Body mass index and age are associated with ventricular end-diastolic pressure in adults with a Fontan circulation

Abstract Introduction: Systemic ventricular end-diastolic pressure is an important haemodynamic variable in adult patients with Fontan circulation. Risk factors associated with elevated end-diastolic pressure have not been clearly identified in this population. Methods: All patients > 18 years with Fontan circulation who underwent cardiac catheterisation at our centre between 1/08 and 3/19 were included. Relevant patient variables were extracted. Univariate and multivariate general linear models were analysed to identify variables associated with end-diastolic pressure. Results: Forty-two patients were included. Median age was 24.0 years (20.9–29.0) with a body mass index of 23.7 kg/m2 (21.5–29.7). 10 (23.8%) patients had a systemic right ventricle. The median (Interquartile range) and mean pulmonary artery pressure were 11.0 mmHg (9.0–12.0) and 16.0 mmHg (13.0–18.0), respectively. On univariate analysis, end-diastolic pressure was positively associated with body mass index (p < 0.01), age > 25 years (p = 0.04), symptoms of heart failure (p < 0.01), systemic ventricular systolic pressure (p = 0.03), pulmonary artery mean pressure (p < 0.01), and taking diuretics (p < 0.01) or sildenafil (p < 0.01). End-diastolic pressure was negatively associated with aortic saturation (p < 0.01). On multivariate analysis, end-diastolic pressure was positively associated with age ≥ 25 years (p < 0.01), and body mass index (p = 0.04). Conclusions: In a cohort of adult patients with Fontan circulation undergoing catheterisation, end-diastolic pressure was positively associated with age ≥ 25 years and body mass index on multivariate analysis. Maintaining a healthy body mass index may offer haemodynamic benefit in adults with Fontan physiology.

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Prediction of Difficult Mask Ventilation

Anesthesiology ◽

10.1097/00000542-200005000-00009 ◽

2000 ◽

Vol 92 (5) ◽

pp. 1229-1236 ◽

Cited By ~ 519

Author(s):

Olivier Langeron ◽

Eva Masso ◽

Catherine Huraux ◽

Michel Guggiari ◽

André Bianchi ◽

...

Keyword(s):

Body Mass Index ◽

Multivariate Analysis ◽

Confidence Interval ◽

Body Mass ◽

Univariate Analysis ◽

Positive Pressure ◽

Mask Ventilation ◽

Airway Patency ◽

Difficult Mask Ventilation ◽

History Of

Background Maintenance of airway patency and oxygenation are the main objectives of face-mask ventilation. Because the incidence of difficult mask ventilation (DMV) and the factors associated with it are not well known, we undertook this prospective study. Methods Difficult mask ventilation was defined as the inability of an unassisted anesthesiologist to maintain the measured oxygen saturation as measured by pulse oximetry > 92% or to prevent or reverse signs of inadequate ventilation during positive-pressure mask ventilation under general anesthesia. A univariate analysis was performed to identify potential factors predicting DMV, followed by a multivariate analysis, and odds ratio and 95% confidence interval were calculated. Results A total of 1,502 patients were prospectively included. DMV was reported in 75 patients (5%; 95% confidence interval, 3.9-6.1%), with one case of impossible ventilation. DMV was anticipated by the anesthesiologist in only 13 patients (17% of the DMV cases). Body mass index, age, macroglossia, beard, lack of teeth, history of snoring, increased Mallampati grade, and lower thyromental distance were identified in the univariate analysis as potential DMV risk factors. Using a multivariate analysis, five criteria were recognized as independent factors for a DMV (age older than 55 yr, body mass index > 26 kg/m2, beard, lack of teeth, history of snoring), the presence of two indicating high likelihood of DMV (sensitivity, 0.72; specificity, 0.73). Conclusion In a general adult population, DMV was reported in 5% of the patients. A simple DMV risk score was established. Being able to more accurately predict DMV may improve the safety of airway management.

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Effect of increased pulmonary vascular resistance on right ventricular systolic performance in dogs

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1984.246.3.h339 ◽

1984 ◽

Vol 246 (3) ◽

pp. H339-H343 ◽

Cited By ~ 1

Author(s):

M. Ghignone ◽

L. Girling ◽

R. M. Prewitt

Keyword(s):

Pulmonary Artery ◽

Right Ventricular ◽

Pulmonary Vascular Resistance ◽

Vascular Resistance ◽

Diastolic Pressure ◽

Systolic Pressure ◽

Glass Beads ◽

Ventricular Systolic Pressure ◽

Bead Injection ◽

The Right

We tested the possibility that for a given contractile state and right ventricular systolic pressure (RVSP), rate and extent of ventricular shortening would be reduced as resistance to ejection increased. In eight anesthetized, ventilated dogs, we measured RV and pulmonary artery pressure (Ppa), blood pressure, heart rate, cardiac output (CO), and RV dP/dt before (condition 1) and after (condition 2) pulmonary vascular resistance (PVR) was increased by injection of small (80 micron) glass beads. Glass beads caused a large increase (P less than 0.001) in Ppa and in RVSP and, despite increased RV end-diastolic pressure (EDP), CO and stroke volume (SV) were reduced. A third set of measurements was obtained following a further increase in resistance (condition 3). A comparison of condition 2 with condition 3, despite constant RVSP, constant mean Ppa, and increased EDP, showed a marked fall in CO and SV (P less than 0.001) when glass bead injection increased calculated resistance from 21 (condition 2) to 34 (condition 3) mmHg X 1(-1) X min. RV contractility, as assessed by Vmax and peak dP/dt was similar in both conditions. In five additional dogs, we measured the same parameters as before plus instantaneous pulmonary artery flow in all conditions. In a comparison of conditions 2 and 3, despite constant RVSP and increased EDP, peak and total flow (P less than 0.05) were reduced as resistance to RV ejection increased. We conclude that the right ventricle shortens more slowly and to a smaller extent against the same systolic pressure when its resistive afterload increases.

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Identification of patient variables that are associated with ventricular end-diastolic pressure before the bidirectional Glenn operation

Cardiology in the Young ◽

10.1017/s1047951121000810 ◽

2021 ◽

pp. 1-7

Author(s):

Matthew C. Schwartz ◽

Aravinth Karunanandaa ◽

William E. Anderson ◽

J. Rene Herlong ◽

Joseph Paolillo ◽

...

Keyword(s):

Right Ventricle ◽

Diastolic Pressure ◽

Fontan Operation ◽

Univariate Analysis ◽

Systolic Pressure ◽

Ventricular Systolic Pressure ◽

Bidirectional Glenn ◽

Systemic Right Ventricle ◽

History Of ◽

Patient Variables

Abstract Introduction: Systemic ventricular end-diastolic pressure is important in patients with single ventricle heart disease. Predictors of an elevated systemic ventricular end-diastolic pressure prior to bidirectional Glenn operation have been incompletely identified. Methods: All patients who underwent bidirectional Glenn operation operation at our centre between January 2007 and March 2017 were retrospectively identified and patient variables were extracted. For patients who had undergone Fontan operation at the time of this study, post-Fontan patient variables were also extracted. Results: One-hundred patients were included with a median age at pre-bidirectional Glenn operation catheterisation of 4.5 months. In total, 71 (71%) patients had a systemic right ventricle. At the pre-bidirectional Glenn operation catheterisation, the mean systemic ventricular end-diastolic pressure was higher amongst those with systemic right ventricle compared to left ventricle (9.1 mmHg ± 2.1 versus 7.7 ± 2.7 mmHg, p < 0.01). On univariate analysis, pre-bidirectional Glenn operation systemic ventricular end-diastolic pressure was positively associated with the presence of a systemic right ventricle (p < 0.01), history of recoarctation (p = 0.03), history of Norwood operation (p = 0.04), and ventricular systolic pressure (p < 0.01). On multivariate analysis, systemic ventricular end-diastolic pressure was positively associated with the presence of a systemic right ventricle (p < 0.01) and ventricular systolic pressure (p < 0.01). Amongst those who had undergone Fontan operation at the time of study (n = 49), those with a higher pre-bidirectional Glenn operation systemic ventricular end-diastolic pressure were more likely to have experienced death, transplantation, or listed for transplantation (p = 0.02) and more likely to have had heart failure symptoms (p = 0.04) at a mean time from Fontan of 5.2 years ± 1.3. Conclusions: In patients undergoing bidirectional Glenn operation operation, the volume-loaded, pre-bidirectional Glenn operation state may expose diastolic dysfunction that has prognostic value.

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Gambaran Tekanan Darah, Indeks Massa Tubuh, dan Aktivitas Fisik pada Mahasiswa Kedokteran Umum Angkatan Tahun 2014

Jurnal e-Biomedik ◽

10.35790/ebm.5.2.2017.18509 ◽

2017 ◽

Vol 5 (2) ◽

Author(s):

Yoel P. Abaa ◽

Hedison Polii ◽

Pemsi M. Wowor

Keyword(s):

Physical Activity ◽

Blood Pressure ◽

Body Mass Index ◽

Body Mass ◽

Random Sampling ◽

Diastolic Pressure ◽

Systolic Pressure ◽

Simple Random Sampling ◽

Normal Body Mass Index ◽

Cross Sectional

Abstract: This study was aimed to obtain the profile of blood pressure and factors that could influence blood pressure of Medical Faculty students of Sam Ratulangi University of Manado year 2014. This was a descriptive study with a cross sectional design. Study population consisted of 75 students year 2014. Respondents were 48 students obtained by using simple random sampling technique. The results showed that most respondents had normal systolic pressure (41 respondents; 85.4%), normal diastolic pressure (44 respondents; 91.6%), normal body mass index (27 respondents; 56.2%), and low physical activity (43 respondents; 89.6%). Conclusion: Most students had normal systolic blood pressure, normal diastolic blood pressure, normal BMI, and low physical activity.Keywords: blood pressure, body mass index, physical activity Abstrak: Penelitian ini bertujuan untuk mengetahui gambaran tekanan darah dan faktor-faktor yang dapat memengaruhi tekanan darah mahasiswa Fakultas Kedokteran Universitas Sam Ratulangi Manado angkatan tahun 2014. Jenis penelitian ialah deskriptif dengan desain potong lintang. Populasi penelitian ialah seluruh mahasiswa angkatan 2014 Fakultas Kedokteran Universitas Sam Ratulangi yang berjumlah 75 orang. Terdapat 48 responden diperoleh dengan teknik simple random sampling. Hasil penelitian mendapatkan bahwa tekanan sistolik terbanyak ialah kategori normal (41 responden; 85,4%) dan tekanan diastolik terbanyak ialah kategori normal (44 responden; 91,6%). Indeks massa tubuh terbanyak ialah kategori normal (27 responden; 56,2%). Tingkat aktivitas fisik responden terbanyak yaitu aktifitas fisik ringan 43 orang (89,6%). Simpulan: Pada penelitian ini sebagian besar mahasiswa memiliki tekanan darah sistolik kategori normal, tekanan darah diastolik kategori normal, IMT normal, dan aktivitas fisik ringan.Kata kunci: tekanan darah, indeks massa tubuh, dan aktivitas fisik

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Abstract 16135: Higher Body Mass Index in Early Childhood is Associated With Adult Obesity in Patients With a Fontan Circulation

Circulation ◽

10.1161/circ.142.suppl_3.16135 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Anjali P Chadayammuri ◽

Tarek ALSAIED ◽

Adam W Powell ◽

Samuel G Wittekind ◽

James Cnota ◽

...

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

Early Childhood ◽

Body Mass ◽

Diastolic Pressure ◽

Fontan Procedure ◽

Fontan Circulation ◽

Adult Obesity ◽

Obese Adults ◽

Cardiac Testing

Introduction: Obesity is associated with comorbidities that may be detrimental to single-ventricle patients who have had a Fontan procedure. We assessed the prevalence of obesity in adults with a Fontan circulation and evaluated the hypothesis that higher body mass index (BMI) in early childhood is associated with obesity in adulthood. Methods: Retrospective cohort study of patients with a Fontan circulation aged 18-32 years, seen 2011-2019. Those with an atriopulmonary Fontan or chromosomal abnormality known to affect growth were excluded. Historical height and weight measurements, results of recent cardiac testing, and body mass index (BMI) over time were recorded. Obesity was defined as BMI ≥30 kg/m 2 . The associations between childhood anthropometrics, adult BMI, and most recent cardiac testing were assessed. Results: The cohort included 113 adults with a Fontan circulation (median age 22.7 [IQR 20.2-26.4] years; 44% female). There were no significant differences in age, age at Fontan, Fontan type, or ventricular morphology between obese (n=21, 19%; 52% female) and non-obese (n=92, 81%; 41% female) patients. Compared to non-obese adults, obese patients had higher BMI percentiles at age 2 years (80 th [33-95] vs 43 rd [13-82] percentile, p=0.02), at age 4 years (90 th [73-93] vs 57 th [22-81] percentile, p=0.002), and at the time of the Fontan procedure (85 th [51-98] vs 20 th [5-57] percentile, p=0.002). Being overweight at time of Fontan (BMI percentile >85%) strongly predicted later obesity (OR=18.3, 95% CI 3.7-90.3, p<0.001). Obese adults had lower peak VO 2 (19.1±5.2 vs 25.5±6.6 mL/kg/min, p<0.001,) a trend to a lower % predicted VO 2 (59±13 vs 65±14% predicted, p=0.06), higher systolic blood pressure (121±17 vs 112±12 mmHg, p=0.007) and higher ventricular end-diastolic pressure (11±4 vs 9±3 mmHg, p= 0.03). Adult BMI weakly correlated with ventricular end-diastolic pressure (r=0.24, p=0.048). Conclusions: Higher BMI in early childhood is associated with obesity in adults with a Fontan circulation. Adult obesity is associated with worse exercise capacity, higher blood pressure, and higher ventricular end-diastolic pressure. Weight interventions in children with a Fontan circulation may help prevent later obesity and its adverse consequences.

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Prognostic significance of body mass index in breast cancer patients with hormone receptor-positive tumours after curative surgery

Clinical & Investigative Medicine ◽

10.25011/cim.v36i6.20627 ◽

2013 ◽

Vol 36 (6) ◽

pp. 297 ◽

Cited By ~ 4

Author(s):

Peng Xing ◽

Ji-Guang Li ◽

Feng Jin ◽

Ting-Ting Zhao ◽

Qun Liu ◽

...

Keyword(s):

Breast Cancer ◽

Body Mass Index ◽

Body Mass ◽

Hormone Receptor ◽

Univariate Analysis ◽

Prognostic Significance ◽

Axillary Lymph ◽

Nodal Stage ◽

Hormone Receptor Positive ◽

High Bmi

Purpose: Obesity has been recognized as a significant risk factor for postmenopausal breast cancer. The aim of this study is to investigate the prognostic significance of body mass index (BMI) in hormone receptor-positive, operable breast cancer. Methods: In this retrospective cohort study, 1,192 consecutive patients with curative resection of primary breast cancer were enrolled. Patients were assigned to two groups according to BMI: normal or underweight (BMI < 23.0 kg/m2) and overweight or obese (BMI ≥23.0 kg/m2). Associations among BMI and clinicopathological characteristics and prognosis of patients were assessed. Results: A high BMI was significantly (P < 0.01) correlated with age, nodal stage, ALNR, ER positivity, PR positivity and menopausal status at diagnosis. Univariate analysis revealed that BMI, pathologic T stage, nodal stage, axillary lymph node ratio (ALNR) and adjuvant radiotherapy history were significantly (P < 0.05) associated with disease-free survival and overall survival, irrespective of tumour hormone receptor status. Multivariate analysis revealed BMI as an independent prognostic factor in all cases and in hormone receptor-positive cases. Conclusion: A high BMI (≥23.0 kg/m^2) is independently associated with poor prognosis in hormone receptor-positive breast cancer.

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Serum Periostin as a Potential Biomarker in Pediatric Patients with Primary Hypertension

Journal of Clinical Medicine ◽

10.3390/jcm10102138 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2138

Author(s):

Michał Szyszka ◽

Piotr Skrzypczyk ◽

Anna Stelmaszczyk-Emmel ◽

Małgorzata Pańczyk-Tomaszewska

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

Uric Acid ◽

Body Mass ◽

Pediatric Patients ◽

Univariate Analysis ◽

Primary Hypertension ◽

Potential Biomarker ◽

Arterial Damage ◽

Serum Periostin

Experimental studies suggest that periostin is involved in tissue repair and remodeling. The study aimed to evaluate serum periostin concentration as potential biomarker in pediatric patients with primary hypertension (PH). We measured serum periostin, blood pressure, arterial damage, biochemical, and clinical data in 50 children with PH and 20 age-matched healthy controls. In univariate analysis, children with PH had significantly lower serum periostin compared to healthy peers (35.42 ± 10.43 vs. 42.16 ± 12.82 [ng/mL], p = 0.038). In the entire group of 70 children serum periostin concentration correlated negatively with peripheral, central, and ambulatory blood pressure, as well as with aortic pulse wave velocity (aPWV). In multivariate analysis, periostin level significantly correlated with age (β = −0.614, [95% confidence interval (CI), −0.831–−0.398]), uric acid (β = 0.328, [95%CI, 0.124–0.533]), body mass index (BMI) Z-score (β = −0.293, [95%CI, −0.492–−0.095]), high-density lipoprotein (HDL)-cholesterol (β = 0.235, [95%CI, 0.054–0.416]), and triglycerides (β = −0.198, [95%CI, −0.394–−0.002]). Neither the presence of hypertension nor blood pressure and aPWV influenced periostin level. To conclude, the role of serum periostin as a biomarker of elevated blood pressure and arterial damage in pediatric patients with primary hypertension is yet to be unmasked. Age, body mass index, uric acid, and lipid concentrations are key factors influencing periostin level in pediatric patients.

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Effect of individual- versus collective-based nutritional-lifestyle intervention on the atherogenic index of plasma in children with obesity: a randomized trial

Nutrition & Metabolism ◽

10.1186/s12986-020-00537-w ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Elvira Verduci ◽

Giuseppe Banderali ◽

Elisabetta Di Profio ◽

Sara Vizzuso ◽

Gianvincenzo Zuccotti ◽

...

Keyword(s):

Body Mass Index ◽

Lifestyle Intervention ◽

Body Mass ◽

Univariate Analysis ◽

Atherogenic Index ◽

Z Score ◽

Blood Profile ◽

Atherogenic Index Of Plasma ◽

Paediatric Obesity ◽

The Individual

Abstract Background The Atherogenic Index of Plasma is a predictive biomarker of atherosclerosis in adults but there is a lack of studies in paediatric population aimed at evaluating the longitudinal changes of the AIP and of the cardiometabolic blood profile related to nutritional interventions. The aim of this study was to compare the effect of individual- versus collective-based nutritional-lifestyle intervention on the Atherogenic Index of Plasma in schoolchildren with obesity. Methods One-hundred sixty-four children aged 6–12 years with Body Mass Index z-score > 2 referred to the Paediatric Obesity Clinic, San Paolo Hospital, Milan, Italy, were consecutively enrolled and randomized to undergo to either an individual- (n = 82) or a collective- (n = 82) based intervention promoting a balanced normo-caloric diet and physical activity. In addition, the individual intervention included a tailored personalized nutritional advice and education based on the revised Coventry, Aberdeen, and London-Refined taxonomy. Both at baseline and after 12 months of intervention, dietary habits and anthropometric measures were assessed, a fasting blood sample were taken for biochemistry analysis. Results The participation rate at 12 months was 93.3% (n = 153 patients), 76 children in the individual-intervention and 77 children in the collective intervention. At univariate analysis, mean longitudinal change in Atherogenic Index of Plasma was greater in the individual than collective intervention (− 0.12 vs. − 0.05), as well as change in triglyceride-glucose index (− 0.22 vs. − 0.08) and Body Mass Index z-score (− 0.59 vs. − 0.37). At multiple analysis, only change in Body Mass Index z-score remained independently associated with intervention (odds ratio 3.37). Conclusion In children with obesity, an individual-based nutritional and lifestyle intervention, including techniques from the CALO-RE taxonomy, could have an additional beneficial effect over a collective-based intervention, although the actual size of the effect remains to be clarified. Trial Registration Clinical Trials NCT03728621

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Major post-prostate biopsy complications under antibiotic augmentation prophylaxis protocol

Journal of Clinical Urology ◽

10.1177/2051415820984037 ◽

2021 ◽

pp. 205141582098403

Author(s):

Antônio Antunes Rodrigues ◽

Valdair Muglia ◽

Emanuel Veras de Albuquerque ◽

Rafael Ribeiro Mori ◽

Rafael Neuppmann Feres ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Antibiotic Prophylaxis ◽

Body Mass ◽

Bacterial Resistance ◽

Univariate Analysis ◽

Specific Antigen ◽

Outlet Obstruction ◽

Psa Density ◽

Biopsy Complications

Objective: To identify risk factors for major post-biopsy complications under augmented prophylaxis protocol. The risk factors already described mainly comprise outdated antibiotic prophylaxis protocols. Material and methods: This retrospective cohort study included patients that underwent transrectal ultrasound-guided biopsies, from 2011 to 2016. All patients had received antibiotic prophylaxis with ciprofloxacin and gentamicin. Patients were grouped according to the presence or absence of post-biopsy complications. Demographic variables and possible risk factors based on routine clinical assessment were registered. Correlation tests, univariate and multivariate analyses were used to identify risk factors for post-biopsy complications. Results: Of the 404 patients that were included, 25 (6.2%) presented 27 post-biopsy complications, distributed as follows: acute urinary retention ( n = 14, 3.5%), infections ( n = 11, 2.7%) and hemorrhage ( n = 2, 0.5%). On univariate analysis, patients who presented complications showed higher body mass index and post-voiding residual volumes. Multivariate analysis identified ethnicity and prostate-specific antigen (PSA) density as possible risk factors for biopsy complications. The presence of bacterial resistance identified by rectal swabs did not correlate with the incidence of complications and infections. Conclusions: Non-infectious post-biopsy complications were more frequent than infectious ones in this cohort. Higher post-voiding residual volumes and PSA density, that indicates prostate enlargement, were identified as risk factors and interpreted as secondary to bladder outlet obstruction. The higher body mass index and ethnicity were also identified as risk factors and attributed to the heterogeneity of the patients included. Level of evidence: Not applicable for this multicentre audit.

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Right ventricular pressure response to +GZ acceleration stress

Journal of Applied Physiology ◽

10.1152/jappl.1982.53.4.908 ◽

1982 ◽

Vol 53 (4) ◽

pp. 908-913 ◽

Cited By ~ 2

Author(s):

J. E. Whinnery ◽

M. H. Laughlin

Keyword(s):

Right Ventricular ◽

Diastolic Pressure ◽

Vena Cava ◽

Systolic Pressure ◽

Ventricular Pressure ◽

Miniature Swine ◽

Right Ventricular Systolic Pressure ◽

Ventricular Systolic Pressure ◽

The Right ◽

Acceleration Stress

Measurements of right ventricular pressure in miniature swine were made at +Gz levels from +1 through +9 Gz. Polyethylene catheters were chronically placed in the cranial vena cava of five 2-yr-old female miniature swine (35–50 kg). The catheters were large enough to allow the introduction of a Millar pressure transducer into the venous system for placement in the right heart. The animals were fitted with an abdominal anti-G suit, restrained in a fiberglass couch, and exposed to the various +Gz levels on a centrifuge while fully conscious and unanesthetized. Right ventricular pressure and heart rate were measured during and for 2 min following 30-s exposures to each level of +Gz stress. The maximum right ventricular systolic pressure observed during +Gz was 200 Torr at +5 Gz with the maximum diastolic pressure being 88 Torr observed at +5 Gz. Mean heart rates were 200–210 beats/min at all levels of +Gz greater than or equal to +3 Gz when the animal remained stable. Mean maximum right ventricular pressures during +Gz stress were observed to increase through +5 Gz (85 Torr) and to decrease at higher levels of +Gz, indicating that through +5 Gz there is at least a partial compensation during acceleration stress. Decompensation in response to the stress began to occur during acceleration above +5 Gz with all animals decompensating during +9 Gz.

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