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Zhou K, Ran S, Guo Y, Ye H. CAROTID ARTERY ULTRASOUND FOR ASSESSING FLUID RESPONSIVENESS IN PATIENTS UNDERGOING MECHANICAL VENTILATION WITH LOW TIDAL VOLUME AND PRESERVED SPONTANEOUS BREATHING. Shock 2024; 61:360-366. [PMID: 38117132 DOI: 10.1097/shk.0000000000002288] [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: 12/21/2023]
Abstract
ABSTRACT Objective : This study aimed to investigate whether changes in carotid artery corrected flow time (ΔFTc bolus ) and carotid artery peak flow velocity respiratory variation (Δ V peak bolus ) induced by the fluid challenge could reliably predict fluid responsiveness in mechanically ventilated patients with a tidal volume < 8 mL/kg Predicted Body Weight while preserving spontaneous breathing. Methods : Carotid artery corrected flow time, Δ V peak, and hemodynamic data were measured before and after administration of 250 mL crystalloids. Fluid responsiveness was defined as a 10% or more increase in stroke volume index as assessed by noninvasive cardiac output monitoring after the fluid challenge. Results : A total of 43 patients with acute circulatory failure were enrolled in this study. Forty-three patients underwent a total of 60 fluid challenges. The ΔFTc bolus and Δ V peak bolus showed a significant difference between the fluid responsiveness positive group (n = 35) and the fluid responsiveness negative group (n = 25). Spearman correlation test showed that ΔFTc bolus and Δ V peak bolus with the relative increase in stroke volume index after fluid expansion ( r = 0.5296, P < 0.0001; r = 0.3175, P = 0.0135). Multiple logistic regression analysis demonstrated that ΔFTc bolus and Δ V peak bolus were significantly correlated with fluid responsiveness in patients with acute circulatory failure. The areas under the receiver operating characteristic curves of ΔFTc bolus and Δ V peak bolus for predicting fluid responsiveness were 0.935 and 0.750, respectively. The optimal cutoff values of ΔFTc bolus and Δ V peak bolus were 0.725 (sensitivity = 97.1%, specificity = 84%) and 4.21% (sensitivity = 65.7%, specificity = 80%), respectively. Conclusion : In mechanically ventilated patients with a tidal volume < 8 mL/kg while preserving spontaneous breathing, ΔFTc bolus and Δ V peak bolus could predict fluid responsiveness. The predictive performance of ΔFTc bolus was superior to Δ V peak bolus .
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Affiliation(s)
- Kefan Zhou
- Department of Intensive Care Medicine, Changshu Hospital Affiliated to Soochow University, Changshu No. 1 People's Hospital, Suzhou, China
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Middel C, Stetzuhn M, Sander N, Kalkbrenner B, Tigges T, Pielmus AG, Spies C, Pietzner K, Klum M, von Haefen C, Hunsicker O, Sehouli J, Konietschke F, Feldheiser A. Perioperative advanced haemodynamic monitoring of patients undergoing multivisceral debulking surgery: an observational pilot study. Intensive Care Med Exp 2023; 11:61. [PMID: 37682496 PMCID: PMC10491568 DOI: 10.1186/s40635-023-00543-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Patients undergoing high-risk surgery show haemodynamic instability and an increased risk of morbidity. However, most of the available data concentrate on the intraoperative period. This study aims to characterise patients with advanced haemodynamic monitoring throughout the whole perioperative period using electrical cardiometry. METHODS In a prospective, observational, monocentric pilot study, electrical cardiometry measurements were obtained using an Osypka ICON™ monitor before surgery, during surgery, and repeatedly throughout the hospital stay for 30 patients with primary ovarian cancer undergoing multivisceral cytoreductive surgery. Severe postoperative complications according to the Clavien-Dindo classification were used as a grouping criterion. RESULTS The relative change from the baseline to the first intraoperative timepoint showed a reduced heart rate (HR, median - 19 [25-quartile - 26%; 75-quartile - 10%]%, p < 0.0001), stroke volume index (SVI, - 9.5 [- 15.3; 3.2]%, p = 0.0038), cardiac index (CI, - 24.5 [- 32; - 13]%, p < 0.0001) and index of contractility (- 17.5 [- 35.3; - 0.8]%, p < 0.0001). Throughout the perioperative course, patients had intraoperatively a reduced HR and CI (both p < 0.0001) and postoperatively an increased HR (p < 0.0001) and CI (p = 0.016), whereas SVI was unchanged. Thoracic fluid volume increased continuously versus preoperative values and did not normalise up to the day of discharge. Patients having postoperative complications showed a lower index of contractility (p = 0.0435) and a higher systolic time ratio (p = 0.0008) over the perioperative course in comparison to patients without complications, whereas the CI (p = 0.3337) was comparable between groups. One patient had to be excluded from data analysis for not receiving the planned surgery. CONCLUSIONS Substantial decreases in HR, SVI, CI, and index of contractility occurred from the day before surgery to the first intraoperative timepoint. HR and CI were altered throughout the perioperative course. Patients with postoperative complications differed from patients without complications in the markers of cardiac function, a lower index of contractility and a lower SVI. The analyses of trends over the whole perioperative time course by using non-invasive technologies like EC seem to be useful to identify patients with altered haemodynamic parameters and therefore at an increased risk for postoperative complications after major surgery.
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Affiliation(s)
- Charlotte Middel
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Matthias Stetzuhn
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nadine Sander
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Björn Kalkbrenner
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Timo Tigges
- Department of Electronics and Medical Signal Processing, Technical University, Berlin, Germany
| | | | - Claudia Spies
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klaus Pietzner
- Department of Gynaecology With Center for Oncological Surgery, Campus Virchow Klinikum, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Klum
- Department of Electronics and Medical Signal Processing, Technical University, Berlin, Germany
| | - Clarissa von Haefen
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Oliver Hunsicker
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynaecology With Center for Oncological Surgery, Campus Virchow Klinikum, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Frank Konietschke
- Institute of Biometry and Clinical Epidemiology, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Aarne Feldheiser
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Evangelische Kliniken Essen-Mitte, Huyssens-Stiftung/Knappschaft, 45136, Essen, Germany.
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Sanchez-Perez JA, Gazi AH, Rahman FN, Seith A, Saks G, Sundararaj S, Erbrick R, Harrison AB, Nichols CJ, Modak M, Chalumuri YR, Snow TK, Hahn JO, Inan OT. Transcutaneous auricular Vagus Nerve Stimulation and Median Nerve Stimulation reduce acute stress in young healthy adults: a single-blind sham-controlled crossover study. Front Neurosci 2023; 17:1213982. [PMID: 37746156 PMCID: PMC10512834 DOI: 10.3389/fnins.2023.1213982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Stress is a major determinant of health and wellbeing. Conventional stress management approaches do not account for the daily-living acute changes in stress that affect quality of life. The combination of physiological monitoring and non-invasive Peripheral Nerve Stimulation (PNS) represents a promising technological approach to quantify stress-induced physiological manifestations and reduce stress during everyday life. This study aimed to evaluate the effectiveness of three well-established transcutaneous PNS modalities in reducing physiological manifestations of stress compared to a sham: auricular and cervical Vagus Nerve Stimulation (taVNS and tcVNS), and Median Nerve Stimulation (tMNS). Using a single-blind sham-controlled crossover study with four visits, we compared the stress mitigation effectiveness of taVNS, tcVNS, and tMNS, quantified through physiological markers derived from five physiological signals peripherally measured on 19 young healthy volunteers. Participants underwent three acute mental and physiological stressors while receiving stimulation. Blinding effectiveness was assessed via subjective survey. taVNS and tMNS relative to sham resulted in significant changes that suggest a reduction in sympathetic outflow following the acute stressors: Left Ventricular Ejection Time Index (LVETI) shortening (tMNS: p = 0.007, taVNS: p = 0.015) and Pre-Ejection Period (PEP)-to-LVET ratio (PEP/LVET) increase (tMNS: p = 0.044, taVNS: p = 0.029). tMNS relative to sham also reduced Pulse Pressure (PP; p = 0.032) and tonic EDA activity (tonicMean; p = 0.025). The nonsignificant blinding survey results suggest these effects were not influenced by placebo. taVNS and tMNS effectively reduced stress-induced sympathetic arousal in wearable-compatible physiological signals, motivating their future use in novel personalized stress therapies to improve quality of life.
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Affiliation(s)
| | - Asim H. Gazi
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Farhan N. Rahman
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Alexis Seith
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Georgia Saks
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | | | - Rachel Erbrick
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Anna B. Harrison
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Christopher J. Nichols
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Mihir Modak
- Department of Bioengineering, University of Maryland, College Park, MD, United States
| | - Yekanth R. Chalumuri
- Department of Mechanical Engineering, University of Maryland, College Park, MD, United States
| | - Teresa K. Snow
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, United States
| | - Jin-Oh Hahn
- Department of Mechanical Engineering, University of Maryland, College Park, MD, United States
| | - Omer T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
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Hung KC, Huang YT, Tsai WW, Tan PH, Wu JY, Huang PY, Liu TH, Chen IW, Sun CK. Diagnostic Efficacy of Carotid Ultrasound for Predicting the Risk of Perioperative Hypotension or Fluid Responsiveness: A Meta-Analysis. Diagnostics (Basel) 2023; 13:2290. [PMID: 37443683 DOI: 10.3390/diagnostics13132290] [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: 05/29/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Despite the acceptance of carotid ultrasound for predicting patients' fluid responsiveness in critical care and anesthesia, its efficacy for predicting hypotension and fluid responsiveness remains unclear in the perioperative setting. Electronic databases were searched from inception to May 2023 to identify observational studies focusing on the use of corrected blood flow time (FTc) and respirophasic variation in carotid artery blood flow peak velocity (ΔVpeak) for assessing the risks of hypotension and fluid responsiveness. Using FTc as a predictive tool (four studies), the analysis yielded a pooled sensitivity of 0.82 (95% confidence interval (CI): 0.72 to 0.89) and specificity of 0.94 (95% CI: 0.88 to 0.97) for the risk of hypotension (area under curve (AUC): 0.95). For fluid responsiveness, the sensitivity and specificity of FTc were 0.79 (95% CI: 0.72 to 0.84) and 0.81 (95% CI: 0.75 to 0.86), respectively (AUC: 0.87). In contrast, the use of ΔVpeak to predict the risk of fluid responsiveness showed a pooled sensitivity of 0.76 (95% CI: 0.63 to 0.85) and specificity of 0.74 (95% CI: 0.66 to 0.8) (AUC: 0.79). The current meta-analysis provides robust evidence supporting the high diagnostic accuracy of FTc in predicting perioperative hypotension and fluid responsiveness, which requires further studies for verification.
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Affiliation(s)
- Kuo-Chuan Hung
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City 80424, Taiwan
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 70101, Taiwan
| | - Wen-Wen Tsai
- Department of Neurology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Ping-Heng Tan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City 80424, Taiwan
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Po-Yu Huang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Ting-Hui Liu
- Department of General Internal Medicine, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City 73657, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung City 82445, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan
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Bai Y, Jia H, Avolio A, Qian Y, Zuo J. Association of Carotid-Femoral Pulse Wave Velocity and Ejection Duration with Target Organ Damage. Rev Cardiovasc Med 2023; 24:41. [PMID: 39077415 PMCID: PMC11273147 DOI: 10.31083/j.rcm2402041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/19/2022] [Accepted: 12/06/2022] [Indexed: 07/31/2024] Open
Abstract
Background Carotid-femoral pulse wave velocity (cfPWV) and ejection duration (ED) have different impacts on target organ damage (TOD). The aim of this study was to determine the relationship of cfPWV and ED with TOD. Methods A total of 1254 patients (64.27% males) from Ruijin Hospital were enrolled in this study from December 2018 to August 2022. Medical records, blood samples and urine samples were collected. The cfPWV was measured and ED was generated using SphygmoCor software (version 8.0, AtCor Medical, Sydney, Australia). TOD including left ventricular hypertrophy (LVH), microalbuminuria, chronic kidney disease (CKD), and abnormality of carotid intima-media thickness (CIMT) were evaluated. Results Multiple stepwise linear regression models of cfPWV and ED (individually or together) showed that cfPWV was positively correlated with left ventricular mass index (LVMI) ( β = 0.131, p = 0.002) and Log (albumin-creatinine ratio, ACR) ( β = 0.123, p = 0.004), while ED was negatively correlated with LVMI ( β = -0.244, p < 0.001) and positively correlated with the estimated glomerular filtration rate (eGFR) ( β = 0.115, p = 0.003). When cfPWV and ED were added separately or together in multiple stepwise logistic regression models, cfPWV was associated with CKD [odds ratio (OR) = 1.240, 95% confidence interval (CI) 1.055-1.458, p = 0.009], while ED was associated with LVH (OR = 0.983, 95% CI 0.975-0.992, p < 0.001). In the control group with normal cfPWV and normal ED, LVH was significantly lower in patients with high ED (OR = 0.574, 95% CI 0.374-0.882, p = 0.011), but significantly elevated in those with high cfPWV and low ED (OR = 6.799, 95% CI 1.305-35.427, p = 0.023). Conclusions cfPWV was more strongly associated with renal damage, while ED was more strongly associated with cardiac dysfunction. cfPWV and ED affect each other, and together have an effect on LVH.
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Affiliation(s)
- Yaya Bai
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China
| | - Huiying Jia
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, 2109 Sydney, Australia
| | - Yi Qian
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China
| | - Junli Zuo
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, 2109 Sydney, Australia
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Corradi F, Santori G, Brusasco C, Robba C, Wong A, Di Nicolò P, Tecchi L, Dazzi F, Taddei E, Isirdi A, Coccolini F, Forfori F, Tavazzi G. Electrocardiographic Time-Intervals Waveforms as Potential Predictors for Severe Acute Kidney Injury in Critically Ill Patients. J Clin Med 2023; 12:jcm12020700. [PMID: 36675629 PMCID: PMC9866689 DOI: 10.3390/jcm12020700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/17/2023] Open
Abstract
Background: Acute kidney injury (AKI) is common in critically ill patients admitted to intensive care units (ICU) and is frequently associated with poorer outcomes. Hence, if an indicator is available for predicting severe AKI within the first few hours of admission, management strategies can be put into place to improve outcomes. Materials and methods: This was a prospective, observational study, involving 63 critically ill patients, that aimed to explore the diagnostic accuracy of different Doppler parameters in predicting AKI in critically ill patients from a mixed ICU. Participants were enrolled at ICU admission. All underwent ultrasonographic examinations and hemodynamic assessment. Renal Doppler resistive index (RDRI), venous impedance index (VII), arterial systolic time intervals (a-STI), and venous systolic time intervals (v-STI) were measured within 2 h from ICU admission. Results: Cox proportional hazards models, including a-STI, v-STI, VII, and RDRI as independent variables, returned a-STI as the only putative predictor for the development of AKI or severe AKI. An overall statistically significant difference (p < 0.001) was observed in the Kaplan−Meier plots for cumulative AKI events between patients with a-STI higher or equal than 0.37 and for cumulative severe AKI-3 between patients with a-STI higher or equal than 0.63. As assessed by the area under the receiver operating curves (ROC) curves, a-STI performed best in diagnosing any AKI and/or severe AKI-3. Positive correlations were found between a-STI and the N-terminal brain natriuretic peptide precursor (NT-pro BNP) (ρ = 0.442, p < 0.001), the sequential organ failure assessment (SOFA) score (ρ: 0.361, p = 0.004), and baseline serum creatinine (ρ: 0.529, p < 0.001). Conclusions: Critically ill patients who developed AKI had statistically significant different a-STI (on admission to ICU), v-STI, and VII than those who did not. Moreover, a-STI was associated with the development of AKI at day 5 and provided the best diagnostic accuracy for the diagnosis of any AKI or severe AKI compared with RDRI, VII, and v-STI.
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Affiliation(s)
- Francesco Corradi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
- Azienda Ospedaliero Universitaria Pisana, Via Paradisa, 2, 56124 Pisa, Italy
- Correspondence: ; Tel.: +39-348-2311657
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16126 Genoa, Italy
| | - Claudia Brusasco
- Anesthesia and Intensive Care Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience, 16126 Genoa, Italy
| | - Adrian Wong
- Department of Critical Care, King’s College Hospital, London SE5 9RS, UK
| | - Pierpaolo Di Nicolò
- Nephrology and Dialysis Unit, “S. Maria della Scaletta” Hospital, 40026 Imola, Italy
| | - Ludovica Tecchi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Federico Dazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Erika Taddei
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Alessandro Isirdi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Federico Coccolini
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Francesco Forfori
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Guido Tavazzi
- Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Anaesthesia, Intensive Care and Pain Therapy, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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Sur Mukherjee S, Aditya Chowdhury, Sharmistha Ghoshal, Bithika Pramanik. The effect of mild dynamic exercise on the electromechanical systole of heart in non-athlete, healthy first year medical students of Bengal as a predictive biomarker of arrhythmia. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i3.1399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction and Aim: Measurement of Systolic Time Intervals (STIs) is a non-invasive and convenient way of assessing left ventricular electro-mechanical activity. In this study, we assessed effect of mild dynamic exercise on QT, QS2, QT/QS2 ratio, QS2-Index among healthy young first year students at a government medical college of West Bengal, India and compared the same among girls and boys.
Materials and Methods: IX-TA-220 multichannel recorder was used to record Electrocardiogram, Phonocardiogram and Carotid pulse tracing among 180 subjects before and after 1 minute of mild exercise with Harvard's Step of 30 cm height with metronome rhythm of 120 beats per minute. Results were analyzed by Microsoft Excel and comparison of each parameter between boys and girls were done using SPSS software in two hemodynamic states. P-value <0.05 was taken as statistically significant.
Results: Post exercise mean QT and QS2 shortened and their ratio QT/QS2 increased. There was a statistically significant difference between pre-exercise and post-exercise mean QT, QT/QS2 ratio, QS2 index and significant differences were observed between mean values of the boys and girls.
Conclusion: With hemodynamic changes as in exercise, due to sympathetic stimulation & catecholamine release, both QT andQS2 should reduce as all the phases of systole shorten but if QT does not reduce in comparison to QS2 it may lead to arrhythmia in future. Hence QT/QS2 can be a useful pro-arrhythmic biomarker and may complement ECG and Echocardiography in borderline cases.
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Shandhi MMH, Fan J, Heller JA, Etemadi M, Klein L, Inan OT. Estimation of Changes in Intracardiac Hemodynamics Using Wearable Seismocardiography and Machine Learning in Patients with Heart Failure: A Feasibility Study. IEEE Trans Biomed Eng 2022; 69:2443-2455. [PMID: 35100106 PMCID: PMC9347221 DOI: 10.1109/tbme.2022.3147066] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Tracking changes in hemodynamic congestion and the consequent proactive readjustment of treatment has shown efficacy in reducing hospitalizations for patients with heart failure (HF). However, the cost-prohibitive nature of these invasive sensing systems precludes their usage in the large patient population affected by HF. The objective of this research is to estimate the changes in pulmonary artery mean pressure (PAM) and pulmonary capillary wedge pressure (PCWP) following vasodilator infusion during right heart catheterization (RHC), using changes in simultaneously recorded wearable seismocardiogram (SCG) signals captured with a small wearable patch. METHODS A total of 20 patients with HF (20% women, median age 55 (interquartile range (IQR), 44-64) years, ejection fraction 24 (IQR, 16-43)) were fitted with a wearable sensing patch and underwent RHC with vasodilator challenge. We divided the dataset randomly into a trainingtesting set (n=15) and a separate validation set (n=5). We developed globalized (population) regression models to estimate changes in PAM and PCWP from the changes in simultaneously recorded SCG. RESULTS The regression model estimated both pressures with good accuracies: root-mean-square-error (RMSE) of 2.5 mmHg and R2 of 0.83 for estimating changes in PAM, and RMSE of 1.9 mmHg and R2 of 0.93 for estimating changes in PCWP for the training-testing set, and RMSE of 2.7 mmHg and R2 of 0.81 for estimating changes in PAM, and RMSE of 2.9 mmHg and R2 of 0.95 for estimating changes in PCWP for the validation set respectively. CONCLUSION Changes in wearable SCG signals may be used to track acute changes in intracardiac hemodynamics in patients with HF. SIGNIFICANCE This method holds promise in tracking longitudinal changes in hemodynamic congestion in hemodynamically-guided remote home monitoring and treatment for patients with HF.
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Seetharam S, Vinutha Shankar MS, Reddy N. Evaluation of systolic time intervals in patients of ischemic heart disease with clinical heart failure. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.4103/jpcs.jpcs_17_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Seetharam S, Shankar MSV, Reddy N. A narrative review of clinical applications of systolic time intervals. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.4103/jpcs.jpcs_63_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Orter S, Möstl S, Bachler M, Hoffmann F, Mayer CC, Kaniusas E, Reisinger M, Wassertheurer S, Tank J, Jordan J, Hametner B. A comparison between left ventricular ejection time measurement methods during physiological changes induced by simulated microgravity. Exp Physiol 2021; 107:213-221. [PMID: 34921742 PMCID: PMC9303723 DOI: 10.1113/ep090103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/08/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? There are two aims of this study. First, we validated easy-to-use oscillometric LVET against the classical echocardiographic LVET. Second, we investigated the progression of LVETI, PEPI, QS2I and PEP/LVET ratio during 60 days HDT. What is the main finding and its importance? LVETosci and LVETecho showed good agreement in effect direction. Thus, LVETosci might be a useful measure to evaluate cardiovascular responses during space flight. Moreover, the approach may have utility for individual follow up of patients with altered ejection times. Furthermore, significant effects of 60 days HDT were captured by measurements of LVETI, PEPI, QS2I and PEP/LVET ratio. ABSTRACT Easy to detect systolic time intervals may be used as parameters reflecting cardiovascular deconditioning. We compared left ventricular ejection time (LVET) measured via ultrasound doppler on the left ventricular outflow tract with oscillometric measured LVET measured at the brachialis. Furthermore, we assessed the progression of left ventricular ejection time index (LVETI), pre-ejection period index (PEPI) the Weissler index (PEP/LVET) and the total electromechanical systole index (QS2I) during prolonged strict head-down tilt bedrest including 16 male and 8 female subjects. Simultaneous oscillometric and echocardiographic LVET measurements show significant correlation (r = 0.53 with p = .0084 before bedrest and r = 0.73 with p < .05 at the last day of bedrest). The shortening of LVET during head-down tilt bedrest measured with both approaches is highly concordant in their effect direction with a concordance rate of 0.96. Our results furthermore report a significant decrease of LVETI (p < .0001) and QS2I (p = .0992) as well as a prolongation of PEPI (p = .0049) and PEP/LVET (p = .0003) during head down tilt bedrest over 60 days. 4 days after bedrest LVETI fully recovers to its baseline value. Because of the relationship between shortening of LVETI and heart failure progression, the easy-to-use oscillometric method might be not only a useful measure to evaluate the cardiovascular system during space flights, butcould also be of high value in a clinical setting. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Stefan Orter
- Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria.,Institute of Electrodynamics, Microwave and Circuit Engineering, Vienna University of Technology, Vienna, Austria
| | - Stefan Möstl
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Martin Bachler
- Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | - Fabian Hoffmann
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Christopher C Mayer
- Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | - Eugenijus Kaniusas
- Institute of Electrodynamics, Microwave and Circuit Engineering, Vienna University of Technology, Vienna, Austria
| | - Michaela Reisinger
- Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | | | - Jens Tank
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Bernhard Hametner
- Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
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12
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Möstl S, Orter S, Hoffmann F, Bachler M, Hametner B, Wassertheurer S, Rabineau J, Mulder E, Johannes B, Jordan J, Tank J. Limited Effect of 60-Days Strict Head Down Tilt Bed Rest on Vascular Aging. Front Physiol 2021; 12:685473. [PMID: 34122149 PMCID: PMC8194311 DOI: 10.3389/fphys.2021.685473] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Cardiovascular risk may be increased in astronauts after long term space flights based on biomarkers indicating premature vascular aging. We tested the hypothesis that 60 days of strict 6° head down tilt bed rest (HDTBR), an established space analog, promotes vascular stiffening and that artificial gravity training ameliorates the response. Methods We studied 24 healthy participants (8 women, 24–55 years, BMI = 24.3 ± 2.1 kg/m2) before and at the end of 60 days HDTBR. 16 subjects were assigned to daily artificial gravity. We applied echocardiography to measure stroke volume and isovolumetric contraction time (ICT), calculated aortic compliance (stroke volume/aortic pulse pressure), and assessed aortic distensibility by MRI. Furthermore, we measured brachial-femoral pulse wave velocity (bfPWV) and pulse wave arrival times (PAT) in different vascular beds by blood pressure cuffs and photoplethysmography. We corrected PAT for ICT (cPAT). Results In the pooled sample, diastolic blood pressure (+8 ± 7 mmHg, p < 0.001), heart rate (+7 ± 9 bpm, p = 0.002) and ICT (+8 ± 13 ms, p = 0.036) increased during HDTBR. Stroke volume decreased by 14 ± 15 ml (p = 0.001). bfPWV, aortic compliance, aortic distensibility and all cPAT remained unchanged. Aortic area tended to increase (p = 0.05). None of the parameters showed significant interaction between HDTBR and artificial gravity training. Conclusion 60 days HDTBR, while producing cardiovascular deconditioning and cephalad fluid shifts akin to weightlessness, did not worsen vascular stiffness. Artificial gravity training did not modulate the response.
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Affiliation(s)
- Stefan Möstl
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Stefan Orter
- Center for Health and Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | - Fabian Hoffmann
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany.,Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Martin Bachler
- Center for Health and Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | - Bernhard Hametner
- Center for Health and Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | | | - Jérémy Rabineau
- Laboratory of Physics and Physiology, University of Brussels, Brussels, Belgium
| | - Edwin Mulder
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Bernd Johannes
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Jens Jordan
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany.,Chair of Aerospace Medicine, University Hospital Cologne, Cologne, Germany
| | - Jens Tank
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
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13
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Tocci ND, Collier SR, Meucci M. Measures of ejection duration and subendocardial viability ratio in normal weight and overweight adolescent children. Physiol Rep 2021; 9:e14852. [PMID: 33991440 PMCID: PMC8123553 DOI: 10.14814/phy2.14852] [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: 02/15/2021] [Revised: 03/29/2021] [Accepted: 04/08/2021] [Indexed: 12/03/2022] Open
Abstract
The aim of our study was to determine how being overweight (OW) affects measures of ejection duration (ED), subendocardial viability ratio (SEVR), and central arterial health in a sample of adolescent children. Thirty‐four sex and age‐matched adolescent children (n = 34, 17 OW, age = 14 ± 2 years) participated in one laboratory visit. Anthropometric measures, body composition, and cardiovascular measures including resting heart rate, aortic systolic blood pressure (ASBP), carotid‐femoral pulse wave velocity (cf‐PWV), ED (EDms absolute vs. relative ED%), and the SEVR were ascertained. Transfer functions were applied to obtain ASBP. ED was measured as the time from the beginning of the upstroke of the pulse wave and the dicrotic notch, SEVR as the quotient of the diastolic pressure‐time area to the systolic pressure‐time area, and cf‐PWV as the quotient of distance between carotid‐femoral measurement sites and the transit time of the pulse wave. cf‐PWV was significantly higher in OW compared to normal weight participants (5.13 ± 0.85 vs. 4.53 ± 0.46 m/s respectively; p = 0.015, d = 0.51). OW adolescents also reported significantly higher values for ASBP (103.1 ± 11.8 vs. 95.7 ± 8.2 mmHg respectively; p = 0.043, d = 0.72) and significantly lower values of SEVR (114.4 ± 25.9% vs. 132.2 ± 22.0% respectively; p = 0.038; d = 0.33). Overweight adolescents demonstrated higher cf‐PWV, ASBP, and SEVR then normal weight peers.
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Affiliation(s)
- Nicholas D Tocci
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
| | - Scott R Collier
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
| | - Marco Meucci
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
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14
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Jiménez-González A. Timing the opening and closure of the aortic valve using a phonocardiogram envelope: a performance test for systolic time intervals measurement. Physiol Meas 2021; 42:025004. [PMID: 33705357 DOI: 10.1088/1361-6579/abe0fe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This work explored the reliability of using points on the heart sounds envelope as indicators of the opening and closure of the aortic valve (AVO, AVC) to measure the pre-ejection period (PEP) and the left ventricular ejection time (LVET). APPROACH 36 phonocardiograms (PCGs) from healthy subjects and cardiovascular disease subjects were denoised using single-channel independent component analysis (SCICA) and, from the Hilbert envelopes, the positions of the S1 and S2 peaks were detected (pS1, pS2). Complementarily, the positions of the local maxima of S1 and S2 (mS1, mS2) and the points surrounding pS1 and pS2 (tS1, tS2) were obtained. Finally, the reliability of these points (and the corresponding PEP and LVET intervals) was evaluated by the calculation of three error indexes (ePEP, eLVET, and score) and by comparison to reference annotations provided by echocardiography using the Bland-Altman analysis and the paired T-test. MAIN RESULTS The results indicated that, from a total of 920 and 341 heartbeats in the healthy and diseased groups, respectively, the timing points given by pS1 and pS2 (or mS1 and mS2) were unlikely to substitute for the reference annotations and, thus, are unreliable for measuring the PEP and LVET intervals in the PCG. The t-points evaluation, on the other hand, indicated that tS1 was likely to substitute for AVO and was thus reliable for measuring the PEP using the PCG, with median and interquartile ranges of 0.3(8.3) ms and -0.2(7.5) ms for each group. Future work will generate an envelope with higher temporal resolution, from where tS1 and tS2 can be more accurately detected to improve the PEP and LVET measurements on a larger dataset. SIGNIFICANCE The statistical tests revealed that the envelope of S1 is suitable for extracting a timing point from which the pre-ejection interval can be reliably quantified, and discarded the local maximum used in other studies.
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Affiliation(s)
- Aída Jiménez-González
- Department of Electrical Engineering, Universidad Autónoma Metropolitana-Iztapalapa, Av. San Rafael Atlixco 186, Col. Vicentina, Alcaldía Iztapalapa, C.P. 09340, México City, México
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15
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Reyes Del Paso GA, Contreras-Merino AM, de la Coba P, Duschek S. The cardiac, vasomotor, and myocardial branches of the baroreflex in fibromyalgia: Associations with pain, affective impairments, sleep problems, and fatigue. Psychophysiology 2021; 58:e13800. [PMID: 33645659 DOI: 10.1111/psyp.13800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 12/22/2022]
Abstract
This study investigated the cardiac, vasomotor, and myocardial branches of the baroreflex in fibromyalgia using the spontaneous sequence method. Systolic blood pressure (SBP), interbeat interval (IBI), stroke volume (SV), pre-ejection period (PEP), and total peripheral resistance (TPR) were continuously recorded in 40 fibromyalgia patients and 30 healthy individuals during a cold pressor test and a mental arithmetic task. Sequences of covariation between SBP and IBI (cardiac branch), SV and PEP (myocardial branch), and TPR (vasomotor branch) were identified. Baroreflex sensitivity (BRS) was represented by the slope of the regression line between values in the sequences; baroreflex effectiveness (BEI) was indexed by the proportion of progressive SBP changes that elicited reflex responses. Patients exhibited lower BRS in the three branches, lower BEI in the cardiac and vasomotor branches, and reduced reactivity in cardiac BRS and BEI, SBP, IBI, SV, and PEP. Moreover, BRS and BEI were inversely related to clinical pain, cold pressor pain, depression, trait anxiety, sleep problems, and fatigue. Reduced function of the three baroreflex branches implies diminished resources for autonomic inotropic, chronotropic, and vascular regulation in fibromyalgia. Blunted stress reactivity indicates a limited capacity for autonomic cardiovascular adjustment to situational requirements. The associations of BRS and BEI with pain perception may reflect the antinociceptive effects arising from baroreceptor afferents, where reduced baroreflex function may contribute to the hyperalgesia characterizing fibromyalgia. The associations with affective impairments, sleep problems, and fatigue suggest that baroreflex dysfunctions are also involved in the secondary symptoms of the disorder.
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Affiliation(s)
| | | | | | - Stefan Duschek
- Institute of Psychology, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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16
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Mariscal-Harana J, Charlton PH, Vennin S, Aramburu J, Florkow MC, van Engelen A, Schneider T, de Bliek H, Ruijsink B, Valverde I, Beerbaum P, Grotenhuis H, Charakida M, Chowienczyk P, Sherwin SJ, Alastruey J. Estimating central blood pressure from aortic flow: development and assessment of algorithms. Am J Physiol Heart Circ Physiol 2020; 320:H494-H510. [PMID: 33064563 PMCID: PMC7612539 DOI: 10.1152/ajpheart.00241.2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Central blood pressure (cBP) is a highly prognostic cardiovascular (CV) risk factor whose accurate, invasive assessment is costly and carries risks to patients. We developed and assessed novel algorithms for estimating cBP from noninvasive aortic hemodynamic data and a peripheral blood pressure measurement. These algorithms were created using three blood flow models: the two- and three-element Windkessel (0-D) models and a one-dimensional (1-D) model of the thoracic aorta. We tested new and existing methods for estimating CV parameters (left ventricular ejection time, outflow BP, arterial resistance and compliance, pulse wave velocity, and characteristic impedance) required for the cBP algorithms, using virtual (simulated) subjects (n = 19,646) for which reference CV parameters were known exactly. We then tested the cBP algorithms using virtual subjects (n = 4,064), for which reference cBP were available free of measurement error, and clinical datasets containing invasive (n = 10) and noninvasive (n = 171) reference cBP waves across a wide range of CV conditions. The 1-D algorithm outperformed the 0-D algorithms when the aortic vascular geometry was available, achieving central systolic blood pressure (cSBP) errors≤2.1 ± 9.7mmHg and root-mean-square errors (RMSEs)≤6.4 ± 2.8mmHg against invasive reference cBP waves (n = 10). When the aortic geometry was unavailable, the three-element 0-D algorithm achieved cSBP errors ≤ 6.0 ± 4.7mmHg and RMSEs ≤ 5.9 ± 2.4mmHg against noninvasive reference cBP waves (n = 171), outperforming the two-element 0-D algorithm. All CV parameters were estimated with mean percentage errors ≤ 8.2%, except for the aortic characteristic impedance (≤13.4%), which affected the three-element 0-D algorithm’s performance. The freely available algorithms developed in this work enable fast and accurate calculation of the cBP wave and CV parameters in datasets containing noninvasive ultrasound or magnetic resonance imaging data.
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Affiliation(s)
- Jorge Mariscal-Harana
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom
| | - Peter H Charlton
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom
| | - Samuel Vennin
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom.,Department of Clinical Pharmacology, King's College London, King's Health Partners, London , United Kingdom
| | - Jorge Aramburu
- TECNUN Escuela de Ingenieros, Universidad de Navarra, Donostia-San Sebastián, Spain
| | - Mateusz Cezary Florkow
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom.,Philips Research, Cambridge, United Kingdom
| | - Arna van Engelen
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom
| | - Torben Schneider
- Philips Healthcare UK, Philips Centre, Guildford Business Park, Guildford, Surrey, United Kingdom
| | - Hubrecht de Bliek
- HSDP Clinical Platforms, Philips Healthcare, Eindhoven, The Netherlands
| | - Bram Ruijsink
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom.,Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Israel Valverde
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom.,Cardiovascular Pathophysiology, Institute of Biomedicine of Seville, University Hospital of Virgen del Rocío, University of Seville, CIBERCV, CSIC, Seville, Spain
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Heynric Grotenhuis
- Department of Pediatric Cardiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Marietta Charakida
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom
| | - Phil Chowienczyk
- Department of Clinical Pharmacology, King's College London, King's Health Partners, London , United Kingdom
| | - Spencer J Sherwin
- Department of Aeronautics, South Kensington Campus, Imperial College London, London, United Kingdom
| | - Jordi Alastruey
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom.,Institute of Personalized Medicine, Sechenov University, Moscow, Russia
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17
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Hasan Shandhi MM, Aras M, Wynn S, Fan J, Heller JA, Etemadi M, Klein L, Inan OT. Cardiac Function Monitoring for Patients Undergoing Cancer Treatments Using Wearable Seismocardiography: A Proof-of-Concept Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:4075-4078. [PMID: 33018894 DOI: 10.1109/embc44109.2020.9176074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Advances in cancer therapeutics have dramatically improved the survival rate and quality of life in patients affected by various cancers, but have been accompanied by treatment-related cardiotoxicity, e.g. left ventricular (LV) dysfunction and/or overt heart failure (HF). Cardiologists thus need to assess cancer treatment-related cardiotoxic risks and have close followups for cancer survivors and patients undergoing cancer treatments using serial echocardiography exams and cardiovascular biomarkers testing. Unfortunately, the cost-prohibitive nature of echocardiography has made these routine follow-ups difficult and not accessible to the growing number of cancer survivors and patients undergoing cancer treatments. There is thus a need to develop a wearable system that can yield similar information at a minimal cost and can be used for remote monitoring of these patients. In this proof-of-concept study, we have investigated the use of wearable seismocardiography (SCG) to monitor LV function non-invasively for patients undergoing cancer treatment. A total of 12 subjects (six with normal LV relaxation, five with impaired relaxation and one with pseudo-normal relaxation) underwent routine echocardiography followed by a standard six-minute walk test. Wearable SCG and electrocardiogram signals were collected during the six-minute walk test and, later, the signal features were compared between subjects with normal and impaired LV relaxation. Pre-ejection period (PEP) from SCG decreased significantly (p < 0.05) during exercise for the subjects with impaired relaxation compared to the subjects with normal relaxation, and changes in PEP/LV ejection time (LVET) were also significantly different between these two groups (p < 0.05). These results suggest that wearable SCG may enable monitoring of patients undergoing cancer treatments by assessing cardiotoxicity.
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18
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Bair A, Marksteiner J, Falch R, Ettinger U, Reyes Del Paso GA, Duschek S. Features of autonomic cardiovascular control during cognition in major depressive disorder. Psychophysiology 2020; 58:e13628. [PMID: 32621782 DOI: 10.1111/psyp.13628] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 11/27/2022]
Abstract
Previous research has suggested reduced parasympathetic cardiac regulation during cognitive activity in major depressive disorder (MDD). However, little is known about possible abnormalities in sympathetic control and cardiovascular reactivity. This study aimed to provide a comprehensive analysis of autonomic cardiovascular control in the context of executive functions in MDD. Thirty six MDD patients and 39 healthy controls participated. Parameters of sympathetic (pre-ejection period, PEP) and parasympathetic control (high and low frequency heart rate variability, HF HRV, LF HRV; and baroreflex sensitivity, BRS) as well as RR interval were obtained at rest and during performance of executive function tasks (number-letter task, n-back task, continuous performance test, and Stroop task). Patients, as compared to controls, exhibited lower HF HRV and LF HRV during task execution and smaller shortenings in PEP and RR interval between baseline and tasks. They displayed longer reaction times during all conditions of the tasks and more omission errors and false alarms on the continuous performance test. In the total sample, on-task HF HRV, LF HRV and BRS, and reactivity in HF HRV, LF HRV, and PEP, were positively associated with task performance. As performance reduction arose independent of executive function load of the tasks, the behavioral results reflect impairments in attention and processing speed rather than executive dysfunctions in MDD. Abnormalities in cardiovascular control during cognition in MDD appear to involve both divisions of the autonomic nervous system. Low tonic parasympathetic control and blunted sympathetic reactivity imply reduced physiological adjustment resources and, by extension, provide suboptimal conditions for cognitive performance.
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Affiliation(s)
- Angela Bair
- Institute of Psychology, UMIT - University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Josef Marksteiner
- Department of Psychiatry, County Hospital of Hall in Tirol, Hall in Tirol, Austria
| | - Reingard Falch
- Department of Psychiatry, County Hospital of Hall in Tirol, Hall in Tirol, Austria
| | | | | | - Stefan Duschek
- Institute of Psychology, UMIT - University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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19
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Garrido A, Duschek S, Rodríguez Árbol J, González Usera I, Vila J, Mata JL. Sympathetic contributions to habituation and recovery of the cardiac defense response. Biol Psychol 2020; 151:107846. [DOI: 10.1016/j.biopsycho.2020.107846] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 11/29/2019] [Accepted: 01/14/2020] [Indexed: 12/20/2022]
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20
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Ultrasound Assessment of the Change in Carotid Corrected Flow Time in Fluid Responsiveness in Undifferentiated Shock. Crit Care Med 2019; 46:e1040-e1046. [PMID: 30134304 DOI: 10.1097/ccm.0000000000003356] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Adequate assessment of fluid responsiveness in shock necessitates correct interpretation of hemodynamic changes induced by preload challenge. This study evaluates the accuracy of point-of-care Doppler ultrasound assessment of the change in carotid corrected flow time induced by a passive leg raise maneuver as a predictor of fluid responsiveness. Noninvasive cardiac output monitoring (NICOM, Cheetah Medical, Newton Center, MA) system based on a bioreactance method was used. DESIGN Prospective, noninterventional study. SETTING ICU at a large academic center. PATIENTS Patients with new, undifferentiated shock, and vasopressor requirements despite fluid resuscitation were included. Patients with significant cardiac disease and conditions that precluded adequate passive leg raising were excluded. INTERVENTIONS Carotid corrected flow time was measured via ultrasound before and after a passive leg raise maneuver. Predicted fluid responsiveness was defined as greater than 10% increase in stroke volume on noninvasive cardiac output monitoring following passive leg raise. Images and measurements were reanalyzed by a second, blinded physician. The accuracy of change in carotid corrected flow time to predict fluid responsiveness was evaluated using receiver operating characteristic analysis. MEASUREMENTS AND MAIN RESULTS Seventy-seven subjects were enrolled with 54 (70.1%) classified as fluid responders by noninvasive cardiac output monitoring. The average change in carotid corrected flow time after passive leg raise for fluid responders was 14.1 ± 18.7 ms versus -4.0 ± 8 ms for nonresponders (p < 0.001). Receiver operating characteristic analysis demonstrated that change in carotid corrected flow time is an accurate predictor of fluid responsiveness status (area under the curve, 0.88; 95% CI, 0.80-0.96) and a 7 ms increase in carotid corrected flow time post passive leg raise was shown to have a 97% positive predictive value and 82% accuracy in detecting fluid responsiveness using noninvasive cardiac output monitoring as a reference standard. Mechanical ventilation, respiratory rate, and high positive end-expiratory pressure had no significant impact on test performance. Post hoc blinded evaluation of bedside acquired measurements demonstrated agreement between evaluators. CONCLUSIONS Change in carotid corrected flow time can predict fluid responsiveness status after a passive leg raise maneuver. Using point-of-care ultrasound to assess change in carotid corrected flow time is an acceptable and reproducible method for noninvasive identification of fluid responsiveness in critically ill patients with undifferentiated shock.
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21
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Duschek S, Hoffmann A, Montoro CI, Reyes del Paso GA. Autonomic Cardiovascular Dysregulation at Rest and During Stress in Chronically Low Blood Pressure. J PSYCHOPHYSIOL 2019. [DOI: 10.1027/0269-8803/a000204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Abstract. Chronic low blood pressure (hypotension) is accompanied by symptoms such as fatigue, reduced drive, faintness, dizziness, cold limbs, and concentration difficulties. The study explored the involvement of aberrances in autonomic cardiovascular control in the origin of this condition. In 40 hypotensive and 40 normotensive subjects, impedance cardiography, electrocardiography, and continuous blood pressure recordings were performed at rest and during stress induced by mental calculation. Parameters of cardiac sympathetic control (i.e., stroke volume, cardiac output, pre-ejection period, total peripheral resistance), parasympathetic control (i.e., heart rate variability), and baroreflex function (i.e., baroreflex sensitivity) were obtained. The hypotensive group exhibited markedly lower stroke volume, heart rate, and cardiac output, as well as higher pre-ejection period and baroreflex sensitivity than the control group. Hypotension was furthermore associated with a smaller blood pressure response during stress. No group differences arose in total peripheral resistance and heart rate variability. While reduced beta-adrenergic myocardial drive seems to constitute the principal feature of the autonomic impairment that characterizes chronic hypotension, baroreflex-related mechanisms may also contribute to this state. Insufficient organ perfusion due to reduced cardiac output and deficient cardiovascular adjustment to situational requirements may be involved in the manifestation of bodily and mental symptoms.
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Affiliation(s)
- Stefan Duschek
- UMIT – University of Health Sciences Medical informatics and Technology, Institute of Psychology, Hall in Tirol, Austria
| | - Alexandra Hoffmann
- UMIT – University of Health Sciences Medical informatics and Technology, Institute of Psychology, Hall in Tirol, Austria
| | - Casandra I. Montoro
- UMIT – University of Health Sciences Medical informatics and Technology, Institute of Psychology, Hall in Tirol, Austria
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Bastos MB, Massolt ET, Kam BLR, Peeters RP, Van Mieghem NM, Visser WE, den Uil CA. Pressure-volume analysis in athyroid patients off and on thyroxine supplementation: a pilot study. Physiol Rep 2018; 6:e13883. [PMID: 30350459 PMCID: PMC6198138 DOI: 10.14814/phy2.13883] [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] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 11/24/2022] Open
Abstract
Thyroid hormone importantly affects the cardiovascular system. However, evaluation of stroke volume (SV) and its determinants is confounded by variations in volume status that occur along different thyroid states. This study applied the pressure-volume (PV) framework to obtain relatively load-independent estimates of cardiac function in hypothyroidism as compared to euthyroidism. Ten athyroid patients were assessed echocardiographically after 4 weeks in deep hypothyroid state, and again after supplementation with oral Levothyroxine (LT4) for 3 months. Thyroid hormone levels were assessed and noninvasive pressure-volume (PV) analysis based on dedicated repeated echocardiograms was performed. Changes were assessed using paired tests. Results are presented as medians and interquartile ranges. Hypothyroidism was associated with reduced stroke volume (SV: 67.6 ± 17 vs. 75.7 ± 20.6 mL, P = 0.024), preload (end-diastolic volume, EDV: 122.6 ± 32.5 vs. 135.7 ± 33.6 mL, P = 0.004), and contractility (end-systolic elastance, Ees : 1.7 ± 0.33 vs. 2.58 ± 1.33 mmHg/mL, P = 0.01). Afterload was constant (effective arterial elastance, Ea : 1.66 ± 0.32 vs. 1.79 ± 0.52 mmHg/mL, P = 0.43) and the total energy spent was lower (PVA∙HR: 86.7 ± 28 vs. 110.9 ± 32.1 J, P = 0.04). Hemodynamic manifestations of frank hypothyroidism in humans are characterized by reduced preload and contractility, and unchanged total afterload. LT4 therapy increased work efficiency and heart rate, but not the net energy expenditure. Noninvasive PV analysis may be useful to follow-up different thyroid states.
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Affiliation(s)
| | - Elske T. Massolt
- Division of EndocrinologyErasmus MCRotterdamThe Netherlands
- Rotterdam Thyroid CenterDepartment of Internal MedicineErasmus MCRotterdamThe Netherlands
| | - Boen L. R. Kam
- Department of Nuclear MedicineErasmus MCRotterdamThe Netherlands
| | - Robin P. Peeters
- Division of EndocrinologyErasmus MCRotterdamThe Netherlands
- Rotterdam Thyroid CenterDepartment of Internal MedicineErasmus MCRotterdamThe Netherlands
| | | | - W. Edward Visser
- Division of EndocrinologyErasmus MCRotterdamThe Netherlands
- Rotterdam Thyroid CenterDepartment of Internal MedicineErasmus MCRotterdamThe Netherlands
| | - Corstiaan A. den Uil
- Department of CardiologyErasmus MCRotterdamThe Netherlands
- Department of Intensive CareErasmus MCRotterdamThe Netherlands
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Reyes del Paso GA, de la Coba P, Martín-Vázquez M, Thayer JF. Time domain measurement of the vascular and myocardial branches of the baroreflex: A study in physically active versus sedentary individuals. Psychophysiology 2017; 54:1528-1540. [DOI: 10.1111/psyp.12898] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/20/2017] [Accepted: 04/27/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Pablo de la Coba
- Department of Psychology; University of Jaén, Campus Las Lagunillas; 23071 Jaén Spain
| | - María Martín-Vázquez
- Department of Psychology; University of Jaén, Campus Las Lagunillas; 23071 Jaén Spain
| | - Julian F. Thayer
- Department of Psychology; The Ohio State University; Columbus Ohio USA
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Autonomic Cardiovascular Control and Executive Function in Chronic Hypotension. Ann Behav Med 2016; 51:442-453. [DOI: 10.1007/s12160-016-9868-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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25
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Boubaker H, Grissa MH, Beltaief K, Dridi Z, Najjar MF, Bouida W, Boukef R, Marghli S, Nouira S. Systolic time intervals combined with Valsalva maneuver for the diagnosis of left ventricular dysfunction in COPD exacerbations. Int J Chron Obstruct Pulmon Dis 2016; 11:2237-2243. [PMID: 27695311 PMCID: PMC5029838 DOI: 10.2147/copd.s96280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The goal of this study was to determine the value of systolic time intervals and their change during Valsalva maneuver (VM) in the diagnosis of left ventricular dysfunction (LVD) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods We included 166 patients admitted to the emergency department for AECOPD. Measurement of systolic time intervals included electromechanical activation time (EMAT), left ventricular ejection time (LVET), and EMAT/LVET ratio. These were performed at baseline and during the first strain phase of the VM using a computerized phonoelectrocardiographic method. The diagnosis of LVD was determined on the basis of clinical examination, echocardiography, and brain natriuretic peptide. The values of systolic time intervals were compared between patients with and without LVD; their diagnostic performance was assessed using the area under receiver operating characteristic (ROC) curve. Results Patients with LVD (n=95) had a significantly higher EMAT and lower LVET and EMAT/LVET ratio compared to patients without LVD (n=71); the area under ROC curve was 0.79, 0.88, and 0.90, respectively, for EMAT, LVET, and EMAT/LVET ratio. All baseline systolic time intervals changed significantly during VM in patients without LVD but they did not change in patients with LVD. The area under ROC curve increased to 0.84 and 0.93, respectively, for EMAT and EMAT/LVET ratio but did not change for LVET. Conclusion Simple and noninvasive measurements of systolic time intervals combined with VM could be helpful to detect or rule out LVD in patients admitted to the emergency room for COPD excacerbation. The EMAT/LVET ratio seems to have the best diagnostic value.
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Affiliation(s)
- Hamdi Boubaker
- Department of Emergency, Fattouma Bourguiba University Hospital; Research Laboratory (LR12SP18), University of Monastir
| | - Mohamed Habib Grissa
- Department of Emergency, Fattouma Bourguiba University Hospital; Research Laboratory (LR12SP18), University of Monastir
| | - Kaouther Beltaief
- Department of Emergency, Fattouma Bourguiba University Hospital; Research Laboratory (LR12SP18), University of Monastir
| | | | | | - Wahid Bouida
- Department of Emergency, Fattouma Bourguiba University Hospital; Research Laboratory (LR12SP18), University of Monastir
| | - Riadh Boukef
- Department of Emergency, Sahloul University Hospital, Sousse
| | - Soudani Marghli
- Department of Emergency, Tahar Sfar University Hospital, Mahdia, Tunisia
| | - Semir Nouira
- Department of Emergency, Fattouma Bourguiba University Hospital; Research Laboratory (LR12SP18), University of Monastir
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26
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Systolic time intervals derived from electrocardiographic gated intra-renal artery Doppler waveform associated with left ventricular systolic function. Sci Rep 2016; 6:29293. [PMID: 27553182 PMCID: PMC4995511 DOI: 10.1038/srep29293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 06/10/2016] [Indexed: 01/20/2023] Open
Abstract
The aims of this study were to investigate the correlation between renal and cardiac STIs, including pre-ejection period (PEP), ejection time (ET), and PEP/ET, and to assess the diagnostic values of renal STIs in predicting left ventricular ejection fraction (LVEF) <50%. The cross sectional observation study enrolled 230 participants. The renal STIs, including renal PEP (rPEP), renal ET (rET), and rPEP/rET, were measured from electrocardiographic gated renal Doppler ultrasound and cardiac PEP, ET, and PEP/ET were measured from echocardiography. Renal STIs were correlated with cardiac STIs (all P < 0.001). Multivariate analyses showed that rPEP/rET was independently associated with LVEF (unstandardized coefficient β = −0.116, P = 0.046) and LVEF <50% (odds ratio = 2.145, per 0.11 increase; P = 0.017). The areas under the curve for rPEP, 1/rET, and rPEP/rET in predicting LVEF <50% were 0.773, 0.764, and 0.821, respectively. The sensitivity and specificity of rPEP/rET > 0.46 in prediction of LVEF <50% were 76.7% and 78.1%, respectively. Our study demonstrated that the novel parameters of renal STIs were significantly associated with cardiac STIs. However, the clinical application of renal STIs needs to be investigated in future studies.
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27
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Asgari S, Vespa PM, Bergsneider M, Hu X. Latency relationships between cerebral blood flow velocity and intracranial pressure. ACTA NEUROCHIRURGICA. SUPPLEMENT 2012; 114:5-9. [PMID: 22327656 DOI: 10.1007/978-3-7091-0956-4_2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Pulsatile intracranial pressure (ICP) is a key to the understanding of several neurological disorders in which compliance is altered, e.g., hydrocephalus. A recently proposed model suggests that ICP pulse is a standing wave and not a transmitted wave. The present work, aimed at obtaining a better understanding of the pulsatility in the cranium, tries to test the following hypotheses: first, ICP pulse onset latency would be lower than that of cerebral blood flow velocity (CBFV) pulses measured at a distal vessel; second, CBFV pulse at different intracranial arteries will have different pulse onset latencies, and hence they are not generated as a standing wave. The dataset used in the present study consists of ICP and CBFV signals collected from 60 patients with different diagnoses. The results reveal that the ICP pulse leads CBFV for 90% of the patients regardless of the diagnosis and mean ICP value. In addition, we show that CBFV pulse onset latency is roughly determined by the distance of the measurement point to the heart. We conclude that the ICP signal is not generated as a standing wave and that ICP pulse onset may be related to the arteries proximal to the heart.
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Affiliation(s)
- Shadnaz Asgari
- Department of Neurosurgery, The David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
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28
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Kamran H, Salciccioli L, Pushilin S, Kumar P, Carter J, Kuo J, Novotney C, Lazar JM. Characterization of cardiac time intervals in healthy bonnet macaques (Macaca radiata) by using an electronic stethoscope. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE : JAALAS 2011; 50:238-243. [PMID: 21439218 PMCID: PMC3061425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 08/13/2010] [Accepted: 10/19/2010] [Indexed: 05/30/2023]
Abstract
Nonhuman primates are used frequently in cardiovascular research. Cardiac time intervals derived by phonocardiography have long been used to assess left ventricular function. Electronic stethoscopes are simple low-cost systems that display heart sound signals. We assessed the use of an electronic stethoscope to measure cardiac time intervals in 48 healthy bonnet macaques (age, 8±5 y) based on recorded heart sounds. Technically adequate recordings were obtained from all animals and required 1.5±1.3 min. The following cardiac time intervals were determined by simultaneously recording acoustic and single-lead electrocardiographic data: electromechanical activation time (QS1), electromechanical systole (QS2), the time interval between the first and second heart sounds (S1S2), and the time interval between the second and first sounds (S2S1). QS2 was correlated with heart rate, mean arterial pressure, diastolic blood pressure, and left ventricular ejection time determined by using echocardiography. S1S2 correlated with heart rate, mean arterial pressure, diastolic blood pressure, left ventricular ejection time, and age. S2S1 correlated with heart rate, mean arterial pressure, diastolic blood pressure, systolic blood pressure, and left ventricular ejection time. QS1 did not correlate with any anthropometric or echocardiographic parameter. The relation S1S2/S2S1 correlated with systolic blood pressure. On multivariate analyses, heart rate was the only independent predictor of QS2, S1S2, and S2S1. In conclusion, determination of cardiac time intervals is feasible and reproducible by using an electrical stethoscope in nonhuman primates. Heart rate is a major determinant of QS2, S1S2, and S2S1 but not QS1; regression equations for reference values for cardiac time intervals in bonnet macaques are provided.
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Affiliation(s)
- Haroon Kamran
- Division of Cardiovascular Medicine University of New York Downstate Medical Center, Brooklyn, New York
| | - Louis Salciccioli
- Division of Cardiovascular Medicine University of New York Downstate Medical Center, Brooklyn, New York
| | - Sergei Pushilin
- Division of Cardiovascular Medicine University of New York Downstate Medical Center, Brooklyn, New York
| | - Paraag Kumar
- Division of Cardiovascular Medicine University of New York Downstate Medical Center, Brooklyn, New York
| | - John Carter
- Division of Cardiovascular Medicine University of New York Downstate Medical Center, Brooklyn, New York
| | - John Kuo
- Division of Cardiovascular Medicine University of New York Downstate Medical Center, Brooklyn, New York
| | - Carol Novotney
- Primate Behavior Laboratory, Department of Psychiatry, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Jason M Lazar
- Division of Cardiovascular Medicine University of New York Downstate Medical Center, Brooklyn, New York
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29
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Cardiovascular impact of dobutamine in neonates with myocardial dysfunction. Early Hum Dev 2007; 83:307-12. [PMID: 16982162 DOI: 10.1016/j.earlhumdev.2006.06.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Revised: 05/29/2006] [Accepted: 06/26/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To study effects of dobutamine on cardiac functional parameters, cerebral, mesenteric and renal blood flow in preterm neonates with myocardial dysfunction. STUDY DESIGN Prospective evaluation of Doppler sonographically measured left ventricular systolic time intervals, stroke volume (SV), cardiac output (CO), and blood flow parameters of anterior cerebral artery (ACA), superior mesenteric artery (SMA) and renal arteries (RA), before, after 20 min and 8-10 h of dobutamine treatment in 20 neonates (gestational age 29.6+/-4.4 weeks, birth weight 1450+/-609 g and postnatal age 2+/-2.1 days). Dobutamine was given in a mean dosage of 9.1+/-1.1 microg/kg. RESULTS After 20 min SV increased from 1.71+/-0.5 ml to 2.12+0.57 ml/kg, CO from 223+/-76 to 290 ml/kg/min. A shortening of left ventricular pre ejection period from 86+/-12 to 66+/-13 ms and of the ratio of pre-ejection period/ejection time from 0.52+/-0.12 to 0.40+/-0.11 were observed. Blood flow velocities of ACA increased after 8-10 h: peak systolic flow velocity (PSV) from 19.0+/-6 to 29.6+/-7.1 ms, end diastolic velocity (EDV) from 2.9+/-2.6 to 12.7+/-11.3 ms. PSV of SMA increased from 32.5+/-4.7 to 49.7+/-7.8 ms after 8-10 h, EDV from 8.9+/-8 ms to 20.6+/-6.1 ms. PSV of RA increased from 18.2+/-6.1 ms to 39.9+/-4.8 ms, EDV from 2.2+/-1.2 to 8.2+/-2.1 ms after 8-10 h. The pulsatility indices decreased significantly after 8-10 h: ACA from 2.3+/-0.6 to 1.4+/-0.5, SMA from 1.7 to 1.2 and RA from 2.57 to 1.57. CONCLUSION Dobutamine improves the cardiac functional parameters already after 20 min and has an influence on the blood flow parameters of ACA, SMA and RA 8-10 h after administration in neonates with myocardial dysfunction.
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30
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Geeraerts T, Albaladejo P, Declère AD, Duranteau J, Sales JP, Benhamou D. Decrease in left ventricular ejection time on digital arterial waveform during simulated hypovolemia in normal humans. ACTA ACUST UNITED AC 2004; 56:845-9. [PMID: 15187752 DOI: 10.1097/01.ta.0000063406.34651.e5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Left ventricular ejection time (LVET) measured in central arteries is modified during hypovolemia. We compared modifications of the pulse wave in a central artery (carotid) and in a peripheral artery (digital) during central hypovolemia induced by lower body negative pressure (LBNP) in conscious volunteers. METHODS Hypovolemia was simulated with progressive LBNP (baseline, -10, -20, and -30 mm Hg) in nine young healthy volunteers. The carotid arterial pressure waveform was recorded using a Millar tonometric method. The digital pulse wave was measured with a volume-clamp method (Finapres) and the stroke volume with a thoracic impedance method (Biomed). RESULTS Mean arterial pressure did not change during LBNP. Compared with baseline values, heart rate increased significantly at the -30 mm Hg level (68 +/- 13 beats/min vs. 59 +/- 11 beats/min), and stroke volume decreased as soon as -10 mm Hg was achieved (113 +/- 41 mL vs. 127 +/- 35 mL). Both carotid and digital LVET decreased significantly at the -10 mm Hg level (337 +/- 26 and 339 +/- 24 ms vs. 360 +/- 35 and 361 +/- 24 ms, respectively). CONCLUSION Peripheral LVET could reflect variation of central LVET during LBNP and be a reliable noninvasive parameter for monitoring hypovolemia.
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Affiliation(s)
- Thomas Geeraerts
- Department of Anesthesiology and UPRES 3540, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
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31
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Mertens zur Borg IRAM, Lim A, Verbrugge SJC, IJzermans JNM, Klein J. Effect of intraabdominal pressure elevation and positioning on hemodynamic responses during carbon dioxide pneumoperitoneum for laparoscopic donor nephrectomy: a prospective controlled clinical study. Surg Endosc 2004; 18:919-23. [PMID: 15108115 DOI: 10.1007/s00464-003-8817-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2003] [Accepted: 10/02/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Carbon dioxide (CO2) pneumoperitoneum (PP) increases mean arterial blood pressure (MAP) and systemic vascular resistance (SVR) but decreases stroke volume (SV) and cardiac output (CO). This study evaluated the hemodynamic effects of elevated intraabdominal pressure (IAP) occurring during laparoscopic donor nephrectomy (LDN). METHODS Twenty-two patients undergoing LDN were investigated and hemodynamic parameters, P(v)CO2) (carbon dioxide partial pressure), and VCO2 (carbon dioxide production) were monitored during the procedure. Before and after PP, IAP was raised from 12 to 20 mmHg and the hemodynamic effects were measured every 30 s. RESULTS During IAP of 12 mmHg and stable serum CO2, there was no change in SV compared to preinsufflation levels. When IAP was elevated from 12 to 20 mmHg, SV initially decreased (p < 05), followed by an increase in MAP and SVR (p < 0.05). CONCLUSION This study shows that with the fluid and ventilation protocol used, PP has no significant effect on SV at an IAP of 12 mmHg, whereas increasing IAP to 20 mmHg does. In this study, the hemodynamic effects induced by CO2 PP of 12 mmHg are not due to changes in serum CO2. Compression of the venous system during a PP of 20 mmHg reduces preload, with an subsequent increase in SVR.
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Affiliation(s)
- I R A M Mertens zur Borg
- Department of Anesthesiology, Erasmus University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands.
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Robel-Tillig E, Knüpfer M, Vogtmann C. Cardiac adaptation in small for gestational age neonates after prenatal hemodynamic disturbances. Early Hum Dev 2003; 72:123-9. [PMID: 12782424 DOI: 10.1016/s0378-3782(03)00045-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Small for gestational age neonates with prenatal hemodynamic disturbances are at increased risk for neonatal morbidity. Investigations of fetal cardiac function have proved some functional impairments. The aim of the study was to investigate postnatal cardiac adaptation in these neonates in comparison with neonates without prenatal hemodynamic impairments. METHODS AND RESULTS Forty-one neonates with prenatal hemodynamic disturbances and 40 neonates with undisturbed prenatal hemodynamics were observed during the first 5 days of life. Doppler sonographic measurements of left ventricular time intervals, stroke volume, cardiac output and the incidence of patent ductus arteriosus were obtained in all neonates of both groups. Heart rate and blood pressure were recorded simultaneously. RESULTS A higher incidence of patent ductus arteriosus and a diminished stroke volume, but increased cardiac output, based on a significantly increased heart rate, were determined in SGA neonates with prenatal hemodynamic disturbances. In contrast, systolic left ventricular time intervals were not changed in these neonates, as expected. CONCLUSIONS The described findings could be signs of persistent hemodynamic impairments in growth-retarded neonates with prenatal disturbed hemodynamics. The neonates revealed a reduced ability to compensate the prenatal hemodynamic disturbances. This aspect should be included in the discussion of perinatal management in cases of severe growth retardation.
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Roy L, Ramanathan S. ST-segment depression and myocardial contractility during cesarean section under spinal anesthesia. Can J Anaesth 1999; 46:52-5. [PMID: 10078404 DOI: 10.1007/bf03012515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate myocardial contractility during ST segment depression in healthy parturients during Cesarean section (CS). METHODS Forty-seven consecutive term parturients undergoing elective CS under spinal anesthesia were studied. The ST segment was recorded continuously on leads II and V5 using a Holter monitor. Myocardial performance was evaluated by measuring cardiac index (CI), heart rate (HR), pre-ejection period (PEP), ventricular ejection time (VET), systolic time ratio (STR, PEP/VET), and ejection fraction (EF) with an impedance cardiograph. RESULTS Fourteen patients (30%) developed ST segment depression within 15 min after delivery and the remaining 33 (70%) did not (controls). Seven patients developed a 1 mm change, five patients a 2 mm change and the remaining two a 3 mm change in the ST segment. Compared with pre-anesthesia values, the mean HR increased from 103 +/- 10 to 116 +/- 10 (ISD) bpm (P = 0.001), CI from 4.7 +/- 0.7 to 5.6 +/- 1.7 L.min-1 (P = 0.01), EF from 0.58 +/- 0.08 to 0.66 +/- 0.05 (P = 0.01) and STR decreased from 0.26 +/- 0.06 to 0.2 +/- 0.04 (P = 0.01) during ST segment depression. At this time, CI, HR and EF were greater and STR smaller than values obtained 15 min after delivery in the control subjects. CONCLUSION ST-segment depression occurring during CS is associated with a hyperkinetic myocardial contractile state.
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Affiliation(s)
- L Roy
- Department of Anesthesiology, Magee-Womens Hospital, University of Pittsburgh School of Medicine, PA 15044 USA
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Francini G, Petrioli R, Lorenzini L, Mancini S, Armenio S, Tanzini G, Marsili S, Aquino A, Marzocca G, Civitelli S. Folinic acid and 5-fluorouracil as adjuvant chemotherapy in colon cancer. Gastroenterology 1994; 106:899-906. [PMID: 8143995 DOI: 10.1016/0016-5085(94)90748-x] [Citation(s) in RCA: 143] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIMS Colon cancer is one of the major health problems in industrialized countries, and its incidence appears to be increasing. Surgical resectability is the most important prognostic determinant, although despite apparently curative surgery, recurrent tumors are common. Metastatic disease cannot be cured, and thus, there is a need for better adjuvant therapies. METHODS Two hundred and thirty-nine patients with surgically resected colon cancer in Dukes' stage B2 or C were randomly assigned to chemotherapy or observation alone to determine whether adjuvant chemotherapy could effectively reduce the rate of cancer recurrence. One hundred and twenty-one patients in stage B2 and 118 patients in stage C were enrolled in the study. Adjuvant treatment consisted of folinic acid 200 mg/m2, intravenously, plus 5-fluorouracil 400 mg/m2, intravenously, on days 1-5 every 4 weeks for 12 cycles. RESULTS In stage B2, no significant difference between the adjuvant arm and the observation arm was noted. In stage C, adjuvant chemotherapy produced an advantage over observation in terms of a reduction in cancer recurrence rate with prolongation of a disease-free interval (P = 0.0016) and an improvement in overall survival (P = 0.0025). CONCLUSIONS This study shows that folinic acid plus 5-fluorouracil adjuvant chemotherapy is effective in patients with surgically resected Dukes' stage C colon carcinoma.
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Affiliation(s)
- G Francini
- Institute of Medical Pathology, S. Maria della Scala Hospital, University of Siena, Italy
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35
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Affiliation(s)
- Q Li
- Zentrum für Kardiovaskuläre Pharmakologie, ZeKaPha GmbH, Mainz, Germany
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36
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Francini G, Petrioli R, Manganelli A, Cintorino M, Marsili S, Aquino A, Mondillo S. Weekly chemotherapy in advanced prostatic cancer. Br J Cancer 1993; 67:1430-6. [PMID: 8512828 PMCID: PMC1968505 DOI: 10.1038/bjc.1993.265] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
This randomised phase II study was performed in order to evaluate the effectiveness of a weekly chemotherapy regimen in advanced prostatic carcinoma patients (stage D2) refractory to hormonal therapy. Seventy-two cases were studied: they were randomised in a 2:1 ratio to receive either epirubicin (30 mg m-2 weekly) or doxorubicin (25 mg m-2 weekly); 48 patients received epirubicin and 24 received doxorubicin. After 12 courses of chemotherapy, the 45 evaluable patients in the epirubicin arm showed a response rate of 37.7% and the 21 evaluable patients in the doxorubicin arm showed a response rate of 33.3% (P = 0.51). Pain intensity, bone and prostatic tumour markers rapidly and significantly decreased in responders. An improvement in physical symptoms, functional conditions and in emotional well-being was observed in the majority of the treated patients. The histological analysis of bone metastases, performed before and after 12 courses of chemotherapy showed a significant reduction in neoplastic invasion and in new bone formation in responders. Cardiac performance worsened in five out of 45 patients and in ten out of 21 during the first 12 courses of epirubicin or doxorubicin respectively (P = 0.014). The median survival was 12.5 months in the epirubicin arm and 8.0 months in the doxorubicin arm (P = 0.042). Our data indicate that in advanced prostatic carcinoma, a weekly epirubicin regimen may give rapid palliative results, similar to that of doxorubicin, but with less side-effects.
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Affiliation(s)
- G Francini
- Institute of Medical Pathology, University of Siena, Italy
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37
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Francini G, Petrioli R, Aquino A, Gonnelli S. Advanced breast cancer treatment with folinic acid, 5-fluorouracil, and mitomycin C. Cancer Chemother Pharmacol 1993; 32:359-64. [PMID: 7687933 DOI: 10.1007/bf00735919] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A total of 44 women with advanced breast cancer who had failed first- and second-line chemotherapy were given combination chemotherapy consisting of folinic acid (FA), 5-fluorouracil (5-FU) and mitomycin C (MMC). The treatment schedule was: 200 mg/m2 FA and 400 mg/m2 5-FU given i.v. over 2 h for 5 days plus 5 mg/m2 MMC given i.v. on days 3-5; in 19 patients with an Eastern Cooperative Oncology Group (ECOG) performance status of 3-4 and bone marrow depression, the MMC dose was 3 mg/m2 given i.v. on days 3-5. In all, 41 patients were evaluable for response; 15 had a partial remission (PR), 18 had stable disease (SD), and 8 showed progressive disease (PD). The median response duration was 6 months and the median survival was 10 months. Toxicity was mild and consisted mainly of stomatitis, diarrhea, and leukopenia. A rapid improvement in performance status was noted in responding patients. A striking result was the reduction of analgesics in most cases and their complete withdrawal in responding patients. This combination chemotherapy achieved satisfactory effectiveness and improved the quality of life of patients.
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Affiliation(s)
- G Francini
- Medical Pathology Institute, University of Siena, Italy
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38
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Atkins CE, Snyder PS. Systolic time intervals and their derivatives for evaluation of cardiac function. J Vet Intern Med 1992; 6:55-63. [PMID: 1588542 DOI: 10.1111/j.1939-1676.1992.tb03152.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Systolic time intervals provide a noninvasive indication of global left ventricular performance, are relatively sensitive, and are easily obtained from an M-mode echocardiogram. This paper defines systolic time intervals (preejection period, left ventricular ejection time, and total electromechanical systole) and their derivatives (preejection period/left ventricular ejection time and velocity of circumferential fiber shortening). Their utility and weaknesses, as well as the effects of heart rate, loading conditions, cardiac contractility, and drug therapies on systolic time intervals are discussed. Normal values for systolic time intervals for the dog and cat are provided.
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Affiliation(s)
- C E Atkins
- Department of Companion Animal and Special Species Medicine, College of Veterinary Medicine, North Carolina State University, Raleigh 27606
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39
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Ng HW, Walley T, Tsao Y, Breckenridge AM. Comparison and reproducibility of transthoracic bioimpedance and dual beam Doppler ultrasound measurement of cardiac function in healthy volunteers. Br J Clin Pharmacol 1991; 32:275-82. [PMID: 1777364 PMCID: PMC1368518 DOI: 10.1111/j.1365-2125.1991.tb03899.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
1. We compared the ease of use and reproducibility of two noninvasive methods, transthoracic electrical bioimpedance (TEB) (BoMed NCCOM3-R7) and non-imaging dual beam Doppler ultrasound (Quantascope--Vital Science), in cardiac output (CO) and stroke volume (SV) measurement in healthy volunteers at rest and during physiological stress, both short term and from day to day. 2. The TEB method was easier to use and not dependent on the operator. The TEB method was more reproducible both in the short term and from day to day. Both devices were able to detect CO and SV changes under physiological stress, but were less reproducible day to day during exercise. 3. At supine rest, the within subject coefficient of variation between time point for TEB was 4.6% for CO and 6.1% for SV, and 7.9% for CO and 7.4% for SV with Doppler. 4. The results from each device showed a linear correlation coefficient (r) of 0.69 for CO (P less than 0.0005) and 0.64 for SV (P less than 0.0005). The correlation coefficient improved to 0.76 (P less than 0.0005) when only changes in CO and SV were considered. There was no systematic difference in the changes detected by the two methods, but the individual variation was wide.
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Affiliation(s)
- H W Ng
- Department of Pharmacology and Therapeutics, University of Liverpool
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40
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Price DE, O'Malley BP, Northover B, Rosenthal FD. Changes in circulating thyroid hormone levels and systolic time intervals in acute hypothyroidism. Clin Endocrinol (Oxf) 1991; 35:67-9. [PMID: 1889141 DOI: 10.1111/j.1365-2265.1991.tb03498.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We have previously reported that, in thyrotoxic patients treated with carbimazole, serum T4 and T3 levels are the first parameters to return to normal, followed by the systolic time interval (STI, a marker of thyroid function at tissue level) and then the serum TSH. The aim of this study was to compare the rate of change of thyroid hormones, TSH and STI in treated hypothyroid patients after the sudden withdrawal of thyroxine. DESIGN AND PATIENTS Serum T4, T3 (free and total) and TSH were measured in 12 patients taking thyroxine for primary hypothyroidism; seven were biochemically euthyroid and five were over-replaced, as defined by an elevated free T4 and a sub-normal TSH. Thyroxine was withdrawn and the measurements repeated three times a week until the STI rose above the euthyroid range (0.26-0.32). RESULTS After stopping thyroxine, the serum TSH and STI left the normal range, in advance of the free T4 and T3, after 9.5 +/- 0.95 and 12.2 +/- 1.5 days respectively (mean +/- SEM). The TSH was the first parameter to leave the euthyroid range in all subjects except one in whom the serum TSH was fully suppressed (less than 0.05 mU/l) initially. In the euthyroid group the TSH and STI increased rapidly after stopping thyroxine (time to leave euthyroid range 7.4 +/- 0.8 and 9.4 +/- 0.7 days respectively). In contrast, in the over-replaced group serum TSH and STI became elevated after 12.4 +/- 1.0 days (P less than 0.005 vs euthyroid group) and 16.0 +/- 2.7 days (P less than 0.05 vs euthyroid group) respectively. There was no delay in the fall in serum T4 or T3 in the over-replaced group when compared with the euthyroid group. CONCLUSIONS In the evolution of primary hypothyroidism, markers of thyroid function at a tissue level (TSH and STI) become abnormal in advance of thyroid hormones. After stopping thyroxine therapy in treated hypothyroid patients, there is a delayed rise in STI and serum TSH levels in subjects with a subnormal TSH level, as compared with those with a normal TSH on treatment. This suggests mild tissue thyrotoxicosis in these individuals.
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41
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A comparison of the effects of medifoxamine and amitriptyline on the systolic time intervals and the tyramine pressor response test. Postgrad Med J 1990. [DOI: 10.1136/pgmj.66.779.798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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42
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Proceedings of the British Pharmacological Society, British Pharmacology Section. 18-20 April 1990, Sheffield. Abstracts. Br J Clin Pharmacol 1990; 30:303P-43P. [PMID: 2206794 PMCID: PMC1368234 DOI: 10.1111/j.1365-2125.1990.tb03781.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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43
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Affiliation(s)
- B M Fisher
- Diabetic Clinic, Royal Infirmary, Glasgow, Scotland, UK
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44
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Rmö P, Karhunen M, Rämö OJ. Systolic time intervals in canine experimental acute hemorrhagic pancreatitis. J Surg Res 1989; 46:212-5. [PMID: 2921860 DOI: 10.1016/0022-4804(89)90058-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The effect of experimental acute hemorrhagic pancreatitis on hemodynamics and systolic time intervals were studied simultaneously by catheterization in dogs. Following the initial hemodynamic measurements pancreatitis was induced by a mixture of trypsin and sodium taurocholate infused into the pancreatic duct (PG, n = 7). After 60 min of surveillance the hemodynamic measurements were repeated and the results were compared to those obtained from the sham-operated group (CG, n = 7) paced at a similar contraction frequency to the PG after the follow-up time. Left ventricular ejection time (LVET) and the ratio of PEP/LVET (PEP, preejection period) increased more in the PG than in the CG (P less than 0.05 and P less than 0.001, respectively). This was related to a lower left ventricular end-diastolic volume and pressure in the PG in comparison to the CG (P less than 0.05). PEP remained unaltered in both groups during the interventions. No significant differences between the groups were observed in the responses of the maximum value of the left ventricular systolic pressure rise (dP/dtmax). The ejection fraction decreased more in the PG than in the CG (P less than 0.05), which was related to the decreased end-diastolic volume in the PG (P less than 0.001). Mean aortic pressure decreased significantly in the PG (P less than 0.01). The results indicate that experimental acute hemorrhagic pancreatitis leads to altered loading conditions of the heart and causes marked alterations in the systolic phases of the contraction cycle. This model of experimental pancreatitis does not depress the myocardial contractility on the basis of these results.
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Affiliation(s)
- P Rmö
- Department of Physiology, University of Oulu, Finland
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45
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Crane J, Burgess C, Beasley R. Cardiovascular and hypokalaemic effects of inhaled salbutamol, fenoterol, and isoprenaline. Thorax 1989; 44:136-40. [PMID: 2928998 PMCID: PMC461717 DOI: 10.1136/thx.44.2.136] [Citation(s) in RCA: 98] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The cardiovascular and hypokalaemic effects of equal doses of inhaled fenoterol, isoprenaline and salbutamol were compared in eight healthy male volunteers, in a double blind, placebo controlled study. Increasing doses of 400, 600, and 800 micrograms were given from a metered dose inhaler at 15 minute intervals, followed by measurements of heart rate, blood pressure, total electromechanical systole (as a measure of inotropic response), QTc interval, and plasma potassium concentration. After repeated inhalation, fenoterol resulted in significantly greater chronotropic, electrocardiographic, and hypokalaemic effects than either isoprenaline or salbutamol. The maximum inotropic effect of fenoterol was similar to that of isoprenaline.
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Affiliation(s)
- J Crane
- Department of Medicine, Wellington School of Medicine, New Zealand
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46
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Ramanathan S, Grant GJ. Vasopressor therapy for hypotension due to epidural anesthesia for cesarean section. Acta Anaesthesiol Scand 1988; 32:559-65. [PMID: 3188826 DOI: 10.1111/j.1399-6576.1988.tb02786.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Maternal hemodynamic changes and neonatal acid-base status were assessed in 127 healthy patients undergoing elective cesarean section under epidural anesthesia. An impedance cardiograph was used to measure stroke volume (SV), ejection fraction (EF) and end-diastolic volume (EDV). In addition, neonatal umbilical venous and arterial PO2, PCO2, pH, base excess, lactate, pyruvate, excess lactate, and L/P ratio were measured at birth. Patients were divided into three groups. Group 1 (n = 53) required no vasopressor (normotensive controls). In Group 2 (n = 37), mean blood pressure (BP) decreased from 90 mmHg (13.3 kPa). In Group 3 (n = 37), BP decreased from 83 mmHg to 62 mmHg (11.1 to 8.2 kPa), and phenylephrine was administered in 100 micrograms increments to maintain systolic BP greater than 100 mmHg (13.3 kPa). In Groups 2 and 3 the SV and EDV decreased 43% and 33% respectively when hypotension developed. Both vasopressors restored BP, SV and EDV to near baseline values. Neonatal Apgar scores and acid-base profiles were not significantly different among the three groups of neonates, nor were they different between the two hypotensive groups. It is concluded that: 1) transient maternal hypotension does not affect neonatal acid-base status; 2) both ephedrine and phenylephrine increase cardiac preload; and 3) an alpha agent like phenylephrine does not cause fetal acidosis when used for treating maternal hypotension.
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Affiliation(s)
- S Ramanathan
- Department of Anaesthesiology, New York University Medical Center, New York
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47
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Partanen J, Heikkilä J, Pellinen T, Nieminen MS. Effect of digoxin on the heart in normal subjects: influence of isometric exercise and autonomic blockade: a noninvasive study. Br J Clin Pharmacol 1988; 25:331-40. [PMID: 3358896 PMCID: PMC1386357 DOI: 10.1111/j.1365-2125.1988.tb03311.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
1. Eight healthy subjects were studied before digoxin and after successive therapy periods of 1 week 0.125, 0.25 and 0.50 mg of digoxin. The mean serum concentrations (+/- s. d.) were 0.4 +/- 0.2, 0.6 +/- 0.3 and 1.4 +/- 0.5 nmol l-1, respectively. The effects of digitalis were studied by echocardiography and systolic time intervals at rest and after 3 min handgrip exercise. Effects of simultaneous autonomic blockade induced by atropine and propranolol were also examined. 2. Digoxin in increasing doses slowed the heart rate at rest; with the daily dose of 0.50 mg from 63 +/- 10 to 53 +/- 6 beats min-1, and fractional shortening rose from 28 +/- 6 to 33 +/- 3% (P less than 0.05 for both). Preload, afterload and cardiac output did not change. The electromechanic systolic time index (QS2I) decreased (P less than 0.001) and the observed alteration of QS2I was dose-related. 3. The influence of digoxin was similar during isometric exercise, except for unchanged fractional shortening. 4. During autonomic blockade digoxin slowed the intrinsic heart rate from 93 +/- 6 to 86 +/- 6 beats min-1 (0.25 mg) and to 83 +/- 6 beats min-1 (0.50 mg) (P less than 0.01 for both). QS2I was shortened (P less than 0.01). Echocardiographically determined ejection phase indices remained unchanged. 5. When handgrip stress was induced during autonomic blockade, digoxin evoked a clearcut increase in contractile function, resembling the effects of digoxin alone at rest. Thus, fractional shortening increased by 14% and QS2I decreased by 16 ms (P less than 0.01 for both). 6. We conclude that digoxin increases the contractility in normal heart without changes in loading conditions. The rise in inotropy at rest is obvious from both fractional shortening by echo and systolic time intervals. The same takes place during handgrip with autonomic blockade, when the heart lacks sympathetic support. The influence of long-term digoxin on heart rate is partly direct without autonomic mediation. The effect of digoxin is dose-dependent.
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Affiliation(s)
- J Partanen
- Cardiovascular Laboratory, University Central Hospital, Helsinki, Finland
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48
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Walley TJ, Heagerty AM, Woods KL, Bing RF, Pohl JE, Barnett DB. Acute inotropic effects of intravenous nifedipine and its vehicle compared with saline: a double-blind study of systolic time intervals in normal subjects. Br J Clin Pharmacol 1988; 25:187-93. [PMID: 3358882 PMCID: PMC1386473 DOI: 10.1111/j.1365-2125.1988.tb03290.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
1. The inotropic effects of intravenous nifedipine and its vehicle were studied noninvasively in a double-blind placebo controlled crossover fashion using systolic time intervals in 12 normal subjects. 2. Nifedipine caused vasodilation, a fall in systolic and diastolic blood pressure, and increased heart rate. The vehicle alone caused vasodilation and decreased systolic blood pressure, without a change in heart rate. 3. Nifedipine increased left ventricular ejection time (LVET) and decreased pre-ejection period (PEP) and the ratio PEP/LVET, whereas the vehicle alone had the opposite effect. Neither treatment affected the total duration of electromechanical systole. 4. These results suggest that the vehicle has a negative inotropic effect, which is overcome by the indirect positive inotropic effect of nifedipine when they are administered together systemically.
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Affiliation(s)
- T J Walley
- Department of Pharmacology and Therapeutics, University of Leicester
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49
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Rüegg PC, Nüesch E. The effect of a new inotropic agent, DPI 201-106, on systolic time intervals and the electrocardiogram in healthy subjects. Br J Clin Pharmacol 1987; 24:453-8. [PMID: 3689626 PMCID: PMC1386306 DOI: 10.1111/j.1365-2125.1987.tb03197.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
1. DPI 201-106 (DPI) is a novel inotropic agent, with Na+ channel agonistic action combined with a sensitization of contractile proteins to Ca++. In a double-blind trial in healthy volunteers (n = 20) cardiovascular effects (blood pressure, heart rate, ECG) of single oral doses were studied. In addition systolic time intervals (STIs) were assessed in 10 of these subjects. DPI plasma concentrations were measured by h.p.l.c. 2. Preejection period was shortened by 14 ms (P less than 0.01) and 30 ms (P less than 0.01) 1 h after 30 and 60 mg, respectively, suggesting a dose-dependent inotropic effect. Heart rate was slightly reduced after both doses. Mean blood pressure remained unchanged. 3. Corrected QT interval duration (QTc) was prolonged by a mean of 7 ms (NS) and 22 ms (P less than 0.001) 1 h after 30 and 60 mg, respectively. PQ and QRS intervals remained unaffected. 4. Peak plasma levels were attained at 1-2 h and the terminal elimination half-life was approximately 15 h. 5. It is concluded that DPI has positive inotropic and negative chronotropic properties which make it potentially useful for the treatment of heart failure.
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Affiliation(s)
- P C Rüegg
- Clinical Research Department, Sandoz Ltd, Basel, Switzerland
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50
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Franco-Cereceda A, Gennari C, Nami R, Agnusdei D, Pernow J, Lundberg JM, Fischer JA. Cardiovascular effects of calcitonin gene-related peptides I and II in man. Circ Res 1987; 60:393-7. [PMID: 3495374 DOI: 10.1161/01.res.60.3.393] [Citation(s) in RCA: 100] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Calcitonin gene-related peptide (CGRP) is present in sensory nerve fibers in the heart and around peripheral arteries. On interaction with specific CGRP binding sites and activation of adenylate cyclase, CGRP causes vasodilation and has positive inotropic and chronotropic effects on the heart. In the present study, human CGRP I and II exerted positive inotropic effects on isolated human right auricles and relaxed small arteries from human skeletal muscle precontracted with norepinephrine (EC50 for CGRP I 0.59 nM and for CGRP II 0.37 nM). CGRP I and II (3.2 nmol) administered i.v. to 6 normal subjects exerted positive inotropic actions on the human heart concomitant with positive chronotropic effects, hypotension, and vasodilation. CGRP may, therefore, be of importance for cardiovascular control in man.
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