To the question of the development of arterial hypertension in urban residents with obesity

Background. The relevance of the study is due to the need to optimize the prevention of arterial hypertension (AH) among the urban population of Ukraine, primarily those with obesity. The purpose was to detail the features of AH development in obese urban residents, and to develop a method for predicting AH in this category of the population. Materials and methods. A total of 1,094 residents of the city of Kharkiv who had not been treated for obesity and AH were examined. Body mass index, waist circumference, blood pressure were evaluated. Bioimpedance analysis was used to study body composition, immunoassay — serum levels of insulin, leptin, renin, aldosterone and clusterin. Features of central hemodynamics were assessed by the method of integral body rheography: stroke volume (ml), cardiac output (L/min), stroke volume index (ml/m2), cardiac index (L/min/m2) were determined. Results. It was found that middle-aged urban residents with obesity require intensification of preventive work in terms of AH development. In men, it should be started even before the age of 40. Development of concomitant pathology of AH and obesity in middle-aged people is due to the presence of insulin resistance, which is accompanied by changes in the circulating levels of insulin, leptin, aldosterone, in the stroke volume index and total peripheral vascular resistance, the occurrence of low-grade systemic inflammation in the body. Patients with obesity and AH differ from those with AH without obesity in terms of the level of volemia, the severity of changes in hemodynamics caused by the functioning of the heart, total peripheral vascular resistance, the degree of changes in the renin-aldosterone system, and the intensity of low-grade systemic inflammation. The results of the work made it possible to assert that one of the factors that primarily determine the development and progression of obesity in this category of the population is insulin resistance. Integral body rheography, a method for detecting changes in the stroke volume index, is an informative marker for the development and progression of AH. The presence of concomitant pathology of AH and obesity is characterized by changes in the levels of leptin and clusterin compared to the patients with obesity without hypertension, which should also be taken into account when developing therapeutic approaches. Conclusions. The approaches to the prognostic classification (created using the discriminant analysis program) of middle-aged urban residents — representatives of the Ukrainian population, identified in the process of work, can become the basis for optimizing the algorithms for the formation of risk groups for the development of obesity and AH.

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Cardiovascular responses to exhaustive upright cycle exercise in highly trained older men

Journal of Applied Physiology ◽

10.1152/jappl.1994.77.3.1500 ◽

1994 ◽

Vol 77 (3) ◽

pp. 1500-1506 ◽

Cited By ~ 45

Author(s):

J. L. Fleg ◽

S. P. Schulman ◽

F. C. O'Connor ◽

G. Gerstenblith ◽

L. C. Becker ◽

...

Keyword(s):

Cardiac Index ◽

Stroke Volume ◽

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Stroke Volume Index ◽

Cardiovascular Responses ◽

Radionuclide Ventriculography ◽

Volume Index ◽

Heart Rates ◽

Peak Vo2

It is unclear whether the markedly enhanced aerobic exercise capacity of older endurance-trained men relative to their sedentary age peers is mediated primarily by central or peripheral cardiovascular mechanisms. To address this question, we performed radionuclide ventriculography with respiratory gas exchange measurements during exhaustive upright cycle ergometry in 16 endurance-trained men aged 63 +/- 7 yr and in 35 untrained men of similar age. As expected, maximal O2 consumption during treadmill exercise was much higher in athletes than in controls. At rest and during fixed submaximal cycle work rates through 100 W, athletes demonstrated lower heart rates and greater stroke volume indexes than controls while maintaining similar cardiac indexes and O2 uptake (VO2). At exhaustion, athletes achieved 53% higher work rates and peak VO2 per kilogram body weight than the sedentary men. The higher peak VO2 in athletes was achieved by a 22.5% larger cardiac index and a 15.6% greater arteriovenous O2 difference. The larger peak cardiac index in the athletes than in sedentary controls was mediated entirely by a greater stroke volume index; peak heart rates were virtually identical. The athletes' greater stroke volume index was achieved through an 11% larger end-diastolic volume index and a 7% higher ejection fraction, both of borderline significance. At exhaustion, athletes demonstrated a lower systemic vascular resistance than controls, despite a higher value at rest. Athletes also showed greater exercise-induced increments in heart rate, stroke volume index, and cardiac index and a greater reduction in systemic vascular resistance from rest to maximal workload.(ABSTRACT TRUNCATED AT 250 WORDS)

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Nitric Oxide Stroke Volume Index as a New Hemodynamic Prognostic Parameter for Patients with Pulmonary Arterial Hypertension

Journal of Clinical Medicine ◽

10.3390/jcm9092939 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2939

Author(s):

Karolina Barańska-Pawełczak ◽

Celina Wojciechowska ◽

Mariusz Opara ◽

Wojciech Jacheć

Keyword(s):

Nitric Oxide ◽

Pulmonary Arterial Hypertension ◽

Confidence Interval ◽

Stroke Volume ◽

Arterial Hypertension ◽

Lung Transplantation ◽

Stroke Volume Index ◽

Volume Index ◽

Pulmonary Arterial

The aim of the study was to determine the prognostic value of hemodynamic parameters measured during initial diagnostic right heart catheterization (RHC) in standard conditions and using a nitric oxide reversibility test. A retrospective observational study of 62 patients with pulmonary arterial hypertension (PAH) was performed. Clinical, biochemical, echocardiographic, and hemodynamic data obtained at the time of the PAH diagnosis were precisely analyzed. Patients were followed for five years. Death or lung transplantation was considered as a primary endpoint. The mean follow-up period was 1090 ± 703 days and the median age was 46.84 years. In the studied group, 25 patients survived, 36 patients died, and one underwent a lung transplantation. From all the examined parameters, only stroke volume index during reversibility test with iNO (SVI(NO test)) (HR = 0.910; 95% confidence interval 0.878–0.944; p < 0.001) and initial arterial oxygen saturation (SaO2) (HR = 0.910; 95% confidence interval 0.843–0.982; p = 0.015) have been established as independent predictors of death or lung transplantation in the five-year follow–up. An SVI(NO test) value above 39.86 mL/m2 was associated with 100% five-year survival rate (AUC = 0.956; 95% confidence interval 0.899–1.000; p < 0.001; specificity/sensitivity: 100/84%). The results of the analysis suggest that the SVI(NO test) measured during the initial diagnostic RHC could be a very valuable prognostic factor in the PAH patients.

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Mechanisms contributing to hypotension after anesthetic induction with sufentanil, propofol, and rocuronium: a prospective observational study

Journal of Clinical Monitoring and Computing ◽

10.1007/s10877-021-00653-9 ◽

2021 ◽

Author(s):

Bernd Saugel ◽

Elisa-Johanna Bebert ◽

Luisa Briesenick ◽

Phillip Hoppe ◽

Gillis Greiwe ◽

...

Keyword(s):

Heart Rate ◽

Arterial Pressure ◽

Stroke Volume ◽

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Resistance Index ◽

Stroke Volume Index ◽

Volume Index ◽

Systemic Vascular Resistance Index ◽

Anesthetic Induction

AbstractIt remains unclear whether reduced myocardial contractility, venous dilation with decreased venous return, or arterial dilation with reduced systemic vascular resistance contribute most to hypotension after induction of general anesthesia. We sought to assess the relative contribution of various hemodynamic mechanisms to hypotension after induction of general anesthesia with sufentanil, propofol, and rocuronium. In this prospective observational study, we continuously recorded hemodynamic variables during anesthetic induction using a finger-cuff method in 92 non-cardiac surgery patients. After sufentanil administration, there was no clinically important change in arterial pressure, but heart rate increased from baseline by 11 (99.89% confidence interval: 7 to 16) bpm (P < 0.001). After administration of propofol, mean arterial pressure decreased by 23 (17 to 28) mmHg and systemic vascular resistance index decreased by 565 (419 to 712) dyn*s*cm−5*m2 (P values < 0.001). Mean arterial pressure was < 65 mmHg in 27 patients (29%). After propofol administration, heart rate returned to baseline, and stroke volume index and cardiac index remained stable. After tracheal intubation, there were no clinically important differences compared to baseline in heart rate, stroke volume index, and cardiac index, but arterial pressure and systemic vascular resistance index remained markedly decreased. Anesthetic induction with sufentanil, propofol, and rocuronium reduced arterial pressure and systemic vascular resistance index. Heart rate, stroke volume index, and cardiac index remained stable. Post-induction hypotension therefore appears to result from arterial dilation with reduced systemic vascular resistance rather than venous dilation or reduced myocardial contractility.

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Renal Sympathetic Denervation in Patients With Heart Failure With Preserved Ejection Fraction

Circulation Heart Failure ◽

10.1161/circheartfailure.120.007421 ◽

2021 ◽

Vol 14 (3) ◽

Cited By ~ 1

Author(s):

Karl-Patrik Kresoja ◽

Karl-Philipp Rommel ◽

Karl Fengler ◽

Maximilian von Roeder ◽

Christian Besler ◽

...

Keyword(s):

Heart Failure ◽

Stroke Volume ◽

Arterial Hypertension ◽

Stroke Volume Index ◽

Aortic Distensibility ◽

Volume Index ◽

Renal Sympathetic Denervation ◽

Preserved Ejection Fraction ◽

Patients With Heart Failure ◽

Renal Sympathetic

Background: Arterial hypertension is the most common comorbidity in patients with heart failure with preserved ejection fraction (HFpEF) and mediates adverse hemodynamics through related aortic stiffness and increased pulsatile load. We aimed to investigate the clinical and hemodynamic implications of renal sympathetic denervation (RDN) in patients with HFpEF and uncontrolled arterial hypertension. Methods: Patients undergoing RDN between 2011 and 2018 in a single-center were retrospectively analyzed and classified as HFpEF (n=99) or no HF (n=65). Stroke volume index and aortic distensibility were measured through cardiac magnetic resonance imaging, and left ventricular (LV) systolic and diastolic properties were assessed echocardiographically. Results: At baseline, patients with HFpEF had higher stroke volume index (median 40 [interquartile range, 33–48] versus 33 [26–40] mL/m 2 , P =0.002), pulse pressure (69 [63–77] versus 61 [55–67] mm Hg, P <0.001), but lower LV-VPES 100mm Hg (18 [10–28] versus 24 [15–40] mL, P =0.007) and aortic distensibility (1.5 [1.1–2.6] versus 2.7 [1.1–3.5] 10 −3 mm Hg −1 , P =0.013) as compared to no-HF patients. Systolic blood pressure decreased comparable in patients with HFpEF and no-HF patients following RDN (−9 [−16 to −2], P <0.001). After RDN stroke volume index (−3 [−9 to +3] mL/m 2 , P =0.011) decreased and aortic distensibility (0.2 [−0.1 to +1.1] 10 −3 mm Hg −1 , P =0.007) and systolic stiffness ( P <0.001) increased in HFpEF patients. LV diastolic stiffness and LV filling pressures as well as NT-proBNP (N-terminal pro-B-type natriuretic peptide) decreased after RDN in patients with HFpEF ( P =0.032, P =0.043, and P <0.001, respectively). Conclusions: Patients with HFpEF undergoing RDN showed increased stroke volume index, vascular, and LV stiffness as compared to no-HF patients. Following RDN those hemodynamic alterations and reduced systolic and diastolic LV stiffness were partly normalized, implying RDN might be a potential therapeutic strategy for arterial hypertension and HFpEF.

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PROGNOSTIC VALUE OF STROKE VOLUME INDEX IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION AT INTERMEDIATE RISK

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)32725-x ◽

2020 ◽

Vol 75 (11) ◽

pp. 2098

Author(s):

Fabio Dardi ◽

Massimiliano Palazzini ◽

Elisa Zuffa ◽

Daniele Guarino ◽

Alessandro De Lorenzis ◽

...

Keyword(s):

Pulmonary Arterial Hypertension ◽

Stroke Volume ◽

Arterial Hypertension ◽

Prognostic Value ◽

Stroke Volume Index ◽

Volume Index ◽

Intermediate Risk ◽

Pulmonary Arterial

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About choosing a vasodilator for vasoreactivity tests in heart transplant candidates

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2014-3-43-47 ◽

2015 ◽

Vol 18 (3) ◽

pp. 43 ◽

Cited By ~ 1

Author(s):

A. Ye. Bautin ◽

P. A. Fedotov ◽

G. V. Nikolaev ◽

O. M. Moiseeva ◽

M. Yu. Sitnikova ◽

...

Keyword(s):

Vascular Resistance ◽

Heart Transplant ◽

Randomized Study ◽

Stroke Volume Index ◽

Volume Index ◽

Group Differences ◽

Peripheral Vascular ◽

Inhaled Iloprost ◽

The Mean ◽

Transplant Candidates

The purpose of our prospective, consistent, non-randomized study was to analyze the results of vasoreactivity tests (VRT) performed with nitric oxide (NO) or inhaled Iloprost in heart transplant candidates. 72 VRTs were done in 58 candidates for heart transplantation. All patients had heart failure III-IV NYHA and pulmonary hypertension (PH) with pulmonary vascular resistance (PVR) over 2.5 WU. 43 patients received NO, 80 ppm for 20 min. 29 patients inhaled 20 g of Iloprost (Ventavis, Bayer). Hemodynamic parameters were measured at baseline, 20 min after NO inhalation and 15 min following the completion of Iloprost inhalation. There were no between-group differences in the severity of patient's condition and baseline hemodynamic indicators. Both vasodilators caused statistically significant reduction in mean PAP: in the NO group it dropped (p = 0.002), in the Iloprost group the mean PAP decreased (p<0.0001). A more than 20% decrease in PAP was recorded in 13 cases (30.2%) in the NO group and in 16 cases (55.2%) in the Iloprost group (p = 0.03). A more than 20% decrease in PVR was noted in 24 cases (55.8%) in the NO group and in 24 cases (82.8%) in the Iloprost group (p<0.02). We found some differences in the effect of NO and Iloprost on LV efficiency. There were no changes in the stroke volume index (SVI) in the NO group, while inhaled Iloprost increased SVI (p<0.001). A probable cause of the increase in LV efficiency might have been the reduction of total peripheral vascular resistance (p<0.0001). There were no differences in SVI during NO inhala-tion. It should be noted in conclusion that Iloprost is more effective in decreasing mean PAP and PVR in heart transplant candidates. Inhaled Iloprost causes favorable changes in preload and afterload of the impaired LV and increases its performance.

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Prognostic Value of Stroke Volume Index in Patients with Pulmonary Arterial Hypertension at Intermediate Risk

10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2052 ◽

2020 ◽

Author(s):

F. Dardi ◽

M. Palazzini ◽

E. Zuffa ◽

D. Guarino ◽

A. De Lorenzis ◽

...

Keyword(s):

Pulmonary Arterial Hypertension ◽

Stroke Volume ◽

Arterial Hypertension ◽

Prognostic Value ◽

Stroke Volume Index ◽

Volume Index ◽

Intermediate Risk ◽

Pulmonary Arterial

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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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