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4. Health-related quality of life in older patients surviving ICU treatment for COVID-19: results from an international observational study of patients older than 70 years

Author

Soliman, Ivo, Leaver, Susannah, Flaatten, Hans, Fjølner, Jesper, Wernly, Bernhard, Bruno, Raphael, Artigas, Antonio, Bollen Pinto, Bernardo, Schefold, Joerg, Beil, Michael, Sviri, Sigal, van Heerden, Peter Vernon, Szczeklik, Wojciech, Elhadi, Muhammed, Joannidis, Michael, Oeyen, Sandra, Zafeiridis, Tilemachos, Wollborn, Jakob, Banzo, Maria Jose Arche, Fuest, Kristina, Marsh, Brian, Andersen, Finn, Moreno, Rui, Boumendil, Ariane, Guidet, Bertrand, Jung, Christian, de Lange, Dylan, Eller, Philipp, Mesotten, Dieter, Reper, Pascal, Swinnen, Walter, Brix, Helene, Brushoej, Jens, Villefrance, Maja, Nedergaard, Helene Korvenius, Bjerregaard, Anders Thais, Balleby, Ida Riise, Andersen, Kasper, Hansen, Maria Aagaard, Uhrenholt, Stine, Bundgaard, Helle, Mohamed, Aliae Ar Hussein, Salah, Rehab, Ali, Yasmin Khairy Nasreldin Mohamed, Wassim, Kyrillos, Elgazzar, Yumna, Tharwat, Samar, Azzam, Ahmed, Habib, Ayman Abdelmawgoad, Abosheaishaa, Hazem Maarouf, Azab, Mohammed, Galbois, Arnaud, Charron, Cyril, Guerot, Emmanuel, Besch, Guillaume, Rigaud, Jean-Philippe, Maizel, Julien, Djibré, Michel, Burtin, Philippe, Garcon, Pierre, Nseir, Saad, Valette, Xavier, Alexandru, Nica, Marin, Nathalie, Vaissiere, Marie, Plantefeve, Gaëtan, Vanderlinden, Thierry, Jurcisin, Igor, Megarbane, Bruno, Caillard, Anais, Valent, Arnaud, Garnier, Marc, Besset, Sebastien, Oziel, Johanna, Raphaelen, Jean-Herlé, Dauger, Stéphane, Dumas, Guillaume, Goncalves, Bruno, Piton, Gaël, Bruno, Raphael Romano, Kelm, Malte, Wolff, Georg, Barth, Eberhard, Goebel, Ulrich, Kunstein, Anselm, Schuster, Michael, Welte, Martin, Lutz, Matthias, Meybohm, Patrick, Steiner, Stephan, Poerner, Tudor, Haake, Hendrik, Schaller, Stefan, Kindgen-Milles, Detlef, Meyer, Christian, Kurt, Muhammed, Kuhn, Karl Friedrich, Randerath, Winfried, Dindane, Zouhir, Kabitz, Hans-Joachim, Voigt, Ingo, Shala, Gonxhe, Faltlhauser, Andreas, Rovina, Nikoletta, Aidoni, Zoi, Chrisanthopoulou, Evangelia, Papadogoulas, Antonios, Gurjar, Mohan, Mahmoodpoor, Ata, Ahmed, Abdullah Khudhur, Elsaka, Ahmed, Comellini, Vittoria, Rabha, Ahmed, Ahmed, Hazem, Namendys-Silva, Silvio, Ghannam, Abdelilah, Groenendijk, Martijn, Zegers, Marieke, Cornet, Alex, Evers, Mirjam, Haas, Lenneke, Dormans, Tom, Dieperink, Willem, Romundstad, Luis, Sjøbø, Britt, Strietzel, Hans Frank, Olasveengen, Theresa, Hahn, Michael, Czuczwar, Miroslaw, Gawda, Ryszard, Klimkiewicz, Jakub, de Lurdessantos, Maria Campos, Gordinho, André, Santos, Henrique, Assis, Rui, Oliveira, Ana Isabel Pinho, Badawy, Mohamed Raafat, Perez-Torres, David, Gomà, Gemma, Villamayor, Mercedes Ibarz, Mira, Angela Prado, Cubero, Patricia Jimeno, Rivera, Susana Arias, Tomasa, Teresa, Iglesias, David, Vázquez, Eric Mayor, Aldecoa, Cesar, Ferreira, Aida Fernández, Zalba-Etayo, Begoña, Canas-Perez, Isabel, Tamayo-Lomas, Luis, Diaz-Rodriguez, Cristina, Sancho, Susana, Priego, Jesús, Abualqumboz, Enas, Hilles, Momin Majed Yousuf, Saleh, Mahmoud, Ben-Hamouda, Nawfel, Roberti, Andrea, Dullenkopf, Alexander, Fleury, Yvan, Pinto, Bernardo Bollen, Al-Sadawi, Mohammed, Serck, Nicolas, Dewaele, Elisabeth, Kumar, Pritpal, Bundesen, Camilla, Innes, Richard, Gooch, James, Cagova, Lenka, Potter, Elizabeth, Reay, Michael, Davey, Miriam, Humphreys, Sally, Berlemont, Caroline Hauw, Chousterman, Benjamin Glenn, Dépret, François, Ferre, Alexis, Vettoretti, Lucie, Thevenin, Didier, Milovanovic, Milena, Simon, Philipp, Lorenz, Marco, Stoll, Sandra Emily, Dubler, Simon, Mulita, Francesk, Kondili, Eumorifa, Andrianopoulos, Ioannis, Meynaar, Iwan, Cornet, Alexander Daniel, Sjøbøe, Britt, Kluzik, Anna, Zatorski, Paweł, Drygalski, Tomasz, Solek-Pastuszka, Joanna, Onichimowski, Dariusz, Stefaniak, Jan, Stefanska-Wronka, Karina, Zabul, Ewa, Cardoso, Filipe Sousa, Banzo, Maria José Arche, Tomasa-Irriguible, Teresa Maria, Mira, Ángela Prado, Arias-Rivera, Susana, Frutos-Vivar, Fernando, Lopez-Cuenca, Sonia, de Gopegui, Pablo Ruiz, Abidi, Nour, Chau, Ivan, Pugh, Richard, Smuts, Sara, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Bouchard, Mélanie, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), COVIP-study group, Eller, P., Joannidis, M., Mesotten, D., Reper, P., Oeyen, S., Swinnen, W., Brix, H., Brushoej, J., Villefrance, M., Nedergaard, H.K., Bjerregaard, A.T., Balleby, I.R., Andersen, K., Hansen, M.A., Uhrenholt, S., Bundgaard, H., Fjølner, J., Mohamed, AAH, Salah, R., Ali, YKNM, Wassim, K., Elgazzar, Y.A., Tharwat, S., Azzam, A.Y., Habib, A.A., Abosheaishaa, H.M., Azab, M.A., Leaver, S., Galbois, A., Guidet, B., Charron, C., Guerot, E., Besch, G., Rigaud, J.P., Maizel, J., Djibré, M., Burtin, P., Garcon, P., Nseir, S., Valette, X., Alexandru, N., Marin, N., Vaissiere, M., Plantefeve, G., Vanderlinden, T., Jurcisin, I., Megarbane, B., Caillard, A., Valent, A., Garnier, M., Besset, S., Oziel, J., Raphaelen, J.H., Dauger, S., Dumas, G., Goncalves, B., Piton, G., Jung, C., Bruno, R.R., Kelm, M., Wolff, G., Barth, E., Goebel, U., Kunstein, A., Schuster, M., Welte, M., Lutz, M., Meybohm, P., Steiner, S., Poerner, T., Haake, H., Schaller, S., Kindgen-Milles, D., Meyer, C., Kurt, M., Kuhn, K.F., Randerath, W., Wollborn, J., Dindane, Z., Kabitz, H.J., Voigt, I., Shala, G., Faltlhauser, A., Rovina, N., Aidoni, Z., Chrisanthopoulou, E., Papadogoulas, A., Gurjar, M., Mahmoodpoor, A., Ahmed, A.K., Marsh, B., Elsaka, A., Sviri, S., Comellini, V., Rabha, A., Ahmed, H., Namendys-Silva, S.A., Ghannam, A., Groenendijk, M., Zegers, M., de Lange, D., Cornet, A., Evers, M., Haas, L., Dormans, T., Dieperink, W., Romundstad, L., Sjøbø, B., Andersen, F.H., Strietzel, H.F., Olasveengen, T., Hahn, M., Czuczwar, M., Gawda, R., Klimkiewicz, J., de LurdesSantos, M.C., Gordinho, A., Santos, H., Assis, R., Oliveira, AIP, Badawy, M.R., Perez-Torres, D., Gomà, G., Villamayor, M.I., Mira, A.P., Cubero, P.J., Rivera, S.A., Tomasa, T., Iglesias, D., Vázquez, E.M., Aldecoa, C., Ferreira, A.F., Zalba-Etayo, B., Canas-Perez, I., Tamayo-Lomas, L., Diaz-Rodriguez, C., Sancho, S., Priego, J., Abualqumboz, EMY, Hilles, MMY, Saleh, M., Ben-HAmouda, N., Roberti, A., Dullenkopf, A., Fleury, Y., Pinto, B.B., Schefold, J.C., Al-Sadawi, M., Serck, N., Dewaele, E., Kumar, P., Bundesen, C., Innes, R., Gooch, J., Cagova, L., Potter, E., Reay, M., Davey, M., Humphreys, S., Berlemont, C.H., Chousterman, B.G., Dépret, F., Ferre, A., Vettoretti, L., Thevenin, D., Milovanovic, M., Simon, P., Lorenz, M., Stoll, S.E., Dubler, S., Fuest, K., Mulita, F., Kondili, E., Andrianopoulos, I., Meynaar, I., Cornet, A.D., Sjøbøe, B., Kluzik, A., Zatorski, P., Drygalski, T., Szczeklik, W., Solek-Pastuszka, J., Onichimowski, D., Stefaniak, J., Stefanska-Wronka, K., Zabul, E., Cardoso, F.S., Banzo, MJA, Tomasa-Irriguible, T.M., Mira, Á.P., Arias-Rivera, S., Frutos-Vivar, F., Lopez-Cuenca, S., de Gopegui, P.R., Abidi, N., Chau, I., Pugh, R., and Smuts, S.

Subjects
Aging, Activities of Daily Living, Aged, COVID-19, Humans, Intensive Care Units, Prospective Studies, Quality of Life, SARS-CoV-2, Intensive Care Unit (ICU), Older people, Survival, frailty, [SDV]Life Sciences [q-bio], SOCIETY, 610 Medicine & health, General Medicine, INTENSIVE-CARE, humanities, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], [SDV] Life Sciences [q-bio], Medicine and Health Sciences, Geriatrics and Gerontology
Abstract

Background health-related quality of life (HRQoL) is an important patient-centred outcome in patients surviving ICU admission for COVID-19. It is currently not clear which domains of the HRQoL are most affected. Objective to quantify HRQoL in order to identify areas of interventions. Design prospective observation study. Setting admissions to European ICUs between March 2020 and February 2021. Subjects patients aged 70 years or older admitted with COVID-19 disease. Methods collected determinants include SOFA-score, Clinical Frailty Scale (CFS), number and timing of ICU procedures and limitation of care, Katz Activities of Daily Living (ADL) dependence score. HRQoL was assessed at 3 months after ICU admission with the Euro-QoL-5D-5L questionnaire. An outcome of ≥4 on any of Euro-QoL-5D-5L domains was considered unfavourable. Results in total 3,140 patients from 14 European countries were included in this study. Three months after inclusion, 1,224 patients (39.0%) were alive and the EQ-5D-5L from was obtained. The CFS was associated with an increased odds ratio for an unfavourable HRQoL outcome after 3 months; OR 1.15 (95% confidence interval (CI): 0.71–1.87) for CFS 2 to OR 4.33 (95% CI: 1.57–11.9) for CFS ≧ 7. The Katz ADL was not statistically significantly associated with HRQoL after 3 months. Conclusions in critically ill old intensive care patients suffering from COVID-19, the CFS is associated with the subjectively perceived quality of life. The CFS on admission can be used to inform patients and relatives on the risk of an unfavourable qualitative outcome if such patients survive.

Published
2022
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5. The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19

Author

Bruno, Raphael Romano, Wernly, Bernhard, Flaatten, Hans, Fjølner, Jesper, Artigas, Antonio, Baldia, Philipp Heinrich, Binneboessel, Stephan, Bollen Pinto, Bernardo, Schefold, Joerg C., Wolff, Georg, Kelm, Malte, Beil, Michael, Sviri, Sigal, van Heerden, Peter Vernon, Szczeklik, Wojciech, Elhadi, Muhammed, Joannidis, Michael, Oeyen, Sandra, Kondili, Eumorfia, Marsh, Brian, Wollborn, Jakob, Andersen, Finn H., Moreno, Rui, Leaver, Susannah, Boumendil, Ariane, De Lange, Dylan W., Guidet, Bertrand, Jung, Christian, Eller, Philipp, Mesotten, Dieter, Reper, Pascal, Swinnen, Walter, Serck, Nicolas, Dewaele, Elisabeth, Brix, Helene, Brushoej, Jens, Kumar, Pritpal, Nedergaard, Helene Korvenius, Balleby, Ida Riise, Bundesen, Camilla, Hansen, Maria Aagaard, Uhrenholt, Stine, Bundgaard, Helle, Gooch, James, Cagova, Lenka, Potter, Elizabeth, Reay, Michael, Davey, Miriam, Abusayed, Mohammed Abdelshafy, Humphreys, Sally, Galbois, Arnaud, Charron, Cyril, Berlemont, Caroline Hauw, Besch, Guillaume, Rigaud, Jean-Philippe, Maizel, Julien, Djibré, Michel, Burtin, Philippe, Garcon, Pierre, Nseir, Saad, Valette, Xavier, Alexandru, Nica, Marin, Nathalie, Vaissiere, Marie, Plantefeve, Gaëtan, Vanderlinden, Thierry, Jurcisin, Igor, Megarbane, Buno, Chousterman, Benjamin Glenn, Dépret, François, Garnier, Marc, Besset, Sebastien, Oziel, Johanna, Ferre, Alexis, Dauger, Stéphane, Dumas, Guillaume, Goncalves, Bruno, Vettoretti, Lucie, Thevenin, Didier, Schaller, Stefan, Kurt, Muhammed, Faltlhauser, Andreas, Meyer, Christian, Milovanovic, Milena, Lutz, Matthias, Shala, Gonxhe, Haake, Hendrik, Randerath, Winfried, Kunstein, Anselm, Meybohm, Patrick, Steiner, Stephan, Barth, Eberhard, Poerner, Tudor, Simon, Philipp, Lorenz, Marco, Dindane, Zouhir, Kuhn, Karl Friedrich, Welte, Martin, Voigt, Ingo, Kabitz, Hans-Joachim, Goebel, Ulrich, Stoll, Sandra Emily, Kindgen-Milles, Detlef, Dubler, Simon, Fuest, Kristina, Schuster, Michael, Papadogoulas, Antonios, Mulita, Francesk, Rovina, Nikoletta, Aidoni, Zoi, Chrisanthopoulou, Evangelia, Andrianopoulos, Ioannis, Groenendijk, Martijn, Evers, Mirjam, van Lelyveld-Haas, Lenneke, Meynaar, Iwan, Cornet, Alexander Daniel, Zegers, Marieke, Dieperink, Willem, Dormans, Tom, Hahn, Michael, Sjøbøe, Britt, Strietzel, Hans Frank, Olasveengen, Theresa, Romundstad, Luis, Kluzik, Anna, Zatorski, Paweł, Drygalski, Tomasz, Klimkiewicz, Jakub, Solek-pastuszka, Joanna, Onichimowski, Dariusz, Czuczwar, Miroslaw, Gawda, Ryszard, Stefaniak, Jan, Stefanska-Wronka, Karina, Zabul, Ewa, Oliveira, Ana Isabel Pinho, Assis, Rui, de Lurdes Campos Santos, Maria, Santos, Henrique, Cardoso, Filipe Sousa, Gordinho, André, Banzo, Maria José Arche, Zalba-Etayo, Begoña, Cubero, Patricia Patricia, Priego, Jesús, Gomà, Gemma, Tomasa-Irriguible, Teresa Maria, Sancho, Susana, Ferreira, Aida Fernández, Vázquez, Eric Mayor, Mira, Ángela Prado, Ibarz, Mercedes, Iglesias, David, Arias-Rivera, Susana, Frutos-Vivar, Fernando, Lopez-Cuenca, Sonia, Aldecoa, Cesar, Perez-Torres, David, Canas-Perez, Isabel, Tamayo-Lomas, Luis, Diaz-Rodriguez, Cristina, de Gopegui, Pablo Ruiz, Ben-Hamouda, Nawfel, Roberti, Andrea, Fleury, Yvan, Abidi, Nour, Chau, Ivan, Dullenkopf, Alexander, Pugh, Richard, Smuts, Sara, COVIP study group, [missing], Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), COVIP study group, Eller, P., Joannidis, M., Mesotten, D., Reper, P., Oeyen, S., Swinnen, W., Serck, N., Dewaele, E., Brix, H., Brushoej, J., Kumar, P., Nedergaard, H.K., Balleby, I.R., Bundesen, C., Hansen, M.A., Uhrenholt, S., Bundgaard, H., Fjølner, J., Gooch, J., Cagova, L., Potter, E., Reay, M., Davey, M., Abusayed, M.A., Humphreys, S., Galbois, A., Guidet, B., Charron, C., Berlemont, C.H., Besch, G., Rigaud, J.P., Maizel, J., Djibré, M., Burtin, P., Garcon, P., Nseir, S., Valette, X., Alexandru, N., Marin, N., Vaissiere, M., Plantefeve, G., Vanderlinden, T., Jurcisin, I., Megarbane, B., Chousterman, B.G., Dépret, F., Garnier, M., Besset, S., Oziel, J., Ferre, A., Dauger, S., Dumas, G., Goncalves, B., Vettoretti, L., Thevenin, D., Schaller, S., Kurt, M., Faltlhauser, A., Meyer, C., Milovanovic, M., Lutz, M., Shala, G., Haake, H., Randerath, W., Kunstein, A., Meybohm, P., Steiner, S., Barth, E., Poerner, T., Simon, P., Lorenz, M., Dindane, Z., Kuhn, K.F., Welte, M., Voigt, I., Kabitz, H.J., Wollborn, J., Goebel, U., Stoll, S.E., Kindgen-Milles, D., Dubler, S., Jung, C., Fuest, K., Schuster, M., Papadogoulas, A., Mulita, F., Rovina, N., Aidoni, Z., Chrisanthopoulou, E., Kondili, E., Andrianopoulos, I., Groenendijk, M., Evers, M., van Lelyveld-Haas, L., Meynaar, I., Cornet, A.D., Zegers, M., Dieperink, W., De Lange, D.W., Dormans, T., Hahn, M., Sjøbøe, B., Strietzel, H.F., Olasveengen, T., Romundstad, L., Andersen, F.H., Kluzik, A., Zatorski, P., Drygalski, T., Szczeklik, W., Klimkiewicz, J., Solek-Pastuszka, J., Onichimowski, D., Czuczwar, M., Gawda, R., Stefaniak, J., Stefanska-Wronka, K., Zabul, E., Oliveira, AIP, Assis, R., de Lurdes Campos Santos, M., Santos, H., Cardoso, F.S., Gordinho, A., Banzo, MJA, Zalba-Etayo, B., Cubero, P.P., Priego, J., Gomà, G., Tomasa-Irriguible, T.M., Sancho, S., Ferreira, A.F., Vázquez, E.M., Mira, Á.P., Ibarz, M., Iglesias, D., Arias-Rivera, S., Frutos-Vivar, F., Lopez-Cuenca, S., Aldecoa, C., Perez-Torres, D., Canas-Perez, I., Tamayo-Lomas, L., Diaz-Rodriguez, C., de Gopegui, P.R., Ben-Hamouda, N., Roberti, A., Fleury, Y., Abidi, N., Schefold, J.C., Chau, I., Dullenkopf, A., Pugh, R., and Smuts, S.

Subjects
IMPACT, MORTALITY, ICU, Medicine and Health Sciences, ILL ELDERLY-PATIENTS, 610 Medicine & health, ddc:610, Critical Care and Intensive Care Medicine, 610 Medizin und Gesundheit, FRAILTY, human activities, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
Abstract

Open Access funding enabled and organized by Projekt DEAL. This study was endorsed by the ESICM. Free support for running the electronic database and was granted from the dep. of Epidemiology, University of Aarhus, Denmark. Bruno et al. Annals of Intensive Care (2022) 12:26 Page 10 of 11 The support of the study in France by a grant from Fondation Assistance Publique-Hôpitaux de Paris pour la recherche is greatly appreciated. In Norway, the study was supported by a grant from the Health Region West. In addition, the study was supported by a grant from the European Open Science Cloud (EOSC). EOSCsecretariat.eu has received funding from the European Union’s Horizon Programme call H2020-INFRAEOSC-05-2018-2019, grant agreement number 831644. This work was supported by the Collaborative Research Center SFB 1116 (German Research Foundation, DFG) and by the Forschungskommission of the Medical Faculty of the Heinrich-Heine-University Düsseldorf and No. 2020–21 to RRB for a Clinician Scientist Track. No (industry) sponsorship has been received for this investigator-initiated study. PURPOSE: Critically ill old intensive care unit (ICU) patients suffering from Sars-CoV-2 disease (COVID-19) are at increased risk for adverse outcomes. This post hoc analysis investigates the association of the Activities of Daily Living (ADL) with the outcome in this vulnerable patient group. METHODS: The COVIP study is a prospective international observational study that recruited ICU patients ≥ 70 years admitted with COVID-19 (NCT04321265). Several parameters including ADL (ADL; 0 = disability, 6 = no disability), Clinical Frailty Scale (CFS), SOFA score, intensive care treatment, ICU- and 3-month survival were recorded. A mixed-effects Weibull proportional hazard regression analyses for 3-month mortality adjusted for multiple confounders. RESULTS: This pre-specified analysis included 2359 patients with a documented ADL and CFS. Most patients evidenced independence in their daily living before hospital admission (80% with ADL = 6). Patients with no frailty and no disability showed the lowest, patients with frailty (CFS ≥ 5) and disability (ADL

Published
2022
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6. The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study

Author

Christian Jung, Hans Flaatten, Jesper Fjølner, Raphael Romano Bruno, Bernhard Wernly, Antonio Artigas, Bernardo Bollen Pinto, Joerg C. Schefold, Georg Wolff, Malte Kelm, Michael Beil, Sviri Sigal, Peter Vernon van Heerden, Wojciech Szczeklik, Miroslaw Czuczwar, Muhammed Elhadi, Michael Joannidis, Sandra Oeyen, Tilemachos Zafeiridis, Brian Marsh, Finn H. Andersen, Rui Moreno, Maurizio Cecconi, Susannah Leaver, Ariane Boumendil, Dylan W. De Lange, Bertrand Guidet, COVIP study group, Flaatten, H., Wernly, B., Artigas, A., Beil, M., Sviri, S., van Heerden, P.V., Szczeklik, W., Elhadi, M., Zafeiridis, T., Moreno, R., Cecconi, M., Boumendil, A., Abosheaishaa, H.M., Abualqumboz, EMY, Ahmed, A.K., Ahmed, H., Aidoni, Z., Aldecoa, C., Alexandru, N., Ali, YKNM, Al-Sadawi, M., Andersen, K., Andersen, F.H., Assis, R., Azab, M.A., Azzam, A.Y., Badawy, M.R., Balleby, I.R., Barth, E., Ben-HAmouda, N., Besch, G., Besset, S., Bjerregaard, A.T., Brix, H., Bruno, R.R., Brushoej, J., Bundgaard, H., Burtin, P., Caillard, A., Canas-Perez, I., Charron, C., Chrisanthopoulou, E., Comellini, V., Cornet, A., Cubero, P.J., Czuczwar, M., Dauger, S., Diaz-Rodriguez, C., Dieperink, W., Dindane, Z., Djibré, M., Dormans, T., Dullenkopf, A., Dumas, G., Elgazzar, Y.A., Eller, P., Elsaka, A., Evers, M., Faltlhauser, A., Ferreira, A.F., Fjølner, J., Fleury, Y., Galbois, A., Garcon, P., Garnier, M., Gawda, R., Ghannam, A., Goebel, U., Gomà, G., Goncalves, B., Gordinho, A., Groenendijk, M., Guerot, E., Guidet, B., Gurjar, M., Haake, H., Haas, L., Habib, A.A., Hahn, M., Hansen, M.A., Hilles, MMY, Hussein, AARM, Iglesias, D., Joannidis, M., Jung, C., Jurcisin, I., Kabitz, H.J., Kelm, M., Kindgen-Milles, D., Klimkiewicz, J., Kuhn, K.F., Kunstein, A., Kurt, M., De Lange, D.W., Leaver, S., Lutz, M., Mahmoodpoor, A., Maizel, J., Marin, N., Marsh, B., Megarbane, B., Mesotten, D., Meybohm, P., Meyer, C., Mira, A.P., Namendys-Silva, S.A., Nedergaard, H.K., Nseir, S., Oeyen, S., Olasveengen, T., Oliveira, AIP, Oziel, J., Papadogoulas, A., Perez-Torres, D., Bollen Pinto, B., Piton, G., Plantefeve, G., Poerner, T., Priego, J., Rabha, A., Randerath, W., Raphaelen, J.H., Reper, P., Rigaud, J.P., Rivera, S.A., Roberti, A., Romundstad, L., Rovina, N., Salah, R., Saleh, M., Sancho, S., de Lurdes Campos Santos, M., Santos, H., Schaller, S., Schefold, J.C., Schuster, M., Shala, G., Sjøbø, B., Steiner, S., Strietzel, H.F., Swinnen, W., Tamayo-Lomas, L., Tharwat, S., Tomasa, T., Uhrenholt, S., Vaissiere, M., Valent, A., Valette, X., Vanderlinden, T., Vázquez, E.M., Villamayor, M.I., Villefrance, M., Voigt, I., Wassim, K., Welte, M., Wolff, G., Wollborn, J., Zalba-Etayo, B., Zegers, M., and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)

Subjects
Male, Aged, 80 and over, Pandemia, COVID-19/mortality, Frailty, Critical Care, Frail Elderly/statistics & numerical data, COVID-19, 610 Medicine & health, Prognosis, Survival Analysis, Elderly, Frailty/mortality, Humans, Female, Prospective Studies, Outcome, Aged, COVID-19/therapy
Abstract

BackgroundThe COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients.MethodsA prospective multi-centre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the Clinical Frailty Scale (CFS). Additionally, comorbidities, management strategies and treatment limitations were recorded.ResultsThe study included 1346 patients (28% female) with a median age of 75 years (IQR 72-78, range 70-96), 16.3% were older than 80 years and 21% of the patients were frail. The overall survival at 30 days was 59% (95%CI 56-62), with 66% (63-69) in fit, 53% (47-61) in vulnerable and 41% (35-47) in frail patients (pConclusionFrailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities.

Published
2021
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7. Lactate is associated with mortality in very old intensive care patients suffering from COVID-19 : results from an international observational study of 2860 patients

Author

Raphael Romano Bruno, Bernhard Wernly, Hans Flaatten, Jesper Fjølner, Antonio Artigas, Bernardo Bollen Pinto, Joerg C. Schefold, Stephan Binnebössel, Philipp Heinrich Baldia, Malte Kelm, Michael Beil, Sivri Sigal, Peter Vernon van Heerden, Wojciech Szczeklik, Muhammed Elhadi, Michael Joannidis, Sandra Oeyen, Tilemachos Zafeiridis, Jakob Wollborn, Maria José Arche Banzo, Kristina Fuest, Brian Marsh, Finn H. Andersen, Rui Moreno, Susannah Leaver, Ariane Boumendil, Dylan W. De Lange, Bertrand Guidet, Christian Jung, the COVIP Study Group, COVIP Study Group, Eller, P., Joannidis, M., Mesotten, D., Reper, P., Oeyen, S., Swinnen, W., Serck, N., Dewaele, E., Chapeta, E., Brix, H., Brushoej, J., Kumar, P., Nedergaard, H.K., Johnsen, T.K., Bundesen, C., Hansen, M.A., Uhrenholt, S., Bundgaard, H., Fjølner, J., Innes, R., Gooch, J., Cagova, L., Potter, E., Reay, M., Davey, M., Abusayed, M.A., Humphreys, S., Collins, A., Aujayeb, A., Leaver, S., Khaliq, W., Habib, A.A., Azab, M.A., Wassim, K., Elgazzar, Y.A., Salah, R., Abosheaishaa, H.M., Hussein Mohamed, AAR, Azzam, A.Y., Tharwat, S., Ali, YKNM, Elmandouh, O., Galal, I., Abu-Elfatth, A., Motawea, K., Elbahnasawy, M., Shehata, M., Tayeb, M., Osman, N., Abdel-Elsalam, W., Hussein, A.M., Aldhalia, A., Galbois, A., Guidet, B., Charron, C., Berlemont, C.H., Besch, G., Rigaud, J.P., Maizel, J., Djibré, M., Burtin, P., Garcon, P., Nseir, S., Valette, X., Alexandru, N., Marin, N., Vaissiere, M., Plantefeve, G., Mentec, H., Vanderlinden, T., Jurcisin, I., Megarbane, B., Chousterman, B.G., Dépret, F., Garnier, M., Besset, S., Oziel, J., Ferre, A., Dauger, S., Dumas, G., Goncalves, B., Vettoretti, L., Thevenin, D., Schaller, S., Kurt, M., Faltlhauser, A., Meyer, C., Milovanovic, M., Lutz, M., Shala, G., Haake, H., Randerath, W., Kunstein, A., Meybohm, P., Steiner, S., Barth, E., Poerner, T., Simon, P., Lorenz, M., Dindane, Z., Kuhn, K.F., Welte, M., Voigt, I., Kabitz, H.J., Wollborn, J., Goebel, U., Stoll, S.E., Kindgen-Milles, D., Dubler, S., Jung, C., Fuest, K., Schuster, M., Papadogoulas, A., Mulita, F., Rovina, N., Aidoni, Z., Chrisanthopoulou, E., Kondili, E., Andrianopoulos, I., Gurjar, M., Mahmoodpoor, A., Hussein, R., Al-Juaifari, M.A., Karantenachy, AKA, Sviri, S., Elsaka, A., Marsh, B., Comellini, V., Al-Ali, F., Almani, S., Khamees, A.A., Al-Shami, K., El Din, I.S., Abubaker, T., Ahmed, H., Rabha, A., Alhadi, A., Emhamed, M., Abdeewi, S., Abusalama, A., Huwaysh, M., Alghati, E.A., Ghannam, A., Namendys-Sylva, S.A., Groenendijk, M., Evers, M., Van Lelyveld-Haas, L., Meynaar, I., Cornet, A.D., Zegers, M., Dieperink, W., De Lange, D., Dormans, T., Hahn, M., Sjøbøe, B., Strietzel, H.F., Olasveengen, T., Romundstad, L., Andersen, F.H., Massoud, JGG, Khan, A.G., Al-Qasrawi, S., Amro, S., Kluzik, A., Zatorski, P., Drygalski, T., Szczeklik, W., Klimkiewicz, J., Solek-Pastuszka, J., Onichimowski, D., Czuczwar, M., Gawda, R., Stefaniak, J., Stefanska-Wronka, K., Zabul, E., Oliveira, AIP, Assis, R., De Lurdes Campos Santos, M., Santos, H., Cardoso, F.S., Gordinho, A., Grintescu, I.M., Tomescu, D., Badawy, M.R., José Arche Banzo, M., Zalba-Etayo, B., Cubero, P.J., Priego, J., Gomà, G., Tomasa-Irriguible, T.M., Sancho, S., Ferreira, A.F., Vázquez, E.M., Mira, Á.P., Ibarz, M., Iglesias, D., Arias-Rivera, S., Frutos-Vivar, F., Lopez-Cuenca, S., Aldecoa, C., Perez-Torres, D., Canas-Perez, I., Tamayo-Lomas, L., Diaz-Rodriguez, C., De Gopegui, P.R., Saleh, M., Hilles, MMY, Abualqumboz, EMY, Ben-Hamouda, N., Roberti, A., Fleury, Y., Abidi, N., Schefold, J.C., Chau, I., Dullenkopf, A., Chaaban, M.K., Shebani, M.M., Hmaideh, A., Shaher, A., Sahin, A.S., Saracoglu, K.T., Al-Sadawi, M., Pugh, R., Smuts, S., and Al-Saban, RAM

Subjects
SEPSIS, RC86-88.9, IMPACT, Research, SEPTIC SHOCK, LEVEL, Medicine and Health Sciences, Medical emergencies. Critical care. Intensive care. First aid, 610 Medicine & health, ELDERLY-PATIENTS, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
Abstract

Purpose Lactate is an established prognosticator in critical care. However, there still is insufficient evidence about its role in predicting outcome in COVID-19. This is of particular concern in older patients who have been mostly affected during the initial surge in 2020. Methods This prospective international observation study (The COVIP study) recruited patients aged 70 years or older (ClinicalTrials.gov ID: NCT04321265) admitted to an intensive care unit (ICU) with COVID-19 disease from March 2020 to February 2021. In addition to serial lactate values (arterial blood gas analysis), we recorded several parameters, including SOFA score, ICU procedures, limitation of care, ICU- and 3-month mortality. A lactate concentration ≥ 2.0 mmol/L on the day of ICU admission (baseline) was defined as abnormal. The primary outcome was ICU-mortality. The secondary outcomes 30-day and 3-month mortality. Results In total, data from 2860 patients were analyzed. In most patients (68%), serum lactate was lower than 2 mmol/L. Elevated baseline serum lactate was associated with significantly higher ICU- and 3-month mortality (53% vs. 43%, and 71% vs. 57%, respectively, p

Published
2021
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8. The role of artificial intelligence in standardizing global longitudinal strain measurements in echocardiography.

Author

Sveric KM, Botan R, Winkler A, Dindane Z, Alothman G, Cansiz B, Fassl J, Kaliske M, and Linke A

Abstract

Aims: To evaluate the accuracy and feasibility of artificial intelligence (AI) in left ventricular global longitudinal strain (GLS) analysis as compared to conventional (Manual) and semi-automated (SemiAuto) method in echocardiography (Echo)., Methods and Results: GLS validation was performed on 550 standard Echo exams by expert cardiologists. The performance of a beginner cardiologist without experience of GLS analysis was assessed on a subset of 90 exams. The AI employs fully automated view selection, classification, endocardial border tracing, and calculation of GLS from an entire Echo exam, while SemiAuto requires manual chamber view selection, and Manual involves full user input. Interobserver agreement was assessed using the intraclass correlation coefficient (ICC) for all three methods. Agreement of measures included Pearson's correlation (R) and Bland-Altman analysis [median bias; limits of agreement (LOA)]. With an 89% feasibility the AI showed good agreement with Manual (R = 0.92, bias = 0.7% and LOA: -3.5 to 4.8%) and with SemiAuto (r = 0.90, bias = 0.10% and LOA: -4.5 to 4%). ICCs for GLS were 1.0 for AI, 0.93 for SemiAuto, and 0.80 for Manual. After the 55th analysis, the beginner showed stable time performance with Manual (171 s), contrasting with the consistent performance of SemiAuto (85-69 s) from the beginning. The highest agreement between beginner and expert readers was achieved with AI (R = 1.00), followed by SemiAuto (R = 0.85) and Manual (R = 0.74)., Conclusion: Automated GLS analysis enhances efficiency and accuracy in cardiac diagnostics, particularly for novice users. Integration of automated solutions into routine clinical practice could yield more standardized results., Competing Interests: Conflict of interest: A.L. reports honoraria or consultancy fees from Edwards Lifesciences, Boston Scientific, Abiomed, Novartis, Pfizer, Astra Zeneca, Boehringer, Abbott, MSD, Corvia, Daiichi and Meril; received grant support form Edwards Lifesciences and Novartis, and owns stock options from Transverse Medical, Picardia and Filterlex. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Published
2024
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9. Ventricular arrhythmias in the context of chronic kidney disease and electrolyte imbalance.

Author

Masmoudi I, Dindane Z, Richter S, and Ebert M

Subjects
Humans, Tachycardia, Ventricular physiopathology, Tachycardia, Ventricular etiology, Tachycardia, Ventricular therapy, Tachycardia, Ventricular complications, Arrhythmias, Cardiac etiology, Arrhythmias, Cardiac physiopathology, Arrhythmias, Cardiac therapy, Evidence-Based Medicine, Risk Factors, Comorbidity, Ventricular Fibrillation etiology, Ventricular Fibrillation physiopathology, Ventricular Fibrillation therapy, Water-Electrolyte Imbalance etiology, Water-Electrolyte Imbalance therapy, Water-Electrolyte Imbalance complications, Water-Electrolyte Imbalance physiopathology, Death, Sudden, Cardiac etiology, Death, Sudden, Cardiac prevention & control, Renal Insufficiency, Chronic complications
Abstract

Patients with chronic kidney disease face a high risk of sudden cardiac death, particularly in more advanced stages of renal dysfunction. Ventricular arrhythmias are prevalent and contribute to the heightened cardiovascular mortality. This review aims to explore the intricate interplay of disease-specific risk factors, arrhythmic triggers, and electrolyte disorders that amplify susceptibility to ventricular arrhythmias and sudden cardiac death in this population and influence the efficacy of available treatments., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Published
2024
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10. An unusual cause of anterior wall ST-elevation myocardial infarction: a case report.

Author

Dindane Z, Golgor E, Linke A, and Mangner N

Abstract

Background: Metastatic tumours, notably lung cancer, can cause conditions resembling acute myocardial infarctions (AMIs), contributing to the minor percentage of AMIs unrelated to coronary atherosclerosis. These instances necessitate specialized diagnostic and therapeutic approaches due to the distinct underlying pathology., Case Summary: We report a case of a 65-year-old male with metastatic lung cancer presenting with prolonged angina pectoris. Elevated troponin and creatine kinase levels led to emergency catheterization, revealing a total occlusion of the distal left coronary artery attributed to tumour infiltration. Intervention attempts were unsuccessful, and given the palliative context, other revascularization strategies were not pursued. Two-dimensional transthoracic echocardiogram depicted tumour invasion at the heart's apex, confirming the diagnosis. The patient passed away shortly after receiving palliative radiation therapy., Discussion: This case underscores the challenges in diagnosing and managing myocardial infiltrations from metastatic tumours mimicking AMI. It accentuates the importance of imaging studies for accurate diagnosis and the critical evaluation of intervention strategies, highlighting the need for focused palliative care in such complex scenarios., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Published
2024
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11. Association between left ventricular ejection fraction, mortality and use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock.

Author

Sundermeyer J, Kellner C, Beer BN, Besch L, Dettling A, Bertoldi LF, Blankenberg S, Dauw J, Dindane Z, Eckner D, Eitel I, Graf T, Horn P, Jozwiak-Nozdrzykowska J, Kirchhof P, Kluge S, Linke A, Landmesser U, Luedike P, Lüsebrink E, Majunke N, Mangner N, Maniuc O, Winkler SM, Nordbeck P, Orban M, Pappalardo F, Pauschinger M, Pazdernik M, Proudfoot A, Kelham M, Rassaf T, Scherer C, Schulze PC, Schwinger RHG, Skurk C, Sramko M, Tavazzi G, Thiele H, Villanova L, Morici N, Westenfeld R, Winzer EB, Westermann D, and Schrage B

Subjects
Humans, Male, Middle Aged, Aged, Female, Stroke Volume, Ventricular Function, Left, Retrospective Studies, Treatment Outcome, Shock, Cardiogenic diagnosis, Shock, Cardiogenic therapy, Heart-Assist Devices
Abstract

Background: Currently, use of mechanical circulatory support (MCS) in non-ischaemic cardiogenic shock (CS) is predominantly guided by shock-specific markers, and not by markers of cardiac function. We hypothesise that left ventricular ejection fraction (LVEF) can identify patients with a higher likelihood to benefit from MCS and thus help to optimise their expected benefit., Methods: Patients with non-ischaemic CS and available data on LVEF from 16 tertiary-care centres in five countries were analysed. Cox regression models were fitted to evaluate the association between LVEF and mortality, as well as the interaction between LVEF, MCS use and mortality., Results: N = 807 patients were analysed: mean age 63 [interquartile range (IQR) 51.5-72.0] years, 601 (74.5%) male, lactate 4.9 (IQR 2.6-8.5) mmol/l, LVEF 20 (IQR 15-30) %. Lower LVEF was more frequent amongst patients with more severe CS, and MCS was more likely used in patients with lower LVEF. There was no association between LVEF and 30-day mortality risk in the overall study cohort. However, there was a significant interaction between MCS use and LVEF, indicating a lower 30-day mortality risk with MCS use in patients with LVEF ≤ 20% (hazard ratio 0.72, 95% confidence interval 0.51-1.02 for LVEF ≤ 20% vs. hazard ratio 1.31, 95% confidence interval 0.85-2.01 for LVEF > 20%, interaction-p = 0.017)., Conclusion: This retrospective study may indicate a lower mortality risk with MCS use only in patients with severely reduced LVEF. This may propose the inclusion of LVEF as an adjunctive parameter for MCS decision-making in non-ischaemic CS, aiming to optimise the benefit-risk ratio., (© 2023. The Author(s).)

Published
2024
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12. Sex-related differences in patients presenting with heart failure-related cardiogenic shock.

Author

Sundermeyer J, Kellner C, Beer BN, Besch L, Dettling A, Bertoldi LF, Blankenberg S, Dauw J, Dindane Z, Eckner D, Eitel I, Graf T, Horn P, Jozwiak-Nozdrzykowska J, Kirchhof P, Kluge S, Linke A, Landmesser U, Luedike P, Lüsebrink E, Majunke N, Mangner N, Maniuc O, Möbius-Winkler S, Nordbeck P, Orban M, Pappalardo F, Pauschinger M, Pazdernik M, Proudfoot A, Kelham M, Rassaf T, Scherer C, Schulze PC, Schwinger RHG, Skurk C, Sramko M, Tavazzi G, Thiele H, Villanova L, Morici N, Winzer EB, Westermann D, and Schrage B

Subjects
Male, Humans, Female, Stroke Volume, Ventricular Function, Left, Sex Factors, Hospital Mortality, Shock, Cardiogenic diagnosis, Shock, Cardiogenic epidemiology, Shock, Cardiogenic etiology, Heart Failure diagnosis, Heart Failure epidemiology, Heart Failure therapy
Abstract

Background: Heart failure-related cardiogenic shock (HF-CS) accounts for a significant proportion of all CS cases. Nevertheless, there is a lack of evidence on sex-related differences in HF-CS, especially regarding use of treatment and mortality risk in women vs. men. This study aimed to investigate potential differences in clinical presentation, use of treatments, and mortality between women and men with HF-CS., Methods: In this international observational study, patients with HF-CS (without acute myocardial infarction) from 16 tertiary-care centers in five countries were enrolled between 2010 and 2021. Logistic and Cox regression models were used to assess differences in clinical presentation, use of treatments, and 30-day mortality in women vs. men with HF-CS., Results: N = 1030 patients with HF-CS were analyzed, of whom 290 (28.2%) were women. Compared to men, women were more likely to be older, less likely to have a known history of heart failure or cardiovascular risk factors, and lower rates of highly depressed left ventricular ejection fraction and renal dysfunction. Nevertheless, CS severity as well as use of treatments were comparable, and female sex was not independently associated with 30-day mortality (53.0% vs. 50.8%; adjusted HR 0.94, 95% CI 0.75-1.19)., Conclusions: In this large HF-CS registry, sex disparities in risk factors and clinical presentation were observed. Despite these differences, the use of treatments was comparable, and both sexes exhibited similarly high mortality rates. Further research is necessary to evaluate if sex-tailored treatment, accounting for the differences in cardiovascular risk factors and clinical presentation, might improve outcomes in HF-CS., (© 2024. The Author(s).)

Published
2024
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13. Clinical presentation, shock severity and mortality in patients with de novo versus acute-on-chronic heart failure-related cardiogenic shock.

Author

Sundermeyer J, Kellner C, Beer BN, Besch L, Dettling A, Bertoldi LF, Blankenberg S, Dauw J, Dindane Z, Eckner D, Eitel I, Graf T, Horn P, Jozwiak-Nozdrzykowska J, Kirchhof P, Kluge S, Linke A, Landmesser U, Luedike P, Lüsebrink E, Majunke N, Mangner N, Maniuc O, Möbius Winkler S, Nordbeck P, Orban M, Pappalardo F, Pauschinger M, Pazdernik M, Proudfoot A, Kelham M, Rassaf T, Reichenspurner H, Scherer C, Schulze PC, Schwinger RHG, Skurk C, Sramko M, Tavazzi G, Thiele H, Villanova L, Morici N, Winzer EB, Westermann D, Gustafsson F, and Schrage B

Subjects
Humans, Hospital Mortality, Prognosis, Heart Failure, Shock, Cardiogenic etiology
Abstract

Aims: Heart failure-related cardiogenic shock (HF-CS) accounts for a significant proportion of CS cases. Whether patients with de novo HF and those with acute-on-chronic HF in CS differ in clinical characteristics and outcome remains unclear. The aim of this study was to evaluate differences in clinical presentation and mortality between patients with de novo and acute-on-chronic HF-CS., Methods and Results: In this international observational study, patients with HF-CS from 16 tertiary care centres in five countries were enrolled between 2010 and 2021. To investigate differences in clinical presentation and 30-day mortality, adjusted logistic/Cox regression models were fitted. Patients (n = 1030) with HF-CS were analysed, of whom 486 (47.2%) presented with de novo HF-CS and 544 (52.8%) with acute-on-chronic HF-CS. Traditional markers of CS severity (e.g. blood pressure, heart rate and lactate) as well as use of treatments were comparable between groups. However, patients with acute-on-chronic HF-CS were more likely to have a higher CS severity and also a higher mortality risk, after adjusting for relevant confounders (de novo HF 45.5%, acute-on-chronic HF 55.9%, adjusted hazard ratio 1.38, 95% confidence interval 1.10-1.72, p = 0.005)., Conclusion: In this large HF-CS cohort, acute-on-chronic HF-CS was associated with more severe CS and higher mortality risk compared to de novo HF-CS, although traditional markers of CS severity and use of treatments were comparable. These findings highlight the vast heterogeneity of patients with HF-CS, emphasize that HF chronicity is a relevant disease modifier in CS, and indicate that future clinical trials should account for this., (© 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Published
2024
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14. Improved assessment of left ventricular ejection fraction using artificial intelligence in echocardiography: A comparative analysis with cardiac magnetic resonance imaging.

Author

Sveric KM, Ulbrich S, Dindane Z, Winkler A, Botan R, Mierke J, Trausch A, Heidrich F, and Linke A

Subjects
Humans, Stroke Volume, Artificial Intelligence, Echocardiography methods, Magnetic Resonance Imaging methods, Reproducibility of Results, Ventricular Function, Left, Ventricular Dysfunction, Left diagnostic imaging
Abstract

Background: Left ventricular ejection fraction (LVEF) measurement in echocardiography (Echo) using the recommended modified biplane Simpson (MBS) method is operator-dependent and exhibits variability. We aimed to assess the accuracy of a novel fully automated (Auto) artificial intelligence (AI) in view selection and biplane LVEF calculation compared to MBS-Echo, with cardiac magnetic resonance imaging (CMR) as reference., Methods: Each of the 301 consecutive patients underwent CMR and Echo on the same day. LVEF was measured independently by Auto-Echo, MBS-Echo and CMR. Interobserver (n = 40) and test-retest (n = 14) analysis followed., Results: A total of 229 patients (76%) underwent complete analysis. Auto-Echo and MBS-Echo showed high correlations with CMR (R = 0.89 and 0.89) and with each other (R = 0.93). Auto underestimated LVEF (bias: 2.2%; limits of agreement [LOA]: -13.5 to 17.9%), while MBS overestimated it (bias: -2.2%; LOA: 18.6 to 14.1%). Despite comparable areas under the curves of Auto- and MBS-Echo (0.93 and 0.92), 46% (n = 70) of MBS-Echo misclassified LVEF by ≥5% units in patients with a reduced CMR-LVEF <51%. Although LVEF bias variability across different LV function ranges was significant (p < 0.001), Auto-Echo was closer to CMR for patients with reduced LVEF, wall motion abnormalities, and poor image quality than MBS-Echo. The interobserver correlation coefficient of Auto-Echo was excellent compared to MBS-Echo (1.00 vs. <0.91) for different readers. True test-retest variability was higher for MBS-Echo than for Auto-Echo (7.9% vs. 2.5%)., Conclusion: The tested AI has the potential to improve the clinical utility of Echo by reducing user-related variability, providing more accurate and reliable results than MBS., Competing Interests: Declaration of Competing Interest The authors report none., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Published
2024
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15. Use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock.

Author

Schrage B, Sundermeyer J, Beer BN, Bertoldi L, Bernhardt A, Blankenberg S, Dauw J, Dindane Z, Eckner D, Eitel I, Graf T, Horn P, Kirchhof P, Kluge S, Linke A, Landmesser U, Luedike P, Lüsebrink E, Mangner N, Maniuc O, Winkler SM, Nordbeck P, Orban M, Pappalardo F, Pauschinger M, Pazdernik M, Proudfoot A, Kelham M, Rassaf T, Reichenspurner H, Scherer C, Schulze PC, Schwinger RHG, Skurk C, Sramko M, Tavazzi G, Thiele H, Villanova L, Morici N, Wechsler A, Westenfeld R, Winzer E, and Westermann D

Subjects
Humans, Shock, Cardiogenic etiology, Shock, Cardiogenic therapy, Stroke Volume, Retrospective Studies, Intra-Aortic Balloon Pumping methods, Ventricular Function, Left, Treatment Outcome, Heart Failure complications, Heart-Assist Devices adverse effects
Abstract

Aims: Despite its high incidence and mortality risk, there is no evidence-based treatment for non-ischaemic cardiogenic shock (CS). The aim of this study was to evaluate the use of mechanical circulatory support (MCS) for non-ischaemic CS treatment., Methods and Results: In this multicentre, international, retrospective study, data from 890 patients with non-ischaemic CS, defined as CS due to severe de-novo or acute-on-chronic heart failure with no need for urgent revascularization, treated with or without active MCS, were collected. The association between active MCS use and the primary endpoint of 30-day mortality was assessed in a 1:1 propensity-matched cohort. MCS was used in 386 (43%) patients. Patients treated with MCS presented with more severe CS (37% vs. 23% deteriorating CS, 30% vs. 25% in extremis CS) and had a lower left ventricular ejection fraction at baseline (21% vs. 25%). After matching, 267 patients treated with MCS were compared with 267 patients treated without MCS. In the matched cohort, MCS use was associated with a lower 30-day mortality (hazard ratio 0.76, 95% confidence interval 0.59-0.97). This finding was consistent through all tested subgroups except when CS severity was considered, indicating risk reduction especially in patients with deteriorating CS. However, complications occurred more frequently in patients with MCS; e.g. severe bleeding (16.5% vs. 6.4%) and access-site related ischaemia (6.7% vs. 0%)., Conclusion: In patients with non-ischaemic CS, MCS use was associated with lower 30-day mortality as compared to medical therapy only, but also with more complications. Randomized trials are needed to validate these findings., (© 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Published
2023
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16. Single-Site Experience with an Automated Artificial Intelligence Application for Left Ventricular Ejection Fraction Measurement in Echocardiography.

Author

Sveric KM, Botan R, Dindane Z, Winkler A, Nowack T, Heitmann C, Schleußner L, and Linke A

Abstract

Left ventricular ejection fraction (LVEF) is a key parameter in evaluating left ventricular (LV) function using echocardiography (Echo), but its manual measurement by the modified biplane Simpson (MBS) method is time consuming and operator dependent. We investigated the feasibility of a server-based, commercially available and ready-to use-artificial intelligence (AI) application based on convolutional neural network methods that integrate fully automatic view selection and measurement of LVEF from an entire Echo exam into a single workflow. We prospectively enrolled 1083 consecutive patients who had been referred to Echo for diagnostic or therapeutic purposes. LVEF was measured independently using MBS and AI. Test-retest variability was assessed in 40 patients. The reliability, repeatability, and time efficiency of LVEF measurements were compared between the two methods. Overall, 889 Echos were analyzed by cardiologists with the MBS method and by the AI. Over the study period of 10 weeks, the feasibility of both automatic view classification and seamlessly measured LVEF rose to 81% without user involvement. LVEF, LV end-diastolic and end-systolic volumes correlated strongly between MBS and AI (R = 0.87, 0.89 and 0.93, p < 0.001 for all) with a mean bias of +4.5% EF, -12 mL and -11 mL, respectively, due to impaired image quality and the extent of LV function. Repeatability and reliability of LVEF measurement ( n = 40, test-retest) by AI was excellent compared to MBS (coefficient of variation: 3.2% vs. 5.9%), although the median analysis time of the AI was longer than that of the operator-dependent MBS method (258 s vs. 171 s). This AI has succeeded in identifying apical LV views and measuring EF in one workflow with comparable results to the MBS method and shows excellent reproducibility. It offers realistic perspectives for fully automated AI-based measurement of LVEF in routine clinical settings.

Published
2023
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