P4518Cerebral blood flow is lower in heart failure patients with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Babayigit ◽  
Y Cavusoglu ◽  
M Dural ◽  
K U Mert ◽  
T Ulus ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ejection Fraction ◽  
Control Group ◽  
Mean Flow ◽  
Control Groups ◽  
Reduced Ejection Fraction ◽  
And Control ◽  
Flow Velocities

Abstract Purpose Heart and brain interaction is a well-known entity in heart failure (HF) and left ventricular systolic dysfunction poses an increased risk for stroke and cognitive impairment. Transcranial Doppler (TCD) provides valuable information on cerebral blood flow and detects microembolic signals that can be used to determine the risk of cerebrovascular events. However, less is known about cerebral blood flow in HF patients with reduced EF. So, we aimed to evaluate cerebral blood flow rates by means of TCD in HF patients with reduced ejection fraction (EF). Methods This study included 46 HF patients with an EF less than 35% (mean age 65.2±11 years, mean EF 20.1±3.8%) who underwent to TCD examination. In addition, 26 healthy individuals with sinus rhythm and EF >50% (mean age 64.4±9.0 years, mean EF 63.5±2.38%) were included in the study as a control group. Minimum, maximum and mean flow velocities of the both right middle cerebral artery (RMCA) and left middle cerebral artery (LMCA) determined by TCD were analyzed. Results The average of RMCA maximum and mean flow velocities were found to be significantly lower in HF patients than those in control group (76,06±23,7 cm/s and 48,49±16,4 cm/s in HF group vs 87,84±14,5 cm/s and 56,41±10,7 cm/s in control group, p=0,025 and p=0,016, respectively). The average of LMCA maximum and mean flow velocities were also significantly lower in HF patients than those in control group (75,1±22,3 cm/s and 47,57±14.8 cm/s in HF group vs 88,73±17,7 cm/s and 57,15±12,4 cm/s in control group, p=0,009 and p=0,007, respectively). However, there was no significant difference in minimum RMCA or LMCA flow velocities between HF group and control groups (33,5±10,6 cm/s and 32,86±9,58 cm/s in HF group vs 36,34±9,2 cm/s and 36,53±10,4 cm/s in control group, p=0,226 and p=0,157, respectively). No significant microembolic signals were detected in HF and control groups. Conclusions The results of this study showed that HF patients with reduced EF have lower cerebral blood flow velocities as compared to healthy controls, which might be one of the explanations of the adverse interaction between heart and brain in HF.

The use of peripherally inserted central catheter reduced the incidence of phlebitis in heart failure patients: A randomized trial

2021 ◽  
pp. 112972982110596
Author(s):  
Eunice Vieira Cavalcante Silva ◽  
Marcelo Eidi Ochiai ◽  
Kelly Regina Novaes Vieira ◽  
Antonio Carlos Pereira Barretto
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Severe Heart Failure ◽  
Decompensated Heart Failure ◽  
Venous Access ◽  
Control Group ◽  
Control Groups ◽  
Heart Failure Patients ◽  
Peripheral Venous Access ◽  
And Control

Background: During decompensated heart failure, the use of intravenous inotropes can be necessary. With peripheral venous access, prolonged inotrope infusion can cause phlebitis. However, traditional central venous catheters have possible complications. Peripherally inserted central catheters (PICCs) may be an alternative to traditional catheters. Aim: Our objective was to compare the incidence of phlebitis between patients with PICC and those with peripheral venous access catheter indwelling. Methods: In a randomized clinical trial, the patients were randomized to PICC and control groups, with 40 patients in each group. The inclusion criteria were hospitalized patients with advanced heart failure, ejection fraction of <0.45, and platelet count of >50,000/mm3 and current use of continuous intravenous infusion of dobutamine. The patients were randomly assigned to receive a PICC or keep their peripheral venous access. The primary end point was the occurrence of phlebitis. Results: The PICC and control groups included 40 patients each. The median age was 61.5 years; ejection fraction, 0.24; and dobutamine dose, 7.73 µg/(kg min). Phlebitis occurred in 1 patient (2.5%) in the PICC group and in 38 patients (95.0%) in the control group, with an odds ratio of 0.10% (95% confidence interval: 0.01%–1.60%, p < 0.001). Conclusion: In conclusion, in severe heart failure patients who received intravenous dobutamine, PICC use reduced the incidence of phlebitis when compared to patients with peripheral venous access. Therefore, the PICC use should considered over peripheral venous access for prolonged intravenous therapy in heart failure patients.

Abnormal nailfold videocapillaroscopic findings in heart failure patients with preserved ejection fraction

2020 ◽  
pp. 1-7
Author(s):  
Serkan Yüksel ◽  
Esra Pancar Yüksel ◽  
Murat Meriç
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Control Group ◽  
Preserved Ejection Fraction ◽  
Control Groups ◽  
Nailfold Videocapillaroscopy ◽  
Heart Failure Patients ◽  
Significant Difference ◽  
Patients With Heart Failure ◽  
And Control

BACKGROUND: Microvascular dysfunction is one of the pathophysiological mechanisms in heart failure. Nailfold videocapillaroscopy is a noninvasive technique used to examine the microvasculature. OBJECTIVE: In this study; we aimed to investigate the nailfold capillaroscopic abnormalities in heart failure patients with reduced and preserved ejection fraction and compare those with control group. METHODS: Three groups of patients were recruited for the study: HFrEF group includes the patients with heart failure with reduced ejection fraction (HFrEF), HFpEF group, patients with heart failure with preserved ejection fraction (HFpEF) and control group, healthy asymptomatic individuals. Nailfold videocapillaroscopy was performed with a videodermatoscope and all nailfold images were evaluated for enlargement and hemorrhages. RESULTS: Abnormal videocapillaroscopic findings including enlargement and/or hemorrhages were present in 7 (24%) patients in HFrEF group, 19 (66%) patients in HFpEF group and 11 (37%) in control group. The number of patients with abnormal videocapillaroscopic findings were significantly greater in HFpEF group compared to HFrEF (p <  0.05) and control groups (p <  0.05). However, no significant difference was observed in videocapillaroscopic findings between HFrEF and control groups. CONCLUSIONS: Our study showed that microvascular abnormalities demonstrated by videodermatoscopic examination of nailfold capillaries are considerably more common in HFpEF patients compared to HFrEF and control groups.

scholarly journals Hemodynamic responses to small muscle mass exercise in heart failure patients with reduced ejection fraction

2014 ◽  
Vol 307 (10) ◽  
pp. H1512-H1520 ◽  
Author(s):  
Zachary Barrett-O'Keefe ◽  
Joshua F. Lee ◽  
Amanda Berbert ◽  
Melissa A. H. Witman ◽  
Jose Nativi-Nicolau ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Ejection Fraction ◽  
Muscle Mass ◽  
Maximum Voluntary Contraction ◽  
Exercise Intolerance ◽  
Control Group ◽  
Hemodynamic Responses ◽  
Reduced Ejection Fraction ◽  
Small Muscle

To better understand the mechanisms responsible for exercise intolerance in heart failure with reduced ejection fraction (HFrEF), the present study sought to evaluate the hemodynamic responses to small muscle mass exercise in this cohort. In 25 HFrEF patients (64 ± 2 yr) and 17 healthy, age-matched control subjects (64 ± 2 yr), mean arterial pressure (MAP), cardiac output (CO), and limb blood flow were examined during graded static-intermittent handgrip (HG) and dynamic single-leg knee-extensor (KE) exercise. During HG exercise, MAP increased similarly between groups. CO increased significantly (+1.3 ± 0.3 l/min) in the control group, but it remained unchanged across workloads in HFrEF patients. At 15% maximum voluntary contraction (MVC), forearm blood flow was similar between groups, while HFrEF patients exhibited an attenuated increase at the two highest intensities compared with controls, with the greatest difference at the highest workload (352 ± 22 vs. 492 ± 48 ml/min, HFrEF vs. control, 45% MVC). During KE exercise, MAP and CO increased similarly across work rates between groups. However, HFrEF patients exhibited a diminished leg hyperemic response across all work rates, with the most substantial decrement at the highest intensity (1,842 ± 64 vs. 2,675 ± 81 ml/min; HFrEF vs. control, 15 W). Together, these findings indicate a marked attenuation in exercising limb perfusion attributable to impairments in peripheral vasodilatory capacity during both arm and leg exercise in patients with HFrEF, which likely plays a role in limiting exercise capacity in this patient population.

scholarly journals Changes in cerebral blood flow velocity in patients with hypothyroidism

2011 ◽  
Vol 165 (3) ◽  
pp. 465-468 ◽  
Author(s):  
Uygar Utku ◽  
Mustafa Gokce ◽  
Mesut Özkaya
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Hormone Replacement ◽  
Control Group ◽  
Control Groups ◽  
Blood Flow Velocities ◽  
Flow Velocities

BackgroundAt present, hypothyroidism is a well-known risk factor for cardiovascular disorders. The aim of this study was to assess the effects of hypothyroidism on cerebral blood flow velocity with transcranial Doppler (TCD) ultrasonography.Design and methodsIn this study, 30 subjects were enrolled for clinical, subclinical, and healthy control groups. Bilateral middle cerebral artery (MCA) peak-systolic, end-diastolic, and mean blood flow velocities; Gosling's pulsatility index values; and Pourcelot's resistance index values were recorded and compared with each other. TCD was performed in clinical hypothyroid patients after they became euthyroid with thyroid hormone replacement therapy (HRT). The initial and post-HRT results for the clinical hypothyroid group were then compared and evaluated.ResultsThere were 30 subjects in each group. Men/women ratio and mean age in clinical hypothyroid, subclinical hypothyroid, and control groups were 3/27, 4/26, and 5/25, and 37.4, 34.4, and 36.7 respectively. Peak-systolic, end-diastolic, and mean blood flow velocities of bilateral MCA were similar in clinical and subclinical hypothyroid groups but significantly higher when compared with the control group. After adequate thyroid HRT in clinical hypothyroid group, the peak-systolic, end-diastolic, and mean blood flow velocities were significantly decreased.ConclusionsIncreased cerebral blood flow velocities were observed in clinical and subclinical patients with hypothyroidism. The normalization of increased blood flow velocity with thyroid HRT suggests a reversible condition.

P6287Analysis of novel cardiac markers sST2 and IL-33 in chronic heart failure with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Jirak ◽  
M Lichtenauer ◽  
B Wernly ◽  
V Paar ◽  
C Jung ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Inverse Correlation ◽  
Serum Levels ◽  
Control Group ◽  
Significant Elevation ◽  
Serum Samples ◽  
Reduced Ejection Fraction ◽  
Stress Studies ◽  
Cardiac Strain

Abstract Background Soluble (s) ST-2 has been recently evaluated as a monitoring parameter in heart failure (HF). Besides being a marker for cardiac strain and hemodynamic stress, studies also found an influence of ST2 on the immune system, above all mediated through its Janus-Face ligand IL-33, an alarmin released under stress conditions or by cellular death. In contrast to sST2, the role of IL-33 in HF is yet unknown. Objective In this project, we aimed for an analysis of the ST2/IL33 pathway in patients with heart failure with reduced ejection fraction (HFrEF). Methods In total, 200 patients were included in the study: 59 with ischemic (ICM), 65 with dilated (DCM) cardiomyopathy (mean LVEF 38%), as well as 76 control patients without coronary artery disease or signs of heart failure. Serum samples were analyzed by use of ELISA after informed consent. Results sST2 showed a significant elevation in all HF patients (p<0.0001) compared to the control group. No significant differences in levels of sST2 were observed between ICM and DCM patients. In contrast to sST2, no differences between HF patients and control group were observed for IL-33. Furthermore, sST2 showed a significant correlation with CRP (p<0.001, r=0.28), NT-pro-BNP (p<0.0001, r=0.40) and an inverse correlation with ejection fraction (p<0.0001, r=−0.40). Additionally, sST2 showed a significant elevation in patients in NYHA stages I-II (p=0.030) and NYHA stages III-IV (p<0.01). Again, no significant correlations were observed between IL-33 and parameters mentioned above. Analysis of sST2 in heart failure Conclusions We observed a significant increase and correlation with disease severity of sST2 in chronic HFrEF patients of both ischemic and non-ischemic origin, but contrary to our expectations, no significant changes in serum levels of IL-33. Thus, a mechanism independent of ST2/IL33 axis could be responsible of sST2 secretion in HF. Further studies including acute decompensated patients could provide a better understanding of the IL-33 role in HF.

scholarly journals HOBOE (Head-of-Bed Optimization of Elevation) Study: Association of Higher Angle With Reduced Cerebral Blood Flow Velocity in Acute Ischemic Stroke

2011 ◽  
Vol 91 (10) ◽  
pp. 1503-1512 ◽  
Author(s):  
Abigail Jade Hunter ◽  
Suzanne J. Snodgrass ◽  
Debbie Quain ◽  
Mark W. Parsons ◽  
Christopher R. Levi
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ischemic Stroke ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Mean Flow ◽  
Study Association ◽  
Blood Flow Velocities ◽  
Flow Velocities

BackgroundCerebral autoregulation can be impaired after ischemic stroke, with potential adverse effects on cerebral blood flow during early rehabilitation.ObjectiveThe objective of this study was to assess changes in cerebral blood flow velocity with orthostatic variation at 24 hours after stroke.DesignThis investigation was an observational study comparing mean flow velocities (MFVs) at 30, 15, and 0 degrees of elevation of the head of the bed (HOB).MethodsEight participants underwent bilateral middle cerebral artery (MCA) transcranial Doppler monitoring during orthostatic variation at 24 hours after ischemic stroke. Computed tomography angiography separated participants into recanalized (artery completely reopened) and incompletely recanalized groups. Friedman tests were used to determine MFVs at the various HOB angles. Mann-Whitney U tests were used to compare the change in MFV (from 30° to 0°) between groups and between hemispheres within groups.ResultsFor stroke-affected MCAs in the incompletely recanalized group, MFVs differed at the various HOB angles (30°: median MFV=51.5 cm/s, interquartile range [IQR]=33.0 to 103.8; 15°: median MFV=55.5 cm/s, IQR=34.0 to 117.5; 0°: median MFV=85.0 cm/s, IQR=58.8 to 127.0); there were no significant differences for other MCAs. For stroke-affected MCAs in the incompletely recanalized group, MFVs increased with a change in the HOB angle from 30 degrees to 0 degrees by a median of 26.0 cm/s (IQR=21.3 to 35.3); there were no significant changes in the recanalized group (−3.5 cm/s, IQR=−12.3 to 0.8). The changes in MFV with a change in the HOB angle from 30 degrees to 0 degrees differed between hemispheres in the incompletely recanalized group but not in the recanalized group.LimitationsGeneralizability was limited by sample size.ConclusionsThe incompletely recanalized group showed changes in MFVs at various HOB angles, suggesting that cerebral blood flow in this group may be sensitive to orthostatic variation, whereas the recanalized group maintained stable blood flow velocities.

scholarly journals Cerebral blood flow changes during intermittent acute hypoxia in patients with heart failure

2018 ◽  
Vol 46 (10) ◽  
pp. 4214-4225 ◽  
Author(s):  
Antonio P. Mansur ◽  
Glaura Souza Alvarenga ◽  
Liliane Kopel ◽  
Marco Antonio Gutierrez ◽  
Fernanda Marciano Consolim-Colombo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Artery ◽  
Brachial Artery ◽  
Minute Ventilation ◽  
Acute Hypoxia ◽  
Carbon Dioxide Concentration ◽  
Control Group ◽  
Compensatory Mechanisms

Objective Heart failure (HF) is associated with intermittent hypoxia, and the effects of this hypoxia on the cardiovascular system are not well understood. This study was performed to compare the effects of acute hypoxia (10% oxygen) between patients with and without HF. Methods Fourteen patients with chronic HF and 17 matched control subjects were enrolled. Carotid artery changes were examined during the first period of hypoxia, and brachial artery changes were examined during the second period of hypoxia. Data were collected at baseline and after 2 and 4 minutes of hypoxia. Norepinephrine, epinephrine, dopamine, and renin were measured at baseline and after 4 minutes hypoxia. Results The carotid blood flow, carotid systolic diameter, and carotid diastolic diameter increased and the carotid resistance decreased in patients with HF. Hypoxia did not change the carotid compliance, distensibility, brachial artery blood flow and diameter, or concentrations of sympathomimetic amines in patients with HF, but hypoxia increased the norepinephrine level in the control group. Hypoxia increased minute ventilation and decreased the oxygen saturation and end-tidal carbon dioxide concentration in both groups. Conclusion Hypoxia-induced changes in the carotid artery suggest an intensification of compensatory mechanisms for preservation of cerebral blood flow in patients with HF.

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