Hemodynamic Assessment Research Articles

Epicardial Fat Tissue: A Potential Marker for Coronary Microvascular Dysfunction.

Coronary microvascular dysfunction (CMD), which mimics symptoms of obstructive coronary artery disease, has significant prognostic implications. While epicardial adipose tissue normally has a protective role, increased epicardial adipose tissue is associated with inflammation and may contribute to CMD. However, a direct correlation remains unclear. We aimed to investigate this association. The CMDR (Coronary Microvascular Disease Registry) is a prospective, 2-center registry that is enrolling patients with angina and nonobstructive coronary artery disease who underwent invasive hemodynamic assessment of the coronary microvasculature. Patients with chest computed tomography within 1 year of CMD evaluation were included. We measured epicardial fat volume (EFV) and calculated the EFV index. Logistic regression analysis was used to investigate the association between EFV and EFV index to CMD. Our study included 130 CMDR patients with associated chest CT; 35 were diagnosed with CMD. The CMD-negative patients were younger than the CMD-positive patients (58.52±11.97 versus 63.37±9.56 years; P=0.033), with numerically fewer women (64.2% versus 74.3%; P=0.279). Univariate regression analysis demonstrated a statistically significant association between EFV index and CMD diagnosis (odds ratio, 1.037 [95% CI, 1.014-1.063]; P=0.003), while no significance was observed for EFV (odds ratio, 1.006 [95% CI, 0.995-1.017]; P=0.292). Our results suggest a strong association between EFV index (a significant risk factor) and the presence of CMD. Future studies involving larger cohorts are needed to confirm the association of epicardial adipose tissue with CMD and investigate therapeutic targets to prevent CMD. URL: https://www.clinicaltrials.gov; unique identifier: NCT05960474.

Clinical outcomes, hemodynamics, and leaflet thrombosis following transcatheter aortic valve replacement with novel intra-annular devices.

The indication of transcatheter aortic valve replacement (TAVR) is becoming more prevalent among younger and lower-risk patients. However, data on the latest intra-annular TAVR devices are limited. This study aims to compare the short-term clinical outcomes of two intra-annular transcatheter aortic valve replacement (TAVR) devices in Japan: SAPIEN 3 Ultra RESILIA (S3UR) and Navitor. Of the 286 patients who underwent TAVR between May 2022 and October 2023 at our center, we enrolled 97 consecutive patients who received either S3UR or Navitor. We compared the intraprocedural invasive and echocardiographic hemodynamic assessment and post-procedural multidetector computed tomography (MDCT). The basic characteristics of the 97 patients (median age, 86 years [interquartile range, 81-89 years]) were similar. Technical success, defined by the Valve Academic Research Consortium, was achieved in all cases. Despite a smaller annulus, Navitor demonstrated decreased mean pressure gradient by TTE, 9.2 [7.3-13.6] mmHg versus 7.5 [5.9-9.5] mmHg, p = 0.006; but not by invasive measurement 5.1 [3.4-7.7] mmHg versus 5.3 [3.2-7.9] mmHg, p = 0.986). Discordance between echocardiographic and invasive assessment was more prominent with S3UR. However, severe prosthesis-patient mismatch was similarly noted between the two devices. Mild paravalvular leak (PVL) (24.5% vs. 54.5%, p = 0.002) was more frequent with the Navitor, despite no moderate-severe PVL in each group. The incidence of hypoattenuated leaflet thickening (HALT) detected by MDCT was similar between the two groups. Both intra-annular valves demonstrated excellent hemodynamic performance with minimal PVL after TAVR. The incidence of HALT in both devices was comparable.

The hypotension prediction index in major abdominal surgery - A prospective randomised clinical trial protocol.

Patients undergoing major abdominal surgery are at increased risk of developing perioperative hypotension, which is associated with increased mortality and morbidity. Despite using advanced technologies such as evaluating arterial pressure derived cardiac output, anaesthetic management to maintain hemodynamic stability is still reactive when the clinical decision is made after hypotension has developed. Previous perioperative goal-directed studies have not proven the benefits of this approach with high certainty. A new, approved technology called the Hypotension Prediction Index (HPI) aims to prevent hypotension occurrence by allowing the precise hemodynamic monitoring of patients under general anaesthesia, significantly reducing intraoperative hypotension events. This prospective randomised clinical trial aims to compare the rate of perioperative hypotension in patients undergoing major abdominal surgery according to their type of hemodynamic monitoring. and Analysis: Patients meeting the inclusion criteria will be randomly assigned to receive hemodynamic assessment with arterial pressure cardiac output (APCO) monitoring (group A) or hemodynamic monitoring with the HPI software (group B). The primary outcome is a time-weighted average (TWA) mean arterial pressure (MAP) of <65mmHg: TWA MAP = (depth of hypotension [in mmHg] below a MAP of 65mmHg×time [in minutes] spent below a MAP of 65mmHg)/total duration of the operation (in minutes). Its secondary outcomes include perioperative hemodynamic management and the rate of postoperative complications. This trial was approved by the Ethics Committee of the Poznan University of Medical Sciences (KB-559/220; date: 01/07/2022). Its results will be submitted for publication in a peer-reviewed journal. NCT06247384.

Multi-modality non-invasive assessment of cardiopulmonary haemodynamics using cardiovascular magnetic resonance pulmonary transit time and echocardiography

Abstract Introduction Pulmonary transit time (PTT) is the time it takes blood to pass from the right ventricle to the left ventricle via the pulmonary circulation, making it a potentially useful marker for heart failure. We assessed the association of PTT with diastolic dysfunction and mitral valve regurgitation. Methods We evaluated routine stress perfusion cardiovascular magnetic resonance (CMR) scans in 83 patients including assessment of PTT with simultaneously available echocardiographic assessment. Relevant diastolic dysfunction (DD) and mitral valve regurgitation (MVR) were defined as exceeding grade I (impaired relaxation, mild regurgitation). PTT was determined from CMR rest perfusion scans. Normalized PTT (nPTT), adjusted for heart rate, was calculated using Bazett's formula. Results Higher PTT and nPTT values were associated with higher grade DD and MVR. The diagnostic accuracy for prediction of DD as quantified by the area under the ROC curve (AUC) was 0.73 (CI 0.61 to 0.85; p=0.001) for PTT and 0.81 (CI 0.71 to 0.89; p&amp;lt;0.001) for nPTT. For MVR the diagnostic performance amounted to an AUC of 0.80 (CI 0.68 to 0.92; p&amp;lt;0.001) for PTT and 0.78 (CI 0.65 to 0.90; p&amp;lt;0.001) for nPTT. PTT values &amp;lt; 8 s rule-out presence of DD and MVR with a probability of 70% (Negative predictive value 78%). Conclusion CMR-derived PTT is a readily obtainable hemodynamic parameter. It is elevated in patients with DD and moderate to severe MVR. Low PTT values make the presence of DD and MVR - as assessed by echocardiography - unlikely. Pulmonary Transit Time Pulmonary Transit Time

Hemodynamic forces assessment in severe aortic stenosis undergoing transcatheter aortic valve intervention

Abstract Background Estimated hemodynamic forces (HDFs) are a novel and validated marker of cardiac function evaluation computed by standard echocardiography. They have been demonstrated to be altered in many cardiac diseases, such as heart failure. However, their application in valvular disease is still not completely known. Aim to analyze left ventricular (LV) HDFs in patients with severe aortic stenosis before and immediately after transcatheter aortic valve implantation to reveal whether cardiac changes occur early after the procedure. Methods All the patients with severe aortic stenosis referred to ourutively enrolled. Transthoracic echocardiography (TTE) was performed before and early after the procedure (within five days). Standard TTE parameters for volume dimension and function were collected along with peak and mean aortic gradients and aortic valve area. TTE cine loops in 3-2 and 4 chambers were analyzed offline with a dedicated speckle tracking echocardiography (STE) software to compute global longitudinal strain (GLS) and HDFs using LV endocardial displacement and the estimated mitral and aortic valve areas as input. HDFs were computed during the entire cardiac cycle, in systole and diastole, in their two main directions: apex-to-base (AB) and lateral-septal (LS). The LS over AB ratio was also calculated, representing HDFs’ distribution into the LV. HDFs were normalized with LV volumes and expressed as a percentage of the force of gravity. Results 31 patients undergoing TAVI were enrolled (mean age 82 years ± 7, 45 % females, Euroscore II 4.2% ± 2.1, 71% history of CAD). Baseline standard and advanced TTE parameters are described in the table. After the procedure, no significant changes in ejection fraction (55±9 vs. 57±10, p=0.105) were observed, while a trend in GLS improvement was observed even without statistical significance (-16.6±9.1 vs -19.1±5.8, p=0.63). HDFs in the entire cycle showed a significant improvement in terms of magnitude, apical-base (p=0.08) and lateral septal (p=0.01), but no significant changes in the LS/AB ratio were observed, even if there was a slight reduction (p=0.670). A slight improvement in HDFs AB and LS and a reduction in LS/AB ratios were observed in both systole and diastole, even if they were not statistically significant (Table). Conclusions Preliminary data suggest that HDFs by TTE, representing advanced LV function evaluation, showed a trend in improvement after acute pressure unloading in TAVI patients. A greater cohort is needed to expand these data. Figure 1 Table 1

Echocardiographic estimation of cardiovascular energy transfer in patients with heart failure: an explorative study

Abstract Background Heart failure (HF) is a complex and debilitating condition. The pathophysiology of HF is related to the dynamic interplay governing the energy transfer from the heart to the vascular bed. This energy transfer can be estimated by calculating the heart's external power, measured in watts, which is the product of flow and pressure divided by time. Although power measurements can potentially improve hemodynamic assessment in patients with heart failure, clinical estimation of cardiovascular energy transfer is rarely used due to cumbersome analyses and dependence on invasive measurements. We propose a novel method based on echocardiography and continuous non-invasive blood pressure measurement to estimate cardiovascular energy transfer. Aim To test whether non-invasive estimates of cardiovascular energy transfer can differentiate between HF patients with reduced and preserved left ventricular ejection fraction (LVEF). Methods We included patients hospitalized with decompensated HF not optimally treated in the study. All patients underwent an echocardiographic examination using a GE HealthCare Vivid E95 scanner. We used the biplane Simpson method to calculate LVEF and the pulsed wave Doppler velocity spectrum in the left ventricular outflow tract to estimate flow. Continuous non-invasive blood pressure measurements were obtained using a Finapres finger cuff device calibrated with the brachial blood pressure. We developed an application for tracing the velocity spectrum, synchronizing flow and pressure curves, and calculating the power curves as the product of continuous synchronized flow and pressure curves. The patients were categorized into two groups based on whether LVEF was &amp;lt; 40% or ≥ 40%. Results We observed that cardiovascular energy transfer, estimated as external power, differed between patients with LVEF &amp;lt;40% vs. ≥40%. The study cohort comprised twenty-eight patients (25% women), averaging 76 years (SD 11). Eighteen patients had LVEF &amp;lt;40%, with a mean LVEF of 27% (SD = 9%), mean velocity time index (VTI) 11.7 cm (SD = 2.94), and) and mean systolic blood pressure 116 mmHg (SD = 19). Ten patients had LVEF ≥40%, with a mean LVEF of 47% (SD = 6 %), VTI 16.5 cm (SD = 5.50), and mean systolic blood pressure 143 mmHg (SD = 20). External power was significantly different between patients with LVEF &amp;lt;40% vs. ≥40%, 0.81 W (SD = 0.21 W) vs. 1.43 W (SD = 0.41 W), respectively, p&amp;lt;0.0001 (Fig. 1). We observed a modest but significant correlation between LVEF and power (R = 0.28, P-value &amp;lt; 0.005). Conclusion Cardiovascular energy transfer, estimated non-invasively as external power, was significantly lower in acutely decompensated heart failure patients with LVEF &amp;lt;40% compared to those with LVEF ≥ 40%. More extensive studies should explore the possible value of estimating cardiovascular energy transfer in stratification and therapeutic decisions in patients with HF.

Advanced Hemodynamic Monitoring in Polytraumatized Patients: A Comprehensive Review

INTRODUCTION Advanced hemodynamic monitoring plays a crucial role in optimizing the perioperative management of polytraumatized patients, allowing for real-time assessment of cardiovascular status and guiding goal-directed therapy. Traditional monitoring methods, while widely used, have significant limitations that may hinder their effectiveness in dynamic trauma scenarios. The introduction of non-invasive technologies such as continuous non-invasive arterial pressure monitoring and impedance cardiography has improved hemodynamic assessment, providing valuable insights with reduced procedural risks. Despite these advancements, challenges remain in terms of accuracy, clinical integration, and training requirements. OBJETIVE To evaluate the efficacy and applicability of advanced hemodynamic monitoring techniques during anesthesia in polytraumatized patients, highlighting their impact on perioperative outcomes. METHODS This is a narrative review which included studies in the MEDLINE – PubMed (National Library of Medicine, National Institutes of Health), COCHRANE, EMBASE and Google Scholar databases, using as descriptors: “Polytrauma anesthesia” AND “Advanced hemodynamic monitoring” OR “Goal-directed therapy” OR “Non-invasive cardiac output monitoring” OR “Trauma resuscitation strategies” in the last years. RESULTS AND DISCUSSION Results demonstrate that the application of advanced hemodynamic monitoring techniques enhances intraoperative hemodynamic stability and reduces perioperative complications by enabling individualized fluid management and early detection of deterioration. Studies indicate that dynamic indices such as stroke volume variation and pulse pressure variation offer superior predictive value for fluid responsiveness compared to static parameters. However, the widespread implementation of these technologies is influenced by economic constraints, technological limitations, and the need for specialized expertise. CONCLUSION In conclusion, advanced hemodynamic monitoring significantly contributes to improving outcomes in polytraumatized patients under anesthesia by providing continuous and accurate cardiovascular data. Addressing the challenges of implementation through structured training programs and cost-benefit analyses is essential for broader clinical adoption. Future research should focus on refining these technologies to enhance their reliability and applicability across diverse trauma care settings.

At mid gestation, markers of placental function rather than maternal cardiac function are stronger determinants of birthweight.

The role of maternal cardiac and hemodynamic assessment during normal and complicated pregnancies has gained attention during the last few years. Some researchers suggested that the manifestation of complications in pregnancy suffering from impaired placentation is mainly driven by pre-existing cardiac changes, identifiable at an early stage by echocardiographic and hemodynamic assessment. It is therefore of great importance to determine the link between placental perfusion and maternal cardiac function and hemodynamics. Also, the impact of maternal cardiac function on birth weight has not been thoroughly studied. To elucidate the possible association of maternal cardiovascular indices with placental perfusion at mid-gestation and birthweight. Prospective study on women with singleton pregnancies attending Kings' College Hospital, London, UK for a routine hospital visit at 19-24 weeks' gestation. We recorded maternal characteristics and medical history, measured mean arterial pressure (MAP), heart rate, uterine artery pulsatility index (UtA-PI), umbilical artery PI, middle cerebral artery PI, and serum placental growth factor (PlGF). We also performed maternal echocardiogram to assess cardiac output and peripheral vascular resistance as well as indices of diastolic and systolic cardiac function. Multivariable regression modeling was used. Our cohort included 4006 women. Higher UtA-PI values were associated with lower MAP, heart rate, and left ventricular systolic function, after adjustment for maternal characteristics and subsequent development of hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM). In a multivariable approach that explained 17.9% of the variance of the birthweight we found that some cardiovascular indices provided small but significant contribution to the model after accounting for maternal factors, and development of HDP and GDM, UtA-PI, and PlGF. The findings of our study indicate a weak but significant association between maternal cardiovascular indices with placental perfusion at mid-gestation and birthweight. Our data would not support routine maternal cardiovascular assessment for predicting birthweight.

Exploring Integrin α5β1 as a Potential Therapeutic Target for Pulmonary Arterial Hypertension: Insights From Comprehensive Multicenter Preclinical Studies.

Pulmonary arterial hypertension (PAH) is characterized by obliterative vascular remodeling of the small pulmonary arteries (PAs) and progressive increase in pulmonary vascular resistance leading to right ventricular failure. Although several drugs are approved for the treatment of PAH, mortality rates remain high. Accumulating evidence supports a pathological function of integrins in vessel remodeling, which are gaining renewed interest as drug targets. However, their role in PAH remains largely unexplored. The expression of the RGD (arginylglycylaspartic acid)-binding integrin α5β1 was assessed in PAs, PA smooth muscle cells, and PA endothelial cells from patients with PAH and controls using NanoString, immunoblotting, and Mesoscale Discovery assays. RNA sequencing was conducted to identify gene networks regulated by α5β1 inhibition in PAH PA smooth muscle cells. The therapeutic efficacy of α5β1 inhibition was evaluated using a novel small molecule inhibitor and selective neutralizing antibodies in Sugen/hypoxia and monocrotaline rat models, with validation by an external contract research organization. Comparisons were made against standard-of-care therapies (ie, macitentan, tadalafil) and sotatercept and efficacy was assessed using echocardiographic, hemodynamic, and histological assessments. Ex vivo studies using human precision-cut lung slices were performed to further assess the effects of α5β1 inhibition on pulmonary vascular remodeling. We found that the arginine-glycine-aspartate RGD-binding integrin α5β1 is upregulated in PA endothelial cells and PA smooth muscle cells from patients with PAH and remodeled PAs from animal models. Blockade of the integrin α5β1 or depletion of the α5 subunit downregulated FOXM1 (forkhead box protein M1)-regulated gene networks, resulting in mitotic defects and inhibition of the pro-proliferative and apoptosis-resistant phenotype of PAH cells. We demonstrated that α5β1 integrin blockade safely attenuates pulmonary vascular remodeling and improves hemodynamics and right ventricular function and matched or exceeded the efficacy of standard of care and sotatercept in multiple preclinical models. Ex vivo studies further validated its potential in reversing advanced remodeling in human precision-cut lung slices. These findings establish α5β1 integrin as a pivotal driver of PAH pathology and we propose its inhibition as a novel, safe, and effective therapeutic strategy for PAH.

Relationship of maternal ophthalmic artery Doppler with uterine artery Doppler, hemodynamic indices and gestational age: prospective MATERA study.

To examine the relationship of ophthalmic artery (OA) Doppler indices with uterine artery (UtA) Doppler indices, selected maternal hemodynamic parameters and gestational age, and to evaluate the intraobserver reproducibility of OA Doppler indices. This was a prospective cohort study of women recruited between 11 + 0 and 23 + 6 weeks' gestation using a stratified and random sampling approach to ensure adequate distribution across the gestational-age range. OA pulsatility index (PI), first peak systolic velocity (PSV1), second peak systolic velocity (PSV2) and peak systolic velocity ratio (PSV ratio), calculated as PSV2/PSV1, were measured twice in each eye by the same observer. UtA-PI was also measured twice on each side by the same observer. Maternal hemodynamic assessment was undertaken using an ultrasonic cardiac output monitor (USCOM 1A). Pearson's and Spearman's rank correlation coefficients were used to assess the correlations between variables, and Bland-Altman plots were used to evaluate the intraobserver reproducibility of OA Doppler indices. Of 194 women invited to participate in the study, 169 were eligible for inclusion, of whom 16 were excluded following an obstetric ultrasound scan and a further three owing to inadequate or incomplete OA or UtA Doppler assessment, leaving 150 women in the final analysis. Log UtA-PI had a weak correlation with both OA-PI (r = -0.19 (95% CI, -0.34 to -0.03), P = 0.021) and OA-PSV ratio (r = 0.31 (95% CI, 0.15-0.45), P < 0.001). The correlation between gestational age and OA-PI was non-significant (r = 0.14 (95% CI, -0.03 to 0.29), P = 0.097), and that between gestational age and OA-PSV ratio was weak (r = -0.23 (95% CI, -0.38 to -0.07), P = 0.004), as opposed to the strong correlation between gestational age and UtA-PI (r = -0.68 (95% CI, -0.76 to -0.58), P < 0.001). No strong correlations were observed between OA-PI or OA-PSV ratio and maternal hemodynamic indices. The correlations were unaltered by adjustment for maternal age and body mass index. The intraobserver reproducibility of OA-PI and OA-PSV ratio in the same eye was high. The correlation between the right and left eyes was moderate for OA-PI (r = 0.63 (95% CI, 0.53-0.72), P < 0.001) and strong for OA-PSV ratio (r = 0.81 (95% CI, 0.75-0.86), P < 0.001). OA-PI and OA-PSV ratio had a weak or no correlation with UtA-PI and maternal hemodynamic parameters, meaning that they can be used as independent predictors for pre-eclampsia. Gestational age had no clinically relevant effect on OA-PI and OA-PSV ratio, suggesting that these indices could be measured without adjustment at any time between 11 and 23 weeks' gestation. OA Doppler indices had high intraobserver reproducibility and were strongly correlated between the right and left eyes. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Prediction of pre-eclampsia using maternal hemodynamic parameters at 12 + 0 to 15 + 6 weeks.

To compare the maternal hemodynamic profile at 12 + 0 to 15 + 6 weeks' gestation in women who subsequently developed pre-eclampsia (PE) and those who did not, and to assess the screening performance of maternal hemodynamic parameters for PE in combination with the Fetal Medicine Foundation (FMF) triple test, including maternal factors (MF), mean arterial pressure (MAP), uterine artery pulsatility index and placental growth factor. This was a prospective case-control study involving Chinese women with a singleton pregnancy who underwent preterm PE screening at 11 + 0 to 13 + 6 weeks' gestation using the FMF triple test, between February 2020 and February 2023. Women identified as being at high risk (≥ 1:100) for preterm PE by the FMF triple test were matched 1:1 with women identified as low risk (< 1:100) for maternal age ± 3 years, maternal weight ± 5 kg and date of screening ± 14 days. Two-dimensional transthoracic echocardiography was performed at 12 + 0 to 15 + 6 weeks to evaluate maternal hemodynamic parameters (heart rate (HR), stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR)). Maternal hemodynamic parameters were expressed as multiples of the median (MoM) values, determined by linear regression models to adjust for gestational age (GA) and MF. The distribution of log10 MoM values of maternal hemodynamic parameters in cases of PE and unaffected pregnancies, and the association between these hemodynamic parameters and GA at delivery, were assessed. The risks of preterm PE (delivery before 37 weeks) and any-onset PE (delivery at any time) were reassessed using Bayes' theorem after maternal hemodynamic parameters were added to the FMF triple test. The screening performance for preterm PE and any-onset PE was determined by the area under the receiver-operating-characteristics curve (AUC) and detection rate at a 10% fixed false-positive rate (FPR). Differences in AUC (ΔAUC) were assessed using DeLong's test. A total of 743 cases were analyzed, of whom 39 (5.2%) subsequently developed PE, including 29 (3.9%) cases of preterm PE and 10 (1.3%) cases of term PE. Mean log10 SVR MoM was significantly higher in cases of preterm PE and any-onset PE compared with unaffected pregnancies. Mean log10 SV MoM and log10 CO MoM were significantly lower in cases of preterm PE and any-onset PE compared with unaffected pregnancies. Mean log10 HR MoM was not significantly different between the study groups. Mean log10 CO MoM and log10 SVR MoM were not significantly correlated with GA at delivery in preterm PE and any-onset PE. For the prediction of preterm PE and any-onset PE, adding CO or SVR or replacing MAP with CO and SVR in the FMF triple test achieved an identical or greater AUC compared with the FMF triple test, but ΔAUC was not significantly different. In addition, adding CO or SVR or replacing MAP by CO and SVR in the FMF triple test did not improve the detection rate for preterm PE and any-onset PE at a fixed FPR of 10%. Women with preterm PE or any-onset PE exhibited increased SVR and decreased CO before the clinical manifestations of PE became apparent. These changes may serve as early indicators of cardiovascular maladaptation. However, assessment of maternal hemodynamics at 12 + 0 to 15 + 6 weeks does not enhance the screening performance for preterm PE and any-onset PE of these parameters. The FMF triple test remains superior to other biomarker combinations for predicting PE. © 2025 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Outcome prediction for late-onset sepsis after premature birth.

Our aim was to develop a quantitative model for immediately estimating the risk of death and/or brain injury in late-onset sepsis (LOS) in preterm infants, based on objective and measurable data available at the time sepsis is first suspected (i.e., time of blood culture collection). Retrospective study on neonates ≤36 weeks' gestation with a positive blood and/or cerebrospinal fluid culture after 72 hours from birth. Among 3217 preterm live births, 94 cases were included (median gestational age 26.5 weeks' IQR 25.0;28.0), of whom 26 (27.7%) had poor outcomes (17 death; 9 brain injuries). Infants with poor outcomes showed lower postnatal age (11.5 vs 12.5 days, p < 0.001), lower mean blood pressure (30.5 vs 43 mmHg, p < 0.001) and higher lactate levels (4.4 vs 1.5 mmol/l, p < 0.001). Our multivariable model showed good discrimination and calibration (c statistic=0.8618, Hosmer-Lemeshow p = 0.8532), stratifying the population into 3 groups: low-risk (sensitivity 97%, specificity 52%), middle-risk, and high-risk (sensitivity 77%, specificity 80%). This predictive model performs well as a practical and easy-to-use tool to help clinicians early identify the sickest neonates who may benefit from timely and aggressive support (e.g., central line, haemodynamic assessment) and close monitoring (e.g., 1:1 nursing assignment, frequent reassessments). We lack data to early identify the severity of neonatal late-onset sepsis in preterm infants. Delay in treatment contributes to poor prognosis. We developed a model for early prediction of poor outcomes (mortality and brain injuries). The model utilizes immediately available and measurable data at the time sepsis is first suspected. This can help clinicians in tailoring management based on individual risks.

Effect of administration of nanoparticles of human chorionic gonadotropin on testicular hemodynamics, testicular volume, testicular echotexture, and circulating testosterone and nitric oxide in pubescent goat bucks under heat stress conditions

The current study investigated the effect of a single administration of human chorionic gonadotropin hormone (hCG) and its nanoparticles (NPs) on testicular hemodynamics using Doppler ultrasonography, testicular volume, testicular echotexture (PIX), and circulating testosterone and nitric oxide (NO) in pubescent goat bucks during summer months. Fifteen Baladi goats were divided into three groups (5 in each) and subjected to a single intramuscular administration of one ml of physiological saline ( control group), one ml containing 500 IU of hCG (hCG group) or one ml containing 125 IU of hCG NPs (hCG NPs group). Testicular hemodynamics assessment was done just before administration (0 h), and at 2, 4, 6, 24, and daily till 7 days after administration. Testicular volume and PIX were measured and analyzed by B-mode ultrasonography and computer analysis software. Testosterone and NO concentrations were measured using commercial kits. Results revealed significant decreases (P ˂0.05) in Doppler indices values (resistance index and pulsatility index) especially at 24 h in the hCG group (0.314 ± 0.01, 0.382 ± 0.01, respectively) compared with the hCG NPs group (0.428 ± 0.01, 0.567 ± 0.02, respectively), and the control group (0.464 ± 0.006, 0.64 ± 0.01, respectively). There were significant increases (P < 0.001) in testicular volume, PIX, testosterone, and NO concentrations in hCG NPs and hCG groups compared to the control group. There were no significant differences between the hCG NPs and hCG groups (P ˃ 0.05) in testicular volume and PIX, while testosterone significantly increased in the hCG group compared to the hCG NPs group and NO was significantly increased in the hCG NPs group compared to the hCG group. In conclusion, a single administration of hCG or its NPs improved testicular vascularization, testicular volume, and circulating testosterone and NO in pubescent goat bucks. So, hCG NPs could be recommended for improving the reproductive performance of goat bucks under heat-stress conditions.

Current Concepts in Fluid Resuscitation and Vasopressor Use in Cirrhosis.

Critically ill patients with cirrhosis and liver failure not uncommonly have hypotension due to multifactorial reasons, that include hyperdynamic state with increased cardiac index, low systemic vascular resistance due to portal hypertension, following the use of beta blocker or diuretic therapy, and severe sepsis. These changes are mediated by microvascular alterations in the liver, systemic inflammation, activation of renin angiotensin aldosterone system, and vasodilatation due to endothelial dysfunction. Hemodynamic assessment includes measuring inferior vena cava indices, cardiac output and systemic vascular resistance using point-of-care ultrasound (POCUS), in addition to arterial waveform analysis, or pulmonary artery pressures, and lactate clearance to guide fluid resuscitation. Fluid responsiveness reflects the ability of fluid bolus to increase the cardiac output and is assessed effectively by POCUS, passive leg raise manoeuvre, and dynamic tests such as pulse pressure and stroke volume variation both in spontaneously breathing and mechanically ventilated patients. Albumin has pleotropic benefits through anti-inflammatory properties besides its standard action on oncotic pressure and volume expansion in patients with cirrhosis but has potential for precipitating pulmonary edema. In conclusion, fluid therapy in critically ill patients with liver disease is a complex and dynamic process that requires individualised management protocols to optimise patient outcomes.

The Genetic and Imaging Key to Understanding Bicuspid Aortic Valve Disease

Bicuspid Aortic Valve (BAV) is a prevalent congenital heart defect, characterized by the presence of two cusps instead of three, leading to significant clinical implications such as aortic stenosis, regurgitation, and aneurysms. Understanding the genetic underpinnings of BAV is essential for early diagnosis and management, which can prevent severe complications like aortic dissection and heart failure. Recent studies have identified critical genes associated with BAV, including NOTCH1, GATA4, GATA5, SMAD6, NKX2.5, BMP2, and ROBO4, all of which play vital roles in aortic valve development and function. Imaging advancements, particularly in cardiac MRI and echocardiography, have enhanced the assessment of valve morphology and hemodynamics, with Wall Shear Stress emerging as a promising biomarker. This review consolidates current genetic and imaging research, elucidating the contributions of genetic variants to the etiology and progression of BAV, while emphasizing the importance of imaging biomarkers in clinical management. The findings aim to improve genetic screening strategies, facilitate early diagnosis, and guide the development of targeted therapies for individuals with BAV.

Assessment of the Severity of Intermediate Coronary Artery Stenosis Using the Systemic Inflammatory Response Index.

Background: Fractional Flow Reserve (FFR) is a method that enables the hemodynamic assessment of coronary artery stenosis. The Systemic Inflammatory Response Index (SIRI) is a new marker calculated by multiplying the neutrophil-to-lymphocyte ratio (NLR) with the monocyte count. It is indicative of the presence and severity of coronary artery disease. This study evaluates the relationship between the functional significance of FFR measurements and the SIRI in intermediate coronary stenosis. Methods: A total of 294 patients with 50-70% stenosis in their coronary arteries based on quantitative measurement following angiography who underwent FFR measurement were included in the study before the FFR procedure. Total and differential leukocyte counts and routine biochemical tests were performed. Results: A total of 37% of the patients were found to have a positive FFR, while 63% had a negative FFR. Significant differences were observed in the neutrophil count, monocyte count, Systemic Inflammation Response Index (SIRI), total cholesterol, and amount of adenosine used between the groups (p < 0.05). A SIRI value of 1.16 was 77% sensitive and 55% specific for FFR positivity. Multivariate logistic regression analysis identified the SIRI as an independent predictor of FFR positivity. Conclusions: Our study has demonstrated that high values of the SIRI may serve as a new biomarker for predicting FFR positivity.

Pulmonary Atresia with Ventricular Septal Defect without Major Aorto-Pulmonary Collateral Arteries: Echocardiography and the Role of Computed Tomography and Magnetic Resonance Imaging.

Pulmonary atresia with ventricular septal defect (PA-VSD) is usually diagnosed by transthoracic or fetal echocardiography, with the prenatal diagnosis being feasible and accurate if fetal cardiology services are available. The limitations of transthoracic echocardiography (TTE) in the evaluation of PA-VSD include the complete evaluation of the pulmonary arteries and patent ductus arteriosus, quantitative evaluation of the right ventricle size and function, and delineation of associated cardiac anomalies such as coronary artery anomalies, anomalies of systemic or pulmonary venous return, and complex arch anomalies. Echocardiography also has limitations in evaluating hemodynamics such as flow volumes, shunts, and regurgitant fraction. Despite these limitations, TTE remains the most widely available and the most cost-effective cardiac imaging modality for patients with PA-VSD and its accuracy in evaluating the sources of pulmonary blood flow and in selecting patients for systemic-to-pulmonary artery shunt palliation is well established. Cardiac computed tomography (CT) can answer many of the questions not answered by TTE, including demonstrating the PA anatomy and defining coronary artery, systemic and pulmonary venous, and aortic arch anatomies. The short acquisition time allows for the study to be performed without sedation/anesthesia in most patients. Cardiac CT is also useful in defining postoperative anatomy when there are non-magnetic resonance imaging (MRI) compatible devices or even MRI-compatible devices that cause a significant MRI artifact. Cardiac MRI/magnetic resonance angiography has emerged as an ideal modality to evaluate patients with PA-VSD as it allows for anatomic, functional, and hemodynamic assessment without exposure to ionizing radiation or iodinated contrast material. Both cardiac CT and cardiac MRI can be used to generate 3D imaging of the heart.

A 6-Minute Limb Function Assessment forTherapeutic Testing in Experimental Peripheral Artery Disease Models.

In this study, we present a novel 6-minute limb function test that allows for the congruent assessment of muscular performance and hemodynamics in preclinical models of peripheral artery disease. Using several experimental conditions, the results demonstrate the superior efficacy of the 6-minute limb function test to detect differences in the response to hindlimb ischemia across several interventions, including where traditional perfusion recovery, capillary density, and muscle strength measures were unable to detect interventional differences, thus allowing for more rigorous assessment of preclinical therapies before clinical translation.

Hemodynamic forces assessment identifies preclinical abnormalities in hypertrophic cardiomyopathy mutation carriers

Hemodynamic forces assessment identifies preclinical abnormalities in hypertrophic cardiomyopathy mutation carriers

Non-invasive Hemodynamic Assessment: Acoustic Signals And AI To The Rescue

Non-invasive Hemodynamic Assessment: Acoustic Signals And AI To The Rescue