Subclinical target organ damage in subjects with different components of metabolic syndrome.

BACKGROUND: To assess the association of metabolic syndrome (MS) and its components with target organ damage in a follow-up study of relatively healthy bank employers. METHODS: Out of 1600 random samples of office workers in Saint Petersburg (Russia), a group of 383 participants with at least one component of MS and without cardiovascular complications was selected (mean age 46.6 ± 9.0 years, 214 females (64.6%)). Follow-up visit was performed in 331 subjects. Target organ damage (TOD) was assessed by echocardiography, carotid ultrasound, applanational tonometry, brachial-ankle index, and urine albumin excretion measurements. Anthropometry, vital signs, and biochemistry were performed according to standard protocols. RESULTS: Presence of MS was not associated with higher probability of TOD. Multiple linear regression revealed significant association of all markers of TOD with older age. Hypertension was a significant predictor of left ventricular hypertrophy (LVH), increased arterial stiffness, and early signs of carotid atherosclerosis in logistic regression adjusted for age and gender. During follow-up, proportion of patients with LVH significantly decreased (from 46.7% to 32.9%, р = 0.003) and prevalence of patients with IMT > 0.09 сm increased (from 24.5% to 44.1%, p < 0.001) accompanying by significant declining of office blood pressure (BP) and total cholesterol. CONCLUSIONS: MS per se is not related to increased probability to TOD. Hypertension, female gender, and older age are main determinants of subclinical changes. After 2-years follow-up, significant LVH and renal damage regression was observed probably owing to BP reduction. Alternatively, early signs of carotid atherosclerosis increase with aging despite decreasing of the prevalence of hypercholesterolemia.

Correlation of cardiac output and sevoflurane required to maintain anesthetic depth targeted with entropy index.

AIMS AND OBJECTIVES: We investigated the correlation of reduced cardiac output on required sevoflurane to maintain targeted anesthesia depth. MATERIALS AND METHODS: 36 patients undergoing coronary artery bypass grafting with cardiopulmonary bypass were prospectively included in the study. Inspired sevoflurane concentration was adjusted to ensure state entropy index < 40. Analgesia was provided by either boluses of fentanyl 200 µg or continuous infusion of fentanyl 5 µg/kg/h; the total dose of fentanyl administered in the patients was not different (fentanyl boluses 6.5 ± 0.3 µg/kg/h vs. fentanyl infusion 5 µg/kg/h). Cardiac-index (CI), end tidal sevoflurane (ETsev) and entropy index were measured simultaneously at 1-5 min after sternotomy, during internal mammary artery harvesting and during pericardiotomy. 108 sets of variables (entropy index, ETsev, CI) were recorded from 36 subjects at three time points; 13 sets were excluded due to technical drawbacks in measurements. 95 data sets were eligible for analysis. Sixty-five data sets measured in patients with target state entropy index were analyzed to establish the relationship between CI and ETsev. RESULTS: We did not find a linear correlation between ETsev and CI in patients with target entropy index (correlation coefficient = 0.18, P = 0.14). The ETsev necessary to maintain the target level of anesthesia was lower in patients with CI ≤ 2.2 l/min/m2 (1.15% ± 0.28%) than patients with CI > 2.2 l/min/m2 (1.37% ± 0.31%), P = 0.01. CONCLUSION: Relationship between CI and ETsev required for maintaining target level of anesthesia is non-linear. Patients with CI ≤ 2.2 l/min/m2 need lower levels of the ETsev for maintenance of the target anesthesia at an entropy index < 40.