Association of coronary artery calcium with heart rate variability in the Brazilian Longitudinal Study of Adult Health - ELSA-Brasil

Current data shows that the autonomic and vascular systems can influence each other. However, only a few studies have addressed this association in the general population. We aimed to investigate whether heart rate variability (HRV) was associated with coronary artery calcium (CAC) in a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We examined baseline data from 3138 participants (aged 35 to 74 years) without previous cardiovascular disease who underwent CAC score assessment and had validated HRV recordings. Prevalent CAC was defined as a CAC score>0, and HRV analyses were performed over 5-min segments. We detected CAC score>0 in 765 (24.4%) participants. Subgroup analyses in older participants (≥49 years) adjusted for sociodemographic and clinical variables revealed that CAC score>0 was associated with lower values of standard deviation of NN intervals (SDNN) (odds ratio [OR]=1.32; 95%CI: 1.05,1.65), root mean square of successive differences between adjacent NN intervals (RMSSD) (OR=1.28; 95%CI: 1.02,1.61), and low frequency (LF) (OR=1.53, 95%CI: 1.21,1.92). Interaction analysis between HRV indices and sex in age-stratified groups revealed significant effect modification: women showed increased OR for prevalent CAC in the younger group, while for men, the associations were in the older group. In conclusion, participants aged ≥49 years with low SDNN, RMSSD, and LF values were more likely to present prevalent CAC, suggesting a complex interaction between these markers in the pathogenesis of atherosclerosis. Furthermore, our results suggested that the relationship between CAC and HRV might be sex- and age-related.

Heart rate control and influencing factors of patients with coronary heart disease and arrhythmia in Qinghai in 2019 / 公共卫生与预防医学

Objective To investigate the heart rate control and related influencing factors of patients with coronary heart disease and arrhythmia in Qinghai in 2019. Methods Clinical data of 263 patients with coronary heart disease and arrhythmia in our hospital in 2019 were retrospectively analyzed. According to their resting heart rate control status at 6 months after discharge, the patients were divided into a well-controlled heart rate group (n=151) and a poorly controlled heart rate group (n=112). The clinical characteristics of patients with different heart rate control status were compared, and influencing factors of heart rate control were analyzed. Results Among patients with coronary heart disease and arrhythmia in Qinghai in 2019, atrial arrhythmia had a higher incidence rate (55.51%), and the main types of arrhythmia were atrial premature beat. The rate of good heart rate control of patients at 6 months after discharge was 57.41%. The heart rate control status was related to the resting heart rate at discharge, age, smoking status, treatment methods, type of coronary heart disease, CCS grade, NYHA classification, hypertension, diabetes mellitus, cardiac enlargement, use of beta blocker and awareness of heart rate control target at discharge (t=32.370, P2=26.300, P2=45.690, P2=15.161, P2=67.500, P2=18.788, P2=10.228, P=0.006; χ2=78.769, P2=66.374, P2=51.165, P2=43.360, P2=40.315, P<0.001), and the difference was statistically significant. Smoking, coronary artery bypass grafting, myocardial infarction, diabetes mellitus, non-use of beta blockers, and poor awareness of heart rate control were independent risk factors for poor heart rate control in patients with coronary heart disease and arrhythmia (P<0.05). Conclusion In 2019, the rate of good heart rate control in patients with coronary heart disease and arrhythmia in Qinghai is above the average level, and the health education on heart rate control relate knowledge for high-risk groups should be strengthened.

AUTONOMIC, CARDIOVASCULAR & PHYSIOLOGICAL RESPONSES IN STRENGTH TRAINING PROTOCOLS / Respostas autonômicas, cardiovasculares e fisiológicas em protocolos de treinamento de força / Respuestas autonómicas, cardiovasculares y fisiológicas en protocolos de entrenamiento de fuerza

ABSTRACT Introduction Strength training is a recurrent practice among several publics and the topic of several studies, yet there is a shortage of previous studies that analyzed these parameters in the same subjects in training sessions involving volume, interval and different repetitions maximum ranges. Objective The study was aimed at measuring and comparing the acute effect of different ST (strength training) protocols on HR (heart rate), HRV (heart rate variability), [LAC] (lactate concentration), [CK] (creatine kinase) and SPE (subjective perceived exertion). Methods Eleven individuals with previous experience were recruited and in three sessions they performed three different training models, namely: high load (4 sets at 90% of 1RM, 180s rest between sets), medium load (3 sets at 75% of 1 RM, 90s rest between sets), and low load (2 sets at 50% of 1 RM, 45s rest between sets) in free squat, bench press, deadlift and bent-over row exercises. Results There was no difference in CK between low load (resistance) and medium load (hypertrophy) (p = 0.60), between resistance and high load (strength) (p = 0.84), and between hypertrophy and strength (p = 0.91), while there was higher lactate accumulation in training with medium and low loads in comparison to training with high loads (p <0.001). Conclusion It can be noted that workouts with high loads, few repetitions and longer intervals (maximum strength) generate lower blood lactate concentrations and SPE values when compared to training with lower loads and shorter intervals (resistance training and hypertrophy). Additionally, when evaluating autonomic and cardiovascular variables, it would appear that manipulating the percentage of 1RM and the interval time does not generate significant changes in HRV, blood pressure (BP) and HR when the repetitions are executed until failure. Level of evidence II; Prospective comparative study.

RESUMO Introdução O treinamento de força é prática recorrente entre diversos públicos e alvo de diversos estudos, contudo há escassez de estudos prévios que analisaram esses parâmetros nos mesmos indivíduos em sessões de treino envolvendo volume, intervalo e faixas distintas de repetições máximas. Objetivo Mensurar e comparar o efeito agudo de diferentes protocolos de TF (treino de força) sobre a FC (frequência cardíaca), VFC (variabilidade da frequência cardíaca), [LAC] (concentração de lactato), [CK] (creatina quinase) e PSE (percepção subjetiva de esforço). Métodos Foram selecionados 11 indivíduos com experiência prévia e, em três sessões, os mesmos realizaram três diferentes modelos de treino, isto é: carga alta (4 séries a 90% de 1RM, 180s de descanso entre séries), carga média (3 séries a 75% de 1 RM, 90s de descanso entre séries) e carga baixa (2 séries a 50% de 1 RM, 45s de descanso entre séries) em exercícios de agachamento livre, supino reto, levantamento terra e remada curva. Resultados Não houve diferença da CK entre a carga baixa (resistência) e a carga média (hipertrofia) (p=0,60), entre resistência e carga alta (força) (p=0,84) e entre hipertrofia e força (p=0,91) e houve maior acúmulo de lactato nos treinos com carga média e baixa em relação ao treino com cargas altas (p<0,001). Conclusão Observa-se que os treinos com cargas altas, poucas repetições e intervalos mais longos (força máxima) geram concentrações de lactato sanguíneo e PSE menores quando comparados aos treinos que utilizam cargas mais baixas e intervalos mais curtos (treinos de resistência e hipertrofia). Adicionalmente, quando avaliadas as variáveis autonômicas e cardiovasculares, parece que manipular o percentual de 1RM e o tempo de intervalo não é capaz de gerar alterações significativas na VFC, pressão arterial (PA) e FC quando as repetições são executadas até a falha. Nível de evidência II; Estudo prospectivo comparativo.

RESUMEN Introducción El entrenamiento de fuerza es práctica recurrente entre diversos públicos y objetivo de diversos estudios. Sin embargo, hay escasez de estudios previos que analizaron esos parámetros en los mismos individuos en sesiones de entrenamiento abarcando volumen, intervalo y franjas distintas de repeticiones máximas. Objetivo Medir y comparar el efecto agudo de diferentes protocolos de EF (entrenamiento de fuerza) sobre la FC (frecuencia cardíaca), VFC (variabilidad de la frecuencia cardíaca), [LAC] (concentración de lactato), [CK] (creatina quinasa) y PSE (percepción subjetiva de esfuerzo). Métodos Fueron seleccionados 11 individuos con experiencia previa y, en tres sesiones, los mismos realizaron tres modelos de entrenamiento, a saber: carga alta (4 series a 90% de 1RM, 180s de descanso entre series), carga mediana (3 series a 75% 1RM, 90s de descanso entre series), y carga baja (2 series a 50% de 1RM, 45s de descanso entre series) en los ejercicios de agachamiento libre, supino recto, levantamiento tierra y remada curva. Resultados No hubo diferencias de la CK entre la carga baja (resistencia) y la carga mediana (hipertrofia) (p = 0,60) entre resistencia y carga alta (fuerza) (p = 0,84) y entre hipertrofia y fuerza (p = 0,91) y hubo mayor acumulación de lactato en los entrenamientos con carga mediana y baja con relación al entrenamiento con cargas altas (p <0,001). Conclusión Se observa que los entrenamientos con cargas altas, pocas repeticiones e intervalos más largos (fuerza máxima) generan concentraciones de lactato sanguíneo y PSE menores cuando comparados a los entrenamientos que utilizan cargas más bajas e intervalos más cortos (entrenamientos de resistencia e hipertrofia). Además, cuando evaluadas las variables autonómicas y cardiovasculares, parece que manipular el porcentaje de 1RM y el tiempo de intervalo no es capaz de generar alteraciones significativas en la VFC, presión arterial (PA) y FC cuando las repeticiones son ejecutadas hasta la falla. Nivel de evidencia II; Estudio prospectivo comparativo.

Post-exercise Heart Rate Recovery in Patients with Chronic Respiratory Disease

Chronic respiratory diseases are frequently associated with cardiac autonomic dysfunction and this can be evaluated by measuring post-exercise heart rate recovery (HRR). There is evidence that the HRR calculated after one minute of rest following a Six-Minute Walk Test (6MWT) can predict mortality and acute exacerbations in patients with chronic respiratory diseases. The purpose of this study is to compare the heart rate recovery after finishing a Three-Minute Step Test (3MST) in chronic respiratory patients with that obtained after the 6MWT. The 3MST was performed without difficulty in a small doctor's office and all the patients were able to finish it. Applying the Pearson Correlation Index, the result was 0.84 when comparing the HRR one minute after stopping in both tests, showing a good correlation between them. In the Bland-Altman Plot, we can see that the results are within the confidence limits and show concordance despite being a small sample of patients. The 3MST is easily done in a small doctor's office. The results of the HRR after the 3MST are comparable to those obtained after finishing the 6MWT.

Efeitos de um microciclo de Crossfit® em variáveis da carga interna de treinamento / Effects of a Crossfit® microcycle on internal training load variables / Efectos de un microciclo de Crossfit®en variables de la carga interna de entrenamiento

Investigar o efeito de um microciclo habitual de CrossFit®em indicadores da carga interna de treinamento. Participaram do estudo noveindivíduos com média de idade de 28,5±3,4anos. Frequência cardíaca de repouso (FCrep), variabilidade da FC, testes físicos e o perfil de hu-mor foram mensurados no primeiro (PRÉ) e no último dia (PÓS) de um microciclo. Foram aplicados testes tpareados e o tamanho de efeito por dCohen. Dentre os principais achados,a FCrep aumentou (4,3%; p<0,001), o rMSSD reduziu (-8,8%; p=0,04) e o desempenho físico reduziu (-2,5 a -6%; p<0,05).O microciclo de CrossFit®investigado promoveu efeito negati-vo na carga interna dos praticantes como resultado de fadiga acumulada em apenas uma se-mana de treinamento.

To investigate the effect of a typical CrossFit®microcycle on central and peripheral indicators of the internal training load. Nine individuals with mean age of 28.5±3.4 yo. Resting heart rate (HRR), HR variability, physical tests and mood profile were measured on the first (PRE) and on the last day (POS) of a microcycle. Paired t tests and Cohen's d were applied. Among the main findings, resting heart rate (HRR) increased (4.3%; p <0.001), rMSSD decreased (-8.8%, p = 0.04) and physical performance decreased (-2.5 to -6%, p <0.05). The investigated CrossFit® microcycle promoted a significant negative effecton the internal load aspects of the practitioners as a result of accumulated fatigue in only one week of training.

Investigar el efecto de un microciclo habitual de CrossFit® en indicadores de la carga interna de entrenamiento. Materiales y métodos:Participaron del estudio 9 individuos con edad de 28,5±3,4 años. La frecuencia cardíaca de reposo (FCrep), la variabilidad de FC, las pruebas físicas y el perfil de humor se midieron en el primer (PRÉ) y en el último día (POS) de un microciclo. Se aplicaron pruebas tpareadas y el tamaño de efecto por dCohen. Resultados:Entre los principales hallazgos a FCrep aumentó (4,3%, p<0,001), el rMSSD redujo (-8,8%, p=0,04) yel desempeño físico disminuyó (-2,5 a -6%, p<0,05). Conclusión:El microciclo de CrossFit® investigado suscitó efecto negativo en la carga interna como resultado de fatiga acumulada en apenas una semana de entrenamiento.

¿Es la grasa abdominal subcutánea un predictor de la variabilidad cardíaca en hombres con bajo riesgo metabólico? / Is the abdominal subcutaneous fat a predictor of heart rate variability in men with low metabolic risk?

Introducción: Aunque el sobrepeso/obesidad, adiposidad aumentada e inactividad física se asocian a menor variabilidad cardíaca y desregulación autonómica, no se ha explorado en detalle la relación entre estos factores en sujetos de bajo riesgo metabólico. Objetivo: Analizar el tipo y fuerza de asociación entre la variabilidad cardíaca en reposo y la adiposidad en hombres jóvenes, delgados y físicamente activos. Metodología: Estudio descriptivo transversal. Se analizaron los componentes espectrales de la variabilidad cardíaca en 24 hombres de 18-30 años físicamente activos, con peso y adiposidad normales. Se realizaron análisis de regresión lineal múltiple para explicar la variabilidad cardíaca en función de la relación cintura/cadera, pliegue abdominal y actividad física. Resultados: El volumen de actividad física semanal se relacionó positivamente con RMSSD y HF, y negativamente con LF y LF/HF. La relación cintura/cadera y el pliegue abdominal se relacionaron positivamente con HF y negativamente con LF y LF/HF. En todos los casos, los coeficientes de regresión β tipificados estuvieron entre 0,395 y 0,505 (p<0,05). El índice de grasa visceral calculado a partir de bioimpedancia no mostró relación alguna. Conclusiones: Los hallazgos aquí reportados son indicativos de que en hombres jóvenes, delgados y físicamente activos, la actividad física y la grasa subcutánea se relacionan positivamente con el tono vagal y negativamente con el tono simpático, lo que lleva a postular que la acumulación del exceso calórico en forma de tejido adiposo subcutáneo (y no visceral) podría ser un mecanismo de protección contra el desarrollo de síndrome metabólico en estos sujetos.

Objective: To measure the type and strength of the potential association between heart rate variability at rest and some indicators of adiposity in young, lean, and physically active men. Introduction: Although overweight/obesity, increased adiposity and physical inactivity are associated with decreased heart rate variability and autonomic dysregulation, the relationship between these factors has not been explored in detail in subjects with low metabolic risk: normal weight, low adiposity and physically active. Methodology: Cross-sectional analytical study. The spectral components of heart rate variability were analyzed in 24 physically active men, 18-30 years old, with normal weight and adiposity. Multiple linear regression analysis was performed to explain heart rate variability as a function of waist to hip ratio, abdominal skinfod and physical activity. Results: The volume of weekly physical activity was positively related to RMSSD and HF, and negatively with LF and LF/HF. Both the waist to hip ratio and abdominal skinfold were positively related with HF, and negatively with LF and LF/HF. In all cases, the B regression standardized coefficients were between 0.395 and 0.505 (p<0.05). The visceral fat rating calculated from bioimpedance showed no relation. Conclusions: The findings reported here are indicative that in young, lean and physically active men, physical activity and subcutaneous fat are positively related to vagal tone and negatively with sympathetic tone. This leads us to postulate that the accumulation of caloric excess in the form of subcutaneous adipose tissue (not visceral) might be a protective mechanism against the development of metabolic syndrome in these subjects.

The Role of Antiarrhythmics in Atrial Fibrillation / 대한내과학회지

Atrial fibrillation (Afib) is the most common arrhythmia with clinical significance, and its incidence increases with advanced age. Afib is associated with a 3- to 5-fold increased risk of stroke, a 3-fold increase in the risk of heart failure, and higher mortality than without Afib. The treatment of Afib is multifold but revolves around one essential issue: whether to attempt to restore sinus rhythm or to simply control the ventricular rate. This decision depends on symptom severity, the age of the patient, underlying heart disease, and other comorbidities that may limit therapeutic options. The management of Afib with antiarrhythmic medications was reviewed.

Controle autonômico do coração e fração de ejeção na fase crônica do acidente vascular encefálico / Autonomic control of the heart and stroke volume in the chronic phase of cerebrovascular accident / Control autonómico del corazón y fracción de eyección en la fase crónica del accidente vascular encefálico

Introdução: Sujeitos acometidos por acidente vascular encefálico (AVE) podem apresentar alterações na estrutura e função do coração e na modulação autonômica. Objetivo: Verificar função autonômica e cardíaca sistólica em homens após AVE, e se estas variáveis estão associadas. Métodos: Foram avaliados oito homens, com idade entre 55 e 65 anos, acometidos por lesão cerebrovascular há pelo menos seis meses e todos com hemiparesia. Foram realizadas as seguintes avaliações: 1) Ecocardiografia, para avaliar a função cardíaca sistólica. 2) Registro da frequência cardíaca (FC) e dos intervalos R-R (IRR), batimento a batimento, para avaliação do controle neural do coração. Esses dados foram analisados no domínio da frequência, por meio das análises dos seguintes componentes espectrais: alta frequência; baixa frequência e a razão BF/AF. Foi aplicado o teste de correlação de Pearson (p ≤ 0,05). Resultados: Características demográficas, antropométricas e fisiológicas: Idade = 58,62 ± 2,88 anos; IMC = 27,41 ± 5,33 kg/m2 ; BF = 61,78 ± 26,79 (un); AF = 38,23 ± 26,79 (un); BF/AF = 3,41 ± 3,38; FE = 0,65 ± 0,04. Não houve correlação estatisticamente significativa entre os índices espectrais BF e AF com fração de ejeção e a presença de fatores de risco para AVE. Conclusão: No presente estudo, a fração de ejeção do ventrículo esquerdo encontra-se normal e o controle neural do coração pode estar normal ou não, mesmo na presença de fatores de risco para o AVE. .

Introduction: Subjects affected by cerebrovascular accident (CVA) may show changes in the structure and function of the heart and autonomic modulation. Objective: To assessautonomic and cardiac systolic function in men after stroke, and whether these variables are associated. Methods: Eight men aged between 55 and 65 years were evaluated, all suffering from cerebrovascular injury and with hemiparesis for at least six months. The following evaluations were performed: 1) echocardiography to evaluate systolic cardiac function; 2) Record the heart rate (HR) and RR intervals (RRI), beat by beat, to assess neural control of the heart. These data were analyzed in the frequency domain, by means of spectral analysis of the following components: high frequency, low frequency and LF/HF ratio. The Pearson correlation test was applied (p ≤0.05). Results: Demographic. anthropometric and physiological characteristics: Age = 58.62 ± 2.88 years; BMI = 27.41 ± 5.33 kg/m2; LF = 61.78 ± 26.79 (un); HF = 38.23 ± 26.79 (un); LF/HF = 3.41 ± 3.38; EF = 0.65 ± 0.04. There was no statistically significant correlation between the spectral indices of low (LF) and high frequency (HF) with stroke volume and the presence of risk factors for CVA. Conclusion: In the present study, the stroke volume of the left ventricle is normal and the neural control of the heart may be normal or not, even in the presence of risk factors for CVA. .

Introducción: Los sujetos acometidos por accidente vascular encefálico (AVE) pueden presentar alteraciones en la estructura y función del corazón y en la modulación autonómica. Objetivo: Verificar función autonómica y cardíaca sistólica en hombres después de AVE, y si estas variables están asociadas. Métodos: Fueron evaluados ocho hombres, con edad entre 55 y 65 años, acometidos por lesión cerebrovascular desde hace por lo menos seis meses y todos con hemiparesia. Fueron realizadas las siguientes evaluaciones: 1) Ecocardiografía, para evaluar la función cardíaca sistólica. 2) Registro de la frecuencia cardíaca (FC) y de los intervalos R-R (IRR), latido a latido, para evaluación del control neural del corazón. Esos datos fueron analizados en el dominio de la frecuencia, a través del análisis de los siguientes componentes espectrales: alta frecuencia; baja frecuencia y la razón BF/AF. Fue aplicado el test de correlación de Pearson (p ≤ 0,05). Resultados: Características demográficas, antropométricas y fisiológicas: Edad = 58,62 ± 2,88 años; IMC = 27,41 ± 5,33 kg/m2; BF = 61,78 ± 26,79 (un); AF = 38,23 ± 26,79 (un); BF/AF = 3,41 ± 3,38; FE = 0,65 ± 0,04. No hubo correlación estadísticamente significativa entre los índices espectrales BF y AF con fracción de eyección y la presencia de factores de riesgo para AVE. Conclusión: En el presente estudio, la fracción de eyección del ventrículo izquierdo se encuentra normal y el control neural del corazón puede estar normal o no, aún ante la presencia de factores de riesgo para el AVE. .

Influência do número de séries nos ajustes cardiovasculares e autonômicos ao exercício resistido em homens fisicamente ativos / Influence of the number of sets in cardiovascular and autonomic adjustments to resistance exercise in physically active men

OBJETIVO: Avaliar a influência do número de séries nas alterações cardiovasculares e na variabilidade da frequência cardíaca (VFC) pós exercício resistido (ER) em homens fisicamente ativos. MÉTODOS: A amostra foi composta por 13 homens (27,38 ± 1,59 anos), normotensos, praticantes de musculação, submetidos a duas rotinas de musculação. A rotina 1 (R1) foi composta por duas séries de 10RM com intervalo de um minuto entre as séries e dois minutos entre os exercícios, e a rotina 2 (R2) foi similar a R1, no entanto, com três séries para cada exercício. A pressão arterial (PA), o intervalo de pulso (IP) e a VFC foram medidos em repouso e no período de recuperação (60 minutos) do ER. RESULTADOS: O ER induziu redução da PA sistólica pós-R1 (pré: 119,4 ± 1,70 versus pós: 110,8 ± 1,80 mmHg) e R2 (pré: 121,6 ± 2,20 versus pós: 110,3 ± 1,11 mmHg). Entretanto, a PA diastólica (pré: 71,2 ± 1,80 versus pós: 64,3 ± 2,40 mmHg) e a PA média (pré: 88,0 ± 1,60 versus pós: 80,7 ± 1,60 mmHg) reduziram somente após a R2, observando-se frequência cardíaca (FC) aumentada neste momento. A R2 promoveu redução da variância do IP na recuperação quando comparada à R1. Somente a R2 induziu aumento da banda de baixa frequência e redução da banda de alta frequência do IP em relação ao repouso. CONCLUSÃO: A redução da PA foi associada ao maior número de séries, mas não com redução da FC e/ou da modulação simpática cardíaca em praticantes de musculação.

OBJECTIVE: To evaluate the influence of the number of sets on cardiovascular changes and heart rate variability (HRV) in resistance exercise (RE) recovery period in physically active men. METHODS: The sample was composed of 13 (27.38 ± 1.59 years) normotensive men, practitioners of RE. Two RE routines were performed: routine 1 (R1) consisted of two sets of 10RM with 1 minute between sets and 2 minutes between exercises; and routine 2 (R2) was similar to R1; however, with three sets of each exercise. Blood pressure (BP), pulse interval (PI) and HRV were measured at rest and during recovery (60 minutes) from the RE. RESULTS: RE induced reduction in systolic BP after R1 (pre: 119.4 ± 1.70 vs. post: 110.8 ± 1.80 mmHg) and R2 (pre: 121.6 ± 2.20 vs. post: 110 3 ± 1.11 mmHg). However, diastolic BP (pre: 71.2 ± 1.80 vs. post: 64.3 ± 2.40 mmHg) and mean BP (pre: 88.0 ± 1.60 vs. post: 80.7 ± 1.60 mmHg) reduced only after the R2, and heart rate (HR) was increased at this time. The R2 promoted variance of PI reduction in the recovery when compared to the R1. Furthermore, only the R2 induced increase in low frequency band and reduction in high frequency band of PI compared to rest values. CONCLUSION: BP reduction was associated with higher number of sets, but not with reduction in HR and/or cardiac sympathetic modulation in RE practitioners.

Hemodynamic Treatment Aimed to Reduce Catecholamine Toxicity in Patients Suffering from Septic Shock: An Observational Single Center Study.

Aims: Catecholamines represent a cornerstone in the hemodynamic management of septic shock (SS). However, development of toxicity may adversely affect patient outcome. We describe the outcome of 460 consecutive SS patients who were treated with an institutional hemodynamic protocol aimed at decreasing catecholamine toxicity. Study Design: Retrospective observational analysis. Place and Duration of Study: Multidisciplinary intensive care unit in a 460 bed hospital between January 1, 2004 to July 31, 2010. Methodology: Demographic data, premorbidities, admission Simplified Acute Physiology Score (SAPS) II, most aberrant laboratory data, highest dosages of norepinephrine (NE), dobutamine, milrinone, use of ß-adrenoreceptor blocking agents, hydrocortisone and arginine vasopressin (AVP), development of new-onset tachyarrhythmia and myocardial ischemia were analyzed from an electronic database. The institutional hemodynamic treatment protocol includes early administration of hydrocortisol and arginine vasopressin in addition to norepinephrine and aggressive treatment of hyperthermia (T>38.5º). New onset tachyarrhythmia’s/tachycardia were treated using amiodarone and ß-adrenoreceptor blockers to decrease heart rate below 95bpm, respectively. Observed and SAPS-predicted mortality were analyzed for all patients and SAPS-quartiles (QI-QIV) of increasing disease severity. Results: Age, incidence of preexisting heart, renal disease, arterial hypertension, and MODS increased while body mass index significantly declined from QI to QIV. With increasing disease severity, patients received higher dosages of NE, steroids, AVP and milrinone. The incidence of tachycardic atrial fibrillation and myocardial ischemia increased from QI to QIV. Overall, there was no significant difference between the observed and SAPS II predicted mortality (p=0.2, Chi2-test). However, we observed a trend (-12, 2%) towards decreased mortality in QIII (p=0.07) and a significant decrease in hospital mortality (-19%) in QIV (p<0.0001; Chi2-test). Conclusions: Our data suggest that a treatment protocol aimed at decreasing catecholamine toxicity including early administration of hydrocortisone, AVP, aggressive body temperature and heart rate control may decrease SS mortality, particularly in elderly, premorbid patients suffering from advanced SS.