Systemic Hemodynamics Research Articles

The combination of chest compression synchronized ventilation and aortic balloon occlusion improve the outcomes of cardiopulmonary resuscitation in swine.

The primary mission of cardiopulmonary resuscitation (CPR) is to provide adequate blood flow and oxygen delivery for restoring spontaneous circulation from cardiac arrest (CA) events. Previously, studies demonstrated that chest compression synchronized ventilation (CCSV) improved systemic oxygen supply during CPR, and aortic balloon occlusion (ABO) augments the efficacy of external CPR by increasing blood perfusion to vital organs. However, both them failed to make a significant improvement in return of spontaneous circulation (ROSC). In this study, we investigated the effects of combined CCSV and ABO on the outcomes of CPR in swine. Thirty-one male domestic swine were subjected to 8 min of electrically induced and untreated CA followed by 8 min of CPR. CPR was performed by continuous chest compressions and mechanical ventilation. At the beginning of CPR, the animals were randomized to receive intermittent positive pressure ventilation (IPPV, n = 10), CCSV (n = 7), IPPV + ABO (n = 7), or CCSV + ABO (n = 7). During CPR, gas exchange and systemic hemodynamics were measured, and ROSC was recorded. After resuscitation, the function and injury biomarkers of vital organs including heart, brain, kidney, and intestine were evaluated. During CPR, PaO2 was significantly higher accompanied by significantly greater regional cerebral oxygen saturation in the CCSV and CCSV + ABO groups than the IPPV group. Coronary perfusion pressure, end-tidal carbon dioxide, and carotid blood flow were significantly increased in the IPPV + ABO and CCSV + ABO groups compared with the IPPV group. ROSC was achieved in five of ten (IPPV), five of seven (CCSV), six of seven (IPPV + ABO), and seven of seven (CCSV + ABO) swine, with the rate of resuscitation success being significantly higher in the CCSV + ABO group than the IPPV group (P = 0.044). After resuscitation, significantly improved myocardial and neurological function, and markedly less cardiac, cerebral, renal, and intestinal injuries were observed in the CCSV + ABO group compared with the IPPV group. The combination of CCSV and ABO improved both ventilatory and hemodynamic efficacy during CPR, promoted ROSC, and alleviated post-resuscitation multiple organ injury in swine.

Renal artery denervation: unsolved questions about mechanisms of changes of systemic hemodynamics

In the review we discussed the clinical and physiological aspects of the use of renal artery denervation as an interventional method of treatment of refractory essential arterial hypertension. The application of radiofrequency denervation may be considered as an additional treatment to drug therapy in patients with arterial hypertension. At the same time, the main emphasis in the performed experimental and clinical studies was made on the assessment of changes in blood pressure, cardiac output and the calculated index of total peripheral resistance. However, there is no satisfactory data in the literature about changes of the venous return, as well as superior and inferior venae cavae flows. To assess the effectiveness of renal artery denervation on arterial and venous vessels resistance shifts, it is necessary to carry out experimental studies with perfusion of isolated organs in the conditions of modeling arterial hypertension in animals. The question of the extent to which denervation of the renal arteries leads to shifts in the reactions of organ venous vessels in response to pressor reflex stimuli also requires further studies on experimental models. There are practically no data in the literature on the degree of influence of renal artery denervation on orthostatic tolerance. To understand the mechanisms of changes in systemic hemodynamics in response to denervation of the renal arteries, it is also necessary to perform further research on the mechanisms of shifts in the capacitive and resistive functions of the pulmonary circulation with an assessment of pulmonary microcirculation.

The Effect of Submaximal Exercise on Cutaneous Blood Flow, Thermoregulation and Recovery Hemodynamics Following Endurance Exercise

Aim. There are numerous reports of attenuation of cutaneous blood flow (CBF) during the recovery period after a single bout of exercise, but no one has investigated the CBF response to consecutive short-lasting aerobic exercise (SLAE) sessions following exhaustive endurance exercise (EEE) on daily basis, although this is a commonly used training regime in recreational athletes and could cause a cumulative increase in CBF that may be important for wound healing. This study examined the effects of EEE on forearm skin blood flow (LDF), cutaneous vascular conductance (CVC), and mean arterial pressure (MAP) in response to SLAE sessions performed for 7 days after EEE, as well as the correlation between cutaneous blood flow and indices associated with heart rate (HR) to examine the role of thermoregulation in post-exercise HR regulation. Methods. In 19 recreational runners, LDF, MAP, HR, heart rate recovery (HRR), and HR variability indices (lnRMSSD, lnHF, and lnLF/ HF) were measured after SLAE in the form of submaximal graded cycling performed on consecutive days after EEE in the form of a half marathon and compared with baseline values before EEE. A significant time effect was observed for all measured parameters throughout the study period. Results. Postexercise LDF increased 24 hours after EEE compared with baseline (77.814 AU compared with 54.712 AU). Postexercise hypotension was significantly more pronounced immediately after EEE compared with baseline (88.95.3 mmHg compared with 99.33.2 mmHg). However, postexercise CVC showed a progressive increase compared with baseline both immediately and 24 hours after EEE (0.53 0.07 AU/mmHg, 0.66 0.09 AU/mmHg compared with 0.4 0.09 AU/mmHg). A small negative correlation between LDF and HRR was observed throughout the experimental protocol. Conclusion. These results suggest that EEE strongly influences cutaneous and systemic hemodynamics and cardiac autonomic response during recovery after SLAE. Our most important finding was that EEE improved cutaneous perfusion 24 hours after completion of EEE, which may be important for wound healing. The results of our study are potentially applicable for patients with chronic wounds who should be encouraged to exercise moderately on daily basis and to include endurance exercises occasionally, as this strategy potentiates postexercise cutaneous perfusion.

Investigation of Cerebral Autoregulation Using Time-Frequency Transformations.

The authors carried out the study of the state of systemic and cerebral hemodynamics in normal conditions and in various neurosurgical pathologies using modern signal processing methods. The results characterize the condition for the mechanisms of cerebral circulation Institute of Computer Science and Control, Higher School of Cyber-Physical Systems and Control regulation, which allows for finding a solution to fundamental and specific clinical problems for the effective treatment of patients with various pathologies. The proposed method is based on the continuous wavelet transform of systemic arterial pressure and blood flow velocity signals in the middle cerebral artery recorded by non-invasive methods of photoplethysmography and transcranial doppler ultrasonography. The study of these signals in real-time in the frequency range of Mayer waves makes it possible to determine the cerebral autoregulation state in certain diseases before and after surgical interventions. The proposed method uses a cross-wavelet spectrum, which helps obtain wavelet coherence and a phase shift between the wavelet coefficients of systemic arterial pressure signals and blood flow velocity in the Mayer wave range. The obtained results enable comparing the proposed method with that based on the short-time Fourier transform. The comparison showed that the proposed method has higher sensitivity to changes in cerebral autoregulation and better localization of changes in time and frequency.

Concomitant Intra-Aortic Balloon Pumping Significantly Reduces Left Ventricular Pressure during Central Veno-Arterial Extracorporeal Membrane Oxygenation-Results from a Large Animal Model.

(1) Introduction: Simultaneous ECMO and IABP therapy is frequently used. Haemodynamic changes responsible for the success of the concomitant mechanical circulatory support system approach are rarely investigated. In a large-animal model, we analysed haemodynamic parameters before and during ECMO therapy, comparing central and peripheral ECMO circulation with and without simultaneous IABP support. (2) Methods: Thirty-three female pigs were divided into five groups: (1) SHAM, (2) (peripheral)ECMO(-)IABP, (3) (p)ECMO(+)IABP, (4) (central)ECMO(-)IABP, and (5) (c)ECMO(+)IABP. Pigs were cannulated in accordance with the group and supported with ECMO (±IABP) for 10 h. Systemic haemodynamics, cardiac index (CI), and coronary and carotid artery blood flow were determined before, directly after, and at five and ten hours on extracorporeal support. Systemic inflammation (IL-6; IL-10; TNFα; IFNγ), immune response (NETs; cf-DNA), and endothelial injury (ET-1) were also measured. (3) Results: IABP support during antegrade ECMO circulation led to a significant reduction of left ventricular pressure in comparison to retrograde flow in (p)ECMO(-)IABP and (p)ECMO(+)IABP. Blood flow in the left anterior coronary and carotid artery was not affected by extracorporeal circulation. (4) Conclusions: Concomitant central ECMO and IABP therapy leads to significant reduction of intracavitary cardiac pressure, reduces cardiac work, and might therefore contribute to improved recovery in ECMO patients.

Attenuated Relationships Between Indexes of Volume Overload and Atrial Natriuretic Peptide in Uncontrolled, Sustained Volume-Dependent Primary Hypertension.

Whether systolic blood pressure (SBP) control in sustained volume-dependent primary hypertension is associated with blunted ANP (atrial natriuretic peptide) relationships with indexes of volume load is unknown. Systemic hemodynamics (central pressure, echocardiographic aortic velocity and diameter measurements in the outflow tract), circulating ANP concentrations (ELISA assays) and glomerular and tubular function (24-hour urine collections [n=519]) were determined in a community of African ancestry (n=772). As compared with those with a controlled SBP, those with an uncontrolled SBP (n=198) showed lower ANP concentrations (P<0.005) despite higher stroke volume and cardiac output (P<0.0001) and renal differences consistent with enhanced fluid retention. In those with a controlled SBP, fractional Na+ excretion (FeNa+; P<0.0005) and creatinine clearance (glomerular filtration rate; P<0.005) were inversely associated with ANP concentrations independent of confounders. Moreover, in those with a controlled SBP, stroke volume and cardiac output (P<0.0001) were independently and positively associated with ANP concentrations. In addition, in those with a controlled SBP, ANP concentrations were independently and inversely associated with systemic vascular resistance (SVR; P<0.0001) and aortic characteristic impedance (Zc; P<0.005). By contrast, in those with uncontrolled SBP, no relationships between either stroke volume (P>0.25), cardiac output (P>0.29), FeNa+ (P>0.77), or glomerular filtration rate (P>0.47) and ANP concentrations were noted. Furthermore, in those with an uncontrolled SBP, no relationships between ANP concentrations and SVR or Zc were observed (P>0.34). In a population where primary hypertension is strongly volume-dependent, those with an uncontrolled SBP have an attenuated relationship between ANP and both renal and hemodynamic indexes of volume overload and the vascular effects of ANP.

Impact of Rapid Weight Loss after Bariatric Surgery in Systemic Inflammatory Response and Pulmonary Hemodynamics in Severely Obese Subjects with Pulmonary Hypertension.

Pulmonary hypertension (PH) can be associated with obesity. The excessive production of proinflammatory mediators by dysfunctional adipocytes may enhance remodeling of the pulmonary vasculature and worsen pulmonary hemodynamics. This study aimed to describe the changes in pulmonary arterial pressures and systemic inflammation in patients with obesity with PH after bariatric surgery (BaS). In this retrospective cohort study, we compared patients with PH who underwent BaS from 2008 to 2018 at our institution (group 1) to a group of severely obese patients with PH (group 2). Echocardiographic right ventricular systolic pressure (RVSP) was used as an indirect measurement of pulmonary arterial pressures. Red blood cell distribution width (RDW) was used as a marker of systemic inflammation. A total of 40 patients were included, 20 per group. In group 1, the RVSP decreased from 44.69 ± 7.12 mmHg to 38.73 ± 12.81 mmHg (p = 0.041), and the RDW decreased from 15.22 ± 1.53 to 14.41 ± 1.31 (p = 0.020). In group 2, the RVSP decreased from 60.14 ± 18.08 to 59.15 ± 19.10 (0.828), and the RDW increased from 15.37 ± 1.99 to 15.38 ± 1.26 (0.983). For both groups, we found a positive correlation between RVSP and RDW changes, although the correlation was not statistically significant. Previous studies suggest BaS could be a safe and effective procedure to achieve weight loss in obese patients with PH, with an additional modest improvement in pulmonary hemodynamics. The results of this study reinforce this observation and suggest that such improvement could be related to a decrease in systemic inflammation. Further prospective studies with bigger samples are needed to better understand these findings.

Retinal circulation time/arm-to-retina time ratio in the fluorescein angiography to evaluate retina-specific hemodynamics

To evaluate dynamic circulatory flow in the retinal or choroidal circulatory disease, we retrospectively reviewed medical charts of 128 eyes of 128 patients who underwent video recorded fluorescein angiography (FA), at Department of Ophthalmology, St Luke’s International Hospital, between April and September 2020. Mean age was 64.2 ± 14.0 (range 37–93) years, and 87 (67.9%) patients were men. Mean arm-to-retina (AR) time was 16.2 ± 4.1 s, and mean retinal circulation (RC) time was 10.9 ± 3.3 s. Mean RC time/AR time (RC/AR) ratio was 0.69 ± 0.22. AR time was correlated with age, whereas RC time was not. RC time was positively correlated with AR time (R = 0.360, P = 0.017). Moreover, mean RC time was significantly longer, and RC/AR ratio was greater, in the retinal-disease group after adjusting for age and sex. Patients who had an RC/AR ratio ≥ 0.8 more frequently presented with retinal diseases. RC time and RC/AR ratio were negatively correlated with systolic blood pressure only in the retinal-disease group. Given that AR time reflects systemic hemodynamics, RC time, which reflects local circulatory fluency, was influenced by the systemic circulatory condition. Moreover, RC/AR ratio revealed that circulatory changes peculiar to the retina may also be involved in retinal-disease pathogenesis. This study may help elucidate the mechanisms of retinal diseases and assist in diagnosis, although further studies are required.

Impact of Increasing Lower Body Negative Pressure and Its Abrupt Release on Left Ventricular Hemodynamics in Anesthetized Pigs.

Lower body negative pressure (LBNP) has been implemented as a tool to simulate systemic effects of hypovolemia, understand orthostatic challenges and study G load stress in humans. However, the exact hemodynamic mechanisms of graded LBNP followed by its abrupt release have not been characterized in detail, limiting its potential applications in humans. Here, we set out to investigate the immediate hemodynamic alterations occurring during LBNP in healthy Landrace pigs. Invasive cardiac monitoring via extensive pressure volume loop analysis was carried out during application of incremental LBNP up to life threatening levels from −15 to −45 mmHg as well as during its abrupt release. Three different sealing positions were evaluated. Incremental LBNP consistently induced a preload dependent depression of systemic hemodynamics according to the Frank-Starling mechanism. Overall, the pressure–volume loop progressively shifted leftwards and downwards with increasing LBNP intensity. The abrupt release of LBNP reverted the above-described hemodynamic changes to baseline values within only three respiratory cycles. These data provide quantitative translational insights into hemodynamic mechanisms of incremental and very high levels of LBNP, levels of seal and effect of abrupt release for future human applications, such as countermeasure development for long spaceflight.

Increased tissue water in patients with severe sepsis affects tissue oxygenation measured by near-infrared spectroscopy: a prospective, observational case-control study.

BackgroundTissue oedema affects tissue perfusion and interferes with the monitoring of tissue oxygenation in patients with severe sepsis. However, the underlying mechanisms remain unclear. We used a wireless near-infrared spectroscopy (NIRS) device that transmits tri-wavelength light to quantify tissue haemoglobin (Hb) and water (H2O) content. We estimated tissue H2O in severe sepsis patients and healthy controls, compared their difference, and investigated the correlation of tissue H2O with systemic haemodynamics and its impact on tissue oxygenation.MethodsSeventy-seven adult patients with new-onset severe sepsis admitted to the intensive care unit within 72 h and 30 healthy volunteers (controls) were enrolled. The NIRS device was placed on the participant’s leg to estimate the relative tissue concentrations of oxy-Hb ([HbO2]), deoxy-Hb ([HbR]), total Hb ([HbT]), and H2O ([H2O]) at rest for three consecutive days. Two-sample t-test or Mann-Whitney U test, chi-square test, and generalised estimating equations (GEEs) were used for comparisons.ResultsIn severe sepsis patients, the [H2O] in the anterior tibia was higher [mean (standard deviation, 95% confidence interval), 10.57 (3.37, 9.81–11.34) vs. 7.40 (1.89, 6.70–8.11)] and the [HbO2], [HbT], and tissue Hb oxygen saturation (StO2) were lower [0.20 (0.01, 0.20–0.20) vs. 0.22 (0.01, 0.22–0.23), 0.42 (0.02, 0.42–0.43) vs. 0.44 (0.02, 0.44–0.45), and 47.25% (1.97%, 46.80–47.70%) vs. 49.88% (1.26%, 49.41–50.35%), respectively] than in healthy controls in first-day measurements. GEE analysis revealed significant differences in [H2O], [HbO2], [HbT], and StO2 between groups over three consecutive days (all P≤0.001). In addition, [HbO2] and StO2 levels gradually decreased over time in the patient group. A negative correlation was observed between [H2O] and [HbO2] and StO2, which became more obvious over time (day 1: r=−0.51 and r=−0.42, respectively; both P<0.01; day 3: r=−0.67 and r=−0.63, respectively, both P<0.01). Systolic arterial pressure was positively related to [H2O] (r=0.51, P<0.05, on day 1) but was not associated with tissue oxygenation parameters.ConclusionsNIRS can be used to quantify tissue H2O. Severe sepsis patients have increased tissue H2O, which responds to changes in arterial blood pressure and affects tissue oxygenation.

Quantification of exceedingly high levels of von Willebrand factor in cirrhosis: Next upgrading of the MELD-Na score?

That Von Willebrand factor antigen (VWF Ag) levels predict clinical outcome in patients with cirrhosis and portal hypertension was firstly stated by La Mura et al. [1] who described the relation of this (and other) markers of endothelial dysfunction with systemic and hepatic haemodynamics [1]. They found that VWF levels significantly correlated with the Hepatic Vein Pressure Gradient (HVPG), Child–Pugh score and the model for end-stage liver disease (MELD), but independently predicted clinical outcome.

Optimisation of acute pain treatment in children in abdominal surgery at the stages of the perioperative period

The aim of the study. To improve the quality of perioperative analgesia by combined multimodal use of paracetamol and ketorolac tromethamine in children after abdominal surgery.&#x0D; Materials and methods. 48 children (6-17 years old) with choledochal, pancreatic cysts, hepatic echinococcosis, and abdominal trauma. The study period was from January 2021 to January 2022. Group 1 (main group, n=28): baseline analgesia - 15 min before surgery, intravenous paracetamol administration at 25-30 mg/kg. In order to prevent postoperative pain syndrome 15 minutes before the end of the surgery, we administered ketorolac and tromethamine in a dose of 0.5 mg/kg. Pain relief was repeated 6-8 h later with ketorolac at a dose of 0.5 mg/kg. Group 2 (comparison, n=20), who received 0.2 – 0.3 mg/kg promedol (trimeperidin) in the postoperative period. Both groups received standard endotracheal anaesthesia (propofol + fentanyl + arduan against the background of Low-flow anaesthesia with sevoflurane MAK=1). Systemic haemodynamics, C-reactive protein, and glucose were investigated, and a visual analogue scale was applied at the main stages of the study.&#x0D; Results: Analysis of the parameters of central hemodynamics, parameters of the operational stress response and clinical data showed that in the postoperative period, sufficient analgesic effect was established only in children in group 1 with the preventive combined administration of paracetamol and ketorolac on the operating table, which allows recommending them in the practice of perioperative analgesia during abdominal surgical interventions.&#x0D; Conclusions. Optimised method of preventive (preoperative) use of paracetamol in children at a dose of 25-30 mg/kg during abdominal surgery followed by administration of ketorolac tromethamine (15 minutes before the end of the surgery) increases the degree of nociceptive protection. It ensures high efficiency of postoperative pain relief, which allows to recommend it in the practice of perioperative analgesia for the above abdominal surgical interventions in children

Hemodynamic Aberrancies in Left Ventricular Assist Device–Associated Heart Failure Syndromes

Hemodynamic Aberrancies in Left Ventricular Assist Device–Associated Heart Failure Syndromes

INFLUENCE OF VITAMIN E ON THE HAEMODYNAMIC EFFECTS OF INTRAGASTRIC CHROMIUM INTAKE AND LIPID PEROXIDATION IN EXPERIMENTAL RATS

Purpose: To examine the possibility of using vitamin E for the correction of free radical oxidation disorders and haemodynamic effects of potassium bichromate. Methods: Experiments were performed in 90 male Wistar rats; the study included 9 experimental groups. Vitamin E and sunflower oil (control) were injected daily intragastrically through an atraumatic tube into the stomach. At the end of the experimental period (30 days and 60 days), the main parameters of systemic hemodynamics and values of lipid peroxidation were measured. Differences between groups were analyzed using Student’s t-test. Results: The analysis of basic parameters of systemic haemodynamics showed that PO administration of potassium bichromate promoted an increase in mean arterial pressure due to the increase in normalized peripheral vascular resistance (systemic vascular resistance, SVR). At the same time there was a decrease in the stroke volume index. The haemodynamic effects of chromium were more pronounced with prolonged administration. Parameters of systemic hemodynamics in combined administration of potassium bichromate and sunflower oil changed similarly to the effects of combined administration of the metal and vitamin E, but changes were less pronounced. A decrease in SVR and the restoration of the stroke volume index were observed. The isolated administration of the metal for thirty days resulted in an increase in lipid peroxidation (LPO) accompanied by a stimulation of catalase and superoxide dismutase activity. During prolonged (2 months) isolated administration of potassium bichromate, a more pronounced increase in LPO was observed along with the depletion of the antioxidant system. The prevention of chromium intoxication using vitamin E during the first month of administration reduced lipoperoxidation phenomena accompanying increased antioxidant defense activity. These dynamics persisted after two months of the combination of vitamin E and potassium bichromate. Conclusions: The intragastric administration of potassium bichromate for 30 and 60 days resulted in arterial hypertension in a rat model. The administration of toxic doses of potassium bichromate to laboratory animals may lead to the activation of lipid peroxidation. The administration of vitamin E may attenuate the haemodynamic effects of chromium intoxication and the activation of lipid peroxidation.

Immediate reduction in left ventricular ejection time following TAVI is associated with improved quality of life.

BackgroundTAVI has shown to result in immediate and sustained hemodynamic alterations and improvement in health-related quality of life (HRQoL), but previous studies have been suboptimal to predict who might benefit from TAVI. The relationship between immediate hemodynamic changes and outcome has not been studied before. This study sought to assess whether an immediate hemodynamic change, reflecting myocardial contractile reserve, following TAVI is associated with improved HRQoL. Furthermore, it assessed whether pre-procedural cardiac power index (CPI) and left ventricular ejection fraction (LVEF) could predict these changes.MethodsDuring the TAVI procedure, blood pressure and systemic hemodynamics were prospectively collected with a Nexfin® non-invasive monitor. HRQoL was evaluated pre-procedurally and 12 weeks after the procedure, using the EQ-5D-5L classification tool.ResultsOverall, 97/114 (85%) of the included patients were eligible for analyses. Systolic, diastolic and mean arterial pressure, heart rate, and stroke volume increased immediately after TAVI (all p < 0.005), and left ventricular ejection time (LVET) immediately decreased with 10 ms (95%CI = −4 to −16, p < 0.001). Overall HRQoLindex increased from 0.810 [0.662–0.914] before to 0.887 [0.718–0.953] after TAVI (p = 0.016). An immediate decrease in LVET was associated with an increase in HRQoLindex (0.02 index points per 10 ms LVET decrease, p = 0.041). Pre-procedural CPI and LVEF did not predict hemodynamic changes or change in HRQoL.ConclusionTAVI resulted in an immediate hemodynamic response and increase in HRQoL. Immediate reduction in LVET, suggesting unloading of the ventricle, was associated with an increase in HRQoL, but neither pre-procedural CPI nor LVEF predicted these changes.Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT03088787

Использование Fast-Track в детской урологии

Current trends in the anesthesiology require a change in the perioperative management of patients, with a consideration of new approaches to anesthesia and the introduction of methods that reduce the stress response to surgery.To introduce the "fast-track" concept with the analysis of systemic hemodynamics and stress markers at the perioperative stage in children with urological diseases.A prospective and retrospective analysis of the results of 42 children with urological disorders treated from 09.2016 to 04.2021 under spinal anesthesia (SA) was carried out. In each case, perioperative parameters were evaluated, including central hemodynamics and biochemical markers of stress response.Hemodynamic stability under SA in young children has an evidence base and a physiological explanation. Changes in stress response markers in various anesthesia methods revealed a more pronounced stress-protective effect in SA than in general anesthesia.Our data have shown that combined SA for urological procedures in children allows to more effectively and reliably prevent and block the manifestations of stress-induced reactions of hemodynamics and metabolism than general anesthesia. The introduction of fast-track approach in pediatric urology resulted in the faster postoperative recovery and shorter length of stay.

The relationship between muscle sympathetic nerve activity and systemic hemodynamics is altered in women with uterine fibroids.

Women with uterine fibroids (UF), benign tumors of the myometrium, have a higher prevalence of hypertension than women without UF. The cause for this relationship is unclear. Muscle sympathetic nerve activity (MSNA) is a regulator of arterial blood pressure, and it is possible that variations in MSNA predispose women with UF to develop hypertension. The purpose of this study was to assess baseline blood pressure and MSNA and the relationships between MSNA and systemic hemodynamics in women with and without UF. We measured blood pressure (brachial intra‐arterial line), MSNA (microneurography), and systemic hemodynamics (total peripheral resistance and cardiac output) at rest in 14 healthy, normotensive, premenopausal women with UF (42 ± 2 years old) and 9 healthy, normotensive, premenopausal women without UF (41 ± 2 years old). Baseline blood pressure and MSNA did not differ between groups (p > 0.05 for both). In women with UF, there was a positive correlation between MSNA and total peripheral resistance (r = 0.75, p = 0.02), as well as a negative correlation between MSNA and cardiac output (r = −0.73, p = 0.03). In contrast, these relationships were not seen in women without UF (p > 0.05 for both relationships). These data suggest that autonomic interactions with systemic hemodynamics, and thus blood pressure regulation, are different in healthy women with UF compared to healthy women without UF.

Effects of adding hypertonic saline solutions and/or etilefrine to standard diuretics therapy in cirrhotic patients with ascites.

The renin-angiotensin-aldosterone system (RAAS) activation is the milestone in ascites formation. Hypertonic saline solution (HSS) has attracted considerable interest over the last years in ascites control. Other therapeutic models and concepts have been introduced to overcome diuretic resistance and control ascites. We aimed to evaluate the effects of adding HSS infusion and/or etilefrine to oral diuretics therapy on inflammatory and metabolic pathways, renal and systemic hemodynamics, and clinical outcomes by estimating the changes in selected biochemical and biological markers in cirrhotic patients with ascites. Ninety cirrhotic patients with ascites were studied after administration of HSS infusion (n=25) or etilefrine tablets (n=25), or both (n=25) plus standard diuretics therapy (SDT), or SDT alone (n=15). Serum levels of interleukin-6 (IL-6), aldosterone, leptin, and C-reactive protein (CRP). Hepatic and renal functions were measured at baseline, after eight days, then after 38 days. A significant reduction in serum IL-6, serum aldosterone, Child-Pugh score, MELD-Na score, and increase in serum leptin, and mean arterial pressure (p<0.05) were noted after 38 days in HSS and combination groups. A significant improvement in diuresis, in all groups, urinary sodium excretion, and creatinine clearance (p<0.05) were increased after 38 days in all groups except the SDT group. The results suggest that HSS, etilefrine, and their combination plus SDT are superior to SDT alone for ascites control and can exert some benefits on clinical, systemic, inflammatory, renal, and metabolic pathways without renal or hepatic dysfunction.

Maximum Aerobic Exercise Induces Common Carotid Vasoconstriction And Increased Vascular Resistance

Michael Diaz, Zaria Opara, Heysel Morales, Steven Hawkins, Louise Kelly, Allan Knox PURPOSE: Low-to-moderate intensity aerobic exercise has been reported to elicit changes in systemic hemodynamics. Recent evidence suggests that the cerebral circulation reacts independently to systemic circulations to the same physiological stimuli. The aim of this is to determine the influence of high-intensity aerobic exercise on common carotid artery (CCA) hemodynamics. METHODS: Hemodynamic measurements were recorded before and following the cessation of a maximum oxygen uptake test (VO2max). One minute video of the CCA by Doppler ultrasound were recorded and used to determine peak systolic velocity (PSV), end diastolic velocity (EDV), time averaged mean blood velocity (TAMEAN), timed average maximum velocity (TAMAX), pulsatility index (PI), and resistance index (RI). CCA diameters were calculated by commercially available vessel tracking software. Carotid stiffness index (β), Peterson’s pressure modulus (Ep), arterial compliance (AC) was also calculated. RESULTS: A total of 29 individuals, 14 male and 15 females, participated in this study (21.9 ± 3.9 years). Following the cessation of exercise, PSV (p < 0.001), TAMAX (p = 0.0085), RI (p < 0.001), and PI (p = 0.0032) significantly increased whilst the minimum diameter (p = 0.005), and maximum diameter (p = 0.020) decreased. No changes were observed for β (p = 0.491), Ep (p = 0.834) or AC (p = 0.535). CONCLUSION: The results show hemodynamic changes in the CCA following VO2max exercise. Specifically, increases in vascular resistance are likely due to the reductions in arterial diameter, which may be evident downstream of the CCA. Acute maximal aerobic exercise does not change CCA stiffness parameters.

Response Guided Slow Infusion of Albumin, Vasoconstrictors and Furosemide Improves Ascites Mobilization and Survival in Acute on Chronic Liver Failure: A Proof-of-Concept Study.

Background and AimsAcute-on-chronic liver failure (ACLF) with increasing organ failure is associated with poor outcomes. Severely deranged systemic hemodynamics and decreased effective arterial blood volume contribute to tissue damage and organ failure. Response-guided therapy with albumin, vasoconstrictors, and furosemide may help overcome effective hypovolemia, improve diuresis and impact survival.MethodsIn the observation cohort, 230 patients with ACLF (CANONIC criteria) with ascites (≥Grade II) and ACLF ≥Grade I were enrolled. A total of 136 patients (GROUP I) received response-guided (urine sodium >80mmol/day) slow albumin-furosemide infusion ± terlipressin (SAFI ± T), while 94 patients (GROUP II) received standard medical therapy. Twenty-eight-day survival, ascites mobilization (nil or grade 1), and adverse events were noted. In another mechanistic cohort (n = 40), laboratory evidences for improvement in various pathophysiological alterations; gut permeability, endotoxemia, cytokine storm, neutrophil dysfunction, and hemodynamic alterations following SAFI ± T/Noradrenaline (NAdr) were evaluated.ResultsAge, gender, CLIF-C-ACLF, SOFA and MELD scores, ACLF grades and urine sodium were not different between the two groups in the observation cohort. Ascites was mobilized in 102/136 in GROUP I (SAFI ± T) and 23/94 in GROUP II (p < 0.05). Twenty-eight-day survival was significantly higher in GROUP I = 103/136 (75.7%) vs GROUP II = 50/94 (53.2%), (P = <0.001). All those who were unable to reach urine sodium >80 mmol/day died. Four patients in GROUP I developed scrotal gangrene. In the mechanistic cohort, 72% of patients survived with significant improvement in gut permeability, endotoxemia, serum cytokines, neutrophil dysfunction, and hemodynamic alterations.ConclusionAscitic fluid mobilization by response-guided SAFI ± T/NAdr therapy improves survival by improving splanchnic and systemic hemodynamics, decreasing gut congestion, gut permeability, and endotoxemia, improving neutrophil functions, and reducing pro-inflammatory cytokines in circulation.