Hemodynamic and metabolic effects of exercise in Crotalaria-induced pulmonary hypertension in rats

1984 ◽  
Vol 57 (6) ◽  
pp. 1829-1833 ◽  
Author(s):  
L. J. McNabb ◽  
K. M. Baldwin
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Vascular Resistance ◽  
Resistance Index ◽  
Stroke Volume Index ◽  
Exercise Duration ◽  
Left Ventricular ◽  
Metabolic Effects ◽  
Volume Index ◽  
Work Index

The hemodynamic and metabolic effects of exercise were measured in Crotalaria-induced pulmonary hypertension in rats. The Crotalaria group had increased preexercise heart rate, mean pulmonary arterial pressure (PAP), arteriovenous O2 content difference, right ventricular work index (RVWI), and total pulmonary vascular resistance index (TPVRI) and decreased mean systemic blood pressure (BP), arterial O2 content (CaO2), venous O2 content (CvO2), cardiac index (CI), stroke volume index (SVI), and left ventricular work index (LVWI). The Crotalaria group during exercise had increased PAP, RVWI, TPVRI, and total systemic vascular resistance index and decreased BP, O2 consumption, CaO2, CvO2, CI, SVI, LVWI, O2 pulse index, and exercise duration. It is hypothesized that abnormal right ventricular function was a primary factor in the reduced exercise tolerance of the Crotalaria group.

scholarly journals Empagliflozin does not change cardiac index nor systemic vascular resistance but rapidly improves left ventricular filling pressure in patients with type 2 diabetes: a randomized controlled study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Matthias Rau ◽  
Kirsten Thiele ◽  
Niels-Ulrik Korbinian Hartmann ◽  
Alexander Schuh ◽  
Ertunc Altiok ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Resistance Index ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Volume Index ◽  
Hemodynamic Parameters ◽  
Mitral Inflow ◽  
Ventricular Filling Pressure

Abstract Background In the EMPA-REG OUTCOME trial (Empagliflozin Cardiovascular Outcome Event Trial) treatment with the sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin significantly reduced heart failure hospitalization (HHF) in patients with type 2 diabetes mellitus (T2D) and established cardiovascular disease. The early separation of the HHF event curves within the first 3 months of the trial suggest that immediate hemodynamic effects may play a role. However, hitherto no data exist on early effects of SGLT2 inhibitors on hemodynamic parameters and cardiac function. Thus, this study examined early and delayed effects of empagliflozin treatment on hemodynamic parameters including systemic vascular resistance index, cardiac index, and stroke volume index, as well as echocardiographic measures of cardiac function. Methods In this placebo-controlled, randomized, double blind, exploratory study patients with T2D were randomized to empagliflozin 10 mg or placebo for a period of 3 months. Hemodynamic and echocardiographic parameters were assessed after 1 day, 3 days and 3 months of treatment. Results Baseline characteristics were not different in the empagliflozin (n = 22) and placebo (n = 20) group. Empagliflozin led to a significant increase in urinary glucose excretion (baseline: 7.3 ± 22.7 g/24 h; day 1: 48.4 ± 34.7 g/24 h; p < 0.001) as well as urinary volume (1740 ± 601 mL/24 h to 2112 ± 837 mL/24 h; p = 0.011) already after one day compared to placebo. Treatment with empagliflozin had no effect on the primary endpoint of systemic vascular resistance index, nor on cardiac index, stroke volume index or pulse rate at any time point. In addition, echocardiography showed no difference in left ventricular systolic function as assessed by left ventricular ejections fraction and strain analysis. However, empagliflozin significantly improved left ventricular filling pressure as assessed by a reduction of early mitral inflow velocity relative to early diastolic left ventricular relaxation (E/eʹ) which became significant at day 1 of treatment (baseline: 9.2 ± 2.6; day 1: 8.5 ± 2.2; p = 0.005) and remained apparent throughout the study. This was primarily attributable to reduced early mitral inflow velocity E (baseline: 0.8 ± 0.2 m/s; day 1: 0.73 ± 0.2 m/sec; p = 0.003). Conclusions Empagliflozin treatment of patients with T2D has no significant effect on hemodynamic parameters after 1 or 3 days, nor after 3 months, but leads to rapid and sustained significant improvement of diastolic function. Trial registration EudraCT Number: 2016-000172-19; date of registration: 2017-02-20 (clinicaltrialregister.eu)

scholarly journals Empagliflozin does not change cardiac index nor systemic vascular resistance but rapidly improves left ventricular filling pressure in patients with type 2 diabetes: a randomized controlled study 

2020 ◽  
Author(s):  
Matthias Rau ◽  
Kirsten Thiele ◽  
Niels-Ulrik Korbinian Hartmann ◽  
Alexander Schuh ◽  
Ertunc Altiok ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Resistance Index ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Volume Index ◽  
Hemodynamic Parameters ◽  
Mitral Inflow ◽  
Ventricular Filling Pressure

Abstract Background: In the EMPA-REG OUTCOME trial (Empagliflozin Cardiovascular Outcome Event Trial) treatment with the sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin significantly reduced heart failure hospitalization (HHF) in patients with type 2 diabetes mellitus (T2D) and established cardiovascular disease. The early separation of the HHF event curves within the first 3 months of the trial suggest that immediate hemodynamic effects may play a role. However, hitherto no data exist on early effects of SGLT2 inhibitors on hemodynamic parameters and cardiac function. Thus, this study examined early and delayed effects of empagliflozin treatment on hemodynamic parameters including systemic vascular resistance index, cardiac index, and stroke volume index, as well as echocardiographic measures of cardiac function.Methods: In this placebo-controlled, randomized, double blind, exploratory study patients with T2D were randomized to empagliflozin 10 mg or placebo for a period of 3 months. Hemodynamic and echocardiographic parameters were assessed after 1 day, 3 days and 3 months of treatment. Results: Baseline characteristics were not different in the empagliflozin (n=22) and placebo (n=20) group. Empagliflozin led to a significant increase in urinary glucose excretion (baseline: 7.3 ± 22.7 g/24 hrs; day 1: 48.4 ± 34.7 g/24 hrs; p<0.001) as well as urinary volume (1740 ± 601 mL/24 hrs to 2112 ± 837 mL/24 hrs; p=0.011) already after one day compared to placebo. Treatment with empagliflozin had no effect on the primary endpoint of systemic vascular resistance index, nor on cardiac index, stroke volume index or pulse rate at any time point. In addition, echocardiography showed no difference in left ventricular systolic function as assessed by left ventricular ejections fraction and strain analysis. However, empagliflozin significantly improved left ventricular filling pressure as assessed by a reduction of early mitral inflow velocity relative to early diastolic left ventricular relaxation (E/e’) which became significant at day 1 of treatment (baseline: 9.2 ± 2.6; day 1: 8.5 ± 2.2; p=0.005) and remained apparent throughout the study. This was primarily attributable to reduced early mitral inflow velocity E (baseline: 0.8 ± 0.2 m/sec; day 1: 0.73 ± 0.2 m/sec; p=0.003). Conclusions: Empagliflozin treatment of patients with T2D has no significant effect on hemodynamic parameters after 1 or 3 days, nor after 3 months, but leads to rapid and sustained significant improvement of diastolic function.

scholarly journals P899 Reduced right ventricular longitudinal function in patients with chronic left ventricular disease can be due to left ventricular forward failure and not right ventricular dysfunction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Fredholm ◽  
S E Ricksten ◽  
K Karason ◽  
S E Bartfay ◽  
G Dellgren ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Peak Systolic Velocity ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Right Atrial ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Heart Catheterization ◽  
Ventricular Ejection Fraction ◽  
Longitudinal Function

Abstract Background and aim The occurrence of right ventricular failure (RVF) in patients with chronic left heart disease (LHD) has important therapeutic and prognostic consequences. Echocardiography (Echo) parameters describing the RV longitudinal function (tricuspid annular plane systolic excursion, TAPSE; peak systolic free wall longitudinal strain, RV-Str; tricuspid annulus peak systolic velocity, TAPSm) are today commonly used to define RV dysfunction. In the present study we hypothesised that these parameters are load dependent. Methods We retrospectively included 66 patients with LHD (age 52 ± 13 years, males 79%) that underwent right heart catheterization (RHC) and Echo within 48 hours. RHC was performed as part of diagnostic- or pre-transplant work-up. Fifty-six patients (85%) had left ventricular ejection fraction &lt; 40%. From RHC data the patients were divided into three groups: Patients with RV decompensation and increased right atrial pressure (RAP) ≥10 mmHg (iRAP, n = 21), with normal RAP but reduced stroke volume index (SVI &lt; 35 mL/m2) (rSVI, n = 21) and with normal RAP and normal SVI (nSVI, n = 24). Results Patients with iRAP had compared with rSVI/nSVI more advanced LHD with higher PAMP, PCWP and larger RV diastolic area (RVdA). TAPSE, RV-Str and FAC did not differ between iRAP and rSVI patients. The ratio RVdA/RV-Str was significantly higher in iRAP patients compared with rSVI and nSVI. The rSVI and nSVI patients did not differ regarding RAP response during supine exercise (P = 0.84). Conclusions Reduced RV longitudinal function in patients with chronic LHD and normal RAP can be due to left ventricular forward failure and not RV systolic dysfunction. iRAP (n = 21) rSVI (n = 21) nSVI (n = 24) Overall P-value iRAP vs rSVI iRAP vs nSVI rSVI vs nSVI RAP (mmHg) 13 ± 2 5 ± 3 4 ± 2 &lt;0.001 &lt;0.001 &lt;0.001 0.34 PAMP (mmHg) 33 ± 8 24 ± 8 22±] &lt;0.001 0.001 &lt;0.001 0.34 PCWP (mmHg) 22 ± 5 16 ± 8 11 ± 6 &lt;0.001 0.003 &lt;0.001 0.025 CI (l/min/m2) 2.2 ± 0.4 2.2 ± 0.4 2.8 ± 0.5 &lt;0.001 0.75 &lt;0.001 &lt;0.001 PVR (Wood unit) 2.6 ± 1.2 1.5 ± 1.6 1.9 ± 1.0 0.032 0.022 0.035 0.60 RVdA (cm2) 26 ± 7 21 ± 7 21 ± 5 0.012 0.007 0.017 0.63 TAPSE (mm) 12 ± 3 13 ± 3 18 ± 6 &lt;0.001 0.28 &lt;0.001 0.001 TAPSm (cm/s) 8 ± 2 8 ± 2 10 ± 4 0.06 - - - RV-str (%) -15 ± 5 -17 ± 5 -21 ± 6 0.002 0.11 0.001 0.028 FAC (%) 28 ± 9 29 ± 11 39 ± 11 &lt;0.001 0.72 0.001 0.003 RVdA/RV-str (cm2/%) 2.2 ± 1.3 1.3 ± 0.7 1.1 ± 0.6 &lt;0.001 0.013 0.001 0.27

Inhaled nitric oxide improves hemodynamics in patients with acute pulmonary hypertension after high-risk cardiac surgery

Perfusion ◽  
1999 ◽  
Vol 14 (1) ◽  
pp. 37-42 ◽  
Author(s):  
J R Beck ◽  
L B Mongero ◽  
R M Kroslowitz ◽  
A F Choudhri ◽  
J M Chen ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Pulmonary Hypertension ◽  
Cardiac Surgery ◽  
High Risk ◽  
Right Ventricular ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Left Ventricular ◽  
Ventricular Assist ◽  
Acute Pulmonary Hypertension

Severe pulmonary hypertension and right-sided circulatory failure (RSCF) represent an increasing cause of morbidity and mortality in patients undergoing high-risk cardiac surgery. Increased pulmonary vascular resistance in the setting of cardiopulmonary bypass (CPB) may further lead to decreased blood flow across the pulmonary vascular bed; thereby decreasing left ventricular filling and cardiac output. Current management techniques for RSCF include both nonspecific vasodilator and inotropic agents (often limited by systemic hypotension) and the placement of right ventricular assist devices (associated with increased perioperative morbidity). Inhaled nitric oxide (NOi) represents a novel, specific pulmonary vasodilator that has been proven efficacious in these clinical settings. We evaluated 34 patients in 38 operations who underwent cardiac surgery at Columbia Presbyterian Medical Center, and who received NOi (20 ppm) through a modified ventilatory circuit for hemodynamically significant elevations in pulmonary vascular resistance. Nine patients underwent cardiac transplantation, three patients bilateral lung transplantation, 16 patients left ventricular assist device placement and 10 patients routine cardiac surgery. Patients receiving NOi exhibited substantial reductions in mean pulmonary artery pressure (mPAP) (34.6 ± 2.0 to 26.0 ± 1.7 mmHg, p < 0.0001), with improvements in systemic hemodynamics, mean arterial pressure (68 ± 3.1 to 75.9 ± 2.0 mmHg, p = 0.006). In five cases, patients could not be weaned from CPB until NOi was administered. Patients were maintained on NOi from 6 to 240 h postoperatively (median duration 36 h). Inhaled NO induces substantial reductions in mPAP and increases in both cardiac index and systemic blood pressure in patients displaying elevated pulmonary hemodynamics after high-risk cardiac surgery. NO is, therefore, a useful adjunct in these patients in whom acute pulmonary hypertension threatens right ventricular function and hemodynamic stability.

scholarly journals Mechanisms contributing to hypotension after anesthetic induction with sufentanil, propofol, and rocuronium: a prospective observational study

2021 ◽  
Author(s):  
Bernd Saugel ◽  
Elisa-Johanna Bebert ◽  
Luisa Briesenick ◽  
Phillip Hoppe ◽  
Gillis Greiwe ◽  
...  
Keyword(s):  
Heart Rate ◽  
Arterial Pressure ◽  
Stroke Volume ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Resistance Index ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Systemic Vascular Resistance Index ◽  
Anesthetic Induction

AbstractIt remains unclear whether reduced myocardial contractility, venous dilation with decreased venous return, or arterial dilation with reduced systemic vascular resistance contribute most to hypotension after induction of general anesthesia. We sought to assess the relative contribution of various hemodynamic mechanisms to hypotension after induction of general anesthesia with sufentanil, propofol, and rocuronium. In this prospective observational study, we continuously recorded hemodynamic variables during anesthetic induction using a finger-cuff method in 92 non-cardiac surgery patients. After sufentanil administration, there was no clinically important change in arterial pressure, but heart rate increased from baseline by 11 (99.89% confidence interval: 7 to 16) bpm (P < 0.001). After administration of propofol, mean arterial pressure decreased by 23 (17 to 28) mmHg and systemic vascular resistance index decreased by 565 (419 to 712) dyn*s*cm−5*m2 (P values < 0.001). Mean arterial pressure was < 65 mmHg in 27 patients (29%). After propofol administration, heart rate returned to baseline, and stroke volume index and cardiac index remained stable. After tracheal intubation, there were no clinically important differences compared to baseline in heart rate, stroke volume index, and cardiac index, but arterial pressure and systemic vascular resistance index remained markedly decreased. Anesthetic induction with sufentanil, propofol, and rocuronium reduced arterial pressure and systemic vascular resistance index. Heart rate, stroke volume index, and cardiac index remained stable. Post-induction hypotension therefore appears to result from arterial dilation with reduced systemic vascular resistance rather than venous dilation or reduced myocardial contractility.

Clinical Evaluation Gf Right Ventricular Function in Patients with Left Ventricular Assist Device (Lvad)

1992 ◽  
Vol 15 (2) ◽  
pp. 109-113 ◽  
Author(s):  
G.B.W.E. Bennink ◽  
H. Noda ◽  
J.M. Duncan ◽  
O.H. Frazier
Keyword(s):  
Right Ventricular ◽  
Ventricular Function ◽  
Right Ventricular Function ◽  
Heart Function ◽  
Venous Pressure ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Volume Index ◽  
Stroke Work ◽  
Bridge To Transplant

Right ventricular function (RVF) during LVAD support can be a threat for patient survival. Despite extensive research, RVF and its interference with left heart function is unclear. This study examines RVF in a retrospective analysis of 14 patients. Hemodynamic data were collected, including heart rate (HR), central venous pressure (CVP), mean pulmonary artery pressure (mPAP), total cardiac output (CO), calculated stroke volume index (SVI) and right ventricular stroke work index (RVSWI). In all patients, CO increased gradually throughout the study period; CVP showed no significant decrease; mPAP and PCWP decreased significantly over the time period; SVI improved and RVSWI increased from the starting level prior to implantation of the LVAD. We conclude that the CO improved with a lowering of the right ventricular afterload combined with a decrease in total circulating volume. The improvement of RVF with LV assist makes this device an option as a bridge to transplant.

scholarly journals Right ventricular reserve in a piglet model of chronic pulmonary hypertension

2014 ◽  
Vol 45 (3) ◽  
pp. 709-717 ◽  
Author(s):  
Julien Guihaire ◽  
François Haddad ◽  
Pierre-Emmanuel Noly ◽  
David Boulate ◽  
Benoit Decante ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Coupling Efficiency ◽  
Lower Lobe ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Control Group ◽  
Pharmacological Stress ◽  
Right Heart Catheterisation

Right ventricular (RV) response to exercise or pharmacological stress is not well documented in pulmonary hypertension (PH). We investigated the relationship between RV reserve and ventricular–arterial coupling.Surgical ligation of the left pulmonary artery was performed in 13 Large White piglets (PH group), thereafter weekly embolisations of the right lower lobe were performed for 5 weeks. A control group of six piglets underwent sham procedures. Right heart catheterisation and echocardiography were performed at week 6. Pressure–volume loops were recorded before and after dobutamine infusion.Induction of experimental PH resulted in a higher mean±sd pulmonary artery pressure (34±9 versus 14±2 mmHg; p<0.01) and in a lower ventricular–arterial coupling efficiency (0.66±0.18 versus 1.24±0.17; p<0.01) compared with controls at 6 weeks. Dobutamine-induced relative changes in RV stroke volume index (SVI) and end-systolic elastance were lower in the PH group (mean±sd 47±5% versus 20±5%, p<0.01, and 81±37% versus 32±14%, p<0.01, respectively). Change in SVI was strongly associated with resting ventricular–arterial coupling (R2=0.74; p<0.01).RV reserve was associated with ventricular–arterial coupling in a porcine model of chronic pressure overload.

scholarly journals Moderated Posters session: pulmonary hypertension and other conditionsP516Echocardiographic findings predicting mortality in pulmonary arterial hypertension: a systematic review and meta-analysisP517Impairment of endothelial-mediated coronary flow reserve in patients with Anderson Fabry diseaseP518Comparative evaluation of various echocardiography-based methods for the estimation of pulmonary vascular resistance in pulmonary hypertensionP519Detection of early radiotherapy-induced changes in myocardial cyclic variation in breast cancer patients - an ultrasound tissue characterization studyP520Right ventricle adaptation changes resulting from endurance training in the group of junior cyclists - sex is an important determinantP521Impact of pulmonary hypertension on the impairment of right ventricular longitudinal function in patients with obstructive sleep apnea syndromeP522Improvement of echocardiographic (TTE) estimation of pulmonary vascular resistance (PVR) in comparison with right heart catheter measurementsP523Assessment of left ventricular function in breast cancer patients with adjuvant treatment (combined anthracyclines and trastuzumab): two years follow upP5243D regional right ventricular function in pulmonary hypertensionP525Simple echocardiographic parameters to assess right ventricular systolic function in patients with precapillary pulmonary hypertension: a comparison with cardiac magnetic resonance imaging

2015 ◽  
Vol 16 (suppl 2) ◽  
pp. S67-S69
Author(s):  
VJM Baggen ◽  
L Spinelli ◽  
C Venner ◽  
S Tuohinen ◽  
M Konopka ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Cancer Patients ◽  
Ventricular Function ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Left Ventricular ◽  
Breast Cancer Patients ◽  
Obstructive Sleep

scholarly journals Right ventricular end-diastolic stiffness heralds right ventricular failure in monocrotaline-induced pulmonary hypertension

2016 ◽  
Vol 311 (4) ◽  
pp. H1004-H1013 ◽  
Author(s):  
Mohamed Alaa ◽  
Mahmoud Abdellatif ◽  
Marta Tavares-Silva ◽  
José Oliveira-Pinto ◽  
Lucas Lopes ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Stroke Volume ◽  
Right Ventricular ◽  
Diastolic Pressure ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Positive Pressure ◽  
Stroke Work ◽  
Operating Characteristics ◽  
Diastolic Stiffness

Recent studies suggest right ventricular (RV) stiffness is important in pulmonary hypertension (PH) prognosis. Smaller stroke volume (SV) variation after a certain RV end-diastolic pressure (EDP) respiratory variation as assessed by spectral transfer function (STF) may identify RV stiffness. Our aim was to evaluate RV stiffness in monocrotaline (MCT)-induced PH progression and to validate STF gain between EDP and SV as marker of stiffness. Seven-week-old male Wistar rats randomly injected with 60 mg/kg MCT or vehicle were divided into three groups ( n = 12 each) according to cardiac index (CI): controls (Ctrl), preserved CI (MCT pCI), and reduced CI (MCT rCI). All underwent RV pressure-volume (PV) evaluation 24–34 days after MCT, under halogenate anesthesia and constant positive-pressure ventilation. End-diastolic stiffness (βi), end-systolic elastance (Eesi), arterial elastance for indexed volumes (Eai), and preload recruitable stroke work (PRSW) were obtained and beat-to-beat fluctuations during ventilation assessed by STF. Eai was the strongest determinant of CI, alongside βi but not PRSW. MCT rCI showed impaired ventricular-vascular coupling (VVC) and higher βi, along with low end-diastolic pressure (EDP) and stroke volume index (SVi) STF gain, denoting impaired preload reserve. On multivariate analysis βi and not Eesi correlated with EDP-SVi STF gain ( P < 0.001). Receiver-operating characteristics (ROC) curve analysis of EDP-SVi STF gain showed an area under curve of 0.84 for βi prediction ( P = 0.002). Afterload, impaired VVC and RV stiffness are major players in RV failure. RV stiffness can be assessed by STF gain analysis of respiratory fluctuations between EDP and SVi, which may constitute a prognostic tool in PH.

scholarly journals Effects on oxygenation and tissue perfusion of preoperative administration of levosimendan in hip fractures and left ventricular dysfunction

2021 ◽  
Author(s):  
Maria C Martín Lorenzo ◽  
Vanesa González Fariña ◽  
Nuría Montón Giménez ◽  
Jorge Solera Marín ◽  
José A. Reboso Morales
Keyword(s):  
Hip Fractures ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Troponin I ◽  
Resistance Index ◽  
Stroke Volume Index ◽  
Tissue Perfusion ◽  
Left Ventricular ◽  
Volume Index ◽  
High Morbidity

Abstract Background: Hip fracture is common in elderly and has high morbidity and mortality. Many present left ventricular dysfunction, the use of inotropics may reduce perioperative cardiovascular complications. The objective of this study is to evaluate the safety and efficacy of a perioperative hemodynamic optimization protocol based on goal-guided therapy with levosimendan in these patients.Methods: In this prospective study 19 patients with LVEF <45% were recruited forhip surgery. They received an infusion of levosimendan 24h (0.1μg/kg/min) before surgery. Hemodynamic, oxygenation, tissue perfusion and analytical parameters; and ultrasound measurements of cardiac function were obtained before and at 24, 48 hours and 7 days later.Results: Patients mean age was 86±7 years. Both cardiac index, from 2.9±0.6 L.min–1m–2 at baseline to 3.7±0.8 L.min–1m–2 (P <0.001) and stroke volume index, from 36 ± 10 to 44 ± 8 mL/ m–2 (P =0.003) increased significantly at 24 h after drug initiation and remained significantly increased for 48 h. Systemic vascular resistance index decreased significantly (from 2302 ± 726 dyn.s.cm–5 m–2 to 1676 ± 530 dyn.s.cm–5 m–2 , P <0.001). Ejection fraction and left ventricular outflow tract velocity time integral also increased without reaching significance. A decrease in the NT-proBNP values was observed without statistical significance. Troponin I decreased non-significant until day 7, from 0.143 ± 0.42 pg/mL to 0.113 ± 0.15 pg/mL (P=0.17). DO2 increased significantly in parallel to CI from 751 ± 196 mL/min to 854 ± 340 mL/min (P =0.04) at 48 h, while O2 ER decreased significantly during infusion, 36 ± 7% to 32 ± 8% (P =0.04) ScvO2 significantly increased from 61 ± 7% to 69 ± 8% (P =<0.001) 48 h after infusion.Conclusions: The implementation of a preoperative optimization protocol based on goal-directed therapy with levosimendan in patients with left ventricular dysfunction and hip fractures did not present major complications. An improvement in perioperative haemodynamic parameters and also in the balance between oxygen delivery and consumption at tissue level was found. Levosimendan decreased mortality a year with respect to a retrospective case registry.

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