Peripheral Resistance Index Research Articles

An analysis of blood flow indicators in pathological kinked internal carotid arteries with their orthostatic and rotational positions

To assess the dynamics of blood flow in patients with hemodynamically significant pathological kinked internal carotid arteries (PK ICA) with their orthostatic and rotational positions. Eighty-six patients, including 35 with PK ICA due to fibromuscular dysplasia (FMD) and 51 with PK ICA due to hypertensive heart disease, and 20 healthy people were examined. All patients underwent Doppler ultrasound scanning. All indicators were evaluated in the position of the patient lying on his back and functional stress tests (orthostatic, rotational). The peak systolic velocity, end diastolic velocity, peripheral resistance index did not differ significantly in patients with PK ICA due to FMD and hypertensive heart disease. The increase of blood flow in bends was significantly higher with S-shaped kinking, regardless of the reason for their formation (p<0.05). In orthostatic position, significant changes of hemodynamic parameters in ICA in healthy people did not occur. Moreover, more frequent formation of turbulent blood flows in the group with hypertensive heart disease (78%) and a decrease in LBFV in the standing position were found in patients with PK ICA due to FMD. Rotational position did not alter the hemodynamics in ICA in healthy people and significantly influenced the values of LBFV in patients with PK ICA. Changes in hemodynamic parameters in the area of kinking with orthostatic and rotational positions of ICA demonstrate more significant impairments in patients with PK ICA due to hypertensive heart disease compared to patients with FMD. The rotational position of PK ICA is the most informative for identifying turbulent blood flow and an increase in peak systolic velocity in the area of kinking.

Predictors of early occlusion of coronary bypass grafts in patients with extremely low ejection fraction

The authors carried out a retrospective study aimed at revealing predictors of early incompetence of coronary bypass grafts in patients with the ejection fraction below 30%. The study included a total of 104 patients presenting with coronary artery disease and the ejection fraction below 30%, who over the period from 2009 to 2016 underwent coronary artery bypass grafting with the use of autovenous and autoarterial conduits. 77 patients endured plasty of an aneurysm of the left ventricle (LV), 89 patients sustained plasty of the valvular apparatus. All patients were subjected to control coronary bypass angiography (CBA) within 12 postoperative months. Thus, we analysed a total of 184 autoarterial and 84 autovenous shunts. The findings of CBA revealed occlusions of 2 (1%) arterial and 10 (11%) venous conduits. Analysing the coronary bypass angiographies of the patients ranked according to the values of the effective stroke volume index demonstrated the following regularity: a decrease in the LV effective stroke volume index of less than 30 ml/m2 was accompanied bу increased incidence of thrombosis of autovenous shunts in the immediate postoperative period. Predictors of early occlusion of coronary bypass grafts were revealed by means of the Cox regression analysis. It was determined that using an autovein increased the risk of occlusion of the shunt by 26%, a decrease in the effective stroke volume index of the left ventricle by 1 ml/m2 increased the risk of early occlusion of coronary bypass grafts by 18%, a decrease in the diameter of the shunted artery by 0.5 mm increased the risk for early occlusion of the shunt by 12%, a decrease in the blood flow velocity (Qmean) by 1 ml/m2 increased the risk for occlusion of the shunt by 10%, a decrease in the peripheral resistance index (RI) by 1 unit elevated the risk of early occlusion of the bypass graft by 12%. Analysing the revealed independent predictors with the help of the neural network method demonstrated that the strongest influence on early incompetence of the coronary bypass graft was exerted by the type of the conduit and effective stroke index.

Effects of norepinephrine on hemodynamics, vascular elasticity, cardiac pump function, and inflammatory factors in patients with septic shock

The effects of norepinephrine on hemodynamics, vascular elasticity, cardiac pump function, and inflammatory factors in patients with septic shock remained unknown. In this study, we included 124 cases of severe septic shock patients in our hospital. The patients were randomly divided into control group (treated with dopamine) and experimental group (treated with dopamine plus norepinephrine), while the hemodynamic index (heart rate (HR)), blood vessel elasticity index, heart pump function, and inflammatory factor index were recorded. After 12 h of treatment, both groups showed decreased HR, increased levels of cardiac index (CI), mean arterial pressure (MAP), central venous pressure (CVP), peripheral vascular resistance index (PVRI), and vascular elasticity ( P &lt; 0.05). To date, lower HR, higher levels of CI, MAP, CVP, and PVRI were observed in the experimental group ( P &lt; 0.05). Furthermore, the vascular elastic coefficient, stiffness index, arterial compliance, and the precursors of plasma amino-terminal brain natriuretic peptide were also significantly higher in the experimental group than those in the control group ( P &lt; 0.05). However, inflammatory cell tumor necrosis factor alpha factor test group (TNF alpha), interleukin-1 (IL-1), and interleukin-6 (IL-6) concentrations were significantly lower than the control group ( P &lt; 0.05), compared to experimental group ( P &lt; 0.05). This research indicates that phenylephrine could significantly improve hemodynamics in patients with severe septic shock, by maintaining blood vessel elasticity, improving heart pump function, and reducing the inflammatory factors’ activities, and this method could be used as a line of vascular tension of the medications used in patients with septic shock.

Istorijski pregled: značaj kombinacije DHBP i fentanila tokom balansirane anestezije na promene tokom laparoskopske holecistektomije - uticaj različitih tehnika anestezije na kardiovaskularni sistem

Introduction: It is unavoidable that anesthesia during surgery leads to a number of hemodynamic changes in patients. This effect is even more pronounced during laparoscopic procedures. The clinical study presented in this paper was conducted nearly two decades ago, and its goal was to determine which of the tested techniques of anesthesia during laparoscopic cholecystectomy provide the best combination of the required depth of anesthesia with the least negative effect on the hemodynamics of the patients. This study is primarily of historical significance, but its results can still be useful today in clinical judgment and decision-making in certain situations in which we can find ourselves in everyday work. Method: By prospective longitudinal study during 1999. and 2000, which included 90 patients, we performed three different anaesthetic techniques, during laparoscopic cholecystectomy in chronic cholecystitis: general balanced anaesthesia, total intravenous anaesthesia and volatile induction and maintenance anaesthesia. We assessed patient's hemodynamic functions during these operations through following parameters: systolic and diastolic blood pressure, heart rate, total peripheral resistance, cardiac output and cardiac index. Seven predefined perioperative moments had been chosen to measure the hemodynamic parameters, and the values are compared between the groups. Result: In this study, all three applied anesthesia techniques showed a statistically significant difference in the values of systolic and diastolic pressure, and the changes were most pronounced in balanced anesthesia. Since the haemodynamic variables in this study were not measured invasively, the conclusions based on the collected data can only indicate the trend of changes in other haemodynamic parameters, which are invasively measured (impact volume, minute volume, heart index, etc.). Conclusion: From the hemodynamic point of view, the results of our study are in favour of the total intravenous anesthesia and volatile introduction and maintenance of anesthesia. Safe and simple control of the depth of anaesthesia and its effective adjustment to the intensity of surgical stimuli at every moment of operation are made possibly by these techniques.

Peri-Procedural, Non-Invasive Hemodynamic Monitoring In TAVI-Patients: Potential Impact on Patient Selection and Outcome Prediction

Objectives and Background: To investigate short-term hemodynamic improvement following transcatheter aortic valve implantation (TAVI) in patients with severe aortic valve stenosis (AS) using the non-invasive NICaS® whole body electrical bio-impedance monitoring system. Methods: 52 unselected patients subjected to TAVI were analysed between January and September 2018. Endovascular TAVI was applied in local anaesthesia and analgosedation in all patients using the Medtronic Evolut R® (n=32), Edwards Sapien 3® (n=14) or Boston Scientific SYMETIS ACURATE neo ™ TF® (n=4) system. NICaS® measurements were performed at baseline, six to eight hours after TAVI procedure and before discharge. Results and Discussion: When comparing discharge to baseline, there was a successful increase in cardiac output (CO) from 5.01 ± 1.62 to 5.73 ± 1.41 L/min (P=0.009) corresponding to a cardiac index (CI) increase from 2.64 ± 0.80 to 3.13 ± 0.83 L/min/m2 (P=0.002) and of increase in cardiac power index (CPI) from 0.53 ± 0.18 to 0.61 ± 0.16 w/m2 (P=0.008). Additionally, total peripheral resistance (TPR) significantly decrease from 1597.58 ± 624.92 to 1291.29 ± 450.12 dynes*s/cm5 (P=0.0045) corresponding to a total peripheral resistance index (TPRI) decrease from 2968.88 ± 1078.78 to 2436.72 ± 902.37 dynes*s/cm5/m2 (P=0.006). Conclusion: Non-invasive hemodynamic measurements with NICaS® represent an accurate bedside-tool for monitoring short-term adaptive hemodynamic changes in unselected patients subjected to TAVI. Thus, results can be easily used for tailored peri-procedural management early patients´ mobilization and discharge planning.

The value of non-invasive measurement of cardiac output and total peripheral resistance to categorize significant changes of intradialytic blood pressure: a prospective study

BackgroundBlood pressure (BP) is currently the main hemodynamic parameter used to assess the influence of fluid removal during hemodialysis session. Since BP is dependent on cardiac output (CO) and total peripheral resistance (TPRI), investigating these parameters may help to better understand the influence of fluid removal on patient’s hemodynamics. We used a novel non-invasive whole-body bio-impedance cardiography device, recently validated in hemodialysis patients, to examine mechanisms of intradialytic hemodynamics in a Chinese dialysis population.MethodsChronic hemodialysis patients in Sichuan Provincial People’s Hospital were enrolled. Demographic data and dialysis prescriptions were collected. Hemodynamic measurements were made pre-treatment, every 20 min during treatment and immediately after treatment in each random dialysis session. These included blood pressure, cardiac index (CI), total peripheral resistance (TPRI) and cardiac power index (CPI). Patients were divided into 5 hemodynamic groups as per their major hemodynamic response to fluid removal: low CPI, low TPRI, high TPRI, High CPI and those with normal hemodynamics.ResultsTwenty-seven patients were enrolled, with 12 (44.4%) males. The average age was 65 ± 12 y. The average body mass index (BMI) was 23.7 ± 3.9 kg/m2. 12 (44.4%) patients were diabetic. Three hundred twenty-four hemodynamic measurements were made. Weight, BMI, total fluid removal, pretreatment systolic BP, CI, TPRI and CI differed significantly among the 5 hemodynamic groups.11.1% of patients had low CPI, 25.9% had low TPRI, 18.5% had high CPI, 3.7% had high TPRI and 40.7% had normal hemodynamics. Hemodynamic differences among the 5 subgroups were significant.ConclusionThis technology provides multi-dimensional insight into intradialytic hemodynamic parameters, which may be more informative than blood pressure only. Using hemodynamic parameters to describe patients’ status is more specific and accurate, and could help to work out specific and effective therapeutic actions according to underlying abnormalities.

Эффективность комплексного подхода к лечению хронического простатита, в том числе у пациентов с доброкачественной гиперплазией предстательной железы

Concurrent chronic prostatitis (CP) plays an important role in the pathogenesis and progression of benign prostatic hyperplasia (BPH), increasing the severity of lower urinary tract symptoms (LUTS), lowering the quality of life, and increasing the risk of acute urinary retention. However, in the management of patients with BPH, the role of CP is not always taken into account. To evaluate the effectiveness of integrated management of patients with CP and patients with co-occurring BPH and CP using a physiotherapeutic device Mavit for the treatment of inflammatory diseases of the prostate. Clinical effectiveness of integrated therapy using the Mavit device was studied in 45 patients with CP. The first group (BPH + CP) comprised 25 patients, who were diagnosed with stage I-II BPH co-occurring with CP. The group of CP included 20 patients with an established diagnosis of CP. Clinical outcomes were followed for 12 months after treatment. In 10 CP patients, the tissue effect of the Mavit device on the prostate blood circulation was assessed before and after the physiotherapy session using transrectal ultrasound in the color Doppler mapping mode. We studied the linear peak blood flow velocity, index of peripheral vascular resistance, and vascular density pattern. Clinical outcomes were followed for 3 to 12 months. All patients reported an improvement in dysuria and voiding, a reduction in pain in the genital area. Voiding function improvements were confirmed by IPSS, uroflowmetry, and postvoid residual urine volume. Transrectal color Doppler ultrasound mapping showed positive changes in the prostate microcirculation. In 7 patients, the treatment results were followed for 4 to 9 years. During the entire period of observation, the level of prostate-specific antigen remained below 1.75 ng/ml, which indicates the safety of this method in patients with BPH. In patients with symptomatic BPH with concomitant CP in the conservative stage of the disease, integrated treatment of CP using physiotherapeutic modalities has pathogenetic significance. It significantly reduces the LUTS secondary to BPH, improves IPSS, QoL, urinary flow rate, postvoid residual urine volume. The findings allow us to recommend the Mavit device for the treatment of CP, including in patients with I-II stage BPH.

Color Doppler imaging evaluation of blood flow parameters in ophthalmic and posterior ciliary arteries and optic nerve diameter in chronic optic neuritis in multiple sclerosis patients

Background and purposeOptic neuritis (ON) is a common clinical manifestation of Multiple Sclerosis (MS), which is associated with reduced visual acuity, blurred vision, blindness and retro-bulbar pain. In several studies, specific relations between optic nerve diameter and hemodynamics of the eye bulb arteries with ON have been reported. However, no consensus has been reached in this regard. We aim at determining the alterations in optic nerve diameter and eye bulb arteries hemodynamics in ON in MS patients. MethodsThis case-control study includes 40 patients, who at least had experienced one phase of ON, in one of their eyes. To measure hemodynamics of arteries in the affected eyes, a color Doppler imaging was performed and end diastolic velocity (EDV), peak systolic velocity (PSV), peripheral resistance indices i.e. resistance index (RI) and pulsatile index (PI) were measured in posterior ciliary artery (PCA) and ophthalmic artery (OA). Also, optic nerve diameter was measured using sonography. Non-affected eyes of these patients were considered as control group. ResultsThere were no significant differences in EDV, PSV, RI and PI in PCA and OA. The mean optic nerve diameter in the affected eyes was 4.73 mm, whereas, it was 4.31 mm in unaffected eyes, which was significantly different (P = .02). ConclusionThese results indicate that there is a significant relation between eye involvement and increased optic nerve diameter in MS patients with chronic ON. While, there were no significant relations in EDV, PSV, RI and PI in PCA and OA comparing two groups.

Uterine and fetal placental Doppler indices are associated with maternal cardiovascular function

The mechanism underlying fetal-placental Doppler index changes in preeclampsia and/or fetal growth restriction are unknown, although both are associated with maternal cardiovascular dysfunction. We sought to investigate whether there was a relationship between maternal cardiac output and vascular resistance and fetoplacental Doppler findings in healthy and complicated pregnancy. Women with healthy pregnancies (n=62), preeclamptic pregnancies (n=13), preeclamptic pregnancies with fetal growth restriction (n=15), or fetal growth restricted pregnancies (n=17) from 24-40 weeks gestation were included. All of them underwent measurement of cardiac output with the use of an inert gas rebreathing technique and derivation of peripheral vascular resistance. Uterine and fetal Doppler indices were recorded; the latter were z scored to account for gestation. Associations were determined by polynomial regression analyses. Mean uterine artery pulsatility index was higher in fetal growth restriction (1.37; P=.026) and preeclampsia+fetal growth restriction (1.63; P=.001) but not preeclampsia (0.92; P=1) compared with control subjects (0.8). There was a negative relationship between uterine pulsatility index and cardiac output (r2=0.101; P=.025) and umbilical pulsatility index z score and cardiac output (r2=0.078; P=.0015), and there were positive associations between uterine pulsatility index and peripheral vascular resistance (r2=0.150; P=.003) and umbilical pulsatility index z score and peripheral vascular resistance (r2= 0.145; P=.001). There was no significant relationship between cardiac output and peripheral vascular resistance with cerebral Doppler indices. Uterine artery Doppler change is abnormally elevated in fetal growth restriction with and without preeclampsia, but not in preeclampsia, which may explain the limited sensitivity of uterine artery Doppler changes for all these complications when considered in aggregate. Furthermore, impedance within fetoplacental arterial vessels is at least, in part, associated with maternal cardiovascular function. This relationship may have important implications for fetal surveillance and would inform therapeutic options in those pathologic pregnancy conditions currently, and perhaps erroneously, attributed purely to placental maldevelopment. Uterine and fetal placental Doppler indices are associated significantly with maternal cardiovascular function. The classic description of uterine and fetal Doppler changes being initiated by placental maldevelopment is a less plausible explanation for the pathogenesis of the conditions than that relating to maternal cardiovascular changes.

Cardiac and autonomic function in patients with Crohn’s disease during remission

PurposeThe aim of the study was to assess cardiac and autonomic function in patients with Crohn’s disease and explore their relation to disease duration using cardiovascular reflex tests. Materials and methodsCardiovascular parameters, baroreflex sensitivity, spectral-indices of short-term heart rate variability and blood pressure variability were compared between patients with Crohn’s disease in remission (n = 30) and a control group (n = 29). Cardiac autonomic function was assessed during response to standing (tilt) and deep breathing test (expiration/inspiration ratio-E/I). Aortic pulse wave velocity, aortic augmentation index and central systolic blood pressure were measured oscillometrically. ResultsAt rest, Crohn’s disease patients had significantly higher systolic (p = 0.03) and diastolic (p = 0.03) blood pressure, total peripheral resistance index (p = 0.003), sympathetic-parasympathetic ratio (p = 0.033) and lower baroreceptor effectiveness (p = 0.047), myocardial variables (stroke index; p = 0.03, cardiac index; p = 0.025, Heather index; p = 0.039, left ventricular ejection time; p = 0.038), as compared to controls. Orthostatic response to the tilt test in the Crohn’s disease group and the control group was similar, no intergroup differences were observed for E/I ratio and autonomic parameters. In Crohn’s disease patients, disease duration was negatively associated with baroreflex sensitivity and positively correlated with normalised high frequency heart rate variability, sympathetic-parasympathetic ratio at rest and post-tilt changes in Δsystolic blood pressure, p < 0.05. The control group had significantly lower central systolic blood pressure (p = 0.043) compared to Crohn’s disease patients. ConclusionsCrohn’s disease patients in remission have preserved cardiac and autonomic function in response to cardiovascular reflex tests with a shift in cardiovascular autonomic regulation towards sympathetic predominate in the rest position.

Liver volume is lower and associates with resting and dynamic blood pressure variability in chronic fatigue syndrome

ABSTRACT Background: Chronic fatigue syndrome (CFS) in many cases is characterised by abnormal autonomic function and lower blood pressure (BP). In animals the liver is a capacitance vessel for BP homeostasis. We developed a novel liver magnetic resonance (MR) imaging technique to compare liver volume in CFS to controls, and to explore its role in cardiovascular physiology. Methods: Liver MR (single breath-hold, enhanced T1-weighted, high-resolution isotropic volume excitation 3-Tesla Achieva, NL) determined liver volume. Red cell and plasma volume were also measured. A 10 min resting cardiac autonomic assessment using beat-to-beat measurement (Taskforce; CNSystems) was followed by assessment of hemodynamic response to standing to determine blood pressure drop and return to baseline. Results: Forty-four CFS patients (age = 45.5, 34f/10 m, Fukuda criteria) and 10 age, activity and sex matched controls (age = 49.4, 7f/3 m) participated. Adjusted for body size, CFS patients had significantly reduced liver volumes (775 (101) ml/m2 v 846 (96) ml/m2; p = 0.02). At rest, liver volume was unrelated to symptom severity, heart rate, BP or heart rate variability. Both increased systolic and diastolic low frequency (LF) BP variability (predominantly sympathetic) were associated with lower liver volumes. On standing, liver volume was unrelated to BP drop but was associated with successful BP return-to-baseline. Red cell and plasma volume were associated positively with liver volume. Multivariate analysis confirmed return-to-baseline BP on standing which was independently associated with liver volume. Conclusion: Liver volumes were smaller in CFS compared to controls. The relationship between return-to-baseline BP after standing and liver volume suggests, as in animals, that the liver is involved in maintenance of BP. Abbreviations: ACI: Accelerated cardiac index; BPV: Blood pressure variability; BRS: Baroreflex sensitivity; CFS: chronic fatigue syndrome; Chr: Chromium; CI: cardiac index; FIS: Fatigue impact scale; HF: High frequency; HRV: Heart rate variability; LF: Low frequency; MR: magnetic resonance; NU: normalised units; SD: Standardised deviation; PSD: power spectral density; SI: Stroke index; TPRI: Total peripheral resistance index

Cardiovascular Effects of Stress During Acutely Increased Free Fatty Acids in a Randomized, Double-Blind, Cross-Over Study in Humans.

Increased free fatty acids stimulate sympathetic nervous system activity, impair endothelium-dependent vasodilation, and increase regional blood flow. The aim of this study was to assess if fatty acids acutely elevated by infusion of intralipid/heparin affect cardiovascular reactivity employing two stressors eliciting either a cardiac (Stroop test) or vascular (Cold Face test) dominated pressor response. Two stress tasks were performed in 20 healthy subjects (10 women, 10 men) before and during a 180-min intralipid/heparin or saline infusion as placebo on alternate trial days in a randomized crossover study design. Blood pressure, heart rate, cardiac index, and total peripheral resistance index were measured. At baseline, the Stroop test did not affect hemodynamic parameters, and the Cold Face test had an impact on hemodynamic parameters except for heart rate. Plasma fatty acids concentrations increased to 810% (t=11.0, p<0.001) of baseline and C-peptide increased by 17% (t=4.66, p<0.001) during intralipid/heparin infusion. This was paralleled by increased cardiac index (F=9.98; p<0.005 vs. saline) and reduced total peripheral resistance index (F=4.46; p<0.05 vs saline). There was no effect of intralipid/heparin or saline infusion on Stroop test or Cold Face test reactivity of hemodynamic parameters. An acute increase in free fatty acids does not affect the magnitude or pattern of stress response in healthy volunteers, but primarily alter the underlying cardiovascular tone by decreasing total peripheral resistance index and increasing cardiac index to maintain a constant blood pressure.

Hemodynamic response to fluid removal during hemodialysis: categorization of causes of intradialytic hypotension.

Intradialytic hypotension is a clinically significant problem, however, the hemodynamics that underlie ultrafiltration and consequent hypotensive episodes has not been studied comprehensively. Intradialytic cardiac output, cardiac power and peripheral resistance changes from pretreatment measurements were evaluated using a novel regional impedance cardiographic device (NICaS, NI Medical, Peta Tikva, Israel) in 263 hemodialysis sessions in 54 patients in dialysis units in the USA and Brazil with the goal of determining the various hemodynamic trends as blood pressure decreases. Hypotensive episodes occurred in 99 (13.5%) of 736 intra- and postdialytic evaluations. The hemodynamic profiles of the episodes were categorized: (i) The cardiac power index significantly decreased in 35% of episodes by 36%, from 0.66 [95% confidence interval (CI) 0.60-0.72] to 0.43 (95% CI 0.37-0.48) [w/m2] with a small reduction in the total peripheral resistance index. (ii) The total peripheral resistance index significantly decreased in 37.4% of episodes by 33%, from 3342 (95% CI 2824-3859) to 2251 (95% CI 1900-2602) [dyn × s/cm5 × m2] with a small reduction in the cardiac power index. (iii) Both the cardiac power index and total peripheral resistance index significantly decreased in 27.3% of episodes, the cardiac power index by 25% from 0.63 (95% CI 0.57-0.70) to 0.48 (95% CI 0.42-0.53) [w/m2] and the total peripheral resistance index by 23% from 2964 (95% CI 2428-3501) to 2266 (95% CI 1891-2642). The hemodynamic profiles clearly define specific hemodynamic mechanisms of cardiac power reduction and/or vasodilatation as underlying intradialytic hypotensive episodes. A reduction in cardiac power (reduction of both blood pressure and cardiac output) could be the result of preload reduction due to a high ultrafiltration rate with not enough refilling or low target weight. A reduction in peripheral resistance (reduction in blood pressure and increase in cardiac output) could be the result of relative vasodilatation as arteries do not contract to compensate for volume reduction due to autonomous dysfunction. As both phenomena are independent, they may appear at the same time. Based on these results, a reduction of ultrafiltration rate and an increase in target weight to improve preload or immediate therapeutic actions to increase peripheral resistance are rational measures that could be taken to maintain blood pressure and prevent hypotensive ischemic complications in dialysis patients.

Hemodynamic Hyper‐reactivity to Acute Stress in Individuals Reporting Adversity during Childhood: Role of Endothelin‐1

Individuals exposed to adverse childhood experiences (ACE) have an increased risk of developing cardiovascular disease versus those with no ACE. Moreover, these individuals also exhibit an exaggerated blood pressure response to an acute sympathetic stressor; a response that is associated with an increased risk of developing hypertension and shown to be mediated by endothelin‐1 (ET‐1) in animal models. The role of ET‐1 as a modulator of the hemodynamic response to acute stress in humans with high ACE, however, is unknown.PurposeTo compare hemodynamic and plasma ET‐1 responses to a cold pressor test (CPT) in individuals who reported high ACE versus matched controls with no reported ACE.Methods14 participants volunteered for this investigation; 7 of which reported an ACE score ≥4 via questionnaire (HI‐ACE; 5 men, 2 women) and 7 control participants (CON) who were matched for age, ethnicity, sex, and body composition. All participants underwent a CPT protocol which consisted of a 5 min baseline followed by immersion of the right hand up to the wrist in ice water (~2°C) for 3 min. Hemodynamic parameters including total peripheral resistance index (TPRI), cardiac index (CI), and systolic/diastolic blood pressure (SBP/DBP) were measured throughout the protocol using beat‐to‐beat monitoring of finger arterial pressure (Finapres NOVA). Plasma concentrations of ET‐1 were determined at baseline and during the second minute of the CPT.ResultsThere were no differences (all p&gt;0.05) between groups in age, ethnicity, sex, body composition, or fasting blood glucose. Similarly, there were no differences (all p&gt;0.05) in baseline values of TPRI (0.39 ± 0.31 vs. 0.43 ± 0.25 mmHg/ml/m2), CI (3.5 ± 0.8 vs. 3.5 ± 0.6 L/min/m2), SBP (134 ± 14 vs. 133 ± 12 mmHg), or DBP (83 ± 10 vs. 85 ± 11 mmHg) between HI‐ACE and CON. During CPT, a significantly greater increase in SBP (48 ± 20 vs. 29 ± 10 mmHg; p=0.041) and DBP (35 ± 15 vs. 19 ± 5 mmHg; p=0.028) occurred in HI‐ACE compared to CON. While concentrations of ET‐1 at baseline were similar between HI‐ACE and CON (1.28 ± 0.21 vs. 1.22 ± 0.33 pg/ml, respectively), the ET‐1 response during CPT tended (p=0.098) to be higher in HI‐ACE versus CON (Δ1.12 ± 0.03 vs. Δ0.50 ± 0.37 pg/ml).ConclusionThese data suggest that greater plasma concentrations of ET‐1 accompany the exaggerated hemodynamic response to a CPT in individuals who reported high ACE. Future studies are warranted to further elucidate the role of ET‐1 as a mediator of hemodynamic responses to acute stress in individuals with high ACE.Support or Funding InformationSupported in part by NIH/NHLBI P01HL06999.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Assessment of Efficiency of Retrobulbar Infusion of Neurometabolic Preparations in Increase of Hemodynamic of Optic Nerve at Acute Ischemic Optic Neuropathy

Purpose. To study hemodynamic of optic nerve (ON) in process of complex pathogenetic direct treatment in patients with anterior ischemic optic neuropathy (AION). Patients and methods. 43 patients with acute phase AION were exanimated and treated. Besides the functional results (visual acuity, visual field), the diagnosis AION was based on indicators of ophthalmologic and angiographic researches of ON. Patients were divided into two groups. 23 patients were in the main group. They received neurometabolic medicinal preparations (MP) through a silicone retrobulbar catheter. The control group consisted of 20 patients who had the traditional method of medicines injection. Indexes of hemodynamic were estimated according to Doppler ultrasound of local blood flow at the short posterior ciliary arteries (SPCA). At the same time following indexes were estimated: Peak Systolic Velocity (PSV, cm/sec), End Diastolic Velocity (EDV, cm/sec), Average Blood Velocity (ABV, cm/sec), Index of peripheral vascular resistance (R1, M ± m). Results. After the end of hospitalization of patients with AION, more favorable shifts in indexes of hemodynamic in SPCA were reached in patients of main group of research that authentically exceeded the similar data obtained at patients in the control group. Improvement of blood flow of ON was followed by positive changes of thickness of the retinal nerve fiber layer and condition of disk ON. To the final stage of researches (12 months from beginning of treatment) according to degrees of functional disorders severity in the main group of patients prevailed I (14 patients, 60%), less often II degrees (9 patients, 40%) of optic nerve atrophy and absented patients with III degrees of defeat of ON. Among patients of control group II–III degree optic nerve atrophy (12 patients, 60%) met more often, less often I degrees (8 patients, 40%). Conclusion. The conducted research showed that at patients with AION receiving sub-Tenon's infusions of MP more significant favorable functional results were reached thanks to increase of indicators of blood flow in SPCA: PSV — on 24.5%, EDV — on 16.2%, ABV — on 32.2% that significantly exceeds similar data at patients in control group with traditional methods of MP injections.

The timeline of blood pressure changes and hemodynamic responses during an experimental noise exposure

BackgroundNoise exposure increases blood pressure and peripheral vascular resistance in both genders in an experimental setting, as previously reported by the authors. ObjectivesThe aim of this re-analysis was to present the minute-by-minute timeline of blood pressure changes and hemodynamic events provoked by traffic noise in the young and healthy adults. MethodsThe experiment consisted of three 10-min phases: rest in quiet conditions before noise (Leq = 40 dBA), exposure to recorded road-traffic noise (Leq = 89 dBA), and rest in quiet conditions after noise (Leq = 40 dBA). Participants’ blood pressure, heart rate, and hemodynamic parameters (cardiac index and total peripheral resistance index) were concurrently measured with a thoracic bioimpedance device. The raw beat-to-beat data were collected from 112 participants, i.e., 82 women and 30 men, aged 19–32 years. The timeline of events was created by splitting each experimental phase into ten one-minute intervals (30 intervals in total). Four statistical models were fitted to answer the six study questions what is happening from one minute to another during the experiment. ResultsBlood pressure decreased during quiet phase before noise, increased in the first minute of noise exposure and then decreased gradually toward the end of noise exposure, and continued to decline to baseline values after noise exposure. The cardiac index showed a gradual decrease throughout the experiment, whereas total vascular resistance increased steadily during and after noise exposure. ConclusionsThe timeline of events in this 30-min experiment provides insight into the hemodynamic processes underlying the changes of blood pressure before, during and after noise exposure.

АНАЛІЗ ОСОБЛИВОСТЕЙ ЦЕНТРАЛЬНОГО КРОВОТОКУ У ДОСЛІДЖУВАНИХ, ЩО ЗАЗНАЮТЬ ХРОНІЧНОГО ВПЛИВУ НЕГАТИВНИХ ФАКТОРІВ СЕРЕДОВИЩА НА ВИРОБНИЦТВІ

Introduction. The problem of the public health of Ukraine in our country is acute and requires a moderate rise. There are steady tendencies in the increased incidence and the disease dissemination in Ukraine. Currently, the particular scientific researches proved that the bad state of the environment, air, ground and water pollution and the influence of the other negative factors of environment on the human body can be the reasons of the increased incidence, cardiovascular disease in particular. Purpose. The main purpose of the research was to study the dependence of the parameters of the central blood flow and the type of body structure of the workers of the agro-industrial sector and industrial enterprises that undergo chronic effects of a complex of harmful environmental factors. Methods. In the lens of the experiment, 90 people were participants, male aged from 21 to 35 years old. For the purpose of the study all the participants were divided into 3 groups: 1) the population live at least in an ecologically pure zone; 2) the residents of the agrarian districts of the Volyn Region, which are seized in the agricultural area and positively correlated with fertilizers and pesticides; 3) people who work at the enterprises in Lutsk. Proportionality of development and structure of the body of the subjects were studied by calculating the Pignet (IP) index. The study of the central hemodynamic was carried out with the help of the “Askold” (“Kyiv”, 1998), with the use of the method of tetrapolarity reographism by Kubicek. The reograms recording was carried out at the time of the spontaneous respiration and the duration of the inhomogeneous exhalation. Results. Correlation analysis of the indicators of central blood flow and anthropometric indicators showed that in the control group there is a high level of direct dependence of practically all of the studied parameters of the central blood flow from the Pignet index. Thus, in particular, the value of the minute volume of blood flow (r = 0.49), volume of ejection rate (r = 0.31), myocardial capacity (r = 0.34), shock index (r = 0.32) and cardiac index (r = 0.47) is directly proportional to the given index, and the index of the total peripheral resistance (r = -0.41) reveals an inverse relationship. The grounding of the division of the subjects studied into groups, taking into account the index of their constitution (Pignet index), was manifested in the fact that most of the studied parameters were characterized by a significant number of statistically significant correlation relations with this indicator. Such a feature of the obtained results made it possible to analyze the parameters of the cardio-respiratory system of people who have been exposed to harmful factors in the workplace for a long time, taking into account the groups allocated on graduations, which are based on the value of the Pignet index. Analysis of the central blood flow characteristics among the participants of the research, who have chronic effects of negative environmental factors in the workplace (both agro-industrial and industrial) revealed significant differences between the given groups and the group of people from relatively environmentally pure zones in terms of the impact volume of the bloodstream and the capacity of the myocardium . However, the lack of significant differences in the values of the minute volume of blood and energy consumption by the myocardium may indicate a certain compensatory change due to the strengthening of regulatory mechanisms that provide the necessary level of blood supply to the tissues of the body and the absence of organic lesions as the structures of the cardiovascular system, and regulatory circuits of the nervous and endocrine systems that provide a regulation link. Conclusion. People who exposed to negative environmental factors in the workplace, absolute anthropometric indices (age, height, weight, chest) and integral indices (Pignet index) did not differ from those in the control group. The largest number of statistically significant correlation relationships was found in the control group of the participants between functional parameters of the cardiovascular system and the Pignet index, while among people, who have adverse working conditions, such relationships are practically absent. People undergo chronic effects of negative environmental factors in the workplace (both agro-industrial and industrial), there were significant differences in comparison with the group of people from relatively environmentally pure regions in terms of the impact volume of blood flow and the capacity of the myocardium, but these changes have compensatory character. Taking into account the type of body structure of the participants showed that the greatest number of differences between the experimental groups and control was found among mesomorphic people: significant differences are noted in the indicators of myocardial capacity and specific peripheral resistance.

Ventriculo-Arterial Coupling Analysis Predicts the Hemodynamic Response to Norepinephrine in Hypotensive Postoperative Patients: A Prospective Observational Study.

The objectives of the present study were to evaluate, in patients with persistent arterial hypotension in the immediate postcardiac surgery period, the effects of norepinephrine infusion on ventriculo-arterial coupling, its determinants: arterial elastance and end-systolic ventricular elastance, and to test the ability of arterial elastance to end-systolic ventricular elastance ratio to predict stroke volume increases. Prospective observational study. Cardiac-vascular surgical ICU. Twenty-eight postoperative cardiac surgery patients, in whom physicians decided to administer norepinephrine infusion, were included. Arterial pressure, stroke volume index, cardiac index, indexed total peripheral resistance, arterial compliance, arterial elastance, and end-systolic ventricular elastance, were measured before and after norepinephrine infusion. We estimated ventriculo-arterial coupling by the arterial elastance to end-systolic ventricular elastance ratio and defined stroke volume responders by a stroke volume increase greater than or equal to 15%. Twenty-two of the 28 subjects had altered ventriculo-arterial coupling (1.87 [1.57-2.51] vs 1.1 [1-1.18]). Fifteen of the 28 subjects (54%) were stroke volume responders. At baseline, stroke volume responders had similar arterial pressure, higher indexed total peripheral resistance, arterial elastance, arterial elastance to end-systolic ventricular elastance ratio (2.21 [1.69-2.89] vs 1.33 [1.1-1.56]; p < 0.05), and lower arterial compliance, indexed total peripheral resistance and cardiac index. Norepinephrine significantly increased arterial pressure in all subjects. In stroke volume responders, norepinephrine increased arterial elastance, end-systolic ventricular elastance, cardiac index, and improved arterial elastance/end-systolic ventricular elastance coupling. The baseline arterial elastance to end-systolic ventricular elastance ratio predicted stroke volume responsiveness (area under the curve [95% CI], 0.87 [0.71-1]; p < 0.0001). In patients with arterial hypotension norepinephrine increased end-systolic ventricular elastance and arterial elastance. The effects of norepinephrine on stroke volume depend on baseline ventriculo-arterial coupling. Although norepinephrine infusion corrects arterial hypotension in all subjects, increase of stroke volume occurred only in subjects with altered ventriculo-arterial coupling.

Cardiac rehabilitation in patients with cardiovascular disease leads various hemodynamic parameters obtained using simple non-invasive tests to their appropriate levels

We evaluated whether comprehensive cardiac rehabilitation (CR) in patients with cardiovascular disease (CVD) could improve various hemodynamic parameters obtained using simple non-invasive tests. We analyzed 48 CVD patients with (n=38, CR group) or without (n=10, non-CR group) a CR program, and prospectively followed them for 12months. Various parameters were measured at baseline and after 12months using 3 simple non-invasive tests: blood pressure (BP) and severity of atherosclerosis [arterial velocity pulse index (AVI) and atrial pressure volume index] were determined using PASESA®, an index of total autonomic nerve activity and a coefficient of variation of the R-R interval (CVRR) were determined using eHEART®, and the total peripheral resistance, stroke volume and cardiac index (CI) were determined using nico®. The main hemodynamic parameters did not change between baseline and 12months in both groups. Patients in the CR group were divided into higher (H-) and lower (L-) systolic BP (SBP) or AVI according to the average value of SBP or AVI at baseline in the CR group. Patients with H-SBP or H-AVI in the CR group showed a significant reduction of SBP or AVI at 12months. In addition, patients in the CR group were divided into H- and L- CI or CVRR according to the average value of CI or CVRR at baseline in the CR group. Patients with L-CI or L-CVRR in the CR group significantly improved after 12months. In conclusion, CR may lead various hemodynamic parameters obtained using simple non-invasive tests to their appropriate levels.

HEMODYNAMICS CHANGES IN CHILDREN WITH SEPSIS

Sepsis is one of the most common causes of mortality in children. The severe course of sepsis is usually associated with the development of septic shock and multiple organ failure. An important component in the comprehensive examination and evaluation of treatment effectiveness is the monitoring of hemodynamic parameters. We aimed to evaluate changes in central and peripheral hemodynamics by echocardiography and doppler ultrasound in children with sepsis.&#x0D; Material and methods. A retrospective study of cases of septic shock in children aged 0 to 18 years who underwent treatment in the intensive care unit was conducted. Patients were monitored for central and peripheral hemodynamics by echocardiography and doppler ultrasound.&#x0D; Results. 108 cases of sepsis were investigated. Meningococcus was an etiological factor in 53,7% patients, 0.9% – Staphylococcus, 0.9% – Pneumococcus, 0,9% – Yersinia, and in 41,7% aetiology was not been established. In 12 children from the study group fatal outcome was occurred. Septic shock development was associated with significantly higher rates of heart rate (HR) and an increase in peripheral resistance (RI) indices in the abdominal trunk and renal arteries. Fatal course of the disease was associated with a high rate of heart rate and a decrease in diastolic velocity (V min) in the abdominal trunk and renal arteries.&#x0D; Conclusion. Echocardiography and ultrasound dopplerography in children with sepsis are the useful tools to evaluate the pattern and extent of cardiovascular dysfunction.&#x0D; Results of regional blood flow assessment can be a diagnostic criterion for the septic shock and has prognostic value in children with sepsis.