Cardiopulmonary Changes Research Articles

Hemodynamic monitoring during weaning from mechanical ventilation in critically ill pediatric patients: a prospective observational study

BackgroundCardiovascular dysfunction is a significant factor contributing to weaning failure in mechanically ventilated children. Understanding the cardiopulmonary pathophysiological changes that occur during weaning is a prerequisite for the early recognition of weaning failure of cardiovascular origin. This study aimed to assess the effect of weaning trials on central hemodynamics and to identify the indices predictive of cardiac-related weaning failure.MethodsThis prospective observational study was conducted in the Pediatric Intensive Care Unit (PICU) and included mechanically ventilated patients aged between 2 and 30 months who were on minimal ventilatory settings and ready for weaning. Patients who were hemodynamically unstable, diagnosed with neuromuscular diseases, or diagnosed with cardiac diseases were excluded. Hemodynamic parameters were evaluated during weaning from ventilation via echocardiography and noninvasive cardiometry during pressure support (PS) ventilation and at the end of the spontaneous breathing trial (SBT).ResultsThe study included 50 patients, comprising 30 males (60%) and 20 females (40%) with ages ranging from 2 to 30 months. Echocardiography revealed a significant increase in the cardiac index (CI), tricuspid annular plane systolic excursion (TAPSE), and the E/A ratio at the end of SBT. Moreover, right ventricular systolic pressure (RVSP) significantly decreased. Noninvasive cardiometry revealed a significant increase in the index of contractility (ICON) and CI at the end of SBT (p-value = 0.023 and < 0.001, respectively). Of the 12 (25%) patients who failed their first extubation trial, they exhibited a significantly lower CI and TAPSE (p values = 0.001 and 0.001, respectively).ConclusionThis study identified that weaning from mechanical ventilation in children is associated with hemodynamic changes, which can impact weaning success and reveal potential ventricular dysfunction. Bedside echocardiography was found to detect cardiac dysfunctions during weaning, and noninvasive cardiometry was considered a reliable tool that supports echocardiography for detecting changing trends in CI in PICUs. However, accurate values should be confirmed by echocardiography.

Subclinical Cardiopulmonary Changes of Heart Failure with Preserved Ejection Fraction (HFpEF) in CKD

Subclinical Cardiopulmonary Changes of Heart Failure with Preserved Ejection Fraction (HFpEF) in CKD

Evaluation of Anaesthetic Efficacy of Xylazine-Ketamine-Guaifenesin Combination for Relieving Dystocia in Buffaloes

Background: Dystocia in dairy animals remains major concern causing huge economical losses of farmers. Over the past years, field veterinarian relieves dystocia via maneuvering, fetotomy, modified Schaffers and cesarean methods under local or regional anaesthesia which is always stressful and painful procedure leading to excessive tissue damage. Considering the involved stress and further conception during relieving dystocia under local or regional anaesthesia is always questionable. Hence, the present study was aimed to relieve dystocia in buffalo without stress by improving gentle handling of uterus during cesarean or obstetrical method under the anaesthetic combination of xylazine-ketamine-guaifenesin under field condition. Methods: The present study was undertaken in twelve clinical cases of buffaloes with history of dystocia irrespective of age and breed and they were sedated with xylazine and subjected to obstetrical or cesarean procedure under ketamine and guaifenesin anaesthetic protocol. Result: Twelve buffaloes with average age between 3-8 years and body weight 389.66±19.56 kg reported to hospital and amongst them eight were primiparous. Among maternal dystocia, uterine torsion was most common followed by incomplete cervical dilation whereas in foetal dystocia, malpositioned foetus and emphysematous foetus was reported. Tachycardia and hypothermia were consistent findings in all animals. The alkaline phosphatase, SGPT and SGOT has been increased significantly due to muscular damage. Mean duration of general anaesthesia required for obstetrical and cesarean procedure was 35.00±0.25 min and 132.00±0.18 min, respectively. The present study was concluded that, use of ketamine-Guaifenesin combination premedicated with xylazine hydrochloride produced excellent muscle relaxation during obstetrical and cesarean procedure in buffaloes characterized by loss of abdominal muscle tone, stable respiration and minimal cardiopulmonary changes.

A Retrospective Cross-Sectional Analysis of Viral SARI in Pregnant Women in Southern Brazil.

Pregnant women (PW) are at a higher risk of diseases and hospitalization from viral respiratory infections, particularly influenza and SARS-CoV-2, due to cardiopulmonary and immunological changes. This study assessed the impact of viral respiratory infections on PW hospitalized with severe acute respiratory infection (SARI) prior to the COVID-19 pandemic. It is a cross-sectional study with 42 PW and 85 non-pregnant women (NPW) admitted with SARI to two tertiary hospitals between January 2015 and December 2019. The rates of virus prevalence, SARI hospitalization, length of hospital stay, oxygen supplementation, intensive care unit (ICU) admission, and death were comparable between PW and NPW. A multivariate analysis showed that PW had a higher rate of viral SARI hospitalizations (OR = 2.37; 95% CI = 1.02-5.48) as compared to NPW, with the influenza virus being the most prevalent (aOR = 7.58; 95% CI = 1.53-37.66). The length of hospital stays (aOR = 0.83; 95% CI = 0.73-0.95) and admissions to the ICU (aOR = 0.028; 95% CI = 0.004-0.25) were lower in PW as compared to hospitalized NPW. The influenza virus had a greater impact on the frequency of SARI in the group of PW, and these had a better outcome than NPW due to the earlier antiviral treatment they received.

Quantifying the impact of post-acute sequelae of coronavirus on the cardiopulmonary endurance of athletes.

Post-acute sequelae of Coronavirus (PASC), or Long COVID, has emerged as a critical health concern. The clinical manifestations of PASC have been described, but studies have not quantified the cardiopulmonary effects. The goal of this study was to quantify PASC cardiopulmonary changes among endurance athletes. Endurance athletes were recruited via social media; 45 met inclusion criteria, 32 had PASC and 13 were asymptomatic at 3 months (control). Comprehensive interviews were conducted to assess: cardiopulmonary symptoms at 3 months; quantitative and qualitative changes in cardiovascular endurance; exercise hours per week at baseline and 3 months; and Modified Oslo, Dyspnea, and EQ-5D-5L scales. All collected data was based on self-reported symptoms. Wilcoxon rank sum compared PASC with control to distinguish the effects of PASC vs effects of COVID infection/lockdown. PASC subjects were more likely to be female (Table). The most common 3-month symptoms in PASC were fatigue and shortness of breath. Based on self-reported data, subjects endorsed a median decrease of 27% in cardiopulmonary endurance levels compared with 0% in controls (p = 0.0019). PASC subjects exercised less hours and had worse self-reported health as compared with controls. PASC subjects also had significantly worse Modified Oslo, Dyspnea, and EQ-5D-5L scores. Of the 32 PASC patients, 10 (31%) reported a complete inability to engage in any cardiovascular endurance exercise at 3 months. PASC leads to a significant, quantifiable decrease in cardiopulmonary health and endurance.

Preoperative walking exercise to improve prognosis in patients with supratentorial brain tumours after craniotomy: protocol for a randomised controlled trial

IntroductionCardiopulmonary complications and cognitive impairment following craniotomy have a significantly impact on the general health of individuals with brain tumours. Observational research indicates that engaging in walking is linked to...

Ethanol-induced lung and cardiac right ventricular inflammation and remodeling underlie progression to pulmonary arterial hypertension.

Current research on ethanol-induced cardiovascular anomalies has focused on left ventricular (LV) function and blood pressure. To extend this area of research, we sought to determine whether ethanol-induced alterations in the structure and function of the right cardiac ventricle (RV) and pulmonary artery (PA) lead to pulmonary arterial hypertension (PAH). Two groups of male Sprague-Dawley rats received a balanced liquid diet containing 5% ethanol (w/v) or a pair-fed isocaloric liquid diet for 8 weeks. Weekly echocardiography was conducted to evaluate cardiopulmonary function, and lung and RV tissues were collected for exvivo histological and molecular studies. The ethanol-treated rats exhibited: (1) Elevated mean pulmonary arterial pressure and decreased pulmonary artery acceleration time/ejection time; (2) Pulmonary vascular remodeling comprising intrapulmonary artery medial layer thickening; and (3) RV hypertrophy along with increased RV/LV + septum, RV diameter, RV cardiomyocyte cross-sectional area, and LV mass/body weight ratio. These responses were associated with increased lung and RV pro-inflammatory markers, endothelin-1 (ET-1), TNF-α, and IL-6 levels and higher ET-1,ET-1 type A/B receptor ratio, and downregulation of the cytoprotective protein, bone morphogenetic protein receptor 2 (BMPR2), in the lungs. These findings show that moderate ethanol-induced cardiopulmonary changes underlie progression to PAH via an upregulated proinflammatory ET1-TNFα-IL6 pathway and suppression of the anti-inflammatory BMPR2.

Probiotics may alleviate intestinal damage induced by cardiopulmonary bypass in children.

Intestinal ischaemia-reperfusion injury induced by cardiopulmonary bypass causes intestinal epithelial barrier dysfunction, leading to dysbiosis and bacterial translocation. We conducted a randomized prospective study with 2 objectives: (i) to investigate epithelial barrier dysfunction and bacterial translocation induced by cardiopulmonary bypass and changes in the gut microbiota and (ii) to verify whether probiotics can improve these conditions. Between 2019 and 2020, patients 0-15 years old scheduled to undergo cardiac surgery using cardiopulmonary bypass were enrolled and randomly allocated to 2 groups: the intervention group received probiotics and the control group did not receive probiotics. We analysed the microbiota in faeces and blood, organic acid concentrations in faeces, plasma intestinal fatty acid-binding protein and immunological responses. Eighty-two patients were enrolled in this study. The characteristics of the patients were similar in both groups. The total number of obligate anaerobes was higher in the intervention group than in the control group after postoperative day 7. We identified 4 clusters within the perioperative gut microbiota, and cluster changes showed a corrective effect of probiotics on dysbiosis after postoperative day 7. Organic acid concentrations in faeces, incidence of bacterial translocation, intestinal fatty acid-binding protein levels and immunological responses, except for interleukin -17A, were not markedly different between the 2 groups. Administration of probiotics was able to correct dysbiosis but did not sufficiently alleviate the intestinal damage induced by cardiopulmonary bypass. More effective methods should be examined to prevent disturbances induced by cardiac surgery using cardiopulmonary bypass. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037174 UMIN000035556.

Intraoperative Isoflurane End-Tidal Concentration during Infusion of Fentanyl, Tramadol, or Fentanyl-Tramadol Combination in Cats.

The aim of this study was to evaluate the end-tidal concentration of isoflurane required, clinical parameters, intraoperative antinociceptive effect, and postoperative analgesia in cats undergoing ovariohysterectomy, receiving fentanyl, tramadol, or fentanyl/tramadol. Sixty-six cats in three groups, were premedicated with dexmedetomidine and infused with one of the following treatments: fentanyl, tramadol, or fentanyl/tramadol combination. Anesthesia was induced with alfaxolone and maintained with isoflurane, titrated to keep heart rate, respiratory rate and systolic arterial pressure within target values recorded at endotracheal intubation. An intraoperative cumulative scale was performed. Postoperatively, a short form of the Glasgow Composite Measure Pain Scale Feline was used at 2, 12, and 24 h. The groups were similar for age, weight, dose of dexmedetomidine, and alfaxalone administered. A greater reduction in the end-tidal isoflurane fraction was observed with the combined fentanyl/tramadol infusion than with either fentanyl or tramadol alone. No differences in the end-tidal isoflurane fraction were found between fentanyl or tramadol alone. Hemodynamic stability associated with minimal cardiopulmonary changes, low response to noxious intraoperative stimulation, and low postoperative pain scores were also observed with the fentanyl/tramadol combination. The fentanyl/tramadol combination provided a reduction in the end-tidal isoflurane fraction compared with fentanyl or tramadol alone.

Cardiopulmonary radiographic changes in dogs naturally infected with Dirofilaria immitis

Cardiopulmonary radiographic changes in dogs naturally infected with Dirofilaria immitis

The FXYD1 protein plays a protective role against pulmonary hypertension and arterial remodeling via redox and inflammatory mechanisms.

Pulmonary hypertension (PH) consists of a heterogenous group of diseases that culminate in increased pulmonary arterial pressure and right ventricular (RV) dysfunction. We sought to investigate the role of FXYD1, a small membrane protein that modulates Na+-K+-ATPase function, in the pathophysiology of PH. We mined online transcriptome databases to assess FXYD1 expression in PH. We characterized the effects of FXYD1 knockout (KO) in mice on right and left ventricular (RV and LV) function using echocardiography and measured invasive hemodynamic measurements under normal conditions and after treatment with bleomycin sulfate or chronic hypoxia to induce PH. Using immunohistochemistry, immunoblotting, and functional assays, we examined the effects of FXYD1 KO on pulmonary microvasculature and RV and LV structure and assessed signaling via endothelial nitric oxide synthase (eNOS) and inflammatory pathways. FXYD1 lung expression tended to be lower in samples from patients with idiopathic pulmonary arterial hypertension (IPAH) compared with controls, supporting a potential pathophysiological role. FXYD1 KO mice displayed characteristics of PH including significant increases in pulmonary arterial pressure, increased muscularization of small pulmonary arterioles, and impaired RV systolic function, in addition to LV systolic dysfunction. However, when PH was stimulated with standard models of lung injury-induced PH, there was no exacerbation of disease in FXYD1 KO mice. Both the lungs and left ventricles exhibited elevated nitrosative stress and inflammatory milieu. The absence of FXYD1 in mice results in LV inflammation and cardiopulmonary redox signaling changes that predispose to pathophysiological features of PH, suggesting FXYD1 may be protective.NEW & NOTEWORTHY This is the first study to show that deficiency of the FXYD1 protein is associated with pulmonary hypertension. FXYD1 expression is lower in the lungs of people with idiopathic pulmonary artery hypertension. FXYD1 deficiency results in both left and right ventricular functional impairment. Finally, FXYD1 may endogenously protect the heart from oxidative and inflammatory injury.

Laparoskopik Cerrahi ve Anestezi

Laparoscopic surgery (LS) is superior to conventional laparotomy due to its advantages, such as less trauma, early mobilization, minimal blood loss, less scarring, reduced postoperative pain, shorter postoperative recovery time and hospital stay, and lower mortality and morbidity. Significant hemodynamic, cardiopulmonary, and physiological changes occur in the systems due to increased intra-abdominal pressure and hypercarbia after carbon dioxide insufflation is applied for pneumoperitoneum (PP) during LS. The main goals in anesthesia management are understanding the primary pathophysiology, optimizing functional status and hemodynamics, and managing comorbidities. To minimize the effects and impacts of PP in patients who will undergo LS, as in every patient, comprehensive preoperative evaluation should be carried out by multidisciplinary approach that includes an anesthesiologist and surgeon. Our review emphasizes the importance of pathophysiological and systemic changes during LS performed by applying PP and summarizes the recovery and postoperative complications of anesthesia methods applied in clinical practice. Keywords: Laparoscopic surgeries, pneumoperitoneum, hemodynamic and cardiopulmonary changes, anesthesia

Dose-dependent cardiovascular disorders in a rat model with exacerbated emphysema: Implication of inflammation

Chronic obstructive pulmonary disease (COPD) is currently the third cause of death worldwide. Emphysema is an abnormal enlargement of air spaces in the lungs, with destruction of alveolar parishes. Cardiovascular disorders are the most frequent and serious comorbidities of COPD. Their interconnection is poorly understood but several hypotheses have been proposed, including hyperinflation, oxidative stress, and inflammation. In a rat model with exacerbated elastase (ELA)-induced emphysema that develops heart failure with preserved ejection fraction, our goal is to (1) describe the relationship between exacerbated emphysema and cardiovascular hemodynamic disorders, (2) characterize the inflammation status 24 h and 5 weeks after an exacerbation. The model includes a weekly intra-tracheal instillation of ELA, during four weeks with doses of 4, 6 or 10UI. At week 4, lipopolysaccharide (LPS) was instillated with ELA to mimic an exacerbation and approximate clinical conditions. Experiments were performed 24 hours after the last intra-tracheal instillation (ELA + LPS) and at week 9 just before sacrifice. In vivo, we did a cardiac stress test on metabolic treadmill, whole body plethysmography, echocardiography, arterial pressure, and collected blood samples. Ex vivo, we explanted the heart/lung block to assess pulmonary compliance and histology analyses. We identified a respiratory functional impairment proportional to the dose of elastase instilled. An exercise intolerance appeared after the exacerbation and persisted 5 weeks later. We observed a diastolic dysfunction after the exacerbation and at week 9, with a significantly dose dependent increased E/E’ ratio, correlated with the extent of emphysema. A systolic and diastolic arterial hypertension appeared at week 9, especially in the 10UI elastase group. There was an increased lung compliance and decreased elastance. The characterization of inflammation is under investigation. This ELA-LPS animal model presents a chronic profile of heart failure with preserved ejection fraction linked in a dose-dependent manner to the intensity of the emphysema. Cardiopulmonary changes are accompanied by a reduction in exercise tolerance as well as arterial hypertension. This model seems useful to better understand the mechanisms of cardiac changes induced by emphysema. At length, we aim to develop an inhibition of T1 or T2 inflammation pathway, to determine the part played by this inflammation.

Impact of sternotomy and pericardiotomy on cardiopulmonary haemodynamics in a large animal model.

What is the central question of this study? Invasive cardiovascular instrumentation can occur through closed- or open-chest approaches. To what extent will sternotomy and pericardiotomy affect cardiopulmonary variables? What is the main finding and its importance? Opening of the thorax decreased mean systemic and pulmonary pressures. Left ventricular function improved, but no changes were observed in right ventricular systolic measures. No consensus or recommendation exists regarding instrumentation. Methodological differences risk compromising rigour and reproducibility in preclinical research. Animal models of cardiovascular disease are often evaluated by invasive instrumentation for phenotyping. As no consensus exists, both open- and closed-chest approaches are used, which might compromise rigour and reproducibility in preclinical research. We aimed to quantify the cardiopulmonary changes induced by sternotomy and pericardiotomy in a large animal model. Seven pigs were anaesthetized, mechanically ventilated and evaluated by right heart catheterization and bi-ventricular pressure-volume loop recordings at baseline and after sternotomy and pericardiotomy. Data were compared by ANOVA or the Friedmann test where appropriate, with post-hoc analyses to control for multiple comparisons. Sternotomy and pericardiotomy caused reductions in mean systemic (-12±11mmHg, P=0.027) and pulmonary pressures (-4±3mmHg, P=0.006) and airway pressures. Cardiac output decreased non-significantly (-1329±1762ml/min, P=0.052). Left ventricular afterload decreased, with an increase in ejection fraction (+9±7%, P=0.027) and coupling. No changes were observed in right ventricular systolic function or arterial blood gases. In conclusion, open- versus closed-chest approaches to invasive cardiovascular phenotyping cause a systematic difference in key haemodynamic variables. Researchers should adopt the most appropriate approach to ensure rigour and reproducibility in preclinical cardiovascular research.

Associations of hemolysis and anemia with cardiopulmonary dysfunction in an adult sickle cell disease cohort

BackgroundHemolysis contributes to the anemia of sickle cell disease (SCD). Hemolysis and anemia are distinct but inter-related pathophysiological processes that underlie end-organ dysfunction in this condition. We hypothesized that real-world medical tests would reveal distinct contributions of hemolysis and anemia to certain cardiopulmonary changes in adults with SCD. MethodsWe assessed laboratory and clinical tests of cardiopulmonary function obtained during routine delivery of care in 442 adult SCD patients. We characterized hemolysis by the first principal component (PC1) of reticulocyte percent, lactate dehydrogenase (LDH), aspartate amino transferase (AST) and total bilirubin- the hemolytic component. The relationships of hemoglobin concentration and hemolysis to organ dysfunction were analyzed by multiple regression and path analysis to identify independent associations. ResultsDegree of hemolysis and degree of anemia both associated independently with elevated values for left atrial diameter (LAD) and left ventricular end-diastolic diameter (LVED), and with lower percent predicted forced expiratory volume in first second (FEV1). Degree of hemolysis, but not anemia, associated independently with low values for oxygen saturation, forced vital capacity (FVC), and total lung capacity (TLC)]. Path analysis reinforced the trend by multiple regression for association of both degree of hemolysis and anemia with elevated TRV but not with lower diastolic blood pressure. DiscussionAnalysis of real-world clinical tests suggest that, although they are inter-related, the degrees of hemolysis and of anemia make independent contributions to cardiopulmonary dysfunction and that treatments that specifically target both aspects of sickle cell disease may be of maximal benefit.

Effects of Retroperitoneal or Transperitoneal Pneumoperitoneum on Inferior Vena Cava Hemodynamics and Cardiopulmonary Function: A Prospective Real-Time Comparison.

Objective: To evaluate the effects of CO2 pneumoperitoneum on venous hemodynamics and cardiopulmonary function during transperitoneal or retroperitoneal laparoscopic surgery. Materials and Methods: A single-institution prospective study. Forty-three patients with renal-cell carcinoma undergoing retroperitoneal (22) or transperitoneal (21) laparoscopic partial nephrectomy were enrolled. Hemodynamic functions were monitored by minimally invasive FloTrac/Vigileo system. Transesophageal echocardiography was used to measure the diameter and blood flow of the inferior vena cava (IVC). Measured parameters were recorded at baseline, 10, 30, 60 minutes following insufflation to 14 mm Hg and 10 minutes following desufflation. Results: For hemodynamic changes in the transperitoneal laparoscopic surgery (TPL) and retroperitoneal laparoscopic surgery (RPL), transperitoneal CO2 insufflation resulted in a rapid parallel increase in central intravenous pressure (CVP), peak airway pressure (AWP), and IVC blood flow velocity after the first 30 minutes of pneumoperitoneum (p < 0.05). In contrast, CVP, AWP, and IVC blood flow velocity increased progressively in RPL. The variation of those parameters was significantly lower than that of TRL (p < 0.001; p = 0.002; p = 0.004). The mean maximum CVP in the two groups was 20 and 16 mm Hg, respectively. The IVC diameter at the cavoatrial junction was significantly reduced in TPL after 10 minutes of insufflation, but it remained unchanged in RPL throughout the surgery. For cardiopulmonary function changes, heart output decreased after a short period of pneumoperitoneum, but no statistical differences were observed between the two groups. The increments of partial pressure of arterial carbon dioxide and end-tidal carbon dioxide tension were significantly higher in RPL than TPL (p < 0.001; p < 0.001). Conclusions: Compared with retroperitoneal pneumoperitoneum, transperitoneal pneumoperitoneum has significant effects on IVC hemodynamics. Elevated intra-abdominal pressure (IAP) causes higher AWP and venous return resistance, which lead to the significant increase of CVP during transperitoneal approach. Adjusting the balance between IAP and CVP might be an effective way to control intravenous bleeding. Clinical Trial Registry: Registration number: ChiCTR2000038291.

Assessment of the right ventricular-pulmonary circulation unit during stress in ankylosing spondylitis and psoriatic arthritis patients

Abstract Background Cardiopulmonary complications are common in ankylosing spondylitis (AS) and arthritis psoriatica (APs), which have an unfavourable impact on mortality and quality of life. APs may be connected with pulmonary hypertension, while AS is linked to interstitial lung disease and chest wall restriction. We aimed to assess the response of the pulmonary circulation unit during stress in AS and APs patients. Methods A total of 71 patients were enrolled in the study: 28 of them had AS (age 50.8±11.8 years), 17 APs (age 52.1±13.5 years), and 26 were healthy individuals (age 54.23±9.9 years). To the maximally tolerated workload, all subjects underwent resting and exercise stress echocardiography on a supine bicycle ergometer. Echocardiographic measurements were taken at rest, at 50 watts workload, and at maximal exercise. Results AS patients had significantly higher pulmonary artery systolic pressure (PASP; AS: 32.6±16.8 mmHg, APs: 21.6±12.7 mmHg, p&amp;lt;0.05) and pulmonary vascular resistance (PVR; AS: 1.3±0.4 WU, PsA: 1.1±0.3 WU, p&amp;lt;0.05) at maximal workload, while the right ventricular-pulmonary arterial (RV-PA) coupling at peak stress was higher in APs patients (AS: 1.2±0.6 mm/mmHg, PsA: 1.8±1.1 mm/mmHg, p&amp;lt;0.05). Comparing to the control group, AS and PsA patients had significantly higher resting PASP (control: 12.6±6.4 mmHg; AS: 22.8±7.6 mmHg, p&amp;lt;0.001; PsA: 21.4±7.0 mmHg, p&amp;lt;0.001), lower resting RV-PA coupling (control: 2.7±1.4 mm/mmHg; AS: 1.3±0.4, p&amp;lt;0.001; PsA 1.3±0.4 mm/mmHg, p&amp;lt;0.001), and higher peak PVR (control: 0.6±0.4 WU; AS: 1.3±0.4, p&amp;lt;0.001; PsA: 1.1±0.3 WU, p&amp;lt;0.005). One-way analysis of variance of the three groups also showed significant differencies in the resting PASP (p&amp;lt;0.001), peak PASP (p&amp;lt;0.05), resting RV-PA coupling (p&amp;lt;0.001), peak PVR (p&amp;lt;0.001). Conclusion Stress echocardiography is a promising, radiation-free method for assessing the subclinical cardiopulmonary changes among AS and PsA patients. The changes of PVR during stress may highlight the pulmonary complications in the subclinical stage. Funding Acknowledgement Type of funding sources: None.

Post-cardiopulmonary bypass longitudinal strain provides higher prognostic ability than baseline strain or change in strain.

Global longitudinal strain (GLS) measured by speckle-tracking echocardiography demonstrates excellent prognostic ability in predicting major adverse cardiac events after cardiac surgery. However, the optimal timing of intraoperative GLS measurement that provides the best prognostic value is unclear. Our goal was to evaluate whether GLS measured prior to cardiopulmonary bypass (pre-CPB GLS), following CPB (post-CPB GLS), or change in GLS provides the strongest association with postoperative complications. Post hoc analysis of prospectively collected data from a clinical trial (NCT01187329). 72 patients with aortic stenosis undergoing elective AVR ± coronary artery bypass grafting between January 2011 and August 2013. Myocardial deformation analysis from standardized transesophageal echocardiographic examinations were performed after anesthetic induction and chest closure. We evaluated the association between pre-CPB GLS, post-CPB GLS, and change in GLS (percent change from pre-CPB baseline) with postoperative atrial fibrillation and hospitalization >7 days. The association of post-CPB GLS with duration of mechanical ventilation, N-terminal pro-BNP (NT-proBNP) and troponin T were also assessed. Multivariable logistic regression. Risk-adjusted odds (OR[97.5%CI] of prolonged hospitalization increased an estimated 27% (1.27[1.01 to 1.59];Padj =0.035) per 1% decrease in absolute post-CPB GLS. Mean[98.3%CI] NT-proBNP increased 98.4[20 to 177]pg/mL; Padj =0.008), per 1% decrease in post-CPB GLS. Pre-CPB GLS or change in GLS were not associated with any outcomes. Post-CPB GLS provides the best prognostic value in predicting postoperative outcomes. Measuring post-CPB GLS may improve risk stratification and assist in future study design and patient outcome research.

Functional Echocardiographic and Serum Biomarker Changes Following Surgical and Percutaneous Atrial Septal Defect Closure in Children.

BackgroundVentricular performance is temporarily reduced following surgical atrial septal defect closure. Cardiopulmonary bypass and changes in loading conditions are considered important factors, but this phenomenon is incompletely understood. We aim to characterize biventricular performance following surgical and percutaneous atrial septal defect closure and to relate biomarkers to ventricular performance following intervention.Methods and ResultsIn this multicenter prospective study, children scheduled for surgical or percutaneous atrial septal defect closure were included. Subjects were assessed preoperatively, in the second week postintervention (at 2‐weeks follow‐up), and 1‐year postintervention (1‐year follow‐up). At each time point, an echocardiographic study and a panel of biomarkers were obtained. Sixty‐three patients (median age, 4.1 [interquartile range, 3.1–6.1] years) were included. Forty‐three patients underwent surgery. At 2‐weeks follow‐up, right ventricular global longitudinal strain was decreased for the surgical, but not the percutaneous, group (−17.6±4.1 versus −27.1±3.4; P<0.001). A smaller decrease was noted for left ventricular global longitudinal strain at 2‐weeks follow‐up for the surgical group (surgical versus percutaneous, −18.6±3.2 versus −20.2±2.4; P=0.040). At 1‐year follow‐up, left ventricular performance returned to baseline, whereas right ventricular performance improved, but did not reach preintervention levels. Eight biomarkers relating to cardiovascular and immunological processes differed across study time points. Of these biomarkers, only NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) correlated with less favorable left ventricular global longitudinal strain at 2‐weeks follow‐up.ConclusionsRight, and to a lesser degree left, ventricular performance was reduced early after surgical atrial septal defect closure. Right ventricular performance at 1‐year follow‐up remained below baseline levels. Several biomarkers showed a pattern over time similar to ventricular performance. These biomarkers may provide insight into the processes that affect ventricular function.RegistrationURL: https://www.trialregister.nl/; Unique identifier: NL5129

Cardiopulmonary changes in patients with sickle cell anemia: A systematic review

Cardiopulmonary changes in patients with sickle cell anemia: A systematic review