Hemodynamic Data Of Patients Research Articles

Abstract P589: Utilization of Pulmonary Artery Sensor (CardioMEMS Device) During the Sars-CoV-2 Pandemic

Introduction: The implantation of wireless pressure monitoring devices has allowed remote monitoring of hemodynamic data in patients with congestive heart failure. Devices such as the (CardioMEMS HF System) achieve this by remotely monitoring changes in pulmonary artery pressure, which has been shown to be a signal of worsening heart failure. The benefits of wireless pressure monitoring devices in reducing mortality and hospitalizations have been shown in clinical trial data. However, the impact of the COVID-19 pandemic on its use has not been studied. The aim of this study was to examine if the COVID-19 pandemic led to gender and race differences in in-hospital outcomes, length of stay, and total hospital charges in pulmonary artery sensor insertion. Methods: Data was extracted from the National Inpatient Sample database for the calendar year 2020. Patients implanted with a wireless pressure monitoring device were identified using relevant International Classification of Disease, and Clinical Modification codes. The study sample was stratified based on gender and race. The key outcomes of length of stay, total hospitalization cost, and mortality were then accessed. Results: A total of 485 patients were included in the final analysis. The mean age was 66.3 years, 32% (155 of 485) were female and 70% (340 of 485) were Caucasian. The overall inpatient mortality rate was 3.09% (15 of 485), 76.2% (370 of 485) of admissions were non elective, mean length of hospitalization was 14.87 days and mean total hospital charges was 349,599 US dollars. We found no association between differences in mortality rates between both gender and race. Regarding total hospital charges, there was a significant less amount of total hospital charges for females (P<0.05) but not between races. There was no significant difference between length of hospital stay for gender or race. Conclusion: Analysis of this large database of patients undergoing wireless pressure monitoring device implantation suggests that in-hospital mortality and length of stay were comparable in both gender and race during the first year of COVID-19 pandemic. However, females had a significantly less amount of hospital charges. Our study suggests that further randomized data is needed to fully assess gender disparities in patients implanted with wireless pulmonary artery pressure devices.

Abstract 15151: Identification of Novel Right Ventricular Function Phenotypes in Pulmonary Arterial Hypertension Using Unbiased K-Means Clustering

Introduction: Survival in pulmonary arterial hypertension (PAH) is associated with right ventricular (RV) function rather than pulmonary vascular resistance (PVR). At present, RV function is not incorporated in current risk assessment models and studies evaluating RV function are generally limited to single-center studies. The aim was to identify novel RV function phenotypes using unbiased k-means clustering in patients with PAH. Methods: Baseline clinical and hemodynamic data in patients with PAH were harmonized data from 5 PAH clinical trials (COMPASS3: n=98, EARLY: n=176, GRIPHON: n=720, MAESTRO: n=44, and SERAPHIN: n=728). Pearson correlation analysis was used to select variables that reduce the co-linearity (|r| < 0.7) between hemodynamic variables used in the models. K-means clustering methods were applied to advanced RV hemodynamics including end-systolic pressure (ESP), arterial elastance (Ea), single-beat end-diastolic elastance (Eed), Pulse pressure (PP), stroke volume (SV) and RV stroke work (RVSW). Survival analysis was used to compare all-cause mortality among each cluster group. Results: Participants in the harmonized dataset (n=1766) had a mean PAP of 53 ± 17 mmHg, a cardiac output of 4.3±1.4 L/min, a wedge pressure of 9±4 mmHg and a PVR of 11.8±7.4 WU. K-means clustering identified four distinct RV cluster phenotypes that range from mild to severe RV dysfunction (Fig. A). Participants in RV cluster 1 (RV C1) have severe RV dysfunction with increased pressure/afterload, decreased cardiac function, and increased diastolic stiffness compared to RV cluster 4 (RV C4). (Fig. A) RV C1 had decreased six-minute walk distance compared to other clusters. RVC1 and RVC2 had increased risk of mortality compared to RV C4 (Fig. B). Conclusion: Applying K-means clustering to harmonized hemodynamic data from PAH clinical trial data identified 4 unique RV function phenotypes with different clinical outcomes.

Feasibility of Vascular Parameter Estimation for Assessing Hypertensive Pregnancy Disorders.

Hypertensive pregnancy disorders (HPDs), such as pre-eclampsia, are leading sources of both maternal and fetal morbidity in pregnancy. Noninvasive imaging, such as ultrasound (US) and magnetic resonance imaging (MRI), is an important tool for predicting and monitoring these high risk pregnancies. While imaging can measure hemodynamic parameters, such as uterine artery pulsatility and resistivity indices (PI and RI), the interpretation of such metrics for disease assessment relies on ad hoc standards, which provide limited insight to the physical mechanisms underlying the emergence of hypertensive pregnancy disorders. To provide meaningful interpretation of measured hemodynamic data in patients, advances in computational fluid dynamics can be brought to bear. In this work, we develop a patient-specific computational framework that combines Bayesian inference with a reduced-order fluid dynamics model to infer parameters, such as vascular resistance, compliance, and vessel cross-sectional area, known to be related to the development of hypertension. The proposed framework enables the prediction of hemodynamic quantities of interest, such as pressure and velocity, directly from sparse and noisy MRI measurements. We illustrate the effectiveness of this approach in two systemic arterial network geometries: an aorta with branching carotid artery and a maternal pelvic arterial network. For both cases, the model can reconstruct the provided measurements and infer parameters of interest. In the case of the maternal pelvic arteries, the model can make a distinction between the pregnancies destined to develop hypertension and those that remain normotensive, expressed through the value range of the predicted absolute pressure.

Comparison of the Baska Mask® and Endotracheal Tube on Hemodynamic and Respiratory Parameters in Septoplasty Cases.

Laryngeal mask (LM) types have been used as an airway device for an alternative to the standard endotracheal tube (ETT). One of the novel type of LM, the Baska Mask®, can be a safe alternative among the airway devices. The purpose of this study is to compare the effects of the new generation supraglottic airway device the Baska Mask® and the ETT on hemodynamic parameters (heart rate, mean arterial pressure), airway pressure and end tidal carbon dioxide (EtCO2) in patients undergoing general anesthesia. After the approval of the ethics committee, 70 patients who underwent septoplasty were included in the study. Written informed consent forms were taken from these patients. Demographic data of the patients were recorded. Hemodynamic data of patients were measured and recorded preoperative, during induction, at the time of intubation 1th, 3th and 5th minute and during extubation. Also, airway pressure and EtCO2 values of the patients were measured and recorded at the time of intubation, 1th, 3th and 5th minutes. Demographic data were similar in both groups. Mean arterial pressure, heart rate and airway pressure were lower in the group 2 (the Baska Mask® group) than in the group 1 (ETT group) and the difference was statistically significant (p<0.05). EtCO2 values were similar in both groups. No patients had tube leakage. In terms of hemodynamic and respiratory parameters the Baska Mask® is more advantageous than the ETT in short-term surgeries.

Alteration of Right Ventricular to Pulmonary Artery Coupling in Systemic Sclerosis

Purpose Pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc) has a worse prognosis than idiopathic PAH. This may be explained, at least in part, by an uncoupling of the right ventricle (RV) to the pulmonary artery (PA). It has been shown by Guazzi that the RV/PA coupling may be assessed non-invasively by echocardiograpy, using the TAPSE/PAPs ratio². We therefore sought to determine whether this ratio was impaired in SSc and whether this may be associated with other variables assessing the RV function. Methods In our retrospective, single center analysis, 3 groups of subjects were compared: 1) healthy subjects; 2) SSc patients without cardiac or pulmonary impairment; 3) SSc-related PAH patients. We collected anthropometrics, clinical, functional, biological and echocardiographic (focusing the right ventricle function) data. We also analyzed some hemodynamic data of patients who had a right-heart catheterization (RHC), according to international guidelines. Results The TAPSE/PAPs ratio, obtained among 10 patients with SSc-related PAH (Mean ± S.D: 0.26 ±0.13), 66 SSc-patients without PAH (0.91±0.30) and 34 healthy subjects (1.13±0.24) was significantly different between the 3 groups, even after correction for age and sex (figure). The decrease of the RV coupling was related, in the SSc group PAH-free, with a decreased s’ wave and an increased blood level of NT-proBNP. In the PAH group, there is a relation between the decrease of the RV-arterial coupling and a decreased s'wave, an increased PVR and a decreased right ventricular ejection volume. Conclusion The right ventriculo-arterial coupling, assessed by the TAPSE/PAPs ratio, is impaired in systemic sclerosis, regardless of the presence of PAH. A decrease in TAPSE/PAPs is correlated with the level of NT-proBNP and the s’ wave. This suggest a myocardial impairment in SSc which is non-related to the vascular complications.

Comprehensive Exercise Capacity and Quality of Life Assessments Predict Mortality in Patients with Pulmonary Arterial Hypertension.

The 6-minute walk test (6MWT) and cardiopulmonary exercise test (CPET) are exercise tests associated with physical function, quality of life and hemodynamic data in patients with pulmonary arterial hypertension (PAH). This study was conducted to assess correlations between exercise capacity, quality of life and disease functional classification, and to analyze the value of comprehensive assessments in predicting mortality in patients with PAH. Fifty-four patients with PAH were enrolled. Comprehensive assessments including exercise capacity evaluated using the 6MWT and CPET, and health-related quality of life evaluated using the Short Form 36 (SF-36) questionnaire were performed in all participants. The patients were followed for 2 years with the end point of mortality. The survivors had a longer 6-minute walking distance, higher peak oxygen uptake and higher physical component score of the SF-36 than the non-survivors. In addition, exercise capacity combined with SF-36 predicted 2-year mortality in the patients with PAH. The patients with lower peak oxygen uptake (peak VO2 < 11.03 mL/kg/ min) and lower physical component score (score < 44.54) had a higher mortality rate than those with a higher peak VO2 and higher physical component score (adjusted hazard ratio = 19.95, p = 0.011). Comprehensive assessments of exercise capacity and quality of life can be used to predict 2-year mortality in patients with PAH.

Асоціації рівня васкулоендотеліального фактора росту А з показниками гемодинаміки у хворих, що перенесли інфаркт міокарда з елевацією сегмента ST

The aim – to research associations between vascular endothelial growth factor-A (VEGF-A) level and left ventricular remodeling after ST elevation myocardial infarction (MI). Material and methods. 62 patients with MI, 51 (82.3 %) male and 11 (17.7 %) female at average age 58.63±8.90 years were enrolled into the study. VEGF-A level was determined on the 7th day of MI by enzyme-linked immunoassay. Anxiety level was assessed by Taylor questionnaire during the period of 10–14 days before MI. After 6-month observation 47 patients were assessed. Results. In patients with MI in comparison with the control group significant rise of serum VEGF-A level was observed, showing positive correlation with creatine kinase level. The level of VEGF-A below median 160 pg/ml in comparison with its level above the median 160 pg/ml was associated with higher frequency of MI in men (Р=0.023), anxiety before MI (Р=0.019), end diastolic diameter (EDD), end systolic diameter (ESD), end diastolic volume (EDV) increase in acute phase, EDD, ESD, EDV, left ventricular myocardial mass, Е/А, lower exercise tolerance after 6-month observation. This processes indicates unfavorable role of low VEGF-A levels and protective – of high VEG-A levels for intracardiac hemodynamic after myocardial infarction. The level of VEGF-A ≤ 201.86 pg/ml with sensitivity 57.9 % and specificity 85.7 % (AUC 0.711; 95 % CI 0.513–0.908; Р=0.036) have prognostic significance for adverse remodeling development. Conclusions. VEGF-A level – important indicator to estimate the extent of myocardial injury and pathologic remodeling development.

Subclavian and axillary vessel anatomy: a prospective observational ultrasound study.

The primary objective of this study was to define the ultrasound-derived anatomy of the axillary/subclavian vessels. As a secondary objective, we evaluated the relationship between the vascular anatomy and demographic, anthropometric, and hemodynamic data of patients. This observational anatomical study used bedside ultrasound with 150 cardiac surgical patients in the operating room. Bilateral axillary and subclavian anatomy was determined using a high-frequency ultrasound probe with fixed reference points. Images were recorded and analyzed, and correlation with demographic, anthropometric, and hemodynamic data was performed. The images were adequate to evaluate potential anatomical variations in 97.4% of patients with a body mass index as high as 46.4kg·m-2. The mean (standard deviation) diameter of the axillary vein was 1.2 (0.3) cm on the right side and 1.1 (0.2) cm on the left side. The dimensions of the axillary vein were larger on the right side in 69% of patients. The vein was located directly over the artery in the mid-clavicular view in 67% of the patients and in lateral-clavicular view in only 7% of the patients. As we moved the probe laterally, the vein was lateralized in relation to the artery in 89% of patients. There was no significant correlation between the hemodynamic data and vessel size, although direct correlation was found between body mass index and the depth of the vessel (P<0.001). The axillary vein area was smaller in females than in males (P<0.002), and in 4% of patients, the axillary vein was in an aberrant position. In patients undergoing cardiac surgery, axillary vessel anatomy varied considerably, and the patients' hemodynamics could not predict the size of the axillary vessels. Only the patients' weight correlated moderately with the depth of the vein.

Effect of Shen-Fu Injection () on Hemodynamics in Early Volume Resuscitation Treated Septic Shock Patients.

To investigate the hemodynamic effect of Shen-Fu Injection (, SFI) in early volume resuscitation treated septic shock patients by monitoring pulse indicator continuous cardiac output (PICCO). All septic shock patients admitted in the Intensive Care Unit of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 1st, 2014 to December 31th, 2015, were reviewed, and totally 65 were enrolled in this study. They were assigned to SFI group (33 cases) and control group (32 cases). All 65 patients underwent conventional treatment mainly including volume resuscitation, antibiotics and vasoactive drugs therapy. The patients of the SFI group received additional 100 mL of SFI intravenously every 12 h. In all 65 patients, the PICCO arterial catheter and vein catheter were implanted within 1 h after the diagnosis of septic shock. In the course of early volume resuscitation, hemodynamic data of patients were recorded by PICCO monitor at 0, 12, and 24 h after the catheter implantation. The hemodynamic indices of the two groups showed no significant differences at the beginning of 0 h (P>0.05). At 12 and 24 h, the hemodynamic indices of SFI group were significantly improved in comparison with the control group (P<0.05), including cardiac index (CI), global end diastolic volume index (GEDI), mean arterial pressure (MAP) and heart rate (HR). In addition, there was no significant change of extra-vascular lung water index between the two groups (P>0.05). SFI significantly improved hemodynamic indices such as CI, GEDI, MAP and HR in early volume resuscitation treated septic shock patients.

VARIATION IN AORTIC PRESSURE UPSTROKE AND AMPLITUDE IN ELDERLY PATIENTS WITH SEVERE SYMPTOMATIC AORTIC STENOSIS WITH PRESERVED LEFT VENTRICULAR EJECTION FRACTION

Aortic Stenosis (AS) is classically associated with pulsus parvus et tardus. However, with advancing arterial stiffness, pulse velocity is altered, potentially modifying the classic delay and reduced upstroke of aortic (and carotid) arterial waveform. The aims of this prospective study were 1) to evaluate the echocardiographic and hemodynamic data of patients with pure severe symptomatic AS (SSAS), and 2) to determine the parameters associated with ascending aortic calcification as assessed by computed tomography (CT). Patients with preserved left ventricular ejection fraction (PLVEF) by echocardiography were invasively assessed by cardiac catheterization (simultaneous aortic and LV pressure measurements). Peak aortic systolic and aortic pulse pressures are inverse indices for pulsus parvus. The slope of aortic pulse during systole (an inverse index of pulsus tardus) was calculated as the quotient of dP (peak aortic pressure - preceding end-diastolic aortic pressure) and dt (time difference in msec between these two pressure points). These indices were correlated with the degree of valvular stenosis based on mean pressure gradient and valve area utilizing the Pearson correlation coefficient. In a subset of 11 patients who underwent CT scanning, the amount of aortic root and ascending aortic calcification was quantified and correlated with the aortic pulse characteristics. A total of 24 elderly patients (mean age 78.4+/-7.56 years) were included. The mean aortic pressure (Cardiac Catheterization) was 48.2±17.0 mmHg with LVEF 60.42+/-9.08%. Mean peak aortic systolic pressure was 139.3±23.7 mmHg and aortic pulse pressure was 73.7±17.1 mmHg. Mean slope of aortic impulse 0.292±0.076 mmHg/msec and mean aortic rise time 256.43±37.64 msec. The slope of aortic systolic pressure upstroke (inverse measure of pulsus tardus) strongly correlated with peak aortic systolic pressure (r=0.71). However, there was no correlation between the peak aortic systolic pressure (as well as slope of aortic pulse during systole) with aortic valve mean pressure gradient (r=-0.01, for both, respectively). Correlation between the slope of aortic pulse during systole and aortic valve area was modest (r=0.27). Measures of pulsus parvus (peak aortic systolic pressure) and tardus (slope of the aortic pulse) poorly correlated with the average percent calcification of the aorta by area (r=0.24, r=0.05, respectively). There is significant variation in aortic pulse characteristics such that the classical findings of pulsus parvus et tardus are not universally present in elderly patients with SSAS. The findings are not correlated with the magnitude of the stenosis nor with the degree of calcification of the ascending aorta.

Embolization of Veno-venous Collaterals after the Fontan Operation Is Associated with Decreased Survival.

After Fontan operation, hemodynamically significant veno-venous collateral (VVC) vessels can lead to systemic arterial desaturation. Outcomes after embolization of VVCs have not been determined. We sought to determine the frequency of and outcomes for patients undergoing VVCs embolization after Fontan operation. We retrospectively analyzed clinical and hemodynamic data of patients who underwent cardiac catheterization after the Fontan operation from 1995 to 2014 at Mayo Clinic. Clinical, imaging, and hemodynamic data from patients with VVCs were compared based on intervention (embolization) vs. nonintervention. Four hundred ninety-six patients with prior Fontan operation had catheterization; 109 VVCs were identified in 72 patients (37 males, mean age 26 ± 12 years). Embolization was performed in 31/72 patients (43%). Following embolization, no improvement was demonstrated in oxygen saturation or hemoglobin concentration at ambulatory follow-up (2.5 ± 2 years), and cardiac index declined at follow-up catheterization (5.6 ± 3 years). Overall, 15 patients (21%) died at a mean of 2.8 ± 4 years after embolization. Fifty percent of deaths after embolization occurred in patients with Fontan pressures ≥18 mm Hg. Five-year survival of patients with VVCs undergoing embolization was 74% compared with 92% in those patients who did not undergo embolization (P < .01). In multivariate analysis, significant predictors of death on follow-up were embolization [hazard ratio (HR) = 9.3 (95% confidence interval [CI], 2.8-42), P = .0001], atrio-pulmonary Fontan (HR = 4.2 [95% CI, 1.4-15], P = .01), and heterotaxy (HR = 3.7 [95% CI, 1.0-15], P = .05). We observed decreased 5-year survival in patients who had VVC embolization. Embolization of VVC in patients after Fontan should be evaluated very carefully in patients with atrio-pulmonary type Fontan, heterotaxy, and those with Fontan pressure above 18 mm Hg. These patients may benefit from the "natural" fenestration that VVCs provide.

Invasive Hemodynamic Characteristics of Low Gradient Severe Aortic Stenosis Despite Preserved Ejection Fraction

The study sought to compare echocardiographic with invasive hemodynamic data in patients with "paradoxic" aortic stenosis and in patients with conventionally defined severe aortic stenosis. Controversy exists whether low gradient severe aortic stenosis despite preserved ejection fraction ("paradoxic" aortic stenosis; aortic valve area <1 cm(2), mean gradient <40 mm Hg, ejection fraction >50%), which has been mainly diagnosed by echocardiography (echo), may be largely due to mistakes in echocardiographic measurements. We compared echocardiographic and invasive hemodynamic data from 58 patients (43% male, mean age 77 ± 5 years) with "paradoxic" aortic stenosis. Data of 22 patients (45% male, mean age 73 ± 7 years) with conventionally defined severe aortic stenosis area (aortic valve area ≤1 cm(2), mean gradient >40 mm Hg, ejection fraction ≥50%) were also analyzed. In patients with "paradoxic" aortic stenosis, orifice area by echo (0.80 ± 0.15 cm(2)) and catheterization showed modest agreement, whether stroke volume was measured by oxymetry (0.69 ± 0.16 cm(2), bias 0.14 ± 0.17 cm(2)), or by thermodilution (0.85 ± 0.19 cm(2), bias -0.03 ± 0.19 cm(2)). Mean systolic gradients were very similar (32 ± 7 mm Hg vs. 31 ± 6 mm Hg; bias -0.08 ± 7.8 mm Hg). In comparison, in patients with conventionally defined severe aortic stenosis, orifice area by echo was 0.72 ± 0.17 cm(2) and by catheterization 0.51 ± 0.15 cm(2) (oxymetry) and 0.68 ± 0.21 cm(2) (thermodilution), respectively, and mean systolic gradient 51 ± 10 mm Hg and 55 ± 8 mm Hg, respectively. Ejection fractions did not differ significantly in both groups. Ascending aortic diameter was significantly smaller in the "paradoxic" aortic stenosis group than in patients with conventionally defined severe aortic stenosis (28 ± 5 mm vs. 31 ± 5 mm), and energy loss index was significantly larger (0.51 ± 0.12 cm(2)/m(2) vs. 0.42 ± 0.09 cm(2)/m(2), respectively). Heart rate and mean blood pressure during echo and catheterization were not significantly different. Occurrence of low gradient severe aortic stenosis despite preserved ejection fraction was confirmed by invasive hemodynamics and was not the result of a systematic bias in the echo calculation of aortic orifice area.

Out-of-Proportion Pulmonary Hypertension and Heart Failure with Preserved Ejection Fraction

Background: A subset of patients with heart failure with preserved ejection fraction (HFpEF) will have a marked increase in pulmonary artery pressure (PAP). Objective: To evaluate the clinical and hemodynamic characteristics of these patients in comparison to patients with idiopathic pulmonary arterial hypertension (IPAH). Methods: We reviewed the clinical and hemodynamic data of patients with HFpEF with out-of-proportion pulmonary hypertension (HFpEF-PH) and compared it to the corresponding data of age-matched patients with IPAH. Results: Twenty consecutive patients with HFpEF-PH and 20 patients with IPAH were included in the study. The mean age (±SD) was 71.3 ± 7.8 and 70.2 ± 6.7 years, respectively. The majority of the HFpEF-PH patients were postmenopausal females with at least two features of the metabolic syndrome and atrial fibrillation. Although HFpEF-PH patients fulfilled the criteria for out-of-proportion PH, with transpulmonary gradient (TPG) >12 mm Hg, the difference between the diastolic PAP and the pulmonary capillary wedge pressure (PCWP) was significantly lower compared to IPAH (6.3 ± 6.2 vs. 27.5 ± 4.8, p < 0.00001). Conclusions: Our results suggest that a diagnosis of HFpEF-PH should be suspected when severe PH occurs in an elderly postmenopausal female with one or more features of the metabolic syndrome and atrial fibrillation. Interestingly, these patients had significantly lower differences between diastolic PAP and PCWP, suggesting that the increase in TPG is mainly caused by an elevated systolic PAP, possibly as a result of increased pulmonary vascular stiffness, and not pulmonary vascular remodeling.

145 Clinical and hemodynamic results of percutaneous mitral valvuloplasty at patients with mitral stenosis and pulmonary artery hypertension

The percutaneous balloon mitral valvuloplasty (PBMV) became the procedure of choice of the mitral stenosis with favorable morphology. The development of the pulmonary hypertension (PH) is a frequent in patients with mitral stenosis. However, its influence on results of the PBMV is unknown. To determine the impact of the PH on immediate and long term results of the PBMV. Retrospective study that spreads on 6 years (from 1996 to 2002) regrouping all patients having undergone a PBMV for the first time. Clinics, echographic, hemodynamic data of patients have been collected. 72 patient had a systolic arterial pulmonary pressure (SPP) 60 mmHg (group H) whereas 217 had a SPP <60 mmHg (group N). Group H patients were older, had more acute pulmonary edema at admission, an echographic score >8, tricuspid regurgitation and smaller pre PBMV mitral surface. A bad result was noted in 11.4% in group H against 8.6% in group N (p = 0, 04). Post procedural complications were similar, except for the severe mitral regurgitation, more often frequent in the group H. During a mean follow-up of 92 months, fifty-three patients in group H and 204 patients in group N were free of cardiac events. The NYHA class I or II were met more in the N group. The residual systolic pulmonary pressure was higher in H group. The PBMV is an efficient procedure even in presence of PH in spite of the pejorative character that it confers on the immediate and longterm prognosis.

Evaluation of hemodynamic data in patients with aortic regurgitation by MRI and correlation with the left ventricular function and echocardiography

Evaluation of hemodynamic data in patients with aortic regurgitation by MRI and correlation with the left ventricular function and echocardiography

855-4 Cardiac magnetic resonance imaging-derived parameters of right ventricular function correlate significantly with hemodynamic data in patients with pulmonary hypertension

855-4 Cardiac magnetic resonance imaging-derived parameters of right ventricular function correlate significantly with hemodynamic data in patients with pulmonary hypertension

Hemodynamic features of the freestyle aortic bioprosthesis compared with stented bioprosthesis

Background. The Freestyle prosthesis is a new stentless aortic bioprosthesis. Anticipated benefits are improved hemodynamics and increased longevity. Methods. Doppler echocardiograms were performed early and at 3 to 6 months, 1 year, and 2 years after operation in 157 patients (69 men, 88 women, aged 48 to 85 years) with this prosthesis, and results were compared with hemodynamic data in patients with Intact and Mosaic stented bioprostheses. Results. Distinctive features of the prosthesis compared with stented prostheses are (1) an increase in effective orifice area (+0.15 ± 0.26 cm 2; p < 0.05) and a decrease in mean gradient (−3.5 ± 4.0 mm Hg; p < 0.001) during the first 3 to 6 months postoperatively and stabilization thereafter; (2) a markedly lower mean gradient at 1 year after operation (average, 6 ± 4 mm Hg) than in stented prostheses (Intact, 22 ± 8 mm Hg; Mosaic, 12 ± 6 mm Hg); (3) in contrast to stented prostheses, in vivo effective orifice areas much lower (−0.91 ± 0.35 cm 2) than those calculated in vitro; (4) as in stented prostheses, the indexed effective orifice area (cm 2/m 2) is the best predictor (r = 0.77 at 1 year) of the mean gradient after operation; and (5) similar incidence of aortic regurgitation (trivial or mild, 34% versus 29% in Intact). Conclusions. The hemodynamics of the Freestyle are very satisfactory and represent a marked improvement in comparison to stented prosthesis.

Transesophageal echocardiographic measurements of cardiac output in cardiac surgical patients

Transesophageal echocardiography is becoming increasingly popular as a method of intraoperative monitoring because it can be performed continuously, does not transgress the sterile operative field, and provides data with regard to valve function, ventricular volumes, and contractility. Recently it was suggested that it can be used to measure cardiac output; however, controversy remains regarding its accuracy. Cardiac output was measured simultaneously by transesophageal echocardiography (using a 5-MHz pulse-wave Doppler, single-plane viewing probe) and by the thermodilution method in 21 patients undergoing open heart operations. The cardiac outputs measured by thermodilution correlated poorly ( n = 0.45) with the transesophageal values derived from the left ventricular cross-sectional area, and the mean difference was 0.47 /+- 2.17 (standard deviation) L /sd min -1, giving limits of agreement of from -3.87 to +4.81 L /sd min −1. Cardiac outputs measured by thermodilution correlated well ( r = 0.95) with transesophageal Doppler values derived from pulmonary artery flow velocity, with a mean difference of 0.12 /+- 0.45 L /sd min −1 and narrow limits of agreement of from -0.78 to +1.02 L /sd min −1. Based on our findings, transesophageal Doppler echocardiographic determination of cardiac output using pulmonary artery flow measurements can provide accurate hemodynamic data in patients undergoing cardiac operations.

Forearm venous distensibility in relation to severity of symptoms and hemodynamic data in patients with congestive heart failure.

The distensibility of the forearm veins in 24 patients with congestive heart failure was studied by occlusion plethysmography. Relationships between forearm venous distensibility and symptoms, hemodynamic data obtained by right heart catheterization and plasma levels of vasoactive hormones were evaluated. Forearm venous pressure (VP) and volume change (delta V) were measured simultaneously by the venous occlusion technique with strain gauge plethysmography. The relationship between venous pressure and volume change was fitted by the equation VP = c* exp (k* delta V) (r = 0.98 +/- 0.01) and the venous stiffness constant (k) was calculated. Venous volume change at a venous pressure of 20 mmHg (V20) was also measured as another index of venous compliance. The pressure-volume curve of the peripheral veins shifted leftward on the volume axis and the stiffness constant (k) increased as the New York Heart Association functional class grade increased. Mean pulmonary arterial pressure and pulmonary vascular resistance were closely related to k (r = 0.74, p less than 0.001; r = 0.73, p less than 0.001, respectively), and less closely to V20 (r = -0.56, p less than 0.004; r = -0.59, p less than 0.002, respectively). K and V20 were also related to stroke index (r = -0.57, p less than 0.004; r = 0.44, p less than 0.03, respectively) and stroke work index (r = -0.47, p less than 0.02; r = 0.45, p less than 0.03, respectively). K was also related to heart rate (r = 0.55, p less than 0.007), pulmonary capillary wedge pressure (r = 0.54, p less than 0.02), right atrial pressure (r = 0.51, p less than 0.02), cardiac index (r = -0.45, p less than 0.03), and systemic vascular resistance (r = 0.45, p less than 0.03). Both indexes were related to the plasma level of norepinephrine (r = 0.64, p less than 0.008; r = -0.52, p less than 0.04, respectively). We concluded that the venous tone was related to the severity of heart failure, especially to the symptoms, pulmonary arterial pressure and plasma concentration of norepinephrine, and that the venous stiffness constant, k, was a better parameter with which to assess peripheral venous tone.

Are rotating tourniquets useful for left ventricular preload reduction in patients with acute myocardial infarction and heart failure?

We examined the hemodynamic effects of congesting cuffs (rotating tourniquets) in 12 patients with first acute myocardial infarction and new onset of congestive heart failure 24 to 48 hours after admission. Congesting cuffs were applied for two periods of 15 minutes each, 15 minutes apart, and inflated to 30 mm Hg and 60 mm Hg consecutively. No change was noticed in mean pulmonary artery wedge pressure, which was 20 +/- 3 mm Hg at the beginning of the study and 19 +/- 3 mm Hg at the completion (P greater than .05, NS), nor in other hemodynamic and blood gases parameters. Patients' clinical conditions remained unchanged. We conclude that application of congesting cuffs at pressures of 30 mm Hg and 60 mm Hg does not result in any change in clinical or hemodynamic data in patients with acute myocardial infarction and new onset of congestive heart failure.