Publications by authors named "Thomas S Metkus"
The recommendation to employ a heart team to guide revascularization has persisted for over a decade. Despite evidence for improved adherence to guidelines, widespread adoption of the heart team approach has been limited. This review delves into the history of the guidelines endorsing the use of a heart team and the supporting data.
View Article and Find Full Text PDFFACTT-checking pulmonary vascular physiology in the acute respiratory distress syndrome.
Eur Heart J Acute Cardiovasc Care
December 2024
Article Synopsis
- * They focused on adult education fundamentals, necessary training for high-quality patient care, and emphasized diversity, equity, and inclusion.
- * The resulting paper serves as a guide for trainees, providing insights on the current state of critical care cardiology and outlining future directions for the field’s growth.
Article Synopsis
- The post-COVID-19 condition has emerged as a significant clinical issue during the pandemic, characterized by ongoing symptoms affecting multiple body systems after recovering from COVID-19.
- Cardiovascular complications are particularly noteworthy, including issues like heart damage, arrhythmias, and blood vessel problems.
- This review aims to consolidate existing knowledge and highlight research gaps regarding the cardiovascular impacts of the post-COVID-19 condition to improve patient care and understanding.
Arterial hyperoxia and mortality in the cardiac intensive care unit.
Curr Probl Cardiol
October 2024
Article Synopsis
- Arterial hyperoxia (high levels of oxygen in the blood) is linked to worse outcomes in critically ill patients, but its effects in cardiac intensive care units (CICUs) have not been previously studied.
- A study of over 3,300 patients showed a J-shaped relationship between oxygen levels at admission and in-hospital mortality, with a significant increase in risk for those with PaO2 levels over 300 mmHg.
- The findings suggest that higher oxygen levels upon admission to the CICU are associated with increased mortality, particularly for patients with severely elevated PaO2 levels.
Article Synopsis
- A study was conducted to assess the clinical characteristics and outcomes of patients in a cardiac intensive care unit (CICU) who were referred for cardiac surgery from 2017 to 2020 across 29 medical centers.
- Out of 10,321 CICU admissions, 887 patients (8.6%) underwent various types of cardiac surgery, with common admission issues including shock and respiratory insufficiency.
- The overall in-hospital mortality rate for these CICU patients was 11.7%, but those who had surgery had a lower rate of 9.1%, suggesting that clinicians effectively managed higher acuity patients with acceptable risks during surgery.
Article Synopsis
- The study investigates the varying use of pulmonary artery catheters (PACs) in cardiac intensive care units (CICUs) and their impact on patient outcomes, particularly in terms of in-hospital mortality among critically ill cardiac patients.
- Data was collected from a multicenter network involving over 13,000 CICU admissions between 2017 and 2021, focusing on factors like patient diagnosis, demographic information, and PAC usage.
- The findings revealed significant variation in PAC usage between different centers, with its use linked to lower mortality rates in shock patients, highlighting the need for more randomized trials to establish best practices for PAC application in cardiac care.
Background: Transcatheter aortic valve replacement (TAVR) is an increasingly used but relatively expensive procedure with substantial associated readmission rates. It is unknown how cost-constrictive payment reform measures, such as Maryland's All Payer Model, impact TAVR utilization given its relative expense. This study investigated the impact of Maryland's All Payer Model on TAVR utilization and readmissions among Maryland Medicare beneficiaries.
View Article and Find Full Text PDFCritical Care Cardiology Trials Network (CCCTN): a cohort profile.
Eur Heart J Qual Care Clin Outcomes
October 2022
Aims: The aims of the Critical Care Cardiology Trials Network (CCCTN) are to develop a registry to investigate the epidemiology of cardiac critical illness and to establish a multicentre research network to conduct randomised clinical trials (RCTs) in patients with cardiac critical illness.
Methods And Results: The CCCTN was founded in 2017 with 16 centres and has grown to a research network of over 40 academic and clinical centres in the United States and Canada. Each centre enters data for consecutive cardiac intensive care unit (CICU) admissions for at least 2 months of each calendar year.
Background: The ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) is a validated index of right ventricular-pulmonary arterial (RV-PA) coupling with prognostic value. We determined the predictive value of TAPSE/PASP ratio and adverse clinical outcomes in hospitalized patients with COVID-19.
Methods: Two hundred and twenty-nine consecutive hospitalized racially/ethnically diverse adults (≥18 years of age) admitted with COVID-19 between March and June 2020 with clinically indicated transthoracic echocardiograms (TTE) that included adequate tricuspid regurgitation (TR) velocities for calculation of PASP were studied.
(1) Importance: Abnormal left ventricular (LV) diastolic function, with or without a diagnosis of heart failure, is a common finding that can be easily diagnosed by intra-operative transesophageal echocardiography (TEE). The association of diastolic function with duration of hospital stay after coronary artery bypass (CAB) is unknown. (2) Objective: To determine if selected TEE parameters of diastolic dysfunction are associated with length of hospital stay after coronary artery bypass surgery (CAB).
View Article and Find Full Text PDFBackground: The relationship between inflammation and corrected QT (QTc) interval prolongation is currently not well defined in patients with COVID-19.
Objective: This study aimed to assess the effect of marked interval changes in the inflammatory marker C-reactive protein (CRP) on QTc interval in patients hospitalized with COVID-19.
Methods: In this retrospective cohort study of hospitalized adult patients admitted with COVID-19 infection, we identified 85 patients who had markedly elevated CRP levels and serial measurements of an ECG and CRP during the same admission.
Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a serine protease that is a mediator of the immune response to sepsis. PCSK9 is also highly expressed in pneumocytes and pulmonary endothelial cells. We hypothesized that serum PCSK9 levels would be associated with death and ICU outcomes in patients with ARDS.
View Article and Find Full Text PDFBackground: A need exists for systematic evaluation of the differences in baseline characteristics and early outcomes between patients enrolled in randomized controlled trials (RCTs) and clinical practice for coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
Methods: Systematic searches were conducted to identify RCTs comparing CABG vs PCI and CABG or PCI registries. Sixteen predefined baseline characteristics and 30-day mortality were extracted from the included studies.
Background: Patients presenting with acute coronary syndrome are administered a P2Y 12 inhibitor and aspirin before coronary catheterization to prevent further myocardial injury from thrombosis. Guidelines recommend a standard waiting period between the time patients are administered dual antiplatelet therapy (DAPT) and elective cardiac surgery. Since 25% to 30% of the population may be considered nonresponders to clopidogrel, platelet function testing can be utilized for timing of surgery and to assess bleeding risks.
View Article and Find Full Text PDFArticle Synopsis
- The 2021 ACC/AHA/SCAI guidelines emphasize the role of a multidisciplinary heart team in improving patient care through collaborative, evidence-based decision-making for coronary revascularization.
- Two case studies are presented to illustrate the decision-making process of the heart team in managing complex patients with coronary artery disease.
- The focus is on patient-centered approaches that consider individual circumstances while leveraging expert insights from various specialists.
Aim: The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideline. In the full guideline, the recommendations replace the 2011 coronary artery bypass graft surgery guideline and the 2011 and 2015 percutaneous coronary intervention guidelines. This summary offers a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization, as well as the supporting documentation to encourage their use.
View Article and Find Full Text PDFAim: The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use.
Methods: A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered.