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3. Quantifying Hemodynamic Cardiac Stress and Cardiomyocyte Injury in Normotensive and Hypertensive Acute Heart Failure

Author

Nikola Kozhuharov, Eleni Michou, Desiree Wussler, Maria Belkin, Corinna Heinisch, Johan Lassus, Krista Siirilä-Waris, Harjola Veli-Pekka, Nisha Arenja, Thenral Socrates, Albina Nowak, Samyut Shrestha, Julie Valerie Willi, Ivo Strebel, Danielle M. Gualandro, Katharina Rentsch, Micha T. Maeder, Thomas Münzel, Mucio Tavares de Oliveira Junior, Arnold von Eckardstein, Tobias Breidthardt, and Christian Mueller

Subjects
acute heart failure, pathophysiology, natriuretic peptides, cardiac troponin, Biology (General), QH301-705.5
Abstract

Background: The characterization of the different pathophysiological mechanisms involved in normotensive versus hypertensive acute heart failure (AHF) might help to develop individualized treatments. Methods: The extent of hemodynamic cardiac stress and cardiomyocyte injury was quantified by measuring the B-type natriuretic peptide (BNP), N-terminal proBNP (NT-proBNP), and high-sensitivity cardiac troponin T (hs-cTnT) concentrations in 1152 patients presenting with centrally adjudicated AHF to the emergency department (ED) (derivation cohort). AHF was classified as normotensive with a systolic blood pressure (SBP) of 90–140 mmHg and hypertensive with SBP > 140 mmHg at presentation to the ED. Findings were externally validated in an independent AHF cohort (n = 324). Results: In the derivation cohort, with a median age of 79 years, 43% being women, 667 (58%) patients had normotensive and 485 (42%) patients hypertensive AHF. Hemodynamic cardiac stress, as quantified by the BNP and NT-proBNP, was significantly higher in normotensive as compared to hypertensive AHF [1105 (611–1956) versus 827 (448–1419) pg/mL, and 5890 (2959–12,162) versus 4068 (1986–8118) pg/mL, both p < 0.001, respectively]. Similarly, the extent of cardiomyocyte injury, as quantified by hs-cTnT, was significantly higher in normotensive AHF as compared to hypertensive AHF [41 (24–71) versus 33 (19–59) ng/L, p < 0.001]. A total of 313 (28%) patients died during 360 days of follow-up. All-cause mortality was higher in patients with normotensive AHF vs. patients with hypertensive AHF (hazard ratio 1.66, 95%CI 1.31–2.10; p < 0.001). Normotensive patients with a high BNP, NT-proBNP, or hs-cTnT had the highest mortality. The findings were confirmed in the validation cohort. Conclusion: Biomarker profiling revealed a higher extent of hemodynamic stress and cardiomyocyte injury in patients with normotensive versus hypertensive AHF.

Published
2024
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4. Effect of Inhaled Xenon on Cardiac Function in Comatose Survivors of Out-of-Hospital Cardiac Arrest—A Substudy of the Xenon in Combination With Hypothermia After Cardiac Arrest Trial

Author

Saraste, Antti, Ballo, Haitham, Arola, Olli, Laitio, Ruut, Airaksinen, Juhani, Hynninen, Marja, Bäcklund, Minna, Ylikoski, Emmi, Wennervirta, Johanna, Pietilä, Mikko, Roine, Risto O, Harjola, Veli-Pekka, Niiranen, Jussi, Korpi, Kirsi, Varpula, Marjut, Scheinin, Harry, Maze, Mervyn, Vahlberg, Tero, Laitio, Timo, Virtanen, Sami, Parkkola, Riitta, Saunavaara, Jani, Martola, Juha, Silvennoinen, Heli, Tiainen, Marjaana, Grönlund, Juha, Inkinen, Outi, Silvasti, Päivi, Nukarinen, Eija, and Olkkola, Klaus T

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Cardiovascular, Clinical Research, Heart Disease, Clinical Trials and Supportive Activities, cardiac arrest, cardiac function, cardioprotection, echocardiography, ejection fraction, myocardial strain, Clinical sciences
Abstract

This explorative substudy aimed at determining the effect of inhaled xenon on left ventricular function by echocardiography in comatose survivors of out-of-hospital cardiac arrest.DesignA randomized two-group single-blinded phase 2 clinical drug trial.SettingA multipurpose ICU in two university hospitals.PatientsOf the 110 randomized comatose survivors after out-of-hospital cardiac arrest with a shockable rhythm in the xenon in combination with hypothermia after cardiac arrest trial, 38 patients (24-76 yr old) with complete echocardiography were included in this study.InterventionsPatients were randomized to receive either inhaled xenon combined with hypothermia (33°C) for 24 hours or hypothermia treatment alone. Echocardiography was performed at hospital admission and 24 ± 4 hours after hypothermia.Measurements and main resultsLeft ventricular ejection fraction, myocardial longitudinal systolic strain, and diastolic function were analyzed blinded to treatment. There were 17 xenon and 21 control patients in whom echocardiography was completed. Clinical characteristics did not differ significantly between the groups. At admission, ejection fraction was similar in xenon and control patients (39% ± 10% vs 38% ± 11%; p = 0.711) but higher in xenon than control patients after hypothermia (50% ± 10% vs 42% ± 10%; p = 0.014). Global longitudinal systolic strain was similar in xenon and control patients at admission (-9.0% ± 3.8% vs -8.1% ± 3.6%; p = 0.555) but better in xenon than control patients after hypothermia (-14.4.0% ± 4.0% vs -10.5% ± 4.0%; p = 0.006). In patients with coronary artery disease, longitudinal strain improved in the nonischemic myocardial segments in xenon patients. There were no changes in diastolic function between the groups.ConclusionsAmong comatose survivors of a cardiac cause out-of-hospital cardiac arrest, inhaled xenon combined with hypothermia was associated with greater recovery of left ventricular systolic function in comparison with hypothermia alone.

Published
2021

9. The emergency department arrival mode and its relations to ED management and 30-day mortality in acute heart failure: an ancillary analysis from the EURODEM study

Author

Harjola, Pia, Tarvasmäki, Tuukka, Barletta, Cinzia, Body, Richard, Capsec, Jean, Christ, Michael, Garcia-Castrillo, Luis, Golea, Adela, Karamercan, Mehmet A., Martin, Paul-Louis, Miró, Òscar, Tolonen, Jukka, van Meer, Oene, Palomäki, Ari, Verschuren, Franck, Harjola, Veli-Pekka, and Laribi, Said

Published
2022
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10. Inhaled Xenon Attenuates Myocardial Damage in Comatose Survivors of Out-of-Hospital Cardiac Arrest The Xe-Hypotheca Trial

Author

Arola, Olli, Saraste, Antti, Laitio, Ruut, Airaksinen, Juhani, Hynninen, Marja, Bäcklund, Minna, Ylikoski, Emmi, Wennervirta, Johanna, Pietilä, Mikko, Roine, Risto O, Harjola, Veli-Pekka, Niiranen, Jussi, Korpi, Kirsi, Varpula, Marjut, Scheinin, Harry, Maze, Mervyn, Vahlberg, Tero, Laitio, Timo, Group, Xe-HYPOTHECA Study, Virtanen, Sami, Parkkola, Riitta, Saunavaara, Jani, Martola, Juha, Silvennoinen, Heli, Tiainen, Marjaana, Grönlund, Juha, Inkinen, Outi, Silvasti, Päivi, Nukarinen, Eija, and Olkkola, Klaus T

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Heart Disease, Clinical Research, Cardiovascular, Heart Disease - Coronary Heart Disease, Administration, Inhalation, Aged, Cardiopulmonary Resuscitation, Coma, Female, Finland, Heart, Hemodynamics, Humans, Hypothermia, Induced, Intensive Care Units, Male, Middle Aged, Myocardium, Out-of-Hospital Cardiac Arrest, Percutaneous Coronary Intervention, Treatment Outcome, Troponin T, Xenon, cardioprotection, hypothermia, out-of-hospital cardiac arrest, xenon, Xe-HYPOTHECA Study Group, Cardiorespiratory Medicine and Haematology, Public Health and Health Services, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Abstract

BACKGROUND:The authors previously reported that inhaled xenon combined with hypothermia attenuates brain white matter injury in comatose survivors of out-of-hospital cardiac arrest (OHCA). OBJECTIVES:A pre-defined secondary objective was to assess the effect of inhaled xenon on myocardial ischemic damage in the same study population. METHODS:A total of 110 comatose patients who had experienced OHCA from a cardiac cause were randomized to receive either inhaled xenon (40% end-tidal concentration) combined with hypothermia (33°C) for 24 h (n = 55; xenon group) or hypothermia treatment alone (n = 55; control group). Troponin-T levels were measured at hospital admission, and at 24 h, 48 h, and 72 h post-cardiac arrest. All available cases were analyzed for troponin-T release. RESULTS:Troponin-T measurements were available from 54 xenon patients and 54 control patients. The baseline characteristics did not differ significantly between the groups. After adjustments for age, sex, study site, primary coronary percutaneous intervention (PCI), and norepinephrine dose, the mean ± SD post-arrival incremental change of the ln-transformed troponin-T at 72 h was 0.79 ± 1.54 in the xenon group and 1.56 ± 1.38 in the control group (adjusted mean difference -0.66; 95% confidence interval: -1.16 to -0.16; p = 0.01). The effect of xenon on the change in the troponin-T values did not differ in patients with or without PCI or in those with a diagnosis of ST-segment elevation myocardial infarction (group by PCI or ST-segment elevation myocardial infarction interaction effect; p = 0.86 and p = 0.71, respectively). CONCLUSIONS:Among comatose survivors of OHCA, in comparison with hypothermia alone, inhaled xenon combined with hypothermia suggested a less severe myocardial injury as demonstrated by the significantly reduced release of troponin-T.

Published
2017

11. Diagnosis and treatment of right ventricular failure secondary to acutely increased right ventricular afterload (acute cor pulmonale). A Clinical Consensus Statement of the Association for Acute CardioVascular Care (ACVC) of the ESC

Author

Arrigo, Mattia, primary, Price, Susanna, additional, Harjola, Veli-Pekka, additional, Huber, Lars C, additional, Schaubroeck, Hannah A I, additional, Vieillard-Baron, Antoine, additional, Masip, Josep, additional, and Mebazaa, Alexandre, additional

Published
2023
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14. Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).

Author

Harjola, Veli-Pekka, Mullens, Wilfried, Banaszewski, Marek, Bauersachs, Johann, Brunner-La Rocca, Hans-Peter, Chioncel, Ovidiu, Collins, Sean, Doehner, Wolfram, Filippatos, Gerasimos, Flammer, Andreas, Fuhrmann, Valentin, Lainscak, Mitja, Lassus, Johan, Legrand, Matthieu, Masip, Josep, Mueller, Christian, Papp, Zoltán, Parissis, John, Platz, Elke, Rudiger, Alain, Ruschitzka, Frank, Schäfer, Andreas, Seferovic, Petar, Skouri, Hadi, Yilmaz, Mehmet, and Mebazaa, Alexandre

Subjects
Heart failure, Multiple organ failure, Venous congestion, Acute Disease, Cardiology, Diagnostic Imaging, Disease Management, Europe, Heart Failure, Humans, Multiple Organ Failure, Societies, Medical
Abstract

Organ injury and impairment are commonly observed in patients with acute heart failure (AHF), and congestion is an essential pathophysiological mechanism of impaired organ function. Congestion is the predominant clinical profile in most patients with AHF; a smaller proportion presents with peripheral hypoperfusion or cardiogenic shock. Hypoperfusion further deteriorates organ function. The injury and dysfunction of target organs (i.e. heart, lungs, kidneys, liver, intestine, brain) in the setting of AHF are associated with increased risk for mortality. Improvement in organ function after decongestive therapies has been associated with a lower risk for post-discharge mortality. Thus, the prevention and correction of organ dysfunction represent a therapeutic target of interest in AHF and should be evaluated in clinical trials. Treatment strategies that specifically prevent, reduce or reverse organ dysfunction remain to be identified and evaluated to determine if such interventions impact mortality, morbidity and patient-centred outcomes. This paper reflects current understanding among experts of the presentation and management of organ impairment in AHF and suggests priorities for future research to advance the field.

Published
2017

18. Effect of Inhaled Xenon on Cerebral White Matter Damage in Comatose Survivors of Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial

Author

Laitio, Ruut, Hynninen, Marja, Arola, Olli, Virtanen, Sami, Parkkola, Riitta, Saunavaara, Jani, Roine, Risto O, Grönlund, Juha, Ylikoski, Emmi, Wennervirta, Johanna, Bäcklund, Minna, Silvasti, Päivi, Nukarinen, Eija, Tiainen, Marjaana, Saraste, Antti, Pietilä, Mikko, Airaksinen, Juhani, Valanne, Leena, Martola, Juha, Silvennoinen, Heli, Scheinin, Harry, Harjola, Veli-Pekka, Niiranen, Jussi, Korpi, Kirsi, Varpula, Marjut, Inkinen, Outi, Olkkola, Klaus T, Maze, Mervyn, Vahlberg, Tero, and Laitio, Timo

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Clinical Trials and Supportive Activities, Neurosciences, Rehabilitation, Clinical Research, Cardiovascular, Biomedical Imaging, Brain Disorders, Good Health and Well Being, Administration, Inhalation, Adult, Aged, Anisotropy, Cardiopulmonary Resuscitation, Coma, Diffusion Magnetic Resonance Imaging, Female, Finland, Humans, Hypothermia, Induced, Male, Middle Aged, Out-of-Hospital Cardiac Arrest, Single-Blind Method, Statistics, Nonparametric, Survival Analysis, Survivors, Time Factors, Treatment Outcome, White Matter, Xenon, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
Abstract

ImportanceEvidence from preclinical models indicates that xenon gas can prevent the development of cerebral damage after acute global hypoxic-ischemic brain injury but, thus far, these putative neuroprotective properties have not been reported in human studies.ObjectiveTo determine the effect of inhaled xenon on ischemic white matter damage assessed with magnetic resonance imaging (MRI).Design, setting, and participantsA randomized single-blind phase 2 clinical drug trial conducted between August 2009 and March 2015 at 2 multipurpose intensive care units in Finland. One hundred ten comatose patients (aged 24-76 years) who had experienced out-of-hospital cardiac arrest were randomized.InterventionsPatients were randomly assigned to receive either inhaled xenon combined with hypothermia (33°C) for 24 hours (n = 55 in the xenon group) or hypothermia treatment alone (n = 55 in the control group).Main outcomes and measuresThe primary end point was cerebral white matter damage as evaluated by fractional anisotropy from diffusion tensor MRI scheduled to be performed between 36 and 52 hours after cardiac arrest. Secondary end points included neurological outcome assessed using the modified Rankin Scale (score 0 [no symptoms] through 6 [death]) and mortality at 6 months.ResultsAmong the 110 randomized patients (mean age, 61.5 years; 80 men [72.7%]), all completed the study. There were MRI data from 97 patients (88.2%) a median of 53 hours (interquartile range [IQR], 47-64 hours) after cardiac arrest. The mean global fractional anisotropy values were 0.433 (SD, 0.028) in the xenon group and 0.419 (SD, 0.033) in the control group. The age-, sex-, and site-adjusted mean global fractional anisotropy value was 3.8% higher (95% CI, 1.1%-6.4%) in the xenon group (adjusted mean difference, 0.016 [95% CI, 0.005-0.027], P = .006). At 6 months, 75 patients (68.2%) were alive. Secondary end points at 6 months did not reveal statistically significant differences between the groups. In ordinal analysis of the modified Rankin Scale, the median (IQR) value was 1 (1-6) in the xenon group and 1 (0-6) in the control group (median difference, 0 [95% CI, 0-0]; P = .68). The 6-month mortality rate was 27.3% (15/55) in the xenon group and 34.5% (19/55) in the control group (adjusted hazard ratio, 0.49 [95% CI, 0.23-1.01]; P = .053).Conclusions and relevanceAmong comatose survivors of out-of-hospital cardiac arrest, inhaled xenon combined with hypothermia compared with hypothermia alone resulted in less white matter damage as measured by fractional anisotropy of diffusion tensor MRI. However, there was no statistically significant difference in neurological outcomes or mortality at 6 months. These preliminary findings require further evaluation in an adequately powered clinical trial designed to assess clinical outcomes associated with inhaled xenon among survivors of out-of-hospital cardiac arrest.Trial registrationclinicaltrials.gov Identifier: NCT00879892.

Published
2016

20. Comparative Analysis of Short-Term Outcomes of Patients With Heart Failure With a Mid-Range Ejection Fraction After Acute Decompensation

Author

Miró, Òscar, Javaloyes, Patricia, Gil, Víctor, Martín-Sánchez, Francisco J., Jacob, Javier, Herrero, Pablo, Marco-Hernández, Javier, Ríos, José, Harjola, Veli-Pekka, Torres-Gárate, Raquel, Alonso, María I., Piñera, Pascual, Mecina, Ana B., Escoda, Rosa, Müller, Christian, Parissis, John, and Llorens, Pere

Published
2019
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21. Acute heart failure and valvular heart disease: A scientific statement of the Heart Failure Association, the Association for Acute CardioVascular Care and the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology

Author

Chioncel, Ovidiu, primary, Adamo, Marianna, additional, Nikolaou, Maria, additional, Parissis, John, additional, Mebazaa, Alexandre, additional, Yilmaz, Mehmet Birhan, additional, Hassager, Christian, additional, Moura, Brenda, additional, Bauersachs, Johann, additional, Harjola, Veli‐Pekka, additional, Antohi, Elena‐Laura, additional, Ben‐Gal, Tuvia, additional, Collins, Sean P., additional, Iliescu, Vlad Anton, additional, Abdelhamid, Magdy, additional, Čelutkienė, Jelena, additional, Adamopoulos, Stamatis, additional, Lund, Lars H., additional, Cicoira, Mariantonietta, additional, Masip, Josep, additional, Skouri, Hadi, additional, Gustafsson, Finn, additional, Rakisheva, Amina, additional, Ahrens, Ingo, additional, Mortara, Andrea, additional, Janowska, Ewa A., additional, Almaghraby, Abdallah, additional, Damman, Kevin, additional, Miro, Oscar, additional, Huber, Kurt, additional, Ristic, Arsen, additional, Hill, Loreena, additional, Mullens, Wilfried, additional, Chieffo, Alaide, additional, Bartunek, Jozef, additional, Paolisso, Pasquale, additional, Bayes‐Genis, Antoni, additional, Anker, Stefan D., additional, Price, Susanna, additional, Filippatos, Gerasimos, additional, Ruschitzka, Frank, additional, Seferovic, Petar, additional, Vidal‐Perez, Rafael, additional, Vahanian, Alec, additional, Metra, Marco, additional, McDonagh, Theresa A., additional, Barbato, Emanuele, additional, Coats, Andrew J.S., additional, and Rosano, Giuseppe M.C., additional

Published
2023
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23. Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction

Author

Mattei, Mathieu, Thivilier, Carine, Perez, Pierre, Auchet, Thomas, Fritz, Caroline, Boisrame-Helme, Julie, Mercier, Emmanuelle, Garot, Denis, Perny, Jessica, Gette, Sebastien, Hammad, Emmanuelle, Vigne, Coralie, Dargent, Auguste, Andreu, Pascal, Guiot, Philippe, Levy, Bruno, Clere-Jehl, Raphael, Legras, Annick, Morichau-Beauchant, Tristan, Leone, Marc, Frederique, Ganster, Quenot, Jean-Pierre, Kimmoun, Antoine, Cariou, Alain, Lassus, Johan, Harjola, Veli-Pekka, Meziani, Ferhat, Louis, Guillaume, Rossignol, Patrick, Duarte, Kevin, Girerd, Nicolas, Mebazaa, Alexandre, and Vignon, Philippe

Published
2018
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24. Levosimendan Efficacy and Safety: 20 years of SIMDAX in Clinical Use

Author

Papp, Zoltán, Agostoni, Piergiuseppe, Alvarez, Julian, Bettex, Dominique, Bouchez, Stefan, Brito, Dulce, Cˇerný, Vladimir, Comin-Colet, Josep, Crespo-Leiro, Marisa G, Delgado, Juan F, Édes, Istvan, Eremenko, Alexander A, Farmakis, Dimitrios, Fedele, Francesco, Fonseca, Cândida, Fruhwald, Sonja, Girardis, Massimo, Guarracino, Fabio, Harjola, Veli-Pekka, Heringlake, Matthias, Herpain, Antoine, Heunks, Leo MA, Husebye, Tryggve, Ivancan, Višnja, Karason, Kristjan, Kaul, Sundeep, Kivikko, Matti, Kubica, Janek, Masip, Josep, Matskeplishvili, Simon, Mebazaa, Alexandre, Nieminen, Markku S, Oliva, Fabrizio, Papp, Julius-Gyula, Parissis, John, Parkhomenko, Alexander, Põder, Pentti, Pölzl, Gerhard, Reinecke, Alexander, Ricksten, Sven-Erik, Riha, Hynek, Rudiger, Alain, Sarapohja, Toni, Schwinger, Robert HG, Toller, Wolfgang, Tritapepe, Luigi, Tschöpe, Carsten, Wikström, Gerhard, von Lewinski, Dirk, Vrtovec, Bojan, and Pollesello, Piero

Published
2020
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25. Short-term outcomes of heart failure patients with reduced and preserved ejection fraction after acute decompensation according to the final destination after emergency department care

Author

Miró, Òscar, Gil, V.íctor, Martín-Sánchez, Francisco Javier, Jacob, Javier, Herrero, Pablo, Alquézar, Aitor, Llauger, Lluís, Aguiló, Sira, Martínez, Gemma, Ríos, José, Domínguez-Rodríguez, Alberto, Harjola, Veli-Pekka, Müller, Christian, Parissis, John, Peacock, W. Frank, Llorens, Pere, and The Research Group on Acute Heart Failure of the Spanish Society of Emergency Medicine (ICA-SEMES Research Group) Researchers

Published
2018
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27. Frequency and Prognostic Significance of Abnormal Liver Function Tests in Patients With Cardiogenic Shock

Author

Koniari, Katerina, Voumvourakis, Astrinos, Karavidas, Apostolos, Sans-Rosello, Jordi, Vila, Montserrat, Duran-Cambra, Albert, Metra, Marco, Bulgari, Michela, Lazzarini, Valentina, Parenica, Jiri, Stipal, Roman, Ludka, Ondrej, Palsuva, Marie, Ganovska, Eva, Kubena, Petr, Lindholm, Matias G., Hassager, Christian, Bäcklund, Tom, Jurkko, Raija, Järvinen, Kristiina, Nieminen, Tuomo, Pulkki, Kari, Soininen, Leena, Sund, Reijo, Tierala, Ilkka, Tolonen, Jukka, Varpula, Marjut, Korva, Tuomas, Pitkälä, Anne, Marino, Rossella, Sousa, Alexandra, Sousa, Carla, Paiva, Mariana, Rangel, Inês, Almeida, Rui, Pinho, Teresa, Maciel, Maria Júlia, Stepinska, Janina, Skrobisz, Anna, Góral, Piotr, Jäntti, Toni, Tarvasmäki, Tuukka, Harjola, Veli-Pekka, Parissis, John, Sionis, Alessandro, Silva-Cardoso, Jose, Køber, Lars, Banaszewski, Marek, Spinar, Jindrich, Fuhrmann, Valentin, Carubelli, Valentina, diSomma, Salvatore, Mebazaa, Alexandre, and Lassus, Johan

Published
2017
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30. Acute Heart Failure

Author

Harjola, Veli-Pekka, Bueno, Héctor, Parissis, John T., Dorobanţu, Maria, editor, Ruschitzka, Frank, editor, and Metra, Marco, editor

Published
2016
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34. Levosimendan beyond inotropy and acute heart failure: Evidence of pleiotropic effects on the heart and other organs: An expert panel position paper

Author

Farmakis, Dimitrios, Alvarez, Julian, Gal, Tuvia Ben, Brito, Dulce, Fedele, Francesco, Fonseca, Candida, Gordon, Anthony C., Gotsman, Israel, Grossini, Elena, Guarracino, Fabio, Harjola, Veli-Pekka, Hellman, Yaron, Heunks, Leo, Ivancan, Visnja, Karavidas, Apostolos, Kivikko, Matti, Lomivorotov, Vladimir, Longrois, Dan, Masip, Josep, Metra, Marco, Morelli, Andrea, Nikolaou, Maria, Papp, Zoltán, Parkhomenko, Alexander, Poelzl, Gerhard, Pollesello, Piero, Ravn, Hanne Berg, Rex, Steffen, Riha, Hynek, Ricksten, Sven-Erik, Schwinger, Robert H.G., Vrtovec, Bojan, Yilmaz, M. Birhan, Zielinska, Marzenna, and Parissis, John

Published
2016
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35. The role of levosimendan in acute heart failure complicating acute coronary syndrome: A review and expert consensus opinion

Author

Nieminen, Markku S., Buerke, Michael, Cohen-Solál, Alain, Costa, Susana, Édes, István, Erlikh, Alexey, Franco, Fatima, Gibson, Charles, Gorjup, Vojka, Guarracino, Fabio, Gustafsson, Finn, Harjola, Veli-Pekka, Husebye, Trygve, Karason, Kristjan, Katsytadze, Igor, Kaul, Sundeep, Kivikko, Matti, Marenzi, Giancarlo, Masip, Josep, Matskeplishvili, Simon, Mebazaa, Alexandre, Møller, Jacob E., Nessler, Jadwiga, Nessler, Bohdan, Ntalianis, Argyrios, Oliva, Fabrizio, Pichler-Cetin, Emel, Põder, Pentti, Recio-Mayoral, Alejandro, Rex, Steffen, Rokyta, Richard, Strasser, Ruth H., Zima, Endre, and Pollesello, Piero

Published
2016
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36. Epidemiology of patients presenting with dyspnea to emergency departments in Europe and the Asia-Pacific region

Author

Laribi, Said, Keijzers, Gerben, van Meer, Oene, Klim, Sharon, Motiejunaite, Justina, Kuan, Win Sen, Body, Richard, Jones, Peter, Karamercan, Mehmet, Craig, Simon, Harjola, Veli-Pekka, Holdgate, Anna, Golea, Adela, Graham, Colin, Verschuren, Franck, Capsec, Jean, Christ, Michael, Grammatico-Guillon, Leslie, Barletta, Cinzia, Garcia-Castrillo, Luis, and Kelly, Anne-Maree

Published
2018
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37. Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients

Author

Léopold, Valentine, Gayat, Etienne, Pirracchio, Romain, Spinar, Jindrich, Parenica, Jiri, Tarvasmäki, Tuukka, Lassus, Johan, Harjola, Veli-Pekka, Champion, Sébastien, Zannad, Faiez, Valente, Serafina, Urban, Philip, Chua, Horng-Ruey, Bellomo, Rinaldo, Popovic, Batric, Ouweneel, Dagmar M., Henriques, José P. S., Simonis, Gregor, Lévy, Bruno, Kimmoun, Antoine, Gaudard, Philippe, Basir, Mir Babar, Markota, Andrej, Adler, Christoph, Reuter, Hannes, Mebazaa, Alexandre, and Chouihed, Tahar

Published
2018
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38. Management of cardiogenic shock complicating myocardial infarction

Author

Mebazaa, Alexandre, Combes, Alain, van Diepen, Sean, Hollinger, Alexa, Katz, Jaon N., Landoni, Giovanni, Hajjar, Ludhmila Abrahao, Lassus, Johan, Lebreton, Guillaume, Montalescot, Gilles, Park, Jin Joo, Price, Susanna, Sionis, Alessandro, Yannopolos, Demetris, Harjola, Veli-Pekka, Levy, Bruno, and Thiele, Holger

Published
2018
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39. Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure: the SEMICA-2 study

Author

Miró, Òscar, Hazlitt, Melissa, Escalada, Xavier, Llorens, Pere, Gil, Víctor, Martín-Sánchez, Francisco Javier, Harjola, Pia, Rico, Verónica, Herrero-Puente, Pablo, Jacob, Javier, Cone, David C., Möckel, Martin, Christ, Michael, Freund, Yonathan, di Somma, Salvatore, Laribi, Said, Mebazaa, Alexandre, Harjola, Veli-Pekka, and On behalf of the ICA-SEMES Research Group

Published
2018
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40. Association between hypo- and hyperkalemia and outcome in acute heart failure patients: the role of medications

Author

Legrand, Matthieu, Ludes, Pierre-Olivier, Massy, Ziad, Rossignol, Patrick, Parenica, Jiri, Park, Jin-Joo, Ishihara, Shiro, AlHabib, Khalid F., Maggioni, Aldo, Miró, Òscar, Sato, Naoki, Cohen-Solal, Alain, Fairman, Enrique, Lassus, Johan, Harjola, Veli-Pekka, Mueller, Christian, Peacock, Franck W., Choi, Dong-Ju, Plaisance, Patrick, Spinar, Jindřich, Kosiborod, Mikhail, Mebazaa, Alexandre, Gayat, Etienne, and GREAT (Global Research on Acute Conditions Team) Network and INI-CRCT (Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists) network

Published
2018
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41. Adrenomedullin: a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock

Author

Tolppanen, Heli, Rivas-Lasarte, Mercedes, Lassus, Johan, Sans-Roselló, Jordi, Hartmann, Oliver, Lindholm, Matias, Arrigo, Mattia, Tarvasmäki, Tuukka, Köber, Lars, Thiele, Holger, Pulkki, Kari, Spinar, Jindrich, Parissis, John, Banaszewski, Marek, Silva-Cardoso, Jose, Carubelli, Valentina, Sionis, Alessandro, Harjola, Veli-Pekka, and Mebazaa, Alexandre

Published
2017
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43. Performance of Early Capillary Refill Time Measurement on Outcomes in Cardiogenic Shock: An Observational, Prospective Multicentric Study

Author

Merdji, Hamid, primary, Curtiaud, Anais, additional, Aheto, Antoine, additional, Studer, Antoine, additional, Harjola, Veli-Pekka, additional, Monnier, Alexandra, additional, Duarte, Kevin, additional, Girerd, Nicolas, additional, Kibler, Marion, additional, Ait-Oufella, Hafid, additional, Helms, Julie, additional, Mebazaa, Alexandre, additional, Levy, Bruno, additional, Kimmoun, Antoine, additional, and Meziani, Ferhat, additional

Published
2022
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46. Acute heart failure and valvular heart disease: A scientific statement of the Heart Failure Association, the Association for Acute CardioVascular Care and the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology

Author

Chioncel, Ovidiu, Adamo, Marianna, Nikolaou, Maria, Parissis, John, Mebazaa, Alexandre, Yilmaz, Mehmet Birhan, Hassager, Christian, Moura, Brenda, Bauersachs, Johann, Harjola, Veli-Pekka, Antohi, Elena-Laura, Ben-Gal, Tuvia, Collins, Sean P, Iliescu, Vlad Anton, Abdelhamid, Magdy, Čelutkienė, Jelena, Adamopoulos, Stamatis, Lund, Lars H, Cicoira, Mariantonietta, Masip, Josep, Skouri, Hadi, Gustafsson, Finn, Rakisheva, Amina, Ahrens, Ingo, Mortara, Andrea, Janowska, Ewa A, Almaghraby, Abdallah, Damman, Kevin, Miro, Oscar, Huber, Kurt, Ristic, Arsen, Hill, Loreena, Mullens, Wilfried, Chieffo, Alaide, Bartunek, Jozef, Paolisso, Pasquale, Bayes-Genis, Antoni, Anker, Stefan D, Price, Susanna, Filippatos, Gerasimos, Ruschitzka, Frank, Seferovic, Petar, Vidal-Perez, Rafael, Vahanian, Alec, Metra, Marco, Mcdonagh, Theresa A, Barbato, Emanuele, Coats, Andrew J S, and Rosano, Giuseppe M C

Subjects
Acute heart failure, Management, Valvular heart disease
Abstract

Acute heart failure (AHF) represents a broad spectrum of disease states, resulting from the interaction between an acute precipitant and a patient's underlying cardiac substrate and comorbidities. Valvular heart disease (VHD) is frequently associated with AHF. AHF may result from several precipitants that add an acute haemodynamic stress superimposed on a chronic valvular lesion or may occur as a consequence of a new significant valvular lesion. Regardless of the mechanism, clinical presentation may vary from acute decompensated heart failure to cardiogenic shock. Assessing the severity of VHD as well as the correlation between VHD severity and symptoms may be difficult in patients with AHF because of the rapid variation in loading conditions, concomitant destabilization of the associated comorbidities and the presence of combined valvular lesions. Evidence-based interventions targeting VHD in settings of AHF have yet to be identified, as patients with severe VHD are often excluded from randomized trials in AHF, so results from these trials do not generalize to those with VHD. Furthermore, there are not rigorously conducted randomized controlled trials in the setting of VHD and AHF, most of the data coming from observational studies. Thus, distinct to chronic settings, current guidelines are very elusive when patients with severe VHD present with AHF, and a clear-cut strategy could not be yet defined. Given the paucity of evidence in this subset of AHF patients, the aim of this scientific statement is to describe the epidemiology, pathophysiology, and overall treatment approach for patients with VHD who present with AHF.

Published
2023

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