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Bronicki RA, Tume S, Gomez H, Dezfulian C, Penny DJ, Pinsky MR, Burkhoff D. Application of Cardiovascular Physiology to the Critically Ill Patient. Crit Care Med 2024; 52:821-832. [PMID: 38126845 DOI: 10.1097/ccm.0000000000006136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVES To use the ventricular pressure-volume relationship and time-varying elastance model to provide a foundation for understanding cardiovascular physiology and pathophysiology, interpreting advanced hemodynamic monitoring, and for illustrating the physiologic basis and hemodynamic effects of therapeutic interventions. We will build on this foundation by using a cardiovascular simulator to illustrate the application of these principles in the care of patients with severe sepsis, cardiogenic shock, and acute mechanical circulatory support. DATA SOURCES Publications relevant to the discussion of the time-varying elastance model, cardiogenic shock, and sepsis were retrieved from MEDLINE. Supporting evidence was also retrieved from MEDLINE when indicated. STUDY SELECTION, DATA EXTRACTION, AND SYNTHESIS Data from relevant publications were reviewed and applied as indicated. CONCLUSIONS The ventricular pressure-volume relationship and time-varying elastance model provide a foundation for understanding cardiovascular physiology and pathophysiology. We have built on this foundation by using a cardiovascular simulator to illustrate the application of these important principles and have demonstrated how complex pathophysiologic abnormalities alter clinical parameters used by the clinician at the bedside.
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Affiliation(s)
- Ronald A Bronicki
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Sebastian Tume
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Hernando Gomez
- Critical Care Medicine Department, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Cameron Dezfulian
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Daniel J Penny
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Michael R Pinsky
- Critical Care Medicine Department, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Emans TW, Moraes DJA, Ben-Tal A, Barrett CJ, Paton JFR, McBryde FD. Forgotten Circulation: Reduced Mesenteric Venous Capacitance in Hypertensive Rats Is Improved by Decreasing Sympathetic Activity. Hypertension 2024; 81:823-835. [PMID: 38380519 DOI: 10.1161/hypertensionaha.123.21878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND The mesenteric venous reservoir plays a vital role in mediating blood volume and pressure changes and is richly innervated by sympathetic nerves; however, the precise nature of venous sympathetic regulation and its role during hypertension remains unclear. We hypothesized that sympathetic drive to mesenteric veins in spontaneously hypertensive (SH) rats is raised, increasing mean circulatory filling pressure (MCFP), and impairing mesenteric capacitance. METHODS Arterial pressure, central venous pressure, mesenteric arterial, and venous blood flow were measured simultaneously in conscious male Wistar and SH rats. MCFP was assessed using an intraatrial balloon. Hemodynamic responses to volume changes (±20%) were measured before and after ganglionic blockade and carotid body denervation. Sympathetic venoconstrictor activity was measured in situ. RESULTS MCFP in vivo (10.8±1.6 versus 8.0±2.1 mm Hg; P=0.0005) and sympathetic venoconstrictor drive in situ (18±1 versus 10±2 µV; P<0.0001) were higher in SH rats; MCFP decreased in SH rats after hexamethonium and carotid body denervation (7.6±1.4; P<0.0001 and 8.5±1.0 mm Hg; P=0.0045). During volume changes, arterial pressure remained stable. With blood loss, net efflux of blood from the mesenteric bed was measured in both strains. However, during volume infusion, we observed net influx in Wistar (+2.3±2.6 mL/min) but efflux in SH rats (-1.0±1.0 mL/min; P=0.0032); this counterintuitive efflux was abolished by hexamethonium and carotid body denervation (+0.3±1.7 and 0.5±1.6 mL/min, respectively). CONCLUSIONS In SH rats, excessive sympathetic venoconstriction elevates MCFP and reduces capacitance, impairing volume buffering by mesenteric veins. We propose selective targeting of mesenteric veins through sympathetic drive reduction as a novel therapeutic opportunity for hypertension.
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Affiliation(s)
- Tonja W Emans
- Manaaki Manawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand (T.W.E., A.B.-T., C.J.B., J.F.R.P., F.D.M.)
| | - Davi J A Moraes
- Department of Physiology and Biophysics, Biomedical Sciences Institute, University of São Paulo, Brazil (D.J.A.M.)
| | - Alona Ben-Tal
- Manaaki Manawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand (T.W.E., A.B.-T., C.J.B., J.F.R.P., F.D.M.)
- Insightful Modelling Limited, Auckland, New Zealand (A.B.-T.)
| | - Carolyn J Barrett
- Manaaki Manawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand (T.W.E., A.B.-T., C.J.B., J.F.R.P., F.D.M.)
| | - Julian F R Paton
- Manaaki Manawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand (T.W.E., A.B.-T., C.J.B., J.F.R.P., F.D.M.)
| | - Fiona D McBryde
- Manaaki Manawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand (T.W.E., A.B.-T., C.J.B., J.F.R.P., F.D.M.)
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3
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Bronicki RA, Tume SC, Flores S, Loomba RS, Borges NM, Penny DJ, Burkhoff D. The Cardiovascular System in Cardiogenic Shock: Insight From a Cardiovascular Simulator. Pediatr Crit Care Med 2023; 24:937-942. [PMID: 37702585 DOI: 10.1097/pcc.0000000000003354] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Affiliation(s)
- Ronald A Bronicki
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Sebastian C Tume
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Saul Flores
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Rohit S Loomba
- Department of Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, Section of Cardiology, Advocate Children's Hospital Chicago, Chicago, IL
| | - Nirica M Borges
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Daniel J Penny
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
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4
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Policastro P, Mesin L. Processing Ultrasound Scans of the Inferior Vena Cava: Techniques and Applications. Bioengineering (Basel) 2023; 10:1076. [PMID: 37760178 PMCID: PMC10525913 DOI: 10.3390/bioengineering10091076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
The inferior vena cava (IVC) is the largest vein in the body. It returns deoxygenated blood to the heart from the tissues placed under the diaphragm. The size and dynamics of the IVC depend on the blood volume and right atrial pressure, which are important indicators of a patient's hydration and reflect possible pathological conditions. Ultrasound (US) assessment of the IVC is a promising technique for evaluating these conditions, because it is fast, non-invasive, inexpensive, and without side effects. However, the standard M-mode approach for measuring IVC diameter is prone to errors due to the vein movements during respiration. B-mode US produces two-dimensional images that better capture the IVC shape and size. In this review, we discuss the pros and cons of current IVC segmentation techniques for B-mode longitudinal and transverse views. We also explored several scenarios where automated IVC segmentation could improve medical diagnosis and prognosis.
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Affiliation(s)
| | - Luca Mesin
- Mathematical Biology and Physiology, Department Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy;
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5
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Dardi P, dos Reis Costa D, Assunção H, Rossoni L. Venous endothelial function in cardiovascular disease. Biosci Rep 2022; 42:BSR20220285. [PMID: 36281946 PMCID: PMC9685499 DOI: 10.1042/bsr20220285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 09/29/2023] Open
Abstract
The essential role of the endothelium in vascular homeostasis is associated with the release of endothelium-dependent relaxing and contractile factors (EDRF and EDCF, respectively). Different from arteries, where these factors are widely studied, the vasoactive factors derived from the venous endothelium have been given less attention. There is evidence for a role of the nitric oxide (NO), endothelium-dependent hyperpolarization (EDH) mechanism, and cyclooxygenase (COX)-derived metabolites as EDRFs; while the EDCFs need to be better evaluated since no consensus has been reached about their identity in venous vessels. The imbalance between the synthesis, bioavailability, and/or action of EDRFs and/or EDCFs results in a pathological process known as endothelial dysfunction, which leads to reduced vasodilation and/or increased vasoconstriction. In the venous system, endothelial dysfunction is relevant since reduced venodilation may increase venous tone and decrease venous compliance, thus enhancing mean circulatory filling pressure, which maintains or modify cardiac workload contributing to the etiology of cardiovascular diseases. Interestingly, some alterations in venous function appear at the early stages (or even before) the establishment of these diseases. However, if the venous endothelium dysfunction is involved in these alterations is not yet fully understood and requires further studies. In this sense, the present study aims to review the current knowledge on venous endothelial function and dysfunction, and the general state of the venous tone in two important cardiovascular diseases of high incidence and morbimortality worldwide: hypertension and heart failure.
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Affiliation(s)
- Patrizia Dardi
- Laboratory of Vascular Physiology, Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, Brazil
| | | | - Henrique Charlanti Reis Assunção
- Laboratory of Vascular Physiology, Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, Brazil
| | - Luciana Venturini Rossoni
- Laboratory of Vascular Physiology, Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, Brazil
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A C, R C, N B, G DI. Compression therapy, autonomic nervous system, and heart rate variability: A narrative review and our preliminary personal experience. Phlebology 2022; 37:739-753. [DOI: 10.1177/02683555221135321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aims To highlight the relationship among compression therapy (CT), the autonomic nervous system (ANS) (parasympathetic and sympathetic system), and the heart rate variability (HRV) analysis. Background Beyond the typical analgesic and anti-inflammatory effects of CT in patients affected by venous and/or lymphatic diseases, some literature about CT influence on wellbeing has been published as well. More specifically, CT influence on the ANS has been elucidated mostly through HRV application, providing useful quali-quantitative data for scientific and clinical purposes. Material and Methods A literature search was performed through several web-based search engines to investigate the available evidence concerning the possible influence of CT on the ANS and on psychoneuroendocrineimmunology. Moreover, we examined literature data regarding HRV use in the assessment of CT. Lastly, a preliminary cross-over study was performed on 10 patients affected by phlebolymphedema of the lower limbs, undergoing CT with 18–21 mmHg stockings for 10 h and investigated by means of HRV. Results A CT-based increase of the anti-inflammatory activity of the parasympathetic (vagal) system has been elucidated in most scientific literature. Similarly, CT application has generally resulted in an improvement of HRV, which indicates a beneficial influence on the ANS. In our preliminary experience with compression stockings and HRV, two parasympathetic-based parameters improved by 22.8% and 68.0% after 10 h, whereas they decreased in the same subjects without stockings by 2.7% and 8.2%, during normal breathing. The remaining HRV parameters did not show relevant variations, especially during diaphragmatic breathing. Conclusions From literature data and based on our very preliminary experience, it is possible to deduce that CT exerts different effects on the psychobiological parameters of the individual, overall improving HRV and parasympathetic activity. Incorporating both HRV/ANS assessment in phlebolymphology and the beneficial neural action of CT in health care may represent viable options in the future biomedical science.
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Affiliation(s)
- Cavezzi A
- Eurocenter Venalinfa, San Benedetto Del Tronto (AP), Italy
| | - Colucci R
- Eurocenter Venalinfa, San Benedetto Del Tronto (AP), Italy
| | - Barsotti N
- CMO-Centro di Medicina Osteopatica, Firenze, Italy
| | - Di Ionna G
- Strategic Nutrition Center, Bologna, Italy
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Gu Y, Zhou C, Piao Z, Yuan H, Jiang H, Wei H, Zhou Y, Nan G, Ji X. Cerebral edema after ischemic stroke: Pathophysiology and underlying mechanisms. Front Neurosci 2022; 16:988283. [PMID: 36061592 PMCID: PMC9434007 DOI: 10.3389/fnins.2022.988283] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022] Open
Abstract
Ischemic stroke is associated with increasing morbidity and has become the main cause of death and disability worldwide. Cerebral edema is a serious complication arising from ischemic stroke. It causes an increase in intracranial pressure, rapid deterioration of neurological symptoms, and formation of cerebral hernia, and is an important risk factor for adverse outcomes after stroke. To date, the detailed mechanism of cerebral edema after stroke remains unclear. This limits advances in prevention and treatment strategies as well as drug development. This review discusses the classification and pathological characteristics of cerebral edema, the possible relationship of the development of cerebral edema after ischemic stroke with aquaporin 4, the SUR1-TRPM4 channel, matrix metalloproteinase 9, microRNA, cerebral venous reflux, inflammatory reactions, and cerebral ischemia/reperfusion injury. It also summarizes research on new therapeutic drugs for post-stroke cerebral edema. Thus, this review provides a reference for further studies and for clinical treatment of cerebral edema after ischemic stroke.
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Affiliation(s)
- Yuhang Gu
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Chen Zhou
- Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
| | - Zhe Piao
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Honghua Yuan
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Huimin Jiang
- Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
| | - Huimin Wei
- Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yifan Zhou
- Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
| | - Guangxian Nan
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Guangxian Nan,
| | - Xunming Ji
- Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Xunming Ji,
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8
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Gyselaers W, Lees C. Maternal Low Volume Circulation Relates to Normotensive and Preeclamptic Fetal Growth Restriction. Front Med (Lausanne) 2022; 9:902634. [PMID: 35755049 PMCID: PMC9218216 DOI: 10.3389/fmed.2022.902634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
This narrative review summarizes current evidence on the association between maternal low volume circulation and poor fetal growth. Though much work has been devoted to the study of cardiac output and peripheral vascular resistance, a low intravascular volume may explain why high vascular resistance causes hypertension in women with preeclampsia (PE) that is associated with fetal growth restriction (FGR) and, at the same time, presents with normotension in FGR itself. Normotensive women with small for gestational age babies show normal gestational blood volume expansion superimposed upon a constitutionally low intravascular volume. Early onset preeclampsia (EPE; occurring before 32 weeks) is commonly associated with FGR, and poor plasma volume expandability may already be present before conception, thus preceding gestational volume expansion. Experimentally induced low plasma volume in rodents predisposes to poor fetal growth and interventions that enhance plasma volume expansion in FGR have shown beneficial effects on intrauterine fetal condition, prolongation of gestation and birth weight. This review makes the case for elevating the maternal intravascular volume with physical exercise with or without Nitric Oxide Donors in FGR and EPE, and evaluating its role as a potential target for prevention and/or management of these conditions.
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Affiliation(s)
- Wilfried Gyselaers
- Department of Obstetrics, Ziekenhuis Oost Limburg, Genk, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
| | - Christoph Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.,Department of Metabolism, Digestion and Reproduction, Institute for Reproductive and Developmental Biology, Imperial College London, London, United Kingdom.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, London, United Kingdom
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9
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Martin D, Reihe C, Drummer S, Roessler K, Boomer S, Nelson M. Venoconstrictor responses to activation of bradykinin-sensitive pericardial afferents involve the region of the hypothalamic paraventricular nucleus. Physiol Rep 2022; 10:e15221. [PMID: 35307973 PMCID: PMC8935126 DOI: 10.14814/phy2.15221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/26/2022] [Accepted: 02/17/2022] [Indexed: 06/14/2023] Open
Abstract
Veins are important in the control of venous return, cardiac output, and cardiovascular homeostasis. However, the effector systems modulating venous function remain to be fully elucidated. We demonstrated that activation of bradykinin-sensitive pericardial afferents elicited systemic venoconstriction. The hypothalamic paraventricular nucleus (PVN) is an important site modulating autonomic outflow to the venous compartment. We tested the hypothesis that the PVN region is involved in the venoconstrictor response to pericardial injection of bradykinin. Rats were anesthetized with urethane/alpha chloralose and instrumented for recording arterial pressure, vena caval pressure, and mean circulatory filling pressure (MCFP), an index of venous tone. The rats were fitted with a pericardial catheter and PVN injector guide tubes. Mean arterial pressure (MAP), heart rate (HR), and MCFP responses to pericardial injection of bradykinin (1, 10 µg/kg) were recorded before and after PVN injection of omega conotoxin GVIA (200 ng/200 nl). Pericardial injection of saline produced no systematic effects on MAP, HR, or MCFP. In contrast, pericardial injection of bradykinin was associated with short latency increases in MAP (16 ± 4 to 18 ± 2 mm Hg) and MCFP 0.35 ± 0.19 to 1.01 ± 0.27 mm Hg. Heart rate responses to pericardial BK were highly variable, but HR was significantly increased (15 ± 9 bpm) at the higher BK dose. Conotoxin injection in the PVN region did not affect baseline values for these variables. However, injection of conotoxin into the area of the PVN largely attenuated the pressor (-1 ± 3 to 6 ± 3 mm Hg), MCFP (-0.19 ± 0.07 to 0.20 ± 0.18 mm Hg), and HR (4 ± 14 bpm) responses to pericardial bradykinin injection. We conclude that the PVN region is involved in the venoconstrictor responses to pericardial bradykinin injection.
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Affiliation(s)
- Doug Martin
- Division of Basic Biomedical SciencesUniversity of South DakotaVermillionSouth DakotaUSA
| | - Casey Reihe
- Division of Basic Biomedical SciencesUniversity of South DakotaVermillionSouth DakotaUSA
| | - Sam Drummer
- Division of Basic Biomedical SciencesUniversity of South DakotaVermillionSouth DakotaUSA
| | - Kyle Roessler
- Division of Basic Biomedical SciencesUniversity of South DakotaVermillionSouth DakotaUSA
| | - Shane Boomer
- Division of Basic Biomedical SciencesUniversity of South DakotaVermillionSouth DakotaUSA
| | - Madeleine Nelson
- Division of Basic Biomedical SciencesUniversity of South DakotaVermillionSouth DakotaUSA
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10
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The venous system during pregnancy. Part 1: physiologic considerations on the venous system. Int J Obstet Anesth 2022; 50:103273. [DOI: 10.1016/j.ijoa.2022.103273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/13/2022] [Accepted: 02/17/2022] [Indexed: 12/20/2022]
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Hamzaoui O. Combining fluids and vasopressors: A magic potion? JOURNAL OF INTENSIVE MEDICINE 2021; 2:3-7. [PMID: 36789229 PMCID: PMC9923992 DOI: 10.1016/j.jointm.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022]
Abstract
Early detection and prompt reversal of sepsis-induced tissue hypoperfusion are key elements while treating patients with septic shock. Fluid administration is widely accepted as the first-line therapy followed by vasopressor use in persistently hypotensive patients or in those with insufficient arterial pressure to ensure adequate tissue perfusion. Recent evidence suggests a beneficial effect of combining fluids with vasopressors in the early phase of sepsis. Compared with fluids alone, combining fluids and vasopressors increases mean systemic pressure and venous return and corrects hypotension better. This approach also limits fluid overload, which is an independent factor of poor outcomes in sepsis. It produces less hemodilution than fluids alone. As a consequence of these effects, combined treatment may improve outcomes in septic shock patients.
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Liu JL, Zhang XF, Liu Z, Li JM, Wen ZJ, Zhang M, Lin QH, Kou QY. The role of recombinant human brain natriuretic peptide on the cardiac output of patients with acute decompensated heart failure using Guyton venous return curve: A STROBE-compliant retrospective study. Medicine (Baltimore) 2021; 100:e25492. [PMID: 33907098 PMCID: PMC8084054 DOI: 10.1097/md.0000000000025492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/17/2021] [Accepted: 03/20/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT rbBNP has positive cardiac effects in patients with acute decompensated heart failure, but its effects on the systemic venous circulation are not known.A single-center retrospective, self-controlled study was conducted on 14 patients undergone recombinant human brain natriuretic peptide (rhBNP) treatment between January 1, 2015 to December 31, 2018.The cardiac output (CO) significantly increased from 3.75 ± 1.14 L min-1 to 4.24 ± 0.97 L min-1 30 minutes after rbBNP infusion, and to 4.20 ± 1.19 L min-1 3 hours later. The systemic vascular resistance significantly decreased from 18.85 ± 7.66 mm Hg min L-1 to 14.62 ± 6.13 mm Hg min L-1 30 minutes. The resistance to venous return (VR) significantly decreased from 5.93 ± 4.97 mm Hg min L-1 to 4.46 ± 1.53 mmHg min L-1 3 hours later. The mean systemic filling pressure significantly decreased from 32.71 ± 20.00 mm Hg to 28.254 ± 6.09 mm Hg 3 hours later.The role of rhBNP on CO was to reduce the peripheral circulation resistance at 30 minutes after rhBNP infusion and to reduce the resistance to VR at 3 hours later.This trial is registered at ChiCTR: ID ChiCTR1900024562.
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Affiliation(s)
- Jian ling Liu
- Department of Intensive Care Unit, Qingyuan People's Hospital,Qingyuan,China
| | - Xiao fei Zhang
- Department of Intensive Care Unit, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhi Liu
- Department of Intensive Care Unit, Qingyuan People's Hospital,Qingyuan,China
| | - Jie min Li
- Department of Intensive Care Unit, Qingyuan People's Hospital,Qingyuan,China
| | - Zhen jie Wen
- Department of Intensive Care Unit, Qingyuan People's Hospital,Qingyuan,China
| | - Ming Zhang
- Department of Intensive Care Unit, Qingyuan People's Hospital,Qingyuan,China
| | - Qin han Lin
- Department of Intensive Care Unit, Qingyuan People's Hospital,Qingyuan,China
| | - Qiu ye Kou
- Department of Intensive Care Unit, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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13
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Chies AB, Spadella MA, de Oliveira PR, Domeniconi RF, de Mello Santos T, Moreira RP, Rosales CB, Casarini DE, Navar LG. Exercise-Induced Modulation of Angiotensin II Responses in Femoral Veins From 2-Kidney-1-Clip Hypertensive Rats. Front Physiol 2021; 12:620438. [PMID: 33897446 PMCID: PMC8058411 DOI: 10.3389/fphys.2021.620438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/15/2021] [Indexed: 11/17/2022] Open
Abstract
The present study investigated the angiotensin II (Ang II) responses in rat femoral veins taken from 2-kidney-1clip (2K1C) hypertensive rats at 4 weeks after clipping, as well as the effects of exercise on these responses. In this manner, femoral veins taken from 2K1C rats kept at rest or exposed to acute exercise or to exercise training were challenged with Ang II or endothelin-1 (ET-1) in organ bath. Simultaneously, the presence of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) were determined in these preparations by western blotting. In these experiments, femoral veins exhibited subdued Ang II responses. However, after nitric oxide (NO) synthesis blockade, the responses were higher in the femoral veins taken from animals kept at rest [0.137(0.049–0.245); n = 10] than those obtained in trained animals kept at rest [0.008(0.001–0.041); n = 10] or studied after a single bout of exercise [0.001(0.001–0.054); n = 11]. In preparations in which, in addition to NO synthesis, both the local production of prostanoids and the action of ET-1 on type A (ETA) or B (ETB) receptors were inhibited, the differences induced by exercise were no longer observed. In addition, neither ET-1 responses nor the presence of COX-1 and COX-2 in these preparations were modified by the employed exercise protocols. In conclusion, NO maintains Ang II responses reduced in femoral veins of 2K1C animals at rest. However, vasodilator prostanoids as well as other relaxing mechanisms, activated by ETB stimulation, are mobilized by exercise to cooperate with NO in order to maintain controlled Ang II responses in femoral veins.
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Affiliation(s)
| | | | | | | | | | - Roseli Peres Moreira
- Department of Medicine, Nephrology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Carla B Rosales
- Department of Physiology and Hypertension and Renal Center of Excellence, Tulane University School of Medicine, New Orleans, LA, United States
| | - Dulce Elena Casarini
- Department of Medicine, Nephrology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luis Gabriel Navar
- Department of Physiology and Hypertension and Renal Center of Excellence, Tulane University School of Medicine, New Orleans, LA, United States
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Shourav MK, Choi J, Kim JK. Visualization of superficial vein dynamics in dorsal hand by near-infrared imaging in response to elevated local temperature. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-200367R. [PMID: 33624459 PMCID: PMC7900829 DOI: 10.1117/1.jbo.26.2.026003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/03/2021] [Indexed: 05/08/2023]
Abstract
SIGNIFICANCE Dry or moist skin-contact thermal stimulation for vein puncture (VP) and vein cannulation (VC) may not be feasible for sensitive skin. For a damaged, burned, or dark skin, near-infrared (NIR) imaging is preferred to visualize a vein. Postprocessing of NIR images is always required because the skin is a reflective material and veins need segmentation for quantitative analysis. AIM Our pilot study aims to observe the effect of noncontact local heating on the superficial metacarpal veins in the dorsal surface of the hand and to visualize vein dynamics using an NIR imaging system. APPROACH Our experiment consists of studies A and B at two ambient temperatures, 19°C and 25°C. A simple reflection-based NIR imaging system was installed to acquire sequential vein images for 5 min before and after applying 10 min of radiant thermal stimulation. To measure the vein diameter (VD), we trained a convolutional neural network (CNN) on sequential raw images to predict vein-segmentation masks as output images. Later these masked images were postprocessed for the VD measurements. RESULTS The average VD was significantly increased after thermal stimulation in study A. The maximum increments in VD were 39.3% and 9.19%, 1 min after thermal stimulation in studies A and B, respectively. Both the VD and skin temperature (Tskin) follow negative exponentials in time, and the VD is proportional to Tskin. A multiple linear-regression model was made to predict the final VD. A significant difference was observed in the change of the VD. CONCLUSIONS NIR imaging with CNN can be used for quantitative analyses of vein dynamics. This finding can be further extended to develop real-time, image-guided medical devices by integrating them with a radiant heater and to assist medical practitioners in achieving high success rates for VP or VC.
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Affiliation(s)
- Mohiuddin Khan Shourav
- Kookmin University, Graduate School, Department of Mechanical Engineering, Seoul, Republic of Korea
| | - Jungil Choi
- Kookmin University, School of Mechanical Engineering, Seoul, Republic of Korea
| | - Jung Kyung Kim
- Kookmin University, School of Mechanical Engineering, Seoul, Republic of Korea
- Kookmin University, Graduate School, Department of Integrative Biomedical Science and Engineering, Seoul, Republic of Korea
- Address all correspondence to Jung Kyung Kim,
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15
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Venous Pulse Wave Velocity variation in response to a simulated fluid challenge in healthy subjects. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2020.102177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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16
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Alansare AB, Kowalsky RJ, Jones MA, Perdomo SJ, Stoner L, Gibbs BB. The Effects of a Simulated Workday of Prolonged Sitting on Seated versus Supine Blood Pressure and Pulse Wave Velocity in Adults with Overweight/Obesity and Elevated Blood Pressure. J Vasc Res 2020; 57:355-366. [PMID: 32937620 PMCID: PMC7666078 DOI: 10.1159/000510294] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/20/2020] [Indexed: 12/14/2022] Open
Abstract
We evaluated the effects of a simulated workday of prolonged sitting on blood pressure (BP) and pulse wave velocity (PWV) and examined whether posture (seated vs. supine) affected responses. Participants (n = 25) were adults, with overweight/obesity and elevated BP, and performed seated desk work for 7.5 h. BP and PWV were measured in seated and supine postures at baseline (7:15 a.m.), midday (12:05 p.m.), and afternoon (4:45 p.m.). Generalized linear mixed models evaluated the effects of prolonged sitting on BP and PWV within each posture and interactions by posture and sex. In the recommended postures, seated BP and supine carotid-femoral pulse wave velocity (cfPWV) and carotid-ankle pulse wave velocity (caPWV), but not carotid-radial pulse wave velocity (crPWV), significantly increased over the simulated seated workday (all p < 0.05; effect sizes [d] ranged from 0.25 to 0.44). Whilst no posture-by-time interactions were observed (p > 0.05), BP, caPWV, and crPWV were higher when seated versus supine (main effects of posture p < 0.05; d ranged from 0.30 to 1.04). Exploratory analysis revealed that females had greater seated BP responses (p for interaction <0.05); seated PWV and supine BP and PWV responses were similar by sex (p for interaction >0.05). A simulated workday of prolonged sitting increased seated BP and supine cfPWV and caPWV, and posture minimally influenced these responses. These results add to the evidence suggesting a deleterious effect of prolonged sitting on cardiovascular health.
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Affiliation(s)
- Abdullah Bandar Alansare
- Department of Health and Physical Activity, College of Education, University of Pittsburgh, Pittsburgh, Pennsylvania, USA,
- Department of Exercise Physiology, College of Sport Sciences and Physical Activity, King Saud University, Riyadh, Saudi Arabia,
| | - Robert J Kowalsky
- Department of Health and Kinesiology, College of Education and Human Performance, Texas A&M University-Kingsville, Kingsville, Texas, USA
| | - Melissa A Jones
- Department of Health and Physical Activity, College of Education, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sophy J Perdomo
- Department of Health and Physical Activity, College of Education, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lee Stoner
- Department of Sport and Exercise, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bethany Barone Gibbs
- Department of Health and Physical Activity, College of Education, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Activation of bradykinin-sensitive pericardial afferents increases systemic venous tone in conscious rats. Auton Neurosci 2020; 223:102624. [PMID: 31901785 DOI: 10.1016/j.autneu.2019.102624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/26/2019] [Accepted: 12/19/2019] [Indexed: 11/22/2022]
Abstract
Our understanding of reflex regulation of veins lags behind that of the arterial system. While the cardiac sympathetic afferent reflex (CSAR) exerts control over sympathetic outflow, its effect on venous tone is not known. We tested the hypothesis that activation of pericardial bradykinin sensitive afferents elicits systemic venoconstriction. Male and female Sprague Dawley rats were chronically instrumented for measurement of arterial pressure and mean circulatory filling pressure, an index of venous tone, and with an indwelling pericardial catheter. Mean arterial pressure, heart rate and mean circulatory filling pressure responses were assessed in conscious rats in response to graded pericardial injections of bradykinin (1.5-20 μg/kg) before and after ganglionic blockade, and to intravenous norepinephrine (0.05-0.8 μg/kg). Bradykinin B2 receptor was assessed by Western blot. Pericardial bradykinin injections caused graded increases in mean arterial pressure, heart rate and mean circulatory filling pressure. These responses were markedly attenuated after autonomic blockade. The increments in mean circulatory filling pressure were attenuated in female rats. There were no differences in the venoconstrictor responses to norepinephrine or ventricular bradykinin receptor expression between male and females. We interpret these findings to indicate that activation of bradykinin sensitive pericardial afferents elicits a sexually dimorphic, autonomically mediated systemic venoconstrictor response. Differences in venous smooth muscle responses to norepinephrine or ventricular bradykinin receptor expression do not account for the sexual dimorphism. We conclude that systemic venoconstriction contributes to the overall hemodynamic response to activation of the cardiac sympathetic afferent reflex and that this effect is sexually dimorphic.
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18
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Stewart JM, Shaban MA, Fialkoff T, Tuma‐Marcella B, Visintainer P, Terilli C, Medow MS. Mechanisms of tilt-induced vasovagal syncope in healthy volunteers and postural tachycardia syndrome patients without past history of syncope. Physiol Rep 2019; 7:e14148. [PMID: 31250563 PMCID: PMC6597794 DOI: 10.14814/phy2.14148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 05/31/2019] [Indexed: 12/25/2022] Open
Abstract
Upright tilt table testing has been used to test for vasovagal syncope (VVS) but can result in "false positives" in which tilt-induced fainting (tilt+) occurs in the absence of real-world fainting. Tilt+ occurs in healthy volunteers and in patients with postural tachycardia syndrome (POTS) and show enhanced susceptibility to orthostatic hypotension. We hypothesized that the mechanisms for hypotensive susceptibility differs between tilt+ healthy volunteers (Control-Faint (N = 12)), tilt+ POTS patients (POTS-Faint (N = 12)) and a non-fainter control group of (Control-noFaint) (N = 10). Subjects were studied supine and during 70° upright tilt while blood pressure (BP), cardiac output (CO), and systemic vascular resistance (SVR), were measured continuously. Impedance plethysmography estimated regional blood volumes, flows, and vascular resistance. Heart rate was increased while central blood volume was decreased in both Faint groups. CO increased in Control-Faint because of reduced splanchnic vascular resistance; splanchnic pooling was similar to Control-noFaint. Splanchnic blood flow in POTS-Faint decreased and resistance increased similar to Control-noFaint but splanchnic blood volume was markedly increased. Decreased SVR and splanchnic arterial vasoconstriction is the mechanism for faint in Control-Faint. Decreased CO caused by enhanced splanchnic pooling is the mechanism for faint in POTS-Faint. We propose that intrahepatic resistance is increased in POTS-Faint resulting in pooling and that both intrahepatic resistance and splanchnic arterial vasoconstriction are reduced in Control-Faint resulting in increased splanchnic blood flow and reduced splanchnic resistance.
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Affiliation(s)
- Julian M. Stewart
- Departments of Pediatrics and PhysiologyNew York Medical CollegeValhallaNew York
| | - Mohamed A. Shaban
- Departments of Pediatrics and PhysiologyNew York Medical CollegeValhallaNew York
| | - Tyler Fialkoff
- Departments of Pediatrics and PhysiologyNew York Medical CollegeValhallaNew York
| | | | - Paul Visintainer
- Baystate Medical CenterUniversity of Massachusetts School of MedicineSpringfield 01199Massachusetts
| | - Courtney Terilli
- Departments of Pediatrics and PhysiologyNew York Medical CollegeValhallaNew York
| | - Marvin S. Medow
- Departments of Pediatrics and PhysiologyNew York Medical CollegeValhallaNew York
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Maternal Venous Hemodynamic Dysfunction in Proteinuric Gestational Hypertension: Evidence and Implications. J Clin Med 2019; 8:jcm8030335. [PMID: 30862007 PMCID: PMC6462953 DOI: 10.3390/jcm8030335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 01/21/2023] Open
Abstract
This review summarizes current knowledge from experimental and clinical studies on renal function and venous hemodynamics in normal pregnancy, in gestational hypertension (GH) and in two types of preeclampsia: placental or early-onset preeclampsia (EPE) and maternal or late-onset (LPE) preeclampsia, presenting at <34 weeks and ≥34 weeks respectively. In addition, data from maternal venous Doppler studies are summarized, showing evidence for (1) the maternal circulation functioning closer to the upper limits of capacitance than in non-pregnant conditions, with intrinsic risks for volume overload, (2) abnormal venous Doppler measurements obtainable in preeclampsia, more pronounced in EPE than LPE, however not observed in GH, and (3) abnormal venous hemodynamic function installing gradually from first to third trimester within unique pathways of general circulatory deterioration in GH, EPE and LPE. These associations have important clinical implications in terms of screening, diagnosis, prevention and management of gestational hypertensive diseases. They invite for further hypothesis-driven research on the role of retrograde venous congestion in the etiology of preeclampsia-related organ dysfunctions and their absence in GH, and also challenge the generally accepted view of abnormal placentation as the primary cause of preeclampsia. The striking similarity between abnormal maternal venous Doppler flow patterns and those observed at the ductus venosus and other abdominal veins of the intra-uterine growth restricted fetus, also invites to explore the role of venous congestion in the intra-uterine programming of some adult diseases.
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20
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The New Possibility of Lymphoscintigraphy to Guide a Clinical Treatment for Lymphedema in Patient With Breast Cancer. Clin Nucl Med 2019; 44:179-185. [PMID: 30672753 DOI: 10.1097/rlu.0000000000002443] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Lymphedema is a chronic disease that occurs frequently after breast cancer treatment. For the treatment of lymphedema, surgical approach such as vascularized lymph node transfer and super-microscopic lymphovenous anastomosis surgery is well established. Complex decongestive therapy (CDT) and sympathetic ganglion block (SGB) are two non-surgical therapeutic options. This study aimed to evaluate the effectiveness of lymphoscintigraphy in guiding the selection of the optimal non-surgical treatment in lymphedema. METHODS A total of 81 lymphedema patients who underwent lymphoscintigraphy and were treated with CDT or SGB were retrospectively evaluated. The parameters for the lymphoscintigraphic findings included the extent of dermal backflow (small extent/large extent groups), the level of lymphatic flow (trunk flow pattern/upper arm-restricted pattern/forearm-restricted pattern groups), and the visualization of lymph nodes (visualized/non-visualized groups). The change in the circumferential difference between the two sides of the body at the upper arm and forearm was used as the clinical outcome variable. Paired comparison and group comparison analysis were conducted. RESULTS Of 81 patients, 41 received CDT and 40 received SGB. There were no significant differences in demographic data between the CDT and SGB groups. Both CDT and SGB had a significant therapeutic effect. Upper arm edema was more significantly reduced after SGB than after CDT in the small extent group (P = 0.004), the forearm-restricted pattern group (P = 0.002), and the non-visualized group (P = 0.018). In the other groups, SGB and CDT showed comparable therapeutic effects without statistical differences. CONCLUSION SGB was found to have a better therapeutic effect in the lymphedema patients with specific lymphoscintigraphic findings compared with CDT. Lymphoscintigraphy may be helpful in selecting the appropriate approach to lymphedema treatment. Further well-designed prospective studies are warranted to validate the findings of this study.
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21
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Sousa-Oliveira A, Brandão A, Vojtek M, Gonçalves-Monteiro S, Sousa JB, Diniz C. Vascular impairment of adenosinergic system in hypertension: increased adenosine bioavailability and differential distribution of adenosine receptors and nucleoside transporters. Histochem Cell Biol 2018; 151:407-418. [PMID: 30357508 DOI: 10.1007/s00418-018-1743-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2018] [Indexed: 10/28/2022]
Abstract
Adenosinergic system regulates vascular tonicity through the complex system of adenosine, adenosine receptors (ARs) and nucleoside transporters. This work aimed at evaluating the impact of hypertension on adenosine bioavailability and expression/distribution profile of AR subtypes (A1, A2A, A2B, A3) and equilibrative nucleoside transporters (ENT1, ENT2, ENT3, ENT4). Adenosine was measured in vascular tissue extracts by HPLC (fluorescence detection); immunoreactivities (ARs/ENTs) in mesenteric arteries/veins from normotensive Wistar Kyoto (WKY) and spontaneously hypertensive rats (SHR) were analyzed by histomorphometry. Significantly higher adenosine bioavailability occurred in arteries than in veins. Adenosine bioavailability was even more increased in SHR vessels. Expression/distribution of ARs and ENTs observed in all vascular layers (intima, media, adventitia), with more intensified expression in arteries than in veins. In SHR arteries, a downregulation of all ENT along with downregulated and punctuated distribution of A1 and A2B receptors occurred comparatively to WKY arteries. By contrast, expressions of ARs and ENTs were unaltered, exception for an A2A receptor upregulation, and ENT2 downregulation in SHR veins relatively to WKY veins. Our data evidenced clear alterations of adenosinergic dynamics occurring in hypertension, particularly in arterial vessels. An increased adenosine bioavailability was observed, for the first time, in hypertensive vascular tissues.
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Affiliation(s)
- Ana Sousa-Oliveira
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira nº 228, 4050-047, Porto, Portugal
| | - Ana Brandão
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira nº 228, 4050-047, Porto, Portugal
| | - Martin Vojtek
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira nº 228, 4050-047, Porto, Portugal
- LAQV/REQUIMTE, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | | | - Joana B Sousa
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira nº 228, 4050-047, Porto, Portugal
- LAQV/REQUIMTE, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Carmen Diniz
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira nº 228, 4050-047, Porto, Portugal.
- LAQV/REQUIMTE, Faculty of Pharmacy, University of Porto, Porto, Portugal.
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22
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Sharp R, Childs J, Bulmer AC, Esterman A. The effect of oral hydration and localised heat on peripheral vein diameter and depth: A randomised controlled trial. Appl Nurs Res 2018; 42:83-88. [DOI: 10.1016/j.apnr.2018.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 04/26/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
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23
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Gyselaers W, Spaanderman M. Assessment of venous hemodynamics and volume homeostasis during pregnancy: recommendations of the International Working Group on Maternal Hemodynamics. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:174-185. [PMID: 29120514 DOI: 10.1002/uog.18952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/21/2017] [Accepted: 10/30/2017] [Indexed: 06/07/2023]
Abstract
Venous hemodynamics and volume homeostasis are important aspects of cardiovascular physiology. However, today their relevance is still very much underappreciated. Their most important role is maintenance and control of venous return and, as such, cardiac output. A high-flow/low-resistance circulation, remaining constant under physiological circumstances, is mandatory for an uncomplicated course of pregnancy. In this article, characteristics of normal and abnormal venous and volume regulating functions are discussed with respect to normal and pathologic outcomes of pregnancy, and current (non-invasive) methods to assess these functions are summarized. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- W Gyselaers
- Department of Obstetrics and Gynecology, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Physiology, Hasselt University, Diepenbeek, Belgium
| | - M Spaanderman
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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24
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Harter TS, May AG, Federspiel WJ, Supuran CT, Brauner CJ. Time course of red blood cell intracellular pH recovery following short-circuiting in relation to venous transit times in rainbow trout, Oncorhynchus mykiss. Am J Physiol Regul Integr Comp Physiol 2018; 315:R397-R407. [PMID: 29641235 DOI: 10.1152/ajpregu.00062.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Accumulating evidence is highlighting the importance of a system of enhanced hemoglobin-oxygen (Hb-O2) unloading for cardiovascular O2 transport in teleosts. Adrenergically stimulated sodium-proton exchangers (β-NHE) create H+ gradients across the red blood cell (RBC) membrane that are short-circuited in the presence of plasma-accessible carbonic anhydrase (paCA) at the tissues; the result is a large arterial-venous pH shift that greatly enhances O2 unloading from pH-sensitive Hb. However, RBC intracellular pH (pHi) must recover during venous transit (31-90 s) to enable O2 loading at the gills. The halftimes ( t1/2) and magnitudes of RBC β-adrenergic stimulation, short-circuiting with paCA and recovery of RBC pHi, were assessed in vitro, on rainbow trout whole blood, and using changes in closed-system partial pressure of O2 as a sensitive indicator for changes in RBC pHi. In addition, the recovery rate of RBC pHi was assessed in a continuous-flow apparatus that more closely mimics RBC transit through the circulation. Results indicate that: 1) the t1/2 of β-NHE short-circuiting is likely within the residence time of blood in the capillaries, 2) the t1/2 of RBC pHi recovery is 17 s and within the time of RBC venous transit, and 3) after short-circuiting, RBCs reestablish the initial H+ gradient across the membrane and can potentially undergo repeated cycles of short-circuiting and recovery. Thus, teleosts have evolved a system that greatly enhances O2 unloading from pH-sensitive Hb at the tissues, while protecting O2 loading at the gills; the resulting increase in O2 transport per unit of blood flow may enable the tremendous athletic ability of salmonids.
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Affiliation(s)
- Till S Harter
- Department of Zoology, University of British Columbia , Vancouver, BC , Canada
| | - Alexandra G May
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William J Federspiel
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Critical Care Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,ALung Technologies, Inc. , Pittsburgh, Pennsylvania
| | - Claudiu T Supuran
- NEUROFARBA Department, Università degli Studi di Firenze , Florence , Italy
| | - Colin J Brauner
- Department of Zoology, University of British Columbia , Vancouver, BC , Canada
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Gruszecki M, Lancaster G, Stefanovska A, Neary JP, Dech RT, Guminski W, Frydrychowski AF, Kot J, Winklewski PJ. Human subarachnoid space width oscillations in the resting state. Sci Rep 2018; 8:3057. [PMID: 29449606 PMCID: PMC5814422 DOI: 10.1038/s41598-018-21038-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/29/2018] [Indexed: 11/17/2022] Open
Abstract
Abnormal cerebrospinal fluid (CSF) pulsatility has been implicated in patients suffering from various diseases, including multiple sclerosis and hypertension. CSF pulsatility results in subarachnoid space (SAS) width changes, which can be measured with near-infrared transillumination backscattering sounding (NIR-T/BSS). The aim of this study was to combine NIR-T/BSS and wavelet analysis methods to characterise the dynamics of the SAS width within a wide range of frequencies from 0.005 to 2 Hz, with low frequencies studied in detail for the first time. From recordings in the resting state, we also demonstrate the relationships between SAS width in both hemispheres of the brain, and investigate how the SAS width dynamics is related to the blood pressure (BP). These investigations also revealed influences of age and SAS correlation on the dynamics of SAS width and its similarity with the BP. Combination of NIR-T/BSS and time-frequency analysis may open up new frontiers in the understanding and diagnosis of various neurodegenerative and ageing related diseases to improve diagnostic procedures and patient prognosis.
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Affiliation(s)
- Marcin Gruszecki
- Department of Radiology Informatics and Statistics, Medical University of Gdansk, Gdansk, Poland.
| | | | | | - J Patrick Neary
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Canada
| | - Ryan T Dech
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Canada
| | - Wojciech Guminski
- Department of Computer Communications, Faculty of Electronics, Telecommunications and Informatics, Gdansk University of Technology, Gdansk, Poland
| | | | - Jacek Kot
- National Centre for Hyperbaric Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, Poland
| | - Pawel J Winklewski
- Department of Human Physiology, Medical University of Gdansk, Gdansk, Poland.,Department of Clinical Anatomy and Physiology, Pomeranian University of Slupsk, Slupsk, Poland
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Klaassen SH, Tromp J, Nienhuis HL, van der Meer P, van den Berg MP, Blokzijl H, van Veldhuisen DJ, Hazenberg BP. Frequency of and Prognostic Significance of Cardiac Involvement at Presentation in Hereditary Transthyretin-Derived Amyloidosis and the Value of N-Terminal Pro-B-Type Natriuretic Peptide. Am J Cardiol 2018; 121:107-112. [PMID: 29153245 DOI: 10.1016/j.amjcard.2017.09.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/04/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
The aim of this study is to assess the prevalence of cardiac involvement in hereditary transthyretin-derived (ATTRm) amyloidosis at the time of diagnosis and to determine the diagnostic and clinical value of N-terminal pro-B-type natriuretic peptide (NT-proBNP). The University Medical Center Groningen is the national center of expertise for amyloidosis. All consecutive patients between 1994 and 2016 with ATTRm amyloidosis were followed prospectively. Baseline was set at the time of the first positive biopsy. All patients underwent a standard cardiac and neurologic work-up. Cardiac involvement was defined by otherwise unexplained left and/or right ventricular wall hypertrophy on cardiac ultrasound and/or advanced conduction disturbances. Seventy-seven patients had ATTRm amyloidosis and were included in the study. The TTR V30M mutation was present in 30 patients (39%). In both the V30M and the non-V30M groups, the neurologic presentation dominated (77% vs 51%), whereas cardiac presentation was infrequent (7% vs 15%). Clinical work-up showed that cardiac involvement was present at baseline in 51% of all patients irrespective of genotype and was associated with increased overall mortality (hazard ratio 5.95, 95% confidence interval 2.12 to 16.7), independent from clinical confounders. At a cutoff level of 125 ng/L, NT-proBNP had a sensitivity of 92% for establishing cardiac involvement. In conclusion, irrespective of the frequent noncardiac presentation of ATTRm amyloidosis, cardiac involvement is already present at diagnosis in half of the patients and is associated with increased mortality. NT-proBNP is a useful marker to determine cardiac involvement in this disease.
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Cold pressor test in spinal cord injury—revisited. Spinal Cord 2017; 56:528-537. [DOI: 10.1038/s41393-017-0037-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/08/2017] [Accepted: 11/11/2017] [Indexed: 11/08/2022]
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28
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Jardine DL, Wieling W, Brignole M, Lenders JWM, Sutton R, Stewart J. The pathophysiology of the vasovagal response. Heart Rhythm 2017; 15:921-929. [PMID: 29246828 DOI: 10.1016/j.hrthm.2017.12.013] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Indexed: 10/18/2022]
Abstract
In part I of this study, we found that the classical studies on vasovagal syncope, conducted in fit young subjects, overstated vasodilatation as the dominant hypotensive mechanism. Since 1980, blood pressure and cardiac output have been measured continuously using noninvasive methods during tilt, mainly in patients with recurrent syncope, including women and the elderly. This has allowed us to analyze in more detail the complex sequence of hemodynamic changes leading up to syncope in the laboratory. All tilt-sensitive patients appear to progress through 4 phases: (1) early stabilization, (2) circulatory instability, (3) terminal hypotension, and (4) recovery. The physiology responsible for each phase is discussed. Although the order of phases is consistent, the time spent in each phase may vary. In teenagers and young adults, progressive hypotension during phases 2 and 3 can be driven by vasodilatation or falling cardiac output. The fall in cardiac output is secondary to a progressive decrease in stroke volume because blood is pooled in the splanchnic veins. In adults a fall in cardiac output is the dominant hypotensive mechanism because systemic vascular resistance always remains above baseline levels.
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Affiliation(s)
- David L Jardine
- Department of General Medicine, Christchurch Hospital, University of Otago, Christchurch, New Zealand.
| | - Wouter Wieling
- Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Michele Brignole
- Department of Cardiology, Arrhythmologic Centre, Ospedali del Tigullio, Lavagna, Italy
| | - Jacques W M Lenders
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Internal Medicine III, Technical University Dresden, Dresden, Germany
| | - Richard Sutton
- National Heart and Lung institute, Imperial College, London, United Kingdom
| | - Julian Stewart
- Departments of Pediatrics, Physiology, and Medicine, New York Medical College, Valhalla, New York
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Fioretti AC, Ogihara CA, Cafarchio EM, Venancio DP, de Almeida RL, Antonio BB, Sato MA. Renal and femoral venous blood flows are regulated by different mechanisms dependent on α-adrenergic receptor subtypes and nitric oxide in anesthetized rats. Vascul Pharmacol 2017; 99:53-64. [DOI: 10.1016/j.vph.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 09/25/2017] [Accepted: 09/30/2017] [Indexed: 02/07/2023]
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Goswami N, Blaber AP, Hinghofer-Szalkay H, Montani JP. Orthostatic Intolerance in Older Persons: Etiology and Countermeasures. Front Physiol 2017; 8:803. [PMID: 29163185 PMCID: PMC5677785 DOI: 10.3389/fphys.2017.00803] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/29/2017] [Indexed: 12/16/2022] Open
Abstract
Orthostatic challenge produced by upright posture may lead to syncope if the cardiovascular system is unable to maintain adequate brain perfusion. This review outlines orthostatic intolerance related to the aging process, long-term bedrest confinement, drugs, and disease. Aging-associated illness or injury due to falls often leads to hospitalization. Older patients spend up to 83% of hospital admission lying in bed and thus the consequences of bedrest confinement such as physiological deconditioning, functional decline, and orthostatic intolerance represent a central challenge in the care of the vulnerable older population. This review examines current scientific knowledge regarding orthostatic intolerance and how it comes about and provides a framework for understanding of (patho-) physiological concepts of cardiovascular (in-) stability in ambulatory and bedrest confined senior citizens as well as in individuals with disease conditions [e.g., orthostatic intolerance in patients with diabetes mellitus, multiple sclerosis, Parkinson's, spinal cord injury (SCI)] or those on multiple medications (polypharmacy). Understanding these aspects, along with cardio-postural interactions, is particularly important as blood pressure destabilization leading to orthostatic intolerance affects 3-4% of the general population, and in 4 out of 10 cases the exact cause remains elusive. Reviewed also are countermeasures to orthostatic intolerance such as exercise, water drinking, mental arithmetic, cognitive training, and respiration training in SCI patients. We speculate that optimally applied countermeasures such as mental challenge maintain sympathetic activity, and improve venous return, stroke volume, and consequently, blood pressure during upright standing. Finally, this paper emphasizes the importance of an active life style in old age and why early re-mobilization following bedrest confinement or bedrest is crucial in preventing orthostatic intolerance, falls and falls-related injuries in older persons.
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Affiliation(s)
- Nandu Goswami
- Gravitational Physiology and Medicine Research Unit, Institute of Physiology, Medical University of Graz, Graz, Austria
| | - Andrew P Blaber
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Helmut Hinghofer-Szalkay
- Gravitational Physiology and Medicine Research Unit, Institute of Physiology, Medical University of Graz, Graz, Austria
| | - Jean-Pierre Montani
- Department of Medicine/Physiology, University of Fribourg, Fribourg, Switzerland
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Venous pressures and cardiac filling in turtles during apnoea and intermittent ventilation. J Comp Physiol B 2017; 188:481-490. [DOI: 10.1007/s00360-017-1132-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/01/2017] [Accepted: 10/15/2017] [Indexed: 10/18/2022]
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Brauner CJ, Harter TS. Beyond just hemoglobin: Red blood cell potentiation of hemoglobin-oxygen unloading in fish. J Appl Physiol (1985) 2017; 123:935-941. [PMID: 28705992 PMCID: PMC5668442 DOI: 10.1152/japplphysiol.00114.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/26/2017] [Accepted: 07/09/2017] [Indexed: 11/22/2022] Open
Abstract
Teleosts comprise 95% of fish species, almost one-half of all vertebrate species, and represent one of the most successful adaptive radiation events among vertebrates. This is thought to be in part because of their unique oxygen (O2) transport system. In salmonids, recent in vitro and in vivo studies indicate that hemoglobin-oxygen (Hb-O2) unloading to tissues may be doubled or even tripled under some conditions without changes in perfusion. This is accomplished through the short circuiting of red blood cell (RBC) pH regulation, resulting in a large arterial-venous pH difference within the RBC and induced reduction in Hb-O2 affinity. This system has three prerequisites: 1) highly pH-sensitive hemoglobin, 2) rapid RBC pH regulation, and 3) a heterogeneous distribution of plasma-accessible CA in the cardiovascular system (presence in the tissues and absence at the gills). Although data are limited, these attributes may be general characteristics of teleosts. Although this system is not likely operational to the same degree in other vertebrates, some of these prerequisites do exist, and the generation and elimination of pH disequilibrium states at the RBC will likely enhance Hb-O2 unloading to some degree. In human disease states, there are conditions that may partly satisfy those for enhanced Hb-O2 unloading, tentatively an avenue for future work that may improve treatment efficacy.
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Affiliation(s)
- Colin J Brauner
- Department of Zoology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Till S Harter
- Department of Zoology, University of British Columbia, Vancouver, British Columbia, Canada
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García-Pedraza JÁ, García-Domingo M, Gómez-Roso M, Rodríguez-Barbero A, Martín ML, Morán A. 5-HT modulates the rat mesenteric vasopressor outflow by 5-HT1Dsympatholytic receptors. Clin Exp Pharmacol Physiol 2017; 44:1224-1231. [DOI: 10.1111/1440-1681.12841] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 07/18/2017] [Accepted: 07/25/2017] [Indexed: 11/30/2022]
Affiliation(s)
- José-Ángel García-Pedraza
- Laboratory of Pharmacology, Department of Physiology and Pharmacology; Faculty of Pharmacy; University of Salamanca; Salamanca Spain
- Biomedical Research Institute of Salamanca (IBSAL); University Hospital of Salamanca-USAL- CSIC; Salamanca Spain
| | - Mónica García-Domingo
- Laboratory of Pharmacology, Department of Physiology and Pharmacology; Faculty of Pharmacy; University of Salamanca; Salamanca Spain
- Biomedical Research Institute of Salamanca (IBSAL); University Hospital of Salamanca-USAL- CSIC; Salamanca Spain
| | - Miriam Gómez-Roso
- Laboratory of Pharmacology, Department of Physiology and Pharmacology; Faculty of Pharmacy; University of Salamanca; Salamanca Spain
- Biomedical Research Institute of Salamanca (IBSAL); University Hospital of Salamanca-USAL- CSIC; Salamanca Spain
| | - Alicia Rodríguez-Barbero
- Biomedical Research Institute of Salamanca (IBSAL); University Hospital of Salamanca-USAL- CSIC; Salamanca Spain
- Unit of Cardiovascular and Renal Pathophysiology, Research Institute of Nephrology “Reina Sofía”, Department of Physiology and Pharmacology; University of Salamanca; Salamanca Spain
| | - María-Luisa Martín
- Laboratory of Pharmacology, Department of Physiology and Pharmacology; Faculty of Pharmacy; University of Salamanca; Salamanca Spain
- Biomedical Research Institute of Salamanca (IBSAL); University Hospital of Salamanca-USAL- CSIC; Salamanca Spain
| | - Asunción Morán
- Laboratory of Pharmacology, Department of Physiology and Pharmacology; Faculty of Pharmacy; University of Salamanca; Salamanca Spain
- Biomedical Research Institute of Salamanca (IBSAL); University Hospital of Salamanca-USAL- CSIC; Salamanca Spain
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Paulo M, Grando MD, da Silva RS, Minshall RD, Bendhack LM. The nitric oxide donor RuBPY does not induce in vitro cross-tolerance with acetylcholine. Nitric Oxide 2017; 69:69-77. [DOI: 10.1016/j.niox.2017.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/25/2017] [Accepted: 05/20/2017] [Indexed: 11/27/2022]
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Jugular Venous Reflux Is Associated with Perihematomal Edema after Intracerebral Hemorrhage. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7514639. [PMID: 28691032 PMCID: PMC5485297 DOI: 10.1155/2017/7514639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/01/2017] [Accepted: 05/11/2017] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to determine whether jugular venous reflux (JVR) is associated with perihematomal edema (PHE) in individuals with intracerebral hemorrhage (ICH). Patients with spontaneous supratentorial ICH within 72 h of symptom onset were enrolled. Baseline brain computed tomography (CT) scan was performed, with a follow-up CT examination at 12 ± 3 days after onset. Jugular venous color Doppler ultrasound was performed at 12 ± 3 days after onset to examine the JVR status. A total of 65 patients with ICH were enrolled. In logistic regression analysis, absolute PHE volume was significantly associated with JVR (OR, 5.46; 95% CI, 1.04–28.63; p = 0.044) and baseline hematoma volume (OR, 1.14; 95% CI, 1.03–1.26; p = 0.009) within 72 h of onset. It was also correlated with JVR (OR, 15.32; 95% CI, 2.52–92.99; p = 0.003) and baseline hematoma volume (OR, 1.14; 95% CI, 1.04–1.24; p = 0.006) at 12 ± 3 days after onset. In a similar manner, relative PHE volume was significantly associated with JVR (OR, 14.85; 95% CI, 3.28–67.17; p < 0.001) within 72 h of onset and at 12 ± 3 days after onset (OR, 5.87; 95% CI, 1.94–17.77; p = 0.002). JVR is associated with both absolute and relative PHE volumes after ICH.
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Zawadka-Kunikowska M, Słomko J, Tafil-Klawe M, Klawe JJ, Cudnoch-Jędrzejewska A, Newton JL, Zalewski P. Role of peripheral vascular resistance as an indicator of cardiovascular abnormalities in patients with Parkinson's disease. Clin Exp Pharmacol Physiol 2017; 44:1089-1098. [PMID: 28681408 DOI: 10.1111/1440-1681.12809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate cardiovascular autonomic modulation in response to an orthostatic stress in healthy subjects and Parkinson's disease (PD). The study included 47 controls and 56 PD patients divided into groups (vasoconstrictor PD, vasodilator PD, control) according to vasodilation/vasoconstriction response during 70° head up tilt test. Using impedance cardiography (ICG) and electrocardiography (ECG) we measured stroke volume, cardiac output, left ventricular work index, left ventricular ejection time, acceleration index, index of contractility, Heather index, thoracic fluid content, total peripheral resistance, total arterial compliance. We also analyzed heart rate variability (HRV), using spectral analysis and continuous blood pressure (contBP). At rest, the vasodilator PD group showed significantly higher values of total peripheral resistance and lower values of stroke volume and cardiac output, compared to the vasoconstrictor PD and the control groups. A post-tilt drop in ∆ (change rest - tilt) systolic blood pressure, ∆mean blood pressure, ∆total peripheral resistance and ∆Heather index, and a significantly lower increase in ∆diastolic blood pressure was observed in subjects from the vasodilator PD group compared to the vasoconstrictor PD and the control groups. No statistically significant differences were observed for HRV parameters between the vasoconstrictor and vasodilator PD groups, P > .05. Longer duration and higher disease stage of PD correlated with a reduction in post-tilt systolic blood pressure changes in vasodilator group. Positive inotropy of the cardiac muscle represents a significant factor preventing orthostatic hypotension in PD subjects with a concurrent drop in peripheral vascular resistance during orthostatic stress.
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Affiliation(s)
- Monika Zawadka-Kunikowska
- Department of Hygiene, Epidemiology and Ergonomy, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Joanna Słomko
- Department of Hygiene, Epidemiology and Ergonomy, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Małgorzata Tafil-Klawe
- Department of Human Physiology, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Jacek J Klawe
- Department of Hygiene, Epidemiology and Ergonomy, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Agnieszka Cudnoch-Jędrzejewska
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Julia L Newton
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle-upon-Tyne, UK
| | - Paweł Zalewski
- Department of Hygiene, Epidemiology and Ergonomy, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
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Inskip JA, Ravensbergen H(RJC, Sahota IS, Zawadzki C, McPhail LT, Borisoff JF, Claydon VE. Dynamic wheelchair seating positions impact cardiovascular function after spinal cord injury. PLoS One 2017; 12:e0180195. [PMID: 28666000 PMCID: PMC5493360 DOI: 10.1371/journal.pone.0180195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/12/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Innovative wheelchairs allow individuals to change position easily for comfort and social situations. While these wheelchairs are beneficial in multiple ways, the effects of position changes on blood pressure might exacerbate hypotension and cerebral hypoperfusion, particularly in those with spinal cord injury (SCI) who can have injury to autonomic nerves that regulate cardiovascular control. Conversely, cardiovascular benefits may be obtained with lowered seating. Here we investigate the effect of moderate changes in wheelchair position on orthostatic cardiovascular and cerebrovascular reflex control. METHODS Nineteen individuals with SCI and ten neurologically-intact controls were tested in supine and seated positions (neutral, lowered, and elevated) in the Elevation™ wheelchair. Participants with SCI were stratified into two groups by the severity of injury to cardiovascular autonomic pathways. Beat-to-beat blood pressure, heart rate and middle cerebral artery blood flow velocity (MCAv) were recorded non-invasively. RESULTS Supine blood pressure and MCAv were reduced in individuals with lesions to autonomic pathways, and declined further with standard seating compared to those with preserved autonomic control. Movement to the elevated position triggered pronounced blood pressure and MCAv falls in those with autonomic lesions, with minimum values significantly reduced compared to the seated and lowered positions. The cumulative duration spent below supine blood pressure was greatest in this group. Lowered seating bolstered blood pressure in those with lesions to autonomic pathways. CONCLUSIONS Integrity of the autonomic nervous system is an important variable that affects cardiovascular responses to orthostatic stress and should be considered when individuals with SCI or autonomic dysfunction are selecting wheelchairs. SPONSORSHIP This work was supported in part by the Heart and Stroke Foundation of British Columbia and the Yukon (V.E.C).
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Affiliation(s)
- Jessica A. Inskip
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Henrike (Rianne) J. C. Ravensbergen
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Inderjeet S. Sahota
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Christine Zawadzki
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lowell T. McPhail
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Jaimie F. Borisoff
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Institute of Technology (BCIT), Burnaby, British Columbia, Canada
| | - Victoria E. Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
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Beliard S, Menetrier A, Ravier G, Rakobowchuk M, Mourot L, Tordi N. Effects of thermoneutral water, cold-water and contrasting water temperature immersions on lower limb vein cross-section. Sci Sports 2017. [DOI: 10.1016/j.scispo.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stewart JM, Medow MS, Sutton R, Visintainer P, Jardine DL, Wieling W. Mechanisms of Vasovagal Syncope in the Young: Reduced Systemic Vascular Resistance Versus Reduced Cardiac Output. J Am Heart Assoc 2017; 6:e004417. [PMID: 28100453 PMCID: PMC5523632 DOI: 10.1161/jaha.116.004417] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 12/06/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Syncope is a sudden transient loss of consciousness and postural tone caused by cerebral hypoperfusion. The most common form is vasovagal syncope (VVS). Presyncopal progressive early hypotension in older VVS patients is caused by reduced cardiac output (CO); younger patients have reduced systemic vascular resistance (SVR). Using a priori criteria for reduced CO (↓CO) and SVR (↓SVR), we studied 48 recurrent young fainters comparing subgroups of VVS with VVS-↓CO, VVS-↓SVR, and both VVS-↓CO&↓SVR. METHODS AND RESULTS Subjects were studied supine and during 70-degrere upright tilt with a Finometer to continuously measure blood pressure, CO, and SVR and impedance plethysmography to estimate thoracic, splanchnic, pelvic, and calf blood volumes, blood flows, and vascular resistances and electrocardiogram to measure heart rate and rhythm. Central blood volume was decreased in all VVS compared to control. VVS-↓CO was associated with decreased splanchnic blood flow and increased splanchnic blood pooling compared to control. Seventy-five percent of VVS patients had reduced SVR, including 23% who also had reduced CO. Many VVS-↓SVR increased CO during tilt, with no difference in splanchnic pooling, caused by significant increases in splanchnic blood flow and reduced splanchnic resistance. VVS-↓CO&↓SVR patients had splanchnic pooling comparable to VVS-↓CO patients, but SVR comparable to VVS-↓SVR. Splanchnic vasodilation was reduced, compared to VVS-↓SVR, and venomotor properties were similar to control. Combined splanchnic pooling and reduced SVR produced the earliest faints among the VVS groups. CONCLUSIONS Both ↓CO and ↓SVR occur in young VVS patients. ↓SVR is predominant in VVS and is caused by impaired splanchnic vasoconstriction.
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Affiliation(s)
- Julian M Stewart
- Departments of Pediatrics and Physiology, New York Medical College, Valhalla, NY
| | - Marvin S Medow
- Departments of Pediatrics and Physiology, New York Medical College, Valhalla, NY
| | - Richard Sutton
- The National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - Paul Visintainer
- Baystate Medical Center, Tufts University School of Medicine, Springfield, MA
| | - David L Jardine
- Department of General Medicine, Christchurch Hospital, University of Otago, Christchurch, New Zealand
| | - Wouter Wieling
- Departments of Internal Medicine and of Clinical and Experimental Cardiology, Academic Medical Centre, University of Amsterdam, The Netherlands
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Harter TS, Brauner CJ. The O 2 and CO 2 Transport System in Teleosts and the Specialized Mechanisms That Enhance Hb–O 2 Unloading to Tissues. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/bs.fp.2017.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
AbstractFrom the earliest pathological studies the perivenular localization of the demyelination in multiple sclerosis (MS) has been observed. It has recently been suggested that obstructions to venous flow or inadequate venous valves in the great veins in the neck, thorax and abdomen can cause damaging backflow into the cerebral and spinal cord circulations. Paolo Zamboni and colleagues have demonstrated abnormal venous circulation in some multiple sclerosis patients using non-invasive sonography and invasive venography. Furthermore, they have obtained apparent clinical improvement or stabilization by endovascular ballooning of points of obstruction in the great veins in some, at least temporarily. If non-invasive observations by others validate their initial observations of a significantly increased prevalence of venous obstructions in MS then trials of angioplasty/stenting would be justified in selected cases in view of the biological plausibility of the concept.
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Aardenburg R, Spaanderman ME, van Eijndhoven HW, de Leeuw PW, Peeters LL. A Low Plasma Volume in Formerly Preeclamptic Women Predisposes to the Recurrence of Hypertensive Complications in the Next Pregnancy. ACTA ACUST UNITED AC 2016; 13:598-603. [DOI: 10.1016/j.jsgi.2006.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Robert Aardenburg
- Department of Obstetrics and Gynecology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | | | | | | | - Louis L. Peeters
- Departments of Obstetrics and Gynecology and Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands
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Enok S, Leite GSPC, Leite CAC, Gesser H, Hedrick MS, Wang T. Improved cardiac filling facilitates the postprandial elevation of stroke volume in Python regius. ACTA ACUST UNITED AC 2016; 219:3009-3018. [PMID: 27445352 DOI: 10.1242/jeb.142729] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/18/2016] [Indexed: 01/10/2023]
Abstract
To accommodate the pronounced metabolic response to digestion, pythons increase heart rate and elevate stroke volume, where the latter has been ascribed to a massive and fast cardiac hypertrophy. However, numerous recent studies show that heart mass rarely increases, even upon ingestion of large meals, and we therefore explored the possibility that a rise in mean circulatory filling pressure (MCFP) serves to elevate venous pressure and cardiac filling during digestion. To this end, we measured blood flows and pressures in anaesthetized Python regius The anaesthetized snakes exhibited the archetypal tachycardia as well as a rise in both venous pressure and MCFP that fully account for the approximate doubling of stroke volume. There was no rise in blood volume and the elevated MCFP must therefore stem from increased vascular tone, possibly by means of increased sympathetic tone on the veins. Furthermore, although both venous pressure and MCFP increased during volume loading, there was no evidence that postprandial hearts were endowed with an additional capacity to elevate stroke volume. In vitro measurements of force development of paced ventricular strips also failed to reveal signs of increased contractility, but the postprandial hearts had higher activities of cytochrome oxidase and pyruvate kinase, which probably serves to sustain the rise in cardiac work during digestion.
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Affiliation(s)
- Sanne Enok
- Zoophysiology, Department of Bioscience, Aarhus University, Aarhus 8000, Denmark
| | - Gabriella S P C Leite
- Department of Physiological Sciences, Federal University of São Carlos, São Paulo 13565-905, Brazil
| | - Cléo A C Leite
- Department of Physiological Sciences, Federal University of São Carlos, São Paulo 13565-905, Brazil
| | - Hans Gesser
- Zoophysiology, Department of Bioscience, Aarhus University, Aarhus 8000, Denmark
| | - Michael S Hedrick
- Department of Biological Sciences, California State University, East Bay, Hayward, CA 94542, USA
| | - Tobias Wang
- Zoophysiology, Department of Bioscience, Aarhus University, Aarhus 8000, Denmark
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Yuerek M, Rossano JW, Mascio CE, Shaddy RE. Postoperative management of heart failure in pediatric patients. Expert Rev Cardiovasc Ther 2015; 14:201-15. [PMID: 26560361 DOI: 10.1586/14779072.2016.1117388] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Low cardiac output syndrome (LCOS) is a well-described entity occurring in 25-65% of pediatric patients undergoing open-heart surgery. With judicious intensive care management of LCOS, most patients have an uncomplicated postoperative course, and within 24 h after cardiopulmonary bypass, the cardiac function returns back to baseline. Some patients have severe forms of LCOS not responsive to medical management alone, requiring temporary mechanical circulatory support to prevent end-organ injury and to decrease myocardial stress and oxygen demand. Occasionally, cardiac function does not recover and heart transplantation is necessary. Long-term mechanical circulatory support devices are used as a bridge to transplantation because of limited availability of donor hearts. Experience in usage of continuous flow ventricular assist devices in the pediatric population is increasing.
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Affiliation(s)
- Mahsun Yuerek
- a Division of Cardiac Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine , Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - Joseph W Rossano
- b Division of Cardiology, Department of Pediatrics , University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - Christopher E Mascio
- c Division of Pediatric Cardiothoracic Surgery, Department of Surgery , University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - Robert E Shaddy
- b Division of Cardiology, Department of Pediatrics , University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia , Philadelphia , PA , USA
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46
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Skoog J, Lindenberger M, Ekman M, Holmberg B, Zachrisson H, Länne T. Reduced venous compliance: an important determinant for orthostatic intolerance in women with vasovagal syncope. Am J Physiol Regul Integr Comp Physiol 2015; 310:R253-61. [PMID: 26561647 DOI: 10.1152/ajpregu.00362.2015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/09/2015] [Indexed: 11/22/2022]
Abstract
The influence of lower limb venous compliance on orthostatic vasovagal syncope (VVS) is uncertain. The most widespread technique to calculate venous compliance uses a nonphysiological quadratic regression equation. Our aim was therefore to construct a physiologically derived venous wall model (VWM) for calculation of calf venous compliance and to determine the effect of venous compliance on tolerance to maximal lower body negative pressure (LBNP). Venous occlusion plethysmography was used to study calf volume changes in 15 women with VVS (25.5 ± 1.3 yr of age) and 15 controls (22.8 ± 0.8 yr of age). The fit of the VWM and the regression equation to the experimentally induced pressure-volume curve was examined. Venous compliance was calculated as the derivative of the modeled pressure-volume relationship. Graded LBNP to presyncope was used to determine the LBNP tolerance index (LTI). The VWM displayed a better fit to the experimentally induced pressure-volume curve (P < 0.0001). Calf blood pooling was similar in the groups and was not correlated to the LTI (r = 0.204, P = 0.30). Venous compliance was significantly reduced at low venous pressures in women with VVS (P = 0.042) and correlated to the LTI (r = 0.459, P = 0.014) in the low pressure range. No correlation was found between venous compliance at high venous pressures and the LTI. In conclusion, the new VWM accurately adopted the curvilinear pressure-volume curve, providing a valid characterization of venous compliance. Reduced venous compliance at low venous pressures may adversely affect mobilization of peripheral venous blood to the central circulation during hypovolemic circulatory stress in women with VVS.
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Affiliation(s)
- Johan Skoog
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden;
| | - Marcus Lindenberger
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Cardiology, Linköping University, Linköping, Sweden
| | | | - Bengt Holmberg
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Clinical Physiology, Linköping University, Linköping, Sweden; and
| | - Helene Zachrisson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Clinical Physiology, Linköping University, Linköping, Sweden; and
| | - Toste Länne
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Thoracic and Vascular Surgery, Linköping University, Linköping, Sweden
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47
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Harfoush K, Guintard C, Desfontis JC, Thorin C, Douart C, Mallem MY, Betti E. Venous Valvular Distribution in the Thoracic and Pelvic Limbs of the Horse. Anat Histol Embryol 2015; 45:409-417. [DOI: 10.1111/ahe.12209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/21/2015] [Indexed: 11/27/2022]
Affiliation(s)
- K. Harfoush
- Unité d'Anatomie Comparée; Ecole Nationale Vétérinaire; Agroalimentaire et de l'Alimentation Nantes-Atlantique - Oniris; BP 40706 44307 Nantes France
- UPSP 5304 de Physiopathologie Animale et Pharmacologie Fonctionnelle; Ecole Nationale Vétérinaire; Agroalimentaire et de l'Alimentation Nantes-Atlantique - Oniris; BP 40706 44307 Nantes France
| | - C. Guintard
- Unité d'Anatomie Comparée; Ecole Nationale Vétérinaire; Agroalimentaire et de l'Alimentation Nantes-Atlantique - Oniris; BP 40706 44307 Nantes France
| | - J. C. Desfontis
- UPSP 5304 de Physiopathologie Animale et Pharmacologie Fonctionnelle; Ecole Nationale Vétérinaire; Agroalimentaire et de l'Alimentation Nantes-Atlantique - Oniris; BP 40706 44307 Nantes France
| | - C. Thorin
- UPSP 5304 de Physiopathologie Animale et Pharmacologie Fonctionnelle; Ecole Nationale Vétérinaire; Agroalimentaire et de l'Alimentation Nantes-Atlantique - Oniris; BP 40706 44307 Nantes France
| | - C. Douart
- Unité d'Anatomie Comparée; Ecole Nationale Vétérinaire; Agroalimentaire et de l'Alimentation Nantes-Atlantique - Oniris; BP 40706 44307 Nantes France
| | - M. Y. Mallem
- UPSP 5304 de Physiopathologie Animale et Pharmacologie Fonctionnelle; Ecole Nationale Vétérinaire; Agroalimentaire et de l'Alimentation Nantes-Atlantique - Oniris; BP 40706 44307 Nantes France
| | - E. Betti
- Unité d'Anatomie Comparée; Ecole Nationale Vétérinaire; Agroalimentaire et de l'Alimentation Nantes-Atlantique - Oniris; BP 40706 44307 Nantes France
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48
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Flack JM, Bhatt DL, Kandzari DE, Brown D, Brar S, Choi JW, D'Agostino R, East C, Katzen BT, Lee L, Leon MB, Mauri L, O'Neill WW, Oparil S, Rocha-Singh K, Townsend RR, Bakris G. An analysis of the blood pressure and safety outcomes to renal denervation in African Americans and Non-African Americans in the SYMPLICITY HTN-3 trial. ACTA ACUST UNITED AC 2015; 9:769-779. [PMID: 26362830 DOI: 10.1016/j.jash.2015.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/01/2015] [Indexed: 12/24/2022]
Abstract
SYMPLICITY HTN-3, the first trial of renal denervation (RDN) versus sham, enrolled 26% African Americans, a prospectively stratified cohort. Although the 6-month systolic blood pressure (SBP) reduction in African Americans (AAs) was similar in the RDN group (-15.5 ± 25.4 mm Hg, n = 85 vs. -17.8 ± 29.2, n = 49, P = .641), the sham SBP response was 9.2 mm Hg greater (P = .057) in AAs than non-AAs. In multivariate analyses, sham SBP response was predicted by an interaction between AA and a complex antihypertensive regimen (at least one antihypertensive medication prescribed ≥3 times daily), while in the RDN group, SBP response was predicted by an interaction between AA race and baseline BP ≥ 180 mm Hg. AA race did not independently predict SBP response in either sham or RDN. There appears to be effect modification by race with individual-level patient characteristics in both treatment arms that affect the observed pattern of SBP responses.
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Affiliation(s)
- John M Flack
- Department of Medicine, Division of General Medicine, Hypertension Section, Southern Illinois University, Springfield, IL, USA.
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | - David E Kandzari
- Department of Medicine, Division of Cardiology, Piedmont Heart Institute, Atlanta, GA, USA
| | - David Brown
- Department of Medicine, Cardiovascular Division, The Heart Hospital Baylor Plano, Plano, TX, USA
| | - Sandeep Brar
- Clinical Department, Medtronic CardioVascular, Santa Rosa, CA, USA
| | - James W Choi
- Baylor Soltero Cardiovascular Research Center, Heart and Vascular Hospital, Dallas, TX, USA
| | - Ralph D'Agostino
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Cara East
- Baylor Soltero Cardiovascular Research Center, Heart and Vascular Hospital, Dallas, TX, USA
| | - Barry T Katzen
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Lilian Lee
- Clinical Department, Medtronic CardioVascular, Santa Rosa, CA, USA
| | - Martin B Leon
- Department of Medicine, Division of Cardiology, New York Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY, USA
| | - Laura Mauri
- Department of Medicine, Division of Cardiology, Harvard Clinical Research Institute, Boston, MA, USA
| | - William W O'Neill
- Department of Medicine, Division of Cardiology, Henry Ford Detroit Hospital, Detroit, MI, USA
| | - Suzanne Oparil
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama, Birmingham, AL, USA
| | - Krishna Rocha-Singh
- Chief Scientific Officer, Prairie Heart Institute at St John's Hospital, Springfield, IL, USA
| | - Raymond R Townsend
- Department of Medicine, Renal Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - George Bakris
- Hypertensive Disease Center, The University of Chicago Medicine, Chicago, IL, USA
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49
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Mebazaa A, Longrois D, Metra M, Mueller C, Richards AM, Roessig L, Seronde MF, Sato N, Stockbridge NL, Gattis Stough W, Alonso A, Cody RJ, Cook Bruns N, Gheorghiade M, Holzmeister J, Laribi S, Zannad F. Agents with vasodilator properties in acute heart failure: how to design successful trials. Eur J Heart Fail 2015; 17:652-64. [PMID: 26040488 DOI: 10.1002/ejhf.294] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/17/2015] [Accepted: 04/22/2015] [Indexed: 01/08/2023] Open
Abstract
Agents with vasodilator properties (AVDs) are frequently used in the treatment of acute heart failure (AHF). AVDs rapidly reduce preload and afterload, improve left ventricle to aorta and right ventricle to pulmonary artery coupling, and may improve symptoms. Early biomarker changes after AVD administration have suggested potentially beneficial effects on cardiac stretch, vascular tone, and renal function. AVDs that reduce haemodynamic congestion without causing hypoperfusion might be effective in preventing worsening organ dysfunction. Existing AVDs have been associated with different results on outcomes in randomized clinical trials, and observational studies have suggested that AVDs may be associated with a clinical outcome benefit. Lessons have been learned from past AVD trials in AHF regarding preventing hypotension, selecting the optimal endpoint, refining dyspnoea measurements, and achieving early randomization and treatment initiation. These lessons have been applied to the design of ongoing pivotal clinical trials, which aim to ascertain if AVDs improve clinical outcomes. The developing body of evidence suggests that AVDs may be a clinically effective therapy to reduce symptoms, but more importantly to prevent end-organ damage and improve clinical outcomes for specific patients with AHF. The results of ongoing trials will provide more clarity on the role of AVDs in the treatment of AHF.
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Affiliation(s)
- Alexandre Mebazaa
- University Paris Diderot, Sorbonne Paris Cité, Paris, France.,U942 INSERM, AP-HP, Paris, France.,APHP, Department of Anesthesia and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisière, Paris, France
| | - Dan Longrois
- Département d'Anesthésie-Réanimation, Hôpital Bichat-Claude Bernard, University Paris Diderot, Sorbonne Paris Cité, Paris, U1148 INSERM, Paris, France
| | - Marco Metra
- Cardiology, University of Brescia, Brescia, Italy
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Arthur Mark Richards
- Cardiovascular Research Institute, National University of Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lothar Roessig
- Global Clinical Development, Bayer Pharma AG, Berlin, Germany
| | - Marie France Seronde
- Department of Cardiology, University Hospital of Besançon, U942 INSERM, Besançon, France
| | - Naoki Sato
- Internal Medicine, Cardiology, and Intensive Care Medicine, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
| | - Norman L Stockbridge
- Division of Cardiovascular and Renal Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | - Angeles Alonso
- Scientific Advice Working Party European Medicines Agency, Madrid, Spain
| | | | | | - Mihai Gheorghiade
- Department of Medicine, Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Said Laribi
- APHP, Department of Emergency Medicine, Hôpitaux Universitaires Saint Louis-Lariboisière, INSERM U942, Paris, France
| | - Faiez Zannad
- INSERM, Centre d'Investigation Clinique 9501 and Unité 961, Centre Hospitalier Universitaire, and the Department of Cardiology, Nancy University, Université de Lorraine, Nancy, France
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50
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Elasmobranch Cardiovascular System. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/b978-0-12-801286-4.00001-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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