scholarly journals Acute Surgical Anemia Influences the Cardioprotective Effects of β-Blockade

2010 ◽  
Vol 112 (1) ◽  
pp. 25-33 ◽  
Author(s):  
W Scott Beattie ◽  
Duminda N. Wijeysundera ◽  
Keyvan Karkouti ◽  
Stuart McCluskey ◽  
Gordon Tait ◽  
...  
Keyword(s):  
Beta Blocker ◽  
Major Adverse Cardiac Event ◽  
Cardiac Event ◽  
Propensity Scores ◽  
Beta Blockers ◽  
Adverse Cardiac Event ◽  
Beta Blockade ◽  
Cardiac Events ◽  
Cardioprotective Effects ◽  
The Relationship

Background Despite decreasing cardiac events, perioperative beta-blockade also increases perioperative stroke and mortality. Major bleeding and/or hypotension are independently associated with these outcomes. To investigate the hypothesis that beta-blockade limits the cardiac reserve to compensate for acute surgical anemia, the authors examined the relationship between cardiac events and acute surgical anemia in patients with and without beta-blockade. Methods The records of all noncardiac, nontransplant surgical patients between March 2005 and June 2006 were retrospectively retrieved. The primary outcome was a composite that comprised myocardial infarction, nonfatal cardiac arrest, and in-hospital mortality (major adverse cardiac event). The lowest recorded hemoglobin in the first 3 days defined nadir hemoglobin. Propensity scores estimating the probability of receiving a perioperative beta-blocker were used to match (1:1) patients who did or did not receive beta-blockers postoperatively. The relationship between nadir hemoglobin and major adverse cardiac event was then assessed. Results This analysis identified 4,387 patients in whom nadir hemoglobin could be calculated; 1,153 (26%) patients were administered beta-blockers within the first 24 h of surgery. Propensity scores created 827 matched pairs that were well balanced for all measured confounders. Major adverse cardiac event occurred in 54 (6.5%) beta-blocked patients and in 25 (3.0%) beta-blocker naive patients (relative risk 2.38; 95% CI 1.43-3.96; P = 0.0009). The restricted cubic spline relationship demonstrated that this difference was restricted to those patients in whom the hemoglobin decrease exceeded 35% of the baseline value. Conclusions beta-Blocked patients do not seem to tolerate surgical anemia when compared with patients who are naive to beta-blockers. Prospective studies are required to validate these findings.

Impact of Beta-Blockade on Cardiac Events in Patients with Chronic Severe Nonischemic Mitral Regurgitation

Cardiology ◽  
2017 ◽  
Vol 139 (1) ◽  
pp. 1-6
Author(s):  
Phyllis G. Supino ◽  
Ofek Y. Hai ◽  
Abhishek Sharma ◽  
Joshua Lampert ◽  
Clare Hochreiter ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Ejection Fraction ◽  
Cardiac Event ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Beta Blockade ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
Annual Risk

Objectives: The aim of this study was to examine the impact of beta-blockade on cardiac events among patients with initially asymptomatic chronic severe nonischemic mitral valve regurgitation (MR). Methods: Data from 52 consecutive patients in our prospective natural history study of isolated chronic severe nonischemic MR were assessed post hoc over 19 years to examine the relation of chronic beta-blockade use to subsequent cardiac events (death or indications for mitral valve surgery, MVS). At entry, all patients were free of surgical indications; 9 received beta-blockers. Cardiac event rate differences were analyzed by Kaplan-Meier log rank comparison. Results: During follow-up, cardiac events included sudden death (1), heart failure (8), atrial fibrillation (6), left ventricular dimensions at systole ≥4.5 cm (11), left ventricular ejection fraction <60% (6), right ventricular ejection fraction <35% (2), and a combination of cardiac events (7). The cardiac event risk was 4-fold higher among patients receiving beta-blockers (average annual risk = 60.6%) versus those not receiving beta-blockers (average annual risk = 15.2%; p = 0.001). These effects remained statistically significant (p = 0.005) when analysis was adjusted for other baseline covariates. Conclusions: Beta-blockade appears to confer an increased risk of sudden cardiac death or indications for MVS among patients with chronic severe nonischemic MR. Randomized trials are needed to confirm these findings.

scholarly journals The Roles of Pentraxin-3 to Predict In-Hospital and Three Months Major Adverse Cardiac Event in Acute Myocardial Infarction

2020 ◽  
Vol 6 (2) ◽  
pp. 111-120
Author(s):  
Adi Bestara ◽  
Trisulo Wasyanto ◽  
Niniek Purwaningtyas
Keyword(s):  
Myocardial Infarction ◽  
Major Adverse Cardiac Event ◽  
Cardiac Event ◽  
Vascular Inflammation ◽  
Adverse Cardiac Event ◽  
Pentraxin 3 ◽  
Ptx3 Level ◽  
St Elevation ◽  
The Relationship

Background: Pentraxin-3 (PTX3) was a useful marker for localized vascular inflammation and damage in the cardiovascular system. Recent studies have shown that plasma PTX3 is elevated in patients with myocardial infarction; however, its prognostic value still remains unclear. Aims: This study aimed to investigate the relationship between PTX3 and in-hospital and three months of a major adverse cardiac event (MACE) in acute ST-elevation and non-ST-elevation myocardial infarction patients. Methods: This cohort study conducted from September 1st, 2018 to October 31st, 2019 in Dr. Moewardi Hospital. A 144 patient were observed during hospitalization and 130 survived patient were follow up for three months. The admission PTX3 was compared between the patient with and without MACE. Higher levels of PTX3 were defined as concentrations greater than the optimal cut-off value derived from the Receiver Operating Characteristic (ROC) curve. Results: Among patients, 43.75% was anterior STEMI, 35.42% was inferior STEMI, and 20.38% was NSTEMI with median PTX3 level was 8.16 (0.21-69.35) ng/mL. The in-hospital MACE occurred in 52% of patients, while three months of MACE occurred in 17% patient. Patients with MACE had a higher level of PTX3 compared without MACE (p<0.001) during hospitalization, but not in three months follow up (p=0.408). Multivariate analysis also shown PTX3 was as a predictor of in-hospital MACE (OR 1.127; p=0.001), along with heart rate (OR 1.025; p=0.015). There are different of in-hospital MACE between the patient with high (≥8.247 ng/mL) and low (<8.225 ng/mL) PTX3 level with a hazard ratio (HR) 2.142 (95%CI 1.315-3.487; p=0.002), but the result did not similar after three months follow up (p=0.373). Conclusion: The PTX3 can be used as a predictor of in-hospital MACE but not for three months follow up.

scholarly journals Perioperative Beta-blockade: Guidelines and Practice in New Zealand

2005 ◽  
Vol 33 (5) ◽  
pp. 645-650 ◽  
Author(s):  
J. Weller ◽  
Z. Karim
Keyword(s):  
At Risk ◽  
New Zealand ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Beta Blockade ◽  
Adrenergic Blockade ◽  
Cardiac Events ◽  
Patients At Risk ◽  
Risk Patients ◽  
Barriers To Implementation

The aim of our study was to describe the knowledge and practice of New Zealand anaesthetists in relation to perioperative beta-adrenergic blockade, and to define barriers to implementation of perioperative beta-blockade in surgical patients at risk of myocardial ischaemia. A survey was sent to 400 New Zealand specialist anaesthetists. Information was sought on their knowledge and current practice relating to perioperative beta-blockade, and the barriers encountered to implementing therapy. The response rate was 59%. Perioperative beta-blockade was seen as beneficial in at risk patients by 95% of responding anaesthetists, but practice varied widely. Only 45% of anaesthetists always or usually commenced a beta blocker perioperatively, a department protocol was available to only 20%, and understanding of indications and contraindications to beta-blockade varied. There were logistical difficulties when initiating and monitoring perioperative beta-blocker regimens, and where treatment required multidisciplinary commitment. The lack of clarity of the guidelines was also a barrier to more widespread use. Difficulties were encountered relating general guidelines to individual patients, when co-morbidities, concurrent treatment and the influence of regional or general anaesthesia may influence the risk/benefit ratio. This study has identified variations in practice and reasons why New Zealand anaesthetists use of perioperative beta-blockers is at odds with published guidelines. Deficiencies in the guidelines are part of the problem. However, even with consensus on guidelines, effective multidisciplinary strategies will be required to optimize treatment of patients at risk of perioperative cardiac events.

scholarly journals Left Cardiac Sympathetic Denervation Monotherapy in Patients With Congenital Long QT Syndrome

2020 ◽  
Vol 13 (12) ◽  
Author(s):  
Talha Niaz ◽  
J. Martijn Bos ◽  
Katrina B. Sorensen ◽  
Christopher Moir ◽  
Michael J. Ackerman
Keyword(s):  
Beta Blocker ◽  
Long Qt Syndrome ◽  
Cardiac Event ◽  
Beta Blockers ◽  
Sympathetic Denervation ◽  
Cardiac Events ◽  
Long Qt ◽  
Left Cardiac Sympathetic Denervation ◽  
Qt Syndrome ◽  
Cardiac Sympathetic Denervation

Background: Videoscopic left cardiac sympathetic denervation (LCSD) is an effective antifibrillatory, minimally invasive therapy for patients with potentially life-threatening arrhythmia syndromes like long QT syndrome (LQTS). Although initially used primarily for treatment intensification following documented LQTS-associated breakthrough cardiac events while on beta-blockers, LCSD as 1-time monotherapy for certain patients with LQTS requires further evaluation. We are presenting our early experience with LCSD monotherapy for carefully selected patients with LQTS. Methods: Among the 1400 patients evaluated and treated for LQTS, a retrospective review was performed on the 204 patients with LQTS who underwent LCSD at our institution since 2005 to identify the patients where the LCSD served as stand-alone, monotherapy. Clinical data on symptomatic status before diagnosis, clinical, and genetic diagnosis, and breakthrough cardiac events after diagnosis were analyzed to determine efficacy of LCSD monotherapy. Result: Overall, 64 of 204 patients (31%) were treated with LCSD alone (37 [58%] female, mean QTc 466±30 ms, 16 [25%] patients were symptomatic before diagnosis with a mean age at diagnosis 17.3±11.8 years, 5 had [8%] ≥1 breakthrough cardiac event after diagnosis, and mean age at LCSD was 21.1±11.4 years). The primary motivation for LCSD monotherapy was an unacceptable quality of life stemming from beta-blocker related side effects (ie, beta-blocker intolerance) in 56/64 patients (88%). The underlying LQTS genotype was LQT1 in 36 (56%) and LQT2 in 20 (31%). There were no significant LCSD-related surgical complications. With a mean follow-up of 2.7±2.4 years so far, only 3 patients have experienced a nonlethal, post-LCSD breakthrough cardiac event in 180 patient-years. Conclusions: LCSD may be a safe and effective stand-alone therapy for select patients who do not tolerate beta-blockers. However, LCSD is not curative and patient selection will be critical when potentially considering LCSD as monotherapy.

Negative impact of cardio-renal anaemia syndrome on beta-blocker tolerance and subsequent major adverse cardiac event in chronic heart failure

2008 ◽  
Vol 17 ◽  
pp. S32
Author(s):  
Yoko Masukata ◽  
Kazuhiko Hashimura ◽  
Takahiro Ohara ◽  
Hideaki Kanzaki ◽  
Jiyoong Kim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Beta Blocker ◽  
Major Adverse Cardiac Event ◽  
Cardiac Event ◽  
Negative Impact ◽  
Adverse Cardiac Event ◽  
Renal Anaemia

scholarly journals Anesthetic implications and role of preoperative beta blockade in esophageal substitution with stomach in pediatric surgical patients

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Raksha Kundal ◽  
Ranju Singh ◽  
Subhasis Roy Choudhury ◽  
Partap Singh Yadav ◽  
Ajai Kumar ◽  
...  
Keyword(s):  
Beta Blocker ◽  
Beta Blockers ◽  
Anesthetic Management ◽  
Beta Blockade ◽  
Level Of Evidence ◽  
Thoracic Epidural ◽  
Postoperative Ventilation ◽  
Esophageal Substitution ◽  
Complications And Mortality ◽  
Gastric Pull Up

Abstract Background There is a paucity of literature on the anesthetic management of pediatric esophageal substitution using the stomach. We did a retrospective analysis of all such cases done at our institution. We analyzed the patient’s demography, indication, and type of surgery, co-morbid conditions, anesthesia techniques, duration of postoperative ventilation, hospital stay, complications, and mortality. The use of beta-blockers and their effect on the incidence of intraoperative and postoperative tachycardia in gastric pull-up patients was also analyzed. Results Thirty-four cases of gastric substitution of the esophagus in children were done over 19-year period; gastric pull-up was done in 28 patients and a gastric tube was made in 6 patients. General anesthesia was given to all; a thoracic epidural for pain was sited in 25 patients. Twenty-eight patients were ventilated postoperatively; the mean duration of ventilation is 54 h. Significant intraoperative tachycardia was observed in 85.7% of patients without beta-blocker as compared to 23.8% patients with beta-blocker (p = 0.004). Postoperatively, tachycardia was absent in patients receiving beta-blocker and present in 71.4% of patients not receiving beta-blockers (p < 0.001). Overall mortality was 8.8% but mortality due to cardiac arrhythmia was 42.9% in the patients not receiving beta-blockers (p = 0.001). Conclusions A thorough preoperative preparation, control of tachyarrhythmias, postoperative ventilation, and pain management is recommended for a favorable outcome. In addition, our paper supports the preoperative use of beta-blockers in reducing the incidence of fatal tachyarrhythmias associated with gastric pull-up surgery without any serious adverse effects. Level of evidence Level III

scholarly journals The Efficacy of Beta-Blockers in Patients With Long QT Syndrome 1–3 According to Individuals’ Gender, Age, and QTc Intervals: A Network Meta-analysis

2020 ◽  
Vol 11 ◽  
Author(s):  
Lu Han ◽  
Fuxiang Liu ◽  
Qing Li ◽  
Tao Qing ◽  
Zhenyu Zhai ◽  
...  
Keyword(s):  
Long Qt Syndrome ◽  
Clinical Evidence ◽  
Beta Blockers ◽  
Meta Analysis ◽  
Cardiac Events ◽  
Long Qt ◽  
Confounding Variables ◽  
Qt Syndrome ◽  
The Relationship

Long QT syndrome (LQTS) is an arrhythmic heart disease caused by congenital genetic mutations, and results in increased occurrence rates of polymorphic ventricular tachyarrhythmias and sudden cardiac death (SCD). Clinical evidence from numerous previous studies suggested that beta blockers (BBs), including atenolol, propranolol, metoprolol, and nadolol, exhibit different efficacies for reducing the risk of cardiac events (CEs), such as syncope, arrest cardiac arrest (ACA), and SCD, in patients with LQTS. In this study, we identified relevant studies in MEDLINE, PubMed, embase, and Cochrane databases and performed a meta-analysis to assess the relationship between the rate of CEs and LQTS individuals with confounding variables, including different gender, age, and QTc intervals. Moreover, a network meta-analysis was not only established to evaluate the effectiveness of different BBs, but also to provide the ranked efficacies of BBs treatment for preventing the recurrence of CEs in LQT1 and LQT2 patients. In conclusion, nadolol was recommended as a relatively effective strategy for LQT2 in order to improve the prognosis of patients during a long follow-up period.

scholarly journals A Retrospective Observational Study of Patients with Dilated Cardiomyopathy Undergoing Non-Cardiac Surgery

2017 ◽  
Vol 45 (5) ◽  
pp. 619-623
Author(s):  
K. A. Cook ◽  
P. A. MacIntyre ◽  
J. R. McAlpine
Keyword(s):  
Cardiovascular Disease ◽  
Cardiac Surgery ◽  
High Risk ◽  
Dilated Cardiomyopathy ◽  
Major Adverse Cardiac Event ◽  
Cardiac Event ◽  
Adverse Outcome ◽  
Adverse Cardiac Event ◽  
Low Risk ◽  
Surgical Risk

The perioperative risks and factors associated with adverse cardiac outcomes in patients with dilated cardiomyopathy undergoing non-cardiac surgery are unknown. Interrogation of the Nelson Hospital transthoracic echocardiogram database identified 127 patients with dilated cardiomyopathy who satisfied the study criteria and underwent non-cardiac surgery between June 1999 and July 2013. Demographic and clinical data along with postoperative death within 30 days or a major adverse cardiac event were retrieved and analysed. The mean age was 75.9 years. Seventy-one percent of the patients had severe impairment of left ventricular function and 35% had a severely dilated left ventricle. A major adverse cardiac event occurred in 18.1% of patients and 5.5% of patients died within 30 days of surgery. Increased surgical risk and absence of cerebrovascular disease were associated with adverse outcome (P <0.001, P <0.05, respectively). Forty-three and a half percent (43.5%) of patients undergoing high-risk surgery had an adverse outcome compared to 36.1% and 5.9% for moderate and low-risk surgery, respectively. A major adverse cardiac event was observed in 26.7% of patients with cardiovascular disease compared to 9.8% of patients without cardiovascular disease. We were unable to exclude an influence of other potential risk factors due to the retrospective observational nature of the study. These findings highlight a potential increase in complications with moderate or high surgical risk, whilst are reassuring in demonstrating the relative safety of low-risk surgery in this group of high-risk patients.

scholarly journals Family History of Atrial Fibrillation and Risk of Cardiovascular Events

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Daniele Pastori ◽  
Danilo Menichelli ◽  
Gregory Y.H. Lip ◽  
Angela Sciacqua ◽  
Francesco Violi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Family History ◽  
Cardiovascular Mortality ◽  
Major Adverse Cardiac Event ◽  
Cardiovascular Events ◽  
Cardiac Event ◽  
Hazard Ratio ◽  
Adverse Cardiac Event ◽  
Increased Risk ◽  
History Of

Background: To investigate the association between family history of atrial fibrillation (AF) with cardiovascular events (CVEs), major adverse cardiac events (MACE), and cardiovascular mortality. Methods: Multicenter prospective observational cohort study including 1722 nonvalvular AF patients from February 2008 to August 2019 in Italy. Family history of AF was defined as the presence of AF in a first-degree relative: mother, father, sibling, or children. Primary outcome was a composite of CVEs including fatal/nonfatal ischemic stroke and myocardial infarction, and cardiovascular death. Second, we analyzed the association with major adverse cardiac event. Results: Mean age was 74.6±9.4 years; 44% of women. Family history of AF was detected in 368 (21.4%) patients, and 3.5% had ≥2 relatives affected by AF. Age of AF onset progressively decreased from patients without family history of AF, compared with those with single and multiple first-degree affected relatives ( P <0.001). During a mean follow-up of 23.7 months (4606 patients/y) 145 CVEs (3.15%/y), 98 major adverse cardiac event (2.13%/y), and 57 cardiovascular deaths (0.97%/y) occurred. After adjustment for cardiovascular risk factors, family history of AF was associated with a higher risk of CVEs (hazard ratio, 1.524 [95% CI, 1.021–2.274], P =0.039), major adverse cardiac event (hazard ratio, 1.917 [95% CI, 1.207–3.045], P =0.006), and cardiovascular mortality (hazard ratio, 2.008 [95% CI, 1.047–3.851], P =0.036). Subgroup analysis showed that this association was modified by age, sex, and prior ischemic heart disease. Conclusions: In a cohort of elderly patients with a high atherosclerotic burden, family history of AF is evident in >20% of patients and was associated with an increased risk for CVEs and mortality. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01882114.

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