Hemodynamic Profile Research Articles

Impact of ventricular interaction and ventricular afterload on biventricular diastolic dysfunction in heart failure with preserved ejection fraction

Abstract Background Pressure-volume (PV) loop analyses recently identified two different hemodynamic phenotypes in response to exercise in heart failure with preserved ejection fraction (HFpEF). In addition to a rightward shift (RS) along the end-diastolic PV relation, a cohort of HFpEF patients characterised by a straight upward shift (US) of the PV relation with markedly increased systolic and diastolic stiffness and impaired left ventricular (LV) stroke volume (SV) was identified. Whether this is an effect of RV-LV interdependence or an alternative mechanism remains elusive. Purpose To invasively study biventricular exercise physiology in patients with HFpEF to decode cardiac mechanisms underlying exercise intolerance. Methods HFpEF was diagnosed according to the 2016 ESC guidelines. Patients underwent cardiac magnetic resonance imaging prior to invasive hemodynamic characterisation including sequential biventricular PV loop analysis during preload reduction and handgrip exercise. HFpEF patients were grouped according to LV hemodynamic phenotypes into RS cohort (change in indexed end-diastolic volume, ∆EDVi >0ml/m²) and US cohort (∆EDVi ≤0 ml/m²). Results A total of 37 HFpEF patients (n=20 RS and n=17 US, median age 71 years [68, 78], 70% female) were included. Clinical presentation did not differ between cohorts regarding age (p=0.22), functional NYHA class (p=0.52) and NTproBNP (p=0.57). In PV loop analysis, diastolic stiffness (EDP/EDVi ratio) was higher in the US cohort as compared to the RS cohort in both the LV (0.31 vs. 0.23 mmHg/ml, p<0.01) and the RV (0.14 vs. 0.10 mmHg/ml, p=0.03). This difference was even more pronounced during handgrip exercise (LV: 0.45 vs. 0.29 mmHg/ml/m², p<0.01; RV: 0.18 vs. 0.12 mmHg/ml/m², p=0.02). Similarly, exertional systolic stiffness was increased in US cohort compared to the RS cohort in both the LV (V120i 21.1 vs. 30.6 ml/m², p=0.04) and RV (V40i 27.8 vs. 40.5 ml/m², p<0.01). LV and RV volumes were closely correlated at rest (EDVi r=0.77, p<0.01; end-systolic volume, ESVi r=0.54, p<0.01; SVi r=0.95 p<0.01). The US of the LV PV relations could not be explained by ventricular interaction since exercise-induced increases (∆) in RV-EDVi did not correlate with increases in LV diastolic stiffness (∆LV-EDP/EDVi, p=0.58). However, the change in LV afterload from baseline to peak exercise (∆LV-Ea) did correlate with ∆LV-EDP/EDVi (r=0.61, p<0.01). A similar correlation was also found for RV afterload and RV diastolic stiffness (r=0.50, p<0.01). Conclusion Biventricular hemodynamic profiles closely resemble one another. The pathological LV US of the PV relations in response to exercise could not be explained by ventricular interdependence but was rather related to excess of biventricular afterload. Therefore, these findings indicate HFpEF to be a biventricular disease, which should be incorporated in future considerations about pathomechansims and potential therapeutic targets.Schematic biventricular PV-Loops

Right ventricular diastolic adaptation to pressure overload in different rat strains

Abstract Background Different rat strains are used in various animal models of pulmonary hypertension and right ventricular (RV) failure. No systematic assessment has been performed to test differences in RV response to pressure overload between rat strains. Purpose We compared RV adaptation to pulmonary trunk banding (PTB) in Wistar, Sprague Dawley, and Fischer344 rats by hemodynamic profiling focusing on diastolic function. Methods Age-matched male rat weanlings were randomized to sham operation (Wistar sham, n=5; Sprague Dawley sham, n=4; Fischer344 sham, n=4) or PTB (Wistar PTB, n=8; Sprague Dawley PTB, n=8; Fischer344 PTB, n=8). RV function was evaluated after five weeks by echocardiography, cardiac MRI, and invasive pressure-volume measurements and RV remodelling assessed by histological analyses. Results At end of study, Fischer344 rats weighed 25 % less than Wistar and Sprague Dawley rats. PTB increased RV systolic pressures four-fold, and RV failure was evident by a decrease in cardiac index (Wistar PTB: 1.8±0.2 mL/s/m2 vs. Wistar sham: 3.9±0.2 mL/s/m2, p<0.0001; Sprague Dawley PTB: 1.7±0.1 mL/s/m2 vs. Sprague Dawley sham: 3.0±0.3 mL/s/m2, p=0.0029; Fischer344 PTB: 2.1±0.2 mL/s/m2 vs. Fischer344 sham: 3.8±0.3 mL/s/m2, p<0.0001). There was a 2.4-fold increase in RV end-systolic volume index in Wistar PTB and Sprague Dawley PTB compared with sham, while Fischer344 PTB rats were less affected with only a 2.0-fold increase in RV end-systolic volume index compared with Fischer344 sham. Diastolic and right atrial impairment were evident by increased end-diastolic elastance, filling pressure, and E/e’ in PTB rats compared with sham, again Fischer344 PTB the least affected. PTB increased RV fibrosis in all groups compared with sham, though Fischer344 PTB showed a trend towards a smaller increase in RV fibrosis (Fischer344 PTB: 9.2±0.4 % vs Wistar PTB: 10.7±0.2 %, p=0.0919). Conclusions PTB caused RV failure in all rats subjected to the procedure including signs of diastolic dysfunction. Despite similar increase in RV systolic pressure, Fischer344 PTB rats showed less RV dilatation and where more able to sustain diastolic function compared with Wistar and Sprague Dawley PTB rats. All three rat strains are suitable for PTB and studies of RV failure.

Abstract 15927: Polyunsaturated Fatty Acid Levels and Their Relationship With Peak Exercise Measures in HFpEF

Background: Polyunsaturated fatty acids (PUFAs) regulate the inflammatory cascade and have been implicated in potential pathologic and therapeutic roles in heart failure with preserved LVEF (HFpEF). The purpose of this study was to explore the relationship between plasma levels of omega-3 (ω-3) fatty acids and invasive hemodynamic profiles characteristic of early HFpEF. Methods: In a single-center referral cohort undergoing evaluation for exertional dyspnea and suspected HFpEF, we assayed ω-3 concentrations in plasma by liquid chromatography. We derived an ω-3 score by summing Z-scores of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Linear regression was used to relate plasma ω -3 levels to simultaneously collected physiologic data from cardiopulmonary exercise testing (CPET) with invasive catheterization. Results: 588 patients (52% female, age 62 ± 12 years, BMI 30 ± 6 kg/m 2 , peak oxygen uptake (VO 2 ) 15.5 ± 5.1 mL/min/kg [76 ± 20% predicted], NTproBNP 118 [33 - 405] pg/mL) were studied. Median ω -3 concentrations were 72 [46 - 107] pg/mL for EPA and 315 [225 - 457] pg/mL for DHA. Female sex and increased age were associated with higher levels of ω-3 fatty acids ( Table , p=0.03). After adjustment for age, sex, and BMI, a higher ω-3 score was associated with greater exercise capacity measured by peak VO 2 (p<0.001) and peak workload (p<0.001) along with an increase in peak exercise peripheral O 2 extraction (CavO 2 ; p < 0.001). Notably, increased ω-3 score was associated with lower supine pulmonary capillary wedge pressure (PCWP; p=0.03), PCWP to cardiac output (CO) slope during exercise (p = 0.009), and NTproBNP (p < 0.001). Conclusion: These data demonstrate that circulating ω-3 fatty acid levels are associated with exercise capacity and both central cardiac and peripheral function in HFpEF. Further studies are needed to unravel the relationship between modulation of plasma PUFAs and rest and exercise hemodynamic profiles of HFpEF.

Abstract 11798: Comparison of Echocardiographic Measurements and Cardiac Biomarkers Between Neonates With Neonatal Encephalopathy Who Developed Brain Injury or Not During Therapeutic Hypothermia

Background: Despite therapeutic hypothermia (TH), many newborns with neonatal encephalopathy (NE) develop brain injury (BI). We hypothesis that newborns with NE have with brain injury have different echocardiographic (ECHO) parameters to those with no brain injury. Aims: To compare the ECHO parameters on day of life (DOL) 2 between neonates with NE undergoing TH developing or not brain injury. Methods: Prospective cohort study in a single tertiary unit enrolling neonate (born ≥36weeks and ≥1800 grams) undergoing TH for NE, between 2016 and 2020. All neonates presented on admission with moderate to severe NE by amplitude-integrated electroencephalogram (aEEG) profile and underwent a brain magnetic resonance (MRI) on DOL 2. ECHO was performed on the MRI day and data were extracted offline. Multiple logistic regression analyses were constructed to determine which parameters best predicted brain injury or not. Results: A total of 34 neonates were recruited, of which 19 (56%) had brain injury. Those with BI had a higher gestational age (GA) at birth (39.6±1.6 vs 38.2±1.5, p=0.01) and more severe pattern on aEEG (p=0.007) (Table 1). Mortality was also more frequent. Left and right ventricular performance were similar between groups by standard ECHO measures, strain and tissue Doppler imaging (Table 2). Although TAPSE was increased in those with brain injury (p=0.04), the Z-Score accounting for GA was similar. Initial aEEG pattern was the best predictor of brain injury, when accounting for GA and ECHO parameters/biomarkers. Conclusion: Initial aEEG pattern and not hemodynamic profile was most predictive of brain injury on MRI.

COMPARATIVE STUDY OF BUPIVACAINE WITH DEXMEDETOMIDINE AND BUPIVACAINE ALONE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Objective: The objective is to compare the efficacy of bupivacaine with dexmedetomidine and bupivacaine alone when used for supraclavicular brachial plexus block in patients undergoing upper limb surgeries. Methods: This was a comparative study conducted in the department of anesthesiology of a tertiary care medical college. 80 patients scheduled for upper limb surgeries under supraclavicular brachial plexus block were included on the basis of a predefined inclusion and exclusion criteria. Patients were divided into 2 groups depending on whether they received only Bupivacaine (Group B) or Bupivacaine and Dexmedetomidine (Group BD) for supraclavicular block. The onset and duration of sensory as well as motor blockade, intensity of Pain as assessed by Visual Analog Score, requirement of rescue analgesia, hemodynamic profile, and side effects were compared in both the groups. For statistical purpose p<0.05 was taken as statistically significant. Results: Group BD exhibited significantly faster onset and longer duration of sensory blockade compared to Group B. Group BD also showed significantly faster onset and longer duration of motor blockade compared to Group B. Moreover, Group BD had significantly longer analgesia duration (614.84±52.02 min) compared to Group B (352.62±32.46 min). The hemodynamic parameters, including mean heart rate and mean arterial pressure, were not significantly different between the groups. In addition, side effects such as bradycardia and hypotension were observed in Group BD, but these differences were not statistically significant. Conclusion: Dexmedetomidine, when used as an adjuvant to bupivacaine during supraclavicular brachial plexus block in upper limb surgeries provided longer-lasting analgesia, and reduced pain intensity as compared to Bupivacaine alone with a comparable side effect profile.

A COMPARATIVE STUDY BETWEEN 0.5% LEVOBUPIVACAINE AND 0.75% ROPIVACAINE IN PATIENTS UNDERGOING ELECTIVE LOWER LIMB SURGERIES UNDER SUBARACHNOID BLOCK

Objective: The aim of the study was to compare the efficacy of 0.5% levobupivacaine and 0.75% ropivacaine after intrathecal administration in elective lower limb surgeries. Methods: A prospective, randomized, controlled, and double-blind study was conducted on 100 patients undergoing elective lower limb surgeries under subarachnoid block using 0.5% levobupivacaine and 0.75% ropivacaine. Results: Demographic characteristics of both groups are comparable. It is observed the onset of sensory blockade is earlier in ropivacaine group, Grade 4 bromage scale motor blockade onset is shorter in levobupivacaine and most of the parameters are comparable between two groups. Duration of sensory blockade is more in ropivacaine when compared to levobupivacaine. Levobupivacaine is more cardiostable with stable hemodynamic profile compared to ropivacaine. Conclusion: Levobupivacaine is more cardiostable with stable hemodynamic profile compared to ropivacaine.

Abstract 14672: Exercise Hemodynamic Profiles of Resting and Exercise-Based Definitions of Cancer Therapy-Related Cardiac Dysfunction in Anthracycline-Treated Breast Cancer Survivors

Introduction: Detection of cancer therapy-related cardiac dysfunction (CTRCD) is a cornerstone of heart failure (HF) risk assessment. However, it is unclear how closely CTRCD definitions reflect typical HF features of reduced exercise tolerance (VO 2 peak) and blunted cardiac reserve. Hypothesis: Standard CTRCD metrics (resting LVEF and GLS) will show poor agreement with reduced VO 2 peak and changes in cardiac reserve following anthracycline chemotherapy (AC). Methods: This analysis used baseline (pre-AC) and 12-month assessments from a randomized trial of exercise training in breast cancer patients (n=104) undergoing AC ± anti-HER2 therapy. Assessments included resting echocardiography (LVEF and GLS), cardiopulmonary exercise testing (VO 2 peak) and exercise cardiac magnetic resonance (peak cardiac output [CO], stroke volume [SV] and LVEF [LVEF peak ]). CTRCD was defined as ≥10% absolute decline in LVEF to a value <50%, >15% decline in GLS, and a ≥10% decline in VO 2 peak from pre-AC. Results: Seventy-nine participants (76%) completed pre-AC and 12-month assessments, 14 of whom (18%) met LVEF and 30 (38%) met GLS CTRCD criteria (10% met both criteria). In addition to declines in resting LVEF and GLS, these participants showed a reduction in LVEF peak , but no change in peak SV, CO or VO 2 peak (Figure 1A-B). In contrast, 19 participants (24%) had a ≥10% VO 2 peak decline (-17% vs Pre-AC, P<0.001) that coincided with a decline in peak SV (-6%, P=0.03), and LVEF peak (-11%, P=0.02), with no significant change in resting LVEF or GLS (Figure 1C). Of those who met VO 2 peak criteria, only three (16%) and five (26%) met LVEF or GLS criteria, respectively, and only one met all three criteria. Conclusions: Whilst capturing reduced global LV systolic function, CTRCD definitions are insensitive to meaningful declines in VO 2 peak and cardiac reserve. Incorporating measures of VO 2 peak into CTRCD surveillance may improve HF risk stratification in breast cancer survivors.

Abstract 18627: The Relative Contribution of Perfusion vs. Congestion in Predicting Adverse Outcomes in Heart Failure With Preserved Ejection Fraction

Background: Heart Failure with Preserved Ejection Fraction (HFpEF) constitutes greater than half of all heart failure (HF) patients with limited therapies. There are limited data on the role of congestion versus perfusion in prognosticating outcomes. Methods: A total of 243 patients seen at the Johns Hopkins HFpEF Clinic between 2011-2023 with HFpEF and RHC were included for analysis. Subjects were stratified into congestion and perfusion groups based on the median PCWP and CI, which were 15 mmHg and 2.44 L/min/m 2 , respectively. Groups were assigned as follows: dry-warm (PCWP < 15 mmHg, CI ≥ 2.44 L/min/m 2 ), wet-warm (PCWP ≥ 15 mmHg, CI ≥2.44 L/min/m 2 ), dry-cold (PCWP < 15 mmHg, CI < 2.44 L/min/m 2 ), and wet-cold (PCWP ≥ 15 mmHg, CI < 2.44 L/min/m 2 ), seen in Figure 1A . Results: Subjects with hypoperfusion (wet-cold and dry-cold) were older (p=0.01), more likely to have atrial fibrillation (p<0.0001), had worse RV function (p=0.002), and had elevated NT-proBNP (p=0.0001) compared to subjects with normal perfusion. Congested patients were more likely female (p=0.002), had higher BMI (p=0.02), higher creatinine (p=0.005), evidence of metabolic syndrome, including elevated fasting glucose (p=0.0008), elevated cholesterol (p=0.01), and LVH on echocardiography (p=0.002). Kaplan-Meier survival analysis of the hemodynamic profiles for a combined end point of all-cause mortality and HF hospitalization revealed that congested profiles exhibited the lowest event free survival compared to the dry profiles (logrank p=0.008; Figure 1B ) and of these, the wet-warm subjects had the lowest event-free survival at 36 months. Conclusion: Unlike in prior HF studies, congestion in HFpEF appears to be concomitant with obesity and metabolic syndrome. Moreover, while consistent with prior studies that congestion drives outcome differences compared to perfusion, wet-warm HFpEF patients appear to have the lowest event free survival as opposed to wet-cold patients as in other forms of HF.

Relation between waist circumference and the renal hemodynamic in healthy individuals

Background and aimsObesity has been shown to be an independent risk factor for the development of CKD. Little is known about pathways of interaction of visceral fat mass estimated by waist circumference (WC) and metabolic factors with the renal and intraglomerular hemodynamic profile in healthy, non-obese individuals. Methods and resultsThe study population of this post-hoc analysis in 80 healthy individuals, who participated in a randomized, controlled clinical trial (www.clinicaltrials.gov: NCT02783456) was divided into two groups based on median of WC (high WC and low WC group). Renal hemodynamic profiles were analyzed using steady state input clearance (infusion of para-amino-hippuric acid and inulin). Intraglomerular pressure (IGP) and resistances of the afferent (RA) and efferent (RE) arterioles were calculated (Gomez equation). The analysis included healthy, non-smoking individuals, aged 27 ± 9 years with median WC of 84.75 ± 9 cm. Glomerular filtration rate (GFR) (110 ± 15 vs. 127 ± 16 ml/min/m2, p < 0.001), renal plasma flow (RPF) (620 ± 109 vs. 700 ± 104 ml/min, p = 0.001) and IGP (36.7 ± 2.3 vs. 38.5 ± 3.1 mmHg, p = 0.003) were lower in the high WC compared to the low WC group. Patients in the high WC group showed higher renal vascular resistance (RVR) (85 ± 19 vs. 70 ± 12 mmHg/(ml/min), p < 0.001), higher RA (4034 ± 1177 vs. 3069 ± 786 dyn∗s/cm5, p < 0.001) and higher RE (2283 ± 339 vs. 2118 ± 280 dyn∗s/cm5, p = 0.021) compared to the low WC group. Individuals in the high WC group showed higher leptin levels (p = 0.003) and higher HOMA-IR (p = 0.024) compared to the low WC group. ConclusionIncreased WC in healthy young individuals was associated with reduced GFR and RPF likely mediated by increased RVR.

Safety and efficacy of remimazolam for general anesthesia in elderly patients undergoing laparoscopic cholecystectomy: a randomized controlled trial.

There is insufficient evidence regarding the efficacy and safety of remimazolam in elderly patients. Therefore, this study evaluated the differences in the anesthesia characteristics and perioperative hemodynamic profiles of elderly patients receiving total intravenous anesthesia with remimazolam or propofol. Eighty-four patients aged >65 years with an American Society of Anesthesiologists physical status of I-III were randomly assigned to Group R (receiving remimazolam, n = 42) or Group P (receiving propofol, n = 42). In Group R, remimazolam was initiated at a rate of 6 mg/kg/h until loss of consciousness (LOC) was achieved and maintained at 1 mg/kg/h subsequently. In Group P, 1.0-1.5 mg/kg of propofol was injected for 1 min and maintained at 100 μg/kg/min subsequently. The maintenance infusion rate was adjusted to maintain an appropriate depth of anesthesia until the end of the surgery. The primary outcome was the time to LOC. The depth of anesthesia scores and hemodynamic profiles were recorded perioperatively. The time to LOC was significantly longer in Group R (120 s) than in Group P (60 s) (p < 0.001). The time to eye-opening (Group R, 10 min; Group P, 10 min; p = 0.056), the incidence of maintenance of hemodynamic changes within 20% of the peri-anesthetic values, and treatments for hemodynamic instability did not differ significantly between the groups. The depth of anesthesia scores did not differ significantly between the groups; however, the scores were higher in Group R than those in Group P before endotracheal intubation. The hemodynamic parameters did not differ significantly at any time point. The time to extubation was longer in Group R (12 min) than that in Group P (10 min) (p = 0.007). Similarly, the time to discharge from the operating room was significantly longer in Group R (15 min) compared to Group P (12 min) (p = 0.018). Remimazolam does not exhibit a comparable effect to propofol in terms of anesthesia induction and recovery. However, it demonstrates a similar effect to propofol regarding intraoperative anesthesia depth and hemodynamic profile in elderly patients undergoing remifentanil-based total intravenous anesthesia.

Guide to Temporary Mechanical Support in Cardiogenic Shock: Choosing Wisely.

Cardiogenic shock is a multisystem pathology that carries a high mortality rate, and initial pharmacotherapies include the use of vasopressors and inotropes. These agents can increase myocardial oxygen consumption and decrease tissue perfusion that can oftentimes result in a state of refractory cardiogenic shock for which temporary mechanical circulatory support can be considered. Numerous support devices are available, each with its own hemodynamic blueprint. Defining a patient's hemodynamic profile and understanding the phenotype of cardiogenic shock is important in device selection. Careful patient selection incorporating a multidisciplinary team approach should be utilized.

Angiotensin II in liver transplantation (AngLT-1): protocol of a randomised, double-blind, placebo-controlled trial

IntroductionCatecholamine vasopressors such as norepinephrine are the standard drugs used to maintain mean arterial pressure during liver transplantation. At high doses, catecholamines may impair organ perfusion. Angiotensin II is a...

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Pulmonary hypertension (PH) is a syndrome characterized by marked remodeling of the pulmonary vasculature and a progressive rise in the pulmonary vascular load, leading to hypertrophy and remodeling of the right ventricle. PH hemodynamically defined hemodynamically by a mean pulmonary arterial pressure of higher than 20 mm Hg at rest, as measured by right heart catheterization. The several forms of PH are categorized into five clinical groups, based on the 2018 meeting of the World Symposium on PH with the clinical characteristics and hemodynamic profile of each group. PH complicates chronic lung diseases, such as chronic obstructive pulmonary disease (worldwide burden &gt;500 million cases) and interstitial lung disease (10 to 70%). It is estimated that 1% of the world population and up to 10% of persons older than 65 years of age have PH. We reviewed current literature to ascertain the approach to classification, diagnostic and treatment algorithm for confirmed Pulmonary Arterial Hypertension (PAH) according to ESR-ECS 2015 guidelines, 2018 meeting of the World Symposium on PH and randomized controlled trials. Diagnostic algorithm for suspected PH on the basis of symptoms and signs will intergrated with transthoracic echocardiography, as the single most important screening test ordered by the general practitioner. Additional routine blood and imaging tests are involdved in the clinical assessment. Treatment algorithm for confirmed PAH is adapted from Galiè et al and presented with recommendations for approved PAH, therefore further studies need to be carried out.

Computational modeling of the cephalic arch with jugulocephalic vein variant predicts hemodynamic profiles in patients with brachiocephalic fistula

Computational modeling of the cephalic arch with jugulocephalic vein variant predicts hemodynamic profiles in patients with brachiocephalic fistula

Comparison of Dexmedetomidine and Nalbuphine on Intubating Conditions and Hemodynamic Responses During Awake Fiberoptic Intubation: A Randomized Study

Background: The pre-requisites to a successful awake fiberoptic intubation (AFOI) include adequate psychological and pharmacological preparation of the patient. This study aims to compare two pharmacological agents, dexmedetomidine and nalbuphine, in addition to nebulization and airway topicalization, for intubating conditions during AFOI.&#x0D; Methods: Sixty consenting patients belonging to ASA I/II, MPC I/II, age-group of 18-60 years weighing between 40-70 kgs requiring general anaesthesia with endotracheal intubation were randomly allocated to one of the two groups. Patients received dexmedetomidine 1µg/kg i.v. (group D) or nalbuphine 0.2 mg/kg i.v. (group N) over 10 min before intubation. Fiberoptic intubation was attempted. Intubating conditions were assessed in terms of sedation score, cough score and post-intubation score. Hemodynamic responses, lignocaine and propofol requirement were also recorded. Repeated measure ANOVA, Tukey’s test, unpaired t test, Chi‑square test or Fisher’s exact test were used for data analysis. A P &lt; 0.05 was considered significant.&#x0D; Results: Sedation score (P = 1.000), cough score (P = 0.165) and post‑intubation score (P = 0.157) were comparable among the two groups. Hemodynamic responses, propofol and lignocaine requirements were also comparable.&#x0D; Conclusion: Both intravenous dexmedetomidine and nalbuphine provide good intubating condition with minimal adverse effects on haemodynamic profile during awake fibreoptic intubation.

Hemodynamic Differences between Patients Hospitalized with Acutely Decompensated Chronic Heart Failure and De Novo Heart Failure.

Heart failure (HF) is associated with high mortality, morbidity, and frequent hospitalizations due to acute HF (AHF) and requires immediate diagnosis and individualized therapy. Some differences between acutely decompensated chronic heart failure (ADCHF) and de novo HF (dnHF) patients in terms of clinical profile, comorbidities, and outcomes have been previously identified, but the hemodynamics related to both of these clinical states are still not well recognized. To compare patients hospitalized with ADCHF to those with dnHF, with a special emphasis on hemodynamic profiles at admission and changes due to hospital treatment. This study enrolled patients who were at least 18 years old, hospitalized due to AHF (both ADCHF and dnHF), and who underwent detailed assessments at admission and at discharge. The patients' hemodynamic profiles were assessed by impedance cardiography (ICG) and characterized in terms of heart rate (HR), blood pressure (BP), systemic vascular resistance index (SVRI), cardiac index (CI), stroke index (SI), and thoracic fluid content (TFC). The study population consisted of 102 patients, most of whom were men (76.5%), with a mean left ventricle ejection fraction (LVEF) of 37.3 ± 14.1%. The dnHF patients were younger than the ADCHF group and more frequently presented with palpitations (p = 0.041) and peripheral hypoperfusion (p = 0.011). In terms of hemodynamics, dnHF was distinguished by higher HR (p = 0.029), diastolic BP (p = 0.029), SVRI (p = 0.013), and TFC (only numeric, p = 0.194) but lower SI (p = 0.043). The effect of hospital treatment on TFC was more pronounced in dnHF than in ADCHF, and this was also true of N-terminal pro-brain natriuretic peptide (NT-proBNP) and body mass. Some intergroup differences in the hemodynamic profile observed at admission persisted until discharge: higher HR (p = 0.002) and SVRI (trend, p = 0.087) but lower SI (p < 0.001) and CI (p = 0.023) in the dnHF group. In comparison to ADCHF, dnHF is associated with greater tachycardia, vasoconstriction, depressed cardiac performance, and congestion. Despite more effective diuretic therapy, other unfavorable hemodynamic features may still be present in dnHF patients at discharge.

Variability of cardioinhibition in vasovagal syncope: differences between subgroups during cardioinhibition and beyond

PurposeWe compared hemodynamic parameters between subjects with marked, intermediate and minimal cardioinhibition during vasovagal syncope.MethodsThe study included subjects with a decrease in heart rate while experiencing a complete vasovagal syncope during tilt-table testing. The subjects were classified as having marked, intermediate or minimal cardioinhibition, based on tertile values of the decrease in heart rate. Hemodynamic parameters between these groups were compared before tilt in the supine position, shortly after tilt and during cardioinhibition.ResultsA total of 149 subjects with a median age of 43 (interquartile range 24–60) years were included in the study. Among the three groups with different levels of cardioinhibition, the highest heart rate was observed in subjects with marked cardioinhibition both before and shortly after tilt and at the start of cardioinhibition. The heart rate decrease in these subjects was both larger and faster compared to subjects with minimal and intermediate cardioinhibition.ConclusionSubjects with marked cardioinhibition have both a larger and faster decrease in heart rate compared to subjects with intermediate and minimal cardioinhibition, as early as from the start of cardioinhibition. Marked cardioinhibition is related to differences in hemodynamic profiles already present well before the start of cardioinhibition.

Balloon- vs Self-Expanding Transcatheter Valves for Failed Small Surgical Aortic Bioprostheses: 1-Year Results of the LYTEN Trial

BackgroundData comparing valve systems in the valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) field have been obtained from retrospective studies. ObjectivesThe authors sought to compare the 1-year hemodynamic performance and clinical outcomes between balloon-expandable valves (BEV) SAPIEN 3/ULTRA (Edwards Lifesciences) and self-expanding valves (SEV) Evolut R/PRO/PRO+ (Medtronic) in ViV-TAVR. MethodsPatients with a failed small (≤23 mm) surgical valve undergoing ViV-TAVR were randomized to receive a SEV or a BEV. Patients had a clinical and valve hemodynamic (Doppler echocardiography) evaluation at 1-year follow-up. Study outcomes were defined according to VARC-2/VARC-3 criteria. Intended performance of the valve was defined as mean gradient <20 mm Hg, peak velocity <3 m/s, Doppler velocity index ≥0.25 and less than moderate AR. ResultsA total of 98 patients underwent ViV-TAVR (46 BEV, 52 SEV). At 1-year follow-up, patients receiving a SEV had a lower mean transaortic gradient (22 ± 8 mm Hg BEV vs 14 ± 7 mm Hg SEV; P < 0.001), and a higher rate of intended valve performance (BEV: 30%, SEV:76%; P < 0.001). There were no cases of greater than mild aortic regurgitation. There were no differences in functional status (NYHA functional class >II, BEV: 7.3%, SEV: 4.1%; P = 0.505) or quality of life (Kansas City Cardiomyopathy Questionnaire, BEV: 77.9 ± 21.2, SEV: 81.8 ± 14.8; P = 0.334). No differences in all-cause mortality (BEV: 6.5%, SEV: 3.8; P = 0.495), heart failure hospitalization (BEV: 6.5%, SEV: 1.9%; P = 0.214), stroke (BEV: 0%, SEV: 1.9%; P = 0.369), myocardial infarction (BEV: 0%, SEV: 1.9%; P = 0.347), or pacemaker implantation (BEV: 2.2%, SEV: 1.9%; P = 0.898) were found. ConclusionsIn patients who underwent ViV-TAVR for failed small aortic bioprostheses, those receiving a SEV exhibited a better valve hemodynamic profile at 1-year follow-up. There were no differences between SEV and BEV regarding functional status, quality of life, or clinical outcomes.

Clinical features and long-term survival in idiopathic pulmonary arterial hypertension with thyroid dysfunction: insights from a national multicentre prospective study.

Our objective was to clarify the characteristics and long-term survival of idiopathic pulmonary arterial hypertension (IPAH) patients with thyroid dysfunction and compare them with IPAH without thyroid dysfunction. A retrospective analysis was conducted using prospectively collected data. IPAH patients with thyroid dysfunction at baseline were included. Patients with other subgroups of PAH and Group 2-5 pulmonary hypertension were excluded. IPAH patients with euthyroid function were matched 1:1 to IPAH patients with thyroid dysfunction by age and sex. In total, 148 IPAH patients with thyroid dysfunction were included. Patients with hyperthyroidism, hypothyroidism, subclinical hyperthyroidism and subclinical hypothyroidism accounted for 16.2%, 18.9%, 8.1% and 56.8%, respectively. IPAH patients with hyperthyroidism showed the highest mixed venous oxygen saturation (SvO2) and the lowest pulmonary vascular resistance (PVR) at baseline among subgroups, while patients with subclinical hypothyroidism had the lowest SvO2 and highest PVR (p<0.05). Compared with IPAH without thyroid dysfunction, patients with hyperthyroidism (9.14 versus 13.86 WU; p<0.05) and hypothyroidism (10.70 versus 13.86 WU; p<0.05) showed significantly lower PVR. The haemodynamic profiles of patients with subclinical hypothyroidism were similar to IPAH with euthyroid function except for lower right atrial pressure (6 versus 8 mmHg; p=0.009). The long-term survival of patients with clinical thyroid dysfunction was better than IPAH without thyroid dysfunction, while that of those with subclinical diseases was comparable to the latter, even after adjusting for baseline haemodynamics and treatment. IPAH patients with clinical hyper- and hypothyroidism had better haemodynamics and survival than those without thyroid dysfunction, while patients with subclinical hypothyroidism had similar haemodynamics and survival profiles to the latter.

The patient's sex determines the hemodynamic profile in patients with Cushing disease.

Cushing disease (CD) may lead to accelerated cardiovascular remodeling and increased mortality. There are suspected differences in the mechanism of cardiovascular dysfunction between males and females with CD. The purpose of this study was to assess the effect of patient sex on the hemodynamic profile assessed via impedance cardiography and echocardiography in patients newly diagnosed with CD. The 54 patients newly diagnosed with CD (mean age 41 years; 77.8% of females) who were included in this prospective clinical study underwent impedance cardiography to assess specific parameters (including systemic vascular resistance index [SVRI], total arterial compliance index [TACI], Heather index [HI], stroke index [SI], cardiac index [CI], velocity index [VI], and acceleration index [ACI]) and transthoracic echocardiography to assess heart chamber diameters and left ventricular systolic and diastolic function. Males with CD exhibited higher afterload, with higher SVRI (3,169.3 ± 731.8 vs. 2,339.3 ± 640.8 dyn*s*cm-5*m² in males and females, respectively; p=0.002), lower TACI (0.80 ± 0.30 vs. 1.09 ± 0.30 mL/mmHg*m2; p=0.008), and lower hemodynamic parameters of left ventricular function, with lower HI (9.46 ± 2.86 vs. 14.1 ± 5.06 Ohm/s2; p=0.0007), lower VI (35.1 ± 11.9 vs. 44.9 ± 13.1 1*1000-1*s-1; p=0.009), lower SI (36.5 ± 11.7 vs. 43.6 ± 9.57 mL/m2; p=0.04), lower CI (2.36 ± 0.46 vs. 3.17 ± 0.76 mL*m-2*min-1; p=0.0009), and lower ACI (50.4 ± 19.8 vs. 73.6 ± 25.0 1/100/s2; p=0.006). There were no significant differences between the sexes in left ventricular systolic or diastolic function assessed by echocardiography. In comparison with females with CD, males with CD have a less favorable hemodynamic profile, with higher afterload and worse left ventricular function. Sex differences in cardiovascular system function should be taken into consideration in designing personalized diagnostic and therapeutic management of patients with CD.