Hemodynamic Parameters In Patients Research Articles

Effect of Gradual Mobilization with Bed Activity on Hemodynamic Parameters in Patients Undergoing Sleeve Gastrectomy

Effect of Gradual Mobilization with Bed Activity on Hemodynamic Parameters in Patients Undergoing Sleeve Gastrectomy

Changes in Hemodynamic Parameters in Patients Undergoing TURP and TURBT Due to Additive Intrathecal Clonidine

Changes in Hemodynamic Parameters in Patients Undergoing TURP and TURBT Due to Additive Intrathecal Clonidine

Effect of an Informative Video on Anxiety and Hemodynamic Parameters in Patients Requiring Mandibular Third Molar Extraction: A Randomized Clinical Trial

The purpose was to determine the effect of watching an informative video about mandibular third molar (M3M) removal on patient anxiety and hemodynamic parameters. A randomized controlled clinical trial was carried out in healthy patients (aged between 18 and 40years) requiring M3M extraction under local anesthesia. Patients with previous tooth extractions, psychiatric disorders, or cardiac problems or patients undergoing anxiolytic or antidepressant drug treatment were excluded. Participants were randomized into 2 groups according to whether they watched an informative video about the surgical procedure (video group) or not (control group). The primary outcome variable was the difference between groups regarding patient anxiety assessed with the State-Trait Anxiety Inventory (STAI) and the Modified Dental Anxiety Scale (MDAS). The secondary outcome variables were hemodynamic parameters recorded during different moments of the surgical procedure. Descriptive, bivariate, and multivariate analyses were performed, and a repeated-measures mixed model was generated. Statistical significance was considered for P<.05. Fifty patients referred for M3M extraction met the inclusion criteria. The final data analysis was based on 47 patients: 25 from the video group and 22 controls. The bivariate analysis showed the video group to have a significant decrease in anxiety as measured by the MDAS (P=.006; 95% confidence interval [CI], -4.1 to -0.7) and STAI-State (P=.003; 95% CI, -13.7 to -0.7). A significantly lower heart rate was likewise found in the video group (χ2=4.30, df=1, P=.038). The linear regression analysis adjusting for the STAI-Trait also showed lower dental anxiety measured by the MDAS in the video group (P=.023; 95% CI, 0.32 to 4.14). Providing preoperative information through an informative video about M3M removal significantly reduces patient anxiety and heart rate during the surgical procedure.

Assessment of Leg Massage on Hemodynamic Parameters of Intensive Care Patients: A Parallel Single-Blinded Randomized Controlled Trial

ObjectiveWe aimed to determine the effectiveness of leg massage by a nurse and patients’ families on hemodynamic parameters in patients admitted to intensive care units. MethodsThis parallel single-blinded randomized clinical trial involved 75 patients admitted to the intensive care units at Shahid Bahonar Hospital in Kerman, Iran. Patients were assigned to 3 groups by the minimization method (massage by a nurse, massage by the patient's family, and the control group). Swedish massage was used on both legs (each leg for 5 minutes) once a day for 6 days, and the hemodynamic parameters of patients were measured before intervention, at the end of intervention, and 1 week later. ResultsThe results showed that mean arterial pressure decreased in all 3 groups 1 week after intervention, which was not statistically significant. Mean heart rate also decreased in all 3 groups 1 week after intervention, which was statistically significant except for massage by family. Mean arterial oxygen saturation significantly decreased in all 3 groups 1 week after intervention but remained normal. The 3 hemodynamic parameters did not differ significantly among the 3 groups. ConclusionAccording to the results of this study, the use of massage has no effect on hemodynamic parameters.

Non-invasive assessment of haemodynamic parameters in an Emergency Department

Introduction: Hospital Emergency Departments are places where fractions of a second decide about human life and every possibility of quickly and reliably obtaining additional information about the patient’s condition is extremely important. Therefore, an attempt was made to determine the usefulness of non-invasive assessment of haemodynamic parameters in patients in Emergency Departments. Material and methods: The research was conducted in June and July 2019 in the Emergency Room of the Bielanski Hospital, Jerzy Popieluszko in Warsaw. Non-invasive measurement of haemodynamic parameters was performed with the ICON (Osypka Medical, GmbH) Heart Rate Monitor. The study was conducted among patients of the green part of the Emergency Department. P < 0.05 was adopted as the significance level. Results: One-way non-parametric ANOVA confirmed the existence of statistically significant differences (all p for trend 0.05) between age (p = 0.418), SV (p = 0.161), TFC (p = 0.142), and STR (p = 0.094) and for the four groups according to the reason for reporting to the Emergency Department. In simple linear regression analysis (Spearman), BMI was negatively correlated with CO, ICON, SV, and TFC (all p for trend < 0.05). Age was negatively correlated with CO, ICON, and SV. Conclusions: Due to the diversity of patients and their conditions, non-invasive assessment of haemodynamic parameters can become an invaluable help during the diagnosis and subsequent treatment of Emergency Department patients.

Radiological and hemodynamic parameters in patients with suspected ventricular aneurysm and interventricular septal perforation after acute myocardial infarction: A comparison of non-invasive and invasive diagnostic modalities.

Transthoracic echocardiography is a rapid, sensitive and non-invasive technique for diagnosing ventricular septal perforation. Furthermore, left ventricular angiography is generally used for left ventricular aneurysm but right heart catheterization is the gold standard for septal perforation following myocardial infarction. The objectives of the present study were to compare radiological and hemodynamic diagnostic parameters of non-invasive methods with those of right heart catheterization in patients with suspected ventricular aneurysm and interventricular septal perforation after acute myocardial infarction. Data regarding demographics and clinical characteristics, as well as right heart catheterization, echocardiography and angiographic parameters of 199 patients examined within 21 days after myocardial infarction due to suspected ventricular septal defect indicated by persistent colic pain in the pre-cardiac region were collected and analyzed. Coronary angiography identified 149 (75%) patients with single-vessel disease, 42 (21%) patients with two-vessel disease and 8 (4%) patients with triple-vessel disease. Transthoracic color Doppler echocardiography strengthened the diagnostic performance of right heart catheterization regarding segmental motor abnormalities but underestimated the right atrial pressure, systolic pulmonary artery pressure, mean pulmonary artery pressure and pulmonary capillary wedge pressure compared with right heart catheterization (P<0.0001 for all). Overall, there was no procedural complication requiring emergency intervention, no major complications and no conditions resulting in death due to diagnostic modalities. Transthoracic color Doppler echocardiography may strengthen the diagnostic performance of right heart catheterization regarding radiological measurements but underestimated hemodynamic measurements (level of evidence: 3).

Associations of 2D speckle tracking echocardiography-based right heart deformation parameters and invasively assessed hemodynamic measurements in patients with pulmonary hypertension

BackgroundWe aimed to evaluate associations of right atrial (RA) and right ventricular (RV) strain parameters assessed by 2D speckle tracking echocardiography (2D STE) with invasively measured hemodynamic parameters in patients with and without pulmonary hypertension (PH).MethodsIn this study, we analyzed 78 all-comer patients undergoing invasive hemodynamic assessment by left and right heart catheterization. Standard transthoracic echocardiographic assessment was performed under the same hemodynamic conditions. RA and RV longitudinal strain parameters were analyzed using 2D STE. PH was defined as invasively obtained mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest and was further divided into pre-capillary PH (pulmonary capillary wedge pressure [PCWP] ≤ 15 mmHg), post-capillary PH (PCWP > 15 mmHg) and combined PH (PCWP > 15 mmHg and difference between diastolic PAP and PCWP of ≥7 mmHg). Correlation analyses between variables were calculated with Pearson’s or Spearman’s correlation coefficient as applicable.ResultsOut of 78 patients, 45 presented with PH. Within the PH group, 39 had post-capillary, five had combined pre- and post-capillary PH, and one had pre-capillary PH. Patients with PH had a significantly increased RA area (PH 22.0 ± 9.2 cm2, non-PH 17.3 ± 10.7 cm2; p = 0.003) and end-systolic RV area (PH 14.7 ± 6.1, non-PH 11.9 ± 4.8 cm2; p = 0.022). RV mid strain was significantly reduced in PH (PH -17.4 ± 7.8, non-PH: − 21.6 ± 5.5; p = 0.019). Average peak systolic RA strain (RAS) and average peak systolic RV strain (RVS) showed a significant association with mPAP (r = − 0.470, p = 0.001 and r = 0.490, p = 0.001, respectively) and with PCWP (r = − 0.296, p = 0.048 and r = 0.365, p = 0.015, respectively) in patients with PH. Furthermore, RV apical, mid and basal strain as well as RV free wall strain showed moderate associations with mPAP. In patients without PH, there were no associations detectable between RA or RV strain parameters and mPAP and PCWP.ConclusionIn an all-comer cohort, RA and RV strain parameters showed significant associations with invasively assessed mPAP and PCWP in patients with predominantly post-capillary PH. These associations may be useful in clinical practice to assess the impact of post-capillary PH on myocardial right heart function.

Exercise is feasible in patients receiving vasoactive medication in a cardiac surgical intensive care unit: A prospective observational study

BackgroundPatients may require vasoactive medication after cardiac surgery. The effect and safety profile of exercise on haemodynamic parameters in these patients is unclear. ObjectivesThe objective of this study was to measure the effect of upright positioning and low-level exercise on haemodynamic parameters in patients after cardiac surgery who were receiving vasoactive therapy and to determine the incidence of adverse events. MethodsThis was a prospective, single-centre, observational study conducted in an adult intensive care unit of a tertiary, cardiothoracic university–affiliated hospital in Australia. The Flotrac-Vigileo™ system was used to measure haemodynamic changes, including cardiac output, cardiac index, and stroke volume. Normally distributed variables are presented as n (%) and mean (standard deviation), and non-normally distributed variables are presented as median [interquartile range]. ResultsThere were a total of 20 participants: 16 (80%) male, with a mean age of 65.9 (10.6) years. Upright positioning caused significant increases (p = 0.018) in the mean arterial pressure (MAP), with MAP readings increasing from baseline (supine), from 72.31 (11.91) mmHg to 77.44 (9.55) mmHg when back in supine. There were no clinically significant changes in cardiac output, heart rate, stroke volume, or cardiac index with upright positioning. The incidence of adverse events was low (5%). The adverse event was transient hypotension of low severity. ConclusionsLow-level exercise in patients after cardiac surgery receiving vasoactive medication was well tolerated with a low incidence of adverse events and led to significant increases in MAP. Upright positioning and low-level exercise appeared safe and feasible in this patient cohort.

The relationship between T-wave peak-to-end interval and hemodynamic parameters in patients with pulmonary arterial hypertension.

BackgroundT‐wave peak‐to‐end interval (TPEI) is a measure of repolarization dispersion on surface electrocardiogram (ECG). TPEI has been reported as a prognostic parameter with heart disorders. In this study, we aimed to evaluate the relationship between echocardiogram‐derived right heart parameters, right heart catheterization (RHC) measurements, and TPEI in patients with precapillary pulmonary arterial hypertension (PAH).MethodsThirty‐eight patients (29 females and 9 males, mean age of 54.9 ± 10.9 years) who had undergone RHC for a preliminary diagnosis of pulmonary hypertension (PH) were included in the study. We performed transthoracic echocardiography (TTE), and resting 12‐lead ECG was recorded before RHC. TPEI was measured from leads of V1‐V6, DII, DIII, and aVF, and these values are averaged to obtain the global TPEI.ResultsDuration of TPEI was significantly correlated with mean PAP, pulmonary vascular resistance (PVR), and cardiac index (CI). Longer TPEI was associated with higher N terminal probrain natriuretic peptide (NT pro‐BNP) level, lower 6‐min walk distance (6MWD), and lower tricuspid annular plane systolic excursion (TAPSE).ConclusionProlongation of TPEI could be a new predictor of adverse outcome in PAH and may provide additional prognostic information for patients with PAH.

Comparitive Evaluation of Crystalloid Preload and Crystalloid Coload on Hemodynamic Parameters in Patients Undergoing Elective Cesarean Section under Spinal Anesthesia

Comparitive Evaluation of Crystalloid Preload and Crystalloid Coload on Hemodynamic Parameters in Patients Undergoing Elective Cesarean Section under Spinal Anesthesia

Bupivacaine vs. lidocaine: a comparison of local anesthetic efficacy in impacted third molar surgery.

The aim of this study was to compare the anesthetic efficacy, the duration of anesthesia, and the postoperative analgesia of lidocaine and bupivacaine and to determine any difference in hemodynamic parameters in patients who required impacted third molar removal. Thirty-eight patients between the ages of 18 and 40, with no systemic disease, were included in the study, with an indication of impacted lower third molar extraction. One of two local anesthetic agents (Marcaine and Jetokain Simplex) was randomly selected for tooth extractions. The parameters evaluated were the onset of anesthetic agent action, the duration of operation, the duration of postoperative analgesia, and postoperative visual analog scale scores. Hemodynamic parameters were observed and evaluated preoperatively and during the operation. All data were evaluated statistically. When the time of anesthesia onset was analyzed according to both anesthetic solutions, the difference was in favor of lidocaine (p = 0.01). The duration of action was longer in the bupivacaine group than in the lidocaine group (p = 0.00002). VAS values for the pain obtained during injection were lower in the lidocaine group (p = 0.009).However, according to the results of our study, the postoperative analgesic efficacy of bupivacaine is similar to that of lidocaine (p = 0.087). After evaluation of these results, we can recommend the use of lidocaine and bupivacaine safely in dentistry practice. But long-duration effect of bupivacaine and the rapid effect of lidocaine may make lidocaine more preferable. It is important to determine the clinically effective and safe anesthetic solution.

Invasive Hemodynamic Staging Classification of Cardiac Damage in Patients With Aortic Stenosis Undergoing Valve Replacement

BackgroundAn echocardiographic 5-stage classification of cardiac damage in aortic stenosis (AS) has been shown to provide prognostic information. We aimed to create an analogous classification based on invasive hemodynamics. MethodsWe studied 421 patients (age 75 ± 10 years, 59% men) with severe AS with complete invasive hemodynamics obtained before aortic valve replacement (AVR). Cardiac damage stages were defined as follows: stage 0, absence of any of the following criteria; stage 1, left-ventricular end-diastolic pressure >15 mm Hg; stage 2, mean pulmonary artery wedge pressure > 15 mm Hg; stage 3, pulmonary vascular resistance > 3 Wood units and/or systolic pulmonary artery pressure > 60 mm Hg; stage 4, mean right atrial pressure >15 mm Hg. Patients were hierarchically classified in a given stage (worst stage) if the criterion was met for that stage. ResultsSixty-seven (16%) patients were classified as stage 0, 113 (27%) as stage 1, 151 (36%) as stage 2, 73 (17%) as stage 3, and 17 (4%) as stage 4. After a median (interquartile range) follow-up of 3.8 (2.7 to 5.2) years after AVR, mortality was highest in stage 4 (hazard ratio; 95% confidence interval: 6.17 (1.74-21.89) vs stage 0; P = 0.005 and stage 3 patients (hazard ratio; 95% confidence interval: 4.17 (1.39-12.49) vs stage 0; P = 0.01,whereas mortality did not differ between patients in stages 0 to 2. ConclusionsA staging system of cardiac damage based on invasive hemodynamic parameters in patients with severe AS undergoing AVR predicts mortality. Pulmonary vascular disease and high right-atrial pressure are the major drivers of mortality.

Short-term effects of low-dose tolvaptan in acute decompensated heart failure patients with severe aortic stenosis: The LOHAS registry

BackgroundTolvaptan exerts potent diuretic effects in heart failure patients without hemodynamic instability. Nonetheless, its clinical efficacy for acute decompensated heart failure (ADHF) due to severe aortic stenosis (AS) remains unclear. This study aimed to evaluate the short-term effects of tolvaptan in ADHF patients with severe AS. MethodsThe LOw-Dose Tolvaptan (7.5 mg) in Decompensated Heart Failure Patients with Severe Aortic Stenosis (LOHAS) registry is a multicenter (7 centers) prospective registry that assessed the short-term effects of tolvaptan in subjects hospitalized for ADHF with severe AS. A total of 59 subjects were enrolled between September 2014 and December 2017. The primary endpoints were changes in body weight and fluid balance measured daily from baseline up to 4 days. ResultsThe median [interquartile range] patient age and aortic valve area were 85.0 [81.0–89.0] years and 0.58 [0.42–0.74] cm2, respectively. Body weight continuously decreased, and fluid balance was maintained from baseline to day 4 (p < 0.001, p = 0.194, respectively). Median serum B-type natriuretic peptide concentration significantly decreased from 910.5 to 740.0 pg/mL by day 4 (p = 0.002). However, systolic blood pressure and heart rate were non-significantly changed (p = 0.250, p = 0.656, respectively). Hypernatremia (>150 mEq/L) and worsening renal function occurred in 2 (3.4%) and 4 (6.8%) patients, respectively. ConclusionsShort-term treatment with low-dose tolvaptan is safe and effective, providing stable hemodynamic parameters in patients with ADHF and severe AS.

Comparison of Orotracheal versus Nasotracheal Fiberoptic Intubation Using Hemodynamic Parameters in Patients with Anticipated Difficult Airway.

Background:Both nasal and oral routes can be used for fiberoptic intubation. Often it leads to hemodynamic disturbances, which may have a significant effect in patients with limited cardiopulmonary reserve as well as with cerebrovascular diseases.Aims:The aim of the study was to evaluate whether there is a clinically relevant difference between the circulatory responses to oral and nasal fiberoptic intubation.Settings and Design:This was a prospective, randomized, and comparative study.Materials and Methods:In this study, a total of 90 patients with the American Society of Anesthesiologist physical status I and II of either sex in the age group of 18–60 years and having anticipated difficult airway (DA) posted for elective surgery under general anesthesia were randomly allocated into two groups. Patients underwent fiberoptic intubation via either oral or nasal route under sevoflurane anesthesia with bispectral index guidance. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), time taken to intubation, and need of maneuver were measured.Statistical Analysis Used:All the analyses were carried out on SPSS 16.0 version (Inc., Chicago, USA). Mean and standard deviation were calculated. The test of analysis between two groups was done by unpaired t-test.Results:Demographic and DA characteristics were similar in both the groups. Significantly (P < 0.01) lesser alteration in HR, SBP, DBP, and MAP was seen in oral fiberoptic intubation when compared to nasal fiberoptic intubation in the early phase of postintubation. Time taken to intubation was also significantly (P < 0.01) lesser in the oral route compared to the nasal route.Conclusions:Oral fiberoptic intubation causes less hemodynamic alteration and takes less time in comparison to nasal fiberoptic intubation.

Effect of supra-physiological estrogen level on arterial stiffness and hemodynamic parameters

The present study evaluates the arterial stiffness and hemodynamic parameters in patients with a supraphysiological estrogen level due to in vitro fertilization (IVF) with controlled ovarian hyperstimulation (COH).A total of 82 female patients aged 24-45 years were included. Their arterial stiffness parameters were analyzed before and after the appropriate COH protocol involving arteriography using Mobil-O-Graph NG (IEM GmbH, Stolberg, Germany) 24-hour ambulatory blood pressure monitor.Systolic, diastolic, mean, central systolic, and diastolic blood pressures, as well as peripheral vascular resistance, were significantly lower after COH therapy (p=0.001, 0.002, <0.001, <0.001, 0.040, and <0.001, respectively). In contrast, there was no statistically significant difference observed in heart rate, pulse pressure, or cardiac output. The pulse wave velocity measurement was significantly lower after COH than the baseline levels [5.3 m/s (4.5-6.9 m/s) versus 5.4 m/s (4.7-7.3 m/s,); p<0.001], but the augmentation index was not significantly different [28% (4%-41%) versus 29% (5%-43%); p=0.090]. When the patients were grouped according to the occurrence of a pregnancy after IVF therapy, all parameters were not different between the pregnancy (+) and pregnancy (-) patients (p>0.05).Arterial stiffness and hemodynamic parameters significantly decreased in IVF patients who underwent COH therapy. The long-term clinical significance of this short-term effect should be investigated with prospective studies. There was no significant difference in all parameters before and after COH when the pregnancy (+) and pregnancy (-) patients were compared.

Comparison of fentanil and remifentanil for coronary artery surgery with low ejection fraction.

IntroductionIn this study, we evaluated patient response and haemodynamic parameters in patients with low ejection fraction undergoing coronary bypass surgery with either fentanil or remifentanil in conjunction with etomidate.Material and methodsWe evaluated 30 cases of coronary artery surgery, which were divided into two treatment groups (n = 15 each). In group F (fentanil group), the following regimen was employed for anaesthesia induction: 1 mg/kg lidocaine, 0.3 mg/kg etomidate, and, following a 1 µg/kg 60 s bolus dose of fentanil, a 0.1 µg/kg/min fentanil infusion was initiated, after which 0.6 mg/kg rocuronium was administered. In group R (remifentanil group), the following regimen was employed for anaesthesia induction: 1 mg/kg lidocaine, 0.3 mg/kg etomidate and, following a 1 µg/kg 60 s bolus dose of remifentanil, a 0.1 µg/kg/min remifentanil infusion was initiated, after which 0.6 mg/kg rocuronium was administered. Systolic artery pressure, diastolic artery pressure, mean arterial pressure, heart rate, SPO2 (saturation), cardiac output, stroke volume variance, central venous pressure, and systemic vascular resistance values were recorded for all study patients at five minutes before anaesthetic induction (T1), immediately following induction (T2), and immediately following intubation (T3).ResultsThe demographic values obtained for both groups were similar. We found that remifentanil use was associated with decreased cardiac output and increased fluctuations in both heart rate and mean values of arterial pressure.ConclusionsAlthough many studies have demonstrated remifentanil to be as safe as fentanil when titrated to an appropriate dose, our study suggests that fentanil may be a more appropriate choice during the induction of anaesthesia in patients with a low ejection fraction.

Theoretical models of changes in haemodynamic parameters and gas exchange in univentricular circulation

Aim. To develop theoretical models of changes in haemodynamic parameters of patients with univentricular haemodynamics. Methods. We analysed the effects of redistributing blood flow between the two circulatory systems (pulmonary and systemic) on systemic oxygen delivery and examined changes in the arterial and venous blood gas compositions. Mathematical analyses on the basis of oxygen flow into the pulmonary circulatory system and its consumption during circulation were performed according to Fick principle for cardiac output. Calculations were performed using equations describing changes in the delivery and consumption of oxygen during univentricular circulation. Furthermore, computer simulations were employed to investigate changes in haemodynamic parameters and gas exchange associated with pathological processes such as pulmonary venous hypoxemia, reduction in systemic flow rate and mixed venous blood desaturation. Calculations were performed under conditions with oxygen concentration of &gt;0% or &lt;100%. Results. A number of theoretical models were developed, which described (i) the distribution of systemic and pulmonary blood flow and changes in arterial oxygenation depending on Qp/Qs; (ii) the ratio of systemic blood flow to Qp/Qs; (iii) changes in arterial oxygenation depending on Qp/Qs at different levels of central venous saturation; (iv) changes in pulmonary venous saturation depending on arterial saturation and Qp/Qs under conditions of normal and reduced blood flow; (v) level of central venous saturation depending on changes in Qp/Qs and SpvO2 at systemic SaO2 of 75% and (vi) PaO2 dynamics depending on changes in PpvO2 and Qp/Qs. Conclusion. Changes in the oxygen status of patients with univentricular haemodynamics with sufficient combined cardiac output are indicative of the distribution of blood flow. Assessments of the developed models demonstrated that a number of additional factors affect changes in the oxygen composition of blood including (i) the initial level of arterial oxygenation; (ii) the level of oxygenation in the pulmonary veins and (iii) the ratio of pulmonary to systemic blood flow. In addition, the results indicated that PCO2 recorded in the pulmonary veins, arteries and mixed venous blood largely depends on Qp/Qs. The theoretical models presented here can be used to compare the results of haemodynamic status assessments of patients with univentricular physiology. Received 22 May 2019. Revised 4 November 2019. Accepted 10 November 2019. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

Inhaled Iloprost and Oral Sildenafil Combination Therapy: Is it a Chance for Heart Transplant Candidacy?

Severe pulmonary hypertension is a risk factor for mortality, due to increased postoperative right ventricular failure, in a heart transplant patient. Elevated pulmonary vascular resistance (PVR) in heart transplant candidates can be reduced using a left ventricular assist device or medical therapy. This study analysed the effect of inhaled iloprost and oral sildenafil combination therapy (ilo-sil) on pulmonary haemodynamic parameters in patients with secondary pulmonary hypertension. Between May 2011 and April 2014, 25 patients who were unresponsive to reversibility test and PVR >3.5 Wood units (WU) during right heart catheterisation were included in this study. After 6 months of oral sildenafil (3 × 20 mg/day) and inhaled iloprost (6 × 5 μg/day) combination therapy, second right heart catheterisations were performed and eligibility for heart transplant was evaluated. Repeat right heart catheterisation revealed that there was a significant decrease in the PVR from 5.4± 1.6 WU to 3.54± 2.5 WU (p<0.001), with trans-pulmonary gradient from 13.7± 5.6 to 11.46± 6.64 (p=0.042), and mean cardiac index (CI) increasing non-significantly from 1.45± 0.51 L/min/m2 to 1.82± 0.60 (p=0.157). The mean sPAP was initially 57.54± 14.79 mmHg and fell to 52.93± 16.83 mm Hg (p=0.03). Twenty (20) (80%) patients were enrolled in the waiting list since their PVR values decreased to <3.5 WU. Of these 20 patients, one had undergone heart transplant and four were bridged to transplant with mechanical circulatory support devices. After a decrease in PVR with ilo-sil combination therapy for patients with severe pulmonary hypertension, these patients may become candidates for heart transplant without bearing additional risk. Ilo-sil combination therapy could be a viable option with which to evaluate the reversibility of PVR.

Analysis of Hemodynamic Parameters under Conditions of Active Kinesiotherapy Using a Robotic System

The article considers changes in the basic hemodynamic parameters in patients undergoing active kinesiotherapy using the ExoLiteMS robotic rehabilitation system. Standard clinical methods of functional evaluation were used to assess the changes in the hemodynamics in patients at rest and under physical load.

Improvements of right ventricular function and hemodynamics after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension.

Right ventricular (RV) function is an important factor in the prognosis of chronic thromboembolic pulmonary hypertension (CTEPH) in patients. In our study, we aimed to evaluate the timing and magnitude of regional RV function before and after balloon pulmonary angioplasty (BPA) using speckle tracking echocardiography (STE) and their relation to clinical and hemodynamic parameters in patients with CTEPH. We enrolled 20 CTEPH patients and 19 healthy subjects in our study. Enrolled patients underwent echocardiography, right heart catheterization (RHC), and 6-minute walk distance (6MWD) test at baseline and after the BPA. In hemodynamic RHC measurements and clinical evaluations, mean pulmonary artery pressure (median: 53.5mmHg vs 37.0mmHg, P=.001) and pulmonary vascular resistance (median: 12 Wood units [WU] vs 7WU, P=.001) and pro-brain natriuretic peptide level decreased and 6MWD increased after BPA sessions. There was no statistically significant difference between before and after the BPA sessions in conventional echocardiographic measurements. In STE analysis, the electromechanical delay (EMD) between RV free wall (RVF) and LV lateral wall (LVL) (median: 65ms vs 47.5ms, P=.01) and RV peak systolic strain dispersion index (52ms vs 29ms, P=.001) were higher in patients with CTEPH than healthy controls before the BPA. Both these parameters decreased significantly after BPA. Chronic thromboembolic pulmonary hypertension was associated with RV electromechanical delay and dispersion based on the STE analysis. Balloon pulmonary angioplasty might have an important impact on the improvement of both RV function and hemodynamics.