Abstract 322: Cyclooxygenase (COX) Inhibition Prior to CPR Decreases Heart Rate Variability in Pigs

Background: Cyclooxygenase inhibitors (COX-1 and 2) are widely used and inhibit prostaglandin synthesis. COX inhibitors have been shown to increase overall cardiovascular risk. Heart rate variability (HRV) is a measure of the balance of autonomic nervous system and shown to be predictive of neurological outcome after cardiac arrest. Prostaglandins are cardioprotective and modulate HRV. We hypothesized that prostaglandin inhibition impacts short term CPR survival and outcomes based on HRV in swine. Methods: 24 animals (30±5kg) were randomized to pretreatment with indomethacin (I) 2mg/kg (COX-1 Inhibitor), Celecoxib (C) 2mg/kg (COX-2 inhibitor) or placebo (P). VF was induced and after 3 minutes all animals received chest compression and ventilation. After 18 minutes of VF, vasopressin given and defibrillation attempted. Electrocardiogram, echocardiogram and hemodynamic measurements done at baseline (BL), after infusions (Tx) and return of spontaneous circulation (ROSC) at 30 and 180 minutes. Results: ROSC was achieved; 3/8 (I) compared with 7/8 (C), and 7/8 (P). No differences in blood gases or hemodynamics pre, during or post CPR between groups. Echo showed decrease function post resuscitation in surviving animals but not significantly different among groups. COX-2 inhibition induced a significant decrease in linear (SDNN, RMSSD) and frequency (HF) measures of HRV towards greater sympathetic tone, post resuscitation. Compared to P, COX-2 inhibition increased Troponin I levels at 180 min after ROSC; P [84(4)] vs C [721(31)] mg/dl (p< 0.001). Conclusions: COX-1 inhibition decreases ROSC, whereas COX-2 inhibition significantly increases indices of myocardial tissue damage, and decreases HRV. The impact on long term outcome is unknown. Since many adults use COX-1 or COX-2 inhibitors, studies analyzing post resuscitation outcomes of patients should consider the effects of prostaglandin synthesis inhibitors as confounding variables.

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Cardiac Arrhythmias and Impaired Heart Rate Variability in Older Patients With Ventricular Septal Defects

Journal of the American Heart Association ◽

10.1161/jaha.120.020672 ◽

2021 ◽

Author(s):

Marie Maagaard ◽

Filip Eckerström ◽

Vibeke E. Hjortdal

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Ventricular Septal Defects ◽

Cardiac Events ◽

Term Outcome ◽

Premature Ventricular Contractions ◽

Long Term Outcome ◽

Septal Defects ◽

Normal Ranges

Background Congenital ventricular septal defects (VSDs) are considered to have benign long‐term outcome when treated correctly in childhood. However, abnormal parameters are described in younger adults, including impaired heart rate variability (HRV). It is not known whether such abnormalities will deteriorate with age. Therefore, HRV and cardiac events, such as premature ventricular contraction, were evaluated in patients aged >40 years with congenital VSDs and compared with healthy peers. Methods and Results A total of 30 surgically closed VSDs (51±8 years, repair at median age 6.3 years with total range 1.4–54 years) with 30 healthy controls (52±9 years) and 30 small, unrepaired VSDs (55±12 years) with 30 controls (55±10 years) were all equipped with a Holter monitor for 24 hours. Compared with healthy peers, surgically closed patients had lower SD of the normal‐to‐normal (NN) interbeat interval (129±37 versus 168±38 ms; P <0.01), SD of the average NN intervals for each 5‐minute segment of a 24‐hour HRV recording (116±35 versus 149±35 ms; P <0.01) and 24‐hour triangular index (31±9 versus 44±11; P <0.01). SD of the NN intervals, SD of the average NN intervals for each 5‐minute segment of a 24‐hour HRV recording, and triangular index were comparable between unrepaired VSDs and healthy peers. SD of the NN intervals was <100 ms in 22% of surgically closed and 10% of unrepaired VSDs, whereas controls were within normal ranges. A high number of premature ventricular contractions (>200 events) was registered in 57% of surgical patients compared with 3% of controls ( P <0.01), and 53% of unrepaired VSDs compared with 10% in controls ( P <0.01). Conclusions Adults aged >40 with congenital VSDs demonstrate impaired HRV, mainly among surgically closed VSDs. More than half demonstrated a high number of premature ventricular contractions. These novel findings could indicate long‐term cardiovascular disturbances. This necessitates continuous follow‐up of VSDs throughout adulthood.

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The management of Hemorrhoidal Disease by Dearterialization and Mucopexy.

Reviews on Recent Clinical Trials ◽

10.2174/1574887115666200506091306 ◽

2020 ◽

Vol 15 ◽

Author(s):

Veronica De Simone ◽

Francesco Litta ◽

Angelo Parello ◽

Paola Campennì ◽

Raffaele Orefice ◽

...

Keyword(s):

Postoperative Management ◽

Term Outcome ◽

Long Term Outcome ◽

Doppler Probe ◽

Minimally Invasive Surgical ◽

Bowel Movements ◽

Excessive Strain ◽

Life Threatening ◽

Hemorrhoidal Prolapse ◽

The Impact

: Several minimally invasive surgical procedures have been recently developed to treat hemorrhoids without any excision. About 25 years ago, a non-excisional procedure providing doppler-guided ligation of the hemorrhoidal arteries has been proposed - named “hemorrhoidal dearterialization”. The original technique has been modified over the years, and indications were expanded. In particular, a plication of the redundant and prolapsing mucosa/submucosa of the rectum (named “mucopexy”) has been introduced to treat hemorrhoidal prolapse, without excision of the hemorrhoidal piles. At present, the THD® Doppler procedure is one of the most used techniques to treat hemorrhoids. Aim of this technique is to realize a target dearterialization, using a Doppler probe with the final purpose to reduce the arterial overflow to the hemorrhoidal piles. In case of associated hemorrhoidal prolapse, a mucopexy is performed together with Doppler-guided dearterialization. The entity and circumferential extension of the hemorrhoidal prolapse guides the mucopexy, which can be considered tailored to a single patient; the dearterialization should be considered mandatory. Advantages of this surgical technique are the absence of serious and life-threatening postoperative events, chronic complications, and limited recurrence risks. The impact of the procedure on the anorectal physiology is negligible. However, a careful postoperative management is mandatory to avoid complications and to guarantee an improved long-term outcome. Therefore, regular physiologic bowel movements, excessive strain at the defecation and strong physical activity are advisable.

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Mindfulness meditation, well-being, and heart rate variability: A preliminary investigation into the impact of intensive Vipassana meditation

International Journal of Psychophysiology ◽

10.1016/j.ijpsycho.2013.06.017 ◽

2013 ◽

Vol 89 (3) ◽

pp. 305-313 ◽

Cited By ~ 122

Author(s):

Jonathan R. Krygier ◽

James A.J. Heathers ◽

Sara Shahrestani ◽

Maree Abbott ◽

James J. Gross ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Mindfulness Meditation ◽

Preliminary Investigation ◽

Well Being ◽

Vipassana Meditation ◽

The Impact

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The impact of isolated local recurrence on long-term outcome in early-breast cancer patients after breast-conserving therapy

European Journal of Cancer ◽

10.1016/j.ejca.2021.06.018 ◽

2021 ◽

Vol 155 ◽

pp. 28-37

Author(s):

Conny Vrieling ◽

Samson Y. Assele ◽

Lotte Moser ◽

Nicolas Sauvé ◽

Saskia Litière ◽

...

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Cancer Patients ◽

Breast Conserving Therapy ◽

Breast Cancer Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Isolated Local Recurrence ◽

The Impact

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THE IMPACT OF STRESS ON HEART RATE VARIABILITY OF ON-CALL PHYSICIANS

CHEST Journal ◽

10.1378/chest.128.4_meetingabstracts.277s-a ◽

2005 ◽

Vol 128 (4) ◽

pp. 277S

Author(s):

Stavros E. Mountantonakis ◽

Dimitrios A. Moutzouris ◽

Craig McPherson

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

The Impact

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Abstract P315: Increase in Stress May Contribute to Lower Heart Rate Variability in Healthy Young Subjects

Circulation ◽

10.1161/circ.125.suppl_10.ap315 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Amanda C Costa ◽

Ana Gabriela C Silva ◽

Cibele T Ribeiro ◽

Guilherme A Fregonezi ◽

Fernando A Dias

Keyword(s):

Cardiovascular Disease ◽

Heart Rate ◽

Heart Rate Variability ◽

Healthy Volunteers ◽

Perceived Stress ◽

Low Frequency ◽

Statistical Correlation ◽

Total Power ◽

The Impact ◽

Nonparametric Correlation

Background: Stress is one of the risk factors for cardiovascular disease and decreased heart rate variability is associated to increased mortality in some cardiac diseases. The aim of the study was to assess the impact of perceived stress on cardiac autonomic regulation in young healthy volunteers. Methods: 35 young healthy volunteers (19 to 29 years old, 6 men) from a Brazilian population were assessed for perceived stress by the translated and validated Perceived Stress Scale (PSS, 14 questions) and had the R-R intervals recorded at rest on supine position (POLAR RS800CX) and analyzed (5 minutes, Kubius HRV software) by Fast-Fourier Transform for quantification of Heart Rate Variability (HRV). Results: Average data (±SD) for age, heart rate, BMI, waist circumference and percentage of body fat (%BF) were: 21.3±2.7 years; 65.5±7.9 bpm; 22.3±1.9 Kg/m 2 ; 76.0±6.1 cm and 32.1±6.6%; respectively. The mean score for the PSS-14 was 23.5±7.2 and for the HRV parameter as follow: SSDN=54.8±21.2ms; rMSSD=55.9±32.2ms; low-frequency (LF)= 794.8±579.7ms 2 ; High-frequency (HF)= 1508.0±1783.0 ms 2 ; LF(n.u.)= 41.1±16.2; HF(n.u.)= 58.9±16.2; LF/HF=0.89±0.80 and Total power (TP)= 3151±2570ms 2 . Spearman nonparametric correlation was calculated and there was a significant correlation of PSS-14 scores and LF (ms 2 ) (r=−0.343; p= 0.044). Other HRV variables did not shown significant correlation but also had negative values for Spearman r (TP r=−0.265, p=0.124; HF r=−0.158; SSDN r=−0.207; rMSSD r=−0.243, p=0.160). LF/HF and LF(n.u.) did not correlate to PSS-14 having Spearman r very close to zero (LF/HF r=−0.007, p=0.969; LF(n.u.) r=−0.005, p=0.976). No correlation was found for HRV parameters and BMI and there was a trend for statistical correlation of %BF and LF (ms 2 ) (r=−0.309, p=0.071). Conclusions: These data demonstrate a possible association of perceived stress level and HRV at rest. Changes in LF can be a consequence of both sympathetic and parasympathetic activity, however, analyzing the other variables HF, TP, SSDN and rMSSD (all negative Spearman r) and due to the lack of changes in LF/HF ratio and LF(n.u.) we interpret that increased stress may be associated to decrease in overall heart rate variability. These changes were seen in healthy individuals and may point out an important mechanism in cardiovascular disease development.

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Perinatal Care at the Threshold of Viability

PEDIATRICS ◽

10.1542/peds.96.5.974 ◽

1995 ◽

Vol 96 (5) ◽

pp. 974-976

Author(s):

◽

Keyword(s):

Perinatal Care ◽

Survival Rates ◽

Extremely Low Birth Weight ◽

Low Birth Weight Infants ◽

Term Outcome ◽

Long Term Outcome ◽

Obstetric Management ◽

The Cost ◽

The Impact

The survival rate for infants at the threshold of viability has been improving. However, there are insufficient data regarding the cost(s) of initial and ongoing care of these infants and the long-term outcome of survivors. Furthermore, there has been little study of the impact of obstetric management on the survival rates of extremely low birth weight infants and on long-term morbidities. Continued research on these issues is imperative, and physicians need to remain informed of changing statistics.

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Psychological profiles derived by cluster analysis of Minnesota Multiphasic Personality Inventory and long term clinical outcome after coronary artery by pass grafting

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2012.141 ◽

2015 ◽

Vol 78 (1) ◽

Author(s):

Maddalena Modica ◽

Roberta Carabalona ◽

Rosa Spezzaferri ◽

Monica Tavanelli ◽

A. Torri ◽

...

Keyword(s):

Cluster Analysis ◽

Coronary Artery ◽

Clinical Characteristics ◽

Minnesota Multiphasic Personality Inventory ◽

Personality Inventory ◽

Psychological Characteristics ◽

Term Outcome ◽

Long Term Outcome ◽

The Impact

Background: To evaluate the psychological characteristics of coronary heart disease (CHD) patients after coronary artery bypass grafting (CABG) by cluster analysis of Minnesota Multiphasic Personality Inventory (MMPI-2) questionnaires and to assess the impact of the profiles obtained on long-term outcome. Methods: 229 CHD patients admitted to cardiac rehabilitation filled in self-administered MMPI-2 questionnaires early after CABG. We assessed the relation between MMPI- 2 profiles derived by cluster analysis, clinical characteristics and outcome at 3-year follow-up. Results: Among the 215 patients (76% men, median age 66 years) with valid criteria in control scales, we identified 3 clusters (G) with homogenous psychological characteristics: G1 patients (N=75) presented somatoform complaints but overall minimal psychological distress. G2 patients (N=72) presented type D personality traits. G3 subjects (N=68) showed a trend to cynicism, mild increases in anger, social introversion and hostility. Clusters overlapped for clinical characteristics such as smoking (G1 21%, G2 24%, G3 24%, p ns), previous myocardial infarction (G1 43%, G2 47%, G3 49% p ns), LV ejection fraction (G1 60 [51 – 60]; G2 58 [49- 60]; G3 60 [55-60], p ns), 3-vessel-disease prevalence (G1 69%, G2 65%, G3 71%, p ns). Three-year event rates were comparable (G1 15%; G2 18%; G3 15%) and Kaplan- Meier curves overlapped among clusters (p ns). Conclusions: After CABG, the interpretation of MMPI- 2 by cluster analysis is useful for the psychological and personological diagnosis to direct psychological assistance. Conversely, results from cluster analysis of MMPI-2 do not seem helpful to the clinician to predict long term outcome.

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