the peri- and postoperative surgery period. Full article
(This article belongs to the Special Issue New Insights in Critical Care Cardiology)
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15 pages, 1604 KiB  
Article
Analysis of Electrocardiographic Criteria of Right Ventricular Hypertrophy in Patients with Chronic Thromboembolic Pulmonary Hypertension before and after Balloon Pulmonary Angioplasty
by Lukas Ley, Christoph B. Wiedenroth, Hossein Ardeschir Ghofrani, Reinhard Hoeltgen and Dirk Bandorski
J. Clin. Med. 2023, 12(13), 4196; https://doi.org/10.3390/jcm12134196 - 21 Jun 2023
Cited by 3 | Viewed by 1139
Abstract
Background: Chronic thromboembolic pulmonary hypertension (CTEPH) may lead to typical electrocardiographic changes that can be reversed by balloon pulmonary angioplasty (BPA). The aim of this study was to investigate the significance of rarely used electrocardiogram (ECG) parameters, possible electrocardiographic differences between residual and [...] Read more.
Background: Chronic thromboembolic pulmonary hypertension (CTEPH) may lead to typical electrocardiographic changes that can be reversed by balloon pulmonary angioplasty (BPA). The aim of this study was to investigate the significance of rarely used electrocardiogram (ECG) parameters, possible electrocardiographic differences between residual and significantly improved CTEPH and the role of electrocardiographic parameters in low mPAP (mean pulmonary arterial pressure) ranges since the mPAP threshold for the definition of pulmonary hypertension has recently been adjusted (≥25 mmHg to >20 mmHg). Material and Methods: Between March 2014 and October 2020, 140 patients with CTEPH and 10 with CTEPD (chronic thromboembolic pulmonary disease) without pulmonary hypertension (PH) were retrospectively enrolled (12-lead ECG and right heart catheterization before and 6 months after BPA). The ECG parameters of right heart strain validated by studies and clinical experience were evaluated. Special attention was paid to six specific ECG parameters. After BPA, the cohort was divided into subgroups to investigate possible electrocardiographic differences with regard to the haemodynamic result. Results: The present study confirmed that the typical electrocardiographic signs of CTEPH can be found on an ECG, can regress after BPA and partially correlate well with haemodynamic parameters. “R V1, V2 + S I, aVL − S V1” was a parameter of particular note. BPA reduced its frequency (47% vs. 29%) statistically significantly after Bonferroni correction (p < 0.001). Moreover, it showed a good correlation with mPAP and PVR (r-values: 0.372–0.519, p-values: < 0.001). Exceeding its cut-off value before therapy was associated with more severe CTEPH before therapy (higher mPAP, PVR, NT-pro-BNP and troponin and lower TAPSE) and an increased risk of death. Exceeding its cut-off value before and after therapy was associated with more severe CTEPH after therapy (higher RAP, mPAP, PVR, NT-pro-BNP and NYHA class) and an increased risk of death. Men tend to be affected more frequently. After subgrouping, it was observed that a higher median mPAP was associated with a higher right atrial pressure (RAP), a higher pulmonary vascular resistance (PVR) and a lower cardiac output (CO) before and after BPA. In addition, under these conditions, more and more severe electrocardiographic pathologies were detected before and after BPA. Some patients with low mPAP also continued to show mild ECG changes after BPA. In some cases, very few to no pathological ECG changes were detected, and the ECG could present as mostly normal in some patients (5% before BPA and 13% after BPA). Conclusion: “R V1, V2 + S I, aVL − S V1” seems to be able to support the diagnosis of CTEPH, indicate therapeutic improvement and estimate haemodynamics. It also seems capable of predicting a (persistent) severe disease with probably increased need for therapy and increased mortality. Mild PH has been observed to have either no or few mild ECG changes. This might complicate the (early) detection of PH. Full article
(This article belongs to the Special Issue New Insights in Critical Care Cardiology)
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