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von Haehling S, Lainscak M, Kung T, Cramer L, Fülster S, Pelzer U, Hildebrandt B, Sandek A, Schefold JC, Rauchhaus M, Doehner W, Anker SD. Non-invasive assessment of cardiac hemodynamics in patients with advanced cancer and with chronic heart failure: a pilot feasibility study. Arch Med Sci 2013; 9:261-7. [PMID: 23671436 PMCID: PMC3648837 DOI: 10.5114/aoms.2013.34574] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/16/2013] [Accepted: 02/26/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Relationships between cardiac pressure and volume have been suggested as markers of cardiac contractility; parameters include stroke work and the maximal rate of pressure rise during isovolumic contraction (dP/dtmax). Patients with cancer often display dyspnea and fatigue. These are also frequent symptoms in patients with chronic heart failure (HF). The reasons for similar symptoms in cancer patients are unknown. Using the novel Nexfin Finapres technique, we sought to assess measures of cardiac performance in patients with cancer and compare these values with those from control subjects and patients with chronic HF. MATERIAL AND METHODS We prospectively studied 98 patients (control n = 18, chronic HF n = 37, advanced pancreatic or colorectal cancer n = 43) and assessed blood pressure (BP), stroke volume (SV), cardiac output (CO), and dP/dtmax at rest. RESULTS All parameters of interest could be assessed using the Nexfin Finapres technique with SV and CO being significantly higher in patients with cancer than in controls (both p < 0.05). The SV was significantly higher in patients with chronic HF than in controls (p < 0.05). In patients with cancer, SV correlated with age (r = -0.45, p < 0.01) and body weight (r = +0.55, p = 0.0001). In chronic HF, SV declined with increasing age (r = -0.49, p < 0.01); in control subjects, SV increased with increasing body weight (r = +0.57, p = 0.01). CONCLUSIONS Patients with cancer tended to display elevated BP, CO, SV, and dP/dtmax as compared to control subjects and patients with HF. These findings may reveal an elevated risk for cardiovascular diseases in this group.
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Affiliation(s)
- Stephan von Haehling
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
- Center for Cardiovascular Research (CCR), Charité Medical School, Campus Mitte, Berlin, Germany
| | - Mitja Lainscak
- Division of Cardiology, University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Thomas Kung
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Larissa Cramer
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Susann Fülster
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Uwe Pelzer
- Charité-Centrum für Tumormedizin, Department of Hematology and Oncology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Bert Hildebrandt
- Charité-Centrum für Tumormedizin, Department of Hematology and Oncology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Anja Sandek
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Joerg C. Schefold
- Department of Nephrology and Intensive Care Medicine, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Mathias Rauchhaus
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Wolfram Doehner
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
- Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany
| | - Stefan D. Anker
- Centre for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy
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Scolletta S, Romano SM, Giomarelli P. Minimally Invasive Hemodynamic Monitoring Using the Pressure Recording Analytical Method. Intensive Care Med 2007. [DOI: 10.1007/0-387-35096-9_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Romano SM, Scolletta S, Olivotto I, Biagioli B, Gensini GF, Chiostri M, Giomarelli P. Systemic arterial waveform analysis and assessment of blood flow during extracorporeal circulation. Perfusion 2006; 21:109-16. [PMID: 16615689 DOI: 10.1191/0267659106pf857oa] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The pressure recording analytical method (PRAM) is a method for real-time beat-to-beat quantification of peripheral blood flow based on the analysis of arterial waveform morphology. Since PRAM can be implemented in any conditions of flow, whether physiological or artificial, we assessed its accuracy in patients undergoing cardiac surgery during extracorporeal circulation (ECC), using the roller-pump device as the reference gold standard. METHODS We prospectively studied 32 patients undergoing elective coronary surgery. Flow values obtained by PRAM from the radial artery were compared with simultaneous values by thermodilution in physiological conditions of flow and with the roller-pump device readings during ECC. RESULTS Before and after ECC, the overall estimates of flow measured by PRAM closely agreed with thermodilution (mean difference 0.07 +/- 0.40 L/min). During ECC, PRAM estimates of flow also closely correlated with simultaneous pump readings (mean difference 0.11 +/- 0.33 L/min). At time of weaning from ECC, two patterns of hemodynamic adaptation were documented by PRAM following resumption of cardiac contraction: in most patients (n =26; 80%), cardiac output (CO) was stable (reduction < or = 10% compared to the steady ECC phase); six patients (20%) showed a fall in CO exceeding 10% and up to 38%. CONCLUSIONS PRAM provided accurate, continuous quantification of peripheral blood flow during each phase of cardiac surgery, including ECC, and allowed early recognition of patients with low CO during weaning from the pump.
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