Measurement Of Hemodynamic Parameters Research Articles

Use of Impedance Cardiography to Guide Blood Pressure Lowering Medication Selection: Systematic Review of Randomized Controlled Trials.

Blood pressure (BP) control can be difficult to attain due to multiple factors, including choosing and titrating antihypertensive medications. Measurement of hemodynamic parameters using impedance cardiography (ICG) at the point of care may allow better alignment of medication with the mechanism(s) underlying an individual's hypertension. We conducted a systematic review of randomized controlled trials of ICG compared to usual care for attainment of BP control. We searched Medline inclusive of year 1946 to January 31, 2024 using a combination of MeSH terms and key words. English-language articles were eligible for inclusion if they described results of a randomized controlled trial designed to compare ICG-guided BP medication selection to usual care (i.e., clinician judgment/guidelines-based alone) among a sample of hypertensive patients. Of 1952 titles screened, six trials met inclusion criteria. The first was published in 2002 from a specialty clinic in the United States, and the most recent in 2021 from a specialty clinic in China. One trial was conducted in a primary care setting. Sample sizes ranged from 102 to 164. Participants randomized to ICG-guided antihypertensive medication had reduced BP in the short-term to a greater extent than those randomized to usual care, with odds ratios for BP control (<140/90 mmHg) at three months ranging from 1.87 to 2.92. This effect was seen in both specialty clinics and in a primary care setting. Incorporation of ICG in the clinical setting may facilitate medication selection that leads to a greater proportion of patients obtaining BP control in the short-term.

DECIPHERING THE NOVEL ROLE OF ERDOSTEINE IN PREVENTION OF MYOCARDIAL ISCHEMIA-REPERFUSION INJURY IN RAT

Objective: Myocardial ischemia-reperfusion injury (MIRI) is caused by thrombotic obstruction of the coronary artery subsequently leading to heart failure. Despite the availability of improved prognosis, MIRI is a foremost cause of morbidity and mortality worldwide. In this study, we investigated the therapeutic potential of Erdosteine (a mucoactive antioxidant molecule, with multifaceted pharmacological properties), to attenuate myocardial infarction in rat model of MIRI. Design and method: This study was conducted in adult male Wistar rats (n=40), randomized into five groups: Sham, IR-C (disease control), Erdosteine (80 mg/kg; s.c.) + IR, Telmisartan (10 mg/kg; orally) +IR and Erdosteine (80 mg/kg) perse groups. Erdosteine and telmisartan were administered for 28 days as a pre-treatment. On the 29th day, animals were subjected to LAD coronary artery occlusion for 1 h followed by reperfusion for 45 minutes. The cardioprotective potential was assessed through measurement of hemodynamic parameters, biochemical markers (MDA, GSH, SOD), cardiac injury markers (CK-MB and LDH), inflammatory markers (IL-6, TNF), histopathological evaluation, TUNEL assay and immunohistochemistry analysis (Bax, caspase 3, Bcl2). Further, the underlying mechanism was evaluated using immune-blotting of MAPK, Nrf-2/HO-1, and Akt/p-Akt. The statistics analysis was performed by one-way ANOVA followed by Turkey-Kramer post hoc tests. Results: Erdosteine and telmisartan pretreatment improves hemodynamic parameters by preserving MAP, ±LVdP/dt, and HR as compared to the IR-C group. Pretreatment markedly restored the levels of antioxidants (GSH and SOD) and decreased peroxidation marker (MDA) compared to the IR-C group. Also, the pretreatment significantly prevented the damage following IR injury as compared to the IR-C group when investigated through cardiac injury markers and histopathological evaluation. Erdosteine profoundly reversed the expressions of Bcl2/BAX ratio, in comparison to the IR-C group indicating its anti-apoptotic effect when reconfirmed through TUNEL assay. Erdosteine pretreatment preserved the levels of NF-kB, TNF, and IL-6 following IR challenge. Erdosteine pretreatment restores FABP, Nrf-2, and Hsp27. Conclusions: Erdosteine protects the myocardial cell membrane from peroxidation and inhibits oxidative burst and inflammation through NF-kB pathway activation. Erdosteine attenuates MIRI injury in rats preserving the MAPK and Nrf-2 signaling cascade.

Predicting red blood cell traffcking and capillary hemodynamics in angiogenic and tumor microcirculation in silico

Objective: Angiogenic and tumor microvasculatures are known to have abnormal topology due to the presence of frequent vessel junctions, irregular and deflated blood vessels, multi-furcations, and tessellated vessel organization. Although recent advances in imaging techniques in vivo have enabled mapping such vasculatures at high spatial resolution, simultaneous measurements of hemodynamic parameters, such as the wall shear stress (WSS) with full 3D details, remain a challenge. Theoretical network flow models, often used for hemodynamic predictions in such experimentally acquired images, cannot provide the full 3D hemodynamic details either, as these models treat each blood vessel as 1D segment and do not explicitly model red blood cells (RBCs). To overcome this limitation, we have developed a high-fidelity, 3D Computational Fluid Dynamics modeling to predict the flow of a large number of deformable RBCs through physiologically realistic tumor/angiogenic microvascular networks in silico. Methods: We use in vivo images to create such vascular networks in silico and then predict RBC traffcking and capillary hemodynamics. Deformation of every flowing RBC is considered with high accuracy, and 3D geometry of each vessel is accurately modeled. Flow is driven by specifying physiological pressure boundary conditions. Model predictions have been validated against in vivo data. This in-house predictive tool is versatile, can be applied to any microvascular network image obtained in vivo in any organ, and can predict trajectories of diverse cell types including leukocytes, platelets and circulating tumor cells, drug and molecular transport in capillary blood, and cell-vessel adhesion. Results: We provide quantitative differences between healthy microvascular networks and tumor/angiogenic networks in terms of RBC distribution, perfusion, and wall shear stress. Our model shows increased heterogeneity in RBC and flow distribution in both tumor and angiogenic vasculatures than the healthy one. Also, we predict reduced flow and hematocrit in several vessels in both tumor and angiogenic vasculatures. Interestingly, several vessels in the angiogenic vasculature are predicted to have higher flow than the healthy one, while most vessels in the tumor vasculature show flow reduction. This in silico prediction is consistent with a recent in vivo study which showed higher flow in peri-tumor region and reduced flow in tumor. We further predict a significant heterogeneity in WSS and WSS gradient, blood velocity profiles, and near-wall RBC-depleted region. Conclusion: In conclusion, we have developed a versatile, in silico model that allows high-fidelity prediction of capillary hemodynamics in tumor microcirculation and provide information on hemodynamic variables that are not readily measurable in vivo but have physiological significance in tumor progression and treatment. NIH (R01EY033003) and NSF (CBET1804591). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

The Computed Sinusoid

Hepatic sinusoids are lined with thin endothelial cells with transcellular pores, termed fenestrations. These fenestrations are open channels that connect the sinusoidal lumen to the underlying Space of Disse (SoD) and the hepatocytes of the liver parenchyma. Fenestrations range from 0.05 to 0.35 µm in diameter and cover 5–15% of the sinusoidal endothelial surface area, depending on their location along the sinusoids. The direct measurement of hemodynamic parameters, such as pressure and flow velocity, remains challenging within the narrow sinusoids. Such knowledge would increase our understanding of the physiology of the hepatic niche and possible implications in aging or diseases in which fenestrations are reduced or lost. Few simulations of liver blood flow focus on the level of the individual sinusoid, and fewer still include the transcellular pores (fenestrations) of the sinusoidal endothelium. Furthermore, none have included (i) a porosity gradient along the sinusoid wall, modeled using through-all pores rather than a porous medium, (ii) the presence of the SoD, or (iii) lymphatic drainage. Herein, computed fluid dynamics (CFD) simulations were performed using a numerical model with relevant anatomical characteristics (length, diameter, porosity, inlet/outlet pressure, and lymphatic outflow from the portal region of the SoD). The greatest contribution to luminal velocity magnitude and pressure was the overall shape of the vessel. Divergent-radius models yielded velocity magnitudes 1.5–2 times higher than constant-radius models, and pressures were 5–8% lower in the divergent-radius models compared to the constant-radius models. Porosity only modestly contributed to luminal pressure. The luminal velocity magnitude was largely unaffected by the presence or absence of lymphatic drainage. Velocity magnitudes through fenestrations were lower in higher-porosity models (20%) vs. lower-porosity models (5%) across all models (0.4–0.55-fold lower). Velocity magnitudes through the space of Disse were increased 3–4 times via the addition of lymphatic drainage to the models, while pressures were decreased by 6–12%. The flow velocity in the SoD was modified via differences in porosity, while the flow velocity in the lumens of the sinusoids was largely unaffected. The overall shape of the vessel is the single most important factor in the pressure flow behavior of the sinusoidal lumen. The flow rate over hepatocytes and the SoD is modestly affected by the distribution of porosity along the sinusoid and greatly affected by the lymphatic drainage, parameters that would be of interest for modeling the exchange of blood with the hepatic parenchyma.

Pulmonary hypertension: Key aspects in preoperative management

Pulmonary hypertension, characterized by increased pressure in the pulmonary vasculature, can stem from various causes. This condition strains the thin-walled right ventricle of the heart, leading to potential dilation and reduced function over time. Anesthesiologists encounter challenges when managing PH patients during surgery, as the right ventricle poorly responds to inotropic support and undergoes additional stress from surgical conditions. Pulmonary hypertension requires multidisciplinary management in the perioperative setting to ensure appropriate and safe care of patients.Ensuring safe anesthesia for patients with pulmonary hypertension entails careful planning, including a thorough history and physical examination, preoperative testing, optimization of the disease and comorbidities, and comprehensive risk assessment. It is crucial to identify signs and symptoms of progressing pulmonary hypertension and right heart dysfunction. Symptomatic patients with undiagnosed pulmonary hypertension will benefit from referrals to specialists for further evaluation and testing.Diagnostic tools such as electrocardiograms, echocardiography, and right heart catheterization offer valuable information for anesthetic planning and risk assessment. They provide insight into the severity of pulmonary hypertension. Right heart catheterization allows direct measurement of hemodynamic parameters, guiding treatment decisions. Hemodynamic classification distinguishes between pre-capillary, post-capillary, and combined pre- and post-capillary pulmonary hypertension. Another categorization method is clinical grouping based on underlying pathological characteristics, which helps tailor management and treatment choices.This article underscores the significance of perioperative management and the need for a comprehensive evaluation and multidisciplinary approach in patients with pulmonary hypertension. It provides valuable information for anesthesiologists and other healthcare professionals involved in the care of these patients, with a focus on preoperative assessment, risk stratification, and treatment considerations.

Handheld versus conventional ultrasound for assessing carotid artery in routine volunteers.

Carotid ultrasound is a key tool for the diagnosis and evaluation of cardio disease, and the measurement of carotid intima-media thickness (CIMT) and hemodynamic parameters is of paramount importance for the imaging method. The aim of this study was to evaluate the feasibility and accuracy of handheld ultrasound devices for measuring carotid parameters. We performed a carotid ultrasound on 25 participants using a handheld ultrasound device and a conventional ultrasound machine. For each participant, max and mean CIMT of common carotid artery (CCA) and peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) of CCA, bilateral external carotid artery (ECA), internal carotid artery (ICA) and the vertebral artery were measured. Agreement and repeatability were evaluated by linear regression and Bland-Altman analysis. We found a good repeatability and consistent of handheld ultrasound device in measuring mean CIMT (r = 0.68, P < 0.01). Furthermore, there was a moderate to good agreement between handheld and conventional ultrasound systems in measuring max IMT, mean IMT, PSV, EDV and RI of CCA (0.73, 0.79, 0.52, 0.58 and 0.84, respectively). Handheld ultrasound devices were able to provide carotid IMT and hemodynamic parameters measurements similar to those of conventional ultrasound. Such capabilities of handheld ultrasound devices might be useful for the primary assessment of carotid in clinical work.

Measurement error in echocardiographic assessment of aortic stenosis: an epidemiological consideration of research methodology and clinical practice

Abstract Background/Introduction Current international guidelines on treatment of valvular heart disease contain recommendations for aortic valve replacement based exclusively on abnormal echocardiographic parameters in asymptomatic patients with aortic stenosis (AS). To prevent misclassification and subsequent mistreatment of patients, these recommendations require accurate and unbiased measurements of hemodynamic parameters. Purpose To illustrate consideration and impact of measurement error in echocardiographic assessment of aortic stenosis in both the research and clinical setting. Methods First, a systematic review was performed to investigate the recognition of and correction for measurement error in clinical studies on the prognostic value of peak aortic jet velocity (Vmax), mean pressure gradient (MPG), and effective orifice area (EOA). Second, all potential erroneous sources in the calculation of those primary parameters were listed stratified to random or systematic measurement error, and subsequently their magnitude was quantified. Third, the impact of various types of measurement error on current thresholds for intervention was graphically illustrated in different clinical scenarios. Results The presence of measurement error was acknowledged in 44% of the 36 included studies, while none utilized methods to correct for it. Interobserver variability ranged between 0.9–8.3% for Vmax and MPG but was substantially higher for EOA (range 7.7–12.7%) implying lower reliability (Figure 1). Furthermore, the invalid assumption of a circular left ventricular outflow tract area resulted in a median underestimation in EOA of 22.5% compared to 3D-transesophageal echocardiography (3D-TEE), computed tomography (CT), and cardiovascular magnetic resonance (CMR) planimetry. Figure 2 illustrates the impact of this discrepancy on the classification of AS using one-sided t-tests to determine the areas under the curve; the proportion of patients with non-severe AS in a hypothetical cohort (based on values from the PARTNER 3 trial [1[) increased by 42%. Conclusion(s) Measurement error is underrecognized in studies of echocardiographic assessment of aortic stenosis. This review demonstrates that random and systematic measurement errors affect echocardiographic assessment, leading to potential misdiagnosis and subsequent mistreatment. Clinicians and scientists should be aware of the implications of measurement errors to enhance rightful clinical decision-making and assure research validity. Funding Acknowledgement Type of funding sources: None.

Age- and Gender-Related Differences in the Hemodynamic Status of Patients with Mild or Moderate Hypertension.

PurposeThe aim of this study was to use non-invasive impedance cardiography (ICG) to determine the hemodynamic status of patients with grade 1 and grade 2 hypertension in relation to gender and age.Patients and MethodsWe analyse prospectively collected data of 158 patients with grade 1 or grade 2 arterial hypertension. Patients were grouped according to age: 1) <50 years and 2) ≥50 years. Hemodynamic status of patients was assessed by using non-invasive ICG. For the purpose of this study two hemodynamic parameters were used: a) systemic vascular resistance index (SVRI) and b) left cardiac work index (LCWI). The primary endpoint was the hemodynamic status of patients. The secondary endpoint was hypertension-mediated organ damage.ResultsIncreased SVRI was assessed in 80% of patients, more common in the ≥50 years group than in the <50 years group (88.5% vs 64.8%; p < 0.01). The occurrence of increased systemic vascular resistance correlates hierarchically with increasing age. Elevated LCWI (hypervolemia and/or hyperinotropy) was present in 63% of patients, more often in males than females (70.3% vs 57.1%; p < 0.05) as well in those <50 years than in older patients (70.4% vs 59.6%; p < 0.05). Patients with diabetes were less likely to have hypervolemia/hyperinotropy than those without diabetes (46.7% vs 67.2%; p < 0.01). Hypervolemia/hyperinotropy (46.7%) and hypovolemia/hypoinotropy (43.3%) were present in a similar percentage of diabetic patients. Left ventricular hypertrophy was found in 30 patients (19%). Patients with left ventricular hypertrophy were more commonly male (66.7% vs 42.2%; p = 0.016) and had increased systemic vascular resistance (96.7% vs 77.3%; p = 0.015) compared to the patients without left ventricular hypertrophy. Hypertensive retinopathy grade III was found in 14 patients (8.9%). Elevated daytime systolic pressure, diabetes and increased age are independent predictors of grade III hypertensive retinopathy. Patients with reduced renal function had higher mean systolic blood pressure (p < 0.05), were more commonly male (p < 0.01) and older (p < 0.01) than those without reduced renal function.ConclusionAlthough there are certain correlations between hemodynamic disorders and age and gender, specific hemodynamic status of an individual patient with hypertension cannot reliably be predicted on the basis of age and gender. The measurement of hemodynamic parameters by ICG can guide the clinician to select appropriate antihypertensive therapy to the patients’ hemodynamic pathophysiologic condition.

Evaluation of Transfusion-Related Hemodynamic Parameters in Patients with Beta-Thalassemia Major by Ambulatory Blood Pressure Monitoring Method

Introduction: There are very few studies on the effects of regular blood transfusions on the hemodynamic organization of patients with Beta-Thalassemia Major (BTM). Ambulatory Blood Pressure Monitoring is method that evaluates fluctuations in day-night periods and life cycle changes. In this study, we aimed to investigate the effects of blood transfusion on hemodynamic parameters by the Ambulatory Blood Pressure Monitoring method on the day of transfusion in patients with a diagnosis of Beta-Thalassemia Major. Material and Methods: This study was conducted in patients who were followed up with a diagnosis of BTM between June 2020 and July 2020. The study consisted of 30 patients. The blood pressure of the patients was measured by auscultation method on the morning of the day when they received routine red blood cell transfusion treatments, and the patients were fitted with an Ambulatory Blood Pressure Monitoring device. With Ambulatory Blood Pressure Monitoring, mean systolic blood pressure, diastolic blood pressure, heart rate, mean arterial pressure, values were calculated for each patient. Statistical analysis was performed by the IBM SPSS Statistics 21 package program. The significance limit for the p-value was accepted as &lt;0.05. Results: There was a significant difference in mean systolic blood pressure and heart rate values between pre-transfusion, transfusion, and post-transfusion periods. In our study, the rate of white coat hypertension was 8.3%, and the rate of masked hypertension was 4.1%. It was observed that 67% of the patients were non-dippers, and the blood pressure burden of one patient was more than 25%. Conclusions: Measurement of hemodynamic parameters with Ambulatory Blood Pressure Monitoring is the gold standard in terms of detection and follow-up of non-dipper patients, indicating increased cardiovascular risk. In practice, Ambulatory Blood Pressure Monitoring should be used more in the follow-up of chronic patients.

Cardiac output and peripheral vascular resistance during normotensive and hypertensive pregnancy - a systematic review and meta-analysis.

BackgroundIn‐depth insight into haemodynamic changes during normotensive pregnancy may help identify women at risk for gestational hypertensive complications.ObjectivesTo determine the magnitude of changes in cardiac output and its determinants stroke volume and heart rate, and total peripheral vascular resistance during singleton normotensive and hypertensive pregnancies.Search strategyPubMed (NCBI) and Embase (Ovid) databases were searched from their inception up to November 2019.Selection criteriaStudies reporting original measurements of haemodynamic parameters during pregnancy together with a non‐pregnant reference measurement. Studies including women using antihypertensive medication were excluded.Data collection and analysisPooled mean differences between pregnant and non‐pregnant women, and absolute values of haemodynamic parameters were calculated for predefined gestational intervals using a random‐effects model in normotensive and hypertensive pregnancy. Meta‐regression analysis was used to analyse group differences in adjustments and absolute values during pregnancy.Main resultsIn normotensive pregnancies, cardiac output increased from the first weeks on, reaching its highest level early in the third trimester (mean difference, 1.41 l·min1; 95% CI 1.18–1.63 l·min). In parallel, vascular resistance decreased progressively until its nadir in the early third trimester (mean difference, −331 dyn·sec–1·cm–5; 95% CI −384 to −277 dyn·sec–1·cm–5) and then increased slightly at term. In hypertensive pregnancies, the initial cardiac output increase was higher and vascular resistance did not change throughout gestation compared with reference values.ConclusionsHemodynamic changes in women who eventually develop hypertensive complications are substantially different. Serial monitoring and plotting against developed normograms can identify women at risk and may allow timely intervention.Tweetable abstractMonitoring haemodynamic changes in pregnancy helps identify women at risk for hypertensive complications.

Improved Normothermic Machine Perfusion After Short Oxygenated Hypothermic Machine Perfusion of Ischemically Injured Porcine Kidneys.

In an era where global kidney shortage has pushed the field of transplantation towards using more marginal donors, modified kidney preservation techniques are currently being reviewed. Some techniques require further optimization before implementation in full scale transplantation studies. Using a porcine donation after circulatory death kidney model, we investigated whether initial kidney hemodynamics improved during normothermic machine perfusion if this was preceded by a short period of oxygenated hypothermic machine perfusion (oxHMP) rather than static cold storage (SCS). Kidneys subjected to 75 minutes of warm ischemia were randomly assigned to either SCS (n = 4) or SCS + oxHMP (n = 4), with a total cold storage time of 240 minutes. Cold preservation was followed by 120 minutes of normothermic machine perfusion with continuous measurement of hemodynamic parameters and renal function. oxHMP preserved kidneys maintained significantly lower renal resistance throughout the normothermic machine perfusion period compared to SCS kidneys (P < 0.001), reaching lowest levels at 60 minutes with means of 0.71 ± 0.35 mm Hg/mL/min/100 g (SCS) and 0.45 ± 0.15 mm Hg/mL/min/100 g (oxHMP). Accordingly, the oxHMP group had a higher mean renal blood flow versus SCS kidneys (P < 0.001). oxHMP kidneys had higher oxygen consumption during normothermic machine perfusion compared to SCS preserved kidneys (P < 0.001). Creatinine clearance remained similar between groups (P = 0.665). Preceding oxHMP significantly improved initial normothermic machine perfusion hemodynamics and increased total oxygen consumption. With the long period of warm ischemia, immediate kidney function was not observed, reflected by the findings of low creatinine clearance in both groups.

Using heart rate variability to determine individual resistance to the hyperbaric oxygen toxicity

Objective: assessment of the resistance of the body of athletes-divers to the hyperbaric oxygen toxicity on indicators of the heart rate variability (HRV). Materials and methods . The study involved 38 healthy athletes-divers aged 23 to 32 years. Before the session of hyperbaric oxygenation (HBO), the test subject was measured the blood pressure and pulse by the method of oscillometry while he was sitting at rest, after which a five-minute recording of HRV in sitting position at rest was made. After that, the two test subjects were placed together, sitting with a physician in a pressure (decompression) chamber, where an absolute pressure of 0.25 MPa was created. The test subjects were given 100 % medical oxygen to breathe, their pulse and blood pressure were measured every 15 minutes, and their cardiac output (CO) was calculated by the Starr formula. When there was an increasing tendency of the CO, and also after 75 minutes of oxygen breathing, the test subjects were taken out of the pressure chamber. Immediately after leaving the pressure chamber, the HRV of the test subjects was recorded. According to the results of measurement of hemodynamic parameters, the test subjects were divided into 3 groups. The first group — unstable, whose CO began to increase in the first 45 minutes of HBO, the second group included those whose CO began to increase from 46 to 75 minutes, the third group included test subjects whose CO did not increase. Results. HRV analysis showed the most significant reliable ( p &lt; 0.001) VLF spectrum power (ms 2 ) and relative VLF power (%), as well as Alpha 2 after HBO in the first group of test subjects (unstable) compared to the initial parameters and other groups, which reflects the activation of the sympathetic nervous system and suprasegmental structures of the brain. The essence of changes in the HRV time domain indicators (decrease in SNS index, pNN50 (%), PNS index) confirms the presence of pronounced sympathicotonia in the first group. Conclusions: the three most significant metrics (VLF (ms 2 ), VLF (%) and Alpha 2) were determined with high confidence ( p &lt; 0.001), which have a moderate negative correlation (–0.70 &lt; r &lt; –0.30) with the level of divers’ resistance to the to the hyperbaric oxygen toxicity. Observations of athletes with high stability showed that they were characterized by changes in hemodynamics of the vagotonic type, while unstable ones were characterized by the sympathicotonic type of regulation. Evaluation of the results showed amoderate correlation between HRV and symptom of oxygen toxicity on divers and is recommended for a reliable ( p &lt; 0.05) diagnosis.

The molecular mechanism involved in cardioprotection by the dietary flavonoid fisetin as an agonist of PPAR-γ in a murine model of myocardial infarction

The methodology exploring the cardioprotective potential of the flavonoid Fisetin through its ability to modulate PPAR-γ was unraveled in the present study. Computational modelling through molecular docking based binding study of interactions between Fiestin and PPAR-γ revealed the potential role of Fisetin as an agonist of PPAR-γ. A murine model of cardiac ischemia-reperfusion injury was used to explore this further. Male Wistar Rats were randomly assigned to five groups. Fisetin (20 mg/kg; p. o) was administered for 28 days. Ischemia was induced for 45 min on the 29th day followed by 60 min of reperfusion. Fisetin pretreatment upregulated the expression of PPAR-γ in heart tissue significantly Cardioprotection was assessed by measurement of hemodynamic parameters, infarct size, ELISA for oxidative stress, immunohistochemistry and TUNEL assay for apoptosis, and western blot analysis for MAPK proteins and inflammation. PPAR-γ activation by fisetin led to significantly reduced infarct size, suppression of oxidative stress, reduction of cardiac injury markers, alleviation of inflammation, and inhibition of apoptosis The MAPK-based molecular mechanism showed a rise in a key prosurvival kinase, ERK1/ERK2 and suppression of JNK and p38 proteins. The aforementioned beneficial findings of fisetin were reversed on the administration of a specific antagonist of PPAR-γ. In conclusion, through our experiments, we have proved that fisetin protects the heart against ischemia-reperfusion injury and the evident cardioprotection is PPAR-γ dependant. In conclusion, our study has revealed a prime mechanism involved in the cardioprotective effects of fisetin. Hence, Fisetin may be evaluated in further clinical studies as a cardioprotective agent in patients undergoing reperfusion interventions.

P0957DISABILITY OF DIALYSIS PATIENTS AND CONDITION OF THEIR BLOOD VESSELS

Abstract Background and Aims Epidemiological data indicate constant increase of mean age among hemodialysis patients. These population have high burden of comorbid conditions, including cardiovascular (CV) diseases, which lead to disability and the need for continuous care. The aim of the study was to analyze the problems of disability in hemodialysis patients in the context of cardiovascular complication and vascular condition. Method In this cross-sectional study 129 patients (mean age 64.5 y, 54 females, with mean dialysis vintage 61 months) were enrolled from 3 satellite dialysis centers (inclusion criteria: age ≥18 y, dialysis vintage≥3 months). Demographic and comorbidity data were collected from medical records and during interview. The degree of disability (Bartel scale), 10-year cardiovascular risk (QRISK®3 online calculator), degree of imbalance (questionnaire - Falls Efficacy Scale – International (FES-I)) were assessed. In addition, ambulatory measurements of hemodynamic parameters with Mobil-O-Graph monitor (IEM, Stolberg,Germany), which records oscillometric arm blood pressure (SBP and DBP), central systolic (cSBP) and diastolic (cDBP), pulse pressure (pPP), ejection fraktion - (EF), cardiac output - (CO) and pulse waves. It calculates augmentation index (AIx@75) as measure of wave reflections, and pulse wave velocity (PWV) as measure of arterial stiffness. Results The most common causes of renal failure in the study group were ischemic - 35%, and diabetic nephropathy 26% (Fig. 1). Only 8 out of 129 pts. (6.2%) were professionally active, 40 (31%) received disability pension and 81 (62.8%) retirement. 25 (19%) used a wheelchair for transport and 21 (16%) used crutch. More than half (51%) were independent in everyday activities reaching 80-100 points on the Bartel scale, however only 14% were fully independent (100 points). Minimally dependent (60-79 points) constituted 27% (35 pts) of all patients, partially dependent (40-59 points) - 10% (13 pts), highly dependent (20-39 points) - 7% (9 pts) and fully dependent (&amp;lt;20 points) 5% (6 pts). The most common causes of disability were heart problems, including heart failure in 20.9%, lower limb ischemia, diabetic foot and amputation in 13.1% and cerebrovascular event in 10.8% followed by weakness associated with dialysis and degenerative joints disease (Fig. 2). Less disable group (80-100 points on the Bartel scale) showed significantly lower PWV, lower QRISK®3 and FES I index compared to the non self-reliant group (Fig 3). The degree of disability according to Bartel scale negatively correlated with age, PWV, QRISK®3 and FES I index (Fig 4). Conclusion Our results indicate that half of the population of hemodialysis patients show some degree of functional dependence. The group of patients with higher degree of disability are older and characterize of the more advanced changes in the arteries, higher risk of the CV incidents and increase risk of fall.

Non-invasive assessment of haemodynamic parameters in an Emergency Department

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

The Importance of Sleep Fragmentation on the Hemodynamic Dipping in Obstructive Sleep Apnea Patients.

IntroductionObstructive sleep apnea (OSA) has been associated with non-dipping blood pressure (BP). The precise mechanism is still under investigation, but repetitive oxygen desaturation and arousal induced sleep fragmentation are considered the main contributors.MethodsWe analyzed beat-to-beat measurements of hemodynamic parameters (HPs) during a 25-min period of wake–sleep transition. Differences in the mean HP values for heart rate (HR), systolic BP (SBP), and stroke volume (SV) during wake and sleep and their standard deviations (SDs) were compared between 34 controls (C) and 22 OSA patients. The Student’s t-test for independent samples and the effect size by Cohen’s d (d) were calculated. HP evolution was investigated by plotting the measured HP values against each consecutive pulse wave. After a simple regression analysis, the calculated coefficient beta (SCB) was used to indicate the HP evolution. We furthermore explored by a hierarchical block regression which variables increased the prediction for the SCB: model 1 BMI and age, model 2 + apnea/hypopnea index (AHI), and model 3 + arousal index (AI).ResultsBetween the two groups, the SBP increased in OSA and decreased in C resulting in a significant difference (p = 0.001; d = 0.92). The SV demonstrated a similar development (p = 0.047; d = 0.56). The wake/sleep variation of the HP measured by the SD was higher in the OSA group—HR: p < 0.001; d = 1.2; SBP: p = 0.001; d = 0.94; and SV: p = 0.005; d = 0.82. The hierarchical regression analysis of the SCB demonstrated in SBP that the addition of AI to AHI resulted in ΔR2: +0.163 and ΔF + 13.257 (p = 0.001) and for SV ΔR2: +0.07 and ΔF 4.83 (p = 0.003). The AI but not the AHI remained statistically significant in the regression analysis model 3—SBP: β = 0.717, p = 0.001; SV: β = 0.469, p = 0.033.ConclusionIn this study, we demonstrated that in OSA, the physiological dipping in SBP and SV decreased, and the variation of all investigated parameters increased. Hierarchical regression analysis indicates that the addition of the AI to BMI, age, and AHI increases the prediction of the HP evolution following sleep onset for both SBP and SV and may be the most important variable.

The value of intelligent ultrasound sensor used in the measurement of fetal hemodynamics and evaluation of health factors

ObjectiveThe purpose is to discuss the application of intelligent ultrasound sensor in the measurement of fetal hemodynamics and the evaluation of health factors. Methods: 237 pregnant women who were hospitalized in the fourth people's hospital of Jinan from June 2016 to May 2018 were selected as the study objects. According to the situation of pregnant women, they were divided into pre-pregnancy diabetes group (Group IB, 19 cases), gestational diabetes group (Group IA, 93 cases), and normal control group (Group II, 125 cases). In order to evaluate the health status of pregnant women and infants, intelligent ultrasound sensor was used for pregnant women measurement in each group, including ultrasonic parameters, hemodynamic parameters, and body weight. ResultsThere was no significant difference in age, height, weight, and gestational weeks between Group IA, Group IB, and Group II (P > 0.05). Pregnant women in each group showed that the blood glucose content of Group IB and Group IA increased significantly after fasting and glucose tolerance test, compared with the control group (P < 0.05), and the blood glucose content of Group IB was always higher than that of Group IA (P < 0.05). Compared with the control group, fetal ultrasound parameters and body weight were significantly increased in Group IB and Group IA (P < 0.05). The hemodynamic parameters of MCA (Middle Cerebral Artery), UA (Umbilical Artery), and Ut-A (Uterine Artery) in Group IB and Group IA were significantly different from that of the control group (P < 0.05). Furthermore, the area under ROC (Receiver Operating Characteristic) curve of MCA-PI was the largest, and the effect of predicting pregnancy outcome was the most obvious. ConclusionThrough the study, it was found that the measurement of hemodynamic parameters in the later period of pregnancy with intelligent ultrasound sensor could predict the outcome of pregnancy, especially the adverse pregnancy outcome of patients with abnormal glucose metabolism. It could provide experimental basis for the prediction of the outcome of pregnancy and the evaluation of health status of patients with abnormal glucose metabolism in the later period of pregnancy.

Hemodynamic Responses and G Protection Afforded by Three Different Anti-G Systems.

BACKGROUND: UK Royal Air Force fast jet aircrew use three different anti-G systems, however, little objective comparison of the G protection they provide exists. The G-protection afforded by each system and associated hemodynamic responses were investigated.METHODS: Ten subjects performed centrifuge acceleration exposures using Mk-10 (S1) and Mk-4 (S2) five-bladder anti-G trousers (AGT) and full coverage AGT plus pressure breathing for G-protection (PBG; S3). Measurements of relaxed G tolerance (RGT), eye-level blood pressure (BPeye), lower body blood volume (LBV), stroke volume (SV) and total peripheral resistance (TPR) were made during gradual onset runs (GOR) and rapid onset runs (ROR). The subjective effort required to maintain clear vision at +7 and +8 Gz provided an indication of the protection provided by the system.RESULTS: All systems moderated decreases in SV and BPeye and increases in LBV under increased +Gz. S3 provided the greatest mean RGT during GOR (+6.2 Gz) and ROR (+6 Gz), reduced the effort required to maintain clear vision at up to +8 Gz, prevented venous pooling and afforded the greatest rise in TPR. The majority of indices revealed no difference between S1 and S2 although RGT during the ROR was greater with S2 (+0.25 Gz).DISCUSSION: S3 effectively prevented pooling of blood in the lower limbs under +Gz, despite the use of PBG, and offers an advantage over five-bladder AGT. Given the similarities of S1 and S2, it was unsurprising that the majority of indices measured were similar. The objective measurement of hemodynamic parameters provides useful information for comparing the G-protection provided by anti-G systems.Pollock RD, Firth RV, Storey JA, Phillips KE, Connolly DM, Green NDC, Stevenson AT. Hemodynamic responses and G protection afforded by three different anti-G systems. Aerosp Med Hum Perform. 2019; 90(11):925-933.

Fractional flow reserve-based 4D hemodynamic simulation of time-resolved blood flow in left anterior descending coronary artery

BackgroundThe purpose of this study was to investigate the feasibility of the non-invasive assessment of hemodynamic parameters with computational fluid dynamics in left anterior descending coronary artery based on invasive fractional flow reserve. MethodsA left coronary artery model based on computed tomography angiography was reconstructed using MIMICS 18.0 for computational fluid dynamics analysis. With actual fractional flow reserve measured from the patient, 4D hemodynamic profiles of time-resolved blood flow were simulated. FindingsThe 4D blood flow simulation could provide extensive information of blood flow status. Hemodynamic parameters, such as velocity, wall shear stress and pressure were simulated throughout the cardiac cycle. There might be high flow velocities and high wall shear stress in the stenotic region throughout the whole cycle, both of which peaked in the case of the maximum inlet differential pressure. The reverse flow and vortex were detectable at the downstream areas beneath the stenotic site. The pressure remarkably increased near the proximal stenotic end and declined in the mid-stenosis. Moreover, the simulation results provided detailed and accurate mass flow measurements of hemodynamic parameters as well. InterpretationThe computational fluid dynamics analysis of 4D blood flow based on fractional flow reserve is feasible in left anterior descending coronary artery. It presents the merits of providing both qualitative and quantitative information for further investigation of the links between hemodynamic parameters and left anterior descending artery stenosis.

P-Coumaric acid protects cardiac function against lipopolysaccharide-induced acute lung injury by attenuation of oxidative stress.

Objective(s):Acute lung injury (ALI) has a high mortality rate and is characterized by damage to pulmonary system giving rise to symptoms such as histological alteration, lung tissue edema and production of proinflammatory cytokine. p-Coumaric acid (p-CA), as a phenolic compound, that is found in many types of fruits and vegetables has been reported to exhibit a therapeutic effect in several inflammatory disorders. The aim of our study was evaluation of pretreatment with p-CA against heart dysfunction, oxidative stress and nuclear factor-erythroid 2 -related factor 2 (Nrf2) modifications following lipopolysaccharide (LPS)-induced acute lung inflammation. Materials and Methods:The rats were divided into four groups (n=8): Control, LPS (5 mg/kg, it), p-CA (100 mg/kg, IP), and LPS+pCA. Inflammatory response and oxidative stress were evaluated by measurement of interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α) and malondialdehyde (MDA) levels in heart tissue. For evaluation of the effect of LPS on cardiac response, electrocardiography (ECG) and hemodynamic parameters were recorded.Results:A significant increase in lipid peroxidation (P<0.001, cytokine parameters (TNF-α and IL-6 (P<0.01), gene expression of Nrf2 (P<0.05), and antioxidant activity of superoxide dismutase and glutathione (P< 0.05) in addition to glutathione peroxidase (P<0.01) was demonstrated in heart tissue of ALI rats. LPS can impair cardiac function (in in vitro measurement of hemodynamic parameters by using Langendorff setup, and in in vivo measurement of ECG parameters), and pretreatment with p-CA recovered these parameters to control levels in heart. Pretreatment with p-CA causes modulation of cytokines and MDA level that protected cardiac injury caused by LPS in ALI model. Conclusion:Our results showed anti-inflammatory and antioxidative effect of p-CA on LPS-induced ALI.