Publications by authors named "Richard G Jung"
Background: Cardiogenic shock remains highly associated with early mortality, with mortality often exceeding 50%. We sought to determine the association between prognostic factors and in-hospital and 30-day mortality in cardiogenic shock.
Methods: We performed a systematic review and meta-analysis of prognostic factors in cardiogenic shock, searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for records up to June 5, 2023.
Background: Cardiogenic shock due to acute myocardial infarction (AMI-CS) is associated with significant short- and long-term morbidity and mortality. Despite this, little is known about associated cost.
Objectives: The purpose of this study was to evaluate the health care costs and resource use associated with AMI-CS using administrative data from the province of Ontario, Canada.
Article Synopsis
- Cardiogenic shock often leads to poor outcomes, and there's limited research on how inotropic therapies like milrinone and dobutamine perform, especially in patients with kidney problems.
- The study compared the effectiveness of milrinone versus dobutamine for treating cardiogenic shock while considering renal function, specifically looking at kidney health and injury in patients.
- Results showed that while both treatments had similar outcomes in patients with lower kidney function, milrinone was more beneficial for patients without acute kidney injury, suggesting that AKI influences the effectiveness of these medications.
Article Synopsis
- This study investigates device-related thrombus (DRT) occurrences after left atrial appendage closure (LAAC), focusing on how often it persists or recurs.
- It found that about 29% of DRT cases persist, with being female and having a larger initial thrombus size being significant predictors.
- Unfavorable DRT evolution is linked to a higher rate of thromboembolic events, emphasizing the importance of monitoring thrombus size post-LAAC.
Objectives: Inotropic support is commonly used in patients with cardiogenic shock (CS). High-quality data guiding the use of dobutamine or milrinone among this patient population is limited. We compared the efficacy and safety of these two inotropes among patients with low cardiac output states (LCOS) or CS.
View Article and Find Full Text PDFBackground: Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short-term mortality; however, there are limited data on long-term outcomes and trends.
Objectives: This study sought to examine long-term outcomes of AMI-CS patients.
Methods: This was a population-based, retrospective cohort study in Ontario, Canada of critically ill adult patients with AMI-CS who were admitted to hospitals between April 1, 2009 and March 31, 2019.
Background: Cardiogenic shock (CS) is a state of end-organ hypoperfusion related to cardiac dysfunction. Current guidelines recommend consideration of inotrope therapy in patients with CS, however no robust data support their use. The purpose of the CAPITAL DOREMI2 trial is to examine the efficacy and safety of inotrope therapy against placebo in the initial resuscitation of patients with CS.
View Article and Find Full Text PDFAssociation Between the Access Site for Coronary Angiography and Catheter-induced Coronary Artery Dissection.
J Soc Cardiovasc Angiogr Interv
March 2023
Background: Catheter-induced coronary artery dissection (CICAD) is a rare complication of coronary angiography. The association between access site and CICAD remains unclear; however, transradial access (TRA) may be associated with a higher incidence of CICAD due to access vessel tortuosity and the mechanical disadvantage of catheters designed for the transfemoral access (TFA) approach.
Methods: In this retrospective study, the reports of consecutive left heart catheterizations between April 2007, and December 2021 were reviewed for CICAD.
Patients with established coronary artery disease remain at elevated risk of major adverse cardiac events. The goal of this study was to evaluate the utility of plasminogen activator inhibitor-1-positive platelet-derived extracellular vesicles as a biomarker for major adverse cardiac events and to explore potential underlying mechanisms. Our study suggests these extracellular vesicles as a potential biomarker to identify and a therapeutic target to ameliorate neointimal formation of high-risk patients.
View Article and Find Full Text PDFImpact of intracoronary assessments on revascularization decisions: A contemporary evaluation.
Catheter Cardiovasc Interv
November 2022
Article Synopsis
- The study aimed to assess the practical use of intracoronary assessment (ICA) techniques and their effect on the treatment decisions for coronary artery disease (CAD).
- Although traditional coronary angiograms are commonly used for diagnosing vessel narrowing, ICA provides improved three-dimensional imaging and physiological insights, potentially leading to better patient outcomes.
- Results from 1,135 patients indicated that ICA influenced clinical decisions in a significant portion of cases, often resulting in fewer surgical interventions without increasing the risk of major adverse cardiac events in the following year.
Objective: Atrial fibrillation (AF) remains a highly prevalent arrhythmia with significant burden on morbidity and mortality. The impact of AF in the revascularised population remains incompletely described. Given the high prevalence of AF in the revascularised population, we sought to evaluate the incidence and prognosis in patients with pre-existing and new-onset AF following revascularisation.
View Article and Find Full Text PDFArticle Synopsis
- Inotropic support is commonly used for patients with cardiogenic shock (CS), but existing data on arrhythmic events in these patients is potentially biased.
- The DOREMI trial compared the effects of dobutamine and milrinone on patients, assessing the incidence and impact of arrhythmias on in-hospital outcomes.
- Nearly half of the patients experienced arrhythmic events, with ventricular arrhythmias linked to higher mortality, while several patient characteristics could help identify those at greater risk for such complications.
Article Synopsis
- - The study explored the effectiveness of transcatheter edge-to-edge repair (TEER) for patients with significant mitral regurgitation (MR) who are also experiencing cardiogenic shock (CS), analyzing data from almost 3,800 patients over eight years.
- - It found that a successful TEER procedure, defined by notable reductions in MR, was achieved in 85.6% of patients, leading to better health outcomes, including significantly lower rates of mortality and heart failure hospitalizations one year post-procedure.
- - The authors concluded that while TEER can be effectively applied in CS patients, further randomized trials are necessary to fully validate its benefits as a treatment option.
Article Synopsis
- Functional mitral regurgitation (MR) is critical in heart failure patients, and the CAPITAL MINOS trial investigates the impact of transcatheter edge-to-edge repair (TEER) on patients with cardiogenic shock (CS) and MR since this area hasn't been randomized before.!* -
- The study involves 144 patients with advanced CS and significant MR, comparing TEER against standard medical therapy to see which provides better clinical outcomes, including survival and quality of care during hospitalization.!* -
- Findings from the CAPITAL MINOS trial will help clarify the effectiveness of TEER in this high-risk group, potentially leading to improved treatment strategies for patients experiencing both CS and MR.!*
Purpose Of Review: Cardiogenic shock with significant mitral regurgitation portends a poor prognosis with limited therapeutic options. Herein, we review the available evidence regarding the patient characteristics, management, impact of transcatheter edge-to-edge repair (TEER) on hemodynamics, and clinical outcomes of patients with cardiogenic shock and mitral regurgitation.
Recent Findings: Several observational studies and systematic reviews have demonstrated the feasibility and safety of TEER in cardiogenic shock complicated by degenerative or functional mitral regurgitation.
Article Synopsis
- Cardiogenic shock (CS) is a serious condition linked to high rates of complications and death, and the DOREMI trial looked at how sex might affect outcomes in CS patients.
- In a detailed analysis of 192 participants, researchers found that female patients had similar rates of severe outcomes as male patients, including death and need for mechanical support.
- Ultimately, no significant differences were seen in the clinical outcomes between males and females in the study, regardless of the type of treatment (dobutamine or milrinone) used.
Article Synopsis
- Patients who experience return of spontaneous circulation (ROSC) after an out-of-hospital cardiac arrest (OHCA) may require sedation for care, prompting a study on the use of volatile anesthetics versus conventional sedatives.
- In a systematic review of 1,973 citations, three studies with 604 patients were included, showing uncertain effects of volatile agents on delirium, survival to discharge, and ICU length of stay, with some indications of shorter mechanical ventilation duration.
- The conclusion suggested that while volatile anesthetics might lead to shorter ventilation times, the evidence is low quality, indicating a need for more research in this area.
Background: Patients with cardiogenic shock (CS) suffer high rates of in-hospital mortality, with little evidence guiding management. The impact of valvular heart disease in patients with CS remains unclear. We therefore conducted a post hoc analysis of the randomized Dobutamine Compared to Milrinone (DOREMI) trial to determine the impact of valvular disease on outcomes in patients with CS.
View Article and Find Full Text PDFArticle Synopsis
- Recent studies highlight the benefit of early mechanical circulatory support in cardiogenic shock but lack clear real-time therapeutic targets based on clinical data.
- A post hoc analysis of the DOREMI trial found that lactate clearance can effectively predict in-hospital survival, with complete lactate clearance showing strong association with patient outcomes.
- These findings support using lactate clearance as a viable treatment target for improving mortality rates in future cardiogenic shock treatments.
Objective: We sought to evaluate the association between the institutional volume of catheter-directed thrombolysis (CDT) for pulmonary embolism and in-hospital mortality.
Background: CDT is an increasingly utilized therapy in patients with intermediate/high-risk PE. However, data on the relationship between hospital volume and clinical outcomes remain limited.
A 54-year-old man presented in profound obstructive shock. Investigations revealed a right atrial mass causing severe right ventricular inflow obstruction and compromised cardiac output. The patient was treated with emergency balloon catheter intervention to relieve the obstruction, with resulting hemodynamic stability.
View Article and Find Full Text PDF