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1.
Clin Biochem ; 73: 115-117, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31398309

RESUMO

BACKGROUND: A laboratory investigation was initiated after a renal failure patient had a 2.18 mg/dL decrease in serum creatinine, which was not explained through medical intervention. The investigation revealed specimens providing questionably low results had been collected from a peripherally inserted central catheter (PICC) line. METHODS: Patient specimens and serum pools were analyzed by the Siemens Vista enzymatic creatinine measurement procedure. A simulation of the patient's infusion protocol examined potential PICC line carryover and specimen collection technique. RESULTS: A simultaneously collected specimen set, arterial line and PICC line, yielded a difference of 1.86 mg/dL. Infusion and collection simulation studies suggested the most likely scenario was the infusion pump was not shut off while the specimen collection occurred and contaminated the specimen. CONCLUSION: Providers should be aware of erroneously low creatinine results when administering catecholamine drugs and collecting specimens through the same catheter. The mechanism of specimen contamination is consistent with a siphoning effect from one lumen to the other during collection with the infusion pumps still running.


Assuntos
Análise Química do Sangue , Creatinina/sangue , Dobutamina/administração & dosagem , Dopamina/administração & dosagem , Cateterismo Periférico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
2.
J Cardiovasc Magn Reson ; 21(1): 43, 2019 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-31340834

RESUMO

BACKGROUND: We hypothesize that dobutamine-induced stress impacts intracardiac hemodynamic parameters and that this may be linked to decreased exercise capacity in Fontan patients. Therefore, the purpose of this study was to assess the effect of pharmacologic stress on intraventricular kinetic energy (KE), viscous energy loss (EL) and vorticity from four-dimensional (4D) Flow cardiovascular magnetic resonance (CMR) imaging in Fontan patients and to study the association between stress response and exercise capacity. METHODS: Ten Fontan patients underwent whole-heart 4D flow CMR before and during 7.5 µg/kg/min dobutamine infusion and cardiopulmonary exercise testing (CPET) on the same day. Average ventricular KE, EL and vorticity were computed over systole, diastole and the total cardiac cycle (vorticity_volavg cycle, KEavg cycle, ELavg cycle). The relation to maximum oxygen uptake (VO2 max) from CPET was tested by Pearson's correlation or Spearman's rank correlation in case of non-normality of the data. RESULTS: Dobutamine stress caused a significant 88 ± 52% increase in KE (KEavg cycle: 1.8 ± 0.5 vs 3.3 ± 0.9 mJ, P < 0.001), a significant 108 ± 49% increase in EL (ELavg cycle: 0.9 ± 0.4 vs 1.9 ± 0.9 mW, P < 0.001) and a significant 27 ± 19% increase in vorticity (vorticity_volavg cycle: 3441 ± 899 vs 4394 ± 1322 mL/s, P = 0.002). All rest-stress differences (%) were negatively correlated to VO2 max (KEavg cycle: r = - 0.83, P = 0.003; ELavg cycle: r = - 0.80, P = 0.006; vorticity_volavg cycle: r = - 0.64, P = 0.047). CONCLUSIONS: 4D flow CMR-derived intraventricular kinetic energy, viscous energy loss and vorticity in Fontan patients increase during pharmacologic stress and show a negative correlation with exercise capacity measured by VO2 max.


Assuntos
Agonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Circulação Coronária/efeitos dos fármacos , Dobutamina/administração & dosagem , Teste de Esforço , Tolerância ao Exercício/efeitos dos fármacos , Técnica de Fontan , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Hemodinâmica/efeitos dos fármacos , Imagem Cinética por Ressonância Magnética , Imagem de Perfusão do Miocárdio/métodos , Consumo de Oxigênio/efeitos dos fármacos , Adolescente , Feminino , Cardiopatias Congênitas/fisiopatologia , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
3.
PLoS One ; 14(7): e0213414, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291253

RESUMO

In acidosis, catecholamines are attenuated, and higher doses are often required to improve cardiovascular function. Colforsin activates adenylate cyclase in cardiomyocytes without beta-adrenoceptor. Here, six beagles were administered colforsin or dobutamine four times during eucapnia (partial pressure of arterial carbon dioxide 35-40 mm Hg; normal) and hypercapnia (ibid 90-110 mm Hg; acidosis) conditions. The latter was induced by CO2 inhalation. Anesthesia was induced with propofol and maintained with isoflurane. Cardiovascular function was measured by thermodilution and a Swan-Ganz catheter at baseline and 60 min after 0.3 µg/kg/min (low), 0.6 µg/kg/min (middle), and 1.2 µg/kg/min (high) colforsin administration. The median pH was 7.38 [range 7.33-7.42] and 7.01 [range 6.96-7.08] at baseline in the Normal and Acidosis conditions, respectively. Endogenous adrenaline and noradrenaline levels at baseline were significantly (P < 0.05) higher in the Acidosis than in the Normal condition. Colforsin induced cardiovascular effects similar to those caused by dobutamine. Colforsin increased cardiac output in the Normal condition (baseline: 3.9 ± 0.2 L/kg/m2 [mean ± standard error], low: 5.2 ± 0.4 L/kg/min2, middle: 7.0 ± 0.4 L/kg/m2, high: 9.4 ± 0.2 L/kg/m2; P < 0.001) and Acidosis condition (baseline: 6.1 ± 0.3 L/kg/m2, low: 6.2 ± 0.2 L/kg/m2, middle: 7.2 ± 0.2 L/kg/m2, high: 8.3 ± 0.2 L/kg/m2; P < 0.001). Colforsin significantly increased heart rate and decreased systemic vascular resistance compared to values at baseline. Both drugs increased pulmonary artery pressure, but colforsin (high: 13.3 ± 0.6 mmHg in Normal and 20.1 ± 0.2 mmHg in Acidosis) may have lower clinical impact on the pulmonary artery than dobutamine (high: 19.7 ± 0.6 in Normal and 26.7 ± 0.5 in Acidosis). Interaction between both drugs and experimental conditions was observed in terms of cardiovascular function, which were similarly attenuated with colforsin and dobutamine under acute respiratory acidosis.


Assuntos
Acidose Respiratória/tratamento farmacológico , Cardiotônicos/administração & dosagem , Colforsina/análogos & derivados , Acidose Respiratória/fisiopatologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Débito Cardíaco/efeitos dos fármacos , Catecolaminas/sangue , Colforsina/administração & dosagem , Modelos Animais de Doenças , Dobutamina/administração & dosagem , Cães , Relação Dose-Resposta a Droga , Feminino , Frequência Cardíaca/efeitos dos fármacos , Masculino , Artéria Pulmonar/efeitos dos fármacos , Artéria Pulmonar/fisiopatologia , Resistência Vascular/efeitos dos fármacos
4.
Scand Cardiovasc J ; 53(3): 153-161, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31063000

RESUMO

Objective. Skeletal muscle perfusion during walking relies on complex interactions between cardiac activity and vascular control mechanisms, why cardiac dysfunction may contribute to intermittent claudication (IC) symptoms. The study aims were to describe cardiac function at rest and during stress in consecutive IC patients, to explore the relations between cardiac function parameters and treadmill performance, and to test the hypothesis that clinically silent myocardial ischemia during stress may contribute to IC limb symptomatology. Design. Patients with mild to severe IC (n = 111, mean age 67 y, 52% females, mean treadmill distance 195 m) underwent standard echocardiography, dobutamine stress echocardiography (SE) and treadmill testing. The patient cohort was separated in two groups based on treadmill performance (HIGH and LOW performance). Results. Ten patients (9%) had regional wall motion abnormalities of which three had left ventricular ejection fraction <50% at standard echocardiography. A majority had lower than expected systolic- and diastolic ventricular volumes. LOW performers had smaller diastolic left ventricular volumes and lower global peak systolic velocity during dobutamine stress. No patient demonstrated significant cardiac dysfunction during dobutamine provocation that was not also evident at standard echocardiography. Conclusions. Most IC patients were without signs of ischemic heart disease or cardiac failure. The majority had small left ventricular volumes. The hypothesis that clinically silent myocardial ischemia impairing left ventricular function during stress may contribute to IC limb symptomatology was not supported.


Assuntos
Agonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Dobutamina/administração & dosagem , Ecocardiografia sob Estresse/métodos , Teste de Esforço , Claudicação Intermitente/diagnóstico por imagem , Função Ventricular Esquerda , Idoso , Feminino , Humanos , Claudicação Intermitente/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença
5.
Int J Cardiovasc Imaging ; 35(9): 1651-1659, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31053980

RESUMO

We investigated the influence of the extent of viability using low dose dobutamine wall motion score index (WMS) on the survival benefit of surgical revascularization (CABG) versus medical therapy. In the STICH trial, viability assessment was not helpful in determining the benefit of CABG. However, the extent of viable myocardium with contractile function was not assessed in the trial. Dobutamine echocardiography was performed in 250 patients with ischemic left ventricular dysfunction (125-medically treated, 125-CABG). The mean ejection fraction (EF) was 32% in both groups. WMS during low dose dobutamine infusion was used to classify patients into groups with extensive (WMS < 2.00), intermediate (WMS 2.00-2.49), and limited (WMS ≥ 2.50) viability. Survival free of cardiac death was assessed at 2 years and for the complete duration of follow-up. There were 44 (35.2%) and 67 (53.6%) cardiac deaths in the revascularized and medically treated patients respectively (follow-up of 5.7 ± 5.8 years). Revascularized and medically treated patients with extensive viability had similar 2-year survival (p = 0.567) but revascularized patients had improved long-term survival (p = 0.0001). In those with intermediate viability, revascularization improved both 2 year (p = 0.014) and long-term survival (p = 0.0001). In patients with limited viability, 2-year survival was worse in revascularized patients (p = 0.04) and long-term survival was similar (p = 0 .25) in revascularized and medically treated groups. Patients with extensive and intermediate amounts of viability have improved survival with CABG but those with limited viability have poorer short-term outcome and no long-term benefit.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Cardiotônicos/administração & dosagem , Ponte de Artéria Coronária , Dobutamina/administração & dosagem , Ecocardiografia sob Estresse/métodos , Isquemia Miocárdica/diagnóstico por imagem , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Idoso , Cardiomiopatias/mortalidade , Cardiomiopatias/fisiopatologia , Cardiomiopatias/cirurgia , Fármacos Cardiovasculares/uso terapêutico , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/cirurgia , Miocárdio/patologia , Seleção de Pacientes , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Sobrevivência de Tecidos , Resultado do Tratamento , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/cirurgia
6.
Medicine (Baltimore) ; 98(18): e15358, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045778

RESUMO

Success of surgical free flap transfer depends on achieving and maintaining adequate perfusion across the microvascular anastomosis. The purpose of this prospective study was to determine the optimal infusion rate of dobutamine to augment duplex ultrasound measured blood flow to the tissue flap during surgery.Twenty-one patients undergoing general anesthesia for lower limb reconstructive surgery were recruited. The optimal dobutamine dose was evaluated using the modified Dixon's up-and-down method, starting at 6 µg·kg·min, and then titrated in increments of 1 µg·kg·min.The optimal dose of dobutamine for improving blood flow to the tissue flap was 3.50 ±â€Š0.57 µg·kg·min in 50% of patients. The 95% effective dose of dobutamine calculated by probit analysis was 4.46 µg·kg·min (95% confidence interval: 3.99-7.00 µg·kg·min).The results of our study suggest that a dobutamine infusion rate less than 5 µg·kg·minprovides significant improvement of blood flow to the tissue flap, while minimizing cardiovascular side effects.


Assuntos
Agonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Dobutamina/administração & dosagem , Retalhos de Tecido Biológico/irrigação sanguínea , Hemodinâmica/efeitos dos fármacos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Agonistas de Receptores Adrenérgicos beta 1/efeitos adversos , Adulto , Anestesia Geral , Dobutamina/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ultrassonografia Doppler Dupla , Adulto Jovem
7.
Int J Cardiovasc Imaging ; 35(6): 1019-1026, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30977036

RESUMO

The peak stress/rest ratio of left ventricular (LV) elastance, or LV force, is a load-independent index of left ventricular contractile reserve (LVCR) with stress echo (SE). To assess the accuracy of LVCR calculated during SE with approaches of different complexity. Two-hundred-forty patients were referred to SE for known or suspected coronary artery disease or heart failure and, of those, 200 patients, age 61 ± 15, 99 females, with interpretable volumetric SE were enrolled. All readers had passed the upstream quality control reading for regional wall motion abnormality (RWMA) and end-systolic volume (ESV) measurement. The employed stress was dipyridamole (0.84 mg, 6 min) in 86 (43%) and dobutamine (up to 40 mcg/kg/min) in 114 (57%) patients. All underwent SE with evaluation of RWMA and simultaneous LVCR assessment with stress/rest ratio of LV force (systolic blood pressure by cuff sphygmomanometer/ESV). ESV was calculated in each patient by two of three methods: biplane Simpson rule (S, in 100 patients), single plane area-length (AL, apical four-chamber area and length, in 100 patients), and Teichholz rule (T, from parasternal long axis and/or short axis view, in 200 patients). RMWA were observed in 54 patients. Success rate for ESV measurement was 76% (100/131) for S, 92% (100/109) for AL, and 100% (240/240) for T. There were 100 paired measurements (rest and stress) with S versus T, and 100 with AL versus T. The analysis time was the shortest for T (33 ± 8 s at rest, 34 ± 7 s at stress), intermediate for AL (70 ± 22 s at rest 67 ± 21 s at stress), and the longest for S (136 ± 24 at rest 129 ± 27 s at stress, p < 0.05 vs. T and AL). ESV absolute values were moderately correlated: T versus S (r rest = 0.746, p < 0.01, n = 100; r stress = 0.794, p < 0.01, n = 100); T vs. AL (r = 0.603 p < 0.01, n = 100, at rest and r = 0.820 p < 0.01 n = 100 at peak stress). LVCR values were tightly correlated independently of the method employed: T versus S (r = 0.899, p < 0.01, n = 100), and T versus AL (r = 0.845, p < 0.01, n = 100). LVCR can be accurately determined with all three methods used to extract the raw values of ESV necessary to generate the calculation of Force. Although S is known to be more precise in determining absolute ESV values, the relative (rest-stress) changes can be assessed, with comparable accuracy, with simpler and more feasible T and AL methods, characterized by higher success rate, shorter imaging and analysis time.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia sob Estresse/métodos , Insuficiência Cardíaca/diagnóstico por imagem , Volume Sistólico , Função Ventricular Esquerda , Agonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Idoso , Doença da Artéria Coronariana/fisiopatologia , Dipiridamol/administração & dosagem , Dobutamina/administração & dosagem , Estudos de Viabilidade , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Sístole , Vasodilatadores/administração & dosagem
8.
J Vet Pharmacol Ther ; 42(3): 285-293, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30724383

RESUMO

This study aimed to assess the effects of incremental doses of dobutamine on diastolic function in healthy and rapid ventricular apical pacing (RVAP)-induced cardiac dysfunction anesthetized dogs. Inotropic and lusitropic effects of dobutamine (2, 4, 8, and 12 µg kg-1  min-1 ) were assessed through left ventricle (LV) pressure-volume relation and Doppler echocardiography in six female dogs before and after 8 weeks of RVAP. Peak rate of LV pressure fall (-dP/dtmin ) improved with doses >4 µg kg-1  min-1 in healthy (4,490 ± 970 vs. 3,265 ± 471 mmHg/s, p < 0.05) and >8 µg kg-1  min-1 in RVAP dogs (3,385 ± 1,122 vs. 1,864 ± 849 mmHg/s, p < 0.05) while the time constant of relaxation (tau) reduced with doses >4 µg kg-1  min-1 in both groups (healthy: 24.0 ± 3.7 vs. 28.2 ± 4.9 ms; RVAP: 32.6 ± 8.5 vs. 37.5 ± 11.4 ms, p < 0.05) comparing with baseline. Indices of relaxation (-dP/dtmin and tau) suggested preserved lusitropic response in contrast with markedly reduced indices of contractility in the RVAP group compared with healthy group at same infusion rates. Doppler echocardiography showed significant reduction of elastic recoil in failing hearts. The results of this study demonstrated maximal positive lusitropic effects of dobutamine at a dose of 8 µg kg-1  min-1 in ventricular pacing-induced cardiac dysfunction without further impairment of ventricular filling.


Assuntos
Arritmias Cardíacas/veterinária , Cardiotônicos/uso terapêutico , Dobutamina/uso terapêutico , Doenças do Cão/tratamento farmacológico , Animais , Arritmias Cardíacas/tratamento farmacológico , Arritmias Cardíacas/fisiopatologia , Cardiotônicos/administração & dosagem , Dobutamina/administração & dosagem , Cães , Relação Dose-Resposta a Droga , Ecocardiografia Doppler/veterinária , Feminino , Ventrículos do Coração/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Contração Miocárdica/efeitos dos fármacos , Função Ventricular/efeitos dos fármacos
9.
Am J Vet Res ; 80(3): 275-283, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30801218

RESUMO

OBJECTIVE To determine the impact of mechanical ventilation (MV) and perfusion conditions on the efficacy of pulse-delivered inhaled nitric oxide (PiNO) in anesthetized horses. ANIMALS 27 healthy adult horses. PROCEDURES Anesthetized horses were allocated into 4 groups: spontaneous breathing (SB) with low (< 70 mm Hg) mean arterial blood pressure (MAP; group SB-L; n = 7), SB with physiologically normal (≥ 70 mm Hg) MAP (group SB-N; 8), MV with low MAP (group MV-L; 6), and MV with physiologically normal MAP (group MV-N; 6). Dobutamine was used to maintain MAP > 70 mm Hg. Data were collected after a 60-minute equilibration period and at 15 and 30 minutes during PiNO administration. Variables included Pao2, arterial oxygen saturation and content, oxygen delivery, and physiologic dead space-to-tidal volume ratio. Data were analyzed with Shapiro-Wilk, Mann-Whitney U, and Friedman ANOVA tests. RESULTS Pao2, arterial oxygen saturation, arterial oxygen content, and oxygen delivery increased significantly with PiNO in the SB-L, SB-N, and MV-N groups; were significantly lower in group MV-L than in group MV-N; and were lower in MV-N than in both SB groups during PiNO. Physiologic dead space-to-tidal volume ratio was highest in the MV-L group. CONCLUSIONS AND CLINICAL RELEVANCE Pulmonary perfusion impacted PiNO efficacy during MV but not during SB. Use of PiNO failed to increase oxygenation in the MV-L group, likely because of profound ventilation-perfusion mismatching. During SB, PiNO improved oxygenation irrespective of the magnitude of blood flow, but hypoventilation and hypercarbia persisted. Use of PiNO was most effective in horses with adequate perfusion.


Assuntos
Anestesia/veterinária , Circulação Sanguínea , Hemodinâmica , Cavalos , Óxido Nítrico/farmacologia , Respiração Artificial/veterinária , Animais , Artérias/efeitos dos fármacos , Gasometria/veterinária , Dobutamina/administração & dosagem , Hemodinâmica/efeitos dos fármacos , Pulmão/efeitos dos fármacos , Óxido Nítrico/administração & dosagem , Oxigênio/sangue , Troca Gasosa Pulmonar/efeitos dos fármacos , Distribuição Aleatória , Respiração/efeitos dos fármacos
10.
Int J Cardiovasc Imaging ; 35(2): 285-294, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30623352

RESUMO

Non-response cardiac resynchronization therapy (CRT) remains an issue, despite the refinement of selection criteria. The purpose of this study was to investigate the role of stress echocardiography along with dyssynchrony parameters for identification of CRT responders or late responders. 106 symptomatic heart failure patients were examined before, 6 months and 2-4 years after CRT implementation. Inotropic contractile reserve (ICR) and inferolateral (IL) wall viability were studied by stress echocardiography. Dyssynchrony was assessed by: (1) Septal to posterior wall motion delay (SPWMD) by m-mode. (2) Septal to lateral wall delay (SLD) by TDI. (3) Interventricular mechanical delay (IVMD) by pulsed wave Doppler for (4) difference in time to peak circumferential strain (TmaxCS) by speckle tracking. (5) Apical rocking (ApR) and septal flash (SF) by visual assessment. At 6 months there were 54 responders, with 12 additional late responders. TmaxCS had the greatest predictive value with an area under curve (AUC) of 0.835, followed by the presence of both ICR and viability of IL wall (AUC 0.799), m-mode (AUC = 0.775) and presence of either ApR or SF (AUC = 0.772). Predictive ability of ApR and of ICR is augmented if late responders are also included. Performance of dyssynchrony parameters is enhanced, in patients with both ICR and IL wall viability. Stress echocardiography and dyssynchrony parameters are simple and reliable predictors of 6-month and late CRT response. A stepwise approach with an initial assessment of ICR and viability and, if positive, further dyssynchrony analysis, could assist decision making.


Assuntos
Agonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Terapia de Ressincronização Cardíaca , Dobutamina/administração & dosagem , Ecocardiografia Doppler em Cores , Ecocardiografia sob Estresse/métodos , Insuficiência Cardíaca/terapia , Contração Miocárdica , Função Ventricular Esquerda , Função Ventricular Direita , Idoso , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
12.
J Pharm Pharmacol ; 71(5): 826-838, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30604484

RESUMO

OBJECTIVES: To evaluate the advantages and disadvantages of using different standard concentration infusions for high-alert inotropic and vasoactive drugs in paediatric intensive care units (ICUs). METHODS: Retrospective data analysis was performed on drug prescriptions for patients in paediatric ICUs. A matrix was developed based on optimal concentration recommendations for each drug, taking into consideration solution stability and patient safety. Hypothetical volumes were calculated for three standard solutions (high concentration - HC, low concentration - LC and fluid restriction - FR) and compared to the actual administered volumes to evaluate the impact of the volumes of each standard solution for varying weight ranges in paediatric care. Finally, a risk assessment of the standard infusions was conducted using the NPSA 20 tool along with an assessment of the pharmacoeconomic impact. KEY FINDINGS: The results suggest the need for at least two standard concentrations for each of the studied drugs in order to attend to the different weight ranges and clinical conditions of paediatric patients in intensive care. CONCLUSIONS: High concentration is ideal for patients up to 20 kg. For patients over 20 kg, FR is recommended, while LC should only be used in specific situations. Modifying the hospital pharmacotherapy system to include standard solutions is safer and reduces the risks of adverse effects. The pharmacoeconomic analysis did not show any impact on costs, although a reduction in adverse effects should be considered.


Assuntos
Cardiotônicos/administração & dosagem , Unidades de Terapia Intensiva Pediátrica , Segurança do Paciente/normas , Vasoconstritores/administração & dosagem , Vasodilatadores/administração & dosagem , Criança , Pré-Escolar , Dobutamina/administração & dosagem , Dopamina/administração & dosagem , Epinefrina/administração & dosagem , Humanos , Lactente , Recém-Nascido , Infusões Intravenosas/normas , Concentração Máxima Permitida , Milrinona/administração & dosagem , Estudos Retrospectivos , Medição de Risco
13.
Int J Cardiovasc Imaging ; 35(4): 645-651, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30499057

RESUMO

The aim of the current study was to investigate whether stress echocardiography improves selection of patients who might have clinical benefit from percutaneous mitral valve repair with the MitraClip. In total, 39 patients selected for MitraClip implantation underwent preprocedural low-dose stress (dobutamine or handgrip) echocardiography from which stroke volume, ejection fraction and MR grade were measured. Outcome after MitraClip implantation was determined by New York Heart Association classification and Quality of Life questionnaires. Clinical benefit from MitraClip treatment was defined as survival and NYHA class I-II at 6 months follow-up. In total, 36 patients with a technically successful procedure were included in the analysis (mean age 79 ± 8 years, 47% male, 50% functional MR). Clinical benefit was achieved in 18 patients. All seven patients with MR decreasing during stress remained in NYHA III-IV or died within 6 months, while 62% (18 out of 29) of the patients with stable or increased MR during stress had clinical benefit (p = 0.008). Significant increase in Quality of Life on 4/8 subscales of the RAND Short Form-36 questionnaire was observed: Physical Functioning (p < 0.001), Social Functioning (p < 0.001), Mental Health (p = 0.022) and Vitality (p = 0.026) was seen in patients with an increase in stroke volume during stress echocardiography. Patients with a decreased MR during preprocedural stress echocardiography remained more symptomatic than patients with a stable or increased MR during stress. Stress echocardiography may support patient selection for percutaneous mitral valve repair.


Assuntos
Cateterismo Cardíaco , Ecocardiografia sob Estresse , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Agonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/mortalidade , Tomada de Decisão Clínica , Dobutamina/administração & dosagem , Exercício Físico , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Hemodinâmica , Humanos , Masculino , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/fisiopatologia , Seleção de Pacientes , Valor Preditivo dos Testes , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento
15.
Int J Cardiovasc Imaging ; 35(4): 627-632, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30460582

RESUMO

Previous studies have suggested a decline in positivity of stress cardiac imaging based on regional wall motion abnormalities (RWMA). To assess the rate of RWMA positivity of stress echocardiography (SE) over 3 decades in the same primary care SE lab. We retrospectively assessed the rate of SE positivity in 7626 SE tests (dipyridamole in 5053, dobutamine in 2496, exercise in 77) in consecutive patients with known or suspected coronary artery disease and /or heart failure who performed SE in a primary care referral center from April 1991 to May 2018. Starting April 2005, SE based on RWMA was complemented by assessment of coronary flow velocity reserve (CFVR) of the left anterior descending coronary artery. Starting October 2016, we added left ventricular contractile reserve (LVCR). Starting October 2016, we also added B-lines by lung ultrasound. There was a progressive decline over time in the rate of SE positivity based on RWMA from 24% (1991-1999) to 10% (2000-2009) down to 4% (2010-2018) (p < 0.0001). Positivity rate was 29% with CFVR, 16% with LVCR, and 12% with B-lines. Over three decades, we observed a dramatic decline in SE positivity rate based on classical RWMA. In the last decade, the positivity rate rose sharply thanks to the stepwise introduction of CFVR, LVCR and B-lines as additional positivity criteria in integrated quadruple SE.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia sob Estresse/métodos , Insuficiência Cardíaca/diagnóstico por imagem , Contração Miocárdica , Função Ventricular Esquerda , Agonistas de Receptores Adrenérgicos beta 1 , Idoso , Doença da Artéria Coronariana/fisiopatologia , Dipiridamol/administração & dosagem , Dobutamina/administração & dosagem , Exercício Físico , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo , Vasodilatadores/administração & dosagem
16.
J Electrocardiol ; 51(6): 1035-1038, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30497726

RESUMO

Dobutamine when used for stress echocardiography (DSE), it rarely causes transient atrio-ventricular (AV) block. We report a heart transplant patient with high cardiovascular risk who developed symptomatic advanced AV block during DSE which persisted after termination of dobutamine administration, necessitating pacemaker implantation. To our knowledge, this is the first published case of persistent high grade AV block in a heart transplant patient induced by DSE.


Assuntos
Bloqueio Atrioventricular/etiologia , Cardiotônicos/efeitos adversos , Dobutamina/efeitos adversos , Ecocardiografia sob Estresse/efeitos adversos , Transplante de Coração , Bloqueio Atrioventricular/diagnóstico , Cardiotônicos/administração & dosagem , Dobutamina/administração & dosagem , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade
17.
An. pediatr. (2003. Ed. impr.) ; 89(6): 369-377, dic. 2018. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-177163

RESUMO

Objetivo: Evaluar el efecto de un protocolo de cribado y tratamiento del bajo flujo sistémico (BFS) durante el periodo transicional en la aparición de hemorragia intraventricular (HIV) grave y/o muerte en prematuros. Métodos: Estudio cuasi-experimental con controles retrospectivos. En la fase de intervención se incluyeron los prematuros de menos de 30semanas de edad gestacional (enero 2016-julio 2017). Los controles (enero de 2013-diciembre de 2015) fueron pareados por edad gestacional, peso al nacimiento y sexo con una relación 1:2. Los casos diagnosticados de BFS por ecocardiografía funcional durante el protocolo recibieron tratamiento con dobutamina (DB) entre 5-10 mig/kg/min durante 48 h. Resultados: Se incluyeron 29 casos en la fase de intervención (aplicación del protocolo) y 54 controles (fase preintervención). Diez de 29 (34,5%) casos durante el protocolo recibieron DB por BFS con 3/29 (10,3%) casos de HIV grave y/o muerte comparado con 17/54 (31,5%) en la fase pre-protocolo (p = 0,032). El protocolo se asoció de forma independiente a una reducción en la HIV grave y/o muerte tanto en la regresión logística (OR: 0,11 (IC95%: 0,01-0,65), p = 0,015) como en el análisis de ponderación por la probabilidad inversa de tratamiento (OR: 0,23 (IC95%: 0,09-0,56); p = 0,001). Conclusiones: En un estudio con controles retrospectivos, la aplicación de un protocolo de cribado y tratamiento del BFS en prematuros se asoció a una reducción en la HIV grave y/o muerte. Son necesarios ensayos clínicos de suficiente potencia para determinar si las intervenciones posnatales sobre el BFS pueden mejorar el pronóstico neurológico


Objective: To assess the effect of a protocolised intervention for low systemic blood flow (SBF) in the occurrence of severe intraventricular haemorrhage (IVH) or death in pre-term infants. Methods: A study with a quasi-experimental design with retrospective controls was conducted on pre-term infants of less than 30 weeks of gestational age, born between January 2016 and July 2017, who were consecutively included in the intervention period. The control cohort included pre-term infants (born between January 2013 and December 2015) matched by gestational age, birth weight, and gender (two controls for each case). The cases of low SBF diagnosed according to functional echocardiography during the study period received dobutamine (5-10 mig/kg/min) for 48 hours. Results: The study included 29 cases (intervention period) and 54 controls (pre-intervention period). Ten out of 29 (34.5%) infants received dobutamine for low SBF during the intervention period, with 3/29 (10.3%) cases of severe IVH and/or death compared to 17/54 (31.5%) in the control cohort (p = .032). There was an independent association between the intervention and a decreased occurrence of severe IVH/death after adjusting for confounding factors both in the logistic regression model (OR 0.11 (95% CI: 0.01-0.65), p = .015), as well as in the sensitivity analysis using inverse probability of treatment weighting (OR 0.23 (95% CI: 0.09-0.56); p = .001). Conclusions: In this study with retrospective controls, a protocolised screening, and treatment for low SBF was associated with a decreased occurrence of severe IVH or death in preterm infants. Large, adequately powered trials, are needed in order to determine whether postnatal interventions directed at low SBF can improve neurological outcomes


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Hemorragia/prevenção & controle , Doenças do Prematuro/mortalidade , Pressão Sanguínea , Baixo Débito Cardíaco/prevenção & controle , Estudos Retrospectivos , Dobutamina/administração & dosagem , Doenças do Prematuro/prevenção & controle , Velocidade do Fluxo Sanguíneo
18.
Prog Cardiovasc Dis ; 61(5-6): 416-422, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30445161

RESUMO

Up to 1/3 of patients with both reduced or preserved left ventricular ejection fraction (LVEF), harbor a mean pressure gradient (MPG) < 40 mm Hg (peak velocity (PV) < 4 m/s), suggesting moderate aortic stenosis (AS) and an aortic valve area (AVA) < 1 cm2 suggesting severe AS raising uncertainties regarding AS severity and appropriate management. In patients with reduced LVEF, increased transvalvular flow and stroke volume ≥ 20% (i.e. contractile reserve) during low-dose dobutamine echocardiography enables distinguishing patients with "true-severe AS" (severe AS with secondary LV dysfunction, PV ≥ 4 m/s or MPG > 30-40 mm Hg at peak while AVA remains <1 cm2) from patients with "pseudo-severe AS" (moderate AS with associated LV dysfunction due to ischemic or dilated cardiomyopathy, AVA at peak ≥1 cm2 with a MPG < 30-40 mm Hg). However, interpretation of dobutamine stress echocardiography is often challenging, and absence of contractile reserve is observed in 20 to 30% of patients. Measurement of the degree of calcification (AVC) using computed tomography is an accurate and flow-independent method for the assessment of AS severity. A score > 1250 AU in women and >2000 UA in men strongly suggest severe AS. Combination of dobutamine echocardiography and AVC scoring enables assessment of AS severity with high confidence. The subset of patients with discordant grading and preserved LVEF is heterogenous and encompasses various conditions. A minority harbor a low flow state related to a reduced myocardial performance, an increased arterial afterload or combination of both. A low flow state is an important prognostic factor but does not provide any information regarding AS severity. Similarly to patients with reduced LVEF, assessment of the degree of AVC seems the best method to differentiate patients with pseudo-severe AS from patients with true severe AS. The latter should be referred for an intervention if symptomatic whereas the optimal management of the former subset remains uncertain.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Calcinose/diagnóstico por imagem , Ecocardiografia sob Estresse/métodos , Tomografia Computadorizada por Raios X , Agonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/terapia , Calcinose/fisiopatologia , Calcinose/terapia , Dobutamina/administração & dosagem , Humanos , Imagem Multimodal , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Volume Sistólico , Função Ventricular Esquerda
19.
J Cardiovasc Magn Reson ; 20(1): 75, 2018 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-30463565

RESUMO

BACKGROUND: Current guidelines for assessing the risk of experiencing a hospitalized cardiovascular (CV) event discourage stress testing of asymptomatic individuals; however, these recommendations are based on evidence gathered primarily from those aged < 60 years, and do not address the possibility of unrecognized "silent myocardial ischemia" in middle aged and older adults. METHODS: We performed dobutamine cardiovascular magnetic resonance (CMR) stress testing in 327 consecutively recruited participants aged > 55 years without CV-related symptoms nor known coronary artery disease, but otherwise at increased risk for a future CV event due to pre-existing hypertension or diabetes mellitus for at least 5 years. After adjusting for the demographics and CV risk factors, log-rank test and Cox proportional hazards models determined the additional predictive value of the stress test results for forecasting hospitalized CV events/survival. Either stress-induced LV wall motion abnormalities or perfusion defects were used to indicate myocardial ischemia. RESULTS: Participants averaged 68 ± 8 years in age; 39% men, 75% Caucasian. There were 38 hospitalized CV events or deaths which occurred during a mean follow-up of 58 months. Using Kaplan-Meier analyses, myocardial ischemia identified future CV events/survival (p <  0.001), but this finding was more evident in men (p <  0.001) versus women (p = 0.27). The crude hazard ratio (HR) of myocardial ischemia for CV events/survival was 3.13 (95% CI: 1.64-5.93; p < 0.001). After accounting for baseline demographics, CV risk factors, and left ventricular ejection fraction/mass, myocardial ischemia continued to be associated with CV events/survival [HR: 4.07 (95% CI: 1.95-8.73) p < 0.001]. CONCLUSIONS: Among asymptomatic middle-aged individuals with risk factors for a sentinel CV event, the presence of myocardial ischemia during dobutamine CMR testing forecasted a future hospitalized CV event or death. Further studies are needed in middle aged and older individuals to more accurately characterize the prevalence, significance, and management of asymptomatic myocardial ischemia. TRIAL REGISTRATION: ( ClinicalTrials.gov identifier): NCT00542503 and was retrospectively registered on October 11th, 2007.


Assuntos
Agonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Dobutamina/administração & dosagem , Imagem por Ressonância Magnética/métodos , Isquemia Miocárdica/diagnóstico por imagem , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Progressão da Doença , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/terapia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
20.
Physiol Rep ; 6(19): e13879, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30311442

RESUMO

Acute ischemic cardiogenic shock is associated with poor prognosis, and the impact of inotropic support on diastolic function in this context is unclear. We assessed two suggested new inotropic strategies in a clinically relevant pig model of ischemic acute heart failure (AHF): treatment with the myosin activator omecamtiv mecarbil (OM) or dobutamine and ivabradine (D+I). Left ventricular (LV) ischemia was induced in anesthetized pigs by coronary microembolization (n = 12). The animals then received OM (bolus 0.75 mg/kg, followed by 0.5 mg/kg per h) (n = 6) or D+I (5 µg/kg per min + 0.29 ± 0.16 mg/kg) (n = 6), respectively. Ischemia reduced the stroke volume (SV), despite the increased left atrial pressure associated with impaired LV early relaxation, systolic dilatation, and LV late diastolic stiffness. Both treatments improved systolic ejection, but only D+I increased the SV from 26 ± 5 to 33 ± 5 mL. D+I enhanced LV early relaxation (Tau; from 45 ± 11 to 29 ± 4 msec) and prolonged the diastolic time (DT) from 338 ± 60 to 352 ± 40 msec. In contrast, OM prolonged Tau (42 ± 5 to 62 ± 10 msec) and shortened the DT (from 326 ± 68 to 248 ± 84 msec). Our data suggest that enhanced early relaxation by D+I improves LV pump function in postischemic acute heart failure. In contrast, OM worsened lusitropy in this model.


Assuntos
Diástole/efeitos dos fármacos , Dobutamina/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Ivabradina/administração & dosagem , Isquemia Miocárdica/tratamento farmacológico , Ureia/análogos & derivados , Animais , Cardiotônicos/administração & dosagem , Fármacos Cardiovasculares/administração & dosagem , Diástole/fisiologia , Quimioterapia Combinada , Insuficiência Cardíaca/fisiopatologia , Masculino , Isquemia Miocárdica/fisiopatologia , Suínos , Resultado do Tratamento , Ureia/administração & dosagem
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