Blood biomarkers for the prediction of outcome after cardiac arrest: an international prospective observational study within the Targeted Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial Marion Moseby-Knappe, Helena Levin, Susann Ullén, Henrik Zetterberg, Kaj Blennow, Alice Lagebrant, Josef Dankiewicz, Janus C Jakobsen, Gisela Lilja, Alistair D Nichol, Glenn Eastwood, Kate Ainscough, Matthew J C Thomas, Anders M Grejs, Thomas R Keeble, Christian Rylander, Joachim Düring, Matt P Wise, Jan Hovdenes, Christian Storm, Ola Borgquist, Alain Cariou, Nicolas Deye, Jean-Baptiste Lascarrou, Jonathan Bannard-Smith, Johan Undén, Philippe Vignon, Stéphane Legriel, Ondřej Šmíd, David Pogson, Jiri Karasek, Peter J McGuigan, Michael Joannidis, Hans Kirkegaard, Jeremy Bewley, Steffen Christensen, Maria Rita Maccaroni, Anna Valerianova, Andreas Lundin, Anna Lybeck, Christoph Leithner, Filip Varhaník, Katie Sweet, Andrew Walden, Hans Friberg, Tobias Cronberg, Niklas Nielsen, Jan Belohlávek, Ronny Beer, Frank Hartig, Raimund Helbok, Sebastian Klein, Andreas Peer, Michal Otáhal, Marek Flaksa, David Kemlink, Jan Malík, Jan Rulíšek, Michal Šíranec, Zdenek Stach, Petra Zavadilova, Anne Adolfsson, Anna Bjärnroos, Kajsa Jönsson, Susann Schrey, Erik Westhall, Frida Antonsson, Git Bergman, Jörgen Gamroth, Maria Meirik, Zoe Garland, Lisa Grimmer, Bethany Gumbrill, Lucy Howie, Zoe Garland, Rebekah Johnson, Chloe Searles, Agnieszka Skorko, Victoria Taylor, Deborah Peripoorani, Peter Juhl-Olsen, Ida Katrine Thomsen, Lisa Gregersen Østergaard, Julien Charpentier, Pierre Dupland, Arianne Gavaud, Pierre Jaubert, Mathieu Jozwiak, Nathalie Marin, Jean-Paul Mira, Frederic Pene, Guillaume Savary, Bruno Megarbane, Pierre Mora, Katarina Rudolfsson, Helena Sandberg, Martin Thorsson, Kristin Savolainen, Maria Hansbo, Malin Helliksson, Björne Nödtveidt, Johan Sanner, Victoria Sem, Gill Adams, Rajesh K Aggarwal, Jo-Anne Cartwright, Steven Church, Gerald J Clesham, Denise Webster, John R Davies, Kelly Farrell, Reto Gamma, Laetitia Sutterlin, Isabelle Malissin, Nicolas Peron, Karim Jaffal, Hélène Migueres, Aymen Mrad, Caroline Grant, Foued El Gharbi, Sebastian Voicu, Hugo Bellut, Guillaume Lacave, Marine Paul, Carole Ouisse, Thomas Daix, Camilla Sund Lindquist, Stefan Persson, Ida Berglund, Eric Bergström, Cathrine Törnqvist, Ingela Östman, Jade Cole, Helen Hill, Michelle Davies, Jane Harding, Rohan Jagathesan, Alamgir Kabir, Paul A Kelly, Lauren Kittridge, Arnaud Desachy, Marco Mion, Naveen Nain, Raghunath Nalgirkar, Bruno Evrard, Bruno Francois, Anne-Laure Fedou, Marine Goudelin, Jens Nee, Roman Desta Lindgren, Elisabeth Myhrman, Birgitta Ryding, Patrik Martner, Louise Martinell, Simon Schmidbauer, Tim Schröder, Åse Rasmussen, Andreas Espinoza, Kristin Wisløff-Aase, Simon Jakobsson, Sven Olav Løstegaard, Ingrid Eiving, Marita Ahlqvist, Rhys Davies, Jenny Brooks, Angharad Williams, Jacqueline Curtain, Emma Thomas, Stephen Fernandez, Matt Morgan, Oscar Lundberg, Mattias Bergström, Julie Highfield, Eve Cocks, Gyanesh Namjoshi, Stacey Pepper, Emily Redman, Nicholas M Robinson, Jeremy Sayer, Amanda Solesbury, Kare H Tang, Sali Urovi, Kunal Waghmare, Ingrid Didriksson, Patrik Johnsson, Marina Larsson, Stefan Hau-Olsson, Petrea Frid, Fredrik Buchwald, Lydia Pennant, Sofia Rose, Stephen Haffey, Aisling O'Neill, Kathryn Ward, Anna Chillingworth, Julie Cloake, Libby Cole, Hilary Galvin, Noel Watson, Teresa Webber, Parminder Bhuie, Nicola Jacques, Zoe Daly, Steve Rose, Rachael Quayle, Anila Sukumaran Lancet Respiratory Medicine, 2026 BACKGROUND: Prognostication of recovery in patients who are unconscious following cardiac arrest can be guided by concentrations of brain injury biomarkers in the blood. The optimal biomarker and cutoff concentrations for the prediction of outcome remain unknown. In this study, we aimed to evaluate which biomarker of brain injury is most accurate for predicting functional outcome after cardiac arrest, and to evaluate cutoff levels for the prediction of good and poor outcome. METHODS: This study was a prospective, international, observational biomarker study within the international Targeted Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial including adults aged 18 years or older with a presumed cardiac cause or unknown cause of arrest. Patients were recruited from 24 European hospitals. Serum samples were collected at 0, 24, 48, and 72 h after admission to intensive care units. Concentrations of neuron-specific enolase, S100, neurofilament light, and glial fibrillary acidic protein were analysed with Elecsys electrochemiluminescence immunoassays. The primary outcome was 6-month good (modified Rankin Scale 0-3) or poor (modified Rankin Scale 4-6) functional outcome. Prognostic accuracy was evaluated by the area under the receiver operating characteristic curve (AUROC). The biomarker with the highest AUROC at each timepoint was compared with that of the second highest marker using DeLong's test. As pre-specified, to account for multiple comparisons using Bonferroni correction, a p value of less than 0·0125 was considered statistically significant. FINDINGS: Between April, 2018, and January, 2020, 113 (12%) of 932 eligible patients were excluded due to death, missed sampling, or missing outcome data. 661 (81%) of 819 included patients were male and 158 (19%) were female, the mean age was 64 years (SD 13), and 418 (51%) had a poor outcome. In patients who were unconscious, neurofilament light predicted functional outcome with AUROCs at 0, 24, 48, and 72 h of 0·77 (95% CI 0·73-0·80), 0·92 (0·90-0·94), 0·93 (0·91-0·95), and 0·93 (0·91-0·95), respectively. Glial fibrillary acidic protein achieved an AUROC of 0·74 (95% CI 0·70-0·77) at 0 h, 0·87 (0·84-0·90) at 24 h, 0·87 (0·84-0·90) at 48 h, and 0·87 (0·84-0·91) at 72 h. Neuron-specific enolase predicted functional outcome with an AUROC of 0·61 (95% CI 0·56-0·65) at 0 h, 0·78 (0·75-0·82) at 24 h, 0·85 (0·81-0·88) at 48 h, and 0·86 (0·82-0·89) at 72 h. S100 achieved an AUROC of 0·74 (95% CI 0·71-0·78) at 0 h, 0·84 (0·81-0·87) at 24 h, 0·79 (0·75-0·82) at 48 h, and 0·78 (0·74-0·82) at 72 h. Neurofilament light had a statistically significantly higher AUROC than the second highest marker, glial fibrillary acidic protein, at 24, 48, and 72 h (p<0·0001), but not at 0 h (p=0·27). INTERPRETATION: Neurofilament light is a highly accurate predictor of long-term outcome after cardiac arrest and superior to other relevant biomarkers evaluated in this study. FUNDING: The Swedish Research Council (Vetenskapsrådet), the Swedish Heart-Lung Foundation, the Stig and Ragna Gorthon Foundation, the Knutsson Foundation, the Laerdal Foundation, the Hans-Gabriel and Alice Trolle-Wachtmeister Foundation for Medical Research, the Bundy Academy at Lund University, Regional Research Support in Skåne, the Swedish Government, and Roche Diagnostics International.
Classifications of haemodialysis vascular access-induced limb ischaemia Katerina Lawrie, Stephen O’Neill, Jan Malik, Peter Balaz, Michael Corr, Petr Waldauf Journal of Vascular Access, 2026 Vascular access-induced limb ischaemia is a potentially severe complication. A classification system for clinical assessment and treatment would be a useful clinical tool for standardising management. There are several classifications described in the current literature using inconsistent terminology. The aim of this review is to identify all the reported classification systems of vascular access-induced limb ischaemia and to present a comprehensive summary. PubMed, Scopus, Web of Science, Google Scholar and the ClinicalTrials.gov registry were searched from inception to the 17th of October 2024. All articles containing newly proposed classifications regarding haemodialysis vascular access were eligible. There were no restrictions to the full text’s language or the type of study. The classifications were evaluated using a modified Buchbinder’s classification critical appraisal tool. From 4694 screened papers, 59 full-text papers were retrieved, and eight articles contained classifications based only on the severity of vascular access-induced limb ischaemia. According to the modified Buchbinder critical appraisal, the classifications identified were overall good quality. The systems are all based on clinical symptoms but use inconsistent terminology and do not consider various aetiologies. We present a summary and propose a unified classification based on the anatomical location of the pathology, which leads to high- or low-flow ischaemia, along with a suitable therapeutic approach for each type.
Improvement of the left atrial systolic function after a surgical reduction of the high flow arteriovenous fistula Vaclav Lejsek, Anna Valerianova, Kristyna Michalickova, Kristina Buryskova Salajova, Marcela Slavikova, Martin Rybar, Jan Malik Frontiers in Medicine, 2026 Background High-output heart failure (HOHF) is a distinct cardiac complication in end-stage kidney disease (ESKD) patients with high-flow arteriovenous fistulae (AVFs). While AVF flow reduction improves hemodynamics and left atrial (LA) volume, its effect on LA systolic function remains unclear. Objective To evaluate changes in left atrial systolic function and left ventricular (LV) filling pressures following surgical AVF flow reduction in haemodialysis patients with high-flow fistulae. Methods In this prospective, single-centre interventional study, 28 ESKD patients (mean age 63 ± 15 years) with high-flow AVFs (&gt;1,500 mL/min) and clinical heart failure (NYHA ≥ II) underwent surgical AVF flow reduction. Echocardiographic assessments were performed before and 6 weeks after intervention. LA ejection fraction (LAEF) and LV filling pressures (E/e′ ratio) were determined from digitally stored imaging data. Results Surgical intervention reduced AVF flow by approximately 50% [2,525 [1,388] to 1,250 [700] mL/min, p = 0.00006]. LA volume index decreased significantly (44.7 ± 17.3 to 38.5 ± 15.4 mL/m 2 , p = 0.01), accompanied by an improvement in LAEF (49.6 ± 14.9% to 53.2 ± 13.5%, p = 0.046). Dyspnoea improved or resolved in all patients. Baseline LAEF correlated negatively with age, LA volume index, and NYHA class, but no independent predictors of post-operative LAEF improvement were identified. Conclusions In patients with high-flow AVF–associated HOHF, surgical AVF flow reduction leads to a significant improvement in LA systolic function alongside decreased LA volume. These findings suggest partial reversibility of atrial remodeling induced by chronic hyperkinetic circulation and highlight the potential cardiovascular benefits of AVF flow optimization in selected dialysis patients.
Correction: Improvement of the left atrial systolic function after a surgical reduction of the high flow arteriovenous fistula (Frontiers in Medicine, (2026), 12, (1732862), 10.3389/fmed.2025.1732862) Vaclav Lejsek, Anna Valerianova, Kristyna Michalickova, Kristina Buryskova Salajova, Marcela Slavikova, Marian Rybar, Jan Malik Frontiers in Medicine, 2026 Chronic kidney disease (CKD) is a condition associated with high morbidity and mortality, affecting an estimated 700 million individuals globally, and posing a substantial economic and healthcare burden: diabetes and hypertension account for the majority of cases [1] [2].Cardiovascular disease is the leading cause of death in the CKD population [3]. In patients with endstage kidney disease (ESKD) requiring maintenance dialysis, cardiovascular disease accounts for approximately 40% of all deaths. [3] This increased cardiovascular risk is partly due to traditional atherosclerotic risk factors common in the CKD population such as hypertension, diabetes, and smoking as well as CKD-specific mechanisms, including chronic inflammation, endothelial dysfunction, accumulation of uremic toxins, and disturbances in calcium-phosphate metabolism) [4].Chronic heart failure (CHF) is also highly prevalent in patients with CKD, affecting nearly 44% of individuals on dialysis in the United States [5]. The most common phenotype is heart failure with preserved ejection fraction (HFpEF), typically associated with diastolic dysfunction due to left ventricular hypertrophy and stiffening, leading to elevated filling pressures [6,7]. A distinct mechanism contributing to heart failure in dialysis patients is hyperkinetic circulation, which may result from fluid overload, anaemia, systemic inflammation, or the presence of a high-flow arteriovenous fistula (AVF) used for maintenance haemodialysis [8]. Hyperkinetic circulation is a key contributor to a specific heart failure phenotype known as high-output heart failure (HOHF). This phenotype is characterized by typical signs and symptoms of heart failure in the presence of an elevated cardiac index (>3.9 L/min/m²) and increased circulating biomarkers, particularly brain natriuretic peptide (BNP) [9]. HOHF is echocardiographically associated with a complex array of structural and functional cardiac alterations, including biventricular dilation, secondary atrioventricular valves regurgitation, left ventricular hypertrophy, increased left ventricular filling pressures, and impaired diastolic function [10,11]. Elevated left atrial (LA) pressure results in LA enlargement, and such pressure overload is a recognized risk factor for atrial fibrillation, which is also frequently encountered in the CKD population [12].Although often considered a passive chamber by non-cardiologists, the left atrium plays a crucial role in cardiac function. Its systolic (contractile) function contributes significantly to late diastolic filling of the left ventricle, and its reservoir function helps unloading the pulmonary venous pressure, thereby mitigating pulmonary congestion. However, in ESKD patients on long-term haemodialysis, both left atrial dilation and impaired contractile function have been consistently documented [13,14]. Previous studies have demonstrated that surgical reduction of AVF flow in patients with haemodialysis-associated HOHF leads to a decrease in left atrial volume and left ventricular filling pressures. However, it remains unclear whether these changes are accompanied by an improvement in left atrial systolic function. In other words: Does LV filling pressure improvement after AVF flow reduction accompany improvement in the left atrial systolic function?" Therefore, we analysed left atrial systolic function and left ventricular filling pressures in a cohort of patients undergoing surgical AVF flow reduction due to high-flow fistulae.This study represents a secondary analysis of previously published prospective investigations assessing the effects of arteriovenous fistula (AVF) flow reduction on cardiovascular parameterssee references [10,11] for details.This was a prospective, single-centre, interventional study approved by the local institutional ethics committee. The study was approved by the Ethical committee of the General University Hospital in Prague. All participants provided written informed consent, and the study adhered to the principles outlined in the Declaration of Helsinki.Patients aged ≥18 years with a high-flow AVF (defined as AVF flow > 1500 mL/min), documented heart failure symptoms (New York Heart Association [NYHA] class II or higher), and sinus rhythm were eligible for inclusion. Surgical AVF flow reduction was performed using one of the following techniques: banding (with or without patch) or revision using distal inflow (RUDI). Procedure selection was according to the vascular surgeon (MS) with the experience of >30years. For this secondary analysis, we included only patients with sinus rhythm and adequate echocardiographic video loops for adequate left atrial border detections.Patients underwent clinical and imaging evaluations before and six weeks after the surgical intervention. Haemodialysis settings were maintained unchanged throughout the study period. To minimize the influence of volume status, all imaging examinations were conducted at a standardized time interval after the most recent dialysis session.Echocardiographic and AVF ultrasonographic assessments were performed using a Vivid E9 system (GE Healthcare, USA), and all data were digitally stored for off-line analysis using EchoPAC software (GE Healthcare, USA).For this secondary analysis, left atrial ejection fraction (LAEF) was derived from the archived echocardiographic video loops. The left atrial largest (=diastolic, LADV) and smallest (=systolic, LASV) volumes were measured by the Simpson method from the apical 4 and 2 chambers views. The left atrial ejection fraction (LAEF) was calculated as follows: LAEF = (LADV-LASV)/LADV and expressed in percentages. Left ventricular filling pressures were estimated using standard Doppler parameters, specifically the E/e′ ratio, where E represents the transmitral early filling velocity and e′ the early diastolic mitral annular velocity. Left ventricular diastolic function was graded according to current echocardiographic guidelines.Dyspnoea was assessed via NYHA functional classification. Blood pressure was measured using an automated BP monitor (Omron, Japan). All parameters were obtained non-invasively. Statistical analyses were conducted using Statistica software (StatSoft, USA).Distribution of all used variables was calculated. Data distribution was assessed by the Shapiro-Wilk test and visual inspection of histograms. All but one variables had normal distribution. Therefore, data are presented as mean±SD and differences calculated using the paired t-test. Only Qa had a non-Gaussian distribution and is presented as median (quartile range) and differences calculated using the Wilcoxon matched pairs test. P-values below 0.05 were considered significant. Covariates of the left atrial ejection fraction were calculated by Pearson correlation analysis.Power analysis: High-flow AVF is a relatively rare disease. When we were considering to perform this study, we had experience with 3 patients, in whom LAEF increased. We performed a power analysis to estimate the sample size required in the intervention group to ensure high probability of detecting the expected effect. Based on these preliminary 3 pilot patients, we assumed a mean change from baseline LAEF 51% to 56%. Using a two-tailed alpha 0.05, statistical power of 0.80 and assumed between group correlation 0.8, the analysis indicated that a minimum of 25 patients would be required. Our relatively low sample size fulfilled these assumptions.We enrolled 28 Caucasian patients (mean age 63.3 ± 15.3 years) with high-flow arteriovenous fistulae (AVF), all undergoing maintenance haemodialysis.The aetiology of ESKD in the cohort was as follows: Hypertension (5 pts), Glomerulopathy (3 pts), IgA nephropathy (4 pts), Diabetes mellitus (5 pts), Polycystic kidney disease (3 pts), Tubulointerstitial nephritis (3 pts), Obstructive nephropathy (3pts) and Multiple myeloma (2 pts).Following surgery, AVF flow was significantly reduced by approximately 50% -from 2525 (1388) mL/min to 1250 (700) mL/min, p = 0.00006. Dyspnoea resolved completely in 20 patients (NYHA class II prior to surgery, NYHA I after the surgery) and improved in the remaining 8 patients (from NYHA class III to II). Further hemodynamic and echocardiographic outcomes are detailed in Table 1. Two different procedures of surgical flow reduction were used: banding and RUDI. The latter was used in patients with higher initial AVF flow and led to more pronounced flow decrease. However, there was no significant difference in the heart effects (see Table 2 for details).At baseline, left atrial ejection fraction (LAEF) showed the following significant correlations: Negative correlations with age (r = -0.43, p = 0.02), left atrial volume index (LAVi) (r = -0.64, p < 0.0001) and with NYHA functional class (r = -0.56, p = 0.02). LAEF was positively related to the diastolic blood pressure (r = 0.43, p = 0.026). No significant predictors of postoperative increase in LAEF were identified.The main finding of this study is that, in patients with high-output heart failure (HOHF) caused by high-flow arteriovenous fistulae (AVFs), surgical flow reduction leads not only to a decrease in left atrial volume, but also to a significant improvement in left atrial systolic function, as reflected by the increase in left atrial ejection fraction (LAEF). Before surgical intervention, LAEF was inversely correlated with left atrial volume, patient age, and NYHA functional class, suggesting that older patients and those with more advanced heart failure tend to have more impaired atrial function.The presence of ESKD treated by maintenance haemodialysis is associated with impaired left atrial systolic function [13][14][15] even among children, where it was related to fibroblast growth factor-23 levels [16]. Our findings therefore suggest a unique and potentially reversible mechanism of atrial dysfunction in the context of high AVF flow. Unlike volume reduction achieved through a single haemodialysis session, which typically does not improve LAEF [14,15], surgical AVF flow reduction appears to exert a more profound and sustained effect on left atrial function. This distinction highlights that the pathophysiological impact of chronic high-flow AVFs cannot be equated with transient fluid overload, and that chronic hyperdynamic circulation induces more complex structural and functional remodelling of the atrium. Apart from the conversion of atrial fibrillation to sinus rhythm [16], studies documented improved left atrial systolic function after physical training. In non-CKD heart failure patients, a supervised concurrent training improves the left atrial contractile function [17]. Speculatively, the hyperkinetic circulation due to a high-flow arteriovenous fistula could have some similar effects as physical training.Interestingly, the main covariates of the left atrial systolic function prior to flow reduction were age and left atrial volume also in these patients with HOHF. We observed the same associations in in ESKD patients on haemodialysis without HOHF [14]. Therefore, these effects seem to be strong and independent. Indeed, left atrial systolic function worsens with age also in the general population [18]. Decreased left atrial systolic function predicts development of atrial fibrillation in non-CKD heart failure patients [19].Importantly, left atrial dysfunction should not be viewed in isolation. It frequently coexists with left ventricular diastolic or systolic dysfunction. Indeed, several studies have demonstrated a strong association between impaired LA systolic function and elevated left ventricular filling pressures [20], reinforcing the concept that left atrial performance serves as an integrated marker of overall diastolic burden.Possible limitation of our study could be the use of the "classical" left atrial assessment by echocardiography. Nowadays, many authors prefer the left atrial strain. However, lower frame rate and other settings of the echocardiography device in this secondary analysis study prevented adequate use of the left atrial strain. Nevertheless, the left atrial systolic function assessment by strain is the least precise [21] and therefore, classical LAEF is considered as a more robust method. Other limitations include smaller sample size (caused by a relatively low occurrence of the high flow fistulas and similar to other studies [22][23][24]), single-centre design and especially short follow-up that precludes evaluation of flow reduction durability, long-term atrial remodelling, atrial fibrillation incidence, or clinical outcomes.Taken together, our findings support the hypothesis that reducing AVF flow in selected dialysis patients with HOHF may not only improve haemodynamics but may also reverse some aspects of atrial remodelling, potentially leading to better cardiovascular outcomes. These changes are similar to that after a physical training in heart failure patients. Further prospective studies with larger cohorts and longer follow-up are warranted to assess the clinical significance of these echocardiographic improvements, particularly with respect to atrial arrhythmias, exercise tolerance, and quality of life.
Negative impact of very mild volume overload on the heart function in patients on chronic hemodialysis Kristyna Michalickova, Jan Malik, Anna Valerianova, Zdenka Hruskova, Vladimira Bednarova, Frantisek Lopot, Kristina Buryskova Salajova, Zuzana Hladinova, Tereza Vychodilova, Satu Sinikka Pesickova, Katarina Rocinova, Monika Tothova, Barbora Szonowska, Marketa Kratochvilova, Lucie Kaiserova, Simona Janakova, Vladimir Tesar Renal Failure, 2026 OBJECTIVES: Heart failure is associated with higher mortality of hemodialysis patients. Fluid overload is a major risk factor for cardiovascular disease in these patients, but it is frequently clinically silent. The optimal assessment of ideal dry weight is still searched for. We hypothesized that even very mild fluid overload would be associated with the left ventricular ejection fraction and on the size of heart chambers. METHODS: Inclusion visit data of a cohort observation study were analyzed: bioelectrical impedance, echocardiography with hemodynamic estimations and basic laboratory tests. Fluid overload was defined by using the fluid overload/extracellular water index (FO/ECW, relative hydration index) > median value. Moreover, analyses according to FO/ECW quartiles were performed. All these measurements were done within an hour and at least 24 h after the previous hemodialysis. RESULTS: = 0.0002), dilatation of all heart chambers, more pronounced hypertrophy of the left ventricle with higher NTproBNP, significantly lower serum albumin levels and lower body mass. The relationship between the relative hydration index and heart changes was gradual. Fluid overload, as defined by the mild criteria, was associated with a worse ejection fraction, but also with other functional and structural heart changes. CONCLUSIONS: Our study demonstrates that in patients on dialysis, even mild (often subclinical) fluid overload is associated with structural and functional heart changes. Early identification of fluid overload with improved methods of volume assessment is thus warranted and especially in lean patients.
Lower cholesterol level on admission predicts poor outcome after prolonged cardiac arrest Jan Malik, Anna Valerianova, Tomas Janota, Jana Smalcova, Nikol Kubinova, Dan Rob, Jan Pudil, Milan Dusik, Petra Kavalkova, Pavel Michalek, Michal Huptych, Jan Belohlavek Scientific Reports, 2025 Higher cholesterol level is a risk factor of coronary artery disease, the major cause of sudden cardiac death (SCD). However, smaller studies observed worse outcomes in SCD patients having lower total and LDL-cholesterol levels. Therefore, the prognostic role of cholesterol itself in patients with SCD remains to be clarified. We aimed to assess the relationship of on-admission cholesterol level to the neurological outcome in a secondary analysis of the randomized Prague OHCA trial population (extracorporeal cardiopulmonary resuscitation (ECPR) vs. standard approach in refractory cardiac arrest). Of 256 included patients with refractory cardiac arrest, 123 were analyzed. The effects of total, HDL and non-HDL cholesterol levels drawn at admission on the best cerebral performance category (CPC) within 180 days were examined. Results are presented as median (interquartile range) and differences compared by the Wilcoxon test. Patients with CPC 1-2 had higher initial levels of total cholesterol [3.70 (3.23-4.27) mmol/L vs. 2.98 (2.35-4.02) mmol/L, p = 0.005], non-HDL cholesterol [2.68 (2.08-3.24) vs. 1.93 (1.62-2.97) mmol/L, p = 0.007 and HDL-cholesterol [0.93 (0.67-1.07) mmol/L vs. 0.74 (0.49-0.96) mmol/L, p = 0.014] compared to patients with CPC 3-5. Chronic use of statins did not influence the outcome. Only the low levels of total and non-HDL cholesterol remained consistent predictors of poor neurological outcomes in all patients and in both separate arms. Lower total and non-HDL cholesterol levels on admission are associated with worse neurological outcomes in patients with refractory cardiac arrest treated by both ECPR and standard approach.
Using ultrasound in preoperative mapping and surveillance of arteriovenous grafts for haemodialysis improves patency rates: Single-centre experience Julia Jarosciakova, Petr Utikal, Jan Malik, Jana Janeckova Journal of Vascular Access, 2025 Background: This study aimed to evaluate patency outcomes of arteriovenous grafts (AVGs) before and after using Duplex doppler ultrasonography (DUS) in preoperative mapping and surveillance of AVG. Methods: In this single-centre, retrospective cohort study 212 patients receiving AVGs from January 2009 to December 2022 were included. In group 1, the creation of AVG as well as screening was based on physical examination alone. In contrast, DUS was used in the preoperative mapping and surveillance of AVG in group 2. The patients also received sulodexide as supplemental medication. Outcomes included primary and secondary patency. The Mann-Whitney U-test was used to compare the differences between groups in number of thrombectomies and preemptive percutaneous transluminal angioplasties (PTAs). Results: Group 1 included 90 AVGs. The mean follow-up time was 333 days (range: 1–1230 days, standard deviation: 318 days). The primary and secondary graft patency rates were 13.3%, 62.2% at 6 months; 2.2%, 52.1% at 12 months; 0%, 44.3% at 24 months and 0%, 44.3% at 36 months respectively. During the 7-year surveillance of AVG, significantly more thrombectomies were performed than preemptive PTA ( p < 0.0001). Group 2 included 122 AVGs. The mean follow-up time was 584 days (range: 1–2040 days, standard deviation: 463 days). The primary and secondary graft patency rates were 54.9%, 95.9% at 6 months; 29.5%, 77.8% at 12 months; and 9.8%, 56.5% at 24 months; 2.5%, 47.1% at 36 months respectively. The primary and secondary graft patency was significantly longer ( p < 0.0001, p = 0.002). During the 7-year surveillance of AVG there were significantly more preemptive PTAs performed ( p = 0.0004). Conclusions: The primary and secondary patency of AVG were significantly improved after using DUS in preoperative mapping and surveillance. DUS surveillance led to a decrease in AVG occlusion. A potential positive effect of sulodexide on patency rate of AVG needs more research.
Management of vascular access inflow-outflow imbalance: A bimodal approach Gerald A Beathard, William C Jennings, Jan Malik, Haimanot Wasse, Bart L Dolmatch, John Ross, Surendra Shenoy, Roy-Chaudhury Pabir, Bharat Sachdeva, Dheeraj Rajan, Vandana Dua Niyyar, George M Nassar, Eric Peden, Timmy Lee, Gordon McLennan, Robert Shahverdyan Journal of Vascular Access, 2025
The predictive value of highly malignant EEG patterns after cardiac arrest: evaluation of the ERC-ESICM recommendations Sara Turella, Josef Dankiewicz, Hans Friberg, Janus Christian Jakobsen, Christoph Leithner, Helena Levin, Gisela Lilja, Marion Moseby-Knappe, Niklas Nielsen, Andrea O. Rossetti, Claudio Sandroni, Frédéric Zubler, Tobias Cronberg, Erik Westhall, , Jan Bělohlávek, Clifton Callaway, Alain Cariou, Tobias Cronberg, Glenn Eastwood, David Erlinge, Jan Hovdenes, Michael Joannidis, Hans Kirkegaard, Matt P. G Morgan, Alistair D Nichol, Per Nordberg, Mauro Oddo, Paolo Pelosi, Christian Rylander, Manoj Saxena, Christian Storm, Fabio S Taccone, Susann Ullén, Matt P Wise, Paul J Young, Kathy Rowan, Paul Mouncey, Manu Shankar-Hari, Duncan Young, Susann Ullén, Theis Lange, Karolina Palmér, Susann Ullén, Ulla-Britt Karlsson, Simon Heissler, Manoj Saxena, Frances Bass, Naomi Hammond, John Myburgh, Colman Taylor, Alain Cariou, Adele Bellino, Marwa Abel-all, Ben Finfer, Carolyn Koch, Yang Li, Anne O’Connor, Julia Pilowsky, Tina Schneider, Anna Tippett, Bridget Ady, Tessa Broadley, Amanda Brown, Liz Melgaard, Mimi Morgan, Vanessa Singh, Rebecca Symons, Kathrin Becker, Nathalie Van Sante, Vendula Saleova, Silvie Zerzanova, Samia Sefr-Kribel, Ute Lübeck, Martina Carrara, Kathryn Fernando, Diane Mackle, Leanlove Navarra, Judith Riley, Elin Westerheim, Marianne Flatebø, Ameldina Ceric, Zana Haxhija, Lovisa Terling, Lena Bossmar, Liz Jergle, Helén Holm Månsson, Samia Abed Maillard, Andreja Vujicic Zagar, Christina Jodlauk, Helen Hill, Jennifer Scrivens, Kate Ainscough, Ciara Fahey, Rinaldo Bellomo, Glenn Eastwood, Leah Peck, Helen Young, Winston Cheung, Rosalba Cross, Michael Hayes, Nitin Jain, Mark Kol, Asim Shah, Atul Wagh, Helen Wong, F. 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Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial Chiara Robba, Rafael Badenes, Denise Battaglini, Lorenzo Ball, Filippo Sanfilippo, Iole Brunetti, Janus Christian Jakobsen, Gisela Lilja, Hans Friberg, Pedro David Wendel-Garcia, Paul J. Young, Glenn Eastwood, Michelle S. Chew, Johan Unden, Matthew Thomas, Michael Joannidis, Alistair Nichol, Andreas Lundin, Jacob Hollenberg, Naomi Hammond, Manoj Saxena, Annborn Martin, Miroslav Solar, Fabio Silvio Taccone, Josef Dankiewicz, Niklas Nielsen, Anders Morten Grejs, Florian Ebner, Paolo Pelosi, Jan Bělohlávek, Clifton Callaway, Alain Cariou, Tobias Cronberg, David Erlinge, Jan Hovdenes, Hans Kirkegaard, Helena Levin, Matt P. G. Morgan, Per Nordberg, Mauro Oddo, Christian Rylander, Christian Storm, Susann Ullén, Matt P. 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