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1.
Korean Circulation Journal ; : 185-202, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-811359

ABSTRACT

Coronary computed tomography angiography (CCTA) is a well-validated and noninvasive imaging modality for the assessment of coronary artery disease (CAD) in patients with stable ischemic heart disease and acute coronary syndromes (ACSs). CCTA not only delineates the anatomy of the heart and coronary arteries in detail, but also allows for intra- and extraluminal imaging of coronary arteries. Emerging technologies have promoted new CCTA applications, resulting in a comprehensive assessment of coronary plaques and their clinical significance. The application of computational fluid dynamics to CCTA resulted in a robust tool for noninvasive assessment of coronary blood flow hemodynamics and determination of hemodynamically significant stenosis. Detailed evaluation of plaque morphology and identification of high-risk plaque features by CCTA have been confirmed as predictors of future outcomes, identifying patients at risk for ACSs. With quantitative coronary plaque assessment, the progression of the CAD or the response to therapy could be monitored by CCTA. The aim of this article is to review the future directions of emerging applications in CCTA, such as computed tomography (CT)-fractional flow reserve, imaging of vulnerable plaque features, and quantitative plaque imaging. We will also briefly discuss novel methods appearing in the coronary imaging scenario, such as machine learning, radiomics, and spectral CT.


Subject(s)
Acute Coronary Syndrome , Angiography , Constriction, Pathologic , Coronary Artery Disease , Coronary Vessels , Heart , Hemodynamics , Humans , Hydrodynamics , Machine Learning , Myocardial Ischemia
2.
Article in English | WPRIM (Western Pacific) | ID: wprim-782519

ABSTRACT

Currently, the optimal resuscitation fluid remains debatable. Therefore, in the present study, we designed a trometamol-balanced solution (TBS) for use as a resuscitation fluid for hemorrhagic shock. Hemorrhagic shock was induced in 18 male Wistar-Kyoto rats, which were assigned to normal saline (NS), Ringer's solution (RS), and TBS groups. During the hemorrhagic state, their hemodynamic parameters were recorded using an Abbott i-STAT analyzer with the CG4+ cartridge (for pH, pressure of carbon dioxide, pressure of oxygen, total carbon dioxide, bicarbonate, base excess, oxygen saturation, and lactate), the CG6+ cartridge (for sodium, potassium, chloride, blood glucose, blood urea nitrogen, hematocrit, and hemoglobin), and enzyme-linked immunosorbent assay kits (calcium, magnesium, creatinine, aspartate aminotransferase, alanine aminotransferase, bilirubin, and albumin). Similar trends were found for the parameters of biochemistries, electrolytes, and blood gas, and they revealed no significant changes after blood withdrawal-induced hemorrhagic shock. However, the TBS group showed more effective ability to correct metabolic acidosis than the NS and RS groups. TBS was a feasible and safe resuscitation solution in this study and may be an alternative to NS and RS for resuscitation in hemorrhagic shock patients without liver damage.


Subject(s)
Acidosis , Alanine Transaminase , Animals , Aspartate Aminotransferases , Bilirubin , Blood Glucose , Blood Urea Nitrogen , Carbon Dioxide , Creatinine , Electrolytes , Enzyme-Linked Immunosorbent Assay , Hematocrit , Hemodynamics , Humans , Hydrogen-Ion Concentration , Liver , Magnesium , Male , Oxygen , Potassium , Rats , Resuscitation , Shock, Hemorrhagic , Sodium
3.
Article in English | WPRIM (Western Pacific) | ID: wprim-782108

ABSTRACT

OBJECTIVE: To examine the fractional flow reserve derived from computed tomographic angiography (CT-FFR) in patients with anomalous origin of the right coronary artery from the left coronary sinus (R-ACAOS) with an interarterial course, assess the relationship of CT-FFR with the anatomical features of interarterial R-ACAOS on coronary computed tomographic angiography (CCTA), and determine its clinical relevance.MATERIALS AND METHODS: Ninety-four patients with interarterial R-ACAOS undergoing CCTA were retrospectively included. Anatomic features (proximal vessel morphology [oval or slit-like], take-off angle, take-off level [below or above the pulmonary valve], take-off type, intramural course, % proximal narrowing area, length of narrowing, minimum luminal area [MLA] at systole and diastole, and vessel compression index) on CCTA associated with CT-FFR ≤ 0.80 were analyzed. Receiver operating characteristic analysis was performed to describe the diagnostic performance of CT-FFR ≤ 0.80 in detecting interarterial R-ACAOS.RESULTS: Significant differences were found in proximal vessel morphology, take-off level, intramural course, % proximal narrowing area, and MLA at diastole (all p < 0.05) between the normal and abnormal CT-FFR groups. Take-off level, intramural course, and slit-like ostium (all p < 0.05) predicted hemodynamic abnormality (CT-FFR ≤ 0.80) with accuracies of 0.69, 0.71, and 0.81, respectively. Patients with CT-FFR ≤ 0.80 had a higher prevalence of typical angina (29.4% vs. 7.8%, p = 0.025) and atypical angina (29.4% vs. 6.5%, p = 0.016).CONCLUSION: Take-off level, intramural course, and slit-like ostium were the main predictors of abnormal CT-FFR values. Importantly, patients with abnormal CT-FFR values showed a higher prevalence of typical angina and atypical angina, indicating that CT-FFR is a potential tool to gauge the clinical relevance in patients with interarterial R-ACAOS.


Subject(s)
Angiography , Coronary Sinus , Coronary Vessel Anomalies , Coronary Vessels , Diastole , Hemodynamics , Humans , Phenobarbital , Prevalence , Retrospective Studies , ROC Curve , Systole
4.
Article in English | WPRIM (Western Pacific) | ID: wprim-782047

ABSTRACT

BACKGROUND: The impact of myocardial damage on the prognosis of patients with septic shock is not clearly elucidated because complex hemodynamic changes in sepsis obscure the direct relationship. We evaluated left ventricular (LV) conditions that reflect myocardial damage independently from hemodynamic changes in septic shock and their influence on the prognosis of patients.METHODS: We retrospectively enrolled 208 adult patients who were admitted to the intensive care unit and underwent echocardiography within 7 days from the diagnosis of septic shock. Patients who were previously diagnosed with structural heart disease or coronary artery disease were excluded. Left ventricular ejection fraction (LVEF) was divided into four categories: normal, ≥ 50%; mild, ≥ 40%; moderate, ≥ 30%; and severe dysfunction, < 30%. Wall motion impairment was categorized into the following patterns: normal, diffuse, ballooning, and focal.RESULTS: There were 141 patients with normal LVEF. Among patients with impaired LV wall motion, the diffuse pattern was the most common (34 patients), followed by the ballooning pattern (26 patients). Finally, 102 patients died, and in-hospital mortality was significantly higher in patients with severe LV systolic dysfunction (hazard ratio [HR], 1.97; 95% confidence interval [CI], 1.04–3.75; P = 0.039) and in patients with diffuse pattern of LV wall motion impairment (HR, 2.28; 95% CI, 1.19–4.36; P = 0.013) than in those with a normal LV systolic function.CONCLUSION: Severe LV systolic dysfunction and diffuse pattern of LV wall motion impairment significantly affected in-hospital mortality in patients with septic shock. Conventional echocardiographic evaluation provides adequate information on the development of myocardial damage and accurately predicts the prognosis of patients with septic shock.


Subject(s)
Adult , Coronary Artery Disease , Diagnosis , Echocardiography , Heart Diseases , Hemodynamics , Hospital Mortality , Humans , Intensive Care Units , Mortality , Prognosis , Retrospective Studies , Sepsis , Shock, Septic , Stroke Volume
5.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 460-465, jan.-dez. 2020. tab
Article in English, Portuguese | LILACS (Americas), BDENF | ID: biblio-1053063

ABSTRACT

Objetivo: Determinar a prevalência da nefropatia induzida por contraste em pacientes cardiopatas submetidos a procedimentos angiográficos de diagnóstico e/ou tratamento. Método: Estudo prospectivo, quantitativo, realizado no setor de hemodinâmica de um hospital de grande porte, situado na região norte do Rio Grande do Sul, Brasil. A amostra foi constituída por 79 participantes através do cálculo de tamanho amostral. Resultados: A amostra foi formada por 52 (65,8%) homens e 27 (34,2%) mulheres. A idade média foi de 65,9 ± 9,52 anos. A incidência de nefropatia induzida por contraste foi de 30,38%, totalizando 24 pacientes. Conclusão: Foi evidenciada uma alta prevalência de nefropatia por contraste, apesar dos pacientes apresentarem poucos fatores de risco, o que ressalta a necessidade de medidas preventivas e redução do volume de contraste


Objective: To determine the prevalence of contrast-induced nephropathy in cardiac patients undergoing diagnostic and / or treatment angiographic procedures. Method: A prospective, quantitative study in the hemodynamics sector of a large hospital, located in the northern region of Rio Grande do Sul, Brazil. The sample consisted of 79 participants through the calculation of sample size. Results: The sample consisted of 52 (65.8%) men and 27 (34.2%) women. The mean age was 65.9 ± 9.52 years. The incidence of contrast-induced nephropathy was 30,38%, totaling 24 patients. Conclusion: A high prevalence of contrast nephropathy was evidenced, despite the fact that patients presented few risk factors, which highlights the need for preventive measures and reduction of contrast volume


Objetivo: Determinar la prevalencia de la nefropatía inducida por contraste en pacientes cardiopatas sometidos a procedimientos angiográficos de diagnóstico y / o tratamiento. Método: Estudio prospectivo, cuantitativo, realizado en el sector de hemodinámica de un hospital de gran porte, situado en la región norte de Rio Grande do Sul, Brasil. La muestra fue constituida por 79 participantes a través del cálculo de tamaño muestral. Resultados: La muestra fue formada por 52 (65,8%) hombres y 27 (34,2%) mujeres. La edad media fue de 65,9 ± 9,52 años. La incidencia de nefropatía inducida por contraste fue del 30,38%, totalizando 24 pacientes. Conclusión: Se evidenció una alta prevalencia de nefropatía por contraste, a pesar de que los pacientes presentaban pocos factores de riesgo, lo que resalta la necesidad de medidas preventivas y reducción del volumen de contraste


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Angiography/adverse effects , Heart Diseases/complications , Heart Diseases/diagnostic imaging , Kidney Diseases/chemically induced , Kidney Diseases/epidemiology , Prospective Studies , Contrast Media/adverse effects , Coronary Disease/complications , Acute Kidney Injury/chemically induced , Hemodynamics
6.
Arq. bras. med. vet. zootec. (Online) ; 71(6): 1846-1852, Nov.-Dec. 2019. tab
Article in English | LILACS (Americas), VETINDEX | ID: biblio-1055133

ABSTRACT

This study aimed to evaluate comparatively the effects of propofol or isoflurane on hemodynamic variables in piglets that received inspired oxygen fraction (FIO2) of 0.5 under spontaneous ventilation. Therefore, sixteen piglets weighing 16±1.1kg, were randomly divided into two groups: GI (Isoflurane and FIO2 of 0.5) and GP (Propofol and FIO2 of 0.5). Heart rate (HR), systolic, diastolic and mean arterial pressure (SAP, DAP and MAP), central venous pressure (CVP), cardiac output (CO), mean pulmonary arterial pressure (mPAP) and mean capillary pulmonary pressure (mCPP) were assessed 40 minutes after anesthetic induction (T0), followed by 15 minutes intervals (from T15 to T60). The variables cardiac index (CI), stroke volume (SV), stroke index (SI), total peripheral resistance (TPR), total peripheral resistance index (TPRI), pulmonary vascular resistance (PVR), and pulmonary vascular resistance index (PVRI) were calculated. SAP and TPRI were significantly different between groups at T30 and T60 (P< 0.05) with higher GP values being recorded. There were no differences in the other variables, however, GP presented mean closer to normality on most of the analyzed variables. Therefore, we conclude that total intravenous anesthesia with propofol presented greater stability of the hemodynamic variables evaluated.(AU)


O objetivo deste estudo foi avaliar comparativamente os efeitos do propofol ou do isoflurano sobre as variáveis hemodinâmicas em leitões que receberam fração inspirada de oxigênio (FIO2) de 0,5 sob ventilação espontânea. Dezesseis leitões, pesando 16±1,1kg, foram divididos aleatoriamente em dois grupos: GI (isoflurano e FIO2 de 0,5) e GP (propofol e FIO2 de 0,5). A frequência cardíaca (FC), a pressão arterial sistólica, a diastólica e a média (PAS, PAD e PAM), a pressão venosa central (PVC), o débito cardíaco (DC),a pressão média da artéria pulmonar (PAPm) e a pressão média capilar pulmonar (PCPm) foram avaliados 40 minutos após a indução anestésica (T0), seguida por intervalos de 15 minutos (de T15 a T60). As variáveis índice cardíaco (IC), volume sistólico (VS), índice sistólico (SI), resistência periférica total (RPT), índice de resistência periférica total (IRPT), resistência vascular pulmonar (RVP) e índice de resistência vascular pulmonar (IRVP) foram calculadas. PAS e IRPT foram significativamente diferentes entre os grupos em T30 e T60 (P<0,05) com maiores valores de GP sendo registrados. Não houve diferenças nas demais variáveis, entretanto o GP apresentou médias próximas da normalidade na maioria das variáveis analisadas. Portanto, concluiu-se que a anestesia intravenosa total com propofol apresentou maior estabilidade das variáveis hemodinâmicas avaliadas.(AU)


Subject(s)
Animals , Swine/blood , Propofol/administration & dosage , Hemodynamics , Isoflurane/administration & dosage , Anesthetics, Inhalation , Heart Rate , Anesthesia, Intravenous
7.
J. bras. nefrol ; 41(4): 550-559, Out.-Dec. 2019. graf
Article in English | LILACS (Americas) | ID: biblio-1056604

ABSTRACT

Abstract Fluid volume and hemodynamic management in hemodialysis patients is an essential component of dialysis adequacy. Restoring salt and water homeostasis in hemodialysis patients has been a permanent quest by nephrologists summarized by the 'dry weight' probing approach. Although this clinical approach has been associated with benefits on cardiovascular outcome, it is now challenged by recent studies showing that intensity or aggressiveness to remove fluid during intermittent dialysis is associated with cardiovascular stress and potential organ damage. A more precise approach is required to improve cardiovascular outcome in this high-risk population. Fluid status assessment and monitoring rely on four components: clinical assessment, non-invasive instrumental tools (e.g., US, bioimpedance, blood volume monitoring), cardiac biomarkers (e.g. natriuretic peptides), and algorithm and sodium modeling to estimate mass transfer. Optimal management of fluid and sodium imbalance in dialysis patients consist in adjusting salt and fluid removal by dialysis (ultrafiltration, dialysate sodium) and by restricting salt intake and fluid gain between dialysis sessions. Modern technology using biosensors and feedback control tools embarked on dialysis machine, with sophisticated analytics will provide direct handling of sodium and water in a more precise and personalized way. It is envisaged in the near future that these tools will support physician decision making with high potential of improving cardiovascular outcome.


Resumo O volume de fluidos e o controle hemodinâmico em pacientes em hemodiálise é um componente essencial da adequação da diálise. A restauração da homeostase do sal e da água em pacientes em hemodiálise tem sido uma busca constante por parte dos nefrologistas, no que condiz à abordagem do "peso seco. Embora essa abordagem clínica tenha sido associada a benefícios no desfecho cardiovascular, recentemente tem sido questionada por estudos que mostram que a intensidade ou agressividade para remover fluidos durante a diálise intermitente está associada a estresse cardiovascular e dano potencial a órgãos.para remover fluidos durante a diálise intermitente está associada a estresse cardiovascular e dano potencial a órgãos. Uma abordagem mais precisa é necessária para melhorar o desfecho cardiovascular nessa população de alto risco. A avaliação e monitorização do estado hídrico baseiam-se em quatro componentes: avaliação clínica, ferramentas instrumentais não invasivas (por exemplo, US, bioimpedância, monitorização do volume sanguíneo), biomarcadores cardíacos (e.g. peptídeos natriuréticos), algoritmos e modelagem de sódio para estimar a transferência de massa. O manejo otimizado do desequilíbrio hídrico e de sódio em pacientes dialíticos consiste em ajustar a remoção de sal e líquido por diálise (ultrafiltração, dialisato de sódio), e restringir a ingestão de sal e o ganho de líquido entre as sessões de diálise. Tecnologia moderna que utiliza biosensores e ferramentas de controle de feedback, hoje parte da máquina de diálise, com análises sofisticadas, proporcionam o manejo direto sobre o sódio e a água de uma maneira mais precisa e personalizada. Prevê-se no futuro próximo que essas ferramentas poderão auxiliar na tomada de decisão do médico, com alto potencial para melhorar o resultado cardiovascular.


Subject(s)
Humans , Sodium/metabolism , Renal Dialysis/adverse effects , Hemodynamics/physiology , Homeostasis/physiology , Kidney Failure, Chronic/therapy , Water-Electrolyte Balance/physiology , Blood Pressure/physiology , Algorithms , Biomarkers/metabolism , Dialysis Solutions/chemistry , Cardiovascular System/physiopathology , Renal Dialysis/standards , Treatment Outcome , Cardiovascular Deconditioning , Nephrologists/statistics & numerical data , Kidney Failure, Chronic/physiopathology
8.
Rev. habanera cienc. méd ; 18(6): 886-897, nov.-dic. 2019. tab
Article in Spanish | LILACS (Americas), CUMED | ID: biblio-1093914

ABSTRACT

Introducción: El espectro clínico de los Síndromes Coronarios Agudos sin elevación del segmento ST incluye tanto a pacientes asintomáticos como a los que presentan isquemia activa, inestabilidad eléctrica, hemodinámica o parada cardiaca. Objetivo: Evaluar probables factores predictivos de complicaciones intrahospitalarias no letales en pacientes con diagnóstico de Síndrome Coronario Agudo sin elevación del segmento ST. Material y Métodos: Estudio observacional, analítico, de corte transversal con un universo de 218 individuos ingresados en la Unidad de Cuidados Coronarios Intensivos del Hospital Clínico-Quirúrgico Manuel Fajardo en 2016 y 2017. Resultados: Predominó el sexo masculino (51.4 por ciento) y la edad media fue de 68 años. Prevaleció la Hipertensión Arterial como factor de riesgo coronario. La edad mostró asociación estadística significativa con la aparición de cualquier complicación (p=0.015) y con las complicaciones hemodinámicas (p=0,014). El riesgo intermedio-alto, según el score TIMI, tuvo asociación estadísticamente muy significativa con las complicaciones hemodinámicas (p<0.01). Conclusiones: La edad tuvo asociación estadística con la aparición de complicaciones intrahospitalarias no letales. El sexo no se asoció con las complicaciones ni los antecedentes estudiados tampoco. Los pacientes con un riesgo intermedio-alto al ingreso, se asociaron con las complicaciones hemodinámicas(AU)


Introduction: The clinical spectrum of Non-ST-segment elevation Acute Coronary Syndromes includes both asymptomatic patients and those with active ischemia, electrical instability, hemodynamic or cardiac arrest. Objective: To evaluate probable predictive factors of non-lethal intra-hospital complications in patients diagnosed with Non-ST-segment elevation Acute Coronary Syndrome. Material and Methods: An observational, analytical, cross-sectional study was conducted with a universe of 218 individuals admitted into the Intensive Coronary Care Unit of Manuel Fajardo Clinical and Surgical Hospital between 2016 and 2017. Results: Male sex predominated (51.4 percent) and the mean age was 68 years. Arterial Hypertension prevailed as a coronary risk factor. The age showed significant statistical association with the appearance of any complication (p = 0.015) and with hemodynamic complications (p =0,014). The intermediate-high risk, according to the TIMI score, had a statistically significant association with hemodynamic complications (p <0.01). Conclusions: Age was statistically associated with the appearance of non-lethal intra-hospital complications. Sex was not associated with complications, nor did the background studied either. Patients with an intermediate-high risk at admission were associated with hemodynamic complications(AU)


Subject(s)
Humans , Male , Female , Aged , Predictive Value of Tests , Coronary Care Units/methods , Non-ST Elevated Myocardial Infarction/epidemiology , Cross-Sectional Studies , Acute Coronary Syndrome/complications , Observational Study , Hemodynamics/physiology
9.
Acta cir. bras ; 34(11): e201901107, Nov. 2019. graf
Article in English | LILACS (Americas) | ID: biblio-1054678

ABSTRACT

Abstract Purpose: To establish a hypotensive brain death pig model and observe the effects of hypotension on small bowel donors. Methods: The hypotensive brain death model was produced using the modified intracranial water sac inflation method in ten domestic crossbred pigs. Effects of hypotensive brain death on small bowel tissue morphology were evaluated through changes in intestinal tissue pathology, tight junction protein of the intestinal mucosa and plasma intestinal fatty acid-binding protein (i-FABP) levels. The pathophysiological mechanism was examined based on changes in superior mesenteric artery (SMA) blood flow and systemic hemodynamics. Results: After model establishment, SMA blood flow, and the mean arterial pressure (MAP) significantly decreased, while heart rate increased rapidly and fluctuated significantly. Small bowel tissue morphology and levels of tight junction protein of the intestinal mucosa showed that after model establishment, small bowel tissue injury was gradually aggravated over time (P<0.05). Plasma i-FABP levels significantly increased after brain death (P<0.05). Conclusions: A hypotensive brain death pig model was successfully established using an improved intracranial water sac inflation method. This method offers a possibility of describing the injury mechanisms more clearly during and after brain death.


Subject(s)
Animals , Male , Female , Brain Death/physiopathology , Disease Models, Animal , Hypotension/physiopathology , Intestine, Small/pathology , Intestine, Small/transplantation , Swine , Time Factors , Biopsy , Enzyme-Linked Immunosorbent Assay , Blotting, Western , Reproducibility of Results , Microscopy, Electron, Transmission , Fatty Acid-Binding Proteins/blood , Zonula Occludens-1 Protein/analysis , Hemodynamics , Intestine, Small/blood supply
10.
Acta cir. bras ; 34(11): e201901106, Nov. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1054683

ABSTRACT

Abstract Purpose: To investigate whether GDF11 ameliorates myocardial ischemia reperfusion (MIR) injury in diabetic rats and explore the underlying mechanisms. Methods: Diabetic and non-diabetic rats subjected to MIR (30 min of coronary artery occlusion followed by 120 min of reperfusion) with/without GDF11 pretreatment. Cardiac function, myocardial infarct size, creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), superoxide dismutase (SOD) 15-F2tisoprostane, autophagosome, LC3II/I ratio and Belcin-1 level were determined to reflect myocardial injury, oxidative stress and autophagy, respectively. In in vitro study, H9c2 cells cultured in high glucose (HG, 30mM) suffered hypoxia reoxygenation (HR) with/without GDF11, hydrogen peroxide (H2O2) and autophagy inhibitor 3-methyladenine (3-MA) treatment, cell injury; oxidative stress and autophagy were assessed. Results: Pretreatment with GDF11 significantly improved cardiac morphology and function in diabetes, concomitant with decreased arrhythmia severity, infarct size, CK-MB, LDH and 15-F2tisoprostane release, increased SOD activity and autophagy level. In addition, GDF11 notably reduced HR injury in H9c2 cells with HG exposure, accompanied by oxidative stress reduction and autophagy up-regulation. However, those effects were completely reversed by H2O2 and 3-MA. Conclusion: GDF11 can provide protection against MIR injury in diabetic rats, and is implicated in antioxidant stress and autophagy up-regulation.


Subject(s)
Animals , Male , Autophagy/drug effects , Myocardial Reperfusion Injury/metabolism , Myocardial Reperfusion Injury/drug therapy , Oxidative Stress/drug effects , Diabetes Mellitus, Type 1/metabolism , Growth Differentiation Factors/pharmacology , Reference Values , Superoxide Dismutase/analysis , Cardiotonic Agents/pharmacology , Myocardial Reperfusion Injury/pathology , Up-Regulation/drug effects , Cell Line , Blotting, Western , Reproducibility of Results , Rats, Sprague-Dawley , Streptozocin , Microscopy, Electron, Transmission , Diabetes Mellitus, Experimental/metabolism , Hemodynamics/drug effects , Antioxidants/pharmacology
11.
Rev. bras. ter. intensiva ; 31(3): 312-317, jul.-set. 2019. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-1042587

ABSTRACT

RESUMO Objetivo: Investigar a influência do manejo da síndrome do desconforto respiratório sobre parâmetros clínicos e ecocardiográficos de avaliação hemodinâmica em recém-nascidos ≤ 32 semanas. Métodos: Foram avaliados prospectivamente 33 recém-nascidos ≤ 32 semanas, submetidos à ventilação mecânica invasiva. A necessidade de surfactante exógeno e os parâmetros clínicos e ecocardiográficos nas primeiras 24 horas de vida foram detalhadas nesse grupo de pacientes. Resultados: O valor da pressão média de vias aéreas foi significativamente maior nos recém-nascidos que necessitaram de inotrópicos [10,8 (8,8 - 23) cmH2O versus 9 (6,2 - 12) cmH2O; p = 0,04]. Houve correlação negativa entre pressão média de vias aéreas e integral velocidade-tempo da artéria pulmonar (r = -0,39; p = 0,026), débito do ventrículo direito (r = -0,43; p = 0,017) e medidas da excursão do plano do anel tricúspide (r = -0,37; p = 0,036). Verificou-se correlação negativa entre o número de doses de surfactante exógeno e: débito de ventrículo direito (r = -0,39; p = 0,028) e a integral velocidade-tempo da artéria pulmonar (r = -0,35; p = 0,043). Conclusão: Nos recém-nascidos ≤ 32 semanas em ventilação mecânica invasiva, elevações de pressão média de vias aéreas e do número de doses de surfactante correlacionam-se com piora da função cardíaca precoce. Aparentemente, o manejo mais agressivo da síndrome do desconforto respiratório contribui para a instabilidade hemodinâmica desses pacientes.


ABSTRACT Objective: To investigate the influence of respiratory distress syndrome management on clinical and echocardiographic parameters used for hemodynamic evaluation in ≤ 32- week newborns. Methods: Thirty-three ≤ 32-week newborns were prospectively evaluated and subjected to invasive mechanical ventilation. The need for exogenous surfactant and clinical and echocardiographic parameters in the first 24 hours of life was detailed in this group of patients. Results: The mean airway pressure was significantly higher in newborn infants who required inotropes [10.8 (8.8 - 23) cmH2O versus 9 (6.2 - 12) cmH2O; p = 0.04]. A negative correlation was found between the mean airway pressure and velocity-time integral of the pulmonary artery (r = -0.39; p = 0.026), right ventricular output (r = -0.43; p = 0.017) and measurements of the tricuspid annular plane excursion (r = -0.37; p = 0.036). A negative correlation was found between the number of doses of exogenous surfactant and the right ventricular output (r = -0.39; p = 0.028) and pulmonary artery velocity-time integral (r = -0.35; p = 0.043). Conclusion: In ≤ 32-week newborns under invasive mechanical ventilation, increases in the mean airway pressure and number of surfactant doses are correlated with the worsening of early cardiac function. Therefore, more aggressive management of respiratory distress syndrome may contribute to the hemodynamic instability of these patients.


Subject(s)
Humans , Male , Female , Infant, Newborn , Respiratory Distress Syndrome, Newborn/physiopathology , Respiratory Distress Syndrome, Newborn/diagnostic imaging , Echocardiography , Hemodynamics , Respiration, Artificial , Respiratory Distress Syndrome, Newborn/therapy , Time Factors , Infant, Premature , Prospective Studies , Age Factors , Gestational Age
12.
Rev. bras. ciênc. mov ; 27(4): 219-227, jul.-set. 2019. ilus
Article in Portuguese | LILACS (Americas) | ID: biblio-1053332

ABSTRACT

O objetivo do presente estudo foi levantar, na literatura atual, estudos relevantes que identifiquem as possíveis respostas hemodinâmicas encontradas em indivíduos hipertensos praticantes do Método Pilates. A revisão sistemática conduzida conforme as recomendações PRISMA em cinco bases de dados eletrônicas (PEDro, PubMed, SciELO, LILACS e Cochrane), disponibilizado desde o início das bases até Março de 2019, com descritores MESH conforme segue: [("Adult" OR "Young adult" OR "Middle Aged" OR "Aged" OR "Elderly") AND ("exercise movement techniques" OR "Pilates-Based Exercises" OR "Pilates Training") AND ("Hemodynamics" OR "Heart Rate" OR "Cardiac Chronotropy" OR "Heart Rate Control" OR "hypertension" OR "Blood Pressure" OR "High Blood Pressure" OR "Systolic Pressure" OR "Diastolic Pressure" OR "High Blood Pressure" OR "Pulse Rate Determination")], posteriormente ajustado para as demais bases. Busca complementar manual nas referências dos artigos incluídos na pesquisa e Google Scholar. Foram incluídos estudos de intervenção, com idade maior ou igual a 18 anos; diagnóstico de hipertensão arterial sistêmica (HAS); submetidos a exercícios de pilates solo e/ou pilates aparelhos como método de intervenção e incluído a descrição de análise das variáveis hemodinâmicas de pressão arterial (PA), frequência cardíaca (FC) e duplo produto (DP). Após processo de seleção foi selecionado apenas um único estudo que tenha contemplado todos os critérios de elegibilidade, totalizando 44 indivíduos do sexo feminino, com média de idade de 50,5 anos (±6,3 anos), hipertensas com utilização de medicação, onde 22 foram submetidas ao pilates solo e 22 permaneceram no grupo controle. O estudo apresentou resultados positivos na frequência cardíaca (FC), pressão arterial (PA) e no duplo-produto (DP) em comparação ao grupo controle. Apesar do número limitado de manuscritos encontrados nesta revisão, os resultados das variáveis hemodinâmicas nos levam a considerar plausível a utilização do Mat pilates em pacientes com HAS. Entretanto, novos estudos devem ser realizados para a confirmação dos achados...(AU)


The aim this study was to raise in the current literature relevant studies that identify the possible hemodynamic responses found in hypertensive individuals practicing the Pilates Method. The systematic review conducted according to PRISMA recommendations in five electronic databases (PEDro, PubMed, SciELO, LILACS and Cochrane), available from the beginning of the databases until March 2019, with MESH descriptors as follows: [("Adult "OR" Young adult "OR" Middle Aged "OR" Aged "OR" Elderly ") AND (" Exercise Movement Techniques "OR" Pilates-Based Exercises "OR" Pilates Training ") AND (" Hemodynamics "OR" Heart Rate " OR "Cardiac Chronotropy" OR "Heart Rate Control" OR "Hypertension" OR "Blood Pressure" OR "High Blood Pressure" OR "Systolic Pressure" OR "Diastolic Pressure" OR "High Blood Pressure" OR "Pulse Rate Determination")] , later adjusted to the other bases. Manual complementary search in the references of the articles included in the search and Google Scholar. Intervention studies, 18 years of age or older were included; diagnosis of systemic arterial hypertension (SAH); submitted to solo pilates exercises and / or pilates apparatus as intervention method and included the description of analysis of hemodynamic variables of blood pressure (BP), heart rate (HR) and double product (SD). After the selection process, only one study was selected that met all the eligibility criteria, totaling 44 female individuals, with a mean age of 50.5 years (± 6.3 years), hypertensive with medication use, where 22 were submitted to solo pilates and 22 remained in the control group. The study showed positive results in heart rate (HR), blood pressure (BP) and double product (SD) compared to the control group. Despite the limited number of manuscripts found in this review, the results of hemodynamic variables lead us to consider the use of Mat pilates in patients with hypertension to be plausible. However, further studies should be performed to confirm the findings...(AU)


Subject(s)
Humans , Female , Middle Aged , Physical Education and Training , Monitoring , Exercise Movement Techniques , Hemodynamics , Hypertension , Exercise , Cardiac Output, High , Muscle Stretching Exercises , Arterial Pressure , Heart Rate
13.
Med. infant ; 26(2): 147-150, Junio 2019.
Article in Spanish | LILACS (Americas) | ID: biblio-1016395

ABSTRACT

El cateterismo cardíaco en niños ha mostrado un avance significativo en las últimas décadas, transformándose de un procedimiento casi exclusivamente diagnóstico en sus inicios a un método predominantemente terapéutico en la actualidad. Para ello han contribuido la aparición de múltiples tecnologías de imágenes, así como el creciente desarrollo de materiales de muy bajo perfil y gran versatilidad que permiten el empleo de dispositivos cada vez más específicos para tratar adecuadamente un sinnúmero de enfermedades cardíacas con gran eficacia y seguridad. Esta tendencia continúa creciendo día a día, con la ayuda de nuevas modalidades de tratamiento híbrido donde cardiólogos intervencionistas y cirujanos cardiovasculares interactúan para ayudarse mutuamente, de manera tal de resolver los problemas existentes o aquellos que se van generando con el correr de los años y que afectan la vida de nuestros pacientes. Existen aún como es lógico controversias en algunos casos especiales, que se irán resolviendo paulatinamente en base a la evidencia reunida con las diferentes terapéuticas médicas utilizadas para mejorar el presente y futuro de los niños con cardiopatías (AU)


Cardiac catheterization in children has shown significant progress in recent decades, transforming from an initially almost exclusively diagnostic procedure to a predominantly therapeutic method today. The emergence of multiple imaging technologies has contributed to this progress, as has the growing development of very low-profile and highly versatile materials that allow the use of increasingly specific devices to adequately treat different types of heart disease with great efficacy and safety. This trend continues to grow day by day, with the help of new hybrid treatment modalities where interventional cardiologists and cardiovascular surgeons interact with mutual support, in order to solve existing problems or those that are generated over the years affecting the lives of our patients. Obviously, there are still controversies in specific cases, which will gradually be resolved based on the evidence that becomes available with the use of different medical therapies used to improve the present and future of children with heart disease.(AU)


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Cardiac Catheterization/methods , Heart Diseases/surgery , Heart Diseases/therapy , Heart Diseases/diagnostic imaging , Cardiac Surgical Procedures/trends , Hemodynamics
14.
Rev. bras. ter. intensiva ; 31(1): 39-46, jan.-mar. 2019. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-1003623

ABSTRACT

RESUMO Objetivo: Comparar a eficiência das técnicas de vibrocompressão e hiperinsuflação com ventilador mecânico de forma isolada e a associação das duas técnicas (hiperinsuflação com ventilador mecânico + vibrocompressão), na quantidade de secreção aspirada e na alteração de parâmetros hemodinâmicos e pulmonares. Métodos: Ensaio clínico randomizado com pacientes críticos em ventilação mecânica, realizado na unidade de terapia intensiva de um hospital universitário. Os pacientes foram randomizados para receber uma das técnicas de higiene brônquica por 10 minutos (vibrocompressão, ou hiperinsuflação com ventilador mecânico, ou hiperinsuflação com ventilador mecânico + vibrocompressão). Após, foram novamente randomizados para receber inicialmente a técnica (previamente randomizada) ou apenas a aspiração isolada. Foram analisados o peso de secreção aspirada (em gramas), dados de mecânica ventilatória e cardiopulmonares, antes e após a aplicação das técnicas. A frequência de reintubação traqueal, o tempo de ventilação mecânica e a mortalidade, também foram avaliados. Resultados: Foram incluídos 93 pacientes (29 vibrocompressão, 32 hiperinsuflação com ventilador mecânico e 32 hiperinsuflação com ventilador mecânico + vibrocompressão) em ventilação mecânica por mais de 24 horas. O grupo hiperinsuflação com ventilador mecânico + vibrocompressão foi o único que apresentou aumento significativo da secreção aspirada, quando comparado a aspiração isolada 0,7g (0,1 - 2,5g) versus 0,2g (0,0 - 0,6g), com valor de p = 0,006. Conclusão: Quando comparada à aspiração isolada, a associação das técnicas hiperinsuflação com ventilador mecânico + vibrocompressão foi mais eficiente na quantidade de secreção aspirada.


ABSTRACT Objective: To compare the effects of vibrocompression and hyperinflation with mechanical ventilator techniques alone and in combination (hyperinflation with mechanical ventilator + vibrocompression) on the amount of aspirated secretion and the change in hemodynamic and pulmonary parameters. Methods: A randomized clinical trial with critically ill patients on mechanical ventilation conducted in the intensive care unit of a university hospital. The patients were randomly allocated to receive one of the bronchial hygiene techniques for 10 minutes (vibrocompression or hyperinflation with mechanical ventilator or hyperinflation with mechanical ventilator + vibrocompression). Afterwards, the patients were again randomly allocated to receive either the previous randomly allocated technique or only tracheal aspiration. The weight of aspirated secretions (in grams), ventilatory mechanics and cardiopulmonary data before and after the application of the techniques were analyzed. The tracheal reintubation frequency and time and mortality on mechanical ventilation were also evaluated. Results: A total of 93 patients (29 vibrocompression, 32 hyperinflation with mechanical ventilator and 32 hyperinflation with mechanical ventilator + vibrocompression) on mechanical ventilation for more than 24 hours were included. The hyperinflation with mechanical ventilator + vibrocompression group was the only one that presented a significant increase in aspirated secretions compared to tracheal aspiration alone [0.7g (0.1 - 2.5g) versus 0.2g (0.0 - 0.6g), p value = 0.006]. Conclusion: Compared to tracheal aspiration alone, the combination of hyperinflation with mechanical ventilator + vibrocompression techniques was most efficient for increasing the amount of aspirated secretions.


Subject(s)
Humans , Male , Female , Aged , Respiration, Artificial , Suction/methods , Ventilators, Mechanical , Intensive Care Units , Time Factors , Critical Illness , Hemodynamics , Hospitals, University , Middle Aged
15.
Arq. bras. med. vet. zootec. (Online) ; 71(1): 68-76, jan.-fev. 2019. tab, graf
Article in English | LILACS (Americas), VETINDEX | ID: biblio-989353

ABSTRACT

Peccaries are wild mammals belonging to the Tayassu genus that are found almost everywhere in the Americas and have demonstrated great potential as an experimental model for scientific investigations. Twelve healthy adult animals were sedated to perform echocardiographic examinations in B, M and Doppler mode. The variables that exhibited statistically significant correlation coefficients with weight were LVFWd, LVIDd, LVIDs, E wave, A'RV, MAM, and TAPSE. The HR exhibited a negative relationship with the IVRT. The LA variable showed a positive correlation with the AO. The MAM exhibited correlations with the LVIDd and LVIDs. The TAPSE showed positive correlations with the E'RV and A'RV. The present study provides the first reference values for echocardiographic measurements in B, M and Doppler modes from peccaries anesthetized with ketamine and midazolam. Echocardiography was easy to perform in collared peccaries, and the collected data revealed values that can aid in their clinical management and conservation.(AU)


Catetos são mamíferos selvagens, pertencentes ao gênero Tayassu, encontrados em quase toda a América, os quais têm se destacado como modelos experimentais. Doze animais adultos saudáveis foram sedados para a realização de exames ecocardiográficos em modos B, M e Doppler. As variáveis que apresentaram coeficientes de correlação estatisticamente significativos em relação ao peso foram: LVFWd, LVIDd, LVIDs, onda E, A'RV, MAM, TAPSE. O HR mostrou correlação positiva com LA/AO, onda E, onda A, MAM, TAPSE e E/IVRT, e negativa com IVRT. Os valores de AVmax mostraram correlações positivas com onda E e onda A'. A variável LA mostrou correlação positiva com AO e correlação negativa com IVSd. A EF apresentou forte correlação com a relação de ondas FS, E/A, com A', E'RV. FS apresentou correlação positiva com a relação de onda E/A. O MAM mostrou correlação com LVIDd e LVIDs. TAPSE mostrou correlações positivas com E'RV e A'RV. O presente estudo forneceu os primeiros valores de referência para medições ecocardiográficas em modos B, M e Doppler de catetos anestesiados com ketamina e midazolam. O exame ecocardiográfico em catetos foi de fácil execução e os dados encontrados evidenciaram valores que podem auxiliar no seu manejo clínico e conservação.(AU)


Subject(s)
Animals , Artiodactyla/abnormalities , Cardiology , Hemodynamics , Animals, Wild/abnormalities
16.
Int. j. cardiovasc. sci. (Impr.) ; 32(1): 41-47, jan.-fev. 2019. tab
Article in English | LILACS (Americas) | ID: biblio-981574

ABSTRACT

Background: Congenital heart disease in adults shares some features with heart failure (HF), including exercise intolerance, ventilatory inefficiency, inflammatory and neurohormonal activation, cardiac arrhythmias and myocardial fibrosis. Over the last years, cardiopulmonary exercise test has gained importance in the diagnostic and prognostic evaluation of congenital heart diseases, as has already occurred in HF. Objective: To describe the behavior of hemodynamic, metabolic and ventilatory parameters in response to exercise in adults with congenital heart disease. Methods: Observational cross-sectional study evaluating 31 adults with congenital acyanotic or cyanotic heart disease, treated clinically, surgically or percutaneously, referred for cardiopulmonary exercise test. A descriptive analysis of the data was performed. Results: Patients aged 35.7 ± 14.2 years were included. Oxygen consumption (VO2) was 44.86 ± 18.01% of predicted at peak exercise and 36.92 ± 12.93% of predicted maximal VO2 at anaerobic threshold. We found an oxygen uptake efficiency slope (OUES) of 1.49 ± 0.89 (61.43 ± 26.63% of predicted), oxygen pulse of 58.90 ± 22.24% and increment in systolic arterial pressure during exercise was 31.42 ± 21.60 mmHg. Conclusion: Adults with congenital heart disease had similar responses to heart failure patients during exercise ­ reduced aerobic capacity, ventilatory inefficiency for oxygen consumption and limited inotropic response to exercise, characterized by reduced oxygen pulse and small increase in systolic arterial pressure


Subject(s)
Humans , Male , Female , Adult , Exercise , Heart Defects, Congenital/metabolism , Hemodynamics , Metabolism , Oxygen Consumption , Statistical Analysis , Ventricular Dysfunction, Right , Ventricular Dysfunction, Left , Cyanosis , Exercise Test , Arterial Pressure , Observational Study , Heart Failure
17.
Int. j. cardiovasc. sci. (Impr.) ; 32(1): 61-69, jan.-fev. 2019. ilus, tab
Article in English | LILACS (Americas) | ID: biblio-981613

ABSTRACT

Arterial hypertension is responsible for high morbidity and mortality. Despite increasing awareness of the consequences of uncontrolled hypertension and the publication of several recommendations and guidelines, blood pressure control rates are suboptimal, and approximately half of the patients do not reach the targets. Defined as an increase in blood pressure, hypertension is characterized by hemodynamic abnormalities in cardiac output, systemic vascular resistance, or arterial compliance. Therefore, the approach to arterial hypertension can be improved by the knowledge of the hemodynamics underlying the blood pressure increase. Impedance Cardiography has emerged as a new strategy to customize therapy and monitor patients aiming to improve blood pressure control according to the hemodynamic profile, rather than a blind intensive care approach. This is a review of impedance cardiography evidence, its benefits, actual and future applications in the approach and management of arterial hypertension


Subject(s)
Humans , Male , Female , Cardiography, Impedance , Hypertension/physiopathology , Stroke Volume , Blood Pressure , Cardiovascular Diseases , Risk Factors , Electrocardiography/methods , Heart Failure , Hemodynamics , Antihypertensive Agents/therapeutic use
18.
Int. j. cardiovasc. sci. (Impr.) ; 32(1): 41-47, jan.-fev. 2019. tab
Article in English | LILACS (Americas) | ID: biblio-984517

ABSTRACT

Congenital heart disease in adults shares some features with heart failure (HF), including exercise intolerance, ventilatory inefficiency, inflammatory and neurohormonal activation, cardiac arrhythmias and myocardial fibrosis. Over the last years, cardiopulmonary exercise test has gained importance in the diagnostic and prognostic evaluation of congenital heart diseases, as has already occurred in HF. Objective: To describe the behavior of hemodynamic, metabolic and ventilatory parameters in response to exercise in adults with congenital heart disease. Methods: Observational cross-sectional study evaluating 31 adults with congenital acyanotic or cyanotic heart disease, treated clinically, surgically or percutaneously, referred for cardiopulmonary exercise test. A descriptive analysis of the data was performed. Results: Patients aged 35.7 ± 14.2 years were included. Oxygen consumption (VO2) was 44.86 ± 18.01% of predicted at peak exercise and 36.92 ± 12.93% of predicted maximal VO2 at anaerobic threshold. We found an oxygen uptake efficiency slope (OUES) of 1.49 ± 0.89 (61.43 ± 26.63% of predicted), oxygen pulse of 58.90 ± 22.24% and increment in systolic arterial pressure during exercise was 31.42 ± 21.60 mmHg. Conclusion: Adults with congenital heart disease had similar responses to heart failure patients during exercise - reduced aerobic capacity, ventilatory inefficiency for oxygen consumption and limited inotropic response to exercise, characterized by reduced oxygen pulse and small increase in systolic arterial pressure


Subject(s)
Humans , Male , Female , Adult , Exercise , Heart Defects, Congenital/metabolism , Hemodynamics , Metabolism , Oxygen Consumption , Data Interpretation, Statistical , Ventricular Dysfunction, Right , Ventricular Dysfunction, Left , Cyanosis , Exercise Test , Arterial Pressure , Observational Study , Heart Failure
19.
Int. j. cardiovasc. sci. (Impr.) ; 32(1): 61-69, jan.-fev. 2019. tab, ilus
Article in English | LILACS (Americas) | ID: biblio-984522

ABSTRACT

Arterial hypertension is responsible for high morbidity and mortality. Despite increasing awareness of the consequences of uncontrolled hypertension and the publication of several recommendations and guidelines, blood pressure control rates are suboptimal, and approximately half of the patients do not reach the targets. Defined as an increase in blood pressure, hypertension is characterized by hemodynamic abnormalities in cardiac output, systemic vascular resistance, or arterial compliance. Therefore, the approach to arterial hypertension can be improved by the knowledge of the hemodynamics underlying the blood pressure increase. Impedance Cardiography has emerged as a new strategy to customize therapy and monitor patients aiming to improve blood pressure control according to the hemodynamic profile, rather than a blind intensive care approach. This is a review of impedance cardiography evidence, its benefits, actual and future applications in the approach and management of arterial hypertension


Subject(s)
Humans , Male , Female , Cardiography, Impedance , Hypertension/physiopathology , Stroke Volume , Blood Pressure , Cardiovascular Diseases , Risk Factors , Electrocardiography/methods , Heart Failure , Hemodynamics , Antihypertensive Agents/therapeutic use
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