Changes In Vascular Resistance Research Articles

The photoplethysmographic amplitude to pulse pressure ratio can track sudden changes in vascular compliance and resistance during liver graft reperfusion: A beat-to-beat analysis.

During liver transplantation, the thermodilution cardiac output (CO) technique cannot respond to sudden hemodynamic changes associated with postreperfusion syndrome. Photoplethysmography (PPG) can reflect changes in intravascular volume and thus can be used to assess vasomotor tone and arterial stiffness on the pressure–volume relation. We investigated whether a beat-to-beat analysis of the arterial pressure–PPG relationship can estimate dynamic changes in vascular characteristics immediately after liver graft reperfusion.In 10 recipients, arterial blood pressure and PPG waveforms recorded simultaneously were analyzed from the beginning of fall to nadir in systolic blood pressure immediately after reperfusion. On a beat-to-beat basis, we compared the ratio of the amplitude of PPG to arterial pulse pressure (PPGamp/PP, as relative vascular compliance) to total peripheral resistance (TPR) and Windkessel compliance (Cwk) obtained from the Modelflow CO algorithm.Following graft reperfusion, PPGamp/PP and Cwk increased (median 41.5%; P = .005 and 42.0%; P < .001, respectively), whereas TPR decreased (median −46.4%; P < .001). Beat-to-beat PPGamp/PP was negatively correlated with TPR (median r = –0.80 [95% CI –0.85 to –0.76] on linear regression and r2 = 0.84 [95% CI 0.73–0.92] on curvilinear regression), and was positively correlated with Cwk (median r = 0.86 [95% CI 0.81–0.91] on linear regression and r2 = 0.88 [95% CI 0.75–0.96] on curvilinear regression).Our results suggest that relative compliance, obtained from beat-to-beat analysis of PPG and arterial pressure waveforms, can track abrupt changes in vascular characteristics associated with postreperfusion syndrome. This simple index would contribute to differential diagnoses of sudden hypotension.

New indices from microneurography to investigate the arterial baroreflex.

Baroreflex‐mediated changes in heart rate and vascular resistance in response to variations in blood pressure are critical to maintain homeostasis. We aimed to develop time domain analysis methods to complement existing cross‐spectral techniques in the investigation of the vascular resistance baroreflex response to orthostatic stress. A secondary goal was to apply these methods to distinguish between levels of orthostatic tolerance using baseline data. Eleven healthy, normotensive males participated in a graded lower body negative pressure protocol. Within individual neurogenic baroreflex cycles, the amount of muscle sympathetic nerve activity (MSNA), the diastolic pressure stimulus and response amplitudes, diastolic pressure to MSNA burst stimulus and response times, as well as the stimulus and response slopes between diastolic pressure and MSNA were computed. Coherence, gain, and frequency of highest coherence between systolic/diastolic arterial pressure (SAP/DAP) and RR‐interval time series were also computed. The number of MSNA bursts per low‐frequency cycle increased from 2.55 ± 0.68 at baseline to 5.44 ± 1.56 at −40 mmHg of LBNP. Stimulus time decreased (3.21 ± 1.48–1.46 ± 0.43 sec), as did response time (3.47 ± 0.86–2.37 ± 0.27 sec). At baseline, DAP‐RR coherence, DAP‐RR gain, and the time delay between decreases in DAP and MSNA bursts were higher in participants who experienced symptoms of presyncope. Results clarified the role of different branches of the baroreflex loop, and suggested functional adaptation of neuronal pathways to orthostatic stress.

Effects of Warm up and Cool Down on Wingate Anaerobic Power Test Hemodynamics

The impact of warm-up (WU) and cool down (CD) on systemic vascular resistance (SVR[dyn.s/cm]) relative to high intensity exercise is limited. SVR (mean arterial pressure – central venous pressure ÷ cardiac output [CO]) is an index of change in vascular resistance of individual vascular beds and provides insight into local hemodynamic (H) function. PURPOSE: The purpose was to examine the effects of a WU and CD on power output and the cardiovascular (CV)/H response to the Wingate Anaerobic Power Test (WAPT). METHODS: Following familiarization with impedance cardiography and the WAPT, 20 subjects (21.9 ± 2.7 yr, 170.7 ± 10 cm, body mass 70.5 ± 10.9 kg, 7 ♂) were randomly assigned in a crossover design to the following trials: WU & CD (C1), WU & no CD (C2), no WU, but CD (C3), and no WU & no CD (C4) with 48 hours between trials. Both WU and CD were 3 min cycling @ 50 rpm @ 50 watts. No WU or no CD required 3 minutes of seated rest. All measures were monitored continuously until 5 min post-test. Blood pressure was measured immediately post exercise. RESULTS: Statistical analysis by ANOVA with repeated measures (p<.05) of combined data of WU trials (C1 & C2) vs no WU trials (C3 & C4) reveals a significant difference (p<.05) pre-WAPT between HR 102 vs 84 b/min, SV 95 vs 83 mL/b, CO 9.8 vs 7.0 L/min, and SVR 681 vs 950 dyn.s/cm, respectively. Combined data of CD trials (C1 & C3) vs no CD (C2 & C4) post-WAPT reveals significant differences (p<.05) in HR 141 vs 130 b/min, CO 16.0 vs 14.4 L/min, and SVR 415 vs 469 dyn.s/cm. SV of 114 vs 111 mL/b was not significantly different. No differences were found between trials performing the same type of WU or CD. Peak power and average power of all trials were 1131 ± 308 W and 583 ± 120 W with NSD among trials. CONCLUSION: Our data indicate that WU had no impact on Wingate Anaerobic Power Test performance. The differences in SV and HR were anticipated because of the protocol used with active and passive WU and CDs. The marked reduction in SVR of 39% from WU prior to WAPT substantiates improved local peripheral hemodynamic function and confirms the opportunity for improved metabolic exchange for a highly demanding anaerobic activity. The benefit of CD following intense exercise is demonstrated with a prolonged attenuation of SVR, which may enhance recovery.

Haemodynamic changes with paracetamol in critically-ill children

PurposeParacetamol has been associated with a reduction in blood pressure, especially in febrile, critically-ill adults. We hypothesised that blood pressure would fall following administration of paracetamol in critically-ill children and this effect would be greater during fever and among children with a high body surface area to weight ratio. MethodsA 12-month prospective observational study of children (0–16years) admitted to paediatric intensive care, who underwent pulse contour analysis and received paracetamol concurrently. ResultsMean arterial blood pressure decreased significantly by 4.7% from baseline (95% CI 1.75–8.07%) in 31 children following 148 doses of paracetamol. The nadir was 2-hour post-dose. The effect was pronounced in children with fever at baseline (6.4%, 95% CI 2.8–10%), although this was not statistically significant. There was no simple relationship between this effect and body surface area to weight ratio. The association between a change in blood pressure and changes in heart rate or measured stroke volume was poor; therefore it was likely that a change in the systemic vascular resistance contributes most to this effect. ConclusionThere is a significant but modest reduction in blood pressure post-paracetamol in critically-ill children. This is likely related to a change in systemic vascular resistance.

Reliability of thermodilution derived cardiac output with different operator characteristics.

Cardiac output (CO) is commonly measured using the thermodilution technique at the time of right heart catheterisation (RHC). However inter-operator variability, and the operator characteristics which may influence that, has not been quantified. Therefore, this study aimed to assess inter-operator variability with the thermodilution technique using a mock circulation loop (MCL) with calibrated flow sensors. Participants were blinded and asked to determine 4 levels of CO using the thermodilution technique, which was compared with the MCL calibrated flow sensors. The MCL was used to randomly generate CO between 3.0 and 7.0L/min through changes in heart rate, contractility and vascular resistance with a RHC inserted through the MCL pulmonary artery. Participant characteristics including gender, specialty, age, height, weight, body-mass index, grip strength and RHC experience were recorded and compared to determine their relationship with CO measurement accuracy. In total, there were 15 participants, made up of consultant cardiologists (6), advanced trainees in cardiology (5) and intensive care consultants (4). The majority (9) had performed 26-100 previous RHCs, while 4 had performed more than 100 RHCs. Compared to the MCL-measured CO, participants overestimated CO using the thermodilution technique with a mean difference of +0.75 ± 0.71L/min. The overall r2 value for actual vs measured CO was 0.85. The difference between MCL and thermodilution derived CO declined significantly with increasing RHC experience (P < 0.001), increasing body mass index (P < 0.001) and decreasing grip strength (P = 0.033). This study demonstrated that the thermodilution technique is a reasonable method to determine CO, and that operator experience was the only participant characteristic related to CO measurement accuracy. Our results suggest that adequate exposure to, and training in, the thermodilution technique is required for clinicians who perform RHC.

Longitudinal changes of ocular blood flow using laser speckle flowgraphy during normal pregnancy.

PurposeInnovative laser speckle flowgraphy (LSFG) enables noninvasive evaluation of retinal microcirculation and the usefulness has been reported in the field of ophthalmology. LSFG has allowed us to measure the real time changes of retinal blood flow without pupillary dilatations and contrast media. Herein, we investigated the change of retinal blood flow in normal pregnant women during gestation using LSFG.MethodsA prospective cohort study was conducted in 53 pregnant women who visited our institution between January, 2013 and July, 2014. Finally, a total of 41 participants without any obstetric complications were available for evaluation. Retinal blood flow was measured with LSFG in a total of 4 times during pregnancy (T1. 11–13 weeks, T2. 19–21 weeks, T3. 28–30 weeks, T4. 34–36 weeks) and mean blur rate (MBR), blowout score (BOS), flow acceleration index (FAI), and resistive index (RI) are analyzed from these measurements. Relations between LSFG parameters and mean arterial blood pressure (MAP) are determined throughout pregnancy.ResultsMBR showed no significant changes throughout pregnancy. BOS showed a tendency to increase in the 3rd trimester. FAI values showed a slight increase from the 1st to 2nd trimester while a significant decrease was noted in the 3rd trimester. RI exhibited no changes between the 1st and 2nd trimesters, values decreased significantly after the 3rd trimester. MAP was positively correlated with BOS, and negatively correlated with FAI and RI.ConclusionThe present study clearly demonstrated that profiles of LSFG parameters demonstrated a decrease of resistance in retinal blood vessels. These changes in indices provide a highly sensitive reflection of physiological changes in vascular resistance due to pregnancy. Thus, LSFG may be useful, as a non-invasive, diagnostic tool to detect pregnancy related disorders such as preeclampsia.

Impact of mild orthostatic stress on aortic-cerebral hemodynamic transmission: insight from the frequency domain.

High cerebral pressure and flow fluctuations could be a risk for future cerebrovascular disease. This study aims to determine whether acute systemic vasoconstriction affects the dynamic pulsatile hemodynamic transmission from the aorta to the brain. We applied a stepwise lower body negative pressure (LBNP) (-10, -20, and -30 mmHg) in 15 young men to induce systemic vasoconstriction. To elucidate the dynamic relationship between the changes in aortic pressure (AoP; estimated from the radial arterial pressure waveforms) and the cerebral blood flow velocity (CBFV) at the middle cerebral artery (via a transcranial Doppler), frequency-domain analysis characterized the beat-to-beat slow oscillation (0.02-0.30 Hz) and the intra-beat rapid change (0.78-9.69 Hz). The systemic vascular resistance gradually and significantly increased throughout the LBNP protocol. In the low-frequency range (LF: 0.07-0.20 Hz) of a slow oscillation, the normalized transfer function gain of the steady-state component (between mean AoP and mean CBFV) remained unchanged, whereas that of the pulsatile component (between pulsatile AoP and pulsatile CBFV) was significantly augmented during -20 and -30 mmHg of LBNP (+28.8% and +32.4% vs. baseline). Furthermore, the relative change in the normalized transfer function gain of the pulsatile component at the LF range correlated with the corresponding change in systemic vascular resistance (r = 0.41, P = 0.005). Regarding the intra-beat analysis, the normalized transfer function gain from AoP to CBFV was not significantly affected by the LBNP stimulation (P = 0.77). Our findings suggest that systemic vasoconstriction deteriorates the dampening effect on the pulsatile hemodynamics toward the brain, particularly in slow oscillations (e.g., 0.07-0.20 Hz).NEW & NOTEWORTHY We characterized the pulsatile hemodynamic transmission from the heart to the brain by frequency-domain analysis. The low-frequency transmission was augmented with a mild LBNP stimulation partly due to the elevated systemic vascular resistance. A systemic vasoconstriction deteriorates the dampening effect on slow oscillations of pulsatile hemodynamics toward the brain.

How to build a lower-body differential pressure chamber integrated on a tilt-table: A pedagogy tool to demonstrate the cardiovagal baroreflex

The cardiovagal baroreflex is an important physiological reflex that is commonly taught in health-related university physiology courses. This reflex is responsible for the rapid maintenance of blood pressure through dynamic changes in heart rate (HR) and vascular resistance. The use of lower-body negative pressure (LBNP) and lower-body positive pressure (LBPP) can manipulate these stretch sensitive baroreceptors. High performance and relatively inexpensive homemade LBNP and LBPP chambers can be easily constructed providing a valuable tool for both research and teaching purposes. There has been previous documentation of how to build a LBNP chamber; however, the information available usually lacks appropriate construction details, and there is currently no literature on how to build a chamber that can accommodate both LBNP and LBPP. In addition, a recently developed novel LBNP/LBPP chamber positioned on a 360° tilt-table provided the unique utility of superimposing both LBNP/LBPP and body position as independent or combined stressors to alter central blood volume. The primary purposes of this manuscript are to (1) provide step-by-step instructions on how to build a tilt-table LBNP/LBPP chamber, and (2) demonstrate the effectiveness of a tilt-table LBNP/LBPP chamber to facilitate undergraduate and graduate learning in the laboratory by effectively demonstrating the cardiovagal baroreflex.

Change in maternal cardiac output from preconception to mid-pregnancy is associated with birth weight in healthy pregnancies.

Birth weight (BW) is thought to be determined by maternal health and genetic, nutritional and placental factors, the latter being influenced by anatomical development and perfusion. Maternal cardiovascular changes contribute to uteroplacental perfusion; however, they have not yet been investigated in relation to fetal growth or BW. Our aim was to explore the relationship between maternal cardiovascular adaptation, fetal growth and BW in healthy pregnancies. This was a longitudinal prospective study of women planning to conceive a pregnancy. Maternal cardiac output (CO), cardiac index (CI), pulse-wave velocity, aortic augmentation index, central blood pressure and peripheral vascular resistance were assessed prior to pregnancy and at 6, 23 and 33 weeks' gestation. Fetal growth was assessed using serial ultrasound measurements of biometry. In total, 143 women volunteered to participate and were eligible for study inclusion. A total of 101 women conceived within 18 months and there were 64 live births with normal pregnancy outcome. There were positive correlations between BW and the pregnancy-induced changes in CO (ρ = 0.4, P = 0.004), CI (ρ = 0.3, P = 0.02) and peripheral vascular resistance (ρ = 0.3, P = 0.02). There were significant associations between second-to-third-trimester fetal weight gain and the prepregnancy-to-second-trimester increase in CO (Δ, 0.8 ± 1.2 L/min; ρ = 0.3, P = 0.02) and CI (Δ, 0.4 ± 0.6 L/min/m2 ; ρ = 0.3, P = 0.04) and reduction in aortic augmentation index (Δ, -10 ± 9%; ρ = -0.3, P = 0.04). In healthy pregnancy, incremental changes in maternal CO in early pregnancy are associated with third-trimester fetal growth and BW. It is plausible that this association is causative as the changes predate third-trimester fetal growth and eventual BW. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Fluid mechanical interpretation of changes in cerebral vascular peripheral resistance caused by bypass surgery

Fluid mechanical interpretation of changes in cerebral vascular peripheral resistance caused by bypass surgery

Cerebral oxygenation during changes in vascular resistance and flow in patients on cardiopulmonary bypass - a physiological proof of concept study.

Despite a rise in blood pressure, cerebral oxygenation decreases following phenylephrine administration, and we hypothesised that phenylephrine reduces cerebral oxygenation by activating cerebral α1 receptors. We studied patients on cardiopulmonary bypass during constant flow. Phenylephrine raised mean arterial pressure (α1 -mediated) from mean (SD) 69 (8) mmHg to 79 (8) mmHg; p = 0.001, and vasopressin raised mean arterial pressure (V1 mediated) from 69 (8) mmHg to 83 (6) mmHg; p = 0.001. Both drugs elicited a comparable decrease in cerebral oxygenation from 61 (7)% to 60 (7)%; p = 0.023 and 61 (8)% to 59 (8)%; p = 0.022, respectively. This implies that after phenylephrine or vasopressin administration, cerebral oxygenation declines as a result of cerebral vasoconstriction, due to either both cerebral α1 and V1 receptors being equipotentially activated or to an intrinsic myogenic mechanism of cerebral vasculature in reaction to blood pressure elevation.

Determinants of coronary blood flow in sandbar sharks, Carcharhinus plumbeus.

The coronary circulation first appeared in the chordate lineage in cartilaginous fishes where, as in birds and mammals but unlike most teleost fishes, it supplies arterial blood to the entire myocardium. Despite the pivotal position of elasmobranch fishes in the evolution of the coronary circulation, the determinants of coronary blood flow have never been investigated in this group. Elasmobranch fishes are of special interest because of the morphological arrangement of their cardiomyocytes. Unlike teleosts, the majority of the ventricular myocardium in elasmobranch fishes is distant to the venous blood returning to the heart (i.e., the luminal blood). Also, the majority of the myocardium is in close association with the coronary circulation. To determine the relative contribution of the coronary and luminal blood supplies to cardiovascular function in sandbar sharks, Carcharhinus plumbeus, we measured coronary blood flow while manipulating cardiovascular status using acetylcholine and adrenaline. By exploring inter- and intra-individual variation in cardiovascular variables, we show that coronary blood flow is directly related to heart rate (R 2=0.6; P<0.001), as it is in mammalian hearts. Since coronary blood flow is inversely related to coronary resistance both in vivo and in vitro, we suggest that in elasmobranch fishes, changes in heart rate mediate changes in coronary vascular resistance, which adjust coronary blood flow appropriately.

Initial orthostatic hypotension in teenagers and young adults.

ObjectiveTo assess: (1) the frequency of an abnormally large fall in blood pressure (BP) upon standing from supine in patients with initial orthostatic hypotension (IOH); (2) the underlying hemodynamic mechanisms of this fall in BP upon standing from supine and from squatting.MethodsIn a retrospective study of 371 patients (≤30 years) visiting the syncope unit, the hemodynamic response to standing and squatting were studied in 26 patients who were diagnosed clinically with IOH, based on history taking only. In six patients changes in cardiac output (CO) and systemic vascular resistance (SVR) were determined, and the underlying hemodynamics were analyzed.Results15/26 (58 %) patients with IOH had an abnormally large initial fall in systolic BP (≥40 mmHg). There was a large scatter in CO and SVR response after arising from supine [ΔCO at BP nadir median −8 % (range −37, +27 %); ΔSVR at BP nadir median −31 % (range −46, +10 %)]. The hemodynamic response after squatting showed a more consistent pattern, with a fall in SVR in all six patients [ΔCO at BP nadir median +23 % (range −12, +31 %); ΔSVR at BP nadir median −42 %, (range −52, −35 %)].InterpretationThe clinical diagnosis of IOH is based on history taking, as an abnormally large fall in systolic BP can only be documented in 58 %. For IOH upon standing after supine rest, the hemodynamic mechanism can be either a large fall in CO or in SVR. For IOH upon arising from squatting a large fall in SVR is a consistent finding.

PS 08-15 ORAL DOSE OF CAPSAICIN INCREASES BLOOD PRESSURE IN HEALTHY SUBJECTS.

Objective: Capsaicin, the active pungent of spicy foods, is the endogenous ligand of the transient receptor potential cation channel vanilloid subfamily member 1 (TRPV1). Experimental data show that TRPV1 activation leads to vasodilation, water retention and natriuresis - effects that may reduce blood pressure (BP). Recent data found an association between spicy food consumption and improved outcomes, including cardiovascular disease. Capsaicin-induced BP lowering might explain this protective effect. We therefore investigated the BP effects of TRPV1 activation by capsaicin in healthy subjects. Design and Method: In this double blind, randomized, placebo-controlled, cross-over study, participants received either two doses of capsaicin (5.2–6.2 mg, 81.250–97.200 SHU) or matching placebo in random order on two different study days, separated by at least one week. In the 2-hour follow-up after the first dose, BP, heart rate (HR), cardiac output (CO) and systemic vascular resistance index (SVRI) using Omron and NexfinTM and both plasma and urine sodium were repeatedly measured. To challenge osmoregulation, we studied the same parameters for 4 hours after a water loading test (20 mL/kg in 20 minutes) combined with the second dose. Results: We included 12 healthy male subjects (mean age: 23 years). Relative to placebo, 30 min after first capsaicin dose systolic BP significantly increased (after 2 hours: +2.8 ± 1.1 mmHg; p=0.02), but not diastolic BP (Fig 1A). The second capsaicin dose plus water load increased placebo-subtracted diastolic, but not systolic, BP with 4.2 ± 3.6 mmHg after 30 min (p = 0.04). Compared to placebo, capsaicin did affect neither water balance nor natriuresis (Fig 1B,C). Effects on HR, CO and SVRI did not differ from placebo. Conclusions: In healthy subjects, capsaicin increased BP on the short term. We could not identify changes in systemic vascular resistance or water and sodium balance, which were thought to underlie the hypothesized BP effects. Whether long-term capsaicin has similar effects remains to be determined.

Short-Term Angiotensin Subtype 1 Receptor Blockade Does Not Alter the Circulatory Responses to Sympathetic Nervous System Modulation in Healthy Volunteers Before and During Sevoflurane Anesthesia: Results of a Pilot Study

The mechanism of perioperative hypotension in patients taking an angiotensin-receptor blocker up to the time of surgery remains unclear. This study tested the hypothesis that short-term angiotensin-receptor blocker treatment attenuated the sympathetic and vascular responses to autonomic stimuli in volunteers undergoing anesthesia. Randomized, crossover, blinded, pilot design. Zablocki Veterans Affairs Medical Center, Milwaukee, WI. The study comprised 8 male and 6 female healthy, young volunteers (age 23±1.2 years [mean±standard error of the mean]). Volunteers were studied after receiving oral placebo or 50 mg of losartan (angiotensin-receptor blocker) for 3 days before each test day. The effectiveness of angiotensin-receptor blocker treatment was confirmed using the mean arterial blood pressure response to intravenous angiotensin II (1-µg bolus). Eight volunteers underwent direct mean arterial pressure and forearm bloodflow measurements during conscious baseline, a cold pressor test, induction of anesthesia, tracheal intubation, maintenance of anesthesia with 1 minimum alveolar concentration of sevoflurane, and airway irritation with 12% desflurane. Six volunteers experienced mean arterial pressure responses to 0.1 mg of phenylephrine at baseline and during 1 minimum alveolar concentration of sevoflurane. Comparisons were made over time and across groups. Angiotensin-receptor blocker treatment significantly reduced-mean arterial pressure and forearm vascular resistance (forearm blood flow/mean arterial pressure) over time and blocked the mean arterial pressure response to angiotensin-II challenge. The changes in mean arterial pressure and forearm vascular resistance in response to all stressors did not differ between treatments. Mean arterial pressure increases from phenylephrine were preserved. In healthy, young volunteers, sympathetically-mediated responses from the short-term use of an angiotensin-receptor blocker were not altered and most likely did not contribute to perioperative hypotension during the intraoperative period.

Increased Pre- and Post-Meal Free Fatty Acid Levels in Black, Obese Adolescents.

Black adolescents are at increased risk of cardiometabolic disease but have lower fasting triglyceride, which is usually associated with decreased risk. No one has studied racial differences in triglycerides or free fatty acids (FFAs) after a high-fat meal. Oral glucose tolerance testing was used to assess insulin secretion, sensitivity, and disposition index (DI). Endothelial function, triglycerides, FFA, c-reactive protein, interleukin 6 (IL6), and adiponectin were measured both pre- and 3 hr postprandially (McDonald's Big Breakfast(®) and 12 ounce Sprite(®)) in obese adolescents (10-13 years, 9 black and 7 white). Endothelial function was assessed using reactive hyperemic changes in forearm vascular resistance (FVR). Oral glucose tolerance test (OGTT) showed no difference in insulin sensitivity, but blacks tended to have (P = 0.08) higher insulin secretion and had increased DI (P = 0.003). After a high-fat meal, triglycerides increased in both groups (P < 0.001), tended to be lower in blacks compared with whites preprandially (64 ± 33 mg/dL vs 110 ± 80, P = 0.064), and was lower postprandially (112 ± 63 vs 188 ± 112, P = 0.039). Pre- and postprandial FFA (Black: 0.58 ± 0.15 and 0.39 ± 0.18 vs. white: 0.44 ± 0.14 and 0.26 ± 0.06, P = 0.020) and adiponectin (P = 0.002) were increased in blacks. FFA decreased in both groups postprandially (P = 0.002). IL6 increased after the meal (P = 0.022). Endothelial function decreased postprandially (P < 0.02), but this was due to a decrease in preocclusion FVR. These results indicate that differences in fat metabolism are present in both black and white obese adolescents. How these differences explain higher rates of cardiometabolic disease in blacks is unclear.

Pulse oximetry–derived pleth variability index can predict dexmedetomidine-induced changes in blood pressure in spontaneously breathing patients

Study objectiveHypertension or hypotension in patients receiving continuous infusions of dexmedetomidine (DEX) is often due to changes in vascular resistance caused by α2 receptor stimulation. We investigated whether baseline perfusion index (PI) and pleth variability index (PVI), derived from pulse oximetry readings, could predict DEX-induced changes in the hemodynamic status in spontaneously breathing patients. DesignObservational study. SettingOperating room. PatientsPatients (American Society of Anesthesiologists performance status 1 or 2) scheduled to undergo lower extremity or abdominal procedures under regional anesthesia were approached. InterventionsThe PI and PVI were set as baseline upon arrival in theater and were then measured at 2.5-minute intervals. Upon attaining stable hemodynamic status under spontaneous breathing, intravenous administration of DEX was initiated at 6 μg kg−1 h−1 for 10minutes, followed by continuous infusion at 0.6 μg kg−1 h−1. MeasurementsBlood pressure, heart rate, PI, and PVI were measured. Hypertension was defined as an increase in systolic blood pressure (SBP) >15% and hypotension as a decrease in SBP <15% from baseline. Main resultsBaseline PI and PVI correlated with the degree of change in SBP. The maximum percentage increase as well as the maximum percentage of decrease in SBP from baseline correlated with baseline PI (r=0.418 [P=.005] and r=0.507 [P<.001], respectively) and PVI (r=−0.658 [P<.001] and r=−0.438 [P=.003], respectively). PVI <15 identified DEX-induced hypertension (sensitivity 94%, specificity 85%) and PVI >16 identified DEX-induced hypotension (sensitivity 83%, specificity 64%). ConclusionsPVI may predict DEX-induced changes in blood pressure in spontaneously breathing patients.

Prognostic value of TAPSE after therapy optimisation in patients with pulmonary arterial hypertension is independent of the haemodynamic effects of therapy

ObjectiveTo evaluate the prognostic significance of right ventricular function assessed by echocardiography after start or escalation of targeted therapy in patients with pulmonary arterial hypertension.MethodsStudy design: longitudinal study. Setting: tertiary...

Insulin sensitizers prevent fine particulate matter-induced vascular insulin resistance and changes in endothelial progenitor cell homeostasis.

Exposure to fine particular matter (PM2.5) increases the risk of developing cardiovascular disease and Type 2 diabetes. Because blood vessels are sensitive targets of air pollutant exposure, we examined the effects of concentrated ambient PM2.5 (CAP) on vascular insulin sensitivity and circulating levels of endothelial progenitor cells (EPCs), which reflect cardiovascular health. We found that CAP exposure for 9 days decreased insulin-stimulated Akt phosphorylation in the aorta of mice maintained on control diet. This change was accompanied by the induction of IL-1β and increases in the abundance of cleaved IL-18 and p10 subunit of Casp-1, consistent with the activation of the inflammasome pathway. CAP exposure also suppressed circulating levels of EPCs (Flk-1(+)/Sca-1(+) cells), while enhancing the bone marrow abundance of these cells. Although similar changes in vascular insulin signaling and EPC levels were observed in mice fed high-fat diet, CAP exposure did not exacerbate diet-induced changes in vascular insulin resistance or EPC homeostasis. Treatment with an insulin sensitizer, metformin or rosiglitazone, prevented CAP-induced vascular insulin resistance and NF-κB and inflammasome activation and restored peripheral blood and bone marrow EPC levels. These findings suggest that PM2.5 exposure induces diet-independent vascular insulin resistance and inflammation and prevents EPC mobilization, and that this EPC mobilization defect could be mediated by vascular insulin resistance. Impaired vascular insulin sensitivity may be an important mechanism underlying PM2.5-induced vascular injury, and pharmacological sensitization to insulin action could potentially prevent deficits in vascular repair and mitigate vascular inflammation due to exposure to elevated levels of ambient air pollution.

The dicrotic notch analyzed by a numerical model

Divergent concepts on the origin of the dicrotic notch are widespread in medical literature and education. Since most medical textbooks explain the origin of the dicrotic notch as caused by the aortic valve closure itself, this is commonly transmitted in medical physiology courses. We present clinical data and numerical simulations to demonstrate that reflected pressure waves could participate as one of the causes of the dicrotic notch. Our experimental data from continuous arterial pressure measurements from adult patients undergoing vascular surgery suggest that isolated changes in peripheral vascular resistance using an intravenous bolus of phenylephrine (a selective alpha 1-receptor agonist and thus a potent vasoconstrictor) modify the dicrotic notch. We then explore the mechanisms behind this phenomenon by using a numerical model based on integrated axisymmetric Navier-Stokes equations to compute the hemodynamic flow. Our model illustrates clearly how modifications in peripheral artery resistance may result in changes in the amplitude of the dicrotic notch by modifying reflected pressure waves. We believe that this could be a useful tool in teaching medical physiology courses.