scholarly journals PERIPAPILLARY RETINAL NERVE FIBER ALTERATIONS IN HEART FAILURE WITH REDUCED EJECTION FRACTION

2021 ◽  
Vol 54 (1) ◽  
pp. 34-39
Author(s):  
Muhammed Nurullah Bulut ◽  
Mert Evlice
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Nerve Fiber ◽  
Control Group ◽  
Research Hospital ◽  
Reduced Ejection Fraction ◽  
Rnfl Thickness ◽  
Speciality Training ◽  
Training And Research ◽  
Retinal Nerve Fiber

Objectives: To evaluate the effect of heart failure with reduced ejection fraction (HFrEF) on retinal nerve fiber layer (RNFL) thickness. Methodology: The study included patients who were being followed at Kartal Kosuyolu High Speciality Training and Research Hospital for HFrEF and were referred to the Eye Clinic of the Dr. Lütfi Kırdar Kartal Training and Research Hospital,  Istanbul, Turkey between 2017-2019. Study participants were divided into two groups, one comprising HFrEF patients and a control group of patients without HF. Each patient underwent a routine ophthalmologic examination including best corrected visual acuity evaluation, intraocular pressure measurement, slit-lamp biomicroscopy and fundus examination. The RNFL of each patient was measured using spectral domain OCT. Results: A total of eyes of 37 HFrEF patients and 38 controls were evaluated. Superior RNFL thickness was 113.71±17.08 μm in the HFrEF group and 126.22 ± 13.68 μm in the control group (p=0.001). Inferior RNFL thickness was 117.88 ± 14.5 μm in the HFrEF group and 131.69 ± 12.93 μm in the control group (p<0.001). Average RNFL thickness in the HFrEF and control groups was 92.32 ± 10.22 μm and 103.31 ± 8.14 μm, respectively. There were significant differences between the study groups in all five parameters. Conclusion: In this study, RNLF thinning occurs in HFrEF compared to the control group that may be useful for demonstrate tissue perfusion deficiency in HFrEF.

scholarly journals Choroidal thickness and retinal nerve fiber layer analysis in acute systemic brucellosis

2021 ◽  
Vol 19 ◽  
pp. 205873922110406
Author(s):  
Kürşad Ramazan Zor ◽  
Tuğba Arslan Gülen ◽  
Gamze Yıldırım Biçer ◽  
Erkut Küçük ◽  
Ayfer İmre ◽  
...  
Keyword(s):  
Nerve Fiber ◽  
Retinal Nerve Fiber Layer ◽  
Choroidal Thickness ◽  
Control Group ◽  
Fiber Layer ◽  
Subfoveal Choroidal Thickness ◽  
Nerve Fiber Layer ◽  
Rnfl Thickness ◽  
The Mean ◽  
Retinal Nerve Fiber

Introduction This study aims to detect changes in choroidal thickness and retinal nerve fiber layer (RNFL) thickness in acute stage brucellosis. Methods Fnewly diagnosed patients with acute brucellosis and 19 healthy individuals as control group were included in the study. Choroidal thickness and RNFL thickness were measured using the Spectral Domain Cirrus OCT Model 400 (Carl Zeiss Meditec, Jena, Germany) for each participant in the patient and control group. Results In the brucella group, in the right eyes, the mean nasal choroidal thickness was 272.77 ± 50.26 μm ( p = 0.689), the mean subfoveal choroidal thickness was 321.14 ± 33.08 μm ( p = 0.590), the mean temporal choroidal thickness was 278.86 ± 48.84 μm ( p = 0.478), and the mean RNFL thickness was 90.43 ± 8.93 μm ( p = 0.567). In the left eyes, the mean nasal choroidal thickness was 282.29 ± 48.93 μm ( p = 0.715), the mean subfoveal choroidal thickness was 316.79 ± 39.57 μm ( p = 0.540), the mean temporal choroidal thickness was 284.93 ± 50.57 μm ( p = 0.392), and the mean RNFL thickness was 92.64 ± 8.95 μm ( p = 0.813). Conclusion No difference was found between the control and the brucella groups regarding to all choroidal regions and RNFL thickness.

P6287Analysis of novel cardiac markers sST2 and IL-33 in chronic heart failure with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Jirak ◽  
M Lichtenauer ◽  
B Wernly ◽  
V Paar ◽  
C Jung ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Inverse Correlation ◽  
Serum Levels ◽  
Control Group ◽  
Significant Elevation ◽  
Serum Samples ◽  
Reduced Ejection Fraction ◽  
Stress Studies ◽  
Cardiac Strain

Abstract Background Soluble (s) ST-2 has been recently evaluated as a monitoring parameter in heart failure (HF). Besides being a marker for cardiac strain and hemodynamic stress, studies also found an influence of ST2 on the immune system, above all mediated through its Janus-Face ligand IL-33, an alarmin released under stress conditions or by cellular death. In contrast to sST2, the role of IL-33 in HF is yet unknown. Objective In this project, we aimed for an analysis of the ST2/IL33 pathway in patients with heart failure with reduced ejection fraction (HFrEF). Methods In total, 200 patients were included in the study: 59 with ischemic (ICM), 65 with dilated (DCM) cardiomyopathy (mean LVEF 38%), as well as 76 control patients without coronary artery disease or signs of heart failure. Serum samples were analyzed by use of ELISA after informed consent. Results sST2 showed a significant elevation in all HF patients (p<0.0001) compared to the control group. No significant differences in levels of sST2 were observed between ICM and DCM patients. In contrast to sST2, no differences between HF patients and control group were observed for IL-33. Furthermore, sST2 showed a significant correlation with CRP (p<0.001, r=0.28), NT-pro-BNP (p<0.0001, r=0.40) and an inverse correlation with ejection fraction (p<0.0001, r=−0.40). Additionally, sST2 showed a significant elevation in patients in NYHA stages I-II (p=0.030) and NYHA stages III-IV (p<0.01). Again, no significant correlations were observed between IL-33 and parameters mentioned above. Analysis of sST2 in heart failure Conclusions We observed a significant increase and correlation with disease severity of sST2 in chronic HFrEF patients of both ischemic and non-ischemic origin, but contrary to our expectations, no significant changes in serum levels of IL-33. Thus, a mechanism independent of ST2/IL33 axis could be responsible of sST2 secretion in HF. Further studies including acute decompensated patients could provide a better understanding of the IL-33 role in HF.

scholarly journals Assessment of retinal nerve fiber layer thickness in migraine patients measured with optical coherence tomography

2018 ◽  
Vol 5 (1) ◽  
pp. 21
Author(s):  
Alireza Khosravi ◽  
Kourosh Shahraki ◽  
Afsaneh Moghaddam
Keyword(s):  
Optical Coherence Tomography ◽  
Nerve Fiber ◽  
Retinal Nerve Fiber Layer ◽  
Control Group ◽  
Optical Coherence ◽  
Fiber Layer ◽  
Nerve Fiber Layer ◽  
Rnfl Thickness ◽  
Standard Value ◽  
Retinal Nerve Fiber

Background: Headache is one of the most disturbing symptoms with common neurological signs. Variations in optic nerve perfusion quality or retinal microcirculation may end up in peripapillary retinal nerve fiber layer (RNFL) thickness in patients with migraine. The aim of this study was to investigate the retinal nerve fiber layer (RNFL) thickness in patients with migraine.Methods: This cross-sectional study was conducted by including thirty patients diagnosed with migraine and thirty normal individuals. Patients were evaluated in groups including migraine with and without aura and controls. Retinal nerve fiber layer (RNFL) thickness was measured using stratus optical coherence tomography (OCT) and then was compared in case and control groups. All data were analyzed using SPSS software version 16.Results: RNFL thickness was significantly thinner in migraine patients compared to the control group. Symmetricity of RNFL showed significantly reduction in patients with migraine compared to standard value (95% vs 68%). Comparison of NRR area between patients and standard value showed significantly reduced values (P=0.0001). Mean value of optic disc area showed significantly reduced value compared to standard value about 2.35 m2 (P=0.0001).Conclusions: This study suggests that migraine leads to a reduction in the peripapillary RNFL thickness and to thinning in choroidal structures. These findings can be explained by a chronic ischemic insult related to migraine pathogenic mechanisms.

scholarly journals Discriminative Utility of Apelin-to-NT-Pro-Brain Natriuretic Peptide Ratio for Heart Failure with Preserved Ejection Fraction among Type 2 Diabetes Mellitus Patients

2022 ◽  
Vol 9 (1) ◽  
pp. 23
Author(s):  
Alexander A. Berezin ◽  
Ivan M. Fushtey ◽  
Alexander E. Berezin
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Serum Levels ◽  
Control Group ◽  
Baseline Serum ◽  
Reduced Ejection Fraction ◽  
Multivariate Logistic Model ◽  
Healthy Control

Background: Apelin is a regulatory vasoactive peptide, which plays a pivotal role in adverse cardiac remodeling and heart failure (HF) with reduced ejection fraction. The purpose of the study was to investigate whether serum levels of apelin is associated with HF with preserved election fraction (HFpEF) in patients with T2DM. Methods: The study retrospectively involved 101 T2DM patients aged 41 to 62 years (48 patients with HFpEF and 28 non-HFpEF patients). The healthy control group consisted of 25 individuals with matched age and sex. Data collection included demographic and anthropometric information, hemodynamic performances and biomarkers of the disease. Transthoracic B-mode echocardiography, Doppler and TDI were performed at baseline. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and apelin were measured by ELISA in all patients at the study entry. Results: Unadjusted multivariate logistic model yielded the only apelin to NT-proBNP ratio (OR = 1.44; p = 0.001), BMI > 34 кг/м2 (OR = 1.07; p = 0.036), NT-proBNP > 458 pmol/mL (OR = 1.17; p = 0.042), LAVI > 34 mL/m2 (OR = 1.06; p = 0.042) and E/e’ > 11 (OR = 1.04; p = 0.044) remained to be strong predictors for HFpEF. After obesity adjustment, multivariate logistic regression showed that the apelin to NT-proBNP ratio < 0.82 × 10−2 units remained sole independent predictor for HFpEF (OR = 1.44; 95% CI: 1.18–2.77; p = 0.001) HFpEF in T2DM patients. In conclusion, we found that apelin to NT-proBNP ratio < 0.82 × 10−2 units better predicted HFpEF in T2DM patients than apelin and NT-proBNP alone. This finding could open new approach for CV risk stratification of T2DM at higher risk of HF.

scholarly journals Impact of canagliflozin in natriuretic peptides in patients with type 2 diabetes after hospitalization for acute heart failure

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Martin Dorado ◽  
R Gonzalez Manzanares ◽  
J.C Castillo Dominguez ◽  
J Lopez Aguilera ◽  
J Perea ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Signs And Symptoms ◽  
Sglt2 Inhibitors ◽  
Control Group ◽  
Dipeptidyl Peptidase 4 ◽  
Reduced Ejection Fraction

Abstract Background Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated to reduce the risk of hospitalization for heart failure (HF) in patients with type 2 diabetes mellitus (T2D). We aimed to assess the changes in N-terminal pro-B-type natriuretic peptide (NT-ProBNP) concentrations in a cohort of patients hospitalized for HF according to whether or not they received canagliflozin at discharge. Methods This cohort study included all patients with T2D admitted for HF from January 2017 to December 2019 in a single center. We excluded patients whose treatment with SGLT2 inhibitors were contraindicated (eGFR ≤45 ml/min/1.73 m2) and those who had other SGLT2 inhibitors than canagliflozin in their treatment at discharged. All patients had received a primary diagnosis of acute decompensated heart failure, including signs and symptoms of fluid overload and a concentration of NT-ProBNP of 1400 pg/mL at least. NT-ProBNP concentrations were collected at 3 months, 6 months, and 1 year after hospitalization with laboratory records if available. The aim of this study is to compare mean NT-ProBNP levels at hospital discharge and 3, 6 and 12 moths of follow-up in patients treated with and without canagliflozin. Results We included a total of 102 patients, 45 patients (44.1%) were prescribed canagliflozin and the remaining 57 (55.9%) were not prescribed any SGLT2 inhibitors (control group). There were no significant differences in clinical and comorbidities in both groups, except for age; slightly younger in the canagliflozin group (69,2±10,3 vs 73,2±11,1; p=0,04). Treatment at discharge was also similar, patients in the control group received more dipeptidyl peptidase-4 (DPP-4) inhibitors (21.1% vs 6.7%; p=0.04). Low rate of patients received sacubitril-valsartan (15,6%) in the canagliflozin group and 14% in the control group. More than a half of patients in both groups have HF with reduced ejection fraction. Mean levels of peptides were similar in both groups at hospital admission and discharge. During the first period of 3 months, we observed a decreased of NT-ProBNP concentration in both groups, but significantly inferior in canagliflozin group (p&lt;0,001). At 6 and 12 months, NT-ProBNP levels were practically maintained in patients treated with canagliflozin, whereas levels in patients in the control group were increased. Difference in both groups at a 12 month-period was significantly superior (p=0,004), with a median reduction of concentration levels at discharge of 64.3% in the canagliflozin group and 15,8% in control group. There were no differences in patients with HF from those with reduced ejection fraction and preserved. Conclusions Canagliflozin therapy at discharge was associated with a significant reduction in NT-ProBNP concentration in patients with diabetes after hospitalization for HF. FUNDunding Acknowledgement Type of funding sources: None. NT-ProBNP according to canagliflozin

scholarly journals Follow-up on new marker confirming the optimal status in the treatment of heart failure with reduced ejection fraction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L.E Tran ◽  
T Nguyen ◽  
H.O.A Pham ◽  
M.I.N.H Thai ◽  
L.O.C Nguyen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Femoral Artery ◽  
Fluid Overload ◽  
Femoral Vein ◽  
Physical Exam ◽  
Control Group ◽  
Fluid Restriction ◽  
Reduced Ejection Fraction

Abstract Background At the present time, there is no strong criterion to guarantee the optimal management for patients with heart failure and reduced ejection fraction (HFrEF). In the past, our group suggested the use of the size of the femoral vein (FV), measured by ultrasound as a marker of the fluid status in the venous compartment. Is this criterion still the best marker of optimal treatment of HFrEF at 3 years follow-up, especially for patients with significant co-morbidities (chronic obstructive pulmonary disease (COPD), end stage renal disease (ESRD) on hemodialysis (HD), cirrhosis of liver or sepsis? Methods Patients with HFrEF and co-morbidities as above were enrolled. All patients had echocardiography to confirm EF &lt;45% and underwent the ultrasound test to assess the size and expansibility of the femoral vein (SEFV). The SEFV is the ultrasound study of the FV examining its size and expansibility with cough. The location of the femoral artery (FA) and FV to be checked is the coronal plane immediately proximal to the bifurcation of the superficial and deep femoral artery. The normal size of FV is a little larger than of the FA. If the size of the FV is twice larger than the FA, the patient has fluid overload in the venous compartment (Figure 1). Then the patient was asked to cough in order to measure the size of the FV. If the FV did not increase its size with cough, the venous compartment was full. If the FV increased its size, the venous compartment was not full and could accommodate more fluid. In physical exam, the fluid overload is proved by the presence of extravascular fluid in the abdominal wall, ascites or leg edema or in the intravascular compartment by the presence of the jugular venous distention. During the 3 years of follow-up, the patients were seen in the office and had the SEFV at regular 6 months intervals. A small group of patients also underwent right heart catheterization to measure to the pulmonary capillary wedge pressure (PCWP). Results 180 patients with HFrEF and significant comorbidities were enrolled. All patients were taught to follow a low Na diet, &lt;2000cc of fluid restriction and the guideline directed medical therapy. After about 3 years, 75% patients in the study group were asymptomatic, was not readmitted to the hospital for HF, and the size of the FV was within normal range. Their physical exam showed no fluid in the extravascular compartment. The PCWP became lower than 24mmHg in 18/20 who underwent the RHC. There was significant weight loss (15 lbs). In the control group, 60% of patients were asymptomatic and 50% were not readmitted for HF (p&lt;0.05). Conclusions With the SEFV test, the patients with HFrEF and significant comorbidities were accurately estimated for presence or absence of fluid overload. This SEFV test was especially sensitive to detect fluid overload in patients with multiple co-morbidities. Further randomized trials are needed to confirm the above preliminary results. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Enlarged size of femoral vein

Effect of intraocular pressure lowering on the capillary density of optic nerve head and retinal nerve fiber layer in patients with glaucoma

2020 ◽  
pp. 112067212096723
Author(s):  
Alessandro de Paula ◽  
Andrea Perdicchi ◽  
Federico Di Tizio ◽  
Serena Fragiotta ◽  
Gianluca Scuderi
Keyword(s):  
Optic Nerve ◽  
Nerve Fiber ◽  
Retinal Nerve Fiber Layer ◽  
Optic Nerve Head ◽  
Capillary Density ◽  
Control Group ◽  
Fiber Layer ◽  
Nerve Fiber Layer ◽  
Rnfl Thickness ◽  
Retinal Nerve Fiber

Purpose: To evaluate the effect of IOP lowering on the capillary density of optic nerve head and retinal nerve fiber layer in patients with primary open angle glaucoma. Methods: Twenty eyes of 14 glaucomatous patients and 15 eyes of nine normal patients were enrolled. The most appropriate hypotonic treatment was applied to every patient. A HD Angio Disc 4.5 scan (Avanti-AngioVue) was performed at baseline and after a month in the glaucomatous eyes. The following parameters were analyzed: Radial Papillary Capillaries (RPC) density, inside disc, peripapillary, superior-hemi, inferior-hemi, quadrants, and peripapillary, hemi-superior, hemi-inferior, and quadrants RNFL thickness. Optic nerve head analysis was also evaluated. In addition, the RPC density and the RNFL were assessed in the eight sectors provided by the software. Results: The RPC density did not significantly change after IOP reduction ( p > 0.05). The inferior-temporal ( p = 0.005) and inferior-nasal sectors ( p < 0.001) showed a greater capillary density than the respective superior sectors in healthy eyes. In contrast in the glaucomatous eyes, the superior-nasal exhibited greater capillary density with respect to the inferior-nasal sectors. The aggregate RPC density of the inferior sectors was greater than the superior ones in the control group ( p < 0.001). An improvement of the average disc area ( p = 0.01) and the average cup volume ( p = 0.059) were also observed along with increased RNFL thickness at different locations (all, p < 0.05) after IOP lowering therapy was initiated. Conclusion: The glaucomatous eyes presented rarefaction of the radial papillary capillaries density in the inferior sectors, but no significant changes in the density after IOP-lowering medications.

scholarly journals Hemodynamic responses to small muscle mass exercise in heart failure patients with reduced ejection fraction

2014 ◽  
Vol 307 (10) ◽  
pp. H1512-H1520 ◽  
Author(s):  
Zachary Barrett-O'Keefe ◽  
Joshua F. Lee ◽  
Amanda Berbert ◽  
Melissa A. H. Witman ◽  
Jose Nativi-Nicolau ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Ejection Fraction ◽  
Muscle Mass ◽  
Maximum Voluntary Contraction ◽  
Exercise Intolerance ◽  
Control Group ◽  
Hemodynamic Responses ◽  
Reduced Ejection Fraction ◽  
Small Muscle

To better understand the mechanisms responsible for exercise intolerance in heart failure with reduced ejection fraction (HFrEF), the present study sought to evaluate the hemodynamic responses to small muscle mass exercise in this cohort. In 25 HFrEF patients (64 ± 2 yr) and 17 healthy, age-matched control subjects (64 ± 2 yr), mean arterial pressure (MAP), cardiac output (CO), and limb blood flow were examined during graded static-intermittent handgrip (HG) and dynamic single-leg knee-extensor (KE) exercise. During HG exercise, MAP increased similarly between groups. CO increased significantly (+1.3 ± 0.3 l/min) in the control group, but it remained unchanged across workloads in HFrEF patients. At 15% maximum voluntary contraction (MVC), forearm blood flow was similar between groups, while HFrEF patients exhibited an attenuated increase at the two highest intensities compared with controls, with the greatest difference at the highest workload (352 ± 22 vs. 492 ± 48 ml/min, HFrEF vs. control, 45% MVC). During KE exercise, MAP and CO increased similarly across work rates between groups. However, HFrEF patients exhibited a diminished leg hyperemic response across all work rates, with the most substantial decrement at the highest intensity (1,842 ± 64 vs. 2,675 ± 81 ml/min; HFrEF vs. control, 15 W). Together, these findings indicate a marked attenuation in exercising limb perfusion attributable to impairments in peripheral vasodilatory capacity during both arm and leg exercise in patients with HFrEF, which likely plays a role in limiting exercise capacity in this patient population.

P4518Cerebral blood flow is lower in heart failure patients with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Babayigit ◽  
Y Cavusoglu ◽  
M Dural ◽  
K U Mert ◽  
T Ulus ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ejection Fraction ◽  
Control Group ◽  
Mean Flow ◽  
Control Groups ◽  
Reduced Ejection Fraction ◽  
And Control ◽  
Flow Velocities

Abstract Purpose Heart and brain interaction is a well-known entity in heart failure (HF) and left ventricular systolic dysfunction poses an increased risk for stroke and cognitive impairment. Transcranial Doppler (TCD) provides valuable information on cerebral blood flow and detects microembolic signals that can be used to determine the risk of cerebrovascular events. However, less is known about cerebral blood flow in HF patients with reduced EF. So, we aimed to evaluate cerebral blood flow rates by means of TCD in HF patients with reduced ejection fraction (EF). Methods This study included 46 HF patients with an EF less than 35% (mean age 65.2±11 years, mean EF 20.1±3.8%) who underwent to TCD examination. In addition, 26 healthy individuals with sinus rhythm and EF >50% (mean age 64.4±9.0 years, mean EF 63.5±2.38%) were included in the study as a control group. Minimum, maximum and mean flow velocities of the both right middle cerebral artery (RMCA) and left middle cerebral artery (LMCA) determined by TCD were analyzed. Results The average of RMCA maximum and mean flow velocities were found to be significantly lower in HF patients than those in control group (76,06±23,7 cm/s and 48,49±16,4 cm/s in HF group vs 87,84±14,5 cm/s and 56,41±10,7 cm/s in control group, p=0,025 and p=0,016, respectively). The average of LMCA maximum and mean flow velocities were also significantly lower in HF patients than those in control group (75,1±22,3 cm/s and 47,57±14.8 cm/s in HF group vs 88,73±17,7 cm/s and 57,15±12,4 cm/s in control group, p=0,009 and p=0,007, respectively). However, there was no significant difference in minimum RMCA or LMCA flow velocities between HF group and control groups (33,5±10,6 cm/s and 32,86±9,58 cm/s in HF group vs 36,34±9,2 cm/s and 36,53±10,4 cm/s in control group, p=0,226 and p=0,157, respectively). No significant microembolic signals were detected in HF and control groups. Conclusions The results of this study showed that HF patients with reduced EF have lower cerebral blood flow velocities as compared to healthy controls, which might be one of the explanations of the adverse interaction between heart and brain in HF.

Hemodynamic Effects of Dexmedetomidine in Adults With Reduced Ejection Fraction Heart Failure

2020 ◽  
pp. 088506662093441
Author(s):  
Tara L. Ruder ◽  
Kevin R. Donahue ◽  
A. Carmine Colavecchia ◽  
David Putney ◽  
Mukhtar Al-Saadi
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Underlying Disease ◽  
Control Group ◽  
Reduced Ejection Fraction ◽  
End Point ◽  
Time Period ◽  
Significant Difference ◽  
Patients With Heart Failure ◽  
Nonsurgical Patients

Background: Dexmedetomidine (DEX) can cause hypotension complicating its use in critically ill patients with labile hemodynamics secondary to an underlying disease state such as heart failure. The aim of this study was to determine the effect of DEX on mean arterial pressure (MAP) in nonsurgical patients with heart failure and reduced ejection fraction (HFrEF). Methods: This retrospective single-center cohort study evaluated patients who received DEX in the cardiac care and medical intensive care units at a large academic hospital. The primary end point was the change in MAP within 6 hours following DEX initiation. Results: Sixty-five patients with HFrEF diagnosis were compared 1:1 to a control group without HFrEF. Both groups experienced a decrease in MAP over the study period. Patients with HFrEF had a greater absolute percentage reduction in MAP 1 hour following DEX initiation compared to the control group (−9.6% vs −5.2%; P < .01). When accounting for the combined effect of DEX initiation and HFrEF diagnosis on the primary end point, patients with HFrEF did not have a significant difference in MAP compared to the control group over the study period. Conclusions: Within 6 hours following DEX initiation, both groups experienced a decrease in MAP. The effect of DEX on MAP over the composite time period was not found to be significantly different in the HFrEF group compared to the non-HFrEF group. However, patients with HFrEF experienced a greater reduction in MAP in the first hour following DEX initiation compared to the non-HFrEF group. Prospective studies are needed to evaluate the effect of DEX on patients with acute decompensated HFrEF compared to patients with compensated HFrEF.

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