BACKGROUND:Cardiogenic shock (CS) often complicates out-of-hospital cardiac arrest (OHCA), contributing to high mortality despite therapeutic advances. METHODS:This study retrospectively analysed patients admitted to a tertiary centre between 2021-2024. The cohort of patients with CS was divided into two groups: OHCA with return of spontaneous circulation and non-OHCA. RESULTS:The study included 280 patients with a median age of 69 (60-76) years, of whom 197 (70%) males. There were 46 (16%) patients in the OHCA group and 234 (84%) in non-OHCA. Acute coronary syndrome (ACS) was a more frequent cause of CS in the OHCA group: 36 (78%) vs. 113 (48%), p < 0.01. The OHCA patients were less likely to have hypertension (41% vs. 63%, p < 0.01), chronic heart failure (CHF) (41% vs. 62%, p < 0.01), and a history of percutaneous coronary intervention (11% vs. 29%, p < 0.01). The OHCA patients exhibited lower C-reactive protein) levels and higher levels of white blood cells. Despite distinct profiles, there was no significant difference in mortality between the study groups. CONCLUSIONS:Patients with OHCA and non-OHCA CS exhibited distinct clinical profiles, with ACS as the leading cause of OHCA and chronic conditions were more often diagnosed in non-OHCA cases. Similar mortality rates suggest improved OHCA management, emphasizing the need for extensive data collection to assess shock risk.

Heart transplantation (HTx) remains the main long-term treatment for end-stage heart failure. Due to the high risk of acute cellular rejection (ACR), HTx recipients undergo multiple endomyocardial biopsies to monitor graft tolerance. This prospective, single-center study evaluated quantitative magnetic resonance imaging (MRI), particularly T1- and T2-mapping, as noninvasive tools for rejection monitoring. The study included 17 adult HTx recipients (men, 88

Background/Objectives: Impella 5.5 provides a higher flow rate than smaller microaxial pumps and has been increasingly adopted for cardiogenic shock (CS). This study aimed to evaluate whether its introduction into our Shock Team program in 2023 improved outcomes compared with a historical cohort supported with other mechanical circulatory support (MCS) devices. Methods: We retrospectively analyzed patients with CS treated with MCS between 2020 and 2024 at a tertiary center. The Impella 5.5 group (n = 17) included patients managed after device implementation, either as stand-alone or sequential therapy. The historical cohort comprised 40 patients treated with ECMO, Impella CP, CentriMag, or IABP prior to 2023. Propensity score matching (age, sex, etiology, lactate, SCAI stage) generated 17 matched pairs. The primary outcome was survival at discharge, 30 days, 3 months, and 6 months. Secondary outcomes included bridging to recovery, heart transplantation (HTx), durable LVAD, and major complications. Results: Impella 5.5 was associated with higher survival at discharge (94.1% vs. 58.8%, p = 0.039), 30 days (94.1% vs. 58.8%, p = 0.039), and 3 months (94.1% vs. 58.8%, p = 0.039). At 6 months, survival remained higher (88.2% vs. 58.8%) but did not reach statistical significance in point analysis (p = 0.118). Bridging occurred more frequently with Impella 5.5 (HTx 64.7% vs. 52.9% (p = 0.464), recovery 17.6% vs. 5.9% (p = 0.292)), while LVAD implantation rates were similar (11.8% vs. 17.6%, p = 1.0). Major bleeding (17.6% vs. 47.1%, p = 0.141), stroke/TIA (5.9% vs. 17.6%, p = 0.601), and the need for renal replacement therapy (5.9% vs. 23.5%, p = 0.335) were numerically lower with Impella 5.5. Conclusions: In this single-center, retrospective analysis, the introduction of Impella 5.5 was associated with higher short-term survival and favorable bridging metrics; estimates are imprecise due to small, heterogeneous samples. These hypothesis-generating findings warrant confirmation in larger, prospective multicenter cohorts

BACKGROUND Coronary vasculopathy is one of the most serious late complications after heart transplantation (Htx). The aim of this study was to assess the utility and safety of the invasive assessment of coronary physiology and investigate the occurrence of coronary microvascular dysfunction (CMD) and its association with clinical characteristics of recipients and donors. MATERIAL AND METHODS Coronary microcirculation was assessed during routine coronary angiography, performed prospectively between December 1, 2020, and July 24, 2023, by using index of microcirculatory resistance (IMR) and coronary flow reserve (CFR). Values of IMR ³25 or CFR <2.0 confirmed CMD. RESULTS Thirty-three patients aged 49±14 years were included; 21 (64%) were men. CMD was found in 8 (24%) patients. There were no complications, and examination was performed in all patients. The median values for IMR and CFR were 13 [IQR: 10-20] and 3.6 [IQR: 2.2-4.9], respectively. CMD was more common in younger patients: 40±16 vs 51±13 years (P=0.045), and those with lower BMI: 22±4 vs 26±4 kg/m² (P=0.016). Patients with CMD were more likely to require pacemaker implantation, with 3 (38%) vs 1 (4%) in the post-transplant period (P=0.012). The median time since Htx was 2 [IQR: 2-10] years and was higher in the CMD group: 9.5 [IQR: 6-16] vs 2 [IQR: 1-8] years, (P=0.042). There were no significant differences in other recipient and donor characteristics. CONCLUSIONS Invasive assessment of coronary physiology was safe and effective and diagnosed CMD in nearly one-fourth of heart transplant recipients. CMD is related to age, time since transplantation, and chronotropic graft dysfunction.

Background/Objectives: Patients with advanced heart failure (HF) often suffer from impaired kidney function. Based on the pathophysiology of types I and II of cardiorenal syndrome, heart transplantation (Htx) may restore renal function. The aim of this study was to identify predictors of improvement in kidney function after HTx. Methods: Htx patients from a tertiary hospital were retrospectively divided into three groups—improvement (n = 24), deterioration (n = 31) and no significant change in eGFR (n = 45)—based on changes in their mean estimated glomerular filtration rate (eGFR) within the first three postoperative months, compared to the last three preoperative months. The threshold for eGFR improvement was defined as a ≥20% increase, while deterioration was defined as a ≥20% decrease. The no significant change group was defined as any change falling between these two values. Results: The median age of analyzed cohort was 54 (45–63) years, and 82% were male. Preoperatively, the improvement group was more frequently treated with inotropes or vasopressors and had significantly higher blood urea and total bilirubin levels before Htx. In the multivariate analysis, total bilirubin before Htx (OR 1.66; 95% CI; 1.24–2.69; p = 0.002) and no need for RRT early after Htx (OR 0.46; 95% CI 0.24–0.88; p = 0.02) were independent predictors of improved kidney function in the first three months after HTx. Conclusions: The improvement in renal function after HTx is uncommon. It could be expected in patients suffering from more severe forms of HF, with impaired kidney and liver function but who did not need RRT after the surgery.

Background: Multi-organ failure (MOF) is a common complication of advanced heart failure (HF), significantly influencing patient prognosis. This study aimed to assess and compare the impact of orthotopic heart transplantation (HTx) and left ventricular assist device (LVAD) implantation on the severity of MOF, as measured by the model for end-stage liver disease excluding INR (MELD-XI) score. Methods: Data from 1 month before to 1 year after HTx or LVAD implantation were analysed. The MELD-XI score was calculated using average bilirubin and creatinine values. Comparative assessments of MELD-XI scores were performed within the HTx and LVAD groups at various time points pre- and post-procedure. Results: The analysis included 107 HTx patients and 30 LVAD patients. The median MELD-XI score 1 month pre-procedure was 11.7 (9.4-16.7) in all patients. There were no significant differences in MELD-XI scores between the groups at 3-, 6-, and 12-month follow-ups. However, a significant difference was observed 1 month post-procedure [HTx: 14.8 (9.4-17.7) vs. LVAD: 11.2 (7.3-14.9), p = 0.02]. In the LVAD group, a significant decrease in MELD-XI score was noted for 3 months post-procedure compared to 1 month pre-procedure (p < 0.001), whereas at 6- and 12-month follow-ups the score did not differ from pre-procedural scores. In the HTx group, significant decreases in MELD-XI scores were observed from 3 months, 6 months, and 1 year post-procedure compared to 1 month pre-procedure (p < 0.002). Conclusions: The MELD-XI scale reveals different MOF trajectories between HTx and LVAD recipients. Both interventions lead to early improvements in liver and kidney function, with sustained benefits in HTx patients, highlighting the distinct impacts on organ function.

Background: The prevalence of cardiogenic shock (CS) resulting from the progression of heart failure (PHF) is increasing and remains associated with high mortality. This study aimed to compare the clinical characteristics and outcomes of patients who developed CS due to PHF versus those whose CS was caused by other aetiologies (non-PHF). Methods: We retrospectively analysed 280 patients admitted to a Polish tertiary care centre between January 2021 and April 2024. The cohort was divided into two groups: PHF (n = 84, 30%) and non-PHF (n = 196, 70%). Results: Compared to the non-PHF group, PHF patients more frequently had chronic kidney disease (30% vs. 15%, p < 0.01), and significant valvular disease (30% vs. 13%, p < 0.01). PHF patients exhibited significantly lower white blood cell counts (9.4 [6.9–16.4] vs. 13.3 [10.4–17.6], p < 0.01) and troponin T levels (188 [61–1392] vs. 10,921 [809–45,792], p < 0.01). In-hospital mortality was significantly lower among PHF patients (52% vs. 65%, p = 0.04). Although the overall use of mechanical circulatory support (MCS) did not differ between groups, significant differences in the types of MCS applied were observed (p < 0.01). Additionally, PHF patients underwent fewer coronary revascularisation procedures (15% vs. 70%, p < 0.01). Conclusions: Patients with PHF-related CS exhibit distinct clinical profiles and may experience lower in-hospital mortality when appropriately diagnosed and treated with a personalised approach. Further prospective, multicentre studies are warranted to optimize the management of this growing subgroup of CS patients.

BACKGROUND:Cardiogenic shock (CS) remains a complex syndrome with alarmingly high mortality despite treatment advances. AIMS:This study aimed to describe the experience of the management of patients with CS according to a standardized multidisciplinary team-based protocols. MATERIAL AND METHODS:This is a retrospective analysis of patients with a diagnosis of CS admitted to a large academic tertiary hospital between 2021 and 2023. Patients were managed according to the CS protocols developed at our institution by a dedicated multidisciplinary shock team. We report patients' clinical characteristics, mechanical circulatory support (MCS) utilization, and in-hospital outcomes. RESULTS:Over the three-year period, we identified 257 patients (median age: 69 years, 69% males). In this cohort, acute coronary syndrome was the most common cause of CS (55% of patients), 17% presented with out-of-hospital cardiac arrest, 18% experienced in-hospital cardiac arrest, and 20% of patients were transferred from remote centers. An MCS system was used in 39% of all patients. In-hospital mortality was 62% with significant improvement in consecutive 1-year periods: 75% in 2021 vs. 69% in 2022 vs. 44% in 2023, respectively, P = 0.004 for trend. This improvement was particularly evident in the group supported with MCS: all-cause mortality: 75% in 2021, 50% in 2022, and 29% in 2023 (P = 0.005). The use of MCS was a significant independent predictor of improved survival in 2022 and 2023 (odds ratio, 0.38; confidence interval, 0.149-0.996; P = 0.04). CONCLUSIONS:Our results suggest that a standardized multidisciplinary approach incorporating the availability of MCS therapies and heart transplantation may be associated with improved outcomes in patients with CS.