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

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

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

2021 ◽  
Vol 23 (2) ◽  
pp. 202-206
Author(s):  
Ya. V. Morozova ◽  
V. Yo. Lysenko ◽  
Ye. O. Karpenko ◽  
V. A. Maloshtan
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Abdominal Surgery ◽  
Brain Natriuretic Peptide ◽  
Fluid Therapy ◽  
Postoperative Period ◽  
Troponin I ◽  
Myocardial Damage ◽  
Major Abdominal Surgery ◽  
Cardiac Safety

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.

The vulnerable myocardium

2015 ◽  
Vol 35 (01) ◽  
pp. 17-24 ◽  
Author(s):  
C. Bode ◽  
H. Bugger
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Diabetic Cardiomyopathy ◽  
Cardiac Complications ◽  
Artery Disease ◽  
Increased Susceptibility

SummaryCardiovascular disease is the major cause of morbidity and mortality in subjects suffering from diabetes mellitus. While coronary artery disease is the leading cause of cardiac complications in diabetics, it is widely recognized that diabetes increases the risk for the development of heart failure independently of coronary heart disease and hypertension. This increased susceptibility of the diabetic heart to develop structural and functional impairment is termed diabetic cardiomyopathy. The number of different mechanisms proposed to contribute to diabetic cardiomyopathy is steadily increasing and underlines the complexity of this cardiac entity.In this review the mechanisms that account for the increased myocardial vulnerability in diabetic cardiomyopathy are discussed.

scholarly journals Risk assessment of cardial complications in patients with concomitant ischemic heart disease using different regimens of intraoperative fluid therapy

2020 ◽  
pp. 50-51
Author(s):  
Ya.V. Morozova
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Postoperative Complications ◽  
Fluid Therapy ◽  
Postoperative Period ◽  
Perioperative Period ◽  
Enzyme Linked Immunosorbent Assay ◽  
Hemodynamic Parameters ◽  
Normal Limits ◽  
Significant Correction

Objective. To investigate the incidence of postoperative cardiac complications when performing advanced surgical interventions for cancer in patients with concomitant coronary heart disease (CHD) using two different regimens of intraoperative fluid therapy. Materials and methods. The study included 89 patients who underwent advanced surgery under general anesthesia. The division of patients into two groups was performed depending on the chosen way of intraoperative fluid therapy: the first (n=45) with a restrictive regimen (7.0±0.2 ml/kg/h), the second (n=44) – with a liberal (13.9±0,6 ml/kg/h). Groups of patients had no differences in anthropometric data, the volume of surgery, anesthesia. Intraoperatively, continuous monitoring of routine hemodynamic parameters (blood pressure, heart rate) and electrocardiography (ECG), quantitative assessment of biomarkers of myocardial damage (TnI, NTproBNP) by enzyme-linked immunosorbent assay in three stages (before surgery, immediately after and in the early postoperative period 18-24 h) of operation. Results and discussion. None of the patients had critical incidents during anesthesia, some of them had postoperative complications that did not require significant correction, but only more careful monitoring. In all patients of both groups, stable hemodynamic parameters were observed in the perioperative period, which was ensured by the adequacy of anesthesia, fluid therapy and the use of maintenance doses of sympathomimetics (phenylephrine) if necessary. In the 1st group 8 patients (17.8 %) needed support with sympathomimetics, in the 2nd – 3 patients (6.8 %). The study of the dynamics of cardiac biomarkers revealed a slight increase in cardiac troponin I in both groups, which was within the upper limit of normal. A more significant increase in troponin levels (so-called myocardial injury) was found in 5 patients (11.1 %) of the 1st group and in 6 patients (13.6 %) of the 2nd group in the postoperative stage. In the study of the concentration of natriuretic peptide found a more significant increase in patients of group 2 in the postoperative period, but these values were within normal limits. Manifestations of heart failure decompensation were not found in either patient in either group. According to ECG monitoring, no ischemic changes were found in any of the patients, benign arrhythmias were detected in 5 patients (11.1 %) of the 1st group and in 7 patients (15.9 %) of the 2nd group. Signs of acute renal injury were not found in either patient of either group, all had sufficient diuresis and blood creatinine levels within normal limits in the perioperative period. According to the statistical indicators of stay in the intensive care unit and in the hospital, the patients of both groups did not differ from each other. Thus, the study found no significant differences in the frequency of postoperative complications in patients with concomitant CHD when using relatively restrictive and liberal regimens of perioperative infusion therapy. The key point in the management of these patients is, in our opinion, the desire for “zero” balance by the end of the 1st day of the postoperative period and beyond. The main tools of the anesthesiologist are careful accounting of the injected fluid and its losses. This tactic may allow the use of a more liberal infusion regimen if necessary in patients without signs of heart failure. Conclusions. Relatively restrictive and liberal regimens of perioperative fluid therapy can be safely used in patients with concomitant CHD without signs of heart failure, provided adequate monitoring and management within the “zero” fluid balance.

scholarly journals FLUID THERAPY EFFECTS ON THE DYNAMICS OF MYOCARDIAL DAMAGE BIOMARKERS AND CARDIAC COMPLICATIONS IN THE PERIOPERATIVE PERIOD IN PATIENTS WITH ISCHEMIC HEART DISEASE

2020 ◽  
Vol 4 (2) ◽  
pp. 4-6
Author(s):  
V.I. Lysenko ◽  
E.A. Karpenko ◽  
Y. V. Morozova
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Fluid Therapy ◽  
Myocardial Damage ◽  
Perioperative Period ◽  
Ischemic Heart ◽  
Cardiac Complications

FLUID THERAPY EFFECTS ON THE DYNAMICS OF MYOCARDIAL DAMAGE BIOMARKERS AND CARDIAC COMPLICATIONS IN THE PERIOPERATIVE PERIOD IN PATIENTS WITH ISCHEMIC HEART DISEASE

Abstract MP013: Strong Inverse Relation between Physical Activity and Incidence of Cardiovascular Disease in African Americans: the Atherosclerosis Risk in Communities Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Elizabeth J Bell
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
African Americans ◽  
Risk Reduction ◽  
Atherosclerosis Risk In Communities ◽  
Baseline Visit ◽  
Atherosclerosis Risk

Introduction: Although there is substantial evidence that physical activity reduces risk of cardiovascular disease (CVD), the few studies that included African Americans offer inconclusive evidence and did not study stroke and heart failure separately. Objective: We examined, in African Americans and Caucasians in the Atherosclerosis Risk in Communities study (ARIC), the association of physical activity with CVD incidence (n=1,039) and its major components - stroke (n=350), heart failure (n=633), and coronary heart disease (n=442) - over a follow-up period of 21 years. Methods: ARIC is a population-based biracial cohort study of 45– to 64-yr-old adults at the baseline visit in 1987–89. Physical activity was assessed using the modified Baecke physical activity questionnaire and categorized by the American Heart Association’s ideal CVD health guidelines: poor, intermediate, and ideal physical activity. An incident CVD event was defined as the first occurrence of 1) heart failure, 2) definite or probable stroke, or 3) coronary heart disease, defined as a definite or probable myocardial infarction or definite fatal coronary heart disease. Results: We included 3,707 African Americans and 10,018 Caucasians free of CVD at the baseline visit. After adjustment for age, sex, cigarette smoking, alcohol intake, hormone therapy use, education, and ‘Western’ and ‘Prudent’ dietary pattern scores, higher physical activity was inversely related to CVD, heart failure, and coronary heart disease incidence in African Americans and Caucasians (p-values for trend tests <.0001), and with stroke in African Americans. Hazard ratios (95% confidence intervals) for CVD for intermediate and ideal physical activity, respectively, compared to poor, were similar by race: 0.65 (0.56, 0.75) and 0.59 (0.49, 0.71) for African Americans, and 0.74 (0.66, 0.83) and 0.67 (0.59, 0.75) for Caucasians (p-value for interaction = 0.38). Physical activity was also associated similarly in African Americans and Caucasians for each of the individual CVD outcomes (coronary heart disease, heart failure, and stroke), with an approximate one-third reduction in risk for intermediate and ideal physical activity versus poor physical activity- this reduction was statistically significant. Conclusions: In conclusion, our findings reinforce public health recommendations that regular physical activity is important for CVD risk reduction, including reductions in stroke and heart failure. They provide strong new evidence that this risk reduction applies to African Americans as well as Caucasians and support the idea that some physical activity is better than none.

Abstract MP77: Projected Impact of Shifting Population Distributions of Blood Pressure on Rates of Coronary Heart Disease, Heart Failure and Stroke: The Atherosclerosis Risk in Communities Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Shakia T Hardy ◽  
Laura R Loehr ◽  
Kenneth R Butler ◽  
Patricia P Chang ◽  
Aaron R Folsom ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Coronary Heart Disease ◽  
African American ◽  
Heart Disease ◽  
Population Distribution ◽  
The United States ◽  
Incidence Rates ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk

Introduction: Rates of cerebrovascular disease, heart failure (HF), and coronary heart disease (CHD), increase progressively as blood pressure rises. Several authors have estimated the theoretical effects of shifting the population distribution of blood pressure; however few studies have examined the degree to which modest decrements in blood pressure affect HF incidence, or included a racially diverse population. Methods: Incident HF was identified by a first hospitalization with discharge diagnosis code of 428.X. Incident hospitalized (definite or probable) CHD and stroke were classified according to protocol. We used multivariable regression to estimate incidence rate differences (IRD) for HF, CHD, and stroke that could be associated with a two mm Hg reduction in systolic blood pressure (SBP) in 15,744 participants from the Atherosclerosis Risk in Communities Study. Results: Over a mean of 18.3 years of follow up, age-adjusted incidence rates for HF, CHD, and stroke were higher among African American than Caucasians (Table 1). After adjusting for antihypertensive use, gender, and age, a two mm Hg decrement in SBP across the total population was associated with an estimated 24/100,000 person-years (PY) and 39/100,000 PY fewer incident HF events in Caucasians and African Americans, respectively. The projected disease reductions were of smaller absolute magnitude for incident CHD and incident stroke. Extrapolation to the African American and Caucasian U.S. populations age greater than 45 years suggests that a two mmHg decrement in SBP could result in approximately 22,000 fewer incident HF events, 15,000 fewer incident CHD events, and 5,000 fewer incident stroke events annually. Conclusion: Our results suggest that modest shifts in SBP, consistent with what could theoretically be achieved through population level lifestyle interventions, could substantially decrease the incidence of HF, stroke, and CHD in the United States, especially among African American populations.

Abstract P253: Proton Pump Inhibitor Use is Positively Associated with Incidence of Cardiovascular Disease

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Elizabeth J Bell ◽  
Jennifer L St. Sauver ◽  
Veronique L Roger ◽  
Nicholas B Larson ◽  
Hongfang Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Language Processing ◽  
Proton Pump ◽  
Hazard Ratio ◽  
Time Varying ◽  
Increased Risk ◽  
The Impact

Introduction: Proton pump inhibitors (PPIs) are used by an estimated 29 million Americans. PPIs increase the levels of asymmetrical dimethylarginine, a known risk factor for cardiovascular disease (CVD). Data from a select population of patients with CVD suggest that PPI use is associated with an increased risk of stroke, heart failure, and coronary heart disease. The impact of PPI use on incident CVD is largely unknown in the general population. Hypothesis: We hypothesized that PPI users have a higher risk of incident total CVD, coronary heart disease, stroke, and heart failure compared to nonusers. To demonstrate specificity of association, we additionally hypothesized that there is not an association between use of H 2 -blockers - another commonly used class of medications with similar indications as PPIs - and CVD. Methods: We used the Rochester Epidemiology Project’s medical records-linkage system to identify all residents of Olmsted County, MN on our baseline date of January 1, 2004 (N=140217). We excluded persons who did not grant permission for their records to be used for research, were <18 years old, had a history of CVD, had missing data for any variable included in our model, or had evidence of PPI use within the previous year.We followed our final cohort (N=58175) for up to 12 years. The administrative censoring date for CVD was 1/20/2014, for coronary heart disease was 8/3/2016, for stroke was 9/9/2016, and for heart failure was 1/20/2014. Time-varying PPI ever-use was ascertained using 1) natural language processing to capture unstructured text from the electronic health record, and 2) outpatient prescriptions. An incident CVD event was defined as the first occurrence of 1) validated heart failure, 2) validated coronary heart disease, or 3) stroke, defined using diagnostic codes only. As a secondary analysis, we calculated the association between time-varying H 2 -blocker ever-use and CVD among persons not using H 2 -blockers at baseline. Results: After adjustment for age, sex, race, education, hypertension, hyperlipidemia, diabetes, and body-mass-index, PPI use was associated with an approximately 50% higher risk of CVD (hazard ratio [95% CI]: 1.51 [1.37-1.67]; 2187 CVD events), stroke (hazard ratio [95% CI]: 1.49 [1.35-1.65]; 1928 stroke events), and heart failure (hazard ratio [95% CI]: 1.56 [1.23-1.97]; 353 heart failure events) compared to nonusers. Users of PPIs had a 35% greater risk of coronary heart disease than nonusers (95% CI: 1.13-1.61; 626 coronary heart disease events). Use of H 2 -blockers was also associated with a higher risk of CVD (adjusted hazard ratio [95% CI]: 1.23 [1.08-1.41]; 2331 CVD events). Conclusions: PPI use is associated with a higher risk of CVD, coronary heart disease, stroke and heart failure. Use of a drug with no known cardiac toxicity - H 2 -blockers - was also associated with a greater risk of CVD, warranting further study.

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

Circulation ◽  
2006 ◽  
Vol 113 (8) ◽  
pp. 1071-1078 ◽  
Author(s):  
Björn Zethelius ◽  
Nina Johnston ◽  
Per Venge
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Troponin I ◽  
Old Men
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