What do the special task forces of the Federal Police and heart surgeons have in common? Maybe the public impression of a burst in power. Or the great responsibility both specialties carry and the expertise in their respective field. The more you think about it, the more parallels become visible.
Background. The LUCAS-2/-3 (Lund University Cardiopulmonary Assist System-2/-3) was developed for automatic chest compressions during cardiopulmonary resuscitation (mechanical CPR or MCPR) and often allows a patient suffering from cardiac arrest to be taken to the cardiac catheterisation room. We report the clinical outcomes of percutaneous coronary interventions (PCI) performed in cardiac arrest patients under automatic MCPR devices.
Methods. We retrieved all patients with cardiac arrest who were referred to PCI under MCPR devices from the Cardio-FR database (003-REP-CER-FR) from January 2016 to December 2021. Patients who were hemodynamically stable at the time of the coronary examination/intervention (even those who had been resuscitated immediately before) were excluded from the analysis. Baseline patient and procedure characteristics were collected. The primary outcome was the return of spontaneous circulation (ROSC).
Results. Of all patients who were on MCPR at the cardiac catheterisation room, 11 still required active CPR during coronary examination/intervention and were included in the analysis. Mean age was 67.9±10 years, 9 were male. The MCPR device was initiated on average after 8.5±8.1 minutes. All patients had ventricular defibrillation and received an average of 3.4±3.6 shocks and 82% adrenaline boluses. The MCPR was used for an average of 51.1±34.4 minutes. Total resuscitation time was on average 59.6±38.3 minutes. Of the 11 patients, 9 underwent ad hoc PCI. ROSC was achieved in 4 patients after 36.5±49.8 min. The survival was 36% (4 patients) at 24 hours and 27% (3 patients) at 3 months. Only one of the patients resuscitated for >25 minutes survived. Patients with in-hospital cardiac arrest were associated with shorter ROSC (p0.01), shorter resuscitation time (p=0.009) and better survival (p=0.03) than patients with out-of-hospital cardiac arrest.
Conclusions. MCPR allows patients in cardiac arrest to reach the cardiac catheterisation room. However, the prognosis is grim with high mortality. One patient survived after >25 minutes of mechanical resuscitation.
The influence of sex – considered to be the biological differences between women and men – and gender – considered to be sociologically constructed differences based on membership in one of the two sex categories – appears to be particularly important for noncommunicable diseases such as type 2 diabetes (T2D) and obesity. Many T2D risk factors are behavioral and greatly, but not only, influenced by gender-related determinants, making them modifiable factors. In this review, we focus on sex-related biological differences in the prevalence of diabetes and its biological risk factors, such as obesity, fat distribution, metabolic syndrome, and glucose homeostasis, with a particular interest in the influence of menopause and pregnancy. Men have had globally a higher prevalence of T2D than women with regional, socioeconomic, and age-related variations. Overall, women tend to be more protected from cardiometabolic diseases before menopause than men. However, hormonal variation during the course of life, particularly during menopause, modifies these risks. Similarly to T2D, there are differences in the prevalence of obesity between women and men that change during the lifespan. The link between obesity and T2D seems to be stronger in women compared to men. Various hormones can impact on glycemic levels and on body fat and their concentrations and effect on metabolic parameters can differ by sex. Understanding and acknowledging sex-related differences in T2DM and its risk factors is important to improve health research and lead to better clinical care and more suitable preventive policies and programs for both women and men.
The prevalence of heart failure (HF) is increasing, mainly due to population aging. There are important biological (sex) and sociocultural (gender) differences in epidemiology, pathophysiology, phenotype, prognosis, and treatment of HF between women and men. While the overall lifetime risk of HF is similar between men and women, women with HF are older, have more comorbidities, and a higher incidence of heart failure with preserved ejection fraction (HFpEF) than men. Men instead present a predisposition to the development of heart failure with reduced ejection fraction (HFrEF) due to their higher incidence of coronary artery disease. Sex differences are also notable in the penetrance of genetic cardiomyopathies, HF risk factors as well as in sex-specific conditions such as peripartum cardiomyopathy (PPCM), cancer treatment-induced cardiomyopathy, and Takotsubo cardiomyopathy. Although women with HF have a better age-adjusted prognosis than men, they experience worse quality of life. Underpinning current sex disparities in HF, HF treatment is limited by a profound underrepresentation of women in clinical trials, which has resulted in a lesser understanding of disease behaviour in female patients and in treatment guidelines that are predominantly based on male-derived data. In addition, a full understanding of the impact of sociocultural gender on HF management and disease course is lacking. This review outlines the key sex differences with respect to clinical characteristics, pathophysiology, and therapeutic responses to HF treatments. Finally, we address existing knowledge gaps in sex-specific mechanisms, optimal drug doses for women and sex-specific criteria for device therapy and heart transplantation.
With the continuous improvement of therapies against breast cancer, the long-term onset of cardiovascular disease (CVD) is becoming increasingly relevant for both cardiologists and oncologists. Not only CVD arises from known cardiac side effects of several anti-cancer therapies, but cancer itself seems to promote CVD. On the other hand, there is increasing evidence that CVD such as myocardial infarction and heart failure predispose to future development of cancer. The fast-developing field of cardio-oncology aims to characterize cancer patients in order to implement effective tools for surveillance and prevention of cardiovascular adverse events and to raise awareness for the increased cancer incidence in patients with CVD. The aim of this review is to highlight cardiovascular side effects and toxicities of some of the most important breast cancer therapies and to provide an overview of what is known on the complex interplay between CVD and breast cancer.