Remifentanil improves left ventricular diastolic parameters in patients with impaired diastolic function: a prospective clinical study.

BACKGROUND: Left ventricular diastolic dysfunction has a significant impact on perioperative morbidity and mortality, and its incidence is high in elderly individuals. Anesthetic agents may impair diastolic function, which may increase the incidence of perioperative complications. The aim of this prospective, clinical, phase 4 study was to investigate the effects of remifentanil on left ventricle (LV) diastolic function in patients with diastolic dysfunction. The study was performed on 30 spontaneously breathing subjects (aged 60-80 years) with diastolic dysfunction. METHODS: Thirty patients (aged 60-80 years) with diastolic dysfunction scheduled for surgery were recruited between November 2019 and March 2023. Left ventricle function was evaluated once the intravenous remifentanil infusion reached a target-controlled concentration of 2 ng/ml with transthoracic echocardiography. Analysis of systolic function focused on left ventricular ejection fraction and mean mitral annular S velocity (Sm), whereas diastolic function focused on changes in transmitral peak flow (E), E/A, mitral septal and lateral e' waves, E/e' ratios and left atrial volume index following remifentanil infusion. RESULTS: Diastolic function measures of LV (mitral E/e', septal and lateral e' waves) statistically significantly improved (E/e' from 10.6 ± 2.9 cm.sn- 1 to 9.5 ± 2.2 cm.sn- 1; p = 0.006) following remifentanil infusion. Left atrial volume index decreased following remifentanil infusion without statistical significance (from 55 ± 14.4 ml.cm- 2 to 51.6 ± 13.3 ml.cm- 2; p = 0.1). Systolic function (ejection fraction and Sm) did not change following remifentanil infusion. CONCLUSIONS: Remifentanil improves left ventricular diastolic parameters in patients with preexisting diastolic dysfunction. Our study suggests that remifentanil at a plasma concentration of 2 ng.ml- 1 might be used safely in patients with left ventricular diastolic dysfunction.

Effects of weight loss after bariatric surgery on atrial electromechanical delay in obese subjects.

Background: The authors investigated the relationship between weight loss after sleeve gastrectomy and change in atrial electromechanical delay values. Methods: A total of 41 patients were included. The primary end point was any effect of total weight loss on atrial electromechanical delay parameters. Results: The mean loss of body weight was 25.50 ± 11.07 kg. There was a significant correlation between mean body weight change and change in interatrial and left intra-atrial electromechanical delays (Pearson's correlation coefficient: 0.575 and 0.871, respectively; p < 0.001). Only change in body weight was significantly related to change in interatrial electromechanical delay (regression coefficient: 0.707; p < 0.01). Conclusion: In this study, a significant relationship was found between amount of body weight loss and decrease in atrial electromechanical values.

Obesity is associated with heart rhythm disturbances. Synchrony between the electrical and mechanical activities of the heart is adversely affected in people with obesity. In this study, the authors aimed to show the effect of amount of weight loss after weight loss surgery on the coupling properties of electrical and mechanical activities of heart chambers called atria. The authors included 41 participants. Heart ultrasound was done before and after weight loss surgery. Statistical analyses were performed to show the effect of total body weight loss on the heart's electrical and mechanical atrial functions. Significant weight loss was observed in participants during short-term follow-up after surgery and was found to be related to the electrical and mechanical functions of the atria. In the authors' study, weight loss achieved in the short term after weight loss surgery improved the electrical and mechanical coupling of the atria. This may translate into decreased rhythm disturbance risk in these patients.

The Association between Serum Heme Oxygenase-1 Levels and Coronary SYNTAX Score.

AIM: The relationship between heme oxygenase-1 (HO-1) levels and atherosclerosis was investigated in multiple studies. The aim of this study was to establish the relationship between HO-1 levels and coronary SYNergy between percutaneous coronary intervention with TAXus and Cardiac Surgery (SYNTAX) score in patients with stable coronary artery disease (CAD). METHODS: Patients who had been planned to undergo invasive coronary angiography due to a suspected CAD, between the dates of September and December 2019, were included in the study. Serum HO-1 levels were measured from peripheral venous blood. The SYNTAX score was calculated using standard coronary angiography images. Regression analysis was performed to establish the relationship between HO-1 levels and the SYNTAX score. RESULTS: In total, 137 patients were included. The median age was 63 years (IQR: 15), and most of the patients were male (75.2%). The median HO-1 level was 1.44 (IQR: 0.88) ng/mL, and the median SYNTAX score was 6 (IQR: 13). Regression analysis showed that HO-1 is the single most important variable associated with the SYNTAX score (HO-1 levels from 1.01 to 1.87 ng/mL, OR: 6.77, 95% confidence interval 5.18-8.36, p < 0.0001). CONCLUSION: In this study, serum HO-1 levels were significantly associated with the coronary SYNTAX score.

Volume Plaquetário Médio está Associado com Reperfusão Inadequada Detectada por Angiografia em Pacientes com Terapia Fibrinolítica Bem Sucedida / Mean Platelet Volume is Associated with Inadequate Reperfusion Detected by Angiography in Patients with Successful Fibrinolytic Therapy

Fundamento: Volume plaquetário médio (VPM) elevado está associado com falha na fibrinólise e eventos adversos em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST). No entanto, não há dados sobre os efeitos do VPM sobre o fluxo sanguíneo coronariano anterógrado e o grau de reperfusão em pacientes com fibrinólise bem sucedida. Objetivo: O objetivo deste estudo foi investigar o papel do VMP sobre a circulação coronariana via contagem de quadros angiográficos (TFC) na trombólise no infarto do miocárdio (TIMI) após terapia fibrinolítica bem sucedida. Métodos: Entre 145 pacientes tratados com agentes fibrinolíticos, 123 (84,8%) pacientes consecutivos com fibrinólise bem sucedida, determinados por eletrocardiografia, foram incluídos. Os pacientes foram divididos em dois grupos de acordo com TFC. Um TCF > 40 foi considerado como um marcador de reperfusão inadequada, e um TCF ≤ 40 aceito como um indicador de reperfusão completa. Resultados: Após a angiografia coronária, 57 pacientes apresentaram TFC ≤ 40 e 66 pacientes apresentaram TFC > 40. O VPM foi significativamente mais alto no grupo com reperfusão inadequada (8,93 ± 0,87 fl vs. 7,92 ± 0,80 fl, p < 0,001). Um VPM elevado foi identificado como um indicador de reperfusão inadequada, e coordenadas da curva ROC indicaram um ponto de corte de 8,3 fl para VPM. Conclusão: VPM elevado na admissão em pacientes com IAMCSST tratados com terapia fibrinolítica bem sucedida associou-se com reperfusão inadequada detectada por TFC

Background: Higher Mean platelet volume (MPV) is associated with fibrinolysis failure and adverse outcomes in patients with ST elevation myocardial infarction (STEMI). However, there are no data about the effects of MPV on antegrade coronary blood flow and the degree of reperfusion in patients with successful fibrinolysis. Objective: The aim of our study was to investigate the role of MPV on coronary circulation via thrombolysis in myocardial infarction (TIMI) frame count (TFC) after successful fibrinolytic therapy. Methods: Among 145 patients treated with fibrinolytics, 123 (84.8%) consecutive patients with successful fibrinolysis determined by electrocardiography criteria were included. The patients were divided into two groups according to TFC. TFC > 40 was accepted as a marker for inadequate reperfusion and TFC ≤ 40 was accepted as an indicator of complete reperfusion. Results: After coronary angiography, 57 patients had TFC ≤ 40 and 66 patients had TFC > 40. MPV was significantly higher in the inadequate reperfusion group (8.93 ± 0.87 fl vs 7.92 ± 0.80 fl, p < 0.001). Higher MPV was found to be an indicator of inadequate reperfusion and coordinates of the ROC curve indicated a cutoff value of 8.3 fl for MPV. Conclusion: Higher MPV on admission in STEMI patients treated with successful fibrinolytic therapy was found to be associated with inadequate reperfusion detected by TFC