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Sramko M, Kryze L, Kukla J, Necasova L, Wunschova H, Bocek J, Sedova KA, Kautzner J. Acute Hemodynamic Effect of a Novel Dual-Vein, Multisite Biventricular Pacing Configuration. JACC Clin Electrophysiol 2023; 9:2329-2338. [PMID: 37632507 DOI: 10.1016/j.jacep.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/07/2023] [Accepted: 07/03/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Biventricular pacing (BVP) from multiple left ventricular (LV) sites could enhance the efficacy of cardiac resynchronization therapy (CRT) by engaging a greater myocardial mass. OBJECTIVES The goal of this study was to evaluate the acute hemodynamic effect of various multisite pacing (MSP) configurations against conventional BVP. METHODS Twenty patients with nonischemic dilated cardiomyopathy and left bundle branch block (mean age: 59 ± 14 years; LV ejection fraction: 27% ± 6%; native QRS: 171 ± 16 milliseconds) were investigated during a routine CRT implant procedure. In addition to conventional right atrial and right ventricular leads, 2 quadripolar leads were placed in the distant coronary venous branches. LV hemodynamics was evaluated by using a micromanometer-tipped catheter during atrioventricular BVP with 4 LV lead configurations: single-lead conventional BVP; single-lead multipoint pacing; triventricular pacing from distal dipoles of 2 LV leads; and maximum MSP (MSP-Max) from 4 dipoles of 2 LV leads. RESULTS Compared with right atrial pacing, any BVP configuration produced a significant increase in the maximal LV diastolic pressure rise (LVdP/dTMax) (a median relative increase of 28% [IQR: 8%-45%], 25% [IQR: 18%-46%], 36% [IQR: 18%-54%], and 38% [IQR: 28%-58%], respectively; all, P < 0.001). MSP-Max but no other multisite BVP generated a significant increase of the maximal LVdP/dTMax than conventional BVP (P = 0.041). Increased LVdP/dTMax during MSP-Max was associated with greater LV diameter and lower LV ejection fraction, independently of the QRS width. CONCLUSIONS The study shows the hemodynamic advantage of a novel dual-vein MSP-Max configuration that could be useful for CRT in patients with advanced LV remodeling.
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Affiliation(s)
- Marek Sramko
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Lukas Kryze
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Kukla
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Lucie Necasova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hanka Wunschova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Bocek
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ksenia A Sedova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Yağmur B, Şimşek E, Kayıkçıoğlu M, İlkay Yüce Ersoy E, Beyazıt Candemir Y, Nalbantgil S, Moğolkoç N, Can L, Kültürsay H. Could Impedance Cardiography be a Non-Invasive Alternative Method of Measuring Cardiac Output in Patients with Pulmonary Hypertension? Anatol J Cardiol 2023; 27:650-656. [PMID: 37466025 PMCID: PMC10621604 DOI: 10.14744/anatoljcardiol.2023.2820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 06/13/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Pulmonary hypertension guidelines recommend invasive right heart catheterization for diagnosis and clinical follow-up. Our aim was to compare non-invasive impedance cardiography with invasive techniques for cardiac index measurements and mortality prediction in patients with pulmonary hypertension. METHODS Between 2008 and 2018, 284 right heart catheterizations were performed for the diagnosis of pulmonary hypertension in 215 patients with mean pulmonary artery pressure >25 mm Hg, and at least 2 methods used for cardiac output measurement were included in the study retrospectively. Patients were evaluated with Pearson's correlation in 3 groups: estimated Fick (eFick) method and thermodilution (group 1), eFick method and impedance cardiography (group 2), and thermodilution and impedance cardiography (group 3). We also compared the predictive power of cardiac index measured by different methods for 1-year overall mortality and hospitalizations. RESULTS There were strong and moderate positive correlations in groups 1 and 3, respectively (r = 0.634, P <.001, r = 0.534, P =.001), and the weakest correlation was in group 2 (r = 0.390, P =.001). The mean difference (bias) between eFick method versus impedance cardiography, impedance cardiography vs. thermodilution, and eFick method vs. thermodilution was 0.6 mL/min, 0.47 mL/min, and -0.2 mL/min respectively, but limits of agreement were wide. In both groups, cardiac index <2.5 L/min/m2 as measured by thermodilution significantly predicted 1-year mortality. Also, impedance cardiography was better than eFick method in predicting mortality (P =.02). CONCLUSIONS Our single-center real-life data showed that for cardiac output and cardiac index measurements, impedance cardiography provides a moderate correlation with thermodilution and is fair with eFick method methods. Moreover, thermodilution appeared superior to both eFick method and impedance cardiography, while impedance cardiography was even better than eFick method in predicting 1-year adverse events, including total mortality and hospitalization, in patients with pulmonary hypertension.
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Affiliation(s)
- Burcu Yağmur
- Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Türkiye
| | - Evrim Şimşek
- Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Türkiye
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Türkiye
| | - Elif İlkay Yüce Ersoy
- Department of Cardiology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Türkiye
| | | | - Sanem Nalbantgil
- Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Türkiye
| | - Nesrin Moğolkoç
- Department of Pulmonology, Faculty of Medicine, Ege University, İzmir, Türkiye
| | - Levent Can
- Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Türkiye
| | - Hakan Kültürsay
- Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Türkiye
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203
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Romanchuk O. Cardiorespiratory dynamics during respiratory maneuver in athletes. Front Netw Physiol 2023; 3:1276899. [PMID: 38020241 PMCID: PMC10643240 DOI: 10.3389/fnetp.2023.1276899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023]
Abstract
Introduction: The modern practice of sports medicine and medical rehabilitation requires the search for subtle criteria for the development of conditions and recovery of the body after diseases, which would have a prognostic value for the prevention of negative effects of training and rehabilitation tools, and also testify to the development and course of mechanisms for counteracting pathogenetic processes in the body. The purpose of this study was to determine the informative directions of the cardiorespiratory system parameters dynamics during the performing a maneuver with a change in breathing rate, which may indicate the body functional state violation. Methods: The results of the study of 183 healthy men aged 21.2 ± 2.3 years who regularly engaged in various sports were analyzed. The procedure for studying the cardiorespiratory system included conducting combined measurements of indicators of activity of the respiratory and cardiovascular systems in a sitting position using a spiroarteriocardiograph device. The duration of the study was 6 min and involved the sequential registration of three measurements with a change in breathing rate (spontaneous breathing, breathing at 0.1 Hz and 0.25 Hz). Results: Performing a breathing maneuver at breathing 0.1 Hz and breathing 0.25 Hz in comparison with spontaneous breathing leads to multidirectional significant changes in heart rate variability indicators-TP (ms2), LF (ms2), LFHF (ms2/ms2); of blood pressure variability indicators-TPDBP (mmHg2), LFSBP (mmHg2), LFDBP (mmHg2), HFSBP (mmHg2); of volume respiration variability indicators - LFR, (L×min-1)2; HFR, (L×min-1)2; LFHFR, (L×min-1)2/(L×min-1)2; of arterial baroreflex sensitivity indicators - BRLF (ms×mmHg-1), BRHF (ms×mmHg-1). Differences in indicators of systemic hemodynamics and indicators of cardiovascular and respiratory systems synchronization were also informative. Conclusion: According to the results of the study, it is shown that during performing a breathing maneuver with a change in the rate of breathing, there are significant changes in cardiorespiratory parameters, the analysis of which the increments made it possible to determine of the changes directions dynamics, their absolute values and informative limits regarding the possible occurrence of the cardiorespiratory interactions dysregulation.
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Affiliation(s)
- Oleksandr Romanchuk
- Department of Medical Rehabilitation, Ukrainian Research Institute of Medical Rehabilitation and Resort Therapy of the Ministry of Health of Ukraine, Odesa, Ukraine
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204
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Qiu K, Lu J, Guo H, Du C, Liu J, Li A. Study on Respiratory Function and Hemodynamics of AIDS Patients with Respiratory Failure. Infect Drug Resist 2023; 16:6941-6950. [PMID: 37928608 PMCID: PMC10624180 DOI: 10.2147/idr.s376752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023] Open
Abstract
Objective We performed a comparative analysis of respiratory function and hemodynamics among patients with Acquired Immunodeficiency Syndrome (AIDS)-associated respiratory failure and those with non-AIDS-associated respiratory failure. Methods Data were collected from critically ill patients diagnosed with Acquired Immunodeficiency Syndrome who were admitted to the Intensive Care Unit (ICU) of Beijing Ditan Hospital, affiliated with Capital Medical University, between January 1, 2019, and December 31, 2019. We simultaneously gathered data from non-AIDS patients admitted to the ICU of Beijing Liangxiang Hospital within the same timeframe. A comparative study was performed to analyze clinical data from these two patient groups, encompassing parameters related to respiratory mechanics and hemodynamic indicators. Results A total of 12 patients diagnosed with Acquired Immunodeficiency Syndrome (AIDS) and experiencing respiratory failure, along with 23 patients with respiratory failure independent of AIDS, were included in our study. Subsequently, a comparative analysis of clinical information was conducted between the two patient cohorts. Our findings demonstrate non-statistically significant differences between the two patient groups when assessing various indicators, encompassing peak airway pressure, plateau pressure, mean pressure, compliance, oxygenation index, and arterial partial pressure of carbon dioxide (P>0.05). Additionally, the comparison of multiple indicators encompassing mean arterial pressure, central venous pressure, cardiac output index, intrathoracic blood volume index, global end-diastolic volume index, extravascular lung water content, and pulmonary vascular permeability index revealed no statistically significant differences between the two patient groups (P>0.05). Ultimately, the Galileo respiratory system was utilized to assess the pressure-volume (P-V) curve of the experimental cohort, revealing a consistent and seamless trajectory devoid of noticeable points of inflection. Conclusion No statistically significant differences were found in the respiratory function and hemodynamic profiles between patients diagnosed with AIDS presenting respiratory failure and those experiencing respiratory failure unrelated to AIDS. Additionally, the pressure-volume curve of individuals diagnosed with AIDS presenting respiratory failure displayed a seamless and uninterrupted trajectory devoid of discernible points of inflection. Hence, there might be constraints when utilizing P-V curve-based adjustments for positive end-expiratory pressure (PEEP) during mechanical ventilation in individuals diagnosed with AIDS presenting respiratory failure.
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Affiliation(s)
- Kai Qiu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Intensive Care Medicine, Liangxiang Hospital of Beijing Fangshan District, Beijing, People’s Republic of China
| | - Jiaqi Lu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hebing Guo
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Chunjing Du
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jingyuan Liu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ang Li
- Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
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205
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Lee EP, Yen CW, Hsieh MS, Lin JJ, Chan OW, Su YT, Mu CT, Wu HP, Hsia SH. Diastolic blood pressure impact on pediatric refractory septic shock outcomes. Pediatr Neonatol 2023:S1875-9572(23)00183-3. [PMID: 38016871 DOI: 10.1016/j.pedneo.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/01/2022] [Accepted: 02/09/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Septic shock is the progression of sepsis, defined as cardiovascular dysfunction during systemic infection, and it has a mortality rate of 40 %-80 %. Loss of vascular tone is an important pathophysiological feature of septic shock. Diastolic blood pressure (DBP) was reported to be associated with vascular tone. This study aimed to identify the associations of several hemodynamic indices, especially DBP, with outcome in pediatric septic shock to allow for timely interventions. METHODS Children with persistent catecholamine-resistant shock had a pulse index continuous cardiac output (PiCCO®) system implanted for invasive hemodynamic monitoring and were enrolled in the current study. Serial cardiac index, systemic vascular resistance index (SVRI), systolic blood pressure (SBP), mean arterial pressure (MAP), and DBP were recorded during the first 24 h following PiCCO® initiation. All hemodynamic parameters associated with 28-day mortality were further analyzed using receiver operating characteristic curve analysis. RESULTS Thirty-three children with persistent catecholamine-resistant shock were enrolled. The median age was 12 years and the youngest children were 5 years old. Univariate analysis noted that SVRI, SBP, MAP, and DBP were significantly higher, and shock index was significant lower, in survivors compared with non-survivors (p < 0.05). In the multivariate analysis, only SVRI and DBP remained independent predictors of 28-day mortality. DBP had the best correlation with SVRI (r = 0.718, n = 219, p < 0.001). The area under the receiver operating characteristic curves of SVRI and DBP for predicting 28-day mortality during the first 24 h of persistent catecholamine-resistant shock were >0.75, indicating a good prediction for mortality. CONCLUSIONS DBP correlated well with SVRI and it can serve as a predictor for mortality in pediatric septic shock. Furthermore, DBP was a superior discriminator of mortality when compared with SBP and MAP. A lower DBP was an independent hemodynamic factor associated with 28-day mortality.
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Affiliation(s)
- En-Pei Lee
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Wei Yen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shun Hsieh
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jainn-Jim Lin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Oi-Wa Chan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Ting Su
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ting Mu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Han-Ping Wu
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Pediatrics, Chiayi Chang-Gung Memorial Hospital, Chiayi County, Taiwan.
| | - Shao-Hsuan Hsia
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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206
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Besha A, Zemedkun A, Tadesse M, Hailu S, Mossie A, Shiferaw A, Angasa D, Adamu Y. Effects of Hyperbaric and Isobaric Bupivacaine on Hemodynamic Profiles and Block Characteristics Among Parturients Undergoing Elective Cesarean Section Under Spinal Anesthesia: A Randomized Controlled Trial. J Pain Res 2023; 16:3545-3558. [PMID: 37881235 PMCID: PMC10595164 DOI: 10.2147/jpr.s428314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
Background Cesarean section (CS) is a surgical procedure where the baby is delivered through incisions made in the abdomen and uterus. Bupivacaine is a widely recognized local anesthetic available in different baricity and it is frequently used for spinal anesthesia. The baricity of bupivacaine impacts hemodynamic profiles and block characteristics. Objective To compare the effects of hyperbaric and isobaric bupivacaine on hemodynamic profiles and block characteristics among parturients undergoing elective cesarean section under spinal anesthesia at Dilla University Referral Hospital. Methods 64 pregnant mothers scheduled for elective cesarean section under spinal anesthesia were randomly assigned to two groups: Group A received a dose of 12.5 mg of isobaric bupivacaine (n = 32), Group B received a dose of 12.5 mg of hyperbaric bupivacaine (n = 32). Prior to conducting the study, the necessary ethical approvals were obtained. For comparing numerical variables between the two groups, the independent Sample t-test or Mann-Whitney U-test was employed as needed. Repeated measurements were analyzed using mixed ANOVA. Categorical variables were assessed using either the chi-square test or Fisher's exact test. Statistical significance was set at P < 0.05, with a power of 90%. Results The mean Systolic Blood Pressure (SBP), Diastolic Blood pressure (DBP), and Mean Arterial Blood Pressure (MAP) showed significant decrement in the group receiving isobaric spinal anesthesia compared to those receiving hyperbaric bupivacaine. The decrement was observed from the 6th to 30th minute (p<0.05). Furthermore, the hyperbaric group had a faster onset time for achieving the maximum sensory block, with a median time of 3 (1) min compared to 4 (2) mins in the isobaric group (p<0.001). Conclusion and Recommendation We conclude that hyperbaric bupivacaine provides stable intraoperative hemodynamic parameters and an earlier onset of block than isobaric bupivacaine. Therefore, we recommend clinicians to use hyperbaric bupivacaine for cesarean delivery.
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Affiliation(s)
- Aschalew Besha
- Department of Anesthesia, College of Health Sciences and Medicine, Hawassa University, Hawassa, Ethiopia
| | - Abebayehu Zemedkun
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Muhiddin Tadesse
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Seyoum Hailu
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Addisu Mossie
- Department of Anesthesia, College of Health Sciences and Medicine, Hawassa University, Hawassa, Ethiopia
| | - Adanech Shiferaw
- Department of Anesthesia, College of Health Sciences and Medicine, Hawassa University, Hawassa, Ethiopia
| | - Dugo Angasa
- Department of Anesthesia, College of Health Sciences and Medicine, Hawassa University, Hawassa, Ethiopia
| | - Yayeh Adamu
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
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Hu X, Deng P, Ma M, Tang X, Qian J, Wu G, Gong Y, Gao L, Zou R, Leng X, Xiang J, Wu J, Ding Z. How does the recurrence-related morphology characteristics of the Pcom aneurysms correlated with hemodynamics? Front Neurol 2023; 14:1236757. [PMID: 37869148 PMCID: PMC10585265 DOI: 10.3389/fneur.2023.1236757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Posterior communicating artery (Pcom) aneurysm has unique morphological characteristics and a high recurrence risk after coil embolization. This study aimed to evaluate the relationship between the recurrence-related morphology characteristics and hemodynamics. Method A total of 20 patients with 22 Pcom aneurysms from 2019 to 2022 were retrospectively enrolled. The recurrence-related morphology parameters were measured. The hemodynamic parameters were simulated based on finite element analysis and computational fluid dynamics. The hemodynamic differences before and after treatment caused by different morphological features and the correlation between these parameters were analyzed. Result Significant greater postoperative inflow rate at the neck (Qinflow), relative Qinflow, inflow concentration index (ICI), and residual flow volume (RFV) were reported in the aneurysms with wide neck (>4 mm). Significant greater postoperative RFV were reported in the aneurysms with large size (>7 mm). Significant greater postoperative Qinflow, relative Qinflow, and ICI were reported in the aneurysms located on the larteral side of the curve. The bending angle of the internal carotid artery at the initiation of Pcom (αICA@PCOM) and neck diameter had moderate positive correlations with Qinflow, relative Qinflow, ICI, and RFV. Conclusion The morphological factors, including aneurysm size, neck diameter, and αICA@PCOM, are correlated with the recurrence-inducing hemodynamic characteristics even after fully packing. This provides a theoretical basis for evaluating the risk of aneurysm recurrence and a reference for selecting a surgical plan.
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Affiliation(s)
- Xiaolong Hu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Peng Deng
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Mian Ma
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Xiaoyu Tang
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Jinghong Qian
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Gang Wu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yuhui Gong
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Liping Gao
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | - Rong Zou
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | | | | | - Jiandong Wu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Zhiliang Ding
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
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Mazimba S, Jeukeng C, Ondigi O, Mwansa H, Johnson AE, Elumogo C, Breathett K, Kwon Y, Mubanga M, Mwansa V, Baldeo C, Ibrahim S, Selinski C, Mehta N, Bilchick K. Coronary perfusion pressure is associated with adverse outcomes in advanced heart failure. Perfusion 2023; 38:1492-1500. [PMID: 35947883 DOI: 10.1177/02676591221118693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Myocardial perfusion is an important determinant of cardiac function. We hypothesized that low coronary perfusion pressure (CPP) would be associated with adverse outcomes in heart failure. Myocardial perfusion impacts the contractile efficiency thus a low CPP would signal low myocardial perfusion in the face of increased cardiac demand as a result of volume overload. METHODS We analyzed patients with complete hemodynamic data in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial using Cox Proportional Hazards regression for the primary outcome of the composite risk of death, heart transplantation, or left ventricular assist device [(LVAD). DT × LVAD] and the secondary outcome of the composite risk of DT × LVAD and heart failure hospitalization (DT × LVADHF). CPP was calculated as the difference between diastolic blood pressure and pulmonary artery wedge pressure. Heart failure categories (ischemic vs non-ischemic) were also stratified based on CPP strata. RESULTS The 158 patients (56.7 ± 13.6 years, 28.5% female) studied had a median CPP of 40 mmHg (IQR 35-52 mmHg). During 6 months of follow-up, 35 (22.2%) had the composite primary outcome and 109 (69.0%) had the composite secondary outcome. When these outcomes were then stratified based on the median, CPP was associated with these outcomes. Increasing CPP was associated with lower risk of both the primary outcome of DT × LVAD (HR 0.96, 95% CI 0.94-0.99 p = .002) and as well as the secondary outcome of DT × LVADHF (p = .0008) There was significant interaction between CPP and ischemic etiology (p = .04). CONCLUSION A low coronary artery perfusion pressure below (median) 40mmHg in patients with advanced heart failure undergoing invasive hemodynamic monitoring with a pulmonary artery catheter was associated with adverse outcomes. CPP could useful in guiding risk stratification of advanced heart failure patients and timely evaluation of advanced heart failure therapies.
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Affiliation(s)
- Sula Mazimba
- University of Virginia Health System, Charlottesville, VA, USA
| | | | - Olivia Ondigi
- University of Virginia Health System, Charlottesville, VA, USA
| | | | | | - Comfort Elumogo
- University of Virginia Health System, Charlottesville, VA, USA
| | | | | | | | | | - Cherisse Baldeo
- University of Virginia Health System, Charlottesville, VA, USA
| | - Sami Ibrahim
- University of Virginia Health System, Charlottesville, VA, USA
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Soliveri L, Bozzetto M, Brambilla P, Caroli A, Remuzzi A. Hemodynamics in AVF over time: A protective role of vascular remodeling toward flow stabilization. Int J Artif Organs 2023; 46:547-554. [PMID: 37753863 PMCID: PMC10629258 DOI: 10.1177/03913988231191960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/20/2023] [Indexed: 09/28/2023]
Abstract
The mechanisms underlying vascular stenosis formation in the arteriovenous fistula (AVF) for hemodialysis (HD) remain mostly unknown. Several computational fluid dynamics (CFD) studies have suggested a potential role for unsteady flow in inducing intimal hyperplasia and AVF stenosis, but the majority of these observations have been limited to a single time point after surgical creation. The aim of the present study was to investigate the relation between hemodynamic conditions and AVF vascular remodeling through a CFD longitudinal study. Non contrast-enhanced MR images and Doppler Ultrasound (US) examinations were acquired at 3 days, 40 days, 6 months, 1 year, and 1.5 years after surgery in a 72-year male referred for native radio-cephalic AVF. Three-dimensional AVF models were generated and high fidelity CFD simulations were performed using pimpleFoam, setting patient-specific boundary conditions derived from US. Morphological and hemodynamic changes over time were then analyzed. Analysis of vessel morphology and hemodynamics during follow-up showed that the AVF had a successful maturation process, characterized by a massive arterial and venous dilatation within the 6 months after surgery, a corresponding increase in blood flow volume and important flow instabilities. Between 6 months and 1 year, a stenosis developed in the juxta-anastomotic vein and caused AVF failure at 1.5 years. The development of stenosis was paralleled by the regularization of blood flow velocity pattern and consequent decrease in the near-wall disturbed flow metrics. These results suggest that development of intimal hyperplasia and vessel stenosis, triggered by unsteady flow, could be the result of vascular inward remodeling toward regularization of turbulent-like flow.
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Affiliation(s)
- Luca Soliveri
- Department of Biomedical Engineering, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Michela Bozzetto
- Department of Biomedical Engineering, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Paolo Brambilla
- Diagnostic Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Anna Caroli
- Department of Biomedical Engineering, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Andrea Remuzzi
- Department of Management, Information and Production Engineering, University of Bergamo, Italy
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210
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Armstrong MK, Nuckols VR, Gimblet CJ, Holwerda SW, DuBose LE, Luehrs RE, Lane AD, Chirinos JA, Voss MW, Pierce GL. Relation of forward and backward traveling pressure waves with subclinical carotid artery wall remodeling and central pulse pressure. J Appl Physiol (1985) 2023; 135:943-949. [PMID: 37650141 PMCID: PMC10642512 DOI: 10.1152/japplphysiol.00286.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/27/2023] [Accepted: 08/26/2023] [Indexed: 09/01/2023] Open
Abstract
Central pulse pressure (PP) is the sum of forward and backward traveling pressure waves that have been associated with cardiovascular disease (CVD) risk. However, previous studies have reported differential findings regarding the importance of the forward versus the backward wave for CVD risk. Therefore, we sought to determine the degree to which the forward and backward pressure waves are associated with subclinical carotid artery wall remodeling and central PP in healthy adults. Using applanation tonometry, carotid pressure waveforms were acquired in 308 healthy individuals (aged 45 ± 17 years, range 19-80 years, 61% women), from which the time integral of the forward (PfTI) and backward (PbTI) pressure waves were derived via pressure-only wave separation analysis. Common carotid artery intima-media thickness (cIMT), a biomarker of subclinical CVD risk, was derived via B-mode ultrasonography measured ∼2 cm from the carotid bulb. Both PfTI (r = 0.31, P < 0.001) and PbTI (r = 0.40, P < 0.001) were correlated with cIMT. However, further analysis revealed that PbTI mediated the relation between PfTI and cIMT (proportion mediated = 156%, P < 0.001). The association between PbTI and cIMT remained after adjusting for age, sex, body mass index, blood glucose, low-density lipoprotein cholesterol, heart rate, brachial systolic pressure, and aortic stiffness (B = 0.02, 95% confidence interval = 0.01, 2.77, P < 0.001). Both PfTI (r = -0.58, P < 0.001) and PbTI (r = -0.50, P < 0.001) were correlated with central PP, however, PfTI fully mediated the association between PbTI and central PP (proportion mediated = 124%, P < 0.001). Although PfTI is correlated with higher central PP, it is PbTI that is directly associated with carotid artery wall remodeling.NEW & NOTEWORTHY The present study contributes to the growing body of evidence highlighting the physiological and clinical insight provided by the pulsatile hemodynamic components of central artery pulse pressure. The notable findings of this study are: 1) The reflected (backward) pressure wave is associated with carotid intima-media thickness independent of traditional cardiovascular risk factors, including systolic blood pressure and aortic stiffness. 2) The incident (forward) pressure wave, and not the reflected pressure wave, is associated with greater central pulse pressure.
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Affiliation(s)
- Matthew K Armstrong
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
| | - Virginia R Nuckols
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
| | - Colin J Gimblet
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
| | - Seth W Holwerda
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Lyndsey E DuBose
- Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Rachel E Luehrs
- Department of Kinesiology, North Central College, Naperville, Illinois, United States
| | - Abbi D Lane
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, United States
| | - Julio A Chirinos
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania and Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Michelle W Voss
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Gary L Pierce
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
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211
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Feng H, Li C, Feng H. Numerical simulation and in vitro experimental study of thrombus capture efficiency of a new retrievable vena cava filter. Comput Methods Biomech Biomed Engin 2023; 26:2034-2046. [PMID: 36625716 DOI: 10.1080/10255842.2022.2163849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 01/11/2023]
Abstract
The vena cava filter is a filtering device to prevent pulmonary embolism caused by thrombosis from lower limbs and pelvis. A new retrievable vena cava filter was evaluated in this paper. To evaluate the hemodynamic performance and thrombus capture efficiency after transplantation, numerical simulation of computational fluid dynamics was performed. In this paper, the two-phase flow model of computational fluid dynamics software was used to analyze the outlet blood flow velocity, inlet-outlet pressure difference, filter wall shear stress, the ratio of area with wall shear stress, and the thrombus capture efficiency with the thrombus diameter of 5 mm, 10 mm, 15 mm and the thrombus content of 10%, 20%, 30%, respectively. Additionally, in vitro experimental test was performed to compare its thrombus capture efficiency with Denali and Aegisy Filters. The Denali Filter showed the least interference with the blood flow, followed by the new filter and the Aegisy Filter. The results indicated that the new filter had a higher capture rate in capturing 5mm small-diameter thrombus. This research certain theoretical significance and reference value for the research and development of the new vena cava filters as well as the evaluation of the thrombus capture efficiency of the filters.
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Affiliation(s)
- Haiquan Feng
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot, P.R. China
| | - Changsheng Li
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot, P.R. China
| | - Haoxiang Feng
- College of Materials Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, P.R. China
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212
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Dounavi ME, Mak E, Swann P, Low A, Muniz-Terrera G, McKeever A, Pope M, Williams GB, Wells K, Lawlor B, Naci L, Malhotra P, Mackay C, Koychev I, Ritchie K, Su L, Ritchie CW, O’Brien JT. Differential association of cerebral blood flow and anisocytosis in APOE ε4 carriers at midlife. J Cereb Blood Flow Metab 2023; 43:1672-1684. [PMID: 37132287 PMCID: PMC10581239 DOI: 10.1177/0271678x231173587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 05/04/2023]
Abstract
Cerebral hemodynamic alterations have been observed in apolipoprotein ε4 (APOE4) carriers at midlife, however the physiological underpinnings of this observation are poorly understood. Our goal was to investigate cerebral blood flow (CBF) and its spatial coefficient of variation (CoV) in relation to APOE4 and a measure of erythrocyte anisocytosis (red blood cell distribution width - RDW) in a middle-aged cohort. Data from 563 participants in the PREVENT-Dementia study scanned with 3 T MRI cross-sectionally were analysed. Voxel-wise and region-of-interest analyses within nine vascular regions were run to detect areas of altered perfusion. Within the vascular regions, interaction terms between APOE4 and RDW in predicting CBF were examined. Areas of hyperperfusion in APOE4 carriers were detected mainly in frontotemporal regions. The APOE4 allele differentially moderated the association between RDW and CBF, an association which was more prominent in the distal vascular territories (p - [0.01, 0.05]). The CoV was not different between the considered groups. We provide novel evidence that in midlife, RDW and CBF are differentially associated in APOE4 carriers and non-carriers. This association is consistent with a differential hemodynamic response to hematological alterations in APOE4 carriers.
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Affiliation(s)
- Maria-Eleni Dounavi
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Elijah Mak
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Peter Swann
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Audrey Low
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Anna McKeever
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Marianna Pope
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Guy B Williams
- Department of Clinical Neurosciences and Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Katie Wells
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Brian Lawlor
- Institute of Neuroscience, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Lorina Naci
- Institute of Neuroscience, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Paresh Malhotra
- Division of Brain Science, Imperial College Healthcare NHS Trust, UK
| | - Clare Mackay
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ivan Koychev
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Li Su
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Craig W Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - John T O’Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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213
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Arai M, Fujino M, Fujita T, Noguchi T. Left Coronary Artery Aneurysm Causing a Third Mogul. Circ Cardiovasc Imaging 2023; 16:e015441. [PMID: 37847762 DOI: 10.1161/circimaging.123.015441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Affiliation(s)
- Marina Arai
- Departments of Cardiovascular Medicine (M.A., M.F., T.N.), National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masashi Fujino
- Departments of Cardiovascular Medicine (M.A., M.F., T.N.), National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomoyuki Fujita
- Cardiovascular Surgery (T.F.), National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Teruo Noguchi
- Departments of Cardiovascular Medicine (M.A., M.F., T.N.), National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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214
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Delfiner MS, Hoffman M, White A, Forfia PR. Impact of Arteriovenous Fistula Compression on Mitral Regurgitation Severity. Circ Heart Fail 2023; 16:e010733. [PMID: 37435745 DOI: 10.1161/circheartfailure.123.010733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Affiliation(s)
- Matthew S Delfiner
- Department of Internal Medicine, Section of Cardiovascular Medicine (M.S.D., P.R.F.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Matthew Hoffman
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO (M.H.)
| | - Austin White
- Department of Internal Medicine (A.W.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Paul R Forfia
- Department of Internal Medicine, Section of Cardiovascular Medicine (M.S.D., P.R.F.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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215
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Siebert V, Goldstein J, Khan R, Lopez J, Darki A, Lewis B, Steen L, Doukas D. A goal-oriented hemodynamic approach to acute myocardial infarction complicated by cardiogenic shock-A single center experience. Catheter Cardiovasc Interv 2023; 102:569-576. [PMID: 37548088 DOI: 10.1002/ccd.30792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/12/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is the most common cause of mortality following AMI, and treatment algorithms vary widely. We report the results of an analysis using time-sensitive, hemodynamic goals in the treatment of AMI-CS in a single center study. METHODS Consecutive patients with AMI-CS from November 2016 through December 2021 were included in our retrospective analysis. Clinical characteristics and outcomes were analyzed using the electronic medical records. We identified 63 total patients who were admitted to our center with AMI-CS, and we excluded patients who did not have clear timing of AMI onset or CS onset. We evaluated the rate of survival to hospital discharge based on the quantity of certain time-sensitive hemodynamic goals were met. RESULTS We identified 63 patients who met criteria for AMI-CS, 39 (62%) of whom survived to hospital discharge. Odds of survival were closely related to the achievement of four time-dependent goals: cardiac power output (CPO) >0.6 Watts (W), pulmonary artery pulsatility index (PAPi) >1, lactate <4 mmol/L, and <2 vasopressors required. Of the 63 total patients, 36 (57%) received intra-aortic balloon pump (IABP) and 18 (29%) received an Impella CP (Abiomed) as an initial mechanical circulatory support strategy. Six patients were escalated from IABP to Impella CP for additional hemodynamic support. Nine patients were treated with vasopressors/inotropes alone. Regarding the 39 patients who survived to hospital discharge, 75% of patients met 3 or 4 goals at 24 h, whereas only 16% of deceased patients met 3 or 4 goals at 24 h. Of the 24 patients who did not survive to hospital discharge, 18 (75%) met either 0-1 goal at 24 h. There was no effect of the initial treatment strategy on achieving 3-4 goals at 24 h. CONCLUSION Our study evaluated the association of meeting 4 time-sensitive goals (CPO >0.6 W, PAPi >1, <2 vasopressors, and lactate <4 mmol/L) at 24 h after treatment for AMI-CS with in-hospital mortality. Our data show, in line with previous data, that the higher number of goals met at 24 h was associated with improved in-hospital mortality regardless of treatment strategy.
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Affiliation(s)
- Vince Siebert
- Division of Cardiology, Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jake Goldstein
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Rizwan Khan
- Division of Cardiology, Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - John Lopez
- Division of Cardiology, Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Amir Darki
- Division of Cardiology, Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Bruce Lewis
- Division of Cardiology, Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Lowell Steen
- Division of Cardiology, Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Demetrios Doukas
- Division of Cardiology, Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
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216
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Wang A, Wang Y, Liu W, Liu L, Zhou J. Effect of valve leaflet surface patterning on valve hydrodynamic performance. Int J Artif Organs 2023; 46:569-573. [PMID: 37698036 DOI: 10.1177/03913988231192118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVE We aimed to elucidate the effects of the micro-structure of the pyrolytic carbon for artificial heart valves on its hydrodynamic performance. METHODS Bileaflet mechanical valves of GKS 23 and 29 A were randomly selected. According to ISO5840, mean transvalvular pressure (MPG), regurgitation fraction (RF), and effective orifice area (EOA) of valve were assessed. Then, parallel-groove pattern was constructed by laser etching on leaflet surface, and the valves were subjected again to the same test. RESULTS Compared with before patterning at 2, 3.5, 5, and 7 L/min, the MPG of the valves in two specifications were higher, the EOA was larger in 23 A, but smaller in 29 A, and the RF was contrary to EOA. At 5 L/min, the RF in both specifications was lower after etching at 45 bpm. At 70 bpm however, the RF in 23 A decreased, in 29 A increased. CONCLUSION The parallel-groove pattern on leaflet surface affected the hemodynamic performance of the valve prostheses.
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Affiliation(s)
- Aili Wang
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Yumiao Wang
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Wanbing Liu
- Beijing Star Medical Devices Co., Ltd., Beijing, PR China
| | - Li Liu
- Center for Medical Devices Testing, National Institutes for Food and Drug Control, Beijing, PR China
| | - Jianye Zhou
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
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217
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Oakland HT, Shah SJ. Comprehensive Investigation of Latent Pulmonary Vascular Disease: An Important Exercise for a Novel HFpEF Phenotype. JACC Heart Fail 2023; 11:1439-1442. [PMID: 37480882 DOI: 10.1016/j.jchf.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 05/30/2023] [Indexed: 07/24/2023]
Affiliation(s)
- Hannah T Oakland
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale New Haven Hospital and Yale School of Medicine, New Haven, Connecticut, USA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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218
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Grinstein J, Cowger JA, Belkin MN, Houston BA, Tedford RJ. Hemodynamic Consequences of Long-Term Continuous Flow: The Importance of the Right Ventricular-Aortic Valve Interactions. Circ Heart Fail 2023; 16:e010713. [PMID: 37577824 DOI: 10.1161/circheartfailure.123.010713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Affiliation(s)
- Jonathan Grinstein
- Department of Medicine, Section of Cardiology, University of Chicago, IL (J.G., M.N.B.)
| | | | - Mark N Belkin
- Department of Medicine, Section of Cardiology, University of Chicago, IL (J.G., M.N.B.)
| | - Brian A Houston
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
| | - Ryan J Tedford
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston (B.A.H., R.J.T.)
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219
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Marquetand C, Aboud A, Hasfurther M, Göttmann J, Bahlmann E, Busch-Tilge C, Tilge P, Ivannikova M, Ensminger S, Stierle U, Reil GH, Reil JC. New insights into the hemodynamics of pulmonary homograft patients under stress echocardiography: The contribution of pressure recovery. Echocardiography 2023; 40:1058-1067. [PMID: 37638407 DOI: 10.1111/echo.15675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/13/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND The importance of pulmonary artery pressure recovery (PR) in patients with Ross procedures in whom a homograft substitutes the resected pulmonary valve, is unknown. The aim of the study was to evaluate the occurrence and extent of PR in the pulmonary artery in 65 asymptomatic patients with pulmonary homograft after Ross surgery during rest and exercise. METHODS Stress echocardiography was performed in 65 pulmonary homograft patients and 31 controls with native pulmonary valves up to 75 W. Right ventricular systolic pressure (RVSP), transvalvular flow, mean pressure gradient (Pmean ), valve resistance, and RV stroke work were determined in the exercise (max. 75 W) and recovery phases in increments of 25 W each. RESULTS Pulmonary homografts demonstrated significantly elevated Pmean compared to controls at all stages. When considering pressure recovery (absolute and relative PR at rest 3.8 ± 1.8 mm Hg, 42.6 ± 7.2%, respectively) and transvalvular energy loss (EL; at rest 4.5 ± 4.3 mm Hg) the homograft hemodynamics reached the level of controls. In a subgroup of patients with tricuspid regurgitation, resting RVSP was the same in homograft patients and controls (21.3 ± 6.1 vs. 20.4 ± 6.3, p = .62), despite significant different Pmax values. CONCLUSIONS Ross patients with pulmonary homograft showed systematically increased hemodynamic parameters compared to normal pulmonary valves. These differences were abolished when PR was considered for homograft patients. The equality of RVSP values at rest in both groups shows non-invasive evidence for PR in the pulmonary system after homograft implantation. Therefore, PR appears to be an important measure in calculating the actual hemodynamics in pulmonary homografts.
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Affiliation(s)
- Christoph Marquetand
- Klinik für Innere Medizin II, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Anas Aboud
- Klinik für Herzchirurgie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Maria Hasfurther
- Klinik für Innere Medizin II, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jan Göttmann
- Department of Analysis and Modeling of Complex Data, Johannes Gutenberg University, Mainz, Germany
| | - Edda Bahlmann
- Department of Cardiology, Asklepios Kliniken St. Georg, Hamburg, Germany
| | - Claudia Busch-Tilge
- Klinik für Herzchirurgie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Patric Tilge
- Klinik für Herzchirurgie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Maria Ivannikova
- Klinik für allgemeine und interventionelle Kardiologie, HDZ-NRW, Bad Oeynhausen, Germany
| | - Stephan Ensminger
- Klinik für Herzchirurgie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ulrich Stierle
- Klinik für Herzchirurgie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Gert-Hinrich Reil
- Universitätsklinik für Innere Medizin I, Kardiologie, Klinikum Oldenburg, Oldenburg, Germany
| | - Jan-Christian Reil
- Klinik für Herzchirurgie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Klinik für allgemeine und interventionelle Kardiologie, HDZ-NRW, Bad Oeynhausen, Germany
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220
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Sukumaran V, Mutlu O, Murtaza M, Alhalbouni R, Dubansky B, Yalcin HC. Experimental assessment of cardiovascular physiology in the chick embryo. Dev Dyn 2023; 252:1247-1268. [PMID: 37002896 DOI: 10.1002/dvdy.589] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 12/13/2022] [Accepted: 03/10/2023] [Indexed: 10/04/2023] Open
Abstract
High resolution assessment of cardiac functional parameters is crucial in translational animal research. The chick embryo is a historically well-used in vivo model for cardiovascular research due to its many practical advantages, and the conserved form and function of the chick and human cardiogenesis programs. This review aims to provide an overview of several different technical approaches for chick embryo cardiac assessment. Doppler echocardiography, optical coherence tomography, micromagnetic resonance imaging, microparticle image velocimetry, real-time pressure monitoring, and associated issues with the techniques will be discussed. Alongside this discussion, we also highlight recent advances in cardiac function measurements in chick embryos.
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Affiliation(s)
| | - Onur Mutlu
- Biomedical Research Center, Qatar University, Doha, Qatar
| | | | | | - Benjamin Dubansky
- Department of Biological and Agricultural Engineering, Office of Research and Economic Development, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Huseyin C Yalcin
- Biomedical Research Center, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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221
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Nørregaard R, Mutsaers HAM, Frøkiær J, Kwon TH. Obstructive nephropathy and molecular pathophysiology of renal interstitial fibrosis. Physiol Rev 2023; 103:2827-2872. [PMID: 37440209 PMCID: PMC10642920 DOI: 10.1152/physrev.00027.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 07/14/2023] Open
Abstract
The kidneys play a key role in maintaining total body homeostasis. The complexity of this task is reflected in the unique architecture of the organ. Ureteral obstruction greatly affects renal physiology by altering hemodynamics, changing glomerular filtration and renal metabolism, and inducing architectural malformations of the kidney parenchyma, most importantly renal fibrosis. Persisting pathological changes lead to chronic kidney disease, which currently affects ∼10% of the global population and is one of the major causes of death worldwide. Studies on the consequences of ureteral obstruction date back to the 1800s. Even today, experimental unilateral ureteral obstruction (UUO) remains the standard model for tubulointerstitial fibrosis. However, the model has certain limitations when it comes to studying tubular injury and repair, as well as a limited potential for human translation. Nevertheless, ureteral obstruction has provided the scientific community with a wealth of knowledge on renal (patho)physiology. With the introduction of advanced omics techniques, the classical UUO model has remained relevant to this day and has been instrumental in understanding renal fibrosis at the molecular, genomic, and cellular levels. This review details key concepts and recent advances in the understanding of obstructive nephropathy, highlighting the pathophysiological hallmarks responsible for the functional and architectural changes induced by ureteral obstruction, with a special emphasis on renal fibrosis.
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Affiliation(s)
- Rikke Nørregaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jørgen Frøkiær
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tae-Hwan Kwon
- Department of Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, Taegu, Korea
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Xiong Z, Yan Y, Wang X, Liu Z, Luo X, Zheng T. The effect of splenic vein diameter on the diagnosis of portal vein thrombosis. Med Phys 2023; 50:6614-6623. [PMID: 37227701 DOI: 10.1002/mp.16481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/03/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND It was still controversial that whether the increase of splenic vein (SV) diameter increased the risk of portal vein thrombosis (PVT), which was a severe disease with high mortality, in the clinic. PURPOSES This study, using computational fluid dynamics method, aimed to investigate how the increase of SV diameter affects the portal vein hemodynamics under different anatomical and geometric features of the portal venous system, thus how it induced to PVT. METHODS The ideal models of the portal system, including different anatomical structures according to the location of left gastric vein (LGV) and inferior mesenteric vein (IMV), and different geometric morphological parameters models were established to carry out numerical simulation in this study. In addition, the morphological parameters of real patients were measured to verify the numerical simulation results. RESULTS First, the wall shear stress (WSS) and helicity intensity, which were closely related to the occurrence of thrombosis, gradually decreased with the increase of SV diameter in all models. However, the degree of decrease was bigger in following models: (1) the models with LGV and IMV linking to SV compared with them linking to PV; (2) the models with big angle of PV and SV compared with small angle. In addition, the morbidity of PVT was higher when LGV and IMV linked to SV rather than them linked to PV in the real patients. Moreover, the angle of PV and SV was also different between PVT and non-PVT patients (125.53° ± 16.90° vs. 115.03° ± 16.10°, p = 0.01). CONCLUSION Whether the increase of SV diameter will result in PVT is depended on the anatomical structure of portal system and the angle between PV and SV, this is also the reason leading to the clinical controversy that the increase of SV diameter is the risk factor of PVT.
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Affiliation(s)
- Zhuxiang Xiong
- Department of Applied Mechanics, Sichuan University, Chengdu, China
- Sichuan University Yibin Park/Yibin Institute of Industrial Technology, Yibin, China
| | - Yuling Yan
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoze Wang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhan Liu
- Department of Applied Mechanics, Sichuan University, Chengdu, China
- Sichuan University Yibin Park/Yibin Institute of Industrial Technology, Yibin, China
| | - Xuefeng Luo
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Tinghui Zheng
- Department of Applied Mechanics, Sichuan University, Chengdu, China
- Sichuan University Yibin Park/Yibin Institute of Industrial Technology, Yibin, China
- West China Information Center, Sichuan University, Chengdu, China
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Liguori MB, Ali SKM, Bussman N, Colaizy T, Hundscheid T, Phad N, Clyman R, de Boode WP, de Waal K, El-Khuffash A, Gupta S, Laughon M. Patent Ductus Arteriosus in Premature Infants: Clinical Trials and Equipoise. J Pediatr 2023; 261:113532. [PMID: 37269903 DOI: 10.1016/j.jpeds.2023.113532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Macrina B Liguori
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Sanoj K M Ali
- Division of Neonatology, Sidra Medicine, Ar-Rayyan, Doha, Qatar
| | - Neidín Bussman
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
| | - Tarah Colaizy
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Tim Hundscheid
- Division of Neonatology, Department of Perinatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Nilkant Phad
- Department of Neonatology, John Hunter Children's Hospital and University of Newcastle, Newcastle, New South Wales, Australia
| | - Ronald Clyman
- Department of Pediatrics and Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA
| | - Willem-Pieter de Boode
- Division of Neonatology, Department of Perinatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Koert de Waal
- Department of Neonatology, John Hunter Children's Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Afif El-Khuffash
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
| | - Samir Gupta
- Division of Neonatology, Sidra Medicine, Ar-Rayyan, Doha, Qatar; Department of Neonatology, Durham University, Durham, United Kingdom
| | - Matthew Laughon
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Sjøen GH, Falk RS, Hauge TH, Tønnessen TI, Langesaeter E. Hemodynamic effects of a low versus a high dose of propofol during induction of anesthesia. A randomized trial. Acta Anaesthesiol Scand 2023; 67:1178-1186. [PMID: 37291731 DOI: 10.1111/aas.14293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Hypotension is common after anesthesia induction with propofol and is associated with increased morbidity. It is important to examine the effects of the proposed interventions to limit preventable hypotension, as suggested by the reduction in the dose of propofol. Our objective was to investigate whether a high dose of propofol is inferior to a low dose with respect to changes in systolic arterial blood pressure (SAP). METHODS This randomized, double-blind, dose-controlled, non-inferiority study included 68 healthy women scheduled for gynecological surgery at the Day Surgery Unit, Haugesund Hospital, Norway. The patients were randomly allocated 1:1 to a low or high dose (1.4 mg/kg total body weight (TBW) versus 2.7 mg/kg TBW of propofol corresponding to maximal effect site concentrations (Ce) of 2.0 μg/mL versus 4.0 μg/mL. The dose of remifentanil was 1.9-2.0 μg/kg TBW, with maximal Ce of 5.0 ng/mL. The patients were observed for 450 s from the start of the infusions. The first 150 s was the sedation period, after which a bolus of propofol and remifentanil was administered. Baseline was defined as 55-5 s before the bolus doses. LiDCOplus was used for invasive beat-to-beat hemodynamic monitoring of changes in SAP, heart rate (HR), cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR). A difference of 10 mmHg in the change in SAP was considered to be clinically important. RESULTS The SAP change difference for low versus high dose was -2.9 mmHg (95% CI -9.0-3.1). The relative changes for low versus high dose were SAP -31% versus -36%, (p < .01); HR -24% versus -20%, (p = .09); SVR -20% versus -31%, (p < .001); SV -16% versus -20%, (p = .04); and CO -35% versus -32%, (p = .33). CONCLUSION A high dose of propofol was not inferior to a low dose, and a reduction in the dose of propofol did not result in clinically important attenuation of major hemodynamic changes during induction in healthy women. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03861364, January 3, 2019.
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Affiliation(s)
- Gunnar Helge Sjøen
- Department of Anaesthesiology, Haugesund Hospital, Haugesund, Norway
- Department of Research and Innovation, Haugesund, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ragnhild Sørum Falk
- Oslo Centre for Epidemiology and Biostatistics, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Tor Hugo Hauge
- Norwegian Ministry of Trade, Industry and Fisheries, Oslo, Norway
| | - Tor Inge Tønnessen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Anaesthesiology and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Eldrid Langesaeter
- Department of Anaesthesiology and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital-Rikshospitalet, Oslo, Norway
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Waldeck S, Overhoff D, Brockmann MA, Becker BV. Detection of Endoleaks Following Thoracic and Abdominal Aortic Endovascular Aortic Repair-: A Comparison of Standard and Dynamic 4D-Computed Tomography Angiography. J Endovasc Ther 2023; 30:739-745. [PMID: 35582987 DOI: 10.1177/15266028221095390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Endoleaks are a common complication after endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR). The detection and correct classification of endoleaks is essential for the further treatment of affected patients. However, standard computed tomography angiography (CTA) provides no hemodynamic information on endoleaks, which can result in misclassification in complex cases. The aim of this study was to compare standard CTA (sCTA) with dynamic, dual-energy CTA (dCTA) for detection and classification of endoleaks following EVAR or TEVAR. MATERIALS AND METHODS This retrospective evaluation compared 69 sCTA diagnostic examinations performed on 50 different patients with 89 dCTA diagnostic examinations performed on 69 different patients. RESULTS In total, 15.9% of sCTA examinations and 49.4% of dCTA examinations led to the detection of endoleaks. With sCTA, 20.0% of patients were diagnosed with endoleaks, while with dCTA, 37.7% of patients were diagnosed with endoleaks. With sCTA, mainly Type 1 endoleaks were detected, whereas, with dCTA, the types of detected endoleaks were more evenly distributed. In comparison with the literature, the frequencies of endoleak types detected with dCTA better reflect the natural distribution than the frequencies detected with standard CTA. CONCLUSION Based on the retrospective comparative evaluation, dCTA could pose a valuable supplementary diagnostic tool resulting in a more accurate and realistic detection and classification of suspected endoleaks.
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Affiliation(s)
- Stephan Waldeck
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
- Institute of Neuroradiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Daniel Overhoff
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc A Brockmann
- Institute of Neuroradiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Benjamin V Becker
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
- Institute of Neuroradiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
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Rommel KP, Pagoulatou S, Kresoja KP, Rosch S, Schöber AR, von Roeder M, Thiele H, Fengler K, Stergiopulos N, Lurz P. Modulation of Pulsatile Left Ventricular Afterload by Renal Denervation in Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2023; 16:e010543. [PMID: 37646196 DOI: 10.1161/circheartfailure.123.010543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 07/28/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Arterial stiffening contributes to hemodynamic derangements in heart failure with preserved ejection fraction (HFpEF). We sought to investigate the impact of renal denervation on pulsatile left ventricular loading in patients with HFpEF and hypertensive patients without heart failure (control). METHODS Patients underwent renal denervation for treatment of hypertension and were followed up at 3 months at a single center. A validated computer model of the arterial tree, noninvasive aortic flow curves, left ventricular volumes, and E/e' as inputs were used to determine key parameters of left ventricular vascular load. RESULTS In comparison to controls (n=30), patients with HFpEF (n=30) demonstrated lower total arterial compliance (mean difference, -0.41 [95% CI, -0.72 to -0.10] mL/mm Hg), higher impedance of the proximal aorta (Zc: 0.02; 0.01 to 0.04 mHg·s/mL), premature wave reflections (shorter backward wave transit time normalized to ejection time: -3.5; -6.5% to -0.5%), and higher wave reflection magnitude (reflection coefficient: 7.3; 2.8% to 11.9%). Overall, daytime systolic (-9.2; -12.2 to -6.2 mm Hg) and diastolic blood pressures (-5.9; -7.6 to -4.1 mm Hg) as well as blood pressure variability (-2.0; -3.0 to -0.9 mm Hg) decreased after renal denervation. In patients with HFpEF, total arterial compliance (0.42; 0.17 to 0.67 mL/mm Hg) and backward transit time normalized to ejection time (1.7; 0.4% to 3.0%) increased; Zc (-0.01; -0.02 to -0.01 mm Hg·s/mL) and reflection coefficient (-2.6; -5.0% to -0.3%) decreased after renal denervation. This was accompanied by a symptomatic improvement in patients with HFpEF. CONCLUSION HFpEF is characterized by heightened aortic stiffness and unfavorable pulsatile left ventricular load. These abnormalities are partly normalized after renal denervation.
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Affiliation(s)
- Karl-Philipp Rommel
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Germany (K.-P.R., K.-P.K., S.R., A.R.S., M.v.R., H.T., K.F., P.L.)
- Cardiovacular Research Foundation, New York, NY (K.-P.R.)
| | - Stamatia Pagoulatou
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, Switzerland (S.P., N.S.)
| | - Karl-Patrik Kresoja
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Germany (K.-P.R., K.-P.K., S.R., A.R.S., M.v.R., H.T., K.F., P.L.)
| | - Sebastian Rosch
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Germany (K.-P.R., K.-P.K., S.R., A.R.S., M.v.R., H.T., K.F., P.L.)
| | - Anne Rebecca Schöber
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Germany (K.-P.R., K.-P.K., S.R., A.R.S., M.v.R., H.T., K.F., P.L.)
| | - Maximilian von Roeder
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Germany (K.-P.R., K.-P.K., S.R., A.R.S., M.v.R., H.T., K.F., P.L.)
| | - Holger Thiele
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Germany (K.-P.R., K.-P.K., S.R., A.R.S., M.v.R., H.T., K.F., P.L.)
| | - Karl Fengler
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Germany (K.-P.R., K.-P.K., S.R., A.R.S., M.v.R., H.T., K.F., P.L.)
| | - Nikolaos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, Switzerland (S.P., N.S.)
| | - Philipp Lurz
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Germany (K.-P.R., K.-P.K., S.R., A.R.S., M.v.R., H.T., K.F., P.L.)
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Ali HR, Thomas J, Sahay S, Guha A. Management of pulmonary hypertension associated with valvular heart disease with angiotensin-receptor neprilysin inhibitor. Pulm Circ 2023; 13:e12303. [PMID: 37937122 PMCID: PMC10626127 DOI: 10.1002/pul2.12303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 08/23/2023] [Accepted: 09/20/2023] [Indexed: 11/09/2023] Open
Abstract
Pulmonary hypertension secondary to left-sided valvular disease (VHD-PH) is associated with high morbidity and mortality. Angiotensin-receptor neprilysin inhibitor (ARNI) is a novel pharmacotherapy, which reduces afterload with natriuresis and peripheral vasodilation. Our cases demonstrate that ARNI may also have a role in the treatment of combined pre- and postcapillary pulmonary hypertension that is independent of its effect on pulmonary capillary wedge pressure and cardiac output. Future prospective trials are needed to evaluate role of ARNIs in treatment of VHD-PH.
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Affiliation(s)
- Hyeon‐Ju Ryoo Ali
- Department of CardiologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Sandeep Sahay
- Department of PulmonologyHouston Methodist HospitalHoustonTexasUSA
| | - Ashrith Guha
- Department of CardiologyHouston Methodist HospitalHoustonTexasUSA
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Kuo CY, Cheng HH, Cheng PC. [Project to Improve FloTrac Cognition and Skill Accuracy in Nurses Working in the Intensive Care Unit]. Hu Li Za Zhi 2023; 70:75-83. [PMID: 37740267 DOI: 10.6224/jn.202310_70(5).10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
BACKGROUND & PROBLEMS FloTrac is used to monitor hemodynamics in patients. Insufficient awareness of and inexperience with this machine put patients at risk. PURPOSE A project was developed to increase FloTrac cognitive accuracy from 57.6% to 85% and skill accuracy from 73.3% to 91% in ICU nurses. Also, FloTrac installation time was intended to be reduced to less than 8 minutes and 38 seconds. RESOLUTION Create a pithy, easy-to-remember formula; make operation teaching videos, operation manuals, and reminder cards; arrange educational training; and monitor quality regularly. RESULTS FloTrac cognitive accuracy increased from 57.6% to 90.4%; FloTrac skill accuracy increased from 73.3% to 99.7%; and installation time was shortened from 8 minutes and 38 seconds to 5 minutes and 42 seconds. CONCLUSIONS After implementation of the project, nurses improved their professional knowledge and were better able to help doctors obtain hemodynamic data efficiently to provide patients with accurate and rapid treatment.
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Affiliation(s)
- Chih-Ying Kuo
- MSN, RN, Department of Nursing, Kaoshiung Chang Gung Memorial Hospital, Taiwan, ROC.
| | - Hsin-Hua Cheng
- BSN, RN, Department of Nursing, Kaoshiung Chang Gung Memorial Hospital, Taiwan, ROC
| | - Pei-Chi Cheng
- BSN, RN, Department of Nursing, Kaoshiung Chang Gung Memorial Hospital, Taiwan, ROC
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Hristovska AM, Uldall-Hansen B, Mehlsen J, Andersen LB, Kehlet H, Foss NB. Orthostatic intolerance after acute mild hypovolemia: incidence, pathophysiologic hemodynamics, and heart-rate variability analysis-a prospective observational cohort study. Can J Anaesth 2023; 70:1587-1599. [PMID: 37752379 PMCID: PMC10600298 DOI: 10.1007/s12630-023-02556-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 02/05/2023] [Accepted: 02/13/2023] [Indexed: 09/28/2023] Open
Abstract
PURPOSE Early postoperative mobilization can be hindered by orthostatic intolerance (OI). Postoperative OI has multifactorial pathogenesis, possibly involving both postoperative hypovolemia and autonomic dysfunction. We aimed to investigate the effect of mild acute blood loss from blood donation simulating postoperative hypovolemia, on both autonomic function and OI, thus eliminating confounding perioperative factors such as inflammation, residual anesthesia, pain, and opioids. METHODS This prospective observational cohort study included 26 blood donors. Continuous electrocardiogram data were collected during mobilization and night sleep, both before and after blood donation. A Valsalva maneuver and a standardized mobilization procedure were performed immediately before and after blood donation, during which cardiovascular and tissue oxygenation variables were continuously measured by LiDCOrapid™ and Massimo Root™, respectively. The incidence of OI, hemodynamic responses during mobilization and Valsalva maneuver, as well as heart rate variability (HRV) responses during mobilization and sleep were compared before and 15 min after blood donation. RESULTS Prior to blood donation, no donors experienced OI during mobilization. After blood donation, 6/26 (23%; 95% CI, 9 to 44) donors experienced at least one OI symptom. Three out of 26 donors (12%; 95% CI, 2 to 30) terminated the mobilization procedure prematurely because of severe OI symptoms. Cardiovascular and cerebral tissue oxygenation responses were reduced in patients with severe OI. After blood loss, HRV indices of total autonomic power remained unchanged but increased sympathetic and decreased parasympathetic outflow was observed during mobilization, but also during sleep, indicating a prolonged autonomic effect of hypovolemia. CONCLUSION We describe a specific hypovolemic component of postoperative OI, independent of postoperative autonomic dysfunction, inflammation, opioids, and pain. STUDY REGISTRATION ClinicalTrials.gov (NCT04499664); registered 5 August 2020.
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Affiliation(s)
- Ana-Marija Hristovska
- Department of Anesthesiology and Intensive Care, Copenhagen University Hospital, Hvidovre Hospital, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark.
| | - Bodil Uldall-Hansen
- Department of Anesthesiology and Intensive Care, Copenhagen University Hospital, Hvidovre Hospital, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Jesper Mehlsen
- Department of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Louise B Andersen
- Department of Anesthesiology and Intensive Care, Copenhagen University Hospital, Hvidovre Hospital, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Henrik Kehlet
- Department of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nicolai B Foss
- Department of Anesthesiology and Intensive Care, Copenhagen University Hospital, Hvidovre Hospital, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
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Bertuccioli A, Cannataro R, Gervasi M, Benelli P, Gregoretti A, Ragazzini M, Neri M, Palazzi CM, Cardinali M, Zonzini G. Preliminary Assessment of the Acute Effects of Far Infrared-Emitting Garments: What Are the Possible Implications for Recovery and Performance? Life (Basel) 2023; 13:1998. [PMID: 37895379 PMCID: PMC10608099 DOI: 10.3390/life13101998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Technical clothing has recently been brought into the spotlight as one of the most promising tools to improve sports performance and to enhance sports recovery. Among technical clothing items, garments engineered to emit far infrared (FIR) spectrum frequencies have come to the fore as a treatment for pain, muscle fatigue, and tissue healing due to their potential antioxidative and anti-inflammatory properties, with applications not only during recovery phases but also in the active phases of exercise. These garments, composed of fibers mixed with noble metals and/or bioceramics that respond to body infrared frequencies by returning an FIR emission backwards, are thought to improve muscle oxygenation and therefore recovery. In this double-blind, randomized, placebo-controlled, crossover study, ten male trail running athletes wore a whole-body-covering suit marketed as Accapì-FIR (Bruno Chiaruttini S.r.l., Rezzato, BS, Italy), while a total body suit with the same polyester fiber without metal components was used as control for the intervention. Parameters such as weight, height, bioimpedance parameters (BIVA), lactate from capillary sampling, salivary cortisol, and average temperatures of different body areas were obtained before and after a twelve-minute incremental work run protocol on a treadmill whilst wearing the two kinds of garment. Using the intervention suit, compared to control, statistically significant reductions in BIVA parameters such as body resistance (-6.7%) and reactance (-5.4%) were observed before and after exercise while a greater, but not significant, weight reduction was observed with the intervention suit. Decrease in resistance could be the result of a different distribution of fluids and ions due to FIR influence on capillary and superficial circulation, leading ultimately to more efficient management of body heat and promoting recovery and supercompensation. Further studies on larger samples will be necessary to confirm and clarify these results.
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Affiliation(s)
- Alexander Bertuccioli
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
- Microbiota International Clinical Society, 10123 Torino, Italy
| | - Roberto Cannataro
- Galascreen Laboratories, University of Calabria, 87036 Rende, Italy
- Research Division, Dynamical Business and Science Society, DBSS International SAS, Bogota 110311, Colombia
| | - Marco Gervasi
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Piero Benelli
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Aurora Gregoretti
- AIFeM (Italian Medicine and Fitness Federation), 48121 Ravenna, Italy
| | - Mirko Ragazzini
- Microbiota International Clinical Society, 10123 Torino, Italy
- AIFeM (Italian Medicine and Fitness Federation), 48121 Ravenna, Italy
| | - Marco Neri
- AIFeM (Italian Medicine and Fitness Federation), 48121 Ravenna, Italy
| | - Chiara Maria Palazzi
- Microbiota International Clinical Society, 10123 Torino, Italy
- AIFeM (Italian Medicine and Fitness Federation), 48121 Ravenna, Italy
| | - Marco Cardinali
- Department of Internal Medicine, Infermi Hospital, AUSL Romagna, 47921 Rimini, Italy
| | - Giordano Zonzini
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
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Bańka P, Wybraniec M, Bochenek T, Gruchlik B, Burchacka A, Swinarew A, Mizia-Stec K. Influence of Aortic Valve Stenosis and Wall Shear Stress on Platelets Function. J Clin Med 2023; 12:6301. [PMID: 37834945 PMCID: PMC10573628 DOI: 10.3390/jcm12196301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Aortic valve stenosis (AS) is a common heart valve disease in the elderly population, and its pathogenesis remains an interesting area of research. The degeneration of the aortic valve leaflets gradually progresses to valve sclerosis. The advanced phase is marked by the presence of extracellular fibrosis and calcification. Turbulent, accelerated blood flow generated by the stenotic valve causes excessive damage to the aortic wall. Elevated shear stress due to AS leads to the degradation of high-molecular weight multimers of von Willebrand factor, which may involve bleeding in the mucosal tissues. Conversely, elevated shear stress has been associated with the release of thrombin and the activation of platelets, even in individuals with acquired von Willebrand syndrome. Moreover, turbulent blood flow in the aorta may activate the endothelium and promote platelet adhesion and activation on the aortic valve surface. Platelets release a wide range of mediators, including lysophosphatidic acid, which have pro-osteogenic effects in AS. All of these interactions result in blood coagulation, fibrinolysis, and the hemostatic process. This review summarizes the current knowledge on high shear stress-induced hemostatic disorders, the influence of AS on platelets and antiplatelet therapy.
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Affiliation(s)
- Paweł Bańka
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Maciej Wybraniec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Tomasz Bochenek
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Bartosz Gruchlik
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Aleksandra Burchacka
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Andrzej Swinarew
- Faculty of Science and Technology, University of Silesia in Katowice, 40-007 Katowice, Poland
- Department of Swimming and Water Rescue, Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
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Imig JD, Wu J, Gohar EY. Editorial: Nuclear receptors in hemodynamics and blood pressure control. Front Physiol 2023; 14:1290411. [PMID: 37829111 PMCID: PMC10565469 DOI: 10.3389/fphys.2023.1290411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023] Open
Affiliation(s)
- John D. Imig
- Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Jing Wu
- Department of Medicine, Institute for Human Health and the Environment, University of Rochester Medical Center, Rochester, NY, United States
- Department of Pharmacology and Physiology, Institute for Human Health and the Environment, University of Rochester Medical Center, Rochester, NY, United States
| | - Eman Y. Gohar
- Vanderbilt University Medical Center, Nashville, TN, United States
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Baenen O, Carreño-Martínez AC, Abraham TP, Rugonyi S. Energetics of Cardiac Blood Flow in Hypertrophic Cardiomyopathy through Individualized Computational Modeling. J Cardiovasc Dev Dis 2023; 10:411. [PMID: 37887858 PMCID: PMC10607792 DOI: 10.3390/jcdd10100411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a congenital heart disease characterized by thickening of the heart's left ventricle (LV) wall that can lead to cardiac dysfunction and heart failure. Ventricular wall thickening affects the motion of cardiac walls and blood flow within the heart. Because abnormal cardiac blood flow in turn could lead to detrimental remodeling of heart walls, aberrant ventricular flow patterns could exacerbate HCM progression. How blood flow patterns are affected by hypertrophy and inter-patient variability is not known. To address this gap in knowledge, we present here strategies to generate personalized computational fluid dynamics (CFD) models of the heart LV from patient cardiac magnetic resonance (cMR) images. We performed simulations of CFD LV models from three cases (one normal, two HCM). CFD computations solved for blood flow velocities, from which flow patterns and the energetics of flow within the LV were quantified. We found that, compared to a normal heart, HCM hearts exhibit anomalous flow patterns and a mismatch in the timing of energy transfer from the LV wall to blood flow, as well as changes in kinetic energy flow patterns. While our results are preliminary, our presented methodology holds promise for in-depth analysis of HCM patient hemodynamics in clinical practice.
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Affiliation(s)
- Owen Baenen
- Department of Mechanical Engineering, Rice University, Houston, TX 77005, USA;
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97239, USA
| | - Angie Carolina Carreño-Martínez
- USCF HCM Center, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA 94158, USA (T.P.A.)
| | - Theodore P. Abraham
- USCF HCM Center, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA 94158, USA (T.P.A.)
| | - Sandra Rugonyi
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97239, USA
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234
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Yu J, Hu M, Zhang J, Chen J. Analyzing characteristics of collateral flow to parasylvian cortical arteries by three-dimensional digital subtraction angiography-magnetic resonance angiography fusion imaging in adult moyamoya disease. Front Neurol 2023; 14:1251844. [PMID: 37808502 PMCID: PMC10551150 DOI: 10.3389/fneur.2023.1251844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/24/2023] [Indexed: 10/10/2023] Open
Abstract
Objective The hemodynamic sources of recipient parasylvian cortical arteries (PSCAs) were significantly related to postoperative cerebral hyperperfusion (CHP) after bypass surgery in patients with moyamoya disease (MMD). The present study aimed to introduce a new method to investigate the characteristics of PSCAs hemodynamic sources and their relationships with clinical presentations in adult MMD and to provide preoperative evaluation for recipient vessel selection in MMD bypass surgery. Methods The hemodynamic sources of the PSCAs in 171 symptomatic MMD hemispheres were analyzed by three-dimensional digital subtraction angiography (3D-DSA) combined with magnetic resonance angiography (MRA) fusion imaging. The spatial and temporal characteristics of the hemodynamic sources of the PSCAs and their associations with the patient's demographics, Suzuki stage, and initial onset type were investigated. Results Six major types of hemodynamic sources in the PSCAs were observed. There was a significant difference between the hemodynamic sources of the PSCAs above and below the SF (P < 0.001). With advancing Suzuki stages, collateral flow to the PSCAs above the SF from the internal carotid arteries (ICAs) significantly decreased, while the non-ICAs increased (P < 0.001). Multivariate analysis revealed that hemodynamic sources of the PSCAs above the SF were significantly associated with patients' initial onset type (P = 0.026). Conclusion In MMD hemispheres, the hemodynamic sources of the PSCAs above the SF are more varied than those below the SF and present a typical conversion trend from ICAs to non-ICAs with advancing Suzuki stages. Analyzing the hemodynamic sources of the PSCAs can help in understanding the conversion pattern of compensatory vascular systems, predicting episodes in MMD, and preoperatively evaluating suitable recipient vessel selection for bypass surgery to avoid postoperative CHP.
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Affiliation(s)
| | | | - Jianjian Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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Lv S, He ZP, Liu GM, Hu SS. Numerical investigation on the effect of impeller axial position on hemodynamics of an extracorporeal centrifugal blood pump. Comput Methods Biomech Biomed Engin 2023:1-12. [PMID: 37724774 DOI: 10.1080/10255842.2023.2256946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
Extracorporeal centrifugal blood pumps are used to treat cardiogenic shock. Owing to the imbalanced excitation or initial assembly configurations, the variation in the impeller axial position has the potential to affect the blood pump performance. This study compared the hydrodynamics and hemolysis outcomes at different impeller axial positions via numerical simulations. The result shows that pressure difference of the blood pump decreased with increasing impeller axial position, with decreasing by 4.5% at a flow rate of 2 L/min. Under axial impeller motion close to the top pump casing, average wall shear stress and scalar shear stress reached their maximum values (64.2 and 29.1 Pa, respectively). The residence time in the impeller center hole and bottom clearance were extended to 0.5 s by increasing impeller axial position. Compared to the baseline blood pump, hemolysis index increased by 12.3% and 24.3% when impeller axial position is 2.5 and 4.0 mm, respectively. As a novelty, the findings reveal that the impeller axial position adversely affects hemolysis performance when the impeller is close to the pump casing. Therefore, in the development process of centrifugal blood pumps, the optimal axial position of the impeller must be defined to ensure hemodynamic performance.
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Affiliation(s)
- Shen Lv
- Shenzhen Key Laboratory of Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, Guangdong Province, China
| | - Zhi-Peng He
- Shenzhen Key Laboratory of Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, Guangdong Province, China
| | - Guang-Mao Liu
- Shenzhen Key Laboratory of Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, Guangdong Province, China
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sheng-Shou Hu
- Shenzhen Key Laboratory of Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, Guangdong Province, China
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Park CG, Lee D, Jeong WS, Kim DS, Jo YY, Kwak HJ. Impact of Remimazolam versus Sevoflurane Anesthesia on Cerebral Oxygenation and Intracranial Pressure during Gynecological Laparoscopy with Mild Hypercapnia. Med Sci Monit 2023; 29:e941315. [PMID: 37717140 PMCID: PMC10510424 DOI: 10.12659/msm.941315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/01/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Remimazolam has the advantage of better hemodynamic stability compared with other anesthetics. We compared the effects of remimazolam and sevoflurane on cerebral oxygenation, intracranial pressure, and intraoperative hemodynamic parameters during mild hypercapnia in patients undergoing laparoscopy in the Trendelenburg position. MATERIAL AND METHODS Sixty-two patients (20-65 years old) scheduled for gynecological laparoscopy were randomly allocated to either the remimazolam (n=31) or sevoflurane (n=31) group. Respiratory and hemodynamic parameters and regional cerebral oxygen saturation (rSO₂) were recorded. Intracranial pressure was measured using the optic nerve sheath diameter (ONSD). RESULTS The change over time in rSO₂ did not differ between groups (P=0.056). The change in ONSD over time showed a significant intergroup difference (P=0.002). ONSD significantly changed over time (P=0.034) in the sevoflurane group but not in the remimazolam group (P=0.115). The changes in mean arterial pressure and heart rate over time showed significant intergroup differences (P=0.045 and 0.031, respectively). The length of stay and the use of rescue antiemetics and analgesics in the postanesthetic care unit were significantly lower in the remimazolam group than in the sevoflurane group (P=0.023, 0.038, and 0.018, respectively). CONCLUSIONS Remimazolam can provide a favorable hemodynamic profile and attenuate the increase in ONSD during gynecological laparoscopy compared with sevoflurane anesthesia during lung-protective ventilation with mild hypercapnia. Remimazolam can provide faster and better postoperative recovery than sevoflurane anesthesia.
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237
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Sun X, Wei C, Li L, Qu C. Levosimendan improves cardiac function, hemodynamics, and body inflammation in patients with acute myocardial infarction and heart failure. Am J Transl Res 2023; 15:5624-5632. [PMID: 37854215 PMCID: PMC10579015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/20/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To examine the effects of levosimendan on cardiac function, hemodynamics, and body inflammation of patients with acute myocardial infarction and heart failure. METHODS A retrospective analysis was conducted on 113 acute myocardial infarction patients with heart failure (admitted to Xianyang First People's Hospital from September 2018 to January 2022). According to the treatment plan, patients were categorized into a control group (n = 53) (treated with conventional diuresis and vasodilation) and observation group (n = 60) (treated with levosimendan in addition to the treatment of the control group). Indexes were compared between the two groups before and after treatment, including effectiveness rate, mean pulmonary arterial pressure (PAMP) and pulmonary capillary wedge pressure (PCWP). Left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and left ventricular ejection fraction (LVEF) were monitored before and after treatment by color Doppler ultrasonography. Serum high-sensitivity C-reactive protein (hs-CRP) levels were measured before and after treatment. Logistic analysis was applied to screen independent factors affecting treatment efficacy. Adverse reactions and life quality after 6 months of treatment were compared between the two groups. RESULTS The overall response rate of the observation group was higher than that of the control group (P<0.05). Changes in PAMP and PCWP in the two groups before and after treatment were significantly different. Patients in the observation group had improved indicators compared with the control group (all P<0.05). After treatment, the cardiac function indexes and inflammation-related factors of the observation group were improved more than those of the control group (P<0.05). Patients in the observation group had a lower incidence of adverse reactions and a higher life quality 6 months after treatment compared to the control group (P<0.05). Diabetes and treatment regimen were independent risk factors affecting treatment efficacy by logistic regression analysis. CONCLUSION The administration of levosimendan helps improve cardiac function, hemodynamics, and body inflammation in patients with acute myocardial infarction and heart failure, with fewer adverse reactions and higher safety.
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Affiliation(s)
- Xiaoxia Sun
- Cardiovascular Division, Xianyang First People’s HospitalNo. 10, Biyuan Road, Qindu District, Xianyang 712000, Shaanxi, China
| | - Congying Wei
- Cardiovascular Division, Xianyang Central HospitalNo. 78, Renmin East Road, Weicheng District, Xianyang 712000, Shaanxi, China
| | - Lei Li
- Cardiovascular Division, Xianyang First People’s HospitalNo. 10, Biyuan Road, Qindu District, Xianyang 712000, Shaanxi, China
| | - Chao Qu
- Cardiovascular Ward I, Xi’an Fifth HospitalNo. 112, Xiguanzheng Street, Lianhu District, Xi’an 710000, Shaanxi, China
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El Sayed R, Park CC, Shah Z, Nahab FB, Haussen DC, Allen JW, Oshinski JN. Assessment of Complex Flow Patterns in Patients With Carotid Webs, Patients With Carotid Atherosclerosis, and Healthy Subjects Using 4D Flow MRI. J Magn Reson Imaging 2023:10.1002/jmri.29013. [PMID: 37706274 PMCID: PMC10937327 DOI: 10.1002/jmri.29013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Carotid webs (CaWs) are fibromuscular projections in the internal carotid artery (ICA) that cause mild luminal narrowing (<50%), but may be causative in up to one-third of seemingly cryptogenic strokes. Understanding hemodynamic alterations caused by CaWs is imperative to assessing stroke risk. Time-Average Wall Shear Stress (TAWSS) and Oscillatory Shear Index (OSI) are hemodynamic parameters linked to vascular dysfunction and thrombosis. PURPOSE To test the hypothesis: "CaWs are associated with lower TAWSS and higher OSI than mild atherosclerosis or healthy carotid bifurcation." STUDY TYPE Prospective study. POPULATION A total of 35 subjects (N = 14 bifurcations with CaW, 11F, age: 49 ± 10, 10 mild atherosclerosis 6F, age: 72 ± 9, 11 healthy 9F, age: 42 ± 13). FIELD STRENGTH/SEQUENCE 4D flow/STAR-MATCH/3D TOF/3T MRI, CTA. ASSESSMENT 4D Flow velocity data were analyzed in two ways: 1) 3D ROI in the ICA bulbar segment (complex flow patterns are expected) was used to quantify the regions with low TAWSS and high OSI. 2) 2D planes were placed perpendicular to the centerline of the carotid bifurcation for detailed analysis of TAWSS and OSI. STATISTICAL TESTS Independent-samples Kruskal-Wallis-H test with 0.05 used for statistical significance. RESULTS The percent surface area where low TAWSS was present in the ICA bulb was 12.3 ± 8.0% (95% CI: 7.6-16.9) in CaW subjects, 1.6 ± 1.9% (95% CI: 0.2-2.9) in atherosclerosis, and 8.5 ± 7.7% (95% CI: 3.6-13.4) in healthy subjects, all differences were statistically significant (ƞ2 = 0.3 [95% CI: 0.05-0.5], P-value CaW vs. healthy = 0.2). OSI had similar values in the CCA between groups (ƞ2 = 0.07 [95% CI: 0.0-0.2], P-value = 0.5), but OSI was significantly higher downstream of the bifurcation in CaW subjects compared to atherosclerosis and normal subjects. OSI returned to similar values between groups 1.5 diameters distal to the bifurcation (ƞ2 = 0.03 [95% CI: 0.0-0.2], P-value = 0.7). CONCLUSION Lower TAWSS and higher OSI are present in the ICA bulb in patients with CaW when compared to patients with atherosclerotic or healthy subjects. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Retta El Sayed
- Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Charlie C. Park
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Zahraw Shah
- Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
| | - Fadi B. Nahab
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Diogo C. Haussen
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Jason W. Allen
- Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia, USA
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - John N. Oshinski
- Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia, USA
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Pujol-Lopez M, Du Fay de Lavallaz J, Rangan P, Beaser A, Aziz Z, Upadhyay GA, Nayak H, Weiss JP, Zawaneh M, Bai R, Su W, Tung R. Vasovagal Responses to Human Monomorphic Ventricular Tachycardia: Hemodynamic Implications From Sinus Rate Analysis. J Am Coll Cardiol 2023; 82:1096-1105. [PMID: 37673510 DOI: 10.1016/j.jacc.2023.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Factors determining hemodynamic stability during human ventricular tachycardia (VT) are incompletely understood. OBJECTIVES The purposes of this study were to characterize sinus rate (SR) responses during monomorphic VT in association with hemodynamic stability and to prospectively assess the effects of vagolytic therapy on VT tolerance. METHODS This is a retrospective analysis of patients undergoing scar-related VT ablation. Vasovagal responses were evaluated by analyzing sinus cycle length before VT induction and during VT. SR responses were classified into 3 groups: increasing (≥5 beats/min, sympathetic), decreasing (≥5 beats/min, vagal), and unchanged, with the latter 2 categorized as inappropriate SR. In a prospective cohort (n = 30) that exhibited a failure to increase SR, atropine was administered to improve hemodynamic tolerance to VT. RESULTS In 150 patients, 261 VT episodes were analyzed (29% untolerated, 71% tolerated) with median VT duration 1.6 minutes. A total of 52% of VT episodes were associated with a sympathetic response, 31% had unchanged SR, and 17% of VTs exhibited a vagal response. A significantly higher prevalence of inappropriate SR responses was observed during untolerated VT (sustained VT requiring cardioversion within 150 seconds) compared with tolerated VT (84% vs 34%; P < 0.001). Untolerated VT was significantly different between groups: 9% (sympathetic), 82% (vagal), and 32% (unchanged) (P < 0.001). Atropine administration improved hemodynamic tolerance to VT in 70%. CONCLUSIONS Nearly one-half of VT episodes are associated with failure to augment SR, indicative of an under-recognized pathophysiological vasovagal response to VT. Inappropriate SR responses were more predictive of hemodynamic instability than VT rate and ejection fraction. Vagolytic therapy may be a novel method to augment blood pressure during VT.
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Affiliation(s)
- Margarida Pujol-Lopez
- University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Section of Cardiology, Chicago, Illinois, USA; University of Arizona College of Medicine, Banner-University Medical Center, Division of Cardiology, Phoenix, Arizona, USA
| | - Jeanne Du Fay de Lavallaz
- University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Section of Cardiology, Chicago, Illinois, USA
| | - Pooja Rangan
- University of Arizona College of Medicine, Banner-University Medical Center, Division of Cardiology, Phoenix, Arizona, USA
| | - Andrew Beaser
- University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Section of Cardiology, Chicago, Illinois, USA
| | - Zaid Aziz
- University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Section of Cardiology, Chicago, Illinois, USA
| | - Gaurav A Upadhyay
- University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Section of Cardiology, Chicago, Illinois, USA
| | - Hemal Nayak
- University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Section of Cardiology, Chicago, Illinois, USA
| | - J Peter Weiss
- University of Arizona College of Medicine, Banner-University Medical Center, Division of Cardiology, Phoenix, Arizona, USA
| | - Michael Zawaneh
- University of Arizona College of Medicine, Banner-University Medical Center, Division of Cardiology, Phoenix, Arizona, USA
| | - Rong Bai
- University of Arizona College of Medicine, Banner-University Medical Center, Division of Cardiology, Phoenix, Arizona, USA
| | - Wilber Su
- University of Arizona College of Medicine, Banner-University Medical Center, Division of Cardiology, Phoenix, Arizona, USA
| | - Roderick Tung
- University of Arizona College of Medicine, Banner-University Medical Center, Division of Cardiology, Phoenix, Arizona, USA.
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d'Avila A, D'Angelo RN. Vasovagal Responses to Human Monomorphic Ventricular Tachycardia: Atropine to the Rescue. J Am Coll Cardiol 2023; 82:1106-1107. [PMID: 37673511 DOI: 10.1016/j.jacc.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Andre d'Avila
- Harvard-Thorndike Electrophysiology Institute, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
| | - Robert N D'Angelo
- Harvard-Thorndike Electrophysiology Institute, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. https://twitter.com/rdangeloMD
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Gualberto PIB, Benvindo VV, Waclawovsky G, Deresz LF. Acute effects of energy drink consumption on cardiovascular parameters in healthy adults: a systematic review and meta-analysis of randomized clinical trials. Nutr Rev 2023:nuad112. [PMID: 37695306 DOI: 10.1093/nutrit/nuad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
CONTEXT Energy drinks (EDs) are beverages that contain ingredients that may pose a risk to consumers' cardiovascular health. But current evidence is conflicting and warrants further investigation. OBJECTIVE A systematic review and meta-analysis was conducted on studies that examined the acute effects of ED consumption on systolic blood pressure (SBP), diastolic blood pressure (DBP), resting heart rate, cardiac output (CO), endothelial function, and QT/QTc interval in healthy adults. DATA SOURCES The databases PubMed, EMBASE, Cochrane, LILACS, Web of Science, SportDiscus, and the gray literature were searched to identify randomized controlled trials (RCTs). DATA EXTRACTION Two independent evaluators screened 2014 studies and extracted relevant data from those selected for the analysis. A risk of bias assessment was also performed with the RoB 2 tool and a strength of evidence assessment was performed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE). DATA ANALYSIS A total of 17 RCTs were included in the meta-analysis. With regard to risk of bias, 11 studies were rated as having "some concerns" and 6 as "high risk of bias." The consumption of EDs increased SBP, DBP, and CO in different time frames. More pronounced effects were seen on SBP at 60-80 minutes (4.71 mmHg; 95% CI: 2.97-6.45; GRADE: moderate), DBP at 120 minutes (4.51 mmHg; 95% CI: 2.60-6.42; GRADE: low), and CO at 30-40 minutes after consumption (0.43 L; 95% CI: 0.08-0.77; GRADE: very low). The effects of ED consumption on resting heart rate and QT/QTc interval were not significant (P ≤ 0.05). The assessment of endothelial function effects was not performed due to the absence of any RCTs meeting the inclusion criteria. CONCLUSIONS Acute consumption of EDs increases SBP, DBP, and CO in healthy adults. However, no alterations were observed in other cardiovascular parameters. The results should be interpreted with caution due to the limited number of studies included in the analysis. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022295335.
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Affiliation(s)
- Pedro I B Gualberto
- Universidade Federal de Juiz de Fora (UFJF), Minas Gerais, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde da UFJF, Governador Valadares, Minas Gerais, Brazil
| | - Vinícius V Benvindo
- Universidade Federal de Juiz de Fora (UFJF), Minas Gerais, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde da UFJF, Governador Valadares, Minas Gerais, Brazil
| | - Gustavo Waclawovsky
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Rio Grande do Sul, Brazil
- Programa de Pós-Graduação em Ciências da Saúde: Cardiologia do IC/FUC, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luís F Deresz
- Universidade Federal de Juiz de Fora (UFJF), Minas Gerais, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde da UFJF, Governador Valadares, Minas Gerais, Brazil
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Nair PJ, Pfaller MR, Dual SA, McElhinney DB, Ennis DB, Marsden AL. Non-invasive estimation of pressure drop across aortic coarctations: validation of 0D and 3D computational models with in vivo measurements. medRxiv 2023:2023.09.05.23295066. [PMID: 37732242 PMCID: PMC10508787 DOI: 10.1101/2023.09.05.23295066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Purpose Blood pressure gradient (Δ P ) across an aortic coarctation (CoA) is an important measurement to diagnose CoA severity and gauge treatment efficacy. Invasive cardiac catheterization is currently the gold-standard method for measuring blood pressure. The objective of this study was to evaluate the accuracy of Δ P estimates derived non-invasively using patient-specific 0 D and 3 D deformable wall simulations. Methods Medical imaging and routine clinical measurements were used to create patient-specific models of patients with CoA (N = 17 ). 0 D simulations were performed first and used to tune boundary conditions and initialize 3 D simulations. Δ P across the CoA estimated using both 0 D and 3 D simulations were compared to invasive catheter-based pressure measurements for validation. Results The 0 D simulations were extremely efficient (~15 secs computation time) compared to 3 D simulations (~30 hrs computation time on a cluster). However, the 0 D Δ P estimates, unsurprisingly, had larger mean errors when compared to catheterization than 3 D estimates (12.1 ± 9.9 mmHg vs 5.3 ± 5.4 mmHg). In particular, the 0 D model performance degraded in cases where the CoA was adjacent to a bifurcation. The 0 D model classified patients with severe CoA requiring intervention (defined as Δ P ≥ 20 mmHg) with 76% accuracy and 3 D simulations improved this to 88%. Conclusion Overall, a combined approach, using 0 D models to efficiently tune and launch 3 D models, offers the best combination of speed and accuracy for non-invasive classification of CoA severity.
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Affiliation(s)
- Priya J. Nair
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Martin R. Pfaller
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department of Pediatrics - Cardiology, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Seraina A. Dual
- Department of Biomedical Signaling and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Doff B. McElhinney
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department of Pediatrics - Cardiology, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Daniel B. Ennis
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
- Division of Radiology, VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Alison L. Marsden
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department of Pediatrics - Cardiology, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
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243
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Collard D, Velde LVD, Stegehuis VE, Delewi R, Beijk MAM, Zijlstra IJAJ, de Winter RJ, Vogt L, van den Born BJH. Assessment of renal sympathetic control using invasive pressure and flow velocity measurements in humans. Am J Physiol Renal Physiol 2023; 325:F263-F270. [PMID: 37382495 DOI: 10.1152/ajprenal.00031.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023] Open
Abstract
Renal sympathetic innervation is important in the control of renal and systemic hemodynamics and is a target for pharmacological and catheter-based therapies. The effect of a physiological sympathetic stimulus using static handgrip exercise on renal hemodynamics and intraglomerular pressure in humans is unknown. We recorded renal arterial pressure and flow velocity in patients with a clinical indication for coronary or peripheral angiography using a sensor-equipped guidewire during baseline, handgrip, rest, and hyperemia following intrarenal dopamine (30 μg/kg). Changes in perfusion pressure were expressed as the change in mean arterial pressure, and changes in flow were expressed as a percentage with respect to baseline. Intraglomerular pressure was estimated using a Windkessel model. A total of 18 patients (61% male and 39% female) with a median age of 57 yr (range: 27-85 yr) with successful measurements were included. During static handgrip, renal arterial pressure increased by 15.2 mmHg (range: 4.2-53.0 mmHg), whereas flow decreased by 11.2%, but with a large variation between individuals (range: -13.4 to 49.8). Intraglomerular pressure increased by 4.2 mmHg (range: -3.9 to 22.1 mmHg). Flow velocity under resting conditions remained stable, with a median of 100.6% (range: 82.3%-114.6%) compared with baseline. During hyperemia, maximal flow was 180% (range: 111%-281%), whereas intraglomerular pressure decreased by 9.6 mmHg (interquartile range: 4.8 to 13.9 mmHg). Changes in renal pressure and flow during handgrip exercise were significantly correlated (ρ = -0.68, P = 0.002). Measurement of renal arterial pressure and flow velocity during handgrip exercise allows the identification of patients with higher and lower sympathetic control of renal perfusion. This suggests that hemodynamic measurements may be useful to assess the response to therapeutic interventions aimed at altering renal sympathetic control.NEW & NOTEWORTHY Renal sympathetic innervation is important in the homeostasis of systemic and renal hemodynamics. We showed that renal arterial pressure significantly increased and that flow decreased during static handgrip exercise using direct renal arterial pressure and flow measurements in humans, but with a large difference between individuals. These findings may be useful for future studies aimed to assess the effect of interventions that influence renal sympathetic control.
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Affiliation(s)
- Didier Collard
- Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lennart van de Velde
- Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Faculty of Science and Technology, Technical Medical Centre, Multi-Modality Medical Imaging Group, University of Twente, Enschede, The Netherlands
| | - Valerie E Stegehuis
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ronak Delewi
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel A M Beijk
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - IJsbrand A J Zijlstra
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Liffert Vogt
- Department of Internal Medicine, Section Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert-Jan H van den Born
- Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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DeCoy M, Page-Goertz C, Nofziger R, Besunder J, Raimer P, Gothard D, Brown M, Stewart R, Ruggles C, Breedlove K, Clark J. Hemodynamic profile effects of PM101 amiodarone formulation in patients with post-operative tachyarrhythmias. Cardiol Young 2023; 33:1643-1648. [PMID: 36124626 DOI: 10.1017/s1047951122002888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Amiodarone may be considered for patients with junctional ectopic tachycardia refractory to treatment with sedation, analgesia, cooling, and electrolyte replacements. There are currently no published pediatric data regarding the hemodynamic effects of the newer amiodarone formulation, PM101, devoid of hypotensive agents used in the original amiodarone formulation. We performed a single-center, retrospective, descriptive study from January 2012 to December 2020 in a pediatric ICU. Thirty-three patients were included (22 male and 11 female) between the ages of 1.1 and 1,460 days who developed post-operative junctional ectopic tachycardia or other tachyarrhythmias requiring PM101. Data analysis was performed on hemodynamic parameters (mean arterial pressures and heart rate) and total PM101 (mg/kg) from hour 0 of amiodarone administration to hour 72. Adverse outcomes were defined as Vasoactive-Inotropic Score >20, patients requiring ECMO or CPR, or patient death. There was no statistically significant decrease in mean arterial pressures within the 6 hours of PM101 administration (p > 0.05), but there was a statistically significant therapeutic decrease in heart rate for resolution of tachyarrhythmia (p < 0.05). Patients received up to 25 mg/kg in an 8-hour time for rate control. Average rate control was achieved within 11.91 hours and average rhythm control within 62 hours. There were four adverse events around the time of PM101 administration, with three determined to not be associated with the medication. PM101 is safe and effective in the pediatric cardiac surgical population. Our study demonstrated that PM101 can be used in a more aggressive dosing regimen than previously reported in pediatric literature with the prior formulation.
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Affiliation(s)
- Meredith DeCoy
- Akron Children's Hospital, Department of Medical Education, Akron, OH, USA
| | | | - Ryan Nofziger
- Akron Children's Hospital, Division of Critical Care, Akron, OH, USA
| | - James Besunder
- Akron Children's Hospital, Division of Critical Care, Akron, OH, USA
| | - Patricia Raimer
- Akron Children's Hospital, Division of Critical Care, Akron, OH, USA
| | - David Gothard
- Biostats, Inc: Data Analysis for Clinical Research Studies, East Canton, OH, USA
| | | | | | - Cassandra Ruggles
- Akron Children's Hospital, Division of Critical Care, Akron, OH, USA
| | | | - John Clark
- Akron Children's Hospital, Heart Center, Akron, OH, USA
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245
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Mazumder NR, Jezek F, Tapper EB, Beard DA. Portal Venous Remodeling Determines the Pattern of Cirrhosis Decompensation: A Systems Analysis. Clin Transl Gastroenterol 2023; 14:e00590. [PMID: 37092902 PMCID: PMC10522110 DOI: 10.14309/ctg.0000000000000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 04/25/2023] Open
Abstract
INTRODUCTION As liver disease progresses, scarring results in worsening hemodynamics ultimately culminating in portal hypertension. This process has classically been quantified through the portosystemic pressure gradient (PSG), which is clinically estimated by hepatic venous pressure gradient (HVPG); however, PSG alone does not predict a given patient's clinical trajectory regarding the Baveno stage of cirrhosis. We hypothesize that a patient's PSG sensitivity to venous remodeling could explain disparate disease trajectories. METHODS We created a computational model of the portal system in the context of worsening liver disease informed by physiologic measurements from the field of portal hypertension. We simulated progression of clinical complications, HVPG, and transjugular intrahepatic portosystemic shunt placement while only varying a patient's likelihood of portal venous remodeling. RESULTS Our results unify hemodynamics, venous remodeling, and the clinical progression of liver disease into a mathematically consistent model of portal hypertension. We find that by varying how sensitive patients are to create venous collaterals with rising PSG we can explain variation in patterns of decompensation for patients with liver disease. Specifically, we find that patients who have higher proportions of portosystemic shunting earlier in disease have an attenuated rise in HVPG, delayed onset of ascites, and less hemodynamic shifting after transjugular intrahepatic portosystemic shunt placement. DISCUSSION This article builds a computational model of portal hypertension which supports that patient-level differences in venous remodeling may explain disparate clinical trajectories of disease.
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Affiliation(s)
- Nikhilesh R. Mazumder
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
- Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Filip Jezek
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Elliot B. Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
- Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Daniel A. Beard
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
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246
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Keck C, Gregoski M, Litwin S, Borlaug BA, Fudim M, Tedford RJ, Houston BA. Decoupling of Hemodynamics and Congestive Symptoms in Obese Patients With Heart Failure. J Card Fail 2023; 29:1249-1256. [PMID: 36963608 DOI: 10.1016/j.cardfail.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/09/2023] [Accepted: 02/19/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Prior studies indicate significant physiological differences between obese and nonobese patients with heart failure (HF), but none have evaluated differences in hemodynamic patterns in these patient populations during treatment for acute decompensated HF (ADHF). OBJECTIVES In this study, we assessed differences in hemodynamic trends between obese and nonobese patients during treatment for ADHF. METHODS Obese (body mass index (BMI) >30, n = 63) and nonobese (BMI < 25, n = 69) patients with ADHF in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) study who had pulmonary artery catheterization data available through the duration of treatment were evaluated. Hemodynamics were analyzed at baseline and optimal day. Changes in BNP levels, weight, creatinine, BUN, 6MWT, orthopnea and dyspnea scores were assessed. RESULTS Despite similar baseline hemodynamics, obese patients had significantly less absolute and relative pulmonary arterial wedge pressure (PAWP) reduction (-16 ± 28 vs -32 ± 29%; P = 0.03) during treatment. Obese patients also had higher PAWPs (19.9 + 8 vs 15.5 + 6.8 mmHg; P = 0.01) and PA pressures at optimization compared with nonobese patients. Obese and nonobese patients had similar relative improvements in weight, BNP, 6-minute walk test distance, dyspnea and orthopnea scores, and similar changes in creatinine and BUN levels. CONCLUSIONS Obese patients treated for ADHF display less reduction in invasively measured left heart filling pressures, despite similar improvements in symptoms, weight loss, and noninvasive surrogates of congestion. Our findings suggest a degree of decoupling between left heart filling pressures and congestive symptoms in obese patients undergoing treatment for ADHF.
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Affiliation(s)
- Carson Keck
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Mathew Gregoski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Sheldon Litwin
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Brian A Houston
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC.
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Natalis A, Masson JB, Mansour MJ, Asmar MA, Potvin J, Gobeil JF, Riahi M, Noiseux N, Stevens LM, Forcillo J. Correlation between measured and predicted mismatch with valve hemodynamics in transcatheter aortic valve replacement: A sex-based analysis. Catheter Cardiovasc Interv 2023; 102:505-512. [PMID: 37449451 DOI: 10.1002/ccd.30764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/15/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Data regarding the reliability of predicted effective orifice area indexed (pEOAi) is scarce in transcatheter aortic valve replacement (TAVR). AIMS To assess the validity of the pEOAi in TAVR by correlating its value with echocardiography-derived hemodynamic data. METHODS A single-center retrospective cohort study of TAVR patients from 2012 to 2021 with available echocardiograms was conducted. Patient-prosthesis mismatch (PPM) was defined based on the Valve Academic Research Consortium 3 criteria. The main endpoints were the congruence of measured effective orifice area indexed (EOAi) and pEOAi with the hemodynamic data obtained by echocardiography. The secondary endpoint included a correlation of predicted PPM (pPPM) and measured PPM (mPPM) with postoperative New York Heart Association (NYHA) status. RESULTS A total of 318 patients were included. pPPM was more frequent than mPPM (54 [17%]; all moderate PPM vs. 39 [12.3%]: 32 moderate and 7 severe PPM). Predicted and measured EOAi were statistically correlated with postprocedural transvalvular mean gradient and Doppler velocity index (all p < 0.001), including in both sex-based subgroups. The positive predictive value and negative predictive value (NPV) of pPPM for postprocedural transvalvular mean gradient ≥ 20 mmHg were 16% and 97%, respectively. Only pPPM was significantly more prevalent in the group in which NYHA failed to improve than in those with symptom improvement (30.1% vs. 16%, p = 0.027). CONCLUSION Predicted PPM has an excellent NPV for postprocedural transvalvular mean gradient ≥ 20 mmHg and seems to be a good predictor of NYHA status evolution as opposed to measured PPM. Predicted EOAi can be used in procedural planning to reduce the risk of PPM in both TAVR male and female patients.
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Affiliation(s)
- Alexandre Natalis
- Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Quebec, Canada
| | - Jean-Bernard Masson
- Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Quebec, Canada
| | - Mohamad J Mansour
- Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Quebec, Canada
| | - Mike Al Asmar
- Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Quebec, Canada
| | - Jeannot Potvin
- Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Quebec, Canada
| | | | - Mounir Riahi
- Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Quebec, Canada
| | - Nicolas Noiseux
- Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Quebec, Canada
| | | | - Jessica Forcillo
- Centre Hospitalier Universitaire de Montréal (CHUM), Montréal, Quebec, Canada
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Li C, Feng H, Wang X, Wang Y. The influencing mechanism of iliac vein stent implantation for hemodynamics at the bifurcation. Comput Methods Biomech Biomed Engin 2023; 26:1452-1461. [PMID: 36082958 DOI: 10.1080/10255842.2022.2120352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/08/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
In the intervention with stent implantation for iliac vein compression syndrome (IVCS), it remains unclear about the influencing mechanism of the structure and implantation position of the stent for the hemodynamics of the affected site. In this paper, an iliac vein model was established. Besides, the computational fluid dynamics (CFD) was utilized to analyze the time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI) in a sine period after stent implantation based on the three different implantation positions of two iliac vein stents (the left branch outlet, contralateral disturbed flow and main iliac vein). The influence of the structure and implantation position of the stent on blood flow was revealed. These findings were verified by the particle image velocimetry (PIV) experiment. The results indicated that the maximum blood flow velocity of the iliac vein decreased after the stent implantation. Among the three positions, the influence of stent implantation on the iliac vein blood flow was the least when the stent implantation was performed at the left branch outlet; the influence of stent implantation on the iliac vein blood flow was the greatest when the stent implantation was performed at the contralateral disturbed flow. Moreover, there was little influence of Venastent implantation on the blood flow. These results could provide a scientific foundation for implantation treatment and stent design related to IVCS.
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Affiliation(s)
- Changsheng Li
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot, P.R. China
| | - Haiquan Feng
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot, P.R. China
| | - Xiaotian Wang
- The First Affiliated Hospital of University of Science and Technology of China, Hefei, P.R. China
| | - Yonggang Wang
- Suzhou Venmed Technology Co., Ltd, Suzhou, P.R. China
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249
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Del Rio-Pertuz G, Morataya C, Parmar K, Elharabi Z, Davis D, Abohelwa M, Ochoa O, Tran A, Nugent K, Paniagua D, Argueta-Sosa E. Association between right heart catheterization hemodynamics and glycosylated hemoglobin levels in adults with heart failure with reduced ejection fraction. Cardiovasc Endocrinol Metab 2023; 12:e0285. [PMID: 37361478 PMCID: PMC10287124 DOI: 10.1097/xce.0000000000000285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/20/2023] [Indexed: 06/28/2023]
Abstract
This study hypothesized that elevated glycosylated hemoglobin (HbA1c) levels are associated with abnormal right heart catheterization (RHC) hemodynamic parameters in patients with heart failure with reduced ejection fraction (HFrEF) and no prior diagnosis of diabetes. Methods Retrospective cohort study of adult patients with HFrEF and no prior diagnosis of diabetes who underwent RHC and had HbA1c levels measured 30 days before or after the RHC. This study excluded patients who had received blood transfusions within 90 days prior to HbA1c measurement and patients with known diabetes. Univariate and multivariate regression analyses adjusted for age, sex, and BMI were used to test for an association between RHC hemodynamic parameters and HbA1c levels. Results A total of 136 patients were included with a mean age of 55 ± 15 years and mean HbA1c was 5.99 ± 0.64%. Unadjusted univariate models showed that HbA1c is significantly associated with cardiac index (CI) by the Fick method and thermodilution, right atrial pressure (RAP), and mean pulmonary arterial pressure (MPAP). After multivariate analysis, for every one unit increase in HbA1c, there was a 0.19 and 0.26 L/min/m2 decrease in expected CI by thermodilution and by the Fick method (P = 0.03 and P < 0.01), respectively. For every one unit increase in HbA1c, there was a 2.39 mmHg increase in expected RAP (P = 0.01). Conclusion Elevated HbA1c levels measured within 30 days before or after the index RHC in patients with a left ventricular ejection fraction <40% were associated with congestive hemodynamic parameters.
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Affiliation(s)
| | - Cristina Morataya
- Department of Internal Medicine, Texas Tech University Health Sciences Center
| | - Kanak Parmar
- Department of Internal Medicine, Texas Tech University Health Sciences Center
| | - Zeyad Elharabi
- Department of Internal Medicine, Texas Tech University Health Sciences Center
| | - Daniel Davis
- Department of Internal Medicine, Texas Tech University Health Sciences Center
| | - Mostafa Abohelwa
- Department of Internal Medicine, Texas Tech University Health Sciences Center
| | - Ozman Ochoa
- Department of Internal Medicine, Texas Tech University Health Sciences Center
| | - Alison Tran
- Department of Internal Medicine, Texas Tech University Health Sciences Center
| | - Kenneth Nugent
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center Lubbock
| | - David Paniagua
- Department of Internal Medicine, Baylor College of Medicine, Houston
| | - Erwin Argueta-Sosa
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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250
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Maramkandam EB, Sudhir BJ, Kannath SK, Patnaik BSV. A novel parameter for the prediction of rupture risk of cerebral aneurysms based on morphology. Proc Inst Mech Eng H 2023; 237:1091-1101. [PMID: 37533293 DOI: 10.1177/09544119231188697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Neurosurgeons often encounter dilemmas in the clinical management of cerebral aneurysms owing to an uncertainty of their rupture status and rupture risk. This study evaluates the influence of natural frequency of an aneurysm, as a novel morphological parameter to understand and analyze rupture status and risk prediction. In this work, we employ the natural frequency of 20 idealized and 50 patient specific aneurysms. The natural frequency of patient specific aneurysms is then compared against their rupture status. A strong correlation was observed between various morphological indicators and natural frequency for ideal and patient specific geometries. A statistical analysis with both Mann Whitney U test and T-test for rupture status against natural frequency has given a p-value less than 0.01 indicating a strong correlation between them. The correlation of morphological parameters with natural frequency from Pearson correlation coefficient and T-test suggests a holistic reflection of their effects on the natural frequency of an aneurysm. Thus, natural frequency could be a good indicator to discern the rupture potential of an aneurysm. The correlation between rupture status and natural frequency makes it a novel parameter that can differentiate between ruptured and unruptured patient specific aneurysms.
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Affiliation(s)
- Eldhose Babu Maramkandam
- Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - B J Sudhir
- Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Santhosh K Kannath
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - B S V Patnaik
- Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
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