scholarly journals Bisoprolol transdermal patch for perioperative care of non-cardiac surgery in patients with hypertrophic obstructive cardiomyopathy

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yoichi Imori ◽  
Hitoshi Takano ◽  
Hiroshi Mase ◽  
Junya Matsuda ◽  
Hideto Sangen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Surgery ◽  
Ejection Fraction ◽  
Pressure Gradient ◽  
Perioperative Care ◽  
Perioperative Period ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Cardiovascular Complications ◽  
Transdermal Patch

Abstract Background Non-cardiac surgery for hypertrophic obstructive cardiomyopathy (HOCM) is considered to require meticulous perioperative care. β-blockers are considered the first-line drugs for patients with HOCM, and they play a key role in preventing cardiovascular complications in perioperative care. The bisoprolol transdermal patch has recently become available in Japan, and it is useful for patients who are unable to take oral medication during perioperative care. The aim of this case series was to assess the hemodynamic features of patients with HOCM who used the bisoprolol transdermal patch during perioperative care for non-cardiac surgery. Methods Between August 2016 and August 2018, we retrospectively analyzed 10 consecutive cases of HOCM with the patients using the bisoprolol transdermal patch during perioperative care. Hemodynamic and echocardiographic features were evaluated before and after patients were switched from oral bisoprolol to transdermal patch therapy or started transdermal patch therapy as a new β-blocker medication. In addition, cardiovascular complications (all-cause death, cardiac death, heart failure, ventricular tachycardia, and ventricular fibrillation) during the perioperative period were evaluated. Results There was no significant change in the patients’ heart rate, blood pressure, ejection fraction, and pressure gradient in the left ventricle after switching from oral bisoprolol to the transdermal patch therapy. On the other hand, patients who started using the bisoprolol transdermal patch as a new ß-blocker medication tended to have a decreased heart rate and pressure gradient thereafter, but there was no significant difference in blood pressure or ejection fraction. No cardiovascular complications occurred during the perioperative period. Conclusions We described the utilization of the bisoprolol transdermal patch during perioperative care for non-cardiac surgery in patients with HOCM. We determined that the hemodynamic features of these patients did not change significantly after switching to patch therapy. Further, initiation of the bisoprolol transdermal patch as a new ß-blocker medication sufficiently tended to decrease the pressure gradient. This unique approach can be an alternate treatment option for HOCM. Trial registration The registry was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000036703). The date of registration was 10/5/2019 and it was “Retrospectively registered”.

Abstract 328: Hemodynamic Comparison of Zucker Diabetic Fatty Rats to Their Lean Littermates After Asphyxial Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Claudius Balzer ◽  
Franz Baudenbacher ◽  
Michele M Salzman ◽  
William J Cleveland ◽  
Susan Eagle ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Arrest ◽  
Ejection Fraction ◽  
Ischemia Reperfusion ◽  
Diabetic Rats ◽  
Arterial Blood ◽  
Zucker Diabetic Fatty Rats ◽  
Zdf Rats ◽  
The Impact

Patients with metabolic syndrome are at higher risk for cardiac arrest (CA), and also have worse neurologic outcome after CA related to their comorbidities (e.g., Type 2 Diabetes Mellitus [T2DM]). Using Zucker Diabetic Fatty (ZDF) rats as a new and relevant model with common comorbidities for CA and cardiopulmonary resuscitation (CPR), we hypothesized that T2DM is associated with a lower chance for return of spontaneous circulation (ROSC) and/or a worse outcome regarding heart function after asphyxial CA compared to their lean littermates. Two groups of rats (8 ZDF, 7 lean) were monitored for 37±2 weeks. The rats were anesthetized and intubated; heart rate was monitored by subcutaneous ECG needles. Femoral artery and vein were cannulated for continuous blood pressure measurement and delivery of fluids and medications, respectively. Before ventilation was stopped to initiate asphyxial CA, rocuronium was given. After 8 minutes of CA, ventilation was re-initiated with FiO 2 1.0, epinephrine and sodium-bicarbonate were administered, and pneumatic chest compression were started with 200 compressions per minute. Chest compressions were stopped when a systolic blood pressure of 120 mmHg was achieved. During 4 hours of observation, vital parameters were closely monitored, blood gases were measured, and ejection fraction (EF %) was assessed with ultrasound. Data are mean ± SD. Statistics: Unpaired student’s t-test (two-tailed), α.05. At baseline, ZDF rats showed significantly higher blood glucose levels (504±52 vs 174±14 mg/dl) compared to their lean littermates. All ZDF and lean rats achieved ROSC, and measurements taken directly after ROSC and after the first hour showed no relevant differences. After four hours, there was no difference in heart rate between ZDF and lean rats. However, diabetic rats had a significantly higher mean arterial blood pressure (142±24vs. 107±19 mmHg) and ejection fraction (42±16%vs 20±8%) compared to their lean littermates. The hypothesis that ROSC-rate in diabetic rats would be lower could not be proven. Conversely, the ZDF rats showed a significantly higher blood pressure related to an increased EF%. Further analysis in this study will focus on the impact of T2DM on cardiac and neurological ischemia-reperfusion injury.

Abstract 13421: Ventricular and Arterial Elastance During Isometric Handgrip Exercise and Post-exercise Circulatory Arrest in Heart Failure With and Without Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Naoki Fujimoto ◽  
Keishi Moriwaki ◽  
Issei Kameda ◽  
Masaki Ishiyama ◽  
Taku Omori ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Circulatory Arrest ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Isometric Handgrip ◽  
Arterial Elastance ◽  
Post Exercise

Introduction: Isometric handgrip (IHG) training at 30% maximal voluntary contraction (MVC) lowers blood pressure in hypertensive patients. Impacts of IHG exercise and post-exercise circulatory arrest (PECA), which isolates metaboreflex control, have been unclear in heart failure (HF). Purpose: To investigate the impacts of IHG exercise and PECA on ventricular-arterial stiffness and left ventricular (LV) relaxation in HF with preserved (HFpEF) and reduced ejection fraction (HFrEF). Methods: We invasively obtained LV pressure-volume (PV) loops in 20 patients (10 HFpEF, 10 HFrEF) using conductance catheter with microtip-manometer during 3 minutes of IHG at 30%MVC and 3 minutes of PECA. Hemodynamics and LV-arterial function including LV end-systolic elastance (Ees) by the single-beat method, effective arterial elastance (Ea), and time constant of LV relaxation (Tau) were evaluated every minute. Results: At rest, HFpEF had higher LV end-systolic pressure (ESP) and lower heart rate than HFrEF with similar LV end-diastolic pressure (EDP). The coupling ratio (Ees/Ea) was greater in HFpEF than HFrEF (1.0±0.3 vs. 0.6±0.3, p<0.01). IHG for 3minutes similarly increased heart rate in HFpEF (by 10±8 bpm) and HFrEF (by 14±6 bpm). IHG also increased end-diastolic and LVESP (134±21 vs. 158±30 mmHg and 113±25 vs. 139±25 mmHg) in both groups (groupхtime effect p≥0.25). In HFpEF, Ees, Ea and Ees/Ea (1.0±0.3 vs. 1.1±0.4) were unaffected during IHG. In HFrEF, IHG induced variable increases in Ea. LV end-systolic volume and the ESPV volume-axis intercept were larger, and Ees at IHG 3 rd min was greater (1.30±0.7 vs. 3.1±2.1 mmHg/ml, p<0.01) than baseline, resulting in unchanged Ees/Ea at IHG 3 rd min (0.6±0.3 vs. 0.8±0.4, p≥0.37). Tau was prolonged only in HFrEF during IHG and was returned to the baseline value during PECA. During the first 2 minutes of PECA, LVESP was lower than that at IHG 3 rd min only in HFpEF, suggesting less metaboreflex control of blood pressure in HFpEF during IHG. Conclusions: IHG exercise at 30%MVC induced modest increases in LV end-systolic and end-diastolic pressures in HFpEF and HFrEF. Although the prolongation of LV relaxation was observed only in HFrEF, the ventricular and arterial coupling was maintained throughout the IHG exercise in both groups.

P3835Improvement of myocardial energetic efficiency during treatment in hypertensive patients: the life study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M A Losi ◽  
C Mancusi ◽  
E Gerdts ◽  
K Wachtell ◽  
S E Kjeldsen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Left Ventricular ◽  
Energetic Efficiency ◽  
Stroke Work ◽  
Hypertensive Patients ◽  
Life Study ◽  
Over Time

Abstract Background Myocardial energetic efficiency (MEE) per unit of left ventricular (LV) mass significantly predicts composite of cardiovascular (CV) events in treated hypertensive patients and specifically heart failure in an event-free population-based cohort with normal ejection fraction, independently of LV hypertrophy (LVH). Purpose To investigate whether MEEi changes over time in treated hypertensive patients, and whether different treatments have different effects. Methods From the Losartan Intervention For Endpoint study (LIFE Echo Sub-study) we selected 744 hypertensive patients (age 66±7 years; 45% women) with LVH at ECG, without atrial fibrillation, previous or incident myocardial infarction and with normal echocardiographic ejection fraction (>50%). MEE was estimated as the ratio of stroke work to the “double” product of heart rate times systolic blood pressure (BP), simplified as the ratio of stroke volume to heart rate, as previously reported. MEE was normalized for LVM (MEEi) and analyzed in quartiles at baseline and at the end treatment, according to an “intention-to-treat” protocol. Results Age and proportion of women were not significantly different from the highest to the lowest quartiles (from 65±7 to 66±7 years, p for trend=0.352; from 45% to 42%, p=0.946, respectively), whereas diastolic blood pressure (from 97±8 to 100±9 mmHg, p=0.006), prevalence of obesity (from 14 to 31%, p=0.001) and diabetes (from 4 to 14%, 0.004) progressively increased. Prevalence of concentric LV geometry and echocardiographic LVH also progressively increased from the highest to the lowest quartile (from 14 to 70%, and 61 to 90%, both p<0.0001). MEEi increased over time (p<0.007), independently of initial diastolic BP, diabetes and obesity, significantly more in patients treated with atenolol than with losartan (p<0.0001) (Figure), due to both increased stroke volume and decreased heart rate (both p<0.0001). Figure 1 Conclusions In a randomized clinical study, MEEi improves with anti-hypertensive therapy. Improvement is more evident in patients with atenolol than with losartan-based treatment, possibly providing pathophysiologic explanation of the comparable performance in prevention of ischemic heart disease previously reported in the LIFE study.

Effect of Multimodal Anesthesia on the Hemodynamic Profile and Acid-Base Balance in the Early Post-Operative Period in Patients Operated for Lung Tumors

2015 ◽  
Vol 22 (4) ◽  
pp. 63-73
Author(s):  
Качур ◽  
S. Kachur ◽  
Долгих ◽  
V. Dolgikh
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Lung Tumors ◽  
Acid Base Balance ◽  
Acid Base ◽  
Arterial Blood ◽  
Post Operative Period ◽  
Base Balance ◽  
Hemodynamic Profile

This work presents the effects of multimodal anesthesia with neuraxial blockade on the basic parameters of central hemodynamics in patients operated for lung tumors, revealed by method of terapolar rheovasography by Kubicek (systolic blood pressure, diastolic, average heart rate, ejection fraction, minute volume of blood circulation, cardiac index, oxygen delivery index, the index of the total peripheral vascular resistance), as well the effects on acid‐base balance of arterial blood in the immediate post‐operative period. The level of antinociceptive protection was assessed by visual analogue scale. Comparison of results of patients operated by means of multimodal anesthesia and the patients, operated in an inhalation intravenous anesthesia with artificial lung ventilation and peri‐operative analgesia by opioid analgesics has revealed that the hemodynamic profile of the first group of patients is characterized by stability of the basic parameters such as blood pressure and heart rate, the lack of a pronounced reduction of the ejection fraction and stroke volume of the heart, despite vasoplegia caused by epidural blockade. The level of partial oxygen tension of arterial blood was decreased in the early postoperative period, but it was in the normal limits and he was statistically significantly higher than in the comparison group that can help reduce the risk of post‐operative complications. Significantly lower level of pain indicates adequate antinociceptive protection of patients.

scholarly journals An Ascending Aortic Haemodynamic Comparison Between Normotensive and Hypertensive Subjects

2018 ◽  
Vol 2 (1) ◽  
pp. 16
Author(s):  
Vijay Kumar Narayana ◽  
Rajeev Sharma ◽  
Niranjan Murthy
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Ejection Fraction ◽  
Pressure Gradient ◽  
Aortic Blood Flow ◽  
Ejection Time ◽  
Acceleration Time ◽  
Aortic Blood ◽  
Ascending Aortic Diameter ◽  
Deceleration Time

<p><strong>Background:</strong> Systemic hypertension, a common disorder with potentially serious complications, exerts ill effects through structural and functional modifications of arterial wall. Haemodynamics play an important role in the development of atherosclerosis. Local hemodynamic temporal pressure and wall shear stress are important for understanding the mechanisms leading to various complications in cardiovascular function.</p><p><strong>Objectives:</strong> Since we could not find such a study in literature involving Indian population, this prompted us to investigate and establish the relationship between the blood pressure and the ascending aortic pulse wave parameters in normal individuals and compare the same with hypertensives.</p><p><strong>Material and Methods:</strong> A case control study was done in a tertiary care hospital involving 25 hypertensive parents and further compared with 25 normotensive subjects of same age group acting as control. The GE ̶ P 100 Doppler echocardiography machine was used to study acceleration time, deceleration time, ejection time, ejection fraction, peak flow velocity and pressure gradient in hypertensives and compared the same with age matched normotensive. Also ascending aortic diameter was mapped at the annulus.</p><p><strong>Results:</strong> The results of our study confirmed our assumption that in hypertensive the ascending aortic haemodynamic parameters are abnormal and both systolic and diastolic blood pressure does exert a statistically significant influence on the Doppler parameters of ascending aorta. The acceleration time, deceleration time, pressure gradient and ejection time showed statistically significant increase in hypertensives when compared to normotensive. At the same time the ejection fraction and the ascending aortic diameter showed a statistically significant decrease than normotensive.</p><p><strong>Conclusion:</strong> We would conclude to say that the Doppler parameters of ascending aortic blood flow are abnormal in hypertensives. This altered haemodynamics may lead to further ill effects by way of altered peripheral haemodynamics. This Doppler evaluation of ascending aortic blood flow can be developed as a clinical tool for evaluating hypertensives and assessing the benefit of treatment of hypertension.</p>

scholarly journals Transvenous endocardial pacemaker pacing in thoracoscopic cardiac surgery

2021 ◽  
Author(s):  
Xiangnian Li ◽  
wu zhang ◽  
Yu Xia ◽  
Shengjie Liao ◽  
xiao shen zhang
Keyword(s):  
Heart Rate ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Median Sternotomy ◽  
Operation Time ◽  
Perioperative Period ◽  
Perioperative Outcomes ◽  
Significant Difference ◽  
Epicardial Pacing ◽  
Endocardial Pacing

Background: Temporary cardiac pacing is frequently required during heart surgery due to life-threatening complications of arrhythmias. The conventional method of epicardial pacing could have risks such as bleeding and myocardial tears. Transvenous endocardial pacing provides another option. The efficiency of transvenous epicardial and endocardial pacing were compared in this study. Methods: We performed a retrospective study and reviewed medical records in patients who received either thoracoscopic cardiac surgery with transvenous endocardial pacing or median sternotomy with transvenous epicardial pacing between June 2019 and January 2021. Patients were assigned into two groups depending on the surgical type and pacing method. Preoperative patient characteristics and perioperative outcomes were collected. The efficiencies of endocardial and epicardial pacing were compared and analyzed in SPSS. Results: A total of 68 patients were included. Thirty-five (51.5%) patients were in the thoracoscopic cardiac surgery group with transvenous endocardial pacing. Thirty-three (48.5%) patients were in the median sternotomy group with transvenous epicardial pacing. Intensive care unit (ICU) time (p = 0.014), in-hospital duration (p = 0.036), operation time (p = 0.005), and the 24-h drainage volume (p < 0.001) showed significant differences between the two groups. There was no significant difference between the pre- and post-operative heart rate and rhythm compared between two groups. Conclusions: Compared with transvenous epicardial pacing, transvenous endocardial pacing showed no significant differences in heart rate and arrhythmia during the perioperative period. Transvenous endocardial pacing was also associated with better operative measurements.

scholarly journals The use of a new type of heart rate-controlled training system HeartGo for patients with chronic Heart failure on the pedelec.

2020 ◽  
Author(s):  
Erik B Friedrich ◽  
Guenter Hennersdorf ◽  
Herbert Loellgen ◽  
Helmut Roeder ◽  
Wolfgang Baltes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Pilot Study ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Clinical Data ◽  
Health Benefits ◽  
Left Ventricular Ejection ◽  
Rate Controlled

Summary: Background: The study "HI-Herz.BIKE Saar" (August 2017 - September 2019) examined health benefits and training effects of e-bikes (pedelecs) in patients with moderate chronic heart failure (CHF) from ambulatory heart groups. Method: The presented study is explicitly marked as a pilot study. 10 subjects with CHF NYHA stage II-III and a left ventricular ejection fraction (LVEF) of <=50% were selected. In our study, we are the first to employ the novel HeartGo system which allows for heart rate controlled training on pedelecs via a smartphone app. Training groups were accompanied during bike rides by a medical doctor and a paramedic. No cardiac complications occurred. Every six months, training sessions increased in duration, distance, and target frequency. Parameters measured were frequency behaviour, pedaling and motor load on the pedelec as well as clinical data such as ejection fraction, the biomarker NT-pro BNP, risk factors, arterial blood pressure and ergometric courses. Results: Power tolerance increased by almost 2.5 times, while a discrete decrease of the resting heart rate by 3.7% was observed and pedaling power improved accordingly. Clinical data show significant increases in well-being determined by questionnaire, in ergometric power by 45%, and in the LVEF by 29%. This was paralleld by a significant decrease in the NT-pro BNP value by 27% and in systolic blood pressure by 11%. Body Mass Index (BMI) remained constant at 27 and cholesterol levels showed no significant changes. Conclusions: Pedaling according to this pilot study with its methodological limitations of low numbers was safe and accompanied by significant health benefits in patient with CHF. Moreover, subjects were enthusiastic and satisfied with this form of training. Therefore, pedelec training using the HeartGo system could be a helpful tool in the training process of heart group participants with stable CHF. The results of this pilot study with its methodological weaknesses should be verified in a larger follow-up study. Key words: Pedelec, e-bike, heart rate control, heart failure, physical activity

scholarly journals Telemonitoring in subjects with newly diagnosed heart failure with reduced ejection fraction: From clinical research to everyday practice

2018 ◽  
Vol 25 (3) ◽  
pp. 167-171 ◽  
Author(s):  
G Koulaouzidis ◽  
D Barrett ◽  
K Mohee ◽  
AL Clark
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Electronic Devices ◽  
Newly Diagnosed ◽  
Online Database ◽  
Reduced Ejection Fraction ◽  
Real World Setting

Introduction Heart failure is increasingly common, and characterised by frequent admissions to hospital. To try and reduce the risk of hospitalisation, techniques such as telemonitoring (TM) may have a role. We wanted to determine if TM in patients with newly diagnosed heart failure and ejection fraction <40% reduces the risk of readmission or death from any cause in a ‘real-world’ setting. Methods This is a retrospective study of 124 patients (78.2% male; 68.6 ± 12.6 years) who underwent TM and 345 patients (68.5% male; 70.2 ± 10.7 years) who underwent the usual care (UC). The TM group were assessed daily by body weight, blood pressure and heart rate using electronic devices with automatic transfer of data to an online database. Follow-up was 12 months. Results Death from any cause occurred in 8.1% of the TM group and 19% of the UC group ( p = 0.002). There was no difference between the two groups in all-cause hospitalisation, either in the number of subjects hospitalised ( p = 0.7) or in the number of admissions per patient ( p = 0.6). There was no difference in the number of heart-failure-related readmissions per person between the two groups ( p = 0.5), but the number of days in hospital per person was higher in the UC group ( p = 0.03). Also, there were a significantly greater number of days alive and out of hospital for the patients in the TM group compared with the UC group ( p = 0.0001). Discussion TM is associated with lower any-cause mortality and also has the potential to reduce the number of days lost to hospitalisation and death.

scholarly journals Associations of Blood Pressure and Heart Rate and Their Contribution to the Development of Cardiovascular Complications and All-Cause Mortality in the Russian Population of 25-64 Years

2020 ◽  
Vol 16 (5) ◽  
pp. 759-769
Author(s):  
S. A. Shalnova ◽  
V. A. Kutsenko ◽  
A. V. Kapustina ◽  
E. B. Yarovaya ◽  
Yu. A. Balanova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiovascular Complications ◽  
Adverse Outcomes ◽  
Average Value ◽  
Risk Of Mortality ◽  
The Right ◽  
Relationship Of ◽  
The Relationship

Aim. To study the relationship of blood pressure (BP) and heart rate (HR) in a sample of men and women 25-64 years old and their predictive value for the development of fatal and non-fatal cardiovascular diseases (CVD) and mortality from all causes.Material and methods. Prospective observation was for cohorts of the population aged 25-64 years from 11 regions of the Russian Federation. 18,251 people were included in the analysis. Each participant gave written informed consent. All surveyed persons were interviewed with a standard questionnaire. BP was measured on the right hand with an automatic tonometer. BP and HR were measured twice with an interval of 2-3 min with the calculation of the average value. The patients were divided into 4 groups: the first group with BP<140/90 ><140/90 mm Hg and HR≤80 beats/min; the second group – BP<140/><140/90 mm Hg and HR>80; the third group – BP≥140/90 mm Hg and HR≤80; the fourth group – BP≥140/90 mm Hg and HR>80 beats/min. Risk factors and cardiovascular history were analyzed as well. Deaths over 6 years of follow-up occurred in 393 people (141 – from CVD). Statistical analysis was performed using the open source R3.6.1 system.Results. A HR>80 beats/min was found in 26.3% of people with BP≥140/90 mm Hg, regardless of medication. Analysis of the associations between HR and BP showed that for every increase in HR by 10 beats/min, systolic BP increases by 3 mm Hg. (p<0.0001). The group with HR>80 beats/min and BP≥140/90 mm Hg had the shortest life expectancy (p<0.001). Adding an increased HR to BP≥140/90 mm Hg significantly><0.001). Adding an increased HR to BP≥140/90 mm Hg significantly worsened the prognosis of patients. Similar results were obtained in the analysis of cardiovascular survival. Elevated BP and elevated HR had the same effect on outcomes, except for the combined endpoint, where the contribution of elevated BP was predominant. However, their combined effect was the largest and highly significant for the development of the studied outcomes, even after adjusting for other predictors. With an increase in HR by every 10 beats/min, the risk of mortality increased statistically significantly by 22%.Conclusion. The prevalence of HR>80 beats/min in people with BP≥140 mm Hg amounted to 26.34%. Every 10 beats/min significantly increases the risk of mortality by 22%. Increased HR with elevated BP leads to increased adverse outcomes.

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