Cardiac safety of intraoperative fluid therapy regimens in patients with concomitant coronary heart disease during major abdominal surgery

Myocardial biomarkers such as brain natriuretic peptide (BNP) and brain natriuretic peptide amino-terminal prohormone (NT-proBNP), cardiac troponins (cTn), C-reactive protein (CRP) are considered as key in the strategy of treatment and prognosis for cardiovascular diseases. It is relevant for patients with high cardiological risk during major abdominal surgery and important in the context of preventing cardiac complications in the perioperative period. The aim. To assess the cardiac safety of intraoperative fluid therapy regimens in patients with high cardiac risk after major abdominal surgery by analyzing the dynamics of NTproBNP, Troponin I and CRP indicators. Materials and methods. The study included 89 patients who were divided into two groups depending on the tactics of the intraoperative fluid therapy: liberal and relatively restrictive. Continuous monitoring of macroindicators of cardiovascular system, quantitative assessment of myocardial damage biomarkers (TnI, NTproBNP) and CRP by enzyme-linked immunosorbent assay were performed at three stages - before surgery, immediately after and in the first 18–24 hours. Results. The rate of intraoperative fluid therapy was significantly different in two groups: in the restrictive 7.0 ± 0.2 ml/kg/h (n = 45), liberal 13.9 ± 0.6 ml/kg/h (n = 44). Evaluation of the dynamics of myocardial damage biomarkers revealed no differences in the levels of Troponin I and NP-proBNP at the first stage of the study. In the early postoperative period, the level of NP-proBNP in the second group was significantly higher than that in the first, 123.1 pg/ml and 68.0 pg/ml, respectively. An increase in Troponin I levels in the postoperative period was detected in 5 patients of the first group and in 6 – of the second, and it was diagnosed as myocardial injury after noncardiac surgery (MINS). Conclusions. The study has demonstrated the relative safety of fluid therapy regimens in patients with concomitant coronary heart disease without manifestations of congestive heart failure during major abdominal surgery. The regimen with relative fluid restriction has appeared to be preferable due to less response induction from compensatory mechanisms with normal NT-proBNP values. Adequate monitoring of cardiovascular system parameters and control of the dynamics of myocardial damage biomarkers can be the key in preventing such severe complications as postoperative myocardial infarction.

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Estimation of the Safety of Intraoperative Fluid Therapy during Great Abdominal Surgery in Patients with Coronary Heart Disease

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs05.05.158 ◽

2020 ◽

Vol 5 (5) ◽

pp. 158-163

Author(s):

V. I. Lysenko ◽

◽

E. A. Karpenko ◽

Ya. V. Morozova

Keyword(s):

Heart Failure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Fluid Therapy ◽

Troponin I ◽

Significant Proportion ◽

Myocardial Damage ◽

Enzyme Linked Immunosorbent Assay ◽

Cardiac Complications ◽

Fluid Regimen

The study of intraoperative fluid therapy tactics has been of great interest over the past few years, especially in people with concomitant coronary heart disease, as they make up a significant proportion of all surgical patients. The purpose of our study was to assess the risk of intraoperative myocardial damage in patients with concomitant coronary heart disease depending on the fluid regimen used based on monitoring of hemodynamic parameters, electrocardiogram and biomarkers of myocardial damage. Material and methods. The study involved 89 patients, who were divided into two groups depending on the tactics of intraoperative fluid therapy – restrictive and liberal. In order to detect cardiac complications at different stages, we assessed biomarkers of myocardial damage Troponin I, NT-proBNP by solid-phase enzyme-linked immunosorbent assay (ELISA). Results and discussion. Analysis of the obtained data showed that MINS (myocardial injury in noncardiac surgery) incidents were diagnosed in 5 patients (11.1%) in the first group and in 6 patients (13.6%) in the second. In patients of both groups there was an increase in NT-proBNP in the dynamics at all stages, and in the 2nd group, with a liberal regimen of intraoperative fluid therapy, it was more pronounced. It should be noted that the obtained values of NT-proBNP in all patients did not differ significantly from those allowed for this age group; such dynamics of NT-proBNP may indicate a relative risk of complications of liberal fluid therapy in patients with baseline heart failure. One of the important points when choosing the mode of fluid therapy in patients with high cardiac risk is the assessment of the initial volemic status and careful monitoring of water balance in the perioperative period with the desire for "zero" balance. The obtained dynamics of laboratory markers of myocardial damage indicates that in patients with a significant reduction in cardiac reserves compensated for heart failure, a restrictive fluid regimen is preferable, which is also confirmed by slight changes in the concentration of biomarkers. Conclusion. Thus, the study demonstrated the relative safety of selected fluid regimens in patients with concomitant coronary heart disease without signs of congestive heart failure

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Effect of SVV-guided Fluid Therapy on Outcomes After Major Abdominal Surgery

Case Medical Research ◽

10.31525/ct1-nct03940144 ◽

2019 ◽

Author(s):

Keyword(s):

Abdominal Surgery ◽

Fluid Therapy ◽

Major Abdominal Surgery

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Faculty Opinions recommendation of Crystalloid versus Colloid for Intraoperative Goal-directed Fluid Therapy Using a Closed-loop System: A Randomized, Double-blinded, Controlled Trial in Major Abdominal Surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732036919.793538429 ◽

2017 ◽

Author(s):

Michael James

Keyword(s):

Abdominal Surgery ◽

Fluid Therapy ◽

Closed Loop ◽

Controlled Trial ◽

Loop System ◽

Major Abdominal Surgery ◽

Closed Loop System ◽

System A ◽

Goal Directed Fluid Therapy ◽

Double Blinded

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Faculty Opinions recommendation of Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733203094.793547158 ◽

2018 ◽

Author(s):

Lee Fleisher ◽

Jesse Raiten

Keyword(s):

Abdominal Surgery ◽

Fluid Therapy ◽

Major Abdominal Surgery

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Troponin I as a Predictor of Coronary Heart Disease and Mortality in 70-Year-Old Men

Circulation ◽

10.1161/circulationaha.105.570762 ◽

2006 ◽

Vol 113 (8) ◽

pp. 1071-1078 ◽

Cited By ~ 196

Author(s):

Björn Zethelius ◽

Nina Johnston ◽

Per Venge

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Troponin I ◽

Old Men

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Efficacy and Safety of TCMI in Patients With Combined Coronary Heart Disease and Heart Failure: A Systematic Review and Network Meta-Analysis

Frontiers in Pharmacology ◽

10.3389/fphar.2021.741261 ◽

2021 ◽

Vol 12 ◽

Author(s):

Penglu Wei ◽

Kuo Yang ◽

Dehuai Long ◽

Yupei Tan ◽

Wenlong Xing ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Coronary Heart Disease ◽

Heart Disease ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Meta Analysis ◽

Controlled Trials ◽

Efficacy And Safety ◽

Effectiveness Rate

Objective: To compare the efficacy and safety of conventional treatments (CTs) to those that included traditional Chinese medicine injections (TCMIs) in patients with combined coronary heart disease and heart failure (CHD-HF).Methods: Eight electronic literature databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure Database, Chinese Scientific Journal Database, Wanfang Database, Chinese Biomedical Database) were searched from their inceptions to May 18, 2021, to identify relevant randomised controlled trials (RCTs). The primary outcomes analyzed included the total effectiveness rate and adverse events (ADRs). The secondary outcomes analyzed included the left ventricular ejection fraction (LVEF), N-terminal pro-brain natriuretic peptide (NT-proBNP), brain natriuretic peptide (BNP), and 6-min walk test (6MWT). Cochrane risk-of-bias tool was used to assess quality of the analyzed RCTs. Stata and OpenBUGS software were used to prior to the systematic review and network meta-analysis.Results: Sixty-one eligible trials involved 5,567 patients and one of the following 15 TCMIs: Shuxuetong, Shenmai, Shenfu, Shengmai, Danshenduofenyansuan, Danhong, Dazhuhongjingtian, Xinmailong, Dengzhanxixin, Gualoupi, Shuxuening, Xuesaitong, Yiqi Fumai, Shenqi Fuzheng, Huangqi. Network meta-analysis revealed that Shuxuetong injection + CT group was superior to CT only in improving the total effectiveness rate [odds ratio (OR): 7.8, 95% confidence interval (CI): 1.17–27.41]. Shenmai injection + CT was superior to CT only for LVEF (OR: 8.97, CI: 4.67–13.18), Xinmailong injection + CT was superior to CT only for NT-proBNP (OR: −317.70, CI: −331.10–303.10), Shenqi Fuzheng injection + CT was superior to CT only for BNP (OR: −257.30, CI: −308.40–242.80); and Danhong injection + CT was superior to CT only for 6MWT (OR: 84.40, CI: 62.62−106.20). Different TCMIs had different toxicity spectrums.Conclusion: TCMIs combined with CT are better than CT alone in treating CHD-HF. Different TCMIs improve different outcomes. Additional properly designed RCTs are needed to conduce a more refined comparison of various TCMIs.Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021258263].

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Stem cells in the treatment of patients with coronary heart disease. Part I

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2011-2-122-128 ◽

2011 ◽

Vol 10 (2) ◽

pp. 122-128 ◽

Cited By ~ 1

Author(s):

N. S. Zhukova ◽

I. I. Staroverov

Keyword(s):

Stem Cells ◽

Coronary Heart Disease ◽

Stem Cell ◽

Heart Disease ◽

Cell Therapy ◽

Stem Cell Therapy ◽

Myocardial Damage ◽

Cellular Cardiomyoplasty ◽

Modern Methods ◽

Death Causes

Heart failure (HF) is one of the leading death causes in patients with myocardial infarction (MI). The modern methods of reperfusion MI therapy, such as thrombolysis, surgery and balloon revascularization, even when performed early, could fail to prevent the development of large myocardial damage zones, followed by HF. Therefore, the researches have been searching for the methods which improve functional status of damaged myocardium. This review is focused on stem cell therapy, a method aimed at cardiac function restoration. The results of experimental and clinical studies on stem cell therapy in coronary heart disease are presented. Various types of stem cells, used for cellular cardiomyoplasty, are characterised. The methods of cell transplantation into myocardium and potential adverse effects of stem cell therapy are discussed.

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