scholarly journals Cardiac Stroke Volume Index Is Associated With Early Neurological Improvement in Acute Ischemic Stroke Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Joseph Miller ◽  
Farhan Chaudhry ◽  
Sam Tirgari ◽  
Sean Calo ◽  
Ariel P. Walker ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Pilot Study ◽  
Stroke Volume ◽  
Acute Ischemic Stroke ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Neurological Improvement ◽  
Arterial Blood ◽  
Cardiac Stroke Volume

Early neurological improvement as assessed with the NIH stroke scale (NIHSS) at 24 h has been associated with improved long-term functional outcomes following acute ischemic stroke (AIS). Cardiac dysfunction is often present in AIS, but its association with outcomes is incompletely defined. We performed a pilot study to evaluate the association between non-invasively measured cardiac parameters and 24-h neurological improvement in prospectively enrolled patients with suspected AIS who presented within 12 h of symptom-onset and had an initial systolic blood pressure>140 mm Hg. Patients receiving thrombolytic therapy or mechanical thrombectomy were excluded. Non-invasive pulse contour analysis was used to measure mean arterial blood pressure (MAP), cardiac stroke volume index (cSVI), cardiac output (CO) and cardiac index (CI). Transcranial Doppler recorded mean middle cerebral artery flow velocity (MFV). We defined a decrease of 4 NIHSS points or NIHSS ≤ 1 at 24-h as neurological improvement. Of 75 suspected, 38 had confirmed AIS and did not receive reperfusion therapy. Of these, 7/38 (18.4%) had neurological improvement over 24 h. MAP was greater in those without improvement (108, IQR 96–123 mm Hg) vs. those with (89, IQR 73–104 mm Hg). cSVI, CO, and MFV were similar between those without and with improvement: 37.4 (IQR 30.9–47.7) vs. 44.7 (IQR 42.3–55.3) ml/m2; 5.2 (IQR 4.2–6.6) vs. 5.3 (IQR 4.7–6.7) mL/min; and 39.9 (IQR 32.1–45.7) vs. 34.4 (IQR 27.1–49.2) cm/s, respectively. Multivariate analysis found MAP and cSVI as predictors for improvement (OR 0.93, 95%CI 0.85–0.98 and 1.14, 95%CI 1.03–1.31). In this pilot study, cSVI and MAP were associated with 24-h neurological improvement in AIS.

Early Manipulation of Arterial Blood Pressure in Acute Ischemic Stroke (MAPAS): Results of a Randomized Controlled Trial

2018 ◽  
Vol 30 (2) ◽  
pp. 372-379 ◽  
Author(s):  
Luiz Antonio Nasi ◽  
Sheila Cristina Ouriques Martins ◽  
Miguel Gus ◽  
Gustavo Weiss ◽  
Andrea Garcia de Almeida ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Randomized Controlled Trial ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Arterial Blood Pressure ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Arterial Blood

Abstract 177: The Association of Blood Pressure and Pretreatment Arterial Collaterals in Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Beisi Jiang ◽  
Leonid Churilov ◽  
Lasheta Kanesan ◽  
Richard Dowling ◽  
Peter Mitchell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Time Delay ◽  
Acute Ischemic Stroke ◽  
Negative Binomial ◽  
Ct Perfusion ◽  
Arterial Occlusion ◽  
Negative Binomial Regression Model ◽  
Arterial Blood ◽  
Filling Time

Introduction: Leptomeningeal collaterals maintain arterial perfusion in acute arterial occlusion but may fluctuate subject to arterial blood pressure (ABP). We aim to investigate the relationship between ABP and collaterals as assessed by CT perfusion in acute ischemic stroke. Methods: We retrospectively analyzed acute anterior circulation ischemic stroke patients with CT perfusion from 2009 to 2014. Collateral status using relative filling time delay (rFTD) determined by time delay of collateral-derived contrast opacification within the Sylvian fissure, from 0 seconds to unlimited count. The data were analyzed by zero-inflated negative binomial regression model including an appropriate interaction examining in the model in terms of occlusion location and onset-to-CT time (OCT). Results: Two hundred and seventy patients were included. We found that increment of 10mm Hg in BP, the odds that a patient would have rFTD equal to 0 seconds increased by 27.9% in SBP (P=0.001), by 73.9% in diastolic blood pressure (DBP) (P<0.001) and by 68.5% in mean blood pressure (MBP) (P<0.001). For patients with rFTD not necessarily equal to 0 seconds, every 10mm Hg increase in BP, there was a 7% decrease in expected count of seconds for rFTD in SBP (P=0.002), 10% decrease for rFTD in DBP and 11% decrease for rFTD in MBP. The arterial occlusion location and OCT showed no significant interaction in the BP-rFTD relationship (P>0.05). Conclusions: In acute ischemic stroke, higher ABP is associated with improved leptomeningeal collaterals as identified by decreased rFTD.

Determinants of aortic root dilatation over time in patients with essential hypertension: The Campania Salute Network

2020 ◽  
pp. 204748732093163
Author(s):  
Grazia Canciello ◽  
Costantino Mancusi ◽  
Raffaele Izzo ◽  
Carmine Morisco ◽  
Teresa Strisciuglio ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Stroke Volume ◽  
Diastolic Blood Pressure ◽  
Aortic Root ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Obese Women ◽  
Aortic Root Dilatation ◽  
Over Time

Background Determinants of changes of aortic root dimension over time are not well defined. Design We investigated whether specific phenotype and treatment exist predicting changes in aortic root dimension in hypertensive patients from the Campania Salute Network. Methods N = 4856 participants (age 53 ± 11 years, 44% women) were included. At first and last available echocardiograms, we measured aortic root and a z-score of aortic root (AOz) was generated as the difference between measured and predicted aortic root, derived from a healthy reference population. Aortic root dilatation (ARD) was defined as AOz >75th percentile of distribution. Results At baseline, 3642 patients (75%) exhibited normal aortic root, and 1214 (25%) ARD. After a follow-up of 6.1 years (interquartile range 3.0–8.8 years), 366 (11%) patients with initial normal aortic root exhibited ARD, whereas 457(38%) with initial ARD exhibited normal aortic root. At multivariate analysis patients with incident ARD were most likely to be women, obese, with left ventricular hypertrophy, lower systolic but higher diastolic blood pressure and stroke volume index at baseline, and higher average value of diastolic blood pressure during follow-up ( p < 0.05); whereas patients normalizing their ARD were non-obese women with lower baseline systolic blood pressure, stroke volume index, average diastolic blood pressure during follow-up and longer follow-up time ( p < 0.05). Anti-renin–angiotensin system (anti-RAS) was associated with 45% greater probability to normalize aortic root dimension. Conclusions Volume (stroke volume index) and pressure loads (diastolic blood pressure) influence aortic root dimension over time. Aortic root normalization, reflecting a more favourable haemodynamic load, is predictable in non-obese women with lower diastolic blood pressure, taking more anti-RAS therapy. This suggest that sex elicits a different response in aortic walls to pathological stimuli.

scholarly journals 2363

2017 ◽  
Vol 1 (S1) ◽  
pp. 36-36
Author(s):  
Leo Buckley ◽  
Justin Canada ◽  
Salvatore Carbone ◽  
Cory Trankle ◽  
Michele Mattia Viscusi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Stroke Volume ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Volume Index ◽  
Stroke Work ◽  
Systolic Volume ◽  
Arterial Blood ◽  
End Systolic Volume

OBJECTIVES/SPECIFIC AIMS: Our goal was to compare the ventriculo-arterial coupling and left ventricular mechanical work of patients with systolic and diastolic heart failure (SHF and DHF). METHODS/STUDY POPULATION: Patients with New York Heart Association Functional Class II-III HF symptoms were included. SHF was defined as left ventricular (LV) ejection fraction<50% and DHF as >50%. Analysis of the fingertip arterial blood pressure tracing captured with a finger plethysmography cuff according to device-specific algorithms provided brachial artery blood pressure and stroke volume. LV end-systolic volume was measured separately via transthoracic echocardiography. Arterial elastance (Ea), a measure of pulsatile and nonpulsatile LV afterload, was calculated as LV end-systolic pressure (ESP)/end-diastolic volume. End-systolic elastance (Ees), a measure of load-independent LV contractility, was calculated as LV ESP/end-systolic volume. Ventriculo-arterial coupling (VAC) ratio was defined as Ea/Ees. Stroke work (SWI) was calculated as stroke volume index×LV end-systolic pressure×0.0136 and potential energy index (PEI) as 1/2×(LV end-systolic volume×LV end-systolic pressure×0.0136). Total work index (TWI) was the sum of SWI+PEI. RESULTS/ANTICIPATED RESULTS: Patients with SHF (n=52) and DHF (n=29) were evaluated. Median (IQR) age was 57 (51–64) years. There were 48 (58%) and 59 (71%) patients were male and African American, respectively. Cardiac index was 2.8 (2.2–3.2) L/minute and 3.0 (2.8–3.3) L/minute in SHF and DHF, respectively (p=0.12). Self-reported activity levels (Duke Activity Status Index, p=0.48) and heart failure symptoms (Minnesota Living with Heart Failure Questionnaire, p=0.55) were not different between SHF and DHF. Ea was significantly lower in DHF compared with SHF patients [1.3 (1.2–1.6) vs. 1.7 (1.4–2.0) mmHg; p<0.001] whereas Ees was higher in DHF vs. SHF [2.8 (2.1–3.1) vs. 0.9 (0.7-1.3) mmHg; p<0.001). VAC was 1.8 (1.3–2.8) in SHF Versus 0.5 (0.4–0.7) in DHF (p<0.001). Compared with SHF, DHF patients had higher SWI [71 (57–83) vs. 48 (39–68) gm×m; p<0.001) and lower PEI [19 (12–26) vs. 44 (36–57) gm×m; p<0.001]. TWI did not differ between SHF and DHF (p=0.14). Work efficiency was higher in DHF than SHF [0.80 (0.74–0.84) vs. 0.53 (0.46–0.64); p<0.001]. DISCUSSION/SIGNIFICANCE OF IMPACT: The results underscore the differences in pathophysiology between SHF and DHF patients with similar symptom burden and exercise capacity. These results highlight the difference in myocardial energy utilization between SHF and DHF.

Abstract TP228: Continuous Non-invasive Blood Pressure versus Oscillometric Assessment in Acute Care After Intracerebral Hemorrhage, Intravenous Thrombolysis for Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Anne Koehler ◽  
Timo Siepmann ◽  
Simon Winzer ◽  
Eric Simon ◽  
Lars-Peder Pallesen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Positive Association ◽  
Diagnostic Agreement ◽  
Altman Plot ◽  
Bland Altman Plot ◽  
Arterial Blood

Introduction: Uncontrolled arterial hypertension increases the risk of intracerebral hemorrhage (ICH) in acute ischemic stroke (AIS) patients treated with intravenous tPA and may lead to hematoma progression in patients with primary ICH. While arterial blood pressure (aBP) is commonly monitored using intermittent oscillometric measurements, vascular unloading based assessment (VUA) allows noninvasive continuous (beat-to-beat) aBP monitoring with a finger cuff. We hypothesized that VUA monitoring is feasible in post thrombolysis and ICH care and shows diagnostic agreement with intermittent oscillometric assessment. Methods: Consecutive patients with either AIS receiving intravenous tPA or ICH were prospectively monitored for 24 hours following the index event using VUA monitoring and contralateral oscillometric aBP measurement every 30 minutes. Bland Altman Plot and linear regression were conducted to define diagnostic agreement. Results: We enrolled 24 AIS patients (10 males, aged 74±15 years, mean±standard deviation) receiving tPA and 24 ICH patients (16 males, aged 67±16 years). Mean systolic aBP assessed via VUA was higher and mean diastolic aBP was lower compared to oscillometric assessment in the entire population (systolic: 147 ± 23 mmHg vs. 144 ± 34, p=0.004; diastolic: 75 ± 14 mmHg vs. 77 ± 20 mmHg vs, p=0.004) There was a positive association between VUA and oscillometric aBP profiles (systolic aBP: coef. 0.24, p<0.005; diastolic aBP: coef. 0.31, p<0.005; figure). However, diagnostic agreement analysis was inconclusive. (Bland Altman Plot) Conclusions: Although VUA and oscillometric aBP profiles were positively associated in our study, diagnostic agreement between the techniques was not sufficient to recommend implementation of VUA in clinical practice. Figure

scholarly journals Cardiovascular Changes during Deep Halothane Anaesthesia in Infants and Children

1988 ◽  
Vol 16 (3) ◽  
pp. 285-291 ◽  
Author(s):  
J. Tibballs ◽  
S. Malbezin
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Cardiac Index ◽  
Stroke Volume ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Infants And Children ◽  
Volume Index ◽  
Induction Of Anaesthesia

Cardiac output, blood pressure and heart rate were measured with noninvasive techniques before, during and after induction of anaesthesia with halothane and after intubation in unpremedicated infants and in diazepam-atropine premedicated children presenting for elective surgery. Cardiac output was measured with pulsed doppler echocardiography. Left ventricular shortening fraction was estimated with M-mode echocardiography during induction. Induction with halothane in infants caused significant decrements in blood pressure, cardiac index, stroke volume index and significant depression of left ventricular shortening fraction. Induction with halothane in diazepam-atropine premedicated children caused a significant increase in heart rate but significant decreases in blood pressure, stroke volume index and left ventricular shortening fraction while cardiac index decreased slightly. Intubation in infants caused a mild increase in heart rate compared with pre-induction values but blood pressure, cardiac index and stroke volume index remained below pre-induction values. Intubation in diazepam-atropine premedicated children caused significant increases in heart rate and cardiac index, and a nonsignificant increase in blood pressure but stroke volume index remained significantly below pre-induction values. Healthy infants and children tolerate induction of anaesthesia with halothane to a depth to permit intubation but large reductions in cardiac output and myocardial contractility are expected with subsequent reductions in blood pressure.

Cardiovascular Responses to Induction of Anaesthesia with Thiopentone and Suxamethonium in Infants and Children

1988 ◽  
Vol 16 (3) ◽  
pp. 278-284 ◽  
Author(s):  
J. Tibballs ◽  
S. Malbezin
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Cardiac Index ◽  
Stroke Volume ◽  
Systolic Blood Pressure ◽  
Stroke Volume Index ◽  
Infants And Children ◽  
Volume Index ◽  
Induction Of Anaesthesia

Cardiac output, systolic blood pressure and heart rate were measured with non-invasive techniques before, during and after induction of anaesthesia with thiopentone (7.5–8.5 mg/kg) and suxamethonium (1.4–1.7 mg/kg), and after intubation in unpremedicated infants and diazepam-atropine premedicated children. Cardiac output was measured with a combination of M-mode and pulsed doppler echocardiography. Significant decreases in systolic blood pressure, cardiac index and stroke volume index were observed during induction in both infants and children. Intubation caused increases above pre-induction levels of heart rate, blood pressure and cardiac index in both infants and children. Stroke volume index increased marginally in infants but remained depressed in children after intubation. Left ventricular shortening fraction decreased significantly in five other children during induction. It is concluded that thiopentone causes significant reduction in cardiac output by depression of myocardial contractility manifested by depression of blood pressure and stroke volume. Premedication with atropine may ameliorate reduction in cardiac output by permitting an increase in heart rate during induction. Induction of anaesthesia with thiopentone and premedication with diazepam does not prevent hypertension and tachycardia occurring with intubation.

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