Cardiac Output Index Research Articles

Comparison of cardiac output index in dogs before and after mitral valve repair as determined using pulse pressure recording analytical methods

Comparison of cardiac output index in dogs before and after mitral valve repair as determined using pulse pressure recording analytical methods

Anemia and 4 cavities myocardial strain in acute heart failure

Abstract Background Anemia is a frequent comorbidity in heart failure (HF) in elderly patients. Few data are available concerning the correlation between anemia and echocardiographic morphologic, functional and hemodynamic markers in acute HF. Purpose The aim of the study was to evaluate 4 cavities myocardial strain in elderly patients hospitalized with acute HF and to evaluate the influence of the presence of concomitant anemia. Methods One hundred and seven patients aged 70 years or older, hospitalized for acute HF were prospectively analyzed. Left ventricle longitudinal strain (LVGLS), left atrial (LA) reservoir, right atrial (RA) reservoir and right ventricle (RV) free wall strain were measured using speckle tracking transthoracic echocardiography (TTE) at admission. The population was divided into 2 groups, with (N = 47) or without (N = 60) of anemia. Results Mean age was 81.2 ± 6.6 years; 67 (62.6%) patients were men. Anemia was documented in 60 (56.1%) patients. Patients with anemia, compared to those without anemia, had more frequently history of hypertension, diabetes, renal insufficiency, and iron deficiency (Table 1). Patients with anemia, compared to those without anemia, had higher indexed cardiac output, LV ejection fraction and tricuspid annular plane systolic excursion, TAPSE (Table 1). Myocardial strain analysis found that patients with anemia, compared to those without anemia, had significantly higher LVGLS, LA and RA reservoir strain (Figure 1). Conclusion Anemia is common in elderly patients with decompensated HF. Patients suffering from both anemia and acute HF exhibited significantly higher myocardial strain (except free wall RV strain), suggesting a possible compensatory mechanism. Further investigations are necessary to understand the pathophysiologic links between HF, anemia and myocardial strain as well as their implications for prognosis.

Cardiovascular Ultrasound Predictors for Brain Alterations in Fetuses With Heart Disease: An Exploratory Review of the Literature.

To identify cardiovascular ultrasound predictors for brain anomalies in fetuses with heart disease. A literature search was performed in the following databases: MEDLINE through OVID, EMBASE, Cochrane Registry Center for Controlled Trials (CENTRAL), and LILACS, from their inception until May 2023. Clinical studies, cross-sectional studies, case-control studies, cohorts, and systematic reviews were included. Data extraction was performed, and the risk of bias was assessed using the QUADAS-2 tool. Among 2705 studies evaluated, after filtering information, 10 articles were selected that met the inclusion criteria. These studies noted the following outcomes: a decrease in fetal head circumference, changes in brain maturation measured in days, decreased depth of brain fissures, and a decrease in total brain volume. The studies show a statistically significant correlation with the presence of the following cardiovascular predictors: low or mixed oxygen content in the ascending aorta (p < 0.001), retrograde flow in the aortic arch (p < 0.001), lower z values of the MCA-PI (p < 0.05), higher UA-PI z values (p < 0.01), and lower CPR (p < 0.05). In addition, lower values of left ventricular flow (p < 0.01), ductus arteriosus (p < 0.0001), and combined cardiac output index (p < 0.01) were reported. This review describes the most relevant evidence correlating the effects of hemodynamic changes that lead to states of chronic hypoxia related to the aforementioned changes in the central nervous system.

Impact of age and sex on heart rate variability and cardiometabolic function in healthy adults

Heart rate variability (HRV) is a non-invasive measure of cardiac autonomic function. A clearer understanding as to whether resting autonomic function represented by HRV could be associated with changes in peak exercise cardiac function remains unanswered. This study evaluated the effect of age and sex on HRV, cardiometabolic function, and determined the correlation between HRV and cardiac function in healthy individuals. Sixty-eight participants (age range: 19–78 years old, females, n = 28) were recruited. Participants were stratified according to age (younger (<40 years old, n = 43, females, n = 17) and older age groups (>55 years old, n = 25, females, n = 11). Firstly, HRV was measured using non-invasive impedance cardiography method (TaskForce, CNSystems, Graz, Austria) and recorded at rest (supine position) for 30 min. HRV measures included: low frequency (LF) power, high frequency (HF) power (both normalised (nu) and absolute units (ms2)) and LF/HF ratio. Participants then completed a progressive cardiorespiratory exercise test using a semi-recumbent cycle ergometer (Corival, Lode, Groningen, Netherlands) with simultaneous gas exchange measurements (Metalyzer 3B, Cortex, Leipzig, Germany). Cardiac function was represented by peak exercise cardiac power output index (CPO). After controlling for body mass index and physical activity, males had significantly higher mean vales of RR interval than females (males = 1043 ± 165; females = 952 ± 128 ms, p = 0.02). There was no significant main effect of age, sex or their interaction on any of the other HRV measures. In younger and older females, resting RR interval had a significant relationship with peak exercise CPO (young females: r = 0.54, p < 0.05; old females: r = 0.81, p < 0.01). There was also a significant relationship between resting HF power and peak exercise CPO in younger females (r = 0.70, p < 0.01). HRV was not influenced by age but RR interval was associated with peak exercise CPO in females regardless of age, whilst HF power was significantly associated with CPO in younger females only.

Differential contribution of elbow flexion and knee extension on vascular and hemodynamic parameters and arterial stiffness indices after acute strength exercise in young adults

BackgroundDifferent types of exercise, performed acutely or chronically, have different repercussions on central hemodynamics, arterial stiffness, and cardiac function. In this study, we aim to compare the effects of acute elbow flexion (EFlex) and knee extension (KExt) exercises on vascular and hemodynamic parameters and arterial stiffness indices in healthy young adults.MethodsYoung adults (20 to 39 years) underwent randomized muscle strength tests to obtain 1 repetition maximum (1RM) for elbow flexion (EFlex) and knee extension (KExt). After a minimum interval of 48 h, cardiovascular parameters were assessed using Mobil-O-Graph® (Mobil-O-Graph, IEM, Germany) at three-time points: at baseline (before exercise), immediately after elbow flexion or knee extension exercises with a load corresponding to 50% of 1RM (T0) and after 15 min of rest (T15).ResultsImmediately after exercise (T0), peripheral systolic blood pressure, peripheral pulse pressure, central systolic blood pressure, and central pulse pressure were significantly higher in KExt than EFlex (Δ 3.13; Δ 3.06; Δ 5.65; Δ 5.61 mmHg, respectively). Systolic volume, cardiac output, and cardiac index were significantly higher immediately after KExt when compared with EFlex (Δ 4.2 ml; Δ 0.27 ml/min and 0.14 l/min*1/m2, respectively). The reflection coefficient and the pulse wave velocity were also significantly higher at T0 in KExt compared to EFlex ( Δ 8.59 and Δ 0.12 m/sec, respectively).ConclusionOur results show differential contribution of muscle mass in vascular and hemodynamic parameters evaluated immediately after EFlex and KExt. In addition, our study showed for the first time that the reflection coefficient, an index that evaluates the magnitude of the reflected waves from the periphery, was only affected by KExt.

Index of Consciousness monitoring may effectively predict and prevent circulatory stress induced by endotracheal intubation under general anesthesia: a prospective randomized controlled trial

BackgroundThe primary objective of anesthesiologists during the induction of anaesthesia is to mitigate the operative stress response resulting from endotracheal intubation. In this prospective, randomized controlled trial, our aim was to assess the feasibility and efficacy of employing Index of Consciousness (IoC, IoC1 and IoC2) monitoring in predicting and mitigating circulatory stress induced by endotracheal intubation for laparoscopic cholecystectomy patients under general anesthesia (GA).MethodsWe enrolled one hundred and twenty patients scheduled for laparoscopic cholecystectomy under GA and randomly allocated them to two groups: IoC monitoring guidance (Group T, n = 60) and bispectral index (BIS) monitoring guidance (Group C, n = 60). The primary endpoints included the heart rate (HR) and mean arterial pressure (MAP) of the patients, as well as the rate of change (ROC) at specific time points during the endotracheal intubation period. Secondary outcomes encompassed the systemic vascular resistance index (SVRI), cardiac output index (CI), stroke volume index (SVI), ROC at specific time points, the incidence of adverse events (AEs), and the induction dosage of remifentanil and propofol during the endotracheal intubation period in both groups.ResultsThe mean (SD) HR at 1 min after intubation under IoC monitoring guidance was significantly lower than that under BIS monitoring guidance (76 (16) beats/min vs. 82 (16) beats/min, P = 0.049, respectively). Similarly, the mean (SD) MAP at 1 min after intubation under IoC monitoring guidance was lower than that under BIS monitoring guidance (90 (20) mmHg vs. 98 (19) mmHg, P = 0.031, respectively). At each time point from 1 to 5 min after intubation, the number of cases with HR ROC of less than 10% in Group T was significantly higher than in Group C (P < 0.05). Furthermore, between 1 and 3 min and at 5 min post-intubation, the number of cases with HR ROC between 20 to 30% or 40% in Group T was significantly lower than that in Group C (P < 0.05). At 1 min post-intubation, the number of cases with MAP ROC of less than 10% in Group T was significantly higher than that in Group C (P < 0.05), and the number of cases with MAP ROC between 10 to 20% in Group T was significantly lower than that in Group C (P < 0.01). Patients in Group T exhibited superior hemodynamic stability during the peri-endotracheal intubation period compared to those in Group C. There were no significant differences in the frequencies of AEs between the two groups (P > 0.05).ConclusionThis promising monitoring technique has the potential to predict the circulatory stress response, thereby reducing the incidence of adverse reactions during the peri-endotracheal intubation period. This technology holds promise for optimizing anesthesia management.Trail registration Chinese Clinical Trail Registry Identifier: ChiCTR2300070237 (20/04/2022).

Childhood family environment and systemic haemodynamics in adulthood: the Cardiovascular Risk in Young Finns Study.

Childhood family environment is associated with adulthood health behaviours and cardiovascular health, but limited data are available concerning the relationship between childhood family environment and adulthood haemodynamic determinants of blood pressure. We evaluated how childhood family environment predicts adulthood systemic haemodynamics. The sample came from the Cardiovascular Risk in Young Finns Study (n=1554-1620). Childhood family environment (1980) was assessed with four cumulative risk scores: socioeconomic family risk, risky emotional family atmosphere, stressful life events, and parents' risky health behaviours. Haemodynamic outcomes in 2007 (participants being 30-45 year-olds) included stroke volume index, systemic vascular resistance index, cardiac output index and heart rate. Analyses were adjusted for childhood (1980) cardiovascular risk factors (high-density lipoprotein and low-density lipoprotein cholesterol, triglycerides, insulin, body mass index and systolic blood pressure); and adulthood (2007) health behaviours (alcohol consumption, smoking, physical activity); and finally for adulthood cardiovascular risk factors. When adjusted for age and sex, high socioeconomic family risk predicted lower stroke volume index (P=0.001), higher heart rate (P=0.001) and higher systemic vascular resistance index (P=0.030). These associations remained after controlling for childhood cardiovascular covariates or adulthood health behaviours (P⩽0.02 for all) but diluted after controlling for adulthood cardiovascular risk factors. The other childhood cumulative risk scores (stressful life events, risky emotional atmosphere, or parents' risky health behaviour) did not predict adulthood haemodynamic outcomes. High childhood socioeconomic family risk predicted adulthood haemodynamic outcomes independently of childhood cardiovascular risk factors and adulthood health behaviours, while other childhood psychosocial adversities were not associated with cardiovascular function in adulthood.

Application of combined anesthesia with spontaneous breathing in the surgery of intertrochanteric fracture of femur in elderly patients.

This study aims to investigate the feasibility and safety of combined anesthesia with spontaneous breathing in the operation of intertrochanteric fracture of femur in the elderly. Between January 2020 and January 2023, a total of 141 elderly patients (45 males, 96 females; mean age: 72.5±6.8 years; range, 65 to 87 years) who underwent proximal femoral nail anti-rotation (PFNA) surgery for intertrochanteric fracture of femur were included in this single-blind, prospective, randomized-controlled study. The patients were randomly divided into three groups. Group A (experimental group) was a general anesthesia with laryngeal mask airway (LMA) group preserving spontaneous breathing, Group B (control group 1) was a general anesthesia with LMA group for mechanical ventilation, and Group C (control group 2) was a tracheal intubation anesthesia group for mechanical ventilation. The differences of related indexes among the three groups were compared. The mean onset time of anesthesia (6.23±1.45 vs. 12.78±2.78 vs. 13.73±2.43 min), postoperative recovery time of consciousness (8.13±0.83 vs. 11.34±0.89 vs. 12.45±0.86 min), and postoperative complete awakening time (10.45±2.34 vs. 18.87±2.56 vs. 19.62±2.93 min) were significantly shorter in Group A than in Groups B and C (p<0.05). The duration of analgesic effect was longer in Group A than in Groups B and C (p<0.05). After anesthesia, the Ramsay Sedation Scale and Visual Analog Scale (VAS) scores were significantly lower in Group A than the other groups (p<0.05). The mean Mini-Mental State Examination (MMS) scores were significantly higher in Group A than in Groups B and C (p<0.05). Hemodynamic parameters showed that blood pressure, heart rate, cardiac output, and cardiac index (CI) levels were significantly higher in Group A than the other groups (p<0.05). Our study results indicate that combined anesthesia preserving spontaneous breathing is safe and feasible in the operation of intertrochanteric fracture of femur in the elderly, with faster anesthesia recovery than the mechanical ventilation group.

Comprehensive non-invasive haemodynamic assessment in acute decompensated heart failure-related cardiogenic shock: a step towards echodynamics.

Haemodynamic assessment can be determinant in phenotyping cardiogenic shock (CS) and guiding patient management. Aim of this study was to evaluate the correlation between echocardiographic and invasive assessment of haemodynamics in acute decompensated heart failure-related CS (ADHF-CS). All consecutive ADHF-CS patients (SCAI shock stage ≥B) undergoing right heart catheterization (RHC) between 2020 and 2022 were prospectively enrolled. Patients underwent echocardiography 30 min before RHC. The evaluated haemodynamic parameters and their echocardiographic estimates ('e') comprised cardiac index (CI), wedge pressure (WP), pulmonary artery pressures (PAP), cardiac power output (CPO) and pulmonary artery pulsatility index (PAPi). Hundred and one ADHF-CS patients (56 ± 11 years, 64% SCAI shock stage C, left ventricular ejection fraction 29 ± 5%) were included. Good correlation was found for CI, systolic PAP, RAP, and CPO (Pearson r > 0.8 for all), moderate correlation for ePAPi (r = 0.67) and PVR (r = 0.51), while estimation of WP was weak. The sensitivity and specificity of eCI to identify low output state (CI ≤2.2 L/min/m2) were 0.97 and 0.73, respectively, those of eWP for elevated filling pressures (WP >15 mmHg) were 0.84 and 0.55, those of ePAPs for PAPs ≥35 mmHg were 0.87 and 0.63, those of eCPO for CPO <0.6 W were 0.76 and 0.85, those of ePAPi for PAPi <1.85 were 0.89 and 0.92. Echocardiographic phenotyping of CS showed a good agreement with invasive classification (K value 0.457, P < 0.001). Echocardiographic estimation of haemodynamics and subsequent phenotypization of CS is feasible with good agreement with invasive evaluation.

The effect of laparoscopic pneumoperitoneum on patient’s respiratory variation of inferior vena cava and stroke volume index: A randomized controlled study

Background: The establishment of pneumoperitoneum has impacts on patient’s cardiovascular function. In this study, the respiratory variation of inferior vena cava (IVC), stroke volume (SV) index, and other parameters was monitored to determine how the pneumoperitoneum affects the patient’s hemodynamic and acknowledge how to resolve it. Materials and Methods: Fifty-five patients were randomly divided into Group A (8 mmHg), Group B (10 mmHg), Group C (12 mmHg), Group D (14 mmHg), and Group E (12 mmHg, infusion with 7 mL/kg crystalloid solution). The parameters including IVC variability, SV index, mean artery pressure (MAP), heart rate (HR), cardiac output index (CI), and airway pressure were measured, to compare the changes before and after pneumoperitoneum. Results: Among Group A, Group B, Group C, and Group D, there were no significant differences in patients’ prepneumoperitoneum information. Compare with prepneumoperitoneum, the difference in IVC variability, SV index, MAP, HR, CI, and airway pressure was statistically significant (P &lt; 0.05). After the establishment of pneumoperitoneum, the difference in IVC variability, SV index, and airway pressure among Group A, Group B, Group C, and Group D was statistically significant (P &lt; 0.05). Compare with Group C, the change rates of IVC variability, SV index, MAP, HR, and CI were smaller in Group E (P &lt; 0.05). Conclusion: The establishment of pneumoperitoneum could increase the patient’s IVC variability and reduce SV index, and with the increase of pressure, IVC variability had an increasing trend, SV index had a decreasing trend. Fluid transfusion could reduce the relative influence of the pneumoperitoneum.

Left ventricular geometry characteristics and clinical outcomes in hemodialysis patients with heart failure with preserved ejection fraction

BackgroundThe relationships among left heart remodeling, cardiac function, and cardiovascular events (CEs) in patients with heart failure (HF) with preserved ejection fraction (HFpEF) undergoing maintenance hemodialysis (MHD) remain unclear. We evaluated the echocardiographic characteristics and clinical outcomes of such patients with diverse left ventricular geometric (LVG) configurations.MethodsOverall, 210 patients with HFpEF undergoing MHD (cases) and 60 healthy controls were enrolled. Cases were divided into four subgroups based on LVG and were followed up for three years. The primary outcomes were the first CEs and all-cause mortality.ResultsLeft ventricular ejection fraction (LVEF) and right ventricular systolic function did significantly differ between cases and controls, whereas echocardiographic parameters of cardiac structure, diastolic function, and left ventricular global longitudinal strain (LVGLS) differed significantly. The proportion of cases with left ventricular hypertrophy (LVH) was 67.1%. In addition, 2.38%, 21.90%, 12.86%, and 62.86% of cases presented with normal geometry (NG), concentric remodeling (CR), eccentric hypertrophy (EH), and concentric hypertrophy (CH), respectively. The left atrial diameter (LAD) was the largest and cardiac output index was the lowest in the EH subgroup. The score of Acute Dialysis Quality Initiative Workgroup (ADQI) HF class was worse in the EH subgroup than in other subgroups at baseline. The proportions of cases free of adverse CEs in the EH subgroup at 12, 24, and 36 months were 40.2%, 14.8%, and 0%, respectively, and the survival rates were 85.2%, 29.6%, 3.7%, respectively, which were significantly lower than those in other subgroups. Multivariate Cox regression revealed that age, TNI (Troponin I), EH, left ventricular mass index (LVMI), age and EH configuration were independent risk factors for adverse CEs and all-cause mortality in the cases.ConclusionMost patients with HFpEF receiving MHD have LVH and diastolic dysfunction. Among the four LVGs, patients with HFpEF undergoing MHD who exhibited EH had the highest risk of adverse CEs and all-cause mortality.

Targeting exercise and sedentary behavior for the prevention of allogeneic stem cell transplant-related cardiovascular dysfunction: The ALLO-Active trial.

12018 Targeting Exercise and Sedentary Behavior to Prevent Allogeneic Stem Cell Transplant-Related Cardiovascular Dysfunction: The ALLO-Active Trial Background: Allogeneic stem cell transplantation (allo-SCT) is a potentially life-saving therapy for hematological malignancy, however, quality of life and longevity post allo-SCT are hampered by exercise intolerance, cardiac dysfunction, and cardiovascular mortality. This randomized controlled trial evaluated the efficacy of a novel multi-component activity program on cardiorespiratory fitness (peak oxygen uptake [VO2peak]) and cardiac function in adults undergoing allo-SCT. Methods: Sixty-two hematological malignancy patients scheduled for allo-SCT were randomized to a 4-month multi-component Activity program (n = 30) designed to increase aerobic and resistance exercise (3-day.week-1) and reduce sedentary time (≥30-min.day-1), or to usual care ( UC, n = 32). The Activity program was delivered over two distinct phases: ‘Inpatient’, which commenced upon admission for allo-SCT and continued until discharge (~4 weeks), and ‘Outpatient’,which commenced at discharge and continued for 12-weeks. Physiological assessments were conducted pre-admission, and 12-weeks post-discharge (4-months from baseline) and included: (1) cardiopulmonary exercise testing to quantify VO2peak, (2) exercise cardiac magnetic resonance imaging to determine peak cardiac output and stroke volume index (COIpeak and SVIpeak), (3) standard of care resting echocardiography-derived left ventricular ejection fraction and global longitudinal strain, and (4) cardiac biochemistry (troponin, B-type natriuretic peptide). Results: Fifty-two patients (84%) completed follow-up (25 Activity; 27 UC), and median (IQR) intervention adherence was 73% (50-81). Activity preserved VO2peak (-0.9ml.kg-1.min-1 [95%CI -2.5, 0.8]) which showed a marked decline with UC (-3.4ml.kg-1.min-1 [95%CI -4.9, -1.8]; interaction, p= 0.029). Activity also showed significant benefits on exercise cardiac function, as shown by a preservation of COIpeak (0.30L.min-1.m2, [95%CI -0.34, 0.41]) and SVIpeak (0.6ml.m2 [95%CI -1.3, 2.5]), both of which declined with UC (COIpeak: -0.68L.min-1.m2, [95%CI -1.3, -0.32]; interaction, p= 0.008; SVIpeak: -2.7ml.m2 [95%CI -4.6, -0.9], interaction, p =0.014). There were no treatment effects of Activity on cardiac injury biomarkers or global longitudinal strain and no changes in left ventricular ejection fraction in either group. Conclusions: Intervening early in the allo-SCT process with an exercise and sedentary behavior intervention can have significant benefits for the preservation of patient’s cardiovascular reserve capacity. Our results may have important long-term implications for cardiovascular disease incidence and mortality in allo-SCT recipients. Clinical trial information: ANZCTR12619000741189.

Cardiac output in patients with small annuli undergoing transcatheter aortic valve implantation with self-expanding versus balloon expandable valve (COPS-TAVI)

BackgroundThere is limited data on cardiac output in patients with small aortic annuli undergoing trans-catheter aortic valve implantation (TAVI) according to the implanted platform of balloon-expandable (BEV) compared to self-expanding valves (SEV). MethodsThis is a retrospective analysis of consecutive patients with severe aortic stenosis and small annuli who underwent successful TAVI. Cardiac output was measured using echocardiography within 4 weeks following TAVI. Data were recorded and analysed by an experienced operator who was not aware of the type of the implanted valve. Results138 patients were included in the analysis, of whom 57 % underwent TAVI with BEV. Clinical and echocardiographic characteristics were comparable between the two platforms, except for more frequent previous cardiac surgery and smaller indexed aortic valve in the BEV group. There was no relationship between computed tomography-derived aortic annulus area and cardiac output post TAVI. When compared to patients who underwent TAVI with BEV, those with SEV had larger cardiac output [mean difference − 0.50 l/min, 95 % CI (−0.99, −0.01)] and cardiac index [mean difference − 0.20 l/min/m2, 95 % CI (−0.47, 0.07)], although the latter did not reach statistical significance. Unlike patients with small body surface area, in those with large body surface area both cardiac output and cardiac index were statistically larger in patients who underwent SEV compared to BEV. ConclusionCardiac output, as measured by echocardiography, was larger in patients with small annuli who underwent TAVI procedure with SEV compared to BEV. Such difference was more evident in patients with large body surface area.

Atrial fibrillation ablation performed under general anesthesia is associated with significantly low arterial blood pressure and higher incidence of hypotensive events

Abstract Introduction Catheter ablation is a pivotal treatment for atrial fibrillation (AF). When performed under general anesthesia (GA), it may be associated to hypotensive events, with unclear prevalence and prognostic impact. Continuous non-invasive blood pressure (CNBP) measurement is a validated and reliable tool for intraprocedural beat-to-beat advanced hemodynamic monitoring. Purpose To assess and compare the hemodynamic impact of GA during AF ablation using a CNBP (ClearSight) system. Methods In an observational single large volume center study we prospectively enrolled all patients undergoing AF ablation at our institution with CNBP monitoring, as per local practice. Patients were assigned to deep sedation (DS) or general anesthesia (GA) group according to the chosen sedation regimen. The following parameters were compared between the two strategies: systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke volume index (SVI). Hypotension events (HE) (MAP &amp;lt; 65 mmHg) were counted and compared between groups. Results Two hundred patients were enrolled from September 2022 to August 2023. 170 patients underwent AF ablation under DS (76,7% male, mean age 56,77±15,76), while 30 patients were treated under GA (70% male, mean age 60,72±13,79). A total of 117709 measurements were analyzed and compared, for an overall monitoring time of 39293,66 minutes. Patients treated under GA had significantly lower average SBP (104,83±21,48 mmHg vs 138,05±22,09 mmHg, p&amp;lt;0,001), DBP (59,59±11,89 mmHg vs 76,12±12,75 mmHg, p&amp;lt;0,001), MAP (74,96±15,02 mmHg vs 97,12±15,38 mmHg, p&amp;lt;0,001). We also observed significantly lower CO (4,40±1,47 L/min vs 5,16±1,62 L/min, p&amp;lt;0,001), CI (2,22±0,71 L/min/m2 vs 2,61±0,78 L/min/m2, p&amp;lt;0,001) SV (62,37±18,04 mL/beat vs 70,65±24,95 mL/beat, p&amp;lt;0,001) and SVI (31,40±8,54 mL/beat/m2 vs 35,80±12,07 mL/beat/m2, p&amp;lt;0,001). Patients treated under GA witnessed a higher number of per-patient HE (10,53±9,16 vs 0,61±2,07, p&amp;lt;0,001), and higher HE duration (4,8±6,62 min vs 2,82±3,66, p&amp;lt;0,001). Conclusion AF ablation performed under general anesthesia is associated with significantly lower systolic, diastolic, and mean arterial pressure, reduced cardiac output, stroke volume and stroke volume index when compared to deep sedation. Patients undergoing AF ablation under GA witness higher incidence and duration of hypotensive events. CNBP is a valid tool for beat-to-beat procedural hemodynamic assessment and can help identifying and treat hypotensive events. Further studies are needed to assess the potential prognostic impact of intraprocedural hypotension during AF ablation.

Role of fetal cardiac assessment in predicting adverse perinatal outcomes in preterm dichorionic twins

Aim: To investigate the role of the fetal modified myocardial performance index (Mod-MPI) and fetal cardiac output index measurement in predicting adverse perinatal outcomes among preterm dichorionic twins. Materials and Method: This prospective cohort study was conducted at the X Clinic and included 34 dichorionic twin fetuses born early preterm and 40 dichorionic twin fetuses born late preterm. The early preterm group was divided into two according to whether they were admitted to the neonatal intensive care unit (NICU). The groups' cardiac function and Mod-MPI measurements were compared regarding their predictive ability for adverse perinatal outcomes. Results: The Mod-MPI values were similar between the early and late preterm groups (p=0.144). The left ventricular cardiac output Z-score was lower in the preterm group (p=0.014). The Mod-MPI and left ventricular outflow tract-isovolumetric contraction and isovolumetric relaxation times were significantly higher among the newborns admitted to the NICU in the early preterm group (p=0.002, p=0.003, and p=0.001, respectively). Conclusion: Our study suggests that the Mod-MPI measurement can be used to predict adverse perinatal outcomes in dichorionic twin fetuses born in the early preterm period.

Sex Differences in Left Ventricular Stroke Volume During Muscle Metaboreflex Activation

Introduction: Muscle metaboreflex activation (MMA) increases blood pressure, possibly by disproportionate increases in left ventricular (LV) stroke volume (SV) in males compared to females due to greater grip strength and metabolite production. The purpose of this study was to determine the effect of sex on SV during isolated MMA using cardiac MRI in young healthy adults. We hypothesized that SV would increase during MMA to a greater degree in males compared to females, and that this effect would be negated by accounting for grip strength. Methods: Ten males [23(2) yrs] and 10 females [26(5) yrs] underwent cardiac MRI during rest, 30% maximal voluntary contraction (MVC) isometric handgrip exercise (6 min), and isolation of MMA with brachial cuff circulatory occlusion (6 min). SV, end-systolic (ESV) and end-diastolic volumes (EDV) were measured by 2- and 4-chamber cine images and indexed (i) to body surface area to account for body size. Heart rate (HR, ECG) and mean arterial pressure (MAP, brachial cuff) were recorded. Cardiac output index (COi) and total peripheral resistance (TPR) were calculated. Analyses included ANOVA (sex × condition), ANCOVA [100% MVC (M=49(13) kg, F=26(7) kg) covariate], and linear regression. Results: SVi decreased from rest to MMA in males [67(8) to 61(5) mL/m2, p=0.0001] but not females [59(9) to 59(7) mL/m2, p=0.998; interaction p=0.002]. Notably, the reduction in SVi during MMA in males ( p=0.002) but not females ( p=0.957) remained with ANCOVA using MVC as the covariate (interaction p=0.021). ESVi increased during MMA in males [39(5) to 48(10) mL/m2, p&lt;0.0001] but not females [32(5) to 36(6) mL/m2, p=0.092; interaction p=0.029]. MMA decreased both EDVi ( p=0.004) and COi ( p=0.045) and increased both MAP ( p&lt;0.0001) and TPR ( p&lt;0.0001) pooled across sex. HR did not change with MMA in either sex (all p≥0.093). Linear regression revealed significant relationships between ΔSVi and ΔESVi in males ( p=0.002, R2=0.709) but not females ( p=0.223, R2=0.179) and between ΔSVi and ΔTPR in males ( p=0.005, R2=0.649) but not females ( p=0.522, R2=0.053). Conclusions: MMA lowers SVi in males but not females, even when accounting for grip strength and despite similar pressor responses in both groups. These findings from gold-standard MRI suggest differential LV responses to MMA between sexes, potentially related to greater sensitivity to increased TPR in males than females. Thus, sex differences in blood pressure control during MMA may be impacted by differences in LV afterload sensitivity. Further, the blood pressure response to MMA may be primarily mediated through TPR and not CO in healthy young adults. Heart and Stroke Foundation of Canada. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Monitorización hemodinámica no invasiva intradiálisis: utilidad de los valores de precarga cardiaca en la predicción de la inestabilidad hemodinámica

IntroductionAdequate control of patient blood volume in hemodialysis (HD) is essential as a modifiable risk factor for morbidity and mortality. In this study, we propose continuous non-invasive hemodynamic monitoring using bioreactance (Starling™ SV. Baxter) and real-time characterization of cardiac preload data to aid in the accurate assessment of volume status and improvement of tolerance in HD. MethodologyObservational and prospective study on the relationship between cardiac preload data and intradialytic hemodynamic instability. Forty-six stable HD patients were recruited. Clinical, analytical, and dialysis data were collected from all participants. The protocol included bioimpedance (BIVA), pre- and post-dialysis echocardiography and tissue Doppler, and monitoring of hemodynamic parameters during the session. ResultsAccording to the Fall20 definition, 24 patients (51.19%) experienced intradialytic hypotension (IDH). We found no relationship between IDH and analytical, echocardiographic, BIVA parameters, or relative blood volume measurement (BVM) values. Regarding hemodynamic monitoring, indexed systolic volume (ISV) was lower in patients with IDH (38.2±0.9 vs. 39.2±1.9; P<.001). Indexed systolic volume variation (ISVV) and heart rate (HR) were higher in the IDH group (14.1±0.7 vs. 13.5±0.7; P<.0001), (70.01±2.1 vs. 68.97±1.1; P<.0001), respectively. Indexed cardiac output (ICO) and indexed peripheral resistances (IPR) were also lower in the IDH group (2.62±0.09 vs. 2.65±0.13; P<.05) and (3201±325 vs. 3432±231; P<.05), respectively. Patients who started the session with lower preload (ΔSV after infusion of 250 cc ≥ 10%) more frequently developed IDH (P<.001). ConclusionsNon-invasive hemodynamic monitoring and preload data may constitute a valid tool in managing the volume status of HD patients and preventing IDH.

Clinical Outcomes in Acute Decompensated Heart Failure Patients with Reduced Ejection Fraction and Impaired Renal Function–A Study Comparing Levosimendan and Dobutamine

Background Cardiorenal syndrome is a disorder in which renal function is affected by heart failure (HF) or vice versa. It occurs in 20% of HF patients. The most common reason for hospitalization is acute decompensation (ADHF). Diuretics and inodilators are the standard of treatment in the management. Our objective was to demonstrate that levosimendan is more effective than dobutamine in improving the outcome of ADHF patients with a low ejection fraction (EF) and impaired kidney function. Material and methods The study was carried out between January to December 2022. Patients with ADHF, a low EF (&lt;40%) on echocardiography, and decreased renal function (estimated glomerular filtration rate [eGFR] &gt;15 and &lt;60 mL/min/m2) were included. All patients have given consent. The study was approved by the institutional ethical committee. The estimated study sample size was 18 in each group, and as the study continued, we enrolled 60 patients, who were divided into two equal groups (30 in each). The patients were assigned either levosimendan or dobutamine based on preassigned numbers in the software. The clinical characteristics (serum creatinine, eGFR, EF, cardiac output, and cardiac index) were measured on the first, seventh, and at one month (30 days). Results Of the 60 patients, 40 were men and 20 were women. The mean age was (50 ± 8.9 vs 50.8 ± 11.2) years. Of the comorbidities, hypertension was seen in 83.3% followed by diabetes (56.7%). Serum creatinine levels in both groups at admission and 30 days were (2.2 ± 0.3 vs. 2.5 ± 0.7, P = 0.1) and (1.6 ± 0.4 vs. 2.4 ± 0.8, P = 0.05). The eGFR of both groups at admission and 30 days follow up was (32.6 ± 9.1 vs. 28.2 ± 11.4, P = 0.2) and (40 ± 15.5 vs. 29.4 ± 12.6, P = 0.05). At 30 days, the predetermined outcomes in terms of improvement in EF, cardiac output, improved eGFR and cardiac index were better in the levosimendan compared to dobutamine group significantly. Conclusion In ADHF patients with decreased EF and poor renal function, levosimendan improved renal and cardiac indices more than dobutamine at 30 days of follow up.

Prediction of fluid responsiveness for patients in shock using a ventilator disconnection test combined with the pulse contour-derived cardiac index.

Finding a simple and reliable method to predict and assess fluid responsiveness has long been of clinical interest. To investigate the predictive value of a ventilator disconnection (DV) test combined with the pulse contour-derived cardiac output (PiCCO) index on fluid responsiveness for patients in shock. Thirty-two patients were chosen for the study. Patients who were in shock, received mechanical ventilation, and met the inclusion criteria were selected. Patients were divided into a fluid-responsive group (14 patients) and fluid-unresponsive group (18 patients) based on whether the increase in cardiac index (Δ CI) was > 10% or not, respectively, following the fluid challenge test. Changes in heart rate, pulse oximeter-measured oxygen saturation, mean arterial pressure (MAP), and CI before and after passive leg raising (PLR), DV, and fluid challenge tests were observed. We used Pearson's correlation coefficient to analyze an increase in the MAP (Δ MAP) and Δ CI before and after the PLR, DV, and fluid challenge tests; the sensitivity and specificity of the Δ MAP and Δ CI in the PLR and DV tests for predicting fluid response were also analyzed by plotting the receiver operating characteristic (ROC) curves. CI results in the PLR and DV tests, as well as the fluid challenge test, were significantly higher in the fluid-responsive group compared with before the test (P< 0.05). The Δ CI before and after the PLR, DV, and fluid challenge tests were positively correlated among patients in the fluid-responsive group. The area under the ROC curve for the post-PLR test CI and the post-DV CI for predicting fluid responsiveness was 0.869 (95% confidence interval (CI) [0.735-1.000, P= 0.000]) and 0.937 (95% CI [0.829-1.000, P= 0.000]), respectively, in patients in the fluid-responsive group. The sensitivity and specificity of the post-DV CI for predicting fluid responsiveness in all patients was 100.0% and 88.9%, respectively, using a 5% increase as the cut-off value. Application of DV, combined with PiCCO, has a high predictive value for fluid responsiveness among patients in shock.

Effects of Continuous Precision Nursing Model on Knowledge, Attitudes, and Practices (KAP) Behavior and Cardiac Function in Patients after Percutaneous Coronary Angiography and Stent Implantation

Objective: To explore the impact of a continuous precision nursing model on patients’ Knowledge, Attitudes, and Practices (KAP) and cardiac function during the nursing process of patients undergoing percutaneous coronary angiography and stent implantation. Methods: Ninety patients who underwent percutaneous coronary angiography and stent implantation in our hospital from April 2022 to April 2023 were selected and randomly divided into the control group (45 cases), in which routine nursing support was carried out during the treatment process, and the observation group (45 cases), in which continuous precision nursing model was carried out during the treatment process. Comparisons were made between the two groups of patients on their KAP, cardiac function, and quality of life during recovery. Results: There was no difference in the left ventricular ejection fraction (LVEF), cardiac output (CO), and cardiac index (CI) levels before intervention. After the intervention, the levels of cardiac function in the observation group were higher than those of the control group (P &lt; 0.05). There was no difference in the Exercise of Self-Care Agency (ESCA) self-care ability scale scores before the intervention. After the intervention, the observation group had higher ESCA scores than the control group (P &lt; 0.05). Conclusion: Implementation of a continuous precision nursing model in the care of patients undergoing percutaneous coronary angiography and stent implantation improved the patient’s cardiac function, and KAP, and promoted recovery.