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BMC Cardiovascular Disorders Sep 2022Heart failure patients demonstrate reduced functional capacity, hemodynamic function, and quality of life (QOL) which are associated with high mortality and morbidity...
BACKGROUND
Heart failure patients demonstrate reduced functional capacity, hemodynamic function, and quality of life (QOL) which are associated with high mortality and morbidity rate. The aim of the present study was to assess the relationship between functional capacity, hemodynamic response to exercise and QOL in chronic heart failure.
METHODS
A single-centre prospective study recruited 42 chronic heart failure patients (11 females, mean age 60 ± 10 years) with reduced left ventricular ejection fraction (LVEF = 23 ± 7%). All participants completed a maximal graded cardiopulmonary exercise test with non-invasive hemodynamic (bioreactance) monitoring. QOL was assessed using Minnesota Living with Heart Failure Questionnaire.
RESULTS
The average value of QOL score was 40 ± 23. There was a significant negative relationship between the QOL and peak O consumption (r = - 0.50, p ≤ 0.01). No significant relationship between the QOL and selected exercise hemodynamic measures was found, including peak exercise cardiac power output (r = 0.15, p = 0.34), cardiac output (r = 0.22, p = 0.15), and mean arterial blood pressure (r = - 0.08, p = 0.60).
CONCLUSION
Peak O consumption, but not hemodynamic response to exercise, is a significant determinant of QOL in chronic heart failure patients.
Topics: Aged; Chronic Disease; Exercise Tolerance; Female; Heart Failure; Hemodynamics; Humans; Middle Aged; Prospective Studies; Quality of Life; Stroke Volume; Ventricular Function, Left
PubMed: 36114473
DOI: 10.1186/s12872-022-02829-w -
British Journal of Anaesthesia Dec 2016Haemodynamic management incorporating direct or surrogate stroke volume monitoring has experienced a rapid evolution, because of emergence of the "goal-directed therapy"... (Review)
Review
Haemodynamic management incorporating direct or surrogate stroke volume monitoring has experienced a rapid evolution, because of emergence of the "goal-directed therapy" concept and technological developments aimed at providing a parameter leading to the goal. Nonetheless, consensus on both definitions of the ideal "goal" and strategies for achieving it remain elusive. For this review, we first consider basic physiological and patient monitoring factors relevant to the concept of "fluid responsiveness", and then focus upon randomized controlled trials and meta-analyses involving goal-directed haemodynamic therapy based on various flow parameters. Finally, we discuss the current status of noninvasive methods for monitoring fluid responsiveness.
Topics: Fluid Therapy; Goals; Hemodynamics; Humans; Perioperative Care
PubMed: 27940452
DOI: 10.1093/bja/aew363 -
European Journal of Heart Failure Feb 2022Patients with obesity frequently present with dyspnoea. Biomarkers that reflect wall stress are often used to evaluate circulatory congestion and help determine whether...
AIMS
Patients with obesity frequently present with dyspnoea. Biomarkers that reflect wall stress are often used to evaluate circulatory congestion and help determine whether dyspnoea is of cardiac causes. Patients with obesity display greater external restraint on the heart, which may alter relationships between intravascular pressures and stress markers.
METHODS AND RESULTS
Subjects with unexplained dyspnoea (n = 212) underwent cardiac catheterization with simultaneous echocardiography. Blood sampling was performed in a subset (n = 58). Relationships between echocardiographic and blood biomarkers of circulatory congestion and directly-measured haemodynamics were compared between participants with severe obesity [body mass index (BMI) ≥35 kg/m , Group B) and those without (BMI <35 kg/m , Group A). Circulatory congestion was assessed by pulmonary capillary wedge pressure (PCWP), and vascular distending pressure was assessed by left ventricular transmural pressure (LVTMP). As compared to Group A, participants in Group B displayed higher PCWP relative to N-terminal pro-B-type natriuretic peptide, mid-regional pro-atrial natriuretic peptide, troponin T, and growth differentiation factor-15 (all p < 0.01). In contrast, the relationships between LVTMP and the biomarkers were superimposable. Echocardiographic biomarkers revealed the same pattern: PCWP was higher for any E/e' ratio in Group B compared to Group A, but the relationship between LVTMP and E/e' was similar. In contrast, levels of C-terminal pro-endothelin-1 and mid-regional pro-adrenomedullin were more robustly correlated with PCWP (r = 0.67 and r = 0.62, both p < 0.0001), with no differential relationship based upon BMI.
CONCLUSIONS
Non-invasive haemodynamic markers underestimate circulatory congestion in patients with obesity, an effect that appears related to uncoupling between cardiac wall stress and intravascular pressures. This may lead to systematic under-recognition of congestion in patients with obesity.
Topics: Echocardiography; Heart Failure; Hemodynamics; Humans; Obesity; Pulmonary Wedge Pressure; Stroke Volume; Ventricular Function, Left
PubMed: 34755429
DOI: 10.1002/ejhf.2377 -
Experimental Physiology Dec 2020What is the central question of this study? How does resistance exercise affect peripheral haemodynamics in the active and inactive limb? What is the main finding and...
NEW FINDINGS
What is the central question of this study? How does resistance exercise affect peripheral haemodynamics in the active and inactive limb? What is the main finding and its importance? Preliminary data indicate that resistance exercise increases flow and shear rate in the active limb transiently. The same exercise has minimal, short-lasting influence on peripheral haemodynamics in the inactive limb, but further research is required to elaborate on resistance exercise-mediated changes in vascular function in active and inactive limbs.
ABSTRACT
Current evidence indicates that to achieve maximum health benefits, regular resistance exercise should be a key component of structured physical activity. Several studies have revealed that regular resistance exercise may be associated with impaired vascular function, although this finding is inconsistent. Proposed explanations for impairment include substantial increases in blood pressure and increased retrograde blood flow in active limbs promoted by resistance exercise. However, few studies have examined the acute haemodynamics of resistance exercise in active - and even fewer in inactive - limbs. The purpose of this study was to characterise the haemodynamic responses in peripheral arteries in active and inactive limbs in response to resistance exercise using upper and lower limbs. Ten participants (five male, five female) familiar with resistance training performed three sets of 10 isotonic repetitions of right-sided bicep curls or knee extensions on separate days. Blood flow, shear rate and muscle oxygenation in the active and inactive limb, and blood pressure were measured before and for 3 min after each set. Blood flow increased in response to resistance exercise in the active limb (∼8-fold and ∼6-fold for the upper and lower limb respectively), with concurrent significant increases in mean and antegrade shear rate. In the inactive limb, blood flow more than doubled for both upper and lower limb exercise, transiently, with no significant change in retrograde shear rate. These acute blood flow profiles following resistance exercise are not indicative of long-term vessel impairment based on current understanding of blood flow and shear stress patterns.
Topics: Adaptation, Physiological; Adult; Blood Flow Velocity; Blood Pressure; Brachial Artery; Endothelium, Vascular; Exercise; Extremities; Female; Hemodynamics; Humans; Male; Muscle, Skeletal; Regional Blood Flow; Resistance Training; Stress, Mechanical; Vasodilation; Young Adult
PubMed: 33058304
DOI: 10.1113/EP088743 -
International Angiology : a Journal of... Jun 2022There is general perception among vascular physicians that primary lower limb superficial chronic venous disease (CVD) can present in various clinical, anatomical and...
BACKGROUND
There is general perception among vascular physicians that primary lower limb superficial chronic venous disease (CVD) can present in various clinical, anatomical and hemodynamical patterns. Nonetheless, and despite the diversity of classifications on this subject, none specifically addresses such patterns in an integrative form. In the authors opinion, an integrated anatomic and hemodynamic classification could prove a valuable tool for both patient stratification and treatment, as well as postoperative outcomes assessment and homogeneous comparison among groups. The purpose of this study was to collect expert opinion on the usefulness and applicability of a new integrated anatomic and hemodynamic classification for primary superficial venous disease, as well as the anatomic and hemodynamic variables to consider.
METHODS
A survey was administered via a web-based platform to a worldwide selected group of experts on vascular pathology. The survey included 27 questions and collected data on physician demographics and clinical experience (6 questions); usefulness and applicability of a new classification (6 questions); and anatomic and hemodynamic variables to consider (15 questions). A 5-point Likert Scale was used for categorization, and open-ended questions were included for commentary.
RESULTS
A total of 278 surveys were sent to experts worldwide, out of which 122 participated (response rate 43.9%). Most participants were European based (85.2%) vascular surgeons (85.2%), but experts from 39 countries across all continents were represented. 88.9% of the respondents agreed that primary varicose veins can be divided in different anatomic and hemodynamic patterns, although only 45.1% believe current classifications are appropriate to differentiate such patterns; 58.2% of respondents agree with an anatomical classification of varicose veins (VV) according to their area of distribution in the lower limb (anterior, posterior, medial, lateral), and 77.1% agree with a hemodynamic categorization of VV in 3 major patterns: VV related with saphenous insufficiency; VV related with pelvic insufficiency; isolated insufficient tributaries and perforator veins. There is general consensus that an integrated anatomic and hemodynamic classification for primary superficial venous disease would be of great use for patient stratification (80.3%), treatment selection (72.2%) and postoperative outcome assessment (70.5%); furthermore, 68.9% of the respondents would use the aforementioned classification, as long as it remained simple and easy to apply in a clinical practice daily basis.
CONCLUSIONS
The results of the present survey demonstrate that vascular physicians involved in the treatment of primary superficial venous disease recognize the limitations on current varicose vein classifications and agree on the need for a more comprehensive classification for such pathology. Experts agree that an integrated anatomic and hemodynamic classification for primary superficial venous disease would be of great use for patient stratification, treatment selection and postoperative outcome assessment, as long as it remained simple and easy to apply in a clinical practice daily basis. Collected evidence provides significant insights on expert opinion on anatomic and hemodynamic variables to assess and may set the bases for a new classification. Further validations using methodologically solid strategies for expert consensus are required.
Topics: Hemodynamics; Humans; Saphenous Vein; Surveys and Questionnaires; Varicose Veins; Veins; Venous Insufficiency
PubMed: 35234433
DOI: 10.23736/S0392-9590.22.04855-6 -
Acta Ophthalmologica Jun 2016To study the retrobulbar haemodynamics in patients with Coats' disease.
PURPOSE
To study the retrobulbar haemodynamics in patients with Coats' disease.
METHODS
The clinical study included 43 patients with Coats' disease. Using colour Doppler imaging, we measured the blood flow velocity in the ophthalmic artery (OA), central retinal artery (CRA) and posterior ciliary arteries (PCA), and recorded the peak systolic velocity (PSV), end diastolic velocity (EDV), time averaged maximum velocity (TAMX), pulsatility index (PI) and resistance indexes (RI). The unaffected contralateral eyes served as control group. The disease was graded into four stages.
RESULTS
Compared to the contralateral eyes, the Coats' disease affected eyes showed for the CRA a significant decrease in PSV (7.08 ± 1.38 cm/s versus 8.64 ± 1.45 cm/s; p < 0.001), EDV (2.03 ± 0.41 cm/s versus 2.52 ± 0.62 cm/s; p < 0.001) and TAMX (3.67 ± 0.96 cm/s versus 4.40 ± 1.22 cm/s; p = 0.003) and for the PCA a significant decrease in PSV (9.15 ± 1.87 cm/s versus 10.14 ± 1.61 cm/s; p = 0.01). Subgroup analysis revealed that the decrease in haemodynamic parameters existed mainly in patients with stage 3A2 and stage 3B of Coats' disease.
CONCLUSIONS
As measured by colour Doppler imaging, the retrobulbar blood vessels showed decreased haemodynamic parameters in patients with Coats' disease on the affected side as compared to the contralateral unaffected side, in particular in advanced stages of the disease. Future studies may address the causes and effects of these haemodynamic changes.
Topics: Adolescent; Blood Flow Velocity; Child; Child, Preschool; Ciliary Arteries; Female; Hemodynamics; Humans; Male; Ophthalmic Artery; Orbit; Pulse Wave Analysis; Retinal Artery; Retinal Telangiectasis; Ultrasonography, Doppler, Color
PubMed: 26686879
DOI: 10.1111/aos.12921 -
Journal of Clinical Monitoring and... Oct 2023Ascites is a frequent complication of cirrhosis. In intensive care units, initial hemodynamic assessment is frequently performed by echocardiography. This study... (Observational Study)
Observational Study
BACKGROUND & AIMS
Ascites is a frequent complication of cirrhosis. In intensive care units, initial hemodynamic assessment is frequently performed by echocardiography. This study evaluated the feasibility and usefulness of early hemodynamic assessment in the gastroenterology ward.
METHODS
This observational cohort study prospectively included all patients admitted to a teaching hospital's gastroenterology unit for decompensated cirrhosis. A gastroenterologist with minimal training and an intensivist both performed an echocardiography exam. The primary outcome was inter-rater agreement and reliability for three echocardiography parameters: visual LVEF (Left Ventricular Ejection Fraction), subaortic VTI (velocity time integral) and E wave velocity. Secondary outcomes were agreement for presence of pleural effusion, description of 3 hemodynamics profiles (hypovolemic, hyperkinetic and intermediate), and 28-day mortality.
RESULTS
From March 2018 to March 2020, 53 patients were included. The median age was 62 years and 81% were men. Patients presented mostly advanced liver disease, with 43% Child-Pugh C and median MELD score of 15.2. The limits of agreement between intensivists and gastroenterologists for subaortic VTI were - 6.6 to 7.2 cm, and ranged from - 0.6 to 0.37 m.s for E wave velocity. Clinically significant differences between intensivists and gastroenterologists were found in 22% for subaortic VTI and 24.5% for E wave velocity. Reliability was good for subaortic VTI (ICC: 0.79, 95% CI [0.58; 0.9;]) and moderate for E wave velocity (0.53, 95% CI [0.19; 0.74]). The three hemodynamics profiles had different prognosis, with a 28-day mortality for Hypovolemic, Intermediate and Hyperkinetic group of 31, 18, and 4%, respectively.
CONCLUSION
Reliability of hemodynamic assessment by gastroenterologists was good, while agreement was unsatisfactory, advocating for further training. Transthoracic echocardiography can differentiate hypovolemia from hyperkinetic states. The role of transthoracic echocardiography in managing decompensated cirrhosis requires further study.
CLINICAL TRIAL NUMBER
NCT03650660.
Topics: Male; Humans; Middle Aged; Female; Gastroenterologists; Stroke Volume; Ventricular Function, Left; Hypovolemia; Reproducibility of Results; Echocardiography; Hemodynamics
PubMed: 36840793
DOI: 10.1007/s10877-023-00983-w -
The Journal of Physiology Aug 2022The cardiovascular response resulting from the individual activation of the muscle mechanoreflex (MMR) or the chemoreflex (CR) is different between men and women....
The cardiovascular response resulting from the individual activation of the muscle mechanoreflex (MMR) or the chemoreflex (CR) is different between men and women. Whether the haemodynamic consequence resulting from the interaction of these sympathoexcitatory reflexes is also sex-dependent remains unknown. MMR and CR were activated by passive leg movement (LM) and exposure to hypoxia (O -CR) or hypercapnia (CO -CR), respectively. Twelve young men and 12 young women completed two experimental protocols: (1) resting in normoxia (P O : ∼83 mmHg, P CO : ∼34 mmHg), normocapnic hypoxia (P O : ∼48 mmHg, P CO : ∼34 mmHg) and hyperoxic hypercapnia (P O : ∼524 mmHg, P CO : ∼44 mmHg); (2) LM under the same gas conditions. During the MMR:O -CR coactivation, in men, the observed mean arterial pressure (MAP) and cardiac output (CO) were not different (additive effect), while the observed leg blood flow (LBF) and vascular conductance (LVC) were significantly lower (hypo-additive), compared with the sum of the responses elicited by each reflex alone. In women, the observed MAP was not different (additive) while the observed CO, LBF and LVC were significantly greater (hyper-additive), compared with the summated responses. During the MMR:CO -CR coactivation, in men, the observed MAP, CO and LBF were not different (additive), while the observed LVC was significantly lower (hypo-additive), compared with the summated responses. In women, the observed MAP was significantly higher (hyper-additive), while the observed CO, LBF and LVC were not different (additive), compared with the summated responses. The interaction of the MMR and CR has a pronounced influence on the autonomic cardiovascular control, with the haemodynamic consequences differing between men and women. KEY POINTS: The cardiovascular response resulting from the activation of the muscle mechanoreflex (MMR) or the chemoreflex (CR) was previously shown to be different between women and men; this study focused on the haemodynamic consequence of the interaction of these two sympathoexcitatory reflexes. MMR and CR were activated by passive leg movement and exposure to hypoxia (O -CR) or hypercapnia (CO -CR), respectively. Individual and interactive reflex effects on central and peripheral haemodynamics were quantified in healthy young women and men. In men, the MMR:O -CR and MMR:CO -CR interactions restricted peripheral haemodynamics, likely by potentiating sympathetic vasoconstriction. In women, the MMR:O -CR interaction facilitated central and peripheral haemodynamics, likely by potentiating sympathetic vasodilatation; however, the MMR:CO -CR interaction was simply additive for the central and peripheral haemodynamics. The interaction between the MMR and the CR exerts a profound influence on the autonomic control of cardiovascular function in humans, with the haemodynamic consequences differing between women and men.
Topics: Carbon Dioxide; Female; Hemodynamics; Humans; Hypercapnia; Hypoxia; Male; Muscles
PubMed: 35710103
DOI: 10.1113/JP283051 -
Industrial Health Aug 2017In the present study, two investigations were conducted at a communication center, to examine white-collar workers' hemodynamic responses during working hours. In...
In the present study, two investigations were conducted at a communication center, to examine white-collar workers' hemodynamic responses during working hours. In investigation I, hemodynamic responses were measured on a working day; and in investigation II, cardiovascular responses were verified on both working and non-working days. In investigation I, blood pressure, cardiac output, heart rate, stroke volume, and total peripheral resistance were measured in 15 workers during working hours (from 9:00 am to 18:00 pm) on one working day. Another 40 workers from the same workplace participated in investigation II, in which blood pressure and heart rate were measured between the time workers arose in the morning until they went to bed on 5 working days and 2 non-working days. The results showed that blood pressure increased and remained at the same level during working hours. The underlying hemodynamics of maintaining blood pressure, however, changed between the morning and the afternoon on working days. Cardiac responses increased in the afternoon, suggesting that cardiac burdens increase in the afternoon on working days. The present study suggested that taking underlying hemodynamic response into consideration is important for managing the work-related cardiovascular burden of white-collar workers.
Topics: Adult; Blood Pressure; Cardiac Output; Female; Heart Rate; Hemodynamics; Humans; Japan; Male; Middle Aged; Occupational Health; Stroke Volume; Vascular Resistance; Work
PubMed: 28428502
DOI: 10.2486/indhealth.2016-0183 -
Current Opinion in Critical Care Jun 2009Clinical examination of hemodynamically unstable patients provides timely, low-risk, and potentially useful diagnostic and prognostic information. This review will... (Review)
Review
PURPOSE OF REVIEW
Clinical examination of hemodynamically unstable patients provides timely, low-risk, and potentially useful diagnostic and prognostic information. This review will examine the evidence behind the use of clinical examination findings to drive treatment decisions and predict outcomes in patients with hemodynamic instability. An additional goal of the review is to place the use of clinical examination in context of more invasive techniques to diagnose and treat hemodynamically unstable patients.
RECENT FINDINGS
The development of novel diagnostic tests based on recently developed technology has focused attention on methods to determine when a test should enter routine clinical use. The widespread incorporation of pulmonary artery catheterization into clinical practice prior to formal evaluation of its ability to improve outcomes highlights the importance of properly evaluating diagnostic tests in critically ill patients. Formal evaluation of clinical examination as a diagnostic test will allow better understanding of its role in the hemodynamic evaluation of critically ill patients.
SUMMARY
Clinical examination remains an important initial step in the diagnosis and risk stratification of patients. Despite limitations of current techniques, the availability, low risk, and ability to perform repetitive tests ensure that clinical examination of the hemodynamically unstable patient will continue to be a useful tool for the intensivist until more useful tests are validated in this patient population.
Topics: Clinical Medicine; Critical Care; Decision Making; Evidence-Based Medicine; Hemodynamics; Humans; Physical Examination; Shock, Septic
PubMed: 19387339
DOI: 10.1097/MCC.0b013e32832b70e5