Faculty Bibliography

Iron deficiency has been reported in up to 50% of patients with heart failure (HF), irrespective of the presence of anemia. Although no formally validated definition for iron deficiency in patients with HF exists, both the American and European Heart Failure Guidelines define iron deficiency as a serum ferritin of < 100 ng/ml, or a ferritin of 100-299 ng/ml, provided that the transferrin saturation (TSAT) is less than 20%. The presence of iron deficiency has been associated with poor patient-oriented outcomes, prompting the assessment of intravenous (IV) iron as a treatment for iron deficiency. This review summarizes the totality of the evidence on the diagnosis, evaluation and treatment of patients with iron deficiency. In addition, we highlight our approach to patients with HF with reduced ejection fraction and highlight areas for both clinical improvement and research.

Durable left ventricular assist devices (dLVAD) remain a lifesaving therapy in patients with stage D heart failure that is refractory to conventional medical therapies. Owing to improvements in technology and patient outcomes, the number of patients supported with dLVADs has increased over the past decade. Despite this growing population, there are few resources for cardiovascular intensivists that integrate epidemiology, diagnostic workup and multidisciplinary medical management of acute emergencies in patients supported with dLVADs.

OBJECTIVES/OBJECTIVE:To evaluate the efficacy of intraoperative hemoadsorption (HA) during cardiopulmonary bypass (CPB) in reducing acute kidney injury (AKI) and other major postoperative complications in patients undergoing cardiac surgery. DESIGN/METHODS:Systematic review and meta-analysis of randomized controlled trials (RCTs) conducted in accordance with PRISMA guidelines, with a protocol registered in PROSPERO (CRD42025638656). SETTING/METHODS:Multicountry, multi-institutional hospital-based studies of patients undergoing cardiac surgery with CPB. PARTICIPANTS/METHODS:A total of 1133 patients from 16 RCTs comparing CPB with versus without intraoperative HA. INTERVENTIONS/METHODS:Intraoperative HA using sorbent-based devices (e.g., CytoSorb, oXiris, Jafron HA 380). MEASUREMENTS AND MAIN RESULT/RESULTS:Primary outcomes included AKI incidence, renal replacement therapy requirement, and mortality. Secondary outcomes included intensive care unit/hospital length of stay, postoperative delirium, stroke, sepsis, and reoperation. HA significantly reduced the incidence (RR 0.75; 95% CI 0.59-0.96; p = 0.020). No significant differences were observed for renal replacement therapy (RR 0.64; p = 0.58) or mortality (RR 0.96; p = 0.861). No significant effects were found for secondary outcomes. CONCLUSIONS:Intraoperative HA during CPB reduces the risk of AKI but does not significantly affect other major postoperative outcomes. Further studies are needed to determine its clinical relevance and optimal patient selection.

BACKGROUND/UNASSIGNED:The Society for Cardiovascular Angiography & Intervention (SCAI) SHOCK stages classification schema risk-stratifies patients with cardiogenic shock (CS). The updated 2022 SCAI SHOCK stages removed the use of respiratory support, either noninvasive (NIV) or invasive mechanical ventilation (IMV), as a criterion. We sought to investigate the impact of receiving respiratory support on in-hospital mortality for patients with CS stratified by SCAI SHOCK stages. METHODS/UNASSIGNED:Utilizing a nationally representative database, adults aged ≥18 years admitted from 2015 to 2023 with a diagnosis of CS were used to assess for the association between respiratory support, either NIV or IMV, on the first day of admission, with in-hospital mortality stratified by SCAI SHOCK stages B through E. We utilized inverse probability treatment weighting, adjusting for demographic characteristics, comorbidities, hospital characteristics, and vasoactive/mechanical circulatory support. RESULTS/UNASSIGNED:We identified 317,325 patients with CS, including 2.4%, 39.0%, 34.2%, and 24.5% with SCAI stages B through E, respectively. Respiratory support was utilized in 38.0% (n = 120,594) of patients, with 5.4% receiving NIV, 33.8% receiving IMV, and 1.1% receiving both on the first day of admission. After inverse probability treatment weighting, respiratory support use remained associated with an increased mortality overall (weighted mean mortality increase of 18.3%; 95% CI, 17.9%-18.7%), when stratified by each SCAI SHOCK stage and in several key sensitivity analyses. CONCLUSIONS/UNASSIGNED:Compared with patients not receiving respiratory support, the use of respiratory support was associated with an increased mortality for each SCAI stage of CS and could be a simple, easily identifiable CS risk modifier.

BACKGROUND:The ARIES-HM3 trial demonstrated the safety and effectiveness of aspirin elimination from the antithrombotic regimen after HeartMate 3 (HM3) LVAD implantation. We explored the interaction of atrial fibrillation, diabetes mellitus and obesity [AF/DM/Ob] with aspirin elimination on hemocompatibility-related adverse events (HRAE) at 1 year post-implant. METHODS:level suppression. RESULTS:levels. CONCLUSION/CONCLUSIONS:Among ARIES-HM3 trial patients with AF/DM/Ob, either comorbidity alone or in combination, did not alter the safety or observed effect size on bleeding reduction with aspirin elimination in patients implanted with the HM3 LVAD.

BACKGROUND:The cardiac intensive care unit (CICU) has evolved into a complex care environment for critically ill patients with cardiac and noncardiac diseases. OBJECTIVES/OBJECTIVE:Our goal was to describe contemporary CICU care delivery and the role of cardiologists therein. METHODS:The American College of Cardiology administered a 42-item survey to U.S. and Canadian CICU-focused cardiologists designed to capture models of care delivery and workforce demographics. RESULTS:The survey was distributed by email to 1,085 U.S. and Canadian CICU cardiologists. The response rate was 20%, yielding a final sample of 166 after excluding trainees and those not board-certified or board-eligible in cardiology. The majority were from medium (34%) or large (64%) academic (81%) medical centers. Fifty-three percent reported working in high-intensity care models and 61% reported that their CICU was dedicated exclusively to medical cardiology patients. Critical care medicine-boarded physicians contributed to care through consultative (53%), comanagement (29%), and/or primary roles (44%). Subspecialization beyond cardiology was common (82%), with critical care medicine being most frequent (46%), followed by echocardiography (37%), advanced heart failure (21%), and interventional cardiology (16%). Limitations include the low survey response rate, which raises the risk of selection bias. CONCLUSIONS:This study provides insight into the current landscape of cardiac critical care delivery in North America, highlighting wide variation in staffing models, subspecialty training, and clinical practice. Our findings highlight growing trends toward high-intensity staffing models that incorporate critical care medicine-boarded physicians in consultative, comanagement, and or primary roles.