Hemodynamic Factors Research Articles

Hemodynamic Risk Factors for Cerebellar Hemorrhage Presence and Volume in Infants Born Very Preterm.

To examine among infants born very preterm the role of hemodynamic disturbances in the occurrence of cerebellar hemorrhage (CbH) and whether cardiovascular instability is associated with larger CbH volume. Prospective, longitudinal, multisite cohort study. Early-life and/or term-equivalent age (TEA) brain MRIs were performed in 309 very preterm infants admitted to 3 tertiary-level neonatal intensive care units. A cut-off of 4 mm was used to distinguish punctate vs large CbH. CbH volumes were obtained by manual segmentation. As a measure of hemodynamic stability, Score for Neonatal Acute Physiology (SNAP-II), patent ductus arteriosus requiring treatment, and hypotension treated with inotropes were recorded. 60 patients (18.3%) were diagnosed with CbH, classified as punctate in 43 infants (71.3%). Hypotension requiring treatment with inotropes was an independent risk factor for CbH (OR 3.07, 95% CI 1.15 to 8.21, p = 0.02) and was associated with larger CbH volume (0.36 logmm3, 95% CI 0.17 to 0.54, p < 0.001). Hypotension treated with inotropes is shown to be an independent risk factor for the presence of CbH as well as for larger CbH volume. These results reinforce the importance of hemodynamics stability, especially an appropriate management of hypotension to prevent CbH and therefore improve neurodevelopmental outcomes among infants born very preterm.

Dobutamine-induced alterations in internal carotid artery blood flow and cerebral blood flow in healthy adults.

Dobutamine, a sympathomimetic agent, is widely used clinically, influencing cardiac output, heart rate (HR), and blood pressure (BP), which may impact cerebral blood flow (CBF), critical for brain metabolism. However, the effects of dobutamine on CBF and internal carotid artery (ICA) blood flow remain unclear, with contradictory reported in both clinical and animal studies. It is necessary to investigate the effects of dobutamine on cervical and cerebral hemodynamics. This study aimed to evaluate the effects of dobutamine infusion on ICA blood flow and CBF, explore their relationship, and identify factors influencing CBF to facilitate timely monitoring in clinical practice. Forty-eight healthy volunteers underwent physiological assessment, ICA ultrasound, and brain magnetic resonance imaging (MRI) data before and after the administration of dobutamine. Paired t and Wilcoxon signed-rank tests were used to analyze changes, while logistic regression explored associations between hemodynamic factors and CBF. Dobutamine infusion significantly increased HR, respiration rate, systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure, while blood oxygen remained stable. Compared with those in the resting state, the peak systolic velocity (Vs), resistance index, pulsatility index, and systolic/diastolic ratio (S/D) increased, whereas end-diastolic velocity (Vd) decreased. ICA diameter and mean velocity showed no significant changes. CBF significantly decreased in the anterior and middle cerebral arteries. Logistic regression identified SBP, DBP, and S/D difference as key factors associated with CBF reduction. Dobutamine altered ICA hemodynamics and reduced CBF in anterior and middle cerebral arteries. Real-time ICA ultrasound monitoring provides valuable guidance during clinical use.

Abstract TMP86: Stratifying risk of hemorrhage of pedatriac brain arteriovenous malformation using quantitative color-coded digital subtraction angiography and iflow analysis

Background: Pediatric brain arteriovenous malformation (bAVM) patients often present with intracranial hemorrhage. While certain angioarchitectural features, such as aneurysms, deep venous drainage, a single draining vein, venous outflow stenosis, or small nidus size, increase hemorrhage risk, they do not fully predict it. Hemodynamic factors, particularly those assessed by quantitative color-coded digital subtraction angiography (cDSA), have also been linked to hemorrhage risk. This study evaluated the relationship between nidal mean transit time (MTT) and hemorrhage history in pediatric bAVM patients. Methods: We retrospectively analyzed 40 pediatric bAVM patients using flow analysis software (syngo iFlow®; Siemens) to generate cDSA images. A neurointerventional radiologist identified regions of interest (ROIs) in each bAVM’s major arterial afferent and venous efferent. ROI peak time and MTT were obtained. ROI peak time was defined as the time that contrast intensity of the selected ROI reached the peak value and MTT was defined as the difference between venous and arterial peak times. Multivariable logistic regression analysis assessed the association between MTT and prior hemorrhage, adjusting for bAVM size. Results: Among the 40 patients (median age 13 years ; 42.5% female), 47.5% (n=19) had a history of hemorrhage. The median bAVM size was 2.7 cm (IQR: 1.8-4.2), and the median nidal MTT was 0.97 seconds (IQR: 0.79-1.27). In logistic regression analysis, each 0.25-second increase in nidal MTT time was associated with a 24% reduction in the risk of prior hemorrhage (OR=0.76, 95% CI: 0.53-1.08, p=0.122), although not statistically significant. Larger bAVM size was significantly associated with a lower risk of prior hemorrhage (OR=0.48 per cm increase, 95% CI: 0.27-0.87, p=0.014). Conclusion: Our findings suggest that prolonged nidal MTT may be associated with a reduced risk of prior bleeding in pediatric bAVM patients after accounting for bAVM size. Larger bAVM size was significantly associated with a lower likelihood of prior hemorrhage.

Aortic Stenosis Prevention: Is a New Cardiovascular Disease Paradigm Coming of Age?

Calcific aortic stenosis (CAS) is currently recognized as the third most frequent cardiovascular disorder in persons aged above 60 years, after atherosclerotic disease and hypertension, and together with its precursor aortic sclerosis it has been found in more than 30% of elderly individuals. CAS is an active multifactorial process characterized by a progressive fibro-calcific remodeling and thickening of the AV leaflets caused by hemodynamic flow factors, genetic factors, lipoprotein deposition, oxidation, chronic inflammation, immunomodulators, and finally osteoblastic transformation of cardiac. Herein a comprehensive state-of-the-art paper is presented regarding the underlying pathophysiological mechanisms of CAS and the potential preventive strategies as an alternative to surgical and interventional treatment.

Cardiac systolic and diastolic function in relation to cardiovascular risk factor distribution: a comparison of strain-rate imaging in Russian and Norwegian populations

Abstract Background and Purpose Cardiovascular morbidity and mortality rates are high in Russia and it is likely that this reflects a similar impact on the general cardiac health of the population. The current study seeks to compare standard echocardiography and strain-based measurements between Russian and Norwegian populations, while also exploring their links to hemodynamic and risk factors. Methods This study included echocardiographic measurements of 1,192 participants from Russia, and 917 from the Study population, Norway. The sample included men and women aged 40–69 years. Normalcy, defined as the absence of hypertension or indicators of CVD, was observed in 840 individuals. We performed conventional echocardiography and analysed two-dimensional speckle-tracking longitudinal strains, including systolic, early-, and late-diastolic SR values. The study population was divided into four groups: normal, controlled hypertension, hypertensive blood pressure, and cardiac disease. Echocardiographic parameters were compared between the Russian and Norwegian populations, adjusted for age, sex, height, body mass index, blood pressure, heart rate (HR), atrial fibrillation (AF), smoking, pulmonary hypertension, and serum values for total, LDL (low density lipoprotein), and HDL (high density lipoprotein) cholesterol; triglycerides; creatinine; high-sensitivity C-reactive protein; and HbA1C. Results Russians showed a tendency towards lower longitudinal systolic functional parameters, which were most prominent in the normotensive group. However, these differences became insignificant after adjusting for parameters that influence pre- and after-loads. Russians also had a lower stroke volume, higher HR, higher left atrial volume, lower A, and higher E/A ratio, indicating a higher incidence of diastolic dysfunction in the Russian population that persisted after adjustments. Conclusion After adjusting for factors that influence cardiac function, there were no differences in systolic functional parameters between the Norwegian and Russian populations. However, differences in diastolic parameters, which persisted after adjusting for conventionally influential factors, indicated unexplained underlying causes of diastolic dysfunction in the Russian population. Figure 1 Table 1

A novel uORF regulates folliculin to promote cell growth and lysosomal biogenesis during cardiac stress

Pathological cardiac remodeling is a maladaptive response that leads to changes in the size, structure, and function of the heart. These changes occur due to an acute or chronic stress on the heart and involve a complex interplay of hemodynamic, neurohormonal and molecular factors. As a critical regulator of cell growth, protein synthesis and autophagy mechanistic target of rapamycin complex 1 (mTORC1) is an important mediator of pathological cardiac remodeling. The tumor suppressor folliculin (FLCN) is part of the network regulating non-canonical mTORC1 activity. FLCN activates mTORC1 by functioning as a guanosine triphosphatase activating protein (GAP). Our work has identified a regulatory upstream open reading frame (uORF) localized in the 5′UTR of the FLCN mRNA. These small genetic elements are important regulators of protein expression. They are particularly important for the regulation of stress-responsive protein synthesis. We have studied the relevance of the FLCN uORF in the regulation of FLCN translation. We show that FLCN downregulation through the uORF is linked to cardiomyocyte growth and increased lysosomal activity. In summary, we have identified uORF-mediated control of RNA translation as another layer of regulation in the complex molecular network controlling cardiomyocyte hypertrophy.

Angulation of the dural venous sinuses in the posterior cranial fossa: an anatomical study and its implications for venous circulation

The purpose of the current study was to determine the angulation of the dural venous sinuses in soft tissue, to evaluate differences between types of tissue, and to discuss the potential influence of these angulations on intracranial venous hemodynamics and related pathologies. Angulations formed in different segments of the transverse, sigmoid, and superior sagittal sinuses were measured in 13 adult human cadaveric heads (26 sides). After the soft tissues were removed, measurements were also taken from the underlying bone. The overall angulation of the transverse sinus was assessed using two reference points, while the lengths and widths of the dural venous sinuses were measured using microcalipers. Statistical analyses were performed considereing sides, sex, and types of tissue. The mean angulation of the superior sagittal sinuses - transverse sinus junction was 116 degrees. The mean angulations of the transverse sinus - sigmoid sinus junction in medial and superior views were 108 degrees and 114 degrees, respectively. The mean angulations of the entire transverse sinus at two different points were 45 degrees and 44 degrees, respectively. There were statistically significant differences in angulation in some variables when they were adjusted for sides and sex, but not types of tissue. Angulation is a paramount factor in venous hemodynamics. Certain angulations of the dural venous sinuses differed significantly between sides and sexes, but not between types of tissue. Future research should investigate the effects of these angulations on intracranial venous circulation and their relevance to related pathologies.

The Effect of Body Composition on Aerobic Fitness Levels and Hemodynamic Factors in Children: A Review of Literature

The benefits of physical activity (PA) are well established. However, the majority of children worldwide fail to meet the recommended weekly requirements for PA, which are essential for enhancing cardiorespiratory fitness (CRF) and maintaining a healthy weight for their age. The present review evaluated published work in an effort to study the effects of body composition on aerobic fitness levels and hemodynamic factors in children. Studies were retrieved from the following databases: Cochrane Database of Systematic Reviews, PubMed (2013-June 2024), Google Scholar, Scopus, Science Direct, EBM Reviews, Current Contents, CISTI Source (2011-June 2024), Sports Discuss (2019-June 2024), and international e-catalogues. Search analysis from these periods represents recent developments, ensuring that the review reflects up-to-date understanding in the field. This helps incorporate the latest methodologies, findings, and technological advancements, and strengthens the validity of this review. The population consists of children from both industrialized and developing nations. The selected study designs were cross-sectional, longitudinal, cohort, review, and systematic review. The analysis of research entailed reading titles, abstracts, and complete texts. Following these processes, thirty articles were considered for review. The broad investigation aims to reveal the effects of body composition on aerobic fitness levels and hemodynamic parameters in preventing childhood obesity. The search strategy, as well as Medical Subject Heading (MeSH) phrases and keywords, were used to effectively route significant papers addressing childhood obesity. The relevant terms were “body composition,” “overweight,” “obesity,” “physical activity,” “heart rate,” “blood pressure,” “aerobic fitness”, “nutrition,” “cardiovascular disease,” and “children aged 10-18 years old.” We discovered 12972 publications related to childhood obesity, hemodynamic variables, physical activity (PA), and aerobic fitness; however, 9194 articles were deleted due to duplication. The number of studies left after removing duplicates was 3778. Furthermore, 1657 articles were removed because they were not in English, 1240 articles had no full text available, and 809 articles only included abstracts. Moreover, the full text was reviewed for eligibility, which included 42 reference reviews and 18 titles. Finally, 30 articles were deemed eligible for review The existing literature suggests that additional investigation is warranted to delineate a precise course of action for mitigating the risks associated with childhood obesity. This entails placing a heightened emphasis on the significance of children engaging in aerobic fitness activities.

Impact of A1 segment asymmetry on hemodynamic conditions around the circle of Willis and anterior communicating artery aneurysm formation.

This study aims to investigate how A1 segment asymmetry-also known as A1 dominancy-influences the development of the anterior communicating artery aneurysm (AcomA) as it affects hemodynamic conditions within the circle of Willis (COW). Using time-of-flight magnetic resonance angiography (TOF-MRA), the research introduces a novel approach to assessing shear stress in A1 segments to uncover the hemodynamic factors contributing to AcomA formation. An observational study was conducted over 6 years at a tertiary university hospital's outpatient clinic. Recruited patients who underwent TOF-MRA imaging were divided into AcomA and non-AcomA groups. MRA images were analyzed using semi-automatic software (VINT, Mediimg, Inc.) to calculate the signal intensity gradient (SIG), which reflects wall shear stress. The comparison metrics included general demographics, anatomical characteristics, and hemodynamic attributes of the COW, mainly focusing on A1 segment asymmetry. Among the 700 subjects, 106 were categorized into the AcomA group, while 594 were placed in the non-AcomA group. The AcomA group showed a more significant difference in the bilateral A1 diameter (49.0% vs. 20.8%, p < 0.001) and a greater prevalence of unilateral A1 aplasia (32.1% vs. 6.7%, p < 0.001) compared to the non-AcomA group. Increased bilateral A1 asymmetry in the AcomA group corresponded with notable variations in A1 SIG, indicating increased wall shear stress. The occurrence of AcomA is associated with both anatomical factors of the circle of Willis, represented by the bilateral A1 diameter ratio, and hemodynamic factors, represented by the bilateral A1 SIG ratio, suggesting that both factors are almost equally significant. Our findings suggest that A1 segment asymmetry influences hemodynamic changes within the COW, contributing to AcomA formation. Hemodynamic factors provide an intuitive understanding of how anatomical characteristics within the COW can lead to aneurysm development.

Factors associated with poor intraoperative perfusion and postoperative complications in otolaryngological autologous tissue transfers: A single-centre retrospective observational study.

The purpose of this study was to identify haemodynamic factors that are associated with tissue hypoperfusion in flap/graft surgical patients that might be modified to reduce perioperative morbidity. We conducted a single-centre, retrospective, observational study of 1355 patients undergoing head and neck flap reconstructions. Logistic regression and chi-square analyses were employed to identify factors which signal perioperative complications. Study endpoints included postoperative lactic acidosis, acute kidney injury (AKI) and early surgical flap revision surgery. Intraoperative data were collected as time-weighted averages of the haemodynamic variables, including pulse pressure variation (PPV), mean arterial pressure, and vasopressor doses. Cumulative volume was used for intravenous (IV) fluids. Relevant patient comorbidities were also included in the analysis. The most common complication was hyperlactataemia (22.9%), followed by AKI (14.1%) and take-back surgery (3.3%). No patient factors were significantly correlated with flap complications. Elevated max PPV was significantly associated with elevated lactate and AKI in univariate regression, but only AKI in the multivariate analysis (P = 0.003). Case duration was the only variable associated with take-back surgery in the multivariate regression (P = 0.007); it was also associated with lactic acidosis (P = 0.003). Neither IV fluid administration nor the use of vasopressors appeared to be associated with study outcomes in the multivariate analysis.

Immunological Approaches in the Treatment of Diabetic Nephropathy.

Diabetic nephropathy (DN), the leading cause of end-stage renal disease, has no definite treatment so far. In fact, a combination of metabolic, hemodynamic, and immunological factors are involved in the pathogenesis of DN; therefore, effective disease management requires a holistic approach to all predisposing contributors. Due to the recent findings about the role of inflammation in the initiation and progression of kidney injury in diabetic patients and considerable advances in immunotherapy methods, it might be useful to revise and reconsider the current knowledge of the potential of immunomodulation in preventing and attenuating DN. In this review, we have summarized the findings of add-on therapeutic methods that have concentrated on regulating inflammatory responses in diabetic nephropathy, including phosphodiesterase inhibitors, nuclear factor-kB inhibitors, Janus kinase inhibitors, chemokine inhibitors, anti-cytokine antibodies, cell therapy, and vaccination.

Impact of Physical Performance on Haemodynamic and Cognitive Status in Romanian Older Adults

Background: Frailty is a major challenge for the aging population, increasing the risk of falls, disability, hospitalization, and death. It's common with age, and often linked to reduced physical activity and poor diet, especially in those prone to sarcopenia. Gait speed tests are frequently used to assess mobility in older adults. Materials and methods: This six-month study at "Sfântul Luca" Chronic Disease Hospital involved 143 patients over 65 (mean age 72.85 ± 10.07), 113 of whom were women. The Tensiomed Arteriograph measured heart rate, pulse wave velocity, and central aortic blood pressure to assess acute vascular stiffness. Results: As patients aged, their physical circumstances changed: in the age group 75-84 years (“Very elderly”) only 39% of the subjects achieved medium- and good-physical performance, while 56% of them were characterized by low-physical activity (Chi-square test, p 0.001). The mean Mini-Mental State Examination (MMSE) values of individuals with inadequate physical activity were significantly lower (21.02 ± 4.68 points) than those with adequate physical activity (Student t-test, p 0.001). Conclusion: Regular physical activity has been shown to improve hemodynamic factors and potentially slow down arterial aging, thus promoting healthy aging. It is imperative for healthcare professionals to promptly evaluate whether older, frail patients can benefit from rehabilitation, enabling swift recovery through multidisciplinary care.

Association of Preoperative Parameters on Intraoperative Indicators in Myocardial Revascularization Surgery: Insights from a Targeted Complex Network Model

Background/Objectives: Myocardial revascularization surgery (MR) is routinely performed in hospitals. However, there is a lack of an algorithm in the scientific literature aimed at predicting intraoperative parameters, such as total surgery time (TST) and cardiopulmonary bypass time (CBT), based on preoperative MR parameters. Therefore, the objective of the present study is to apply a complex network model to predict parameters associated with TST and CBT. Methods: Retrospective data from 124 patients who underwent MR, including medical history, vital signs, and laboratory/biochemical tests, were used, with 30 patients contributing to the construction of the network. Three complex networks were created to study the targets (TST and CBT). The Eigenvector metric was employed to investigate the parameters most relevant to these targets. Results: Regardless of the target, parameters derived from the blood gas analysis followed by erythrogram displayed greater relevance according to the eigenvector metric. However, for TST, the most prominent parameter was Red Blood Cells, while, for CBT, Diastolic Blood Pressure emerged as the most important variable. Conclusion: The targeted complex network model revealed that pulmonary, hemodynamic, and perfusion factors are relevant to the intraoperative parameters of MR. The networks also demonstrated that, although the targets show significant correlation with each other (TST and CBT-r = 0.76; p = 0.000), the importance of the parameters in the networks does not follow the same order. This reiterates the strength of the network in revealing specific information when a particular target is selected.

Modeling Fibrous Tissue in Vascular Fluid-Structure Interaction: A Morphology-Based Pipeline and Biomechanical Significance.

Modeling fibrous tissue for vascular fluid-structure interaction analysis poses significant challenges due to the lack of effective tools for preparing simulation data from medical images. This limitation hinders the physiologically realistic modeling of vasculature and its use in clinical settings. Leveraging an established lumen modeling strategy, we propose a comprehensive pipeline for generating thick-walled artery models. A specialized mesh generation procedure is developed to ensure mesh continuity across the lumen and wall interface. Exploiting the centerline information, a series of procedures are introduced for generating local basis vectors within the arterial wall. The procedures are tailored to handle thick-walled tissues where basis vectors may exhibit transmural variations. Additionally, we propose methods for accurately identifying the centerline in multi-branched vessels and bifurcating regions. These modeling approaches are algorithmically implementable, rendering them readily integrable into mainstream cardiovascular modeling software. The developed fiber generation method is evaluated against the strategy using linear elastostatics analysis, demonstrating that the proposed approach yields satisfactory fiber definitions in the considered benchmark. Finally, we examine the impact of anisotropic arterial wall models on the vascular fluid-structure interaction analysis through numerical examples, employing the neo-Hookean model for comparative purposes. The first case involves an idealized curved geometry, while the second studies an image-based abdominal aorta model. Our numerical results reveal that the deformation and stress distribution are critically related to the constitutive model of the wall, whereas hemodynamic factors are less sensitive to the wall model. This work paves the way for more accurate image-based vascular modeling and enhances the prediction of arterial behavior under physiologically realistic conditions.

Clinical course and outcome of adult patients with primary focal segmental glomerulosclerosis with kidney function loss on presentation.

Kidney function loss or renal insufficiency indicated by elevated creatinine levels and/or an estimated glomerular filtration rate (eGFR) < 60 mL/minute/1.73 m² at presentation in patients with primary focal segmental glomerulosclerosis (FSGS) is commonly seen as a poor prognostic marker for kidney survival. However, a pre>vious study from our center suggested this may be due to hemodynamic factors. To observe the clinical and biochemical parameters, treatment response, kidney survival, and overall outcomes of adult patients with primary FSGS presenting with kidney function insufficiency. This retrospective observational study was conducted at the Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from January 1995 to December 2017. During this period, 401 biopsy-proven primary FSGS patients were identified, of which 98 (24.4%) presented with kidney function loss or renal insufficiency defined as eGFR < 60 mL/minute/1.73 m² at presentation and were studied in detail. Among the 98 patients with renal function loss on presentation, the mean age was 30.9 years ± 13.6 years with a male-to-female ratio of 2.5:1. The mean serum creatinine level was 2.2 mg/dL ± 1.3 mg/dL and mean eGFR 37.1 mL/minute/1.73 m2 ± 12.8 mL/minute/1.73 m2. The mean 24-hour urinary protein excretion was 5.9 g/day ± 4.0 g/day, and the mean serum albumin was 2.1 g/dL ± 1.0 g/dL (median: 1.5 g/dL). The mean systolic blood pressure (BP) was 132.7 mmHg ± 19.8 mmHg, and the mean diastolic BP was 87.4 mmHg ± 12.7 mmHg. Steroid treatment was given to 81 (82.6%) of 98 patients for an average duration of 19.9 weeks ± 14.4 weeks, with a mean total steroid dose of 4.4 g ± 1.5 g. Treatment response showed that 20 (24.6%) patients achieved complete remission, 9 (11.1%) achieved partial remission, and 52 (64.1%) did not respond. The baseline eGFR was significantly lower in the non-responsive group (P = 0.006). The distribution of FSGS variants was also significantly different among steroid-responsive and non-responsive groups (P = 0.012). Renal function loss in FSGS patients at presentation does not necessarily indicate irreversible kidney function loss and a significant number of patients respond to appropriate treatment of the underlying disease.

Diabetic Nephropathy-Associated Impaired Aortic Function Is Not Mediated by Mean Arterial Pressure and Its Determinants.

Objective: The study aimed to assess the potential impacts of mean arterial pressure (MAP) and its determinants (cardiac output and systemic vascular resistance) on diabetic nephropathy (DNP)-associated impaired aortic function. Methods: This multi-ethnic study included 115 chronic kidney disease (CKD) patients (67 non-dialysis and 48 dialysis). Six aortic function measures were evaluated by SpygmoCor. The stroke volume was determined by echocardiography. Results: Hypertensive nephropathy (HNP) (53.9%), DNP (32.2%), glomerulonephritis (19.1%), and HIV-associated nephropathy (7.8%) composed the major CKD etiologies. Concurrent HNP and DNP were present in 31.1% of the patients. Participants with compared with those without concurrent HNP and DNP experienced more frequent established cardiovascular disease (43.2% versus 14.9%, p = 0.01), a faster pulse wave velocity (p = 0.001), and smaller total arterial compliance as an indicator of proximal aortic stiffness (p = 0.03). DNP was associated with each aortic function measure (p < 0.001-0.02) independent of potential confounders and MAP, as well as its determinants. HNP was not related to aortic function (p > 0.05 for all relationships). MAP and its determinants did not mediate the potential impact of DNP on aortic function (-4.1-6.4% contribution). Covariates that were associated with impaired aortic function measures included MAP and its determinants (p < 0.001-0.01). Conclusions: Mean or distending arterial pressure and its determinants were associated with impaired aortic function in the overall CKD population. However, these hemodynamic factors did not mediate DNP-associated impaired aortic function. Our results suggest that blood pressure lowering can be anticipated to improve impaired aortic function in the overall CKD population but not when it is solely induced by DNP.

Pentoxifylline (Vasonit®) – a pathogenetic approach for the correction of cognitive impairment in cerebrovascular diseases. A review

Cognitive impairment is one of the key manifestations of chronic cerebrovascular diseases. Among the factors contributing to their development are microcirculatory disturbances, changes in blood rheological properties, endothelial dysfunction and oxidative stress. This review is devoted to the analysis of the clinical application potential of the nonspecific phosphodiesterase inhibitor pentoxifylline (Vasonit®) in the therapy of patients with chronic cerebral ischaemia in order to correct haemorheological and haemodynamic factors. Data from experimental and clinical studies indicating the possibility and pathogenetic validity of the use of pentoxifylline (Vasonit®) in the complex therapy of cognitive disorders associated with chronic cerebrovascular diseases are considered. The authors describe their own experience of using Vasonit® in a patient with vascular cognitive impairment.

Orthostatic Heart Rate Changes and Prognostic Outcomes in Patients With Heart Failure

Heart rate typically increases during postural changes from a supine to a standing position due to autonomic and hemodynamic factors. Changes in heart rate during orthostasis may reflect the extent of autonomic dysfunction in patients with heart failure (HF). Thus, orthostatic heart rate changes may be useful for evaluating autonomic function and may predict prognosis. This study examined the association between orthostatic heart rate changes and prognosis in patients with HF. We included 320 patients with HF in sinus rhythm (median age 70 years, 70.9% men) who were admitted to Kitasato University Hospital for HF treatment and whose heart rate was evaluated in the supine and upright positions during the stable period before discharge. We calculated heart rate changes based on supine and upright heart rate. We examined the association of orthostatic heart rate changes with patient prognosis (i.e., a composite of all-cause mortality or rehospitalization for HF). During the follow-up period (median 3.8 years; interquartile range 0.8-7.0 years), 129 events occurred. Orthostatic heart rate changes were associated with low composite event rates (log-rank P=0.015). After adjusting for potential confounders, increasing orthostatic heart rate changes were associated with decreased composite event rates (adjusted hazard ratio 0.954; 95% confidence interval 0.925-0.985; P=0.004). In patients with HF, poor orthostatic heart rate changes were associated with a worse prognosis.

Systolic blood pressure, mean arterial pressure and incident mortality in heart failure in a West-African cohort: the blood pressure paradox revisited

BackgroundThe prognostic relevance of blood pressure in Africans with heart failure (HF) has not been well investigated despite the different trajectories of HF in Africans compared to other ethnicities. We investigated the shape and strength of associations of systolic blood pressure (SBP) and mean arterial pressure (MAP) with incident death in Nigerian Africans with hypertensive HF.ResultsPresent analyses include 118 participants (mean age 57.6 years, 55% men) with ambulatory hypertensive HF. Over a median 2.2 years of follow-up, there were 74 incident deaths. There was an inverse log-linear association between each of SBP and MAP, and incident death throughout the distribution of blood pressure studied and no J-shape effect was seen. Individuals in the bottom distribution of SBP (mean 100 mmHg) and MAP (mean 77 mmHg) had the highest cumulative incident death. Each 10 mmHg higher SBP and MAP was associated with lower risk of incident death (aHR 0.80 [95% CI: 0.70–0.91, p < 0.001] and aHR 0.78 [95% CI: 0.66–0.92, p < 0.01] respectively) which persisted despite adjustment for NHYA class, left ventricular function and systolic pulmonary artery pressure. The blood pressure paradox was partially explained by haematocrit, serum sodium, chloride and renal function (aHR SBP: 0.86 [95% CI: 0.73–1.00, p = 0.05] and aHR MAP: 0.88 [95% CI: 0.72–1.08, p = 0.22]).ConclusionsThere was a graded inverse dose−response association between each of SBP, MAP and incident death in hypertensive HF which was not fully explained by haemodynamic and clinical factors.

New Trends of Personalized Medicine in the Management of Abdominal Aortic Aneurysm: A Review.

Abdominal aortic aneurysm (AAA) is a significant vascular condition characterized by the dilation of the abdominal aorta, presenting a substantial risk of rupture and associated high mortality rates. Current management strategies primarily rely on aneurysm diameter and growth rates to predict rupture risk and determine the timing of surgical intervention. However, this approach has limitations, as ruptures can occur in smaller AAAs below surgical thresholds, and many large AAAs remain stable without intervention. This review highlights the need for more precise and individualized assessment tools that integrate biomechanical parameters such as wall stress, wall strength, and hemodynamic factors. Advancements in imaging modalities like ultrasound elastography, computed tomography (CT) angiography, and magnetic resonance imaging (MRI), combined with artificial intelligence, offer enhanced capabilities to assess biomechanical indices and predict rupture risk more accurately. Incorporating these technologies can lead to personalized medicine approaches, improving decision-making regarding the timing of interventions. Additionally, emerging treatments focusing on targeted delivery of therapeutics to weakened areas of the aortic wall, such as nanoparticle-based drug delivery, stem cell therapy, and gene editing techniques like CRISPR-Cas9, show promise in strengthening the aortic wall and halting aneurysm progression. By validating advanced screening modalities and developing targeted treatments, the future management of AAA aims to reduce unnecessary surgeries, prevent ruptures, and significantly improve patient outcomes.