[Evaluation of the efficiency and safety of pain relief in the postoperative period in children after urological interventions]

INTRODUCTION

Urinary tract disorders are one of the most common pathologies in children, regardless of age, and every year their prevalence is growing. Our study is dedicated to improvement of postoperative pain management after pediatric urologic procedures and to implementation of modern approaches for enhanced recovery.

AIM

To develop optimal methods of postoperative pain relief for moderate and severe intensity of pain syndrome in children undergoing urological procedures.

MATERIALS AND METHODS

The study involved 34 patients who were undergone to urological procedures. For an objective assessment of the quality of anesthesia, the following research methods were used: clinical study with the determination of the pain intensity on a visual analogue scale (VAS) and the determination of systolic and diastolic blood pressure, pulse oximetry and echocardiographic study.

RESULTS

The analysis of the postoperative period with monitoring of blood pressure, oxygen saturation, pulse oximetry, subjective assessment of the pain intensity on the VAS and the echocardiographic study showed that the relative stability of the condition was associated with an adequate pain relief. The use of a combination of infulgan, which caused an early analgesic effect, with tramadol realizing its action later, provides a prolongation of analgesia. A combination of tramadol with infulgan was several times more efficient than ketorolac.

CONCLUSIONS

The use of a combined analgesia after urological procedures, including ketorolac, provides a hemodynamically stability in the entire postoperative period.

Non-Invasive Estimation of Central Systolic Blood Pressure by Radial Tonometry: A Simplified Approach

BACKROUND

Central systolic blood pressure (cSBP) provides valuable clinical and physiological information. A recent invasive study showed that cSBP can be reliably estimated from mean (MBP) and diastolic (DBP) blood pressure. In this non-invasive study, we compared cSBP calculated using a Direct Central Blood Pressure estimation (DCBP = MBP2/DBP) with cSBP estimated by radial tonometry.

METHODS

Consecutive patients referred for cardiovascular assessment and prevention were prospectively included. Using applanation tonometry with SphygmoCor device, cSBP was estimated using an inbuilt generalized transfer function derived from radial pressure waveform, which was calibrated to oscillometric brachial SBP and DBP. The time-averaged MBP was calculated from the radial pulse waveform. The minimum acceptable error (DCBP-cSBP) was set at ≤5 (mean) and ≤8 mmHg (SD).

RESULTS

We included 160 patients (58 years, 54%men). The cSBP was 123.1 ± 18.3 mmHg (range 86-181 mmHg). The (DCBP-cSBP) error was -1.4 ± 4.9 mmHg. There was a linear relationship between cSBP and DCBP (R2 = 0.93). Forty-seven patients (29%) had cSBP values ≥ 130 mmHg, and a DCBP value > 126 mmHg exhibited a sensitivity of 91.5% and specificity of 94.7% in discriminating this threshold (Youden index = 0.86; AUC = 0.965).

CONCLUSIONS

Using the DCBP formula, radial tonometry allows for the robust estimation of cSBP without the need for a generalized transfer function. This finding may have implications for risk stratification.

Nutrition Interactions With Exercise Training on Endothelial Function

Exercise is advised to improve overall cardiovascular health and endothelial function. However, the role of nutrition on this exercise-induced endothelial adaptation is not clear. Here, we hypothesize that nutrients interact with exercise to influence endothelial function and chronic disease risk.

Central hemodynamics and the discrepancy between central blood pressure and brachial blood pressure

Despite similar brachial blood pressure, central hemodynamics could be different. The objective of the present study was to investigate the factors, which could influence the discrepancy between central BP (cBP) and brachial blood pressure. Six hundred forty-seven patients (364 males, 48 ± 12 years old) were enrolled. Using applanation tonometry, cBP was noninvasively derived. The median difference between brachial systolic BP (bSBP) and central systolic BP (cSBP) was 8 mm Hg. We defined the discrepancy between bSBP and cSBP as differences >8 mm Hg. For adjustment of cBP, population was divided into 3 groups according to the cBP: group 1, <140 mm Hg of cSBP; group 2, 140 > cSBP < 160 mm Hg; group 3, =160 mm Hg of cSBP. All the central hemodynamic parameters of the patients, including augmentation pressure, augmentation index (AI), heart rate (75 bpm) adjusted augmentation index (AI@HR75), and subendocardial viability ratio, were measured. Using multivariate logistic regression analysis, we evaluated the factors which could influence the discrepancy between bSBP and cSBP. Age, gender, augmentation pressure, AI, and AI@HR75 were correlated with the discrepancy between bSBP and cSBP. AI@HR75 was significantly correlated with the discrepancy between bSBP and cSBP (β-coefficient = -0.376, P < .001 in group 1; β-coefficient = -0.297, P < .001 in group 2; and β-coefficient = -0.545, P < .001 in group 3). In groups 1 and 2, male gender was significantly correlated with the discrepancy between bSBP and cSBP (β-coefficient = -0.857, P = .035 in group 1; β-coefficient = -1.422, P = .039 in group 2). In present study, arterial stiffness might affect the discrepancy between bSBP and cSBP. Also, male gender was closely related to the discrepancy between bSBP and cSBP especially with cSBP <160 mm Hg. Not only cSBP, the discrepancy between cSBP and bSBP should be considered for understanding the central hemodynamics.

Optimization of the target strategy of perioperative infusion therapy based on monitoring data of central hemodynamics in order to prevent complications

Enhanced Recovery After Surgery (ERAS) protocols are increasingly used in the perioperative period around the world. The concept of goal-directed fluid therapy (GDT) is a key element of the ERAS protocols. Inadequate perioperative infusion therapy can lead to a number of complications, including the development of an infectious process, namely surgical site infections, pneumonia, urinary tract infections. Optimal infusion therapy is difficult to achieve with standard parameters (e.g., heart rate, blood pressure, central venous pressure), so there are various methods of monitoring central hemodynamics - from invasive, minimally invasive to non-invasive. The latter are increasingly used in clinical practice. The current evidence base shows that perioperative management, specifically the use of GDT guided by real-time, continuous hemodynamic monitoring, helps clinicians maintain a patient's optimal fluid balance. The manuscript presents the analytical data, which describe the benefits and basic principles of perioperative targeted infusion therapy based on central hemodynamic parameters to reduce the risk of complications.

The Gut Microbiota and Vascular Aging: A State-of-the-Art and Systematic Review of the Literature

The gut microbiota is a critical regulator of human physiology, deleterious changes to its composition and function (dysbiosis) have been linked to the development and progression of cardiovascular diseases. Vascular ageing (VA) is a process of progressive stiffening of the arterial tree associated with arterial wall remodeling, which can precede hypertension and organ damage, and is associated with cardiovascular risk. Arterial stiffness has become the preferred marker of VA. In our systematic review, we found an association between gut microbiota composition and arterial stiffness, with two patterns, in most animal and human studies: a direct correlation between arterial stiffness and abundances of bacteria associated with altered gut permeability and inflammation; an inverse relationship between arterial stiffness, microbiota diversity, and abundances of bacteria associated with most fit microbiota composition. Interventional studies were able to show a stable link between microbiota modification and arterial stiffness only in animals. None of the human interventional trials was able to demonstrate this relationship, and very few adjusted the analyses for determinants of arterial stiffness. We observed a lack of large randomized interventional trials in humans that test the role of gut microbiota modifications on arterial stiffness, and take into account BP and hemodynamic alterations.

Relationship of choroidal thickness with pulsatile hemodynamics in essential hypertensive patients

Controversy exists about the association of choroidal thickness (CTh) with blood pressure (BP) values. There is some evidence suggesting that central hemodynamics changes are associated with microvascular disease. Our study was aimed to assess the relationships between CTh and clinic and 24‐h BP and between CTh and estimated 24‐h aortic pulse pressure (aPP), 24‐h aortic systolic BP (aSBP), and 24‐h aortic augmentation index (aAIx) in a group of hypertensive patients. We enrolled 158 hypertensive subjects (mean age 48 ± 13 years) all of which underwent evaluation of the choroidal district by Swept‐Source optical coherence tomography (SS‐OCT) and 24‐h BP monitoring, in order to measure peripheral BP and to estimate central hemodynamic parameters. Inverse significant correlations of clinic PP, 24‐h aPP, 24‐h aSBP, and 24‐h aAIx with thicknesses of central ring, inner ring, and outer ring of the choroid and its overall average were found. The strongest of these correlations was that relating 24‐h aPP with overall average choroidal thickness (r = −.531; P < .001). When we divided the study population in subjects with 24‐h aPP above and below the median value (35 mm Hg), CTh were thinner in subjects with higher values of 24‐aPP as compared to those with lower ones, even after adjustment for age, and other potential confounders. The relationships of CTh with 24‐h aPP remained significant also taking into account the effects of various covariates in linear multiple regression analyses. Our findings support the concept of a cross‐talk between macro‐ and microcirculation.

[Relationships between aging indicators, central hemodynamics and arterial stiffness in men in the European North of Russia.]

With age, the incidence of cardiovascular diseases is steadily increasing worldwide. Living in the harsh climatic and geographical conditions of the Arctic is associated with premature aging, earlier and more frequent development of age-associated diseases. Apparently, these processes are caused by functional changes in large vessels, the state of which has not yet been studied. Aim and methods: to identify correlations of aging and biological age indicators with the parameters of central hemodynamics and arterial stiffness measured using applanation tonometry by the «Sphygmocor» device in middle-aged men living in the European North of Russia. For the first time, positive associations of parameters of peripheral and central blood pressure, augmentation index, and negative correlation of the time of return of the reflected wave and pulse pressure amplification with indicators of aging were noted, which indicates an age-related decrease in arterial elasticity. There was also a negative association of the subendocardial viability ratio with the northern experience and biological age. Theoretically considered, the results demonstrate the potential involvement of blood vessels in the pathogenesis of premature aging. The practical significance of the work is related to the need to develop preventive measures aimed at controlling blood pressure, reducing arterial stiffness and cardiovascular risk in middle-aged northerners.

Body Composition and Physical Fitness Affect Central Hemodynamics in Young Children

Objective: Central hemodynamics are related to cardiovascular (CV) outcomes in adults, but associations with childhood CV risk remain unclear. The study aimed to investigate the association of obesity, physical activity, and fitness with parameters of central pulse wave reflection in young prepubertal children. Methods: In this cross-sectional study, 1,324 primary school children (aged 7.2 ± 0.4 years) were screened for parameters of pulse wave reflection such as augmentation index (AIx), central pulse pressure (CPP), body mass index (BMI), and cardiorespiratory fitness (CRF) by standardized procedures for children. Results: The mean AIx and AIx@75 were 22.2 ± 7.7 and 29.2 ± 9.2%, respectively. With each unit increase in BMI, AIx [-0.226 (-0.328; -0.125)%] and AIx@75 [-0.444(-0.660; -0.229)%] decreased, whereas peak forward pulse wave increased (p < 0.001). Increasing BMI was associated with higher CPP, but did not remain significant after adjustment for CRF and heart rate. One unit increase in CRF was associated with lower AIx@75 [-0.509(-0.844; -0.173)%, p = 0.003] and lower reflection magnitude [RM: -0.559 (-0.890; -0.227), p = 0.001], independent of body weight and height. Girls had significantly higher AIx, AIx@75, peak backward pulse wave, and RM compared with boys. Conclusion: Childhood obesity was associated with higher CPP but lower augmentation of the reflected pulse wave in children. Assessment of central blood pressures appears to be a valuable asset to childhood CV risk screening. The validity of augmentation indices during childhood development and the association with early vascular aging in children need to be verified in long-term follow-up studies. Physical activity and fitness have the potential to improve vascular hemodynamics in susceptible children and, thus, counteract vascular aging. Trial registry: ClinicalTrials.gov: Exercise and Arterial Modulation in Youth. Identifier: NCT02853747; URL: https://clinicaltrials.gov/ct2/show/NCT02853747.

Music attenuates a widened central pulse pressure caused by resistance exercise: A randomized, single-blinded, sham-controlled, crossover study

Increasing central blood pressure is an independent predictor of cardiovascular disease and is an acute effect of high-intensity resistance exercise. It has been shown that classical music suppresses increased peripheral pressure during exercise. We hypothesized that classical music would suppress increased central pressure induced by high-intensity resistance exercise. To confirm this hypothesis, we examined the effect of classical music on central pressure following high-intensity resistance exercise in 18 young men. A randomized, single-blinded, sham-controlled, crossover trial was conducted under parallel experimental conditions on four separate days. The order of experiments was randomized between sham control (seated rest), music (20-min classical music track compilation), resistance exercise (5 sets of 10 repetitions at 75% of 1 repetition maximum), and resistance exercise with music conditions. Aortic pressure was measured in all subjects. No significant interaction between time, music, and resistance exercise was observed for aortic systolic pressure and diastolic pressure. In contrast, aortic pulse pressure showed a significant interaction; that is, aortic pulse pressure significantly widened after resistance exercise, whereas music significantly attenuated this widening. No significant change was observed in aortic pulse pressure in sham control and music conditions. The present findings suggest that music attenuates resistance exercise-induced increase in central pressure.

Retinal and Renal Microvasculature in Relation to Central Hemodynamics in 11-Year-Old Children Born Preterm or At Term

Background Prematurity disrupts the perinatal maturation of the microvasculature and macrovasculature and confers high risk of vascular dysfunction later in life. No previous studies have investigated the crosstalk between the microvasculature and macrovasculature in childhood. Methods and Results In a case-control study, we enrolled 55 children aged 11 years weighing <1000 g at birth and 71 matched controls (October 2014-November 2015). We derived central blood pressure (BP) wave by applanation tonometry and calculated the forward/backward pulse waves by an automated pressure-based wave separation algorithm. We measured the renal resistive index by pulsed wave Doppler and the central retinal arteriolar equivalent by computer-assisted program software. Compared with controls, patients had higher central systolic BP (101.5 versus 95.2 mm Hg, P<0.001) and backward wave amplitude (15.5 versus 14.2 mm Hg, P=0.029), and smaller central retinal arteriolar equivalent (163.2 versus 175.4 µm, P<0.001). In multivariable analyses, central retinal arteriolar equivalent was smaller with higher values (+1 SD) of central systolic BP (-2.94 µm; 95% CI, -5.18 to -0.70 µm [P=0.011]) and forward (-2.57 µm; CI, -4.81 to -0.32 µm [P=0.026]) and backward (-3.20 µm; CI, -5.47 to -0.94 µm [P=0.006]) wave amplitudes. Greater renal resistive index was associated with higher backward wave amplitude (0.92 mm Hg, P=0.036). Conclusions In childhood, prematurity compared with term birth is associated with higher central systolic BP and forward/backward wave amplitudes. Higher renal resistive index likely moves reflection points closer to the heart, thereby explaining the inverse association of central retinal arteriolar equivalent with central systolic BP and backward wave amplitude. These observations highlight the crosstalk between the microcirculation and macrocirculation in children. Registration URL: http://www.clinicaltrials.gov. Unique Identifier: NCT02147457.

Arterial Stiffness and Central Hemodynamics are Associated with Low Diurnal Urinary Sodium Excretion

BACKGROUND

Excessive salt intake is an important determinant of cardiovascular (CV) health, impacting arterial stiffness and central blood pressure. However, sodium exhibits several patterns of excretion in urine during day- and night-time, which could differently affect CV risk. Here, we sought to explore the relationship between the day:night urinary sodium excretion ratio and arterial stiffness and central hemodynamics in the general population.

METHODS

Cross-sectional analysis in 1062 subjects. Arterial stiffness (pulse-wave velocity, PWV), central blood pressure (central systolic blood pressure, cSBP; central diastolic blood pressure, cDBP), and other hemodynamic parameters were noninvasively assessed. Day- and night-time urinary sodium were separately detected. Analyses were performed according to the day:night urinary sodium excretion ratio tertiles (T1-T3).

RESULTS

Low day-time excretors (T1) showed significantly higher values of arterial stiffness when compared with high day-time excretors (T3) (cf-PWV 7.6 ± 1.9 vs 6.9 ± 1.5 m/sec; p ≤ 0.001), and higher central BP parameters (cSBP: 111.6 ± 12.1 vs 109.0 ± 11.1 mmHg, p ≤ 0.001; cDBP, 76.9 ± 9.2 vs 75.1 ± 9.3 mmHg, p ≤ 0.001). In multivariate linear-regression models (β, CI), the day:night ratio of sodium excretion was significantly associated with arterial stiffness (cf-PWV -0.386, -0.559, -0.213, p ≤ 0.001) and with central hemodynamic parameters (cSBP -1.655, -2.800, -0.510; p ≤ 0.001; cDBP -1.319, -2.218, -0.420, p ≤ 0.001). Associations persisted after controlling for multiple confounding factors. In logistic-regression models, the risk of increased arterial stiffness was significantly reduced as the day:night ratio of urinary sodium excretion increased (OR 0.40, 95% CI 0.25-0.65, p ≤ 0.001).

CONCLUSION

The individual, intra-daily pattern of urinary sodium excretion, characterised by low daytime excretion, is associated with increased arterial stiffness and central blood pressure. Further studies are advocated to clarify the clinical utility of assessing the daily pattern of sodium excretion.

Central hemodynamics in relation to low-level environmental lead exposure

Purpose: Arterial stiffness predicts cardiovascular complications. The association between arterial stiffness and blood lead (BL) remains poorly documented. We aimed to assess the association of central hemodynamic measurements, including pulse wave velocity (aPWV), with blood lead in a Flemish population.Materials and Methods: In this Flemish population study (mean age, 37.0 years; 48.3% women), 267 participants had their whole BL and 24-h urinary cadmium (UCd) measured by electrothermal atomic absorption spectrometry in 1985-2005. After 9.4 years (median), they underwent applanation tonometry to estimate central pulse pressure (cPP), the augmentation index (AI), pressure amplification (PA), and aPWV. The amplitudes of the forward (Pf) and backward (Pb) pulse waves and reflection index (RI) were derived by a pressure-based wave separation algorithm.Results: BL averaged 2.93 μg/dL (interquartile range, 1.80-4.70) and UCd 4.79 µg (2.91-7.85). Mean values were 45.0 ± 15.2 mm Hg for cPP, 24.4 ± 12.4% for AI, 1.34 ± 0.21 for PA, 7.65 ± 1.74 m/s for aPWV, 32.7 ± 9.9 mm Hg for Pf, 21.8 ± 8.4 mm Hg for Pb, and 66.9 ± 18.4% for RI. The multivariable-adjusted association sizes for a 2-fold higher BL were: +3.03% (95% confidence interval, 1.56, 4.50) for AI; -0.06 (-0.08, -0.04) for PA; 1.02 mm Hg (0.02, 2.02) for Pb; and 3.98% (1.71, 6.24) for RI (p ≤ .045). In 206 participants never on antihypertensive drug treatment, association sizes were +2.59 mm Hg (0.39, 4.79) for cPP and +0.26 m/s (0.03, 0.50) for aPWV. Analyses adjusted for co-exposure to cadmium were consistent.Conclusion: In conclusion, low-level environmental lead exposure possibly contributes to arterial stiffening and wave reflection from peripheral sites.

The cardiovascular system in patients with functional and inflammatory bowel diseases

AIM

Identification of subclinical and metamanifests state changes of cardiovascular system in patients with functional and inflammatory bow- el diseases (IBD) without a background of cardiac pathology.

MATERIALS AND METHODS

Was examined 79 patients with colon diseases, 20 patients were diagnosed with irritable bowel syndrome (IBS) with diarrhea, a 37 - undifferentiated colitis (UdC) and 22 patients with ulcerative colitis (UC). As a control group were examined in 50 healthy subjects. All patients received treatment in accordance with international and national guidelines. Prescribed medications had effect on the function of the cardiovascular system. Patients with contacting the hospital and against the onset of remission was performed ultrasound of the heart. Determines the size of the left atrium, heart rate, end-diastolic volume, end-systolic volume, ejection fraction (EF), cardiac index (CI), to- tal peripheral vascular resistance, the presence of right heart failure, blood flow, the area of the right atrium and right ventricle in systole and diastole, and calculated the proportion of contractility of the right atrium and right ventricle. Determined systolic pressure in PA (SPPA), the average pressure in PA (SPPA).

RESULTS

Clinical manifestations of cardiac syndrome was identified in 75,0% of patients with IBS, 54,1% of patients NK and 68,2% patients with UC. When performing correlation analysis in the patients with UdC and UC was noted the relationship of hemodynamic parameters and disease severity was more pronounced in UC. So, when comparing the duration of the disease and levels of the MLC - r=0,52 and r=0,73 (p&lt;0,05), EF - r=-0,51 and r=-0,71 (p&lt;0,05), CI - r=0,49 and r=0,70 (p&lt;0,05), heart rate - r=0,47, r=0,68 (p&lt;0,05); duration of stay in hospi- tal and the magnitudes of MLC - r=0,54 and r=0,77 (p&lt;0,05), EF - r=-0,51 and r=-0,71 (p&lt;0.05), CI - r=0,55 and r=0,73 (p&lt;0,05), heart rate - r=0,47, r=0,63 (p&lt;0,05). For patients with UC, we noted the presence of correlation when the average frequency of exacerbations per year and the values of the MLC - r=0,53 (p&lt;0,05), EF - r=-0,55 (p&lt;0,05), heart rate: r=0,54 (p&lt;0,05); severity of UC and EF (r=-0,67; p&lt;0,05). A statistically significant correlation of changes in EF and value SPPA and APPA, aggravated by the deepening severity of the disease. So, for IBS - r=-0,46, and r=-0,48 (p&lt;0,05); for NK - r=-0,51 and r=-0,59 (p&lt;0,05); for the UC - r=-0,62, and r=-0,67 (p&lt;0,05). In the analysis of duration of hospitalization, and values SPPA and APPA for patients with IBS - r=0.48 and r=0.46 (p&lt;0,05); with UdC - r=0,50 and r=0,53 (p&lt;0,05); with UC - r=0,59 and r=0,62 (p&lt;0,05). Sick UC was characterized by the greatest dilatation of RA and RV with access from outside the variations of the norms of 90.9 and 68.2 per cent, a significant decrease dRA and dRV. Discovered correlation of the squares of PP and SDL - r=0,48, r=0,54 and r=0,61 (p&lt;0,05); APPA - r=0,50, r=0,56 and r=0,63 (p&lt;0,05); RV areas and levels SPPA - r=0,45, r=0,50 and r=0.52 (p&lt;0,05); and APPA - r=0,46, r=0,47 r=0,53 (p&lt;0,05). When analyzing the values of the squares of the pancreas and MLC - r=0,47 r=0,54 and r=0,61 (p&lt;0,05), levels of EF and dRV - r=0,41, r=0,50 and r=0,56 (p&lt;0,05).

CONCLUSION

Cardiac syndrome in patients with IBS and IBD without a background of cardiac pathology can occur in the form of subclinical or manifested weakly, but persistent changes that may not be recognized, but in the future may complicate the course of the underlying dis- ease, necessitating research to develop tactics to correct them.

Cardiac output measurement during exercise in COPD: A comparison of dye dilution and impedance cardiography

INTRODUCTION

Impedance cardiography (IC) derived from morphological analysis of the thoracic impedance signal is now commonly used for noninvasive assessment of cardiac output (CO) at rest and during exercise. However, in Chronic Obstructive Pulmonary Disease (COPD), conflicting findings put its accuracy into question.

OBJECTIVES

We therefore compared concurrent CO measurements captured by IC (PhysioFlow: CO_IC ) and by the indocyanine green dye dilution method (CO_DD ) in patients with COPD.

METHODS

Fifty paired CO measurements were concurrently obtained using the two methods from 10 patients (FEV₁ : 50.5 ± 17.5% predicted) at rest and during cycling at 25%, 50%, 75% and 100% peak work rate.

RESULTS

From rest to peak exercise CO_IC and CO_DD were strongly correlated (r = 0.986, P < 0.001). The mean absolute and percentage differences between CO_IC and CO_DD were 1.08 L/min (limits of agreement (LoA): 0.05-2.11 L/min) and 18 ± 2%, respectively, with IC yielding systematically higher values. Bland-Altman analysis indicated that during exercise only 7 of the 50 paired measurements differed by more than 20%. When data were expressed as changes from rest, correlations and agreement between the two methods remained strong over the entire exercise range (r = 0.974, P < 0.001, with no significant difference: 0.19 L/min; LoA: -0.76 to 1.15 L/min). Oxygen uptake (VO₂ ) and CO_DD were linearly related: r = 0.893 (P < 0.001), CO_DD = 5.94 × VO₂ + 2.27 L/min. Similar results were obtained for VO₂ and CO_IC (r = 0.885, P < 0.001, CO_IC = 6.00 × VO₂ + 3.30 L/min).

CONCLUSIONS

These findings suggest that IC provides an acceptable CO measurement from rest to peak cycling exercise in patients with COPD.

[Peculiarities of hemodynamics and heart rhythm in males with increased arterial pressure depending on initial vegetative tone and age.]

Central hemodynamics and vegetative regulation of heart rhythms in males depending on age were studied. To evaluate and estimate vegetative regulation a method of variative pulsometry was used. It was used on the basis of analysis of variable heart rhythm (temporary and spectral). Certain tendencies of changes of central hemodynamics and indicators of variable heart rhythm in different age periods were revealed. SDNN, RMSSD and power in HF-range decreased. Baevsky's index of tension and VLF-output increased. This shows that persons with initial domination of parasympathetic part of the vegetative nervous system have changes in vegetative balance toward activation of sympatoadrenal link, increase of activity of the central contour of management of heart rhythm and tension of regulatory systems of the human body.

Effect of quercetin on parameters of central hemodynamics and myocardial ischemia in patients with stable coronary heart disease

THE AIM

The aim of our research was to study the effect of quercetin on parameters of central hemodynamics and myocardial ischemia in patients with stable coronary heart disease (CHD).

MATERIAL AND METHODS

The research involved 85 patients with CHD: stable angina pectoris, FC II, and 30 healthy individuals made up the control group. After 1.5 months of stabilizing therapy (ß-blockers, statins, aspirin) patients with CHD were randomized into 2 groups - the research group (30 people) and the comparison group (55 people). Quercetin at a dose of 120 mg per os daily was added to standard treatment of the patients of the research group (with CHD), patients of the comparison group continued receiving the same treatment. The day before randomization and 2 months after prescribing differentiation therapy to the patients, echocardiography (echo) and 24 hour Holter ECG monitoring were made.

RESULTS

Clinical evaluation of echocardiography revealed that diastolic dysfunction of the left ventricle (LV) had been found in 100% of patients studied: in 97.6% - in the form of violation of relaxation (type I), in 2.4% of patients - in the form of pseudonormalization (type II). The 24 hour Holter ECG monitoring revealed episodes of myocardial ischemia (10.7+2.7 episodes a day), premature atrial contractions (PACs) and premature ventricular contractions (PVCs) in patients with stable CHD. After a two-month term of therapy in patients of both research and comparison groups left ventricular systolic function in terms of ejection fraction (EF) of LV significantly improved (by 4.5% and 3.2% respectively). LV diastolic function improved in both groups in terms of the ratio of the phases of the transmitral flow E/A, also IVRT significance decreased (p<0.05). DT value dropped significantly influenced by quercetin, in the comparison group it didn`t change. According to the 24 hour Holter ECG monitoring, the total time and number of episodes of ST segment depression decreased with dominative results in quercetin group. PVC number was significantly reduced only by influence of therapy with quercetin (?=0.0022).

CONCLUSIONS

The data have shown cardioprotective properties of quercetin in conditions of CHD.

Resveratrol has a positive effect on parameters of central hemodynamics and myocardial ischemia in patients with stable coronary heart disease

INTRODUCTION

Cardiovascular diseases, and primarily coronary heart disease (CHD), are the leading cause of mortality in the developing countries, including Ukraine. Prognosis for patients with CHD depends mainly on progression of coronary atherosclerosis (ASVD). Molecular mechanisms of atherogenesis are studied in detail in order to find new targets of pharmacological intervention.

THE AIM

to study the effect of resveratrol on parameters of central hemodynamics and myocardial ischemia in patients with stable coronary heart disease (CHD).

MATERIAL AND METHODS

The research involved 85 patients with CHD: stable angina pectoris, FC II, and 30 healthy individuals made up the control group. Patients with CHD were randomized into the research group (30 people) and the comparison group (55 people). Patients of the comparison group were prescribed the standard therapy (Β-blockers, statins, aspirin). Resveratrol at a dose of 100 mg per os daily was added to standard treatment of the patients of the research group. The day before randomization and 2 months after the prescribing therapy to the patients, echocardiography (echo) and 24 hour Holter ECG monitoring were made.

RESULTS

Diastolic dysfunction of the left ventricle (LV) in the form of violation of relaxation (type I) had been found in 100 % of patients with CHD. The 24 hour Holter ECG monitoring revealed episodes of myocardial ischemia (σt ST depr) (11.07+2.81 episodes a day), premature atrial contractions (PACs) and premature ventricular contractions (PVCs) in patients with stable CHD. After a two-month term of therapy in all patients with CHD, left ventricular systolic function in terms of ejection fraction (EF) of LV significantly improved (by 9.7 % in the research group and by 3.2 % in the comparison group). LV diastolic function improved in both groups in terms of the ratio of the phases of the transmitral flow E/A, dominating in the research group (р=0.004). DT value dropped significantly influenced by resveratrol (by 13 %), in the comparison group it didn`t change. In both groups IVRT significance decreased (р < 0.05). According to the 24 hour Holter ECG monitoring, in patients, additionally taking resveratrol, σt ST depr decreased by 45.9 %, that prevailed the result of the comparison group by 25.2 %. Under the influence of resveratrol, unlike in the comparison group, the number of PACs and PVCs was significantly reduced.

CONCLUSIONS

The data have shown cardioprotective properties of resveratrol and its applicability in the treatment of patients with CHD.

Influence of sympathetic nerve activity on aortic hemodynamics and pulse wave velocity in women

Central (aortic) blood pressure, arterial stiffness, and sympathetic nerve activity increase with age in women. However, it is unknown if the age-related increase in sympathetic activity influences aortic hemodynamics and carotid-femoral pulse wave velocity (cfPWV), an index of central aortic stiffness. The goal of this study was to determine if aortic hemodynamics and cfPWV are directly influenced by sympathetic nerve activity by measuring aortic hemodynamics, cfPWV, and muscle sympathetic nerve activity (MSNA) in women before and during autonomic ganglionic blockade with trimethaphan camsylate. We studied 12 young premenopausal (23 ± 4 yr) and 12 older postmenopausal (57 ± 3 yr) women. These women did not differ in body mass index or mean arterial pressure (P > 0.05 for both). At baseline, postmenopausal women had higher aortic pulse pressure, augmented pressure, augmentation index adjusted for a heart rate of 75 beats/min, wasted left ventricular pressure energy, and cfPWV than young women (P < 0.05). During ganglionic blockade, postmenopausal women had a greater decrease in these variables in comparison to young women (P < 0.05). Additionally, baseline MSNA was negatively correlated with the reductions in aortic pulse pressure, augmented pressure, and wasted left ventricular pressure energy during ganglionic blockade in postmenopausal women (P < 0.05) but not young women. Baseline MSNA was not correlated with the changes in augmentation index adjusted for a heart rate of 75 beats/min or cfPWV in either group (P > 0.05 for all). Our results suggest that some aortic hemodynamic parameters are influenced by sympathetic activity to a greater extent in older postmenopausal women than in young premenopausal women.NEW & NOTEWORTHY Autonomic ganglionic blockade results in significant decreases in multiple aortic pulse wave characteristics (e.g., augmented pressure) and central pulse wave velocity in older postmenopausal women but not in young premenopausal women. Certain aortic pulse wave parameters are negatively influenced by sympathetic activity to a greater extent in older postmenopausal women.

Multimarker Analysis for New Biomarkers in Relation to Central Arterial Stiffness and Hemodynamics in a Chinese Community-Dwelling Population

Central arterial stiffness and hemodynamics independently reflect the risk of cardiovascular events. This Chinese community-based analysis was performed to evaluate the relationships of new biomarkers with central arterial stiffness and hemodynamics by a multimarker method. This analysis consisted of 1540 participants who were fully tested for the new biomarkers including N-terminal prohormone of brain natriuretic peptide, lipid accumulation product, triglyceride-high-density lipoprotein cholesterol (TG-HDL-c) ratio, uric acid, high-sensitivity C-reactive protein, and homocysteine. Carotid-femoral pulse wave velocity (cfPWV), central pulse pressure (cPP), and central augmentation index (cAIx) were measured. The median (range) age of entire cohort was 62 years (21-96 years), and 40.5% were males. The median (interquartile range) of cfPWV, cPP, and cAIx was 11.0 m/s (9.6-13.0 m/s), 42 mm Hg (35-52 mm Hg), and 28% (21%-33%), respectively. In multivariate analysis, participants with higher cfPWV had significantly higher age, peripheral pulse pressure, TG, TG-HDL-c ratio, and homocysteine levels compared with others (P < .05 for all). Multimarker analysis in a Chinese community-dwelling population reinforced the potential clinical value of plasma TG-HDL-c ratio and homocysteine levels as the biomarkers of increased arterial stiffness.

Central hemodynamics are associated with cardiovascular disease and albuminuria in type 1 diabetes

BACKGROUND

We sought to investigate associations between central hemodynamic parameters (estimated from radial pulse wave analyses (PWAs)), cardiovascular disease (CVD), and albuminuria in type 1 diabetes.

METHODS

We conducted an observational study of 636 type 1 diabetes patients. Central hemodynamics were measured by PWA as central aortic systolic pressure (CASP), central aortic pulse pressure (CPP), central aortic diastolic pressure (CADP), and subendocardial viability ratio (SEVR). CVD included revascularization, myocardial infarction, peripheral arterial disease, and stroke. Albuminuria was urinary albumin excretion rate ≥30 mg/24 hours. We computed standardized odds ratios (ORs) adjusted for sex, age, mean arterial pressure (MAP), heart rate, height, estimated glomerular filtration rate, glycated hemoglobin (HbA1c) total cholesterol, antihypertensive medication, and smoking. At follow-up, development of end-stage renal disease (ESRD) and mortality was traced through electronic medical records.

RESULTS

Patients were aged a mean of 54±13 years, and 289 (45%) were women. The mean ± SD was 118±17 mm Hg for CASP, 75±10 mm Hg for CADP, 43±14 mm Hg for CPP, and 150±32 for SEVR. In fully adjusted models, increased CASP and CPP and decreased CADP and SEVR were associated with presence of CVD (n = 132; P ≤ 0.02) and presence of albuminuria (n = 335; P < 0.001). During follow-up, median (range) (2.8 (0.7-3.8) years), SEVR predicted ESRD or mortality combined (n = 26) after adjustment for sex, age, and MAP (P = 0.001), whereas CASP, CPP, and CADP did not (P ≥ 0.13).

CONCLUSIONS

In type 1 diabetes patients, increased CASP and CPP and decreased CADP and SEVR were independently associated with history of CVD and albuminuria. Furthermore, SEVR predicted mortality and ESRD during follow-up. Future studies are needed to determine whether targeting central hemodynamics improves outcome.

Effect of caffeinated versus noncaffeinated energy drinks on central blood pressures

STUDY OBJECTIVE

To evaluate the effects of caffeinated energy shots compared with noncaffeinated energy shots as assessed by changes in peripheral and central hemodynamic parameters in healthy subjects.

DESIGN

Randomized, double-blind, controlled crossover study.

SETTING

University campus.

PATIENTS

Ten healthy volunteers.

MEASUREMENTS AND MAIN RESULTS

Subjects were randomized to receive either a caffeinated or noncaffeinated energy shot; after a minimum 6 days washout period, subjects were given the alternate energy shot. Peripheral blood pressures, and central hemodynamic parameters, were assessed and recorded for each subject at baseline and at 1 and 3 hours after consumption of the energy shots. Peripheral systolic blood pressure (SBP) increased significantly with the caffeinated energy shot compared with noncaffeinated (8.30 ± 4.19 mm Hg and -0.20 ± 5.55, respectively, p=0.009) at 3 hours. Central SBP increased significantly with the caffeinated energy shot compared with noncaffeinated (8.00 ± 4.03 mm Hg and 1.50 ± 6.57, respectively, p=0.045) at 3 hours. Peripheral and central diastolic blood pressure were nonsignificantly higher with the caffeinated energy shot at 3 hours. Peripheral and central pulse pressure were consistently higher with consumption of the caffeinated beverage. Heart rate, augmentation index, pulse pressure amplification ratio, ejection duration and Subendocardial Viability Ratio were not different between the two interventions over time. P1 height was significantly higher with the caffeinated shot compared with the noncaffeinated shot at both 1 and 3 hours (p=0.035 and 0.013, respectively). Three and one subjects experienced an adverse effect with the caffeinated and noncaffeinated shot, respectively.

CONCLUSION

A caffeinated energy shot acutely increases peripheral and central SBPs compared with a noncaffeinated energy shot. Larger studies with a placebo comparator are needed to assess the significance of peripheral and central hemodynamic changes with noncaffeinated energy drinks.

Dehydration, hemodynamics and fluid volume optimization after induction of general anesthesia

OBJECTIVES

Fluid volume optimization guided by stroke volume measurements reduces complications of colorectal and high-risk surgeries. We studied whether dehydration or a strong hemodynamic response to general anesthesia increases the probability of fluid responsiveness before surgery begins.

METHODS

Cardiac output, stroke volume, central venous pressure and arterial pressures were measured in 111 patients before general anesthesia (baseline), after induction and stepwise after three bolus infusions of 3 ml/kg of 6% hydroxyethyl starch 130/0.4 (n=86) or Ringer's lactate (n=25). A subgroup of 30 patients who received starch were preloaded with 500 ml of Ringer's lactate. Blood volume changes were estimated from the hemoglobin concentration and dehydration was estimated from evidence of renal water conservation in urine samples.

RESULTS

Induction of anesthesia decreased the stroke volume to 62% of baseline (mean); administration of fluids restored this value to 84% (starch) and 68% (Ringer's). The optimized stroke volume index was clustered around 35-40 ml/m2/beat. Additional fluid boluses increased the stroke volume by ≥10% (a sign of fluid responsiveness) in patients with dehydration, as suggested by a low cardiac index and central venous pressure at baseline and by high urinary osmolality, creatinine concentration and specific gravity. Preloading and the hemodynamic response to induction did not correlate with fluid responsiveness. The blood volume expanded 2.3 (starch) and 1.8 (Ringer's) times over the infused volume.

CONCLUSIONS

Fluid volume optimization did not induce a hyperkinetic state but ameliorated the decrease in stroke volume caused by anesthesia. Dehydration, but not the hemodynamic response to the induction, was correlated with fluid responsiveness.

Associations of genetic polymorphisms in the renin-angiotensin system with central aortic and ambulatory blood pressure in type 2 diabetic patients

Patients with type 2 diabetes (T2D) are at high risk of developing hypertension and related cardiovascular disease. The renin-angiotensin system (RAS) plays a central role in regulation of blood pressure (BP). Accordingly, each component of this system represents a potential candidate in the etiology of hypertension. This study investigated the impact of polymorphisms within the RAS on ambulatory and central BP in T2D subjects. A cohort of 761 subjects (55-65 years) with T2D was studied. Ambulatory and central BP were measured, and ACE I/D genotype, angiotensinogen M235T, renin rs6693954 and ATR1-A1166C polymorphisms were analyzed. Women carrying the AA-genotype had lower 24-hour and day-time systolic and diastolic BP (p<0.05), and lower night-time and central diastolic BP (p<0.05), compared to T allele carriers. In men, the AA-genotype was instead associated with higher central diastolic BP (p=0.018) and higher augmentation index (p=0.016). Further, the associations between the renin rs6693954 SNP and diastolic BP were strongly gender dependent (p≤0.001). In T2D patients, there is a gender-dependent association of the renin rs6693954 SNP with central and ambulatory BP. Women carrying the renin rs6693954 AA-genotype may be protected against the higher BP seen in men with the same genotype.