Serum NT-Pro-BNP versus Noninvasive Bedside Inotropic Index in Paediatric Shock: A Contest of Myocardial Performance in Response to Fluid Loading

Background. Mild elevation of serum amino-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is associated with myocardial dysfunction. A significantly lower Smith–Madigan inotropic index (SMII) has been shown to accurately represent cardiac contractility among heart failure subjects. We aim to monitor the effect of fluid resuscitation on cardiac function among paediatric patients by measuring serum NT-pro-BNP and SMII. Methods. This is an observational study on 70 paediatric shock patients. NT-pro-BNP and noninvasive bedside haemodynamic monitoring were done by using an ultrasonic cardiac output monitor (USCOM, USCOM, Sydney, Australia). The presence of cardiac diseases was excluded. SMII was obtained from the USCOM. An increase in the stroke volume index (SVI) of ≥15% indicates fluid responders. Measurements were taken before and after fluid loading. Results. Preloading NT-pro-BNP and SMII category were significantly different between the fluid responsiveness group, p = 0.001 and p = 0.004 , respectively. Higher median NT-pro-BNP (preloading NT-pro-BNP of 1175.00 (254.50–9965.00) ng/mL vs. 196.00 (65.00–509.00) ng/mL, p = 0.002 ) was associated with fluid nonresponders (subjects >12 months old). Preloading NT-pro-BNP <242.5 ng/mL was associated with fluid responders (AUC: 0.768 (0.615–0.921), p = 0.003 ), 82.1% sensitivity, and 68.7% specificity for subjects >12 years old. Delta NT-pro-BNP in fluid responders (15.00 (−16.00–950.00) ng/mL) did not differ from fluid nonresponders (505.00 (−797.00–1600.00) ng/mL), p = 0.456 . Postloading SMII >1.25 W·m−2 was associated with fluid responders (AUC: 0.683 (0.553–0.813), p = 0.011), 61.9% sensitivity, and 66.7% specificity, but not preloading SMII. Fluid responders had a higher mean postloading SMII compared to nonresponders (1.36 ± 0.38 vs. 1.10 ± 0.34, p = 0.006 ). Conclusion. Higher NT-pro-BNP and lower SMII in the absence of cardiac diseases were associated with poor response to fluid loading. The SMII is affected by low preload conditions.

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P1754 Regional left ventricular longitudinal myocardial dysfunction in mitral valve prolapse could be primary

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1113 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

P Barbier ◽

O A Annoh ◽

G Liu ◽

M Scorsin ◽

S Moriggia ◽

...

Keyword(s):

Mitral Valve ◽

Ejection Fraction ◽

Stroke Volume ◽

Myocardial Dysfunction ◽

Stroke Volume Index ◽

Volume Overload ◽

Mitral Annulus ◽

Left Ventricular ◽

Volume Index ◽

Maximum Strain

Abstract Background Regional left ventricular dysfunction in patients with mitral valve prolapse (MVP) and normal ejection fraction has been described by different Authors, and recent data point to a dysfunction (prevalently longitudinal strain) of the myocardium of the LV base secondary to dilatation of the mitral annulus. Purpose To investigate degree and extent of regional LV dysfunction and its mechanisms in patients with MVP, severe regurgitation and normal global systolic function, compared to patients with equivalent degree of regurgitation but functional etiology (FMR). Methods Speckle-tracking echocardiography was performed in 30 controls (N), and in severe primary (MVP, n= 50) or functional (FMR, n= 20) mitral regurgitation, to measure global, regional and segmental longitudinal peak systolic strain (LPSS, %), and time delay of peak maximum strain (TTPd, ms, calculated as time to peak maximum strain - time of aortic valve closure). Maximum and minimum mitral annulus diameters and area were measured with 3D echo. We also evaluated as recommended: LV end-diastolic volume index (EDVi, ml/m2), ejection fraction (EF, %), and left atrial end-systolic volume index (LAESVi, ml/m2) with 2D echo; LV stroke volume index, and non-invasive pulmonary systolic (PSP, mmHg) and diastolic pressures (PDP), mmHg) with Doppler echo. Results Age, heart rate, BSA and systolic blood pressure were similar between groups. Atrial fibrillation was present in 34% of MVP and 71% of FMR patients. LV EF was normal in MVP and reduced in FMR (43 ± 14 % vs N, p<.001). LV EDVi (MVP: 77 ± 20 ml/m2; FMR: 107 ± 35, both p<.001 vs N) and LAESVi (MVP: 91 ± 26 ml/m2; FMR: 80 ± 30, both p<.001 vs N) were similarly increased (volume overload) in MVP and FMR, as were PSP (MVP: 42 ± 23 ml/m2; FMR: 52 ± 25, both p<.001 vs N) and PDP (MVP: 16 ± 6 ml/m2; MVP: 15 ± 5, both p<.001 vs N). In FMR, LPSS was reduced globally (-12.8 ± 3.3, p<.001 vs N and MVP) and similarly at LV base, papillary and apical levels. In contrast, in MVP global (-19.4 ± 3.7%) and apical (-23.4 ± 4.5%) LPSS were normal, whereas LV base (-12.3 ± 5.8%, p=.003 vs N) and papillary (-17.1 ± 4%, p=.024 vs N) LPSS were reduced; further, LPSS reduction was localized to the anterior (-16 ± 4, p=.028 vs N), lateral (-17 ± 5, p=.006 vs N) and posterior (-16 ± 6, p=.007 vs N) segments, and was associated with an increased TTPd in the same segments in MVP but not in FMR patients. At multivariate analysis, degree and localisation of regional myocardial dysfunction in patients with MVP was not related to the prolapsing scallop, dimension of the mitral annulus, degree of volume overload or pulmonary pressures, or stroke volume index. Conclusions In patients with MVP, severe regurgitation and normal EF, there is a specific dysfunction pattern of regional LV longitudinal function which appears to be primary and not dependent on the degree of preload increase, mitral annulus dilatation, or localization of the prolapsing scallop.

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Effect of Leg Lift on Stroke Volume Index in Children 11‐17 Years Old Before and After Induction of General Anesthesia

Pediatric Anesthesia ◽

10.1111/pan.14254 ◽

2021 ◽

Author(s):

Andrew F. Stasic ◽

Bethany J. Wolf ◽

Stephen F. Dierdorf ◽

Nicole D. Horn ◽

Korey Vecchione ◽

...

Keyword(s):

Stroke Volume ◽

General Anesthesia ◽

Stroke Volume Index ◽

Volume Index ◽

Before And After

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Echocardiographic evaluation of space shuttle crewmembers

Journal of Applied Physiology ◽

10.1152/jappl.1987.62.1.278 ◽

1987 ◽

Vol 62 (1) ◽

pp. 278-283 ◽

Cited By ~ 51

Author(s):

M. W. Bungo ◽

D. J. Goldwater ◽

R. L. Popp ◽

H. Sandler

Keyword(s):

Space Shuttle ◽

Recovery Period ◽

Stroke Volume Index ◽

Left Ventricular ◽

Volume Index ◽

Heart Volume ◽

Systolic Volume ◽

End Diastolic Volume ◽

Before And After ◽

High Level

Echocardiographic measurements were obtained before and after space flight from 17 members of four shuttle crews. Measurements obtained 1 h after landing (L+0) compared with preflight values (n = 7) demonstrated an increase in heart rate (HR) (16 beats/min, 30.5%, P less than 0.05), mean arterial pressure (12%, P less than 0.05), and systemic vascular resistance (34%, P less than 0.05). End-diastolic volume index (EDVI) fell 17 ml/m2 (-23%, P less than 0.005) and stroke volume index (SVI) fell 15 ml/m2 (-28%, P less than 0.05). Repeat measurements taken 1–2 wk later (n = 17) demonstrated that HR had returned to normal (4 beats/min, P less than 0.05); however, EDVI remained significantly below preflight levels (-11%, P less than 0.005). End-systolic volume index (ESVI) was also still significantly lower (-23%, P less than 0.01). This delayed recovery occurred despite ability of the subjects to fully ambulate and exercise during the postflight period. These results indicate that spaceflight induces significant changes in heart volume affecting left ventricular function. The exact reasons for these specific changes remain unknown and will require additional measurements before, during, and after flight. The prolonged recovery period for the present subject group probably relates to their high level of aerobic conditioning.

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Diabetic heart: Metabolic reasons for the development of cardiomyopathy

Problems of Endocrinology ◽

10.14341/probl12056 ◽

1996 ◽

Vol 42 (6) ◽

pp. 20-26

Author(s):

E. I. Sokolov ◽

O. S. Zaichikova

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Coronary Arteries ◽

Diabetic Cardiomyopathy ◽

Myocardial Dysfunction ◽

Stroke Volume Index ◽

Left Ventricular ◽

Volume Index ◽

Dependent Diabetes Mellitus ◽

Patients With Diabetes

Cardiovascular disease is a common cause of death in patients with diabetes mellitus (DM). The likelihood of developing heart failure with this disease increases, even if you take into account the influence of factors such as age, blood pressure, plasma cholesterol, body weight and the condition of the coronary arteries. The term "diabetic cardiomyopathy" was proposed in 1972 by S. Rubier et al. They performed postmortem autopsy of patients with diabetes complicated by diabetic nephropathy and congestive heart failure without arterial hypertension and severe atherosclerosis of the coronary arteries. The hemodynamic parameters of a group of patients with diabetes without hypertension without significant atherosclerotic changes in the coronary arteries according to angiography were studied by T. Regan et al. In these patients, a decrease in stroke volume index and an increase in diastolic pressure in the left ventricle were detected. The observed changes, indicating a decrease in left ventricular myocardial extensibility, were interpreted as signs of subclinical cardiomyopathy. Based on the results of an echocardiographic examination of patients with insulin-dependent diabetes mellitus (IDDM) Ch. Dimitar proposed the following stages of development of diabetic cardiomyopathy: I - increased myocardial contractility; II - systolic and diastolic functions are not impaired; III - the beginning of the development of diastolic dysfunction, a decrease in the "compliance" of the left ventricular myocardium and dilatation of the left atrium; IV - progression of diastolic myocardial dysfunction (DDM) and the addition of systolic dysfunction.

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Hemodynamic effects of dopamine, norepinephrine, and fluids in a dog model of sepsis

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1995.268.2.h692 ◽

1995 ◽

Vol 268 (2) ◽

pp. H692-H702 ◽

Cited By ~ 3

Author(s):

W. Karzai ◽

J. M. Reilly ◽

W. D. Hoffman ◽

R. E. Cunnion ◽

R. L. Danner ◽

...

Keyword(s):

Escherichia Coli ◽

Mean Arterial Pressure ◽

Cardiac Index ◽

Stroke Volume Index ◽

Left Ventricular ◽

Cardiac Performance ◽

Volume Index ◽

Hemodynamic Effects ◽

Before And After ◽

Lv Ejection Fraction

To study how sepsis affects hemodynamic responses to catecholamines and fluids, either Escherichia coli-infected (septic, n = 8) or sterile (controls, n = 6) fibrin clots were implanted intraperitoneally into 2-yr-old beagles. Hemodynamics were measured at each of four doses of dopamine (0, 5, 10, and 20 micrograms.kg-1.min-1) and norepinephrine (0, 10, 20, and 40 micrograms.min-1), before and after infusion of fluid (Ringer 40 ml.kg-1). Septic animals had lower mean arterial pressure (MAP, P = 0.04), stroke volume index (SVI, P = 0.0001), and left ventricular (LV) ejection fraction (LVEF) (P = 0.0001) than controls. During this time, increasing doses of dopamine and norepinephrine produced corresponding increases (P < 0.001) in LVEF, SVI, and MAP. However, during sepsis, the ability of dopamine to increase MAP diminished, while its ability to increase LVEF and SVI was maintained. Conversely, the ability of norepinephrine to increase LVEF and SVI diminished, but its ability to increase MAP was maintained. During sepsis, fluids alone increased (P < 0.05) MAP, LVEF, SVI, and cardiac index (CI). Fluids with catecholamines also significantly increased (P < 0.05) MAP with only minimal increases in LVEF, SVI, and CI. These data demonstrate that during sepsis without catecholamines, fluids improve cardiac performance and systemic pressures, but with catecholamines, fluids have minimal effects on cardiac performance and augment MAP. Furthermore, during sepsis dopamine is more effective than norepinephrine in increasing LV performance, but norepinephrine is more effective than dopamine in increasing systemic pressures.

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783 Effect of physical and mental stress on HR and HRV before and after exercise training among patients with cardiac diseases

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(07)60505-0 ◽

2007 ◽

Vol 6 (1) ◽

pp. 179-179

Author(s):

S CARLES ◽

D CURNIER ◽

A PATHAK ◽

J RONCALLI ◽

M BOUSQUET ◽

...

Keyword(s):

Exercise Training ◽

Mental Stress ◽

Cardiac Diseases ◽

Before And After

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A proof of principle study of atomoxetine for the prevention of vasovagal syncope: the Prevention of Syncope Trial VI

EP Europace ◽

10.1093/europace/euz250 ◽

2019 ◽

Vol 21 (11) ◽

pp. 1733-1741 ◽

Cited By ~ 4

Author(s):

Robert S Sheldon ◽

Lucy Lei ◽

Juan C Guzman ◽

Teresa Kus ◽

Felix A Ayala-Paredes ◽

...

Keyword(s):

Cardiac Index ◽

Stroke Volume ◽

Vasovagal Syncope ◽

Resistance Index ◽

Stroke Volume Index ◽

Study Drug ◽

Norepinephrine Transporter ◽

Volume Index ◽

Head Up Tilt ◽

Invasive Techniques

Abstract Aims There are few effective therapies for vasovagal syncope (VVS). Pharmacological norepinephrine transporter (NET) inhibition increases sympathetic tone and decreases tilt-induced syncope in healthy subjects. Atomoxetine is a potent and highly selective NET inhibitor. We tested the hypothesis that atomoxetine prevents tilt-induced syncope. Methods and results Vasovagal syncope patients were given two doses of study drug [randomized to atomoxetine 40 mg (n = 27) or matched placebo (n = 29)] 12 h apart, followed by a 60-min drug-free head-up tilt table test. Beat-to-beat heart rate (HR), blood pressure (BP), and cardiac haemodynamics were recorded using non-invasive techniques and stroke volume modelling. Patients were 35 ± 14 years (73% female) with medians of 12 lifetime and 3 prior year faints. Fewer subjects fainted with atomoxetine than with placebo [10/29 vs. 19/27; P = 0.003; risk ratio 0.49 (confidence interval 0.28–0.86)], but equal numbers of patients developed presyncope or syncope (23/29 vs. 21/27). Of patients who developed only presyncope, 87% (13/15) had received atomoxetine. Patients with syncope had lower nadir mean arterial pressure than subjects with only presyncope (39 ± 18 vs. 69 ± 18 mmHg, P < 0.0001), and this was due to lower trough HRs in subjects with syncope (67 ± 30 vs. 103 ± 32 b.p.m., P = 0.006) and insignificantly lower cardiac index (2.20 ± 1.36 vs. 2.84 ± 1.05 L/min/m2, P = 0.075). There were no significant differences in stroke volume index (32 ± 6 vs. 35 ± 5 mL/m2, P = 0.29) or systemic vascular resistance index (2156 ± 602 vs. 1790 ± 793 dynes*s/cm5*m2, P = 0.72). Conclusion Norepinephrine transporter inhibition significantly decreased the risk of tilt-induced syncope in VVS subjects, mainly by blunting reflex bradycardia, thereby preventing final falls in cardiac index and BP.

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Appropriate delivery method for cardiac disease pregnancy based on noninvasive cardiac monitoring

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0348 ◽

2020 ◽

Vol 48 (4) ◽

pp. 376-383 ◽

Cited By ~ 1

Author(s):

Masami Sawada ◽

Jun Yoshimatsuj ◽

Michikazu Nakai ◽

Rie Tsukinaga ◽

Tae Yokouchi-Konishi ◽

...

Keyword(s):

Epidural Anesthesia ◽

Cardiac Disease ◽

Measurement Techniques ◽

Stroke Volume Index ◽

Cardiac Monitoring ◽

Volume Index ◽

Delivery Method ◽

Epidural Group ◽

Venous Circulation ◽

A Prospective Study

AbstractBackgroundThere are numerous significant physiological changes occurring in circulation during labor. To detect these rapid hemodynamic changes, invasive and intermittent measurement techniques are not reliable. To suggest a suitable delivery method for pregnancy with cardiac disease, this study analyzed how each delivery method influences cardiac function using a noninvasive and continuous measurement technique.MethodsA prospective study was accomplished at the National Cerebral and Cardiovascular Center in Japan from October 1, 2014, to November 30, 2018. The classification of the healthy heart pregnant women was according to the delivery method: vaginal delivery (VD) without epidural anesthesia, VD with epidural anesthesia, and caesarean section (CS). The hemodynamic parameters cardiac index (CI), stroke volume index (SI), and heart rate (HR) were evaluated regularly throughout delivery by noninvasive electrical cardiometry monitor.ResultsTen cases were examined for each group. CI and HR were significantly increased before VD, while the increase in CI and HR was mild in the epidural group in comparison to the nonepidural group. SI was increased toward the delivery in the epidural group, and it was constant in the nonepidural group. However, there was no alteration in the level of outcomes of the two groups. In CS, SI increased and HR decreased before delivery. After delivery, SI continued to increase, while HR did not change but CI increased.ConclusionIn VD, the increase in venous circulation according to the autotransfusion is managed by increasing HR. By epidural anesthesia, the increase in HR was suppressed and SI was increased. However, as epidural anesthesia increases the vascular capacity, the level of SI outcome was comparable. In CS, the HR was decreased because of the spinal anesthesia and the SI was increased because of many factors like hydration. As there are many factors to control in CS, VD with epidural anesthesia will be the first preference for most cardiac patients.

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