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1.
J Cardiovasc Transl Res ; 16(6): 1333-1342, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37450208

RESUMO

In this prospective observational study, we investigated whether congenital heart disease (CHD) affects the microcirculation and whether the microcirculation is altered following cardiac surgery with cardiopulmonary bypass (CPB). Thirty-eight children with CHD undergoing cardiac surgery with CPB and 35 children undergoing elective, non-cardiac surgery were included. Repeated non-invasive sublingual microcirculatory measurements were performed with handheld vital microscopy. Before surgery, children with CHD showed similar perfused vessel densities and red blood cell velocities (RBCv) but less perfused vessels (p < 0.001), lower perfusion quality (p < 0.001), and higher small vessel densities (p = 0.039) than children without CHD. After cardiac surgery, perfused vessel densities and perfusion quality of small vessels declined (p = 0.025 and p = 0.032), while RBCv increased (p = 0.032). We demonstrated that CHD was associated with decreased microcirculatory perfusion and increased capillary recruitment. The microcirculation was further impaired after cardiac surgery. Decreased microcirculatory perfusion could be a warning sign for altered tissue oxygenation and requires further exploration.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas , Criança , Humanos , Microcirculação , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Ponte Cardiopulmonar/efeitos adversos , Estudos Prospectivos
3.
Clin Nutr ESPEN ; 23: 212-216, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29460801

RESUMO

BACKGROUND AND AIMS: Children undergoing cardiac surgery with cardio pulmonary bypass often receive glucocorticoids to reduce the systemic inflammatory response. Glucocorticoids stimulate protein breakdown and increase amino acid availability. We studied whether glucocorticoid treatment influences the availability of amino acids, specifically those involved in the nitric oxide pathway. METHODS: We prospectively studied 49 children with congenital heart disease undergoing cardiac surgery. Serum cortisol and amino acid levels were measured in arterial blood sampled before surgery (t = -5 min), directly after surgery (t = 0 h) and at t = 12 h and t = 24 h after surgery. Serum cortisol and amino acid levels were compared between children who had received glucocorticoids (G+) and children who had not (G-). RESULTS: Of 49 patients included ((49% male, age 1.7 (0.5-8.7) y)), 33 (67%) received glucocorticoids. Baseline characteristics were not different between groups, except a higher weighted inotropic score in the G+ group. At t = 0 h, serum cortisol levels in the G+ group were significantly higher than in the G- group (7218 vs. 660 nmol/L; (p < 0.05)), but not different at the other time points. The levels of plasma amino acids had dropped after surgery. Compared to the G- group, in the G+ group the total amount of amino acids was significantly higher at t = 12 and t = 24; citrulline levels were higher at t = 12 and t = 24; and glutamine and arginine levels were higher at t = 12. CONCLUSIONS: Glucocorticoid treatment during cardiac surgery in children preserves serum amino acid levels post-surgery. The preservation of glutamine, citrulline and arginine levels might have a beneficial effect on the related NO metabolism.


Assuntos
Aminoácidos/sangue , Procedimentos Cirúrgicos Cardíacos , Glucocorticoides/farmacologia , Cardiopatias Congênitas/tratamento farmacológico , Cardiopatias Congênitas/cirurgia , Adolescente , Arginina/sangue , Criança , Pré-Escolar , Citrulina/sangue , Feminino , Glutamina/sangue , Humanos , Hidrocortisona/sangue , Lactente , Unidades de Terapia Intensiva Pediátrica , Masculino , Óxido Nítrico/sangue , Estudos Prospectivos
4.
Ned Tijdschr Geneeskd ; 156(44): A5086, 2012.
Artigo em Holandês | MEDLINE | ID: mdl-23114174

RESUMO

BACKGROUND: Healthcare professionals are seeing an increasing number of morbidly obese patients. Medical interventions are often difficult to perform in these patients. In acute situations this can lead to major problems. CASE DESCRIPTION: Assistance from a mobile medical team was requested for a 42-year-old male weighing 350 kg with severe respiratory failure. Transporting the patient was problematic due to his build. The hospital to which he was brought after hours of delay lacked the appropriate space and resources for morbidly obese patients. Since the condition of the patient deteriorated, intubation and mechanical ventilation were required. Despite additional equipments for problematic airway access, the procedure failed and the patient died due to respiratory failure. CONCLUSION: Designating centres for care, also in the acute situations, of morbidly obese patients is recommended, to improve the care of these patients and to prevent disasters.


Assuntos
Obesidade Mórbida/complicações , Insuficiência Respiratória/etiologia , Adulto , Evolução Fatal , Humanos , Intubação Intratraqueal , Masculino , Respiração Artificial , Falha de Tratamento
5.
Eur J Prev Cardiol ; 19(2): 192-8, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21450584

RESUMO

BACKGROUND: Exercise test parameters (exercise ankle brachial index (ABI), walking distance and blood pressure response) separately are associated with long-term outcome in patients with known or suspected peripheral arterial disease (PAD). However, the clinical value of the combination of these parameters together is unknown. METHODS: 2165 patients performed a treadmill exercise test to diagnose or to evaluate their PAD. Resting ABI, exercise ABI, abnormal blood pressure response (hypotensive and hypertensive) and walking distance (impairment <150 m) were measured. The study population was divided into patients with a resting ABI ≥ 0.90 and patients with PAD (resting ABI < 0.90). RESULTS: The mean follow-up period was 5 years (0.5-14 years). Long-term mortality rate and risks increases when more exercise parameters became abnormal (p-value = 0.001). Patients with a normal resting ABI but with an abnormal exercise test had a higher mortality risk--HR 1.90 (1.32-2.73)--than patients with a normal exercise test. The highest mortality risk and cardiac death was observed in PAD patients with a walking impairment together with an abnormal blood pressure response--HR 3.48 (2.22-5.46). CONCLUSION: Exercise tests give multiple parameters, which together provide important prognostic information on long-term outcome in both patients with normal resting ABI and PAD.


Assuntos
Teste de Esforço/métodos , Doença Arterial Periférica/diagnóstico , Idoso , Índice Tornozelo-Braço , Pressão Sanguínea , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Prognóstico , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Caminhada/fisiologia
6.
Atherosclerosis ; 216(2): 365-9, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21397231

RESUMO

BACKGROUND: The clinical value of exercise ankle brachial index (ABI) is still unclear, especially in patients with normal resting ABI. METHOD: 2164 patients performed a single-stage treadmill exercise test to diagnose or evaluate PAD. The population was divided into two groups: a normal resting ABI (resting ABI≥0.90) and PAD (resting ABI<0.90). Patients with a normal resting ABI were divided into 4 exercise ABI groups: exercise ABI<0.90, 0.90-0.99, 1.00-1.09 and 1.10-1.29 (reference). RESULTS: Mean follow-up was 5 years. Exercise ABI added significant prognostic information on all cause long-term mortality only in patients with normal resting ABI (p-value 0.014, HR 0.99 95% CI (0.98-0.99)), not in patients with PAD. Fifty years or older (OR 2.93 95% CI (1.65-5.20)) and resting systolic blood pressure>140 mmHg (OR 2.18 95% CI (1.35-3.55)) were associated with an abnormal exercise ABI in patients with a normal resting ABI. Mortality rate increased when the exercise ABI became worse (p trend 0.0001) with a 2.5-fold increase mortality risk in patients with a normal resting ABI but exercise ABI <0.90 (HR 2.56, 95% CI (1.11-5.91)). CONCLUSION: In patients with a normal resting ABI, treadmill exercise ABI added important prognostic information on long-term mortality. Based on our results we recommend that at least all patients suspected for PAD, with a resting ABI≥0.90, who are 50 years or older and having hypertension should undergo treadmill exercise testing.


Assuntos
Índice Tornozelo-Braço , Tornozelo/fisiopatologia , Doença Arterial Periférica/fisiopatologia , Idoso , Artérias/patologia , Pressão Sanguínea , Índice de Massa Corporal , Cardiologia/métodos , Teste de Esforço , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Prognóstico , Fatores de Risco , Resultado do Tratamento
7.
Coron Artery Dis ; 22(4): 228-32, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21394025

RESUMO

OBJECTIVE: Earlier studies have shown that hypertensive or hypotensive blood pressure (BP) response during a preoperative treadmill exercise test in patients with peripheral arterial disease is associated with a two-fold increased risk of cardiovascular events and mortality. However, it is unknown if these patients also experience an increased perioperative complication risk at major vascular surgery. METHODS: In total 665 consecutive patients with peripheral arterial disease underwent elective major vascular surgery (carotid endarterectomy, abdominal aorta repair, or lower extremity revascularization). Perioperative complications (infection, myocardial infarction, angina pectoris, cardiac arrhythmia, heart failure, cerebrovascular accident or spinal cord ischemia, dialyses, amputation, thrombectomy, reoperation or death) were defined as occurring within 30 days after surgery and were collected using medical records. Hypertensive BP response was defined as a difference between exercise systolic BP and resting systolic BP of more than 55 mmHg. Hypotensive BP response was defined as a drop in exercise systolic BP below resting systolic BP. RESULTS: Patients with a hypertensive BP response during a preoperative exercise test (n = 66) showed a higher risk of early perioperative thrombectomy [hazard ratio (HR) 2.80 95% CI (1.24-6.33)] compared with patients with a normal BP response (n = 582). Patients with a hypotensive BP response (n = 18) showed an increased risk of perioperative myocardial infarction [HR 3.69 95% CI (1.08-12.64)] and cardiac complications [HR 2.90 95% CI (1.02-8.19)] compared with patients with a normal BP response. CONCLUSION: Patients with an abnormal BP response have more cardiovascular complications at elective major vascular surgery.


Assuntos
Pressão Sanguínea/fisiologia , Exercício Físico/fisiologia , Doença Arterial Periférica/cirurgia , Complicações Pós-Operatórias , Idoso , Feminino , Humanos , Hipertensão/fisiopatologia , Hipotensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/fisiopatologia , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Vasculares
8.
Eur J Cardiovasc Prev Rehabil ; 17(3): 321-8, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19838118

RESUMO

AIM: To assess the predictive value of a decline in total walking distance and ankle brachial index (ABI) on all-cause mortality and cardiac death in patients with known or suspected peripheral artery disease. METHODS: Two hundred and sixty-one patients, who performed single-stage treadmill walking test twice to evaluate their peripheral artery disease, were enrolled in an observational study. Patients who underwent surgery during follow-up were excluded. Delta total walking distance and delta resting and exercise ABI consisted of the difference between the first and the second test. All three variables were categorized into two groups: stable/improvement or a decline. RESULTS: The mean follow-up period was 6 years. At both 5 years and total follow-up, a decline in total walking distance was independent and highly associated with an increased mortality risk and cardiac death [hazard ratio: 2.31 (95% confidence interval 1.35-3.96); hazard ratio: 3.55 (95% confidence interval: 1.53-8.21), respectively]. A decline in resting or exercise ABI after adjustment for delta walking distance was not significantly associated with all-cause mortality or cardiac death. CONCLUSION: A decline in total walking distance in single-stage treadmill exercise tests is a strong prognostic predictor of all-cause mortality and cardiac death in the short term and long term.


Assuntos
Teste de Esforço , Tolerância ao Exercício , Doenças Vasculares Periféricas/diagnóstico , Caminhada , Idoso , Índice Tornozelo-Braço , Distribuição de Qui-Quadrado , Feminino , Cardiopatias/etiologia , Cardiopatias/mortalidade , Humanos , Estimativa de Kaplan-Meier , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/mortalidade , Doenças Vasculares Periféricas/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Fatores de Tempo
9.
Vasc Med ; 14(4): 297-304, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19808714

RESUMO

Patients with peripheral arterial disease (PAD) report diverse clinical manifestations that are not always consistent with classic intermittent claudication. We examined the degree to which atypical exertional leg symptoms, intermittent claudication, and exertional leg symptoms that begin at rest were associated with mood states such as anxiety, depressive symptoms, and anhedonia (i.e. lack of positive affect). A cohort of consecutive PAD patients (n = 628) from the Erasmus Medical Center, Rotterdam, The Netherlands, completed the Hospital Anxiety and Depression Scale and the San Diego Claudication questionnaire. The ankle-brachial index and clinical factors were assessed in all patients at baseline. Anxiety was present in 29%, depressive symptoms in 30%, and anhedonia in 28% of patients. Pain at rest was independently associated with anxiety, depressive symptoms, and anhedonia (ORs between 2.5 and 4.0, p

Assuntos
Afeto , Ansiedade/complicações , Depressão/complicações , Claudicação Intermitente/etiologia , Extremidade Inferior/irrigação sanguínea , Doenças Vasculares Periféricas/complicações , Estudos Transversais , Feminino , Humanos , Claudicação Intermitente/psicologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Medição da Dor , Doenças Vasculares Periféricas/psicologia , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários
10.
Coron Artery Dis ; 19(8): 603-7, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19005295

RESUMO

OBJECTIVE: A decline in systolic blood pressure during exercise is thought to be a sign of severe coronary artery disease. However, no studies have yet examined this effect in patients with known or suspected peripheral arterial disease. Therefore, we investigated the prognostic value of hypotensive blood pressure response after single-stage exercise test on long-term mortality, major adverse cerebrovascular and cardiac events (MACCE) and the effects of statin, beta-blocker and aspirin use in patients with known or suspected peripheral arterial disease. METHODS: A total of 2022 patients were enrolled in an observational study with a mean follow-up of 5 years. Hypotensive blood pressure response, 4.6% of the total population, was defined as a drop in exercise systolic blood pressure below resting systolic blood pressure. RESULTS: Our study showed that hypotensive blood pressure response was associated with an increased risk of all-cause mortality [hazard ratio (HR): 1.74, 95% confidence interval (CI): 1.10-2.73] and MACCE (HR: 1.85, 95% CI: 1.14-3.00), independent of other clinical variables. Additionally, after adjustments for clinical risk factors and propensity score, baseline statin use was associated with a reduced risk of all-cause mortality (HR: 0.60, 95% CI: 0.44-0.80). Besides, statin and aspirin use were both also associated with a reduced risk of MACCE (HR: 0.65, 95% CI: 0.47-0.89 and HR: 0.69, 95% CI: 0.53-0.88, respectively). CONCLUSION: Hypotensive blood pressure response after single-stage treadmill exercise tests in patients with known or suspected peripheral arterial disease was associated with a higher risk for all-cause long-term mortality and MACCE, which might be reduced by statin and aspirin use.


Assuntos
Pressão Sanguínea , Doenças Cardiovasculares/etiologia , Teste de Esforço , Hipotensão/etiologia , Doenças Vasculares Periféricas/diagnóstico , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Aspirina/uso terapêutico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipotensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/mortalidade , Doenças Vasculares Periféricas/fisiopatologia , Doenças Vasculares Periféricas/terapia , Inibidores da Agregação Plaquetária/uso terapêutico , Prognóstico , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Tempo
11.
Am J Cardiol ; 102(7): 921-6, 2008 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-18805123

RESUMO

The prognostic value of a hypertensive blood pressure (BP) response is still unclear. Therefore, the prognostic value of a hypertensive BP response in patients during single-stage exercise testing for peripheral arterial disease (PAD) on long-term mortality and major adverse cerebrovascular and cardiac events (MACCEs) was investigated. In addition, effects of statin, beta-blocker, and aspirin use in patients with known or suspected PAD were studied. A total of 2,109 patients were enrolled in an observational prospective study from 1993 to 2005. Hypertensive BP response was defined as an increase in systolic BP > or = 55 mm Hg (95(th) percentile within our population) after a single-stage treadmill exercise test. The outcome was obtained by using the civil registries, and a questionnaire about cardiac events was sent to all survivals. Hypertensive BP response was associated with increased risk of long-term mortality (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.12 to 1.80) and MACCEs (HR 1.47, 95% CI 1.09 to 1.97). After adjustments for clinical risk factors and propensity score, baseline statin use was associated with reduced risk of long-term mortality (HR 0.59, 95% CI 0.44 to 0.79), and statin, beta-blocker, and aspirin use were associated with reduced risk of MACCEs (HR 0.59, 95% CI 0.43 to 0.81; HR 0.75, 95% CI 0.60 to 0.95; HR 0.73, 95% CI, 0.57 to 0.92, respectively). In conclusion, hypertensive BP response at exercise in patients with known or suspected PAD is an important independent risk factor for all-cause long-term mortality and MACCEs, whereas statin, beta-blocker, and aspirin use were associated with an improved outcome.


Assuntos
Doenças Cardiovasculares/epidemiologia , Teste de Esforço , Hipertensão/fisiopatologia , Doenças Vasculares Periféricas/fisiopatologia , Antagonistas Adrenérgicos beta/administração & dosagem , Idoso , Aspirina/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Doenças Cardiovasculares/mortalidade , Causas de Morte , Feminino , Seguimentos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Inquéritos e Questionários , Análise de Sobrevida
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