Changes In Systolic Pressure Research Articles

Longitudinal Blood Pressure Changes and Kidney Function Decline in Persons Without Chronic Kidney Disease: Findings From the MESA Study.

While changes in blood pressure (BP) are independently associated with cardiovascular events, less is known about the association between changes in BP and subsequent changes in renal function in adults with an estimated glomerular filtration rate (eGFR) of >60 ml/min/1.73 m2. The present study included 3,920 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) study who had ≥2 BP measurements during the first 5 years of MESA and had eGFR measurements at both year 5 and 10. Change in BP was estimated as the annualized slope of BP between year 0 and 5 based on linear mixed models (mean number of measurements = 4.0). Participants were then grouped into 1 of 3 categories based on the distribution of systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) change (top 20%, middle 21-79%, bottom 20%). We calculated eGFR from cystatin C (ml/min/1.73 m2), estimated annual change in eGFR (ml/min/1.73 m2/year), and defined rapid kidney function decline as a >30% decrease in eGFR from year 5 to 10. We used multivariable logistic regression adjusting for year 0 demographic and clinical characteristics, including eGFR and BP, to determine associations of BP change with rapid kidney function decline. Median age was 59 [interquartile range (IQR): 52, 67] and median eGFR at year 0 was 95.5 (IQR: 81.7, 105.9) ml/min/1.73 m2. Median SBP at year 0 was 111, 121, and 147 mm Hg for increasing, stable, and decreasing SBP change, respectively. Increasing SBP and widening PP change were each associated with higher odds of rapid kidney function decline compared with stable SBP and PP groups, respectively [odds ratio, OR 1.7 (95% confidence interval, CI 1.3, 2.4) for SBP; OR 1.4 (95% CI 1.1, 1.9) for PP]. Decreasing SBP was associated with rapid kidney function decline after adjusting for all covariates except for year 0 BP [OR 1.4 (95% CI 1.0, 1.8)], but this association was no longer statistically significant after adjustment for year 0 BP. There were no significant associations between DBP change and rapid decline in the fully adjusted models. Similar findings were seen with annual change in eGFR. Increasing SBP and widening PP over time were associated with greater risk for accelerated kidney function decline even at BP levels below established hypertension thresholds.

Changes in pulmonary artery systolic pressure correlate with radiographic severity and peripheral oxygenation in adults with community-acquired pneumonia.

The aim of this prospective observational study was to evaluate the relationship between changes in pulmonary artery systolic pressure (ΔPASP) and both severity of community-acquired pneumonia (CAP) and changes in peripheral blood oxygen partial pressure (PaO2 ). Seventy-five consecutive adult patients hospitalized for treatment of CAP were recruited in this single-center cohort study. Doppler echocardiographic measurement of PASP was performed by 2 staff cardiologists. Follow-up assessment was performed within 2 to 4 weeks of ending antibiotic treatment at radiographic resolution of CAP. Fifteen patients were excluded during follow-up due to confirmation of chronic obstructive pulmonary disease. Pneumonia was unilateral in 40 (66.7%) and bilateral in 20 (33.3%) patients. Radiographic extent of pneumonia involved 2 pulmonary segments in 31 patients (51.7%), 3 to 5 pulmonary segments in 25 (41.7%), and 6 pulmonary segments in 4 patients (6.6%). ΔPASP between hospital admission and follow-up correlated with the number of pulmonary segments involved (Rho = 0.953; P < .001) and PaO2 (Rho = -0.667; P < .001). The maximum PASP was greater during pneumonia than after resolution (34.82 ± 3.96 vs. 22.67 ± 4.04, P < .001). Changes in PASP strongly correlated with radiological severity of CAP and PaO2 . During pneumonia, PASP appeared increased without significant change in left ventricular filling pressures. This suggests that disease-related changes in lung tissue caused by pneumonia may easily and reproducibly be assessed using conventional noninvasive bedside diagnostics such as echocardiography and arterial blood gas analysis.

Hypotension During Haemodialysis: Aetiology, Risk Factors and Outcome

Background: Hypotension during hemodialysis is common. In some patients, the development of hypotension necessitates intravenous fluid replacement before patients are able to safely leave the dialysis unit. Intradialytic hypotension may reduce the efficacy of the dialysis procedure and contributes to the excessive morbidity and mortality that is associated with hemodialysis.Aims: The aim of the study is to identify the patients who develops intradialytic hypotension and find out the aetiology, risk factors and outcome to reduce the mortality and morbidity of those patients.Methodology: This Cross sectional descriptive type of observational study was conducted in the Haemodialysis Unit of Anwer Khan Modern Medical College Hospital over the period from January 2015 to December 2016. The change in systolic pressure during haemodialysis was reviewed for ten consecutive haemodialysis in all the patients. The patients with chronic renal failure who were on regular dialysis were enrolled. Patients with sepsis, hemoglobin level less than 9 g/dL, low cardiac output, acute coronary syndrome, significant valvular lesion or body weight below the dry weight of the patient were excluded from the study.Result: Ninetythree patients were included in the study. Among them male 53(56.98%) and female 40(43.02%) with a M:F ratio was 1.3:1. The mean age of the patients was 53.50±16.82 (Range 13- 90).We found that 28%(26) of the patients developed intradialytic hypotension at least once in consecutive ten dialysis. Out of them 14 were female and 12 patients were male. All of the patients recovered from the incident after adequate management and stoppage of the ultrafiltrate volume, convert the machine to SLED(Sustained low efficacy dialysis) mode and hold antihypertensive drugs morning dose on the day of haemodialysis and treatment of the cause.Conclusion: As a result of increasing age of the patients receiving hemodialysis and the increasing incidence of diabetic nephropathy, hypotension will become a greater problem in future.Anwer Khan Modern Medical College Journal Vol. 8, No. 2: Jul 2017, P 89-93

Right ventricular function during pharmacological and exercise stress testing in horses

The disproportionate rise of pulmonary artery pressure compared to systemic blood pressure during exercise can lead to detrimental right ventricular remodelling in endurance athletes. Horses may act as an extreme model of these athletic cardiovascular adaptations, as they show a three fold increase in pulmonary pressures during exercise. Right ventricular function was examined in ten healthy horses using post-exercise and pharmacological stress echocardiography in a randomised cross-over design. Exercise testing was performed on a treadmill while pharmacological testing was performed using an atropine-dobutamine infusion.Heart rate, systemic blood pressure and cardiac output during echocardiography were similar post-exercise compared to maximal pharmacological stress. Systolic pulmonary artery pressure was significantly higher during the exercise test (121±15mmHg) and during immediate post-exercise echocardiography (93±10mmHg) compared to maximal pharmacological stress (69±12mmHg). Right ventricular diameters as well as the ratio of systolic right to left ventricular area were higher post-exercise. Right ventricular fractional area change was significantly decreased post-exercise (40.5±6.2%) compared to a significant increase during pharmacological stress echocardiography (72.6±7.3%). Serum cardiac troponin I concentration was significantly higher 2h after the pharmacological test compared to baseline values and post-exercise, although the highest value was found post-exercise in the horse with the highest systolic pulmonary artery pressure and lowest right ventricular fractional area change. Pharmacological stress testing is not recommended in further studies on right ventricular adaptations in athletic horses, as this does not reproduce the effects of exercise.

Próba Valsavy zwiększa czułość składowej przywspółczulnej odruchu spowodowanego odbarczeniem baroreceptorów u młodych zdrowych osób

Introduction. The objective was to verify the hypothesis that change in cardiovagal baroreceptor unload reflex sensitivity occurs between early phase 2 (VM2E) and phase 3 (VM3) of the Valsalva manoeuvre (VM). The study was performed on 29 volunteers between the ages of 25 and 40 (29.3 ± SE 4.0). Material and methods. The experimental scheme was as follows: rest in sitting position, VM in sitting position maintaining an expiratory pressure of 20 mm Hg for 15 seconds, rest in sitting position. Changes in systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured using Finapres. Results. In VM2E and VM3, HR increased (+51.76 ± SE 4.06 beats/min., p < 0.001; +37.77 ± SE 8.65 beats/min., p < 0.0001, respectively) in response to a fall in SBP (–47.55 ± SE 3.95 mmHg, p < 0.001; –29.66 ± SE 2.80 mmHg, p < 0.0001; respectively). Both events of baroreceptor unload have been observed within the very similar range of SBP and HR. Conclusion. The slope of regression relating change in heart rate (DHR) and systolic arterial pressure (DSBP) was significantly higher in VM3 (DHR2 = –1.063 × DSBP2 + 7.0986) than in VM2E (DHR1 = –0.4395 × DSBP2 + 30.862), suggesting the increased baroreceptors’ sensitivity toward SBP fall in VM3 compared to VM2E. VM increases vagal baroreceptor unloads reflex sensitivity.

Long-Term Results of Balloon Pulmonary Valvuloplasty

Background: The purpose of our study was to prove the hypothesis that balloon pulmonary valvuloplasty could effectively reduce valvular gradient ranged 30 to 50 mmHg to less than 30 mmHg in long-term follow-up. Methods: This cross-sectional study was performed on 271 consecutive patients aged 12 to 67 years who suffered from severe pulmonary stenosis who were scheduled for balloon pulmonary valvuloplasty at Shahid Rajaie Heart Center in Tehran between 2003 and 2013. Two years after the procedure, the patients were examined by transthoracic echocardiography and parameters related to pulmonary valve and right ventricular condition were reassessed. Among all 271 patients who were initially included into the survey, 37 patients (13.7%) had pulmonary valve gradient 30 to 50 mmHg that included our final targeted population for assessment. Results: Valvular gradient significantly dropped down from 93.19 ± 39.77 mmHg to 38.78 ± 26.26 (P < 0.001). Among all 271 patients initially assessed, in two patients with valvular gradient less than 30 mmHg, the gradient remained unchanged long-term after procedure. In 37 patients with gradient ranged 30 to 50 mmHg before procedure, the gradient reduced to less than 30 mmHg in 32 patients with an overall rate of 86.5%, but remained in the same range in 4 patients and even increased to higher than 50 mmHg in 2 patients. There was a strong positive relationship between the change in valvular gradient and initial right ventricular systolic pressure (beta = 0.519, P < 0.001). Conclusions: Majority of patients with moderate pulmonic stenosis with gradient of 30 to 50 mmHg benefit from this procedure to achieve gradient less than 30 mmHg in long-term follow-up.

Impact of percutaneous mitral valvuloplasty on left ventricular function in patients with mitral stenosis assessed by 3D echocardiography

BackgroundThe status of intrinsic left ventricular (LV) contractility in patients with isolated rheumatic mitral stenosis (MS) has been debated. The acute changes in loading conditions after percutaneous mitral valvuloplasty (PMV) may affect LV performance. We aimed to examine the acute effects of PMV on LV function and identify factors associated with LV ejection fraction (LVEF) changes, and determinants of long-term events following the procedure. MethodsOne hundred and forty-two patients who underwent PMV for symptomatic rheumatic MS (valve area of 0.99±0.3cm2) were prospectively enrolled. LV volumes and LVEF were measured by three-dimensional (3D) echocardiography. Long-term outcome was a composite endpoint of death, mitral valve (MV) replacement, repeat PMV, new onset of atrial fibrillation, and stroke. ResultsThe mean age was 42.3±12.1years, and 125 patients were women (88%). After PMV, LVEF increased significantly (51.4 vs 56.5%, p<0.001), primary due to a significant increase in LV end-diastolic volume (65.8mL vs 67.9mL, p=0.002), and resultant increase in the stroke volume (33.9mL vs 39.6mL, p<0.001). Changes in cardiac index and systolic pulmonary artery pressure were associated with LVEF changes after PMV. During a mean follow-up period of 30.8months, 28 adverse clinical events were observed. Postprocedural mitral regurgitation, MV area, and mean gradient were independent predictors of composite endpoints. ConclusionsIn patients with rheumatic MS, PMV resulted in a significant improvement in LV end-diastolic volume, stroke volume and consequently increased in LVEF. Changes in cardiac index and systolic pulmonary artery pressure were associated with LVEF changes after PMV. The predictors of long-term adverse events following PMV were post-procedural variables, including mitral regurgitation, valve area, and mean gradient.

The Cardiovascular Effect of Single Injection and Toxicologic Effects of Repetitive 2-Week Intravenous Administration of Activin A/BMP-2 Chimera in Beagle Dog.

This study was performed for the purpose to evaluate the effect of activin A/BMP-2 chimera (AB204) on cardiovascular system and toxicological effect in beagle dogs. When administered AB204 at the dose of 0.32mg/kg via intravenous injection in beagle dogs, there were no changes in systolic, diastolic and mean blood pressure as well as in pulse rate, in addition that there were no differences in ORS complex, PR interval, R-R interval, QT interval and QTcV interval on the electrocardiography. Also, when administered AB204 at the doses of 0.25 and 0.5mg/kg/day via repetitive intravenous injection for 2weeks, it did not cause any significant changes in general symptoms, weight, food intake, ophthalmologic abnormality, urine, hematology, serum biochemistry, organ weight and autopsy values. Therefore, AB204 did not affect cardiovascular functions including blood pressure, pulse rate and ECG, when administered at the dose of ≤0.32mg/kg via single intravenous injection in male beagle dogs. When it was administered at the dose of 0.5mg/kg repetitive intravenous injection for 2weeks, it did not show any toxicity.

Surgical Management of Severe Ischaemic Mitral Regurgitation

Coronary artery bypass graft surgery (CABG) with mitral valve surgery is undisputed in severe ischaemic mitral regurgitation (IMR) treatment, but the controversy is whether mitral valve replacement (MVR) or mitral valvuloplasty (MVP) should be used. Data was collected from 130 cases of severe IMR patients who underwent CABG and MVP or MVR from June 2010 to June 2015 to compare the short-term efficacy of CABG with MVP or MVR in the treatment of severe IMR patients. There were 70 cases in the MVP group and 60 in the MVP group. The postoperative major cardiac cerebral vascular events and left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), and left ventricular end-diastolic diameter (LVEDD) were recorded. Eleven patients died in hospital, the remaining patients were followed up for 12 months; 18 patients died. The cumulative survival rate and the major cardiac cerebrovascular events were not significantly different. There was no significant change in LVEF, but LVEDD, LVESD and systolic pulmonary artery pressure (sPAP) improved significantly, and there was no difference between the groups. In the MVR group, the rate of postoperative moderate or severe mitral regurgitation patients was significantly less than that in the MVP group. The short-term survival rate, reversal of left ventricular remodelling and major cardiac or cerebrovascular events post-CABG combined with MVP were not significantly different to those with CABG combined with MVR in the treatment of severe IMR, but long-term efficacy remains to be observed.

Correlation of Ventricular Arrhythmogenesis with Neuronal Remodeling of Cardiac Postganglionic Parasympathetic Neurons in the Late Stage of Heart Failure after Myocardial Infarction.

Introduction: Ventricular arrhythmia is a major cause of sudden cardiac death in patients with chronic heart failure (CHF). Our recent study demonstrates that N-type Ca2+ currents in intracardiac ganglionic neurons are reduced in the late stage of CHF rats. Rat intracardiac ganglia are divided into the atrioventricular ganglion (AVG) and sinoatrial ganglion. Only AVG nerve terminals innervate the ventricular myocardium. In this study, we tested the correlation of electrical remodeling in AVG neurons with ventricular arrhythmogenesis in CHF rats.Methods and Results: CHF was induced in male Sprague-Dawley rats by surgical ligation of the left coronary artery. The data from 24-h continuous radiotelemetry ECG recording in conscious rats showed that ventricular tachycardia/fibrillation (VT/VF) occurred in 3 and 14-week CHF rats but not 8-week CHF rats. Additionally, as an index for vagal control of ventricular function, changes of left ventricular systolic pressure (LVSP) and the maximum rate of left ventricular pressure rise (LV dP/dtmax) in response to vagal efferent nerve stimulation were blunted in 14-week CHF rats but not 3 or 8-week CHF rats. Results from whole-cell patch clamp recording demonstrated that N-type Ca2+ currents in AVG neurons began to decrease in 8-week CHF rats, and that there was also a significant decrease in 14-week CHF rats. Correlation analysis revealed that N-type Ca2+ currents in AVG neurons negatively correlated with the cumulative duration of VT/VF in 14-week CHF rats, whereas there was no correlation between N-type Ca2+ currents in AVG neurons and the cumulative duration of VT/VF in 3-week CHF.Conclusion: Malignant ventricular arrhythmias mainly occur in the early and late stages of CHF. Electrical remodeling of AVG neurons highly correlates with the occurrence of ventricular arrhythmias in the late stage of CHF.

Monitoring Nilai Kritis Tekanan Sistolik Dan Diastolik Pada Asuhan Keperawatan Gagal Ginjal Kronik Yang Dilakukan Hemodialisis Jenis Arteriovena Shunt Cimino Dan Akses Femoral Cephalica

Abstract: Systolic Pressure, Diastolic, Hemodialysis. Renal function at a more serious stage of the remnants of the metabolism could not be removed from the body, besides that, however, the kidneys can no longer change K / H for Na that resulted in an increase in the amount of potassium that machine that later can be triggered the interruption the heart. Hemodialysis is one of the alternative solutions that can be done when the kidneys experiencing the inability to mengekresikan debris from the remnants of the metabolism of the body. This research aims to clarify the picture changes critical value systolic pressure and diastolic pressure that done arteriovenous Cimino shunt type of hemodialysis and femoral access cephalic nursing nursery on chronic renal failure. This is the explanatory research design research with cross-sectional approach. A sample of this research is to patients with chronic renal failure undergoing hemodialysis which numbered 44 samples with sampling techniques using purposive sampling. This research statistics tests using descriptive test with the level of the significance of 95 %. The results of the study showed that the patients who performed hemodialysis aged candidates are age ≥51 about 59 percent and the age of the youngest 29 years and oldest 77 years, which dominated gender male.57 percent patients who do good hemodialysis AV Shunt or dialysis access Cephalica Femoral most no change in systolic pressure and diastolic pressure or settled.

High-Intensity Interval Cycling Exercise on Wave Reflection and Pulse Wave Velocity.

Kingsley, JD, Tai, YL, Vaughan, J, and Mayo, X. High-intensity interval cycling exercise on wave reflection and pulse wave velocity. J Strength Cond Res 31(5): 1313-1320, 2017-The purpose of this study was to assess the effects of high-intensity exercise on wave reflection and aortic stiffness. Nine young, healthy men (mean ± SD: age: 22 ± 2 years) participated in the study. The high-intensity interval cycling exercise consisted of 3 sets of Wingate Anaerobic Tests (WATs) with 7.5% of bodyweight as resistance and 2 minutes of rest between each set. Measurements were taken at rest and 1 minute after completion of the WATs. Brachial and aortic blood pressures, as well as wave reflection characteristics, were measured through pulse wave analysis. Aortic stiffness was assessed through carotid-femoral pulse wave velocity (cfPWV). A repeated-measures analysis of variance was used to investigate the effects of the WATs on blood pressure and vascular function across time. There was no change in brachial or aortic systolic pressure from rest to recovery. There was a significant (p ≤ 0.05) decrease in brachial diastolic pressure (rest: 73 ± 6 mm Hg; recovery: 67 ± 9 mm Hg) and aortic diastolic pressure (rest: 75 ± 6 mm Hg; recovery: 70 ± 9 mm Hg) from rest to recovery. In addition, there was no significant change in the augmentation index (rest: 111.4 ± 6.5%; recovery: 109.8 ± 5.8%, p = 0.65) from rest to recovery. However, there was a significant (p ≤ 0.05) increase in the augmentation index normalized at 75 b·min (rest: 3.29 ± 9.82; recovery 21.21 ± 10.87) during recovery compared with rest. There was no change in cfPWV (rest: 5.3 ± 0.8 m·s; recovery: 5.7 ± 0.5m·s; p = 0.09) in response to the WAT. These data demonstrate that high-intensity interval cycling exercise with short rest periods has a nonsignificant effect on vascular function.

Impact of acute hypertension transients on diastolic function in patients with heart failure with preserved ejection fraction.

To address the mechanisms responsible for the increase in LV filling pressures induced by acute hypertension transients in patients with heart failure with preserved ejection fraction (HFpEF). Multiple-beat pressure-volume loops were recorded during inferior vena cava occlusion in 39 HFpEF patients and 20 controls during handgrip and atrial pacing. We measured the contribution of relaxation, elastic recoil, and stiffness to instantaneous diastolic pressure using a novel processing method. Fibrosis was quantified from endomyocardial biopsies. HFpEF patients showed higher diastolic pressures and stiffness constant than controls (P < 0.05 for all). As opposed to controls, all intrinsic global diastolic properties were sensitive to acute changes in systolic pressure in the HFpEF group. In fact, the stiffness constant increased by more than 50% during handgrip in HFpEF patients (P < 0.05), tightly related to changes in systolic pressure (fixed-effect = 0.26 mm Hg per mm Hg [95% CI = 0.15-0.37]; P < 0.0001). Incomplete relaxation contributed to increasing pressure before atrial contraction, but changes in end-diastolic pressure was mostly caused by the increase in stiffness. The degree of pressure-sensitivity of stiffness correlated with myocardial collagen volume and crosslinking (R = 0.40 to 0.82 for all). Acute chamber stiffening is the main mechanism responsible for rising late-diastolic pressures when HFpEF patients undergo hypertension transients. This stiffening behaviour is related to impaired dynamic systolic-diastolic interactions and correlates with matrix remodelling. Ventricular-vascular relationships are a promising target in HFpEF and should be taken into account when assessing diastolic function.

Effect of aerobic interval training on the expression of renal CD40 in a rat model with myocardial infarction and its mechanism

To study the effects of aerobic interval training (AIT) on renal cluster of differentiation 40 (CD40) expression in rats with myocardial infarction (MI) and its possible mechanism. Thirty-six rats were randomly divided into three groups (n=12):Sham, MI and MI with AIT (ME) groups. The MI model was established by ligation of the left anterior descending coronary artery. Treadmill training was performed five times a week for 8 weeks (AIT:60 min/day with 10 min of warm-up at 10 m/min and 50 min of exercise at 25 m/min 7 min interspersed with 3 min at 15 m/min). After training, cardiaorenal function and renal tissue remodeling were evaluated. The changes of CD40, high-sensitivity C reactive protein(hs-CRP), TNF-α, IL-6, p-NF-κBp65, blood urea nitrogen (BUN) and serum creatinine (sCr) were determined. Compared with the sham group, MI significantly increased left ventricular end-diastolic pressure (LVEDP) and decreased left ventricular systolic pressure (LVSP) and left indoor pressure change rate peak (dp/dtmax) in the MI group, concomitant with the increase in renal collagen volume fraction (CVF), which was reversed by AIT in the ME group. Moreover, compared with the sham group, CD40 was largely dispersed within the cytoplasm of renal tubule cells in the MI group. Meanwhile, the expressions of renal CD40 mRNA and protein, the levels of serum and renal hs-CRP, TNF-α and IL-6, the phosphorylation of NF-κBp65 (p-NF-κBp65) and the levels of sCr and BUN were obviously increased in the MI group. Compared with the MI group, AIT decreased the expressions of renal CD40 mRNA and protein, the levels of serum and renal hs-CRP, TNF-α and IL-6 and the expression of p-NF-κBp65, as well as decreased the levels of sCr and BUN in the ME group. AIT reduces the expressions of renal CD40 protein and mRNA, inhibits NF-κB signaling pathway, and then decreases the levels of inflammatory factors thereby improve the renal dysfunction after MI.

Safety of catheter-directed thrombolysis for massive and submassive pulmonary embolism: Results of a multicenter registry and meta-analysis.

To evaluate the safety and efficacy of catheter-directed thrombolysis (CDT) in the treatment of acute pulmonary embolism (PE). The use of CDT for the treatment of acute submassive and massive PE is increasing in frequency. However, its safety and efficacy have not been well elucidated. This study is made of two parts: one is a two-center registry of acute PE patients treated with CDT. The safety outcome evaluated was any major complication including fatal, intracranial (ICH), intraocular, or retroperitoneal hemorrhage or any overt bleeding requiring transfusion or surgical repair. The efficacy outcome was acute change in invasive pulmonary artery systolic pressure (PASP). The second part is a meta-analysis of all contemporary studies that used CDT for PE. Reported outcomes are the same as in the registry, with the addition of right ventricular to left ventricular (RV/LV) ratio change. In the registry, 137 patients were included (age 59 ± 15, 50% male, 88% submassive PE). ICH occurred in two patients and major complications in 13 (9.4%). PASP decreased post procedure by 19 ± 15 mm Hg (95% CI 16-23). In the meta-analysis, 16 studies were included with 860 patients. Rate of ICH was 0.35% and the major complication rate was 4.65%, most requiring transfusion only. In-hospital mortality was 12.9% in the massive and 0.74% in the submassive group. All studies showed improvement in PASP and/or RV/LV ratio post CDT. CDT is associated with a low major complication rate. Randomized studies are needed to evaluate its efficacy relative to anticoagulation alone. © 2017 Wiley Periodicals, Inc.

Immediate increase of cardiac output after percutaneous mitral valve repair (PMVR) determined by echocardiographic and invasive parameters: Patzelt: Increase of cardiac output after PMVR

BackgroundSuccessful percutaneous mitral valve repair (PMVR) in patients with severe mitral regurgitation (MR) causes changes in hemodynamics. Echocardiographic calculation of cardiac output (CO) has not been evaluated in the setting of PMVR, so far. Here we evaluated hemodynamics before and after PMVR with the MitraClip system using pulmonary artery catheterization, transthoracic (TTE) and transesophageal (TEE) echocardiography. Methods101 patients with severe MR not eligible for conventional surgery underwent PMVR. Hemodynamic parameters were determined during and after the intervention. We evaluated changes in CO and pulmonary artery systolic pressure before and after PMVR. CO was determined with invasive parameters using the Fick method (COi) and by a combination of TTE and TEE (COe). ResultsAll patients had successful clip implantation, which was associated with increased COi (from 4.6±1.4l/min to 5.4±1.6l/min, p<0.001). Furthermore, pulmonary artery systolic pressure (PASP) showed a significant decrease after PMVR (47.6±16.1 before, 44.7±15.5mmHg after, p=0.01). In accordance with invasive measurements, COe increased significantly (COe from 4.3±1.7l/min to 4.8±1.7l/min, p=0.003). Comparing both methods to calculate CO, we observed good agreement between COi and COe using Bland Altman plots. ConclusionsCO increased significantly after PMVR as determined by echocardiography based and invasive calculation of hemodynamics during PMVR. COe shows good agreement with COi before and after the intervention and, thus, represents a potential non-invasive method to determine CO in patients with MR not accessible by conventional surgery.

Algorithm-based arterial blood sampling recognition increasing safety in point-of-care diagnostics.

AIMTo detect blood withdrawal for patients with arterial blood pressure monitoring to increase patient safety and provide better sample dating.METHODSBlood pressure information obtained from a patient monitor was fed as a real-time data stream to an experimental medical framework. This framework was connected to an analytical application which observes changes in systolic, diastolic and mean pressure to determine anomalies in the continuous data stream. Detection was based on an increased mean blood pressure caused by the closing of the withdrawal three-way tap and an absence of systolic and diastolic measurements during this manipulation. For evaluation of the proposed algorithm, measured data from animal studies in healthy pigs were used.RESULTSUsing this novel approach for processing real-time measurement data of arterial pressure monitoring, the exact time of blood withdrawal could be successfully detected retrospectively and in real-time. The algorithm was able to detect 422 of 434 (97%) blood withdrawals for blood gas analysis in the retrospective analysis of 7 study trials. Additionally, 64 sampling events for other procedures like laboratory and activated clotting time analyses were detected. The proposed algorithm achieved a sensitivity of 0.97, a precision of 0.96 and an F1 score of 0.97.CONCLUSIONArterial blood pressure monitoring data can be used to perform an accurate identification of individual blood samplings in order to reduce sample mix-ups and thereby increase patient safety.

Investigation of the elderly’s response to winter temperature steps in severe cold area of China

Twelve seniors were enrolled in the two-day observatory experiment which was carried out in winter (January 2016) of Qiqihaer, Harbin. Their subjective responses including thermal perceptions and discomforts were recorded by questionnaires. Besides, blood pressure was also monitored before and after temperature steps. Results show that cold hands or feet, accelerated heart rate, runny or stuffy nose and shivering are sensitive self-reported symptoms in response to temperature step changes. Thermal sensation and comfort witnessed significantly changes under sudden heating or cooling. Even short temperature alteration also led to rapid and remarkable changes in both systolic and diastolic pressures.

Pulmonary hypertension and vascular remodeling in mice exposed to crystalline silica.

BackgroundOccupational and environmental exposure to crystalline silica may lead to the development of silicosis, which is characterized by inflammation and progressive fibrosis. A substantial number of patients diagnosed with silicosis develop pulmonary hypertension. Pulmonary hypertension associated with silicosis and with related restrictive lung diseases significantly reduces survival in affected subjects. An animal model of silicosis has been described previously however, the magnitude of vascular remodeling and hemodynamic effects of inhaled silica are largely unknown. Considering the importance of such information, this study investigated whether mice exposed to silica develop pulmonary hypertension and vascular remodeling.MethodsC57BL6 mice were intratracheally injected with either saline or crystalline silica at doses 0.2 g/kg, 0.3 g/kg and 0.4 g/kg and then studied at day 28 post-exposure. Pulmonary hypertension was characterized by changes in right ventricular systolic pressure and lung histopathology.ResultsMice exposed to saline showed normal lung histology and hemodynamic parameters while mice exposed to silica showed increased right ventricular systolic pressure and marked lung pathology characterized by a granulomatous inflammatory reaction and increased collagen deposition. Silica-exposed mice also showed signs of vascular remodeling with pulmonary artery muscularization, vascular occlusion, and medial thickening. The expression of pro-inflammatory genes such as TNF-α and MCP-1 was significantly upregulated as well as the expression of the pro-remodeling genes collagen type I, fibronectin and the metalloproteinases MMP-2 and TIMP-1. On the other hand, the expression of several vasculature specific genes involved in the regulation of endothelial function was significantly attenuated.ConclusionsWe characterized a new animal model of pulmonary hypertension secondary to pulmonary fibrosis induced by crystalline silica. Our data suggest that silica promotes the damage of the pulmonary vasculature through mechanisms that might involve endothelial dysfunction, inflammation, and vascular remodeling.

Patent ductus arteriosus with persistent pulmonary artery hypertension after transcatheter closure.

ObjectivesTo observe the change in pulmonary artery systolic pressure (PASP) of patients with persistent pulmonary arterial hypertension (PAH) after patent ductus arteriosus (PDA) occlusion.BackgroundAfter occlusion of PDA in patients with PAH, some patients still tend to suffer from persistent PAH.MethodsA chest X-ray, an electrocardiogram, and an echocardiogram were performed on nine patients at 24 hours, 1 and 6 months, and 1 year serially.ResultsThere was a significant fall (P<0.05) in mean PASP after occlusion (to 59.3±12.7 mmHg). However, the aortic pressure and systemic arterial oxygen saturation changed slightly (P>0.05). During the follow up, there was a further fall in the PASP in five patients (No 1, 5, 6, 7, and 8). Four patients (No 2, 3, 4, and 8) showed the evidence of worsening PAH and were treated with sildenafil. Patient 2 died from acute right heart failure after a period of 11 months from the time of transcatheter closure, triggered by pulmonary infection.ConclusionSome patients with borderline hemodynamic data with PDA and PAH can deteriorate or keep sustained PAH after PDA closure. The treatment of permanent closure to these patients must be cautious.