scholarly journals Transcranial Doppler in Acute COVID-19 Infection

Stroke ◽  
2021 ◽  
Author(s):  
Wendy C. Ziai ◽  
Sung-Min Cho ◽  
Michelle C. Johansen ◽  
Bahattin Ergin ◽  
Mona N. Bahouth
Keyword(s):  
Blood Flow ◽  
Transcranial Doppler ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Arterial Oxygen ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Ventricular Ejection Fraction ◽  
Arterial Oxygen Content

Background and Purpose: Stroke may complicate coronavirus disease 2019 (COVID-19) infection based on clinical hypercoagulability. We investigated whether transcranial Doppler ultrasound has utility for identifying microemboli and clinically relevant cerebral blood flow velocities (CBFVs) in COVID-19. Methods: We performed transcranial Doppler for a consecutive series of patients with confirmed or suspected COVID-19 infection admitted to 2 intensive care units at a large academic center including evaluation for microembolic signals. Variables specific to hypercoagulability and blood flow including transthoracic echocardiography were analyzed as a part of routine care. Results: Twenty-six patients were included in this analysis, 16 with confirmed COVID-19 infection. Of those, 2 had acute ischemic stroke secondary to large vessel occlusion. Ten non-COVID stroke patients were included for comparison. Two COVID-negative patients had severe acute respiratory distress syndrome and stroke due to large vessel occlusion. In patients with COVID-19, relatively low CBFVs were observed diffusely at median hospital day 4 (interquartile range, 3–9) despite low hematocrit (29.5% [25.7%–31.6%]); CBFVs in comparable COVID-negative stroke patients were significantly higher compared with COVID-positive stroke patients. Microembolic signals were not detected in any patient. Median left ventricular ejection fraction was 60% (interquartile range, 60%–65%). CBFVs were correlated with arterial oxygen content, and C-reactive protein (Spearman ρ=0.28 [ P =0.04]; 0.58 [ P <0.001], respectively) but not with left ventricular ejection fraction (ρ=−0.18; P =0.42). Conclusions: In this cohort of critically ill patients with COVID-19 infection, we observed lower than expected CBFVs in setting of low arterial oxygen content and low hematocrit but not associated with suppression of cardiac output.

scholarly journals The Role of Ejection Fraction to Clinical Outcome of Acute Ischemic Stroke Patients

2018 ◽  
Vol 09 (02) ◽  
pp. 197-202 ◽  
Author(s):  
Fidha Rahmayani ◽  
Ismail Setyopranoto ◽  
Keyword(s):  
Ischemic Stroke ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Stroke Patients ◽  
Ventricular Ejection Fraction

ABSTRACT Aims: The aim of the study was to determine the effect of left ventricular ejection fraction on clinical outcomes of acute ischemic stroke patients. Study Design: This study design was a prospective cohort observational study. Place and Duration of Study: This study was conducted at Stroke Unit, Neurology Ward, and Cardiology Ward at the Dr. Sardjito Hospital, Yogyakarta, Indonesia, between July and December 2016. Materials and Methods: Hospitalized acute ischemic stroke patients were recruited, with sample was taken by consecutive sampling until reaching amount fulfilling inclusion criterion was 62 persons. In this study, clinical outcomes were measured by National Institutes of Health Stroke Scale (NIHSS) scores as well as dependent variables and left ventricular ejection fraction as independent variables. Logistic regression analyses were performed to discover any potential independent variable that can influence the left ventricular ejection fraction role at the clinical outcomes with NIHSS scores. Results: Multivariate analyses revealed that several variables were significantly interacted with the influence of left ventricular ejection fraction at the clinical outcomes with NIHSS scores. These variables were the left ventricular ejection fraction <48% (95% confidence interval [CI]: 0.691–0.925; P = 0.001), left ventricular ejection fraction + low high-density lipoprotein (HDL) (95% CI: 0.73–0.949; P = 0,001), left ventricular ejection fraction + diabetes mellitus (DM) (95% CI: 0.799–0.962; P = 0,001), and left ventricular ejection fraction + low HDL + DM (95% CI: 0.841–0.98; P = 0,001). Conclusion: The influence of the lower left ventricular ejection fraction to clinical outcome of ischemic stroke patients has a worsening of neurological deficit outcome by considering the combination of several independent variables including the DM and low HDL.

scholarly journals Features of left ventricular myocardial remodeling associated with state of coronary сollateral arteries in patients with intermediate function of left ventricle and background of acute decompensation of heart failure

2018 ◽  
Vol 20 (3) ◽  
pp. 33-36
Author(s):  
E G Skorodumova ◽  
V A Kostenko ◽  
E A Skorodumova ◽  
A V Siverina ◽  
A V Rysev
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Coronary Artery ◽  
Left Ventricular Ejection Fraction ◽  
Left Ventricle ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Acute Decompensation ◽  
Myocardial Remodelling

Features of left ventricular myocardial remodelling depending on the state of collateral coronary flow are presented. Disorders of the left ventricle`s myocardium local contractility in patients with the intermediate function of left ventricle under acute decompensation of heart failure were studied. It was established that in such patients with postinfarction cardiosclerosis the main disorders were more often obtained in the basal and middle parts of lower and posterior walls of left ventricle vascularized by a circumflex branch of the left coronary artery or right coronary artery. It was shown that as blood flow increased in coronary collaterals; increase in left ventricular ejection fraction was 7%. In this case, an improvement in collateral blood flow by 1 point according to the Rentrop’s modified classification was accompanied by an increase in the left ventricular ejection fraction by 2 relative percents. In addition, in patients with intermediate left ventricular function, types of left ventricular myocardial remodelling were determined. Thus, in the pathogenesis of acute decompensation of heart failure, an important link is remodelling of the left ventricular myocardium, that is a complex of changes in structure and geometry that occurred under the action of trigger factor. Determination of qualitative type of remodelling, as well as its relationship with changes in extracellular matrix, is important for assessing the risk of cardiovascular complications and selecting adequate therapeutic tactics. and a volume fraction of interstitial collagen was calculated in patients with intermediate left ventricular function and background of acute decompensation of heart failure.

scholarly journals Heart Failure Is Not Associated with a Poor Outcome after Mechanical Thrombectomy in Large Vessel Occlusion of Cerebral Arteries

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Marlena Schnieder ◽  
Anneki von Glasenapp ◽  
Amelie Hesse ◽  
Marios N. Psychogios ◽  
Mathias Bähr ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mechanical Thrombectomy ◽  
Left Ventricular ◽  
Large Vessel ◽  
Left Ventricular Ejection ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Significant Difference ◽  
Patients With Heart Failure ◽  
The Impact

The impact of heart failure on outcome in stroke patients is not fully understood. There is evidence for an increased mortality and morbidity, but it remains uncertain whether thrombectomy in patients with large vessel occlusion (LVO) in the anterior circulation is less effective in patients with heart failure compared to patients without. Retrospectively, we analyzed echocardiographic data of all patients in our stroke database, who underwent mechanical thrombectomy (n=668) for the presence of heart failure. Furthermore, we collected baseline characteristics and neurological and neuroradiological parameters. In the analysis, 373 of the 668 patients of our stroke database underwent echocardiography. Of these 373 patients, 90 patients (24%) suffered from heart failure with reduced left ventricular ejection fraction measured by echocardiography according to the current guidelines. After adjustment for age, the Alberta stroke program early CT score (ASPECTS), and time from symptom onset to recanalization, the analysis revealed that thrombectomy in patients with heart failure and LVO is not associated with less favorable outcome measured by the modified Rankin Scale after 90 days (3 (0-6) vs. 3 (1-5); p=0.380). Moreover, we could not find a significant difference in mortality compared to patients without heart failure (11.0% vs. 7.4%; p=0.313).

Effect of warm-up on left ventricular response to sudden strenuous exercise

1982 ◽  
Vol 53 (2) ◽  
pp. 380-383 ◽  
Author(s):  
C. Foster ◽  
D. S. Dymond ◽  
J. Carpenter ◽  
D. H. Schmidt
Keyword(s):  
Blood Flow ◽  
Ejection Fraction ◽  
Myocardial Blood Flow ◽  
Left Ventricular ◽  
Strenuous Exercise ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Warm Up ◽  
Group A ◽  
Group B

Sudden strenuous exercise (SSE) has been shown to produce ischemic electrocardiographic (ECG) responses, abnormalities of myocardial blood flow, and decreases in left ventricular ejection fraction. Prior exercise taken as warm-up has been shown to ameliorate the ECG and myocardial blood flow abnormalities induced by SSE. The purpose of this study was to determine whether warm-up would normalize the responses of the left ventricular ejection fraction to SSE. Twenty healthy male volunteers performed SSE (400-W bicycle exercise) either with (group A, n = 10) or without (group B, n = 10) warm-up. Ejection fraction was measured using first-pass radionuclide angiography under control conditions and during SSE. During SSE ejection fraction decreased from control values in both group A (70.5 +/- 6.3 to 64.8 +/- 8.2%) and group B (70.3 +/- 10.1 to 57.7 +/- 7.7%), although ejection fraction was significantly higher during SSE in group A. The results are consistent with the hypothesis that the abnormal responses to SSE are attributable to subendocardial ischemia secondary to a delay in autoregulation of myocardial blood flow. However, the decrease in ejection fraction during SSE even following warm-up suggests that the mechanism for the abnormal response to SSE is more complicated than previously hypothesized.

scholarly journals Flow Manipulation and the Association with Myocardial Systolic Function During Extracorporeal Life Support

2021 ◽  
Author(s):  
Pauline Yeung NG ◽  
Tammy Sin Kwan MA ◽  
April IP ◽  
Shu FANG ◽  
Andy Chak Cheung LI ◽  
...  
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Blood Flow Rate ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Systolic Function ◽  
Ventricular Ejection Fraction

Abstract Background:Peripheral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is used to support circulatory failure refractory to conventional therapy. However, data on the heart-ECMO interaction at different levels of ECMO blood flow during the immediate period after ECMO initiation are sparse. We evaluated the effects of varying ECMO blood flow rate on left ventricular systolic function.Methods:Adult patients who were supported by peripheral V-A ECMO in a tertiary referral center were recruited. Serial hemodynamic and cardiac performance parameters were measured by transthoracic echocardiogram within the first 48 hours after implementation of V-A ECMO. Measurements at 100%, 120%, and 50% of target blood flow (TBF) were compared.Results:A total of 45 patients were included, 32 (71.1%) were male, and the median age was 57 (50-64) years. The main indications for V-A ECMO were myocardial infarction 25 (55.6%) and myocarditis 6 (13.3%). With a decrease in extracorporeal blood flow from 100% to 50% of TBF, mean arterial pressure dropped from 75±18 to 67±20 mmHg (p<0.001), but stroke volume increased from 15 (8-25) to 21 (13-34) mL (p<0.001), and cardiac index increased from 0.8 (0.5-1.3) to 1.2 (0.7-1.7) L/min/m2 (p<0.001). All indices of left ventricular contractility improved at 50% compared with 100% TBF: the global longitudinal strain improved from -2.8 (-5.4-0) to -4.7 (-8.2- -1.1)% (p<0.001); left ventricular ejection fraction increased from 16.8 (10.0-28.5) to 28.2 (18.0-35.5)% (p<0.001); and left ventricular outflow tract velocity time integral increased from 4.7 (2.7-7.8) to 7.7 (3.9-11.3) cm (p<0.001). The addition of echocardiographic parameters improved the discrimination of the SAVE score in predicting hospital mortality (AUROC 0.71 vs 0.58).Conclusions:In the initial period of V-A ECMO support, left ventricular systolic function quantified bedside echocardiography was inversely related to ECMO blood flow rate. The heart-ECMO interaction should be considered when determining goals of ECMO flow after initiation.

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