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1.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 838-843, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412754

RESUMO

OBJECTIVE: To evaluate the dynamic changes of pulmonary arterial pressure (PAP) and cardiac function in neonates with pulmonary or extra-pulmonary acute respiratory distress syndrome (ARDSp/ARDSexp). METHODS: An observational study was conducted. A total of 128 neonates with ARDS admitted to neonatology department of the Affiliated Yancheng Hospital of Southeast University Medical College from January 2016 to December 2020 were enrolled, with 67 neonates in ARDSp group and 61 neonates in ARDSexp group. After starting mechanical ventilation, oxygenation index [OI, OI = mean airway pressure (Pmean)×fraction of inspired oxygen (FiO2)/arterial partial pressure of oxygen (PaO2)×100], PAP, cardiac function parameters [cardiac index (CI), left ventricular ejection fraction (LVEF), right ventricular Tei (RV-Tei)], and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) were compared between the two groups; the incidence of pulmonary arterial hypertension [PAH, pulmonary artery systolic pressure (PASP) was more than 35 mmHg (1 mmHg = 0.133 kPa) or more than 2/3 of the systolic blood pressure of the body circulation] of neonates was recorded. The correlation between PAP and NT-proBNP was analyzed by Pearson correlation method. The dynamically changes in PAP and RV-Tei before and after using Milrinone in neonates with ARDSp and ARDSexp combined with moderate-severe PAH (PASP 50-69 mmHg was moderate, and PASP ≥ 70 mmHg was severe) were observed. The duration of mechanical ventilation, total length of hospital stay and prognosis were recorded; Kaplan-Meier survival curve was drawn to analyze the 28-day survival of the two groups. RESULTS: The occurrence rate of PAH in ARDSp group was significantly higher than that in ARDSexp group (97.01% vs. 70.49%, P < 0.01). OI, PAP, NT-proBNP and RV-Tei were also higher [OI: 17.61±6.12 vs. 11.04±5.35, PAP (mmHg): 64.27±9.54 vs. 53.61±6.47, NT-proBNP (ng/L): 23 126.32±1 485.14 vs. 18 624.24±1 647.15, RV-Tei: 0.61±0.22 vs. 0.52±0.19, all P < 0.05], but there was no significant difference in CI or LVEF between the two groups. Pearson correlation analysis showed that PAP was significantly positively correlated with NT-proBNP (r = 0.918, P < 0.01). There were 97 ARDS neonates with moderate-severe PAH with 63 in ARDSp group and 34 in ARDSexp group. Both PAP and RV-Tei in the two group showed a decreasing trend with the prolongation of Milrinone treatment, the decrease was more significant in the ARDSexp group compared with ARDSp group, the difference was statistically significant at 72 hours of treatment [PAP (mmHg): 38.42±8.95 vs. 45.67±13.32, RV-Tei: 0.58±0.19 vs. 0.61±0.13, both P < 0.05]; there was no significant difference in PAP or RV-Tei before extubation between the two groups. The duration of mechanical ventilation and the total length of hospital stay in ARDSp group were significantly longer than those in ARDSexp group [duration of mechanical ventilation (days): 10.12±1.36 vs. 6.31±1.31, total length of hospital stay (days): 16.52±3.25 vs. 13.12±3.57, both P < 0.01]. Kaplan-Meier survival curve showed that neonate in ARDSp group had a significantly lower 28-day cumulative survival rate as compared with ARDSexp group (82.09% vs. 95.01%; Log-Rank test: χ2 = 5.062, P = 0.025). CONCLUSIONS: Both PAP and RV-Tei were significantly increased in neonates with ARDS, PAP in neonates with ARDSp were significantly higher than that in neonates with ARDSexp. Dynamic monitoring of PAP and RV-Tei can reflect the severity of ARDS in neonates, and targeted intervention of pulmonary surfactant combined with Milinone for improving oxygenation and reducing PAP is one of the effective methods for the treatment of PAH.


Assuntos
Síndrome do Desconforto Respiratório , Pressão Arterial , Humanos , Recém-Nascido , Pulmão , Volume Sistólico , Função Ventricular Esquerda
2.
Artif Intell Med ; 118: 102118, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34412841

RESUMO

Critical care clinicians are trained to analyze simultaneously multiple physiological parameters to predict critical conditions such as hemodynamic instability. We developed the Multi-task Learning Physiological Deep Learner (MTL-PDL), a deep learning algorithm that predicts simultaneously the mean arterial pressure (MAP) and the heart rate (HR). In an external validation dataset, our model exhibited very good calibration: R2 of 0.747 (95% confidence interval, 0.692 to 0.794) and 0.850 (0.815 to 0.879) for respectively, MAP and HR prediction 60-minutes ahead of time. For acute hypotensive episodes defined as a MAP below 65 mmHg for 5 min, our MTL-PDL reached a predictive value of 90% for patients at very high risk (predicted MAP ≤ 60 mmHg) and 2‰ for patients at low risk (predicted MAP >70 mmHg). Based on its excellent prediction performance, the Physiological Deep Learner has the potential to help the clinician proactively adjust the treatment in order to avoid hypotensive episodes and end-organ hypoperfusion.


Assuntos
Aprendizado Profundo , Hipotensão , Pressão Arterial , Cuidados Críticos , Estado Terminal , Humanos , Hipotensão/diagnóstico
3.
Acta Physiol (Oxf) ; 231(4): e13596, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-34347356

RESUMO

AIM: Renal tissue hypoxia during cardiopulmonary bypass could contribute to the pathophysiology of acute kidney injury. We tested whether renal tissue hypoxia can be alleviated during cardiopulmonary bypass by the combined increase in target pump flow and mean arterial pressure. METHODS: Cardiopulmonary bypass was established in eight instrumented sheep under isoflurane anaesthesia, at a target continuous pump flow of 80 mL·kg-1 min-1 and mean arterial pressure of 65 mmHg. We then tested the effects of simultaneously increasing target pump flow to 104 mL·kg-1 min-1 and mean arterial pressure to 80 mmHg with metaraminol (total dose 0.25-3.75 mg). We also tested the effects of transitioning from continuous flow to partially pulsatile flow (pulse pressure ~15 mmHg). RESULTS: Compared with conscious sheep, at the lower target pump flow and mean arterial pressure, cardiopulmonary bypass was accompanied by reduced renal blood flow (6.8 ± 1.2 to 1.95 ± 0.76 mL·min-1 kg-1) and renal oxygen delivery (0.91 ± 0.18 to 0.24 ± 0.11 mL·O2 min-1 kg-1). There were profound reductions in cortical oxygen tension (PO2) (33 ± 13 to 6 ± 6 mmHg) and medullary PO2 (31 ± 12 to 8 ± 8 mmHg). Increasing target pump flow and mean arterial pressure increased renal blood flow (to 2.6 ± 1.0 mL·min-1 kg-1) and renal oxygen delivery (to 0.32 ± 0.13 mL·O2 min-1kg-1) and returned cortical PO2 to 58 ± 60 mmHg and medullary PO2 to 28 ± 16 mmHg; levels similar to those of conscious sheep. Partially pulsatile pump flow had no significant effects on renal perfusion or oxygenation. CONCLUSIONS: Renal hypoxia during experimental CPB can be corrected by increasing target pump flow and mean arterial pressure within a clinically feasible range.


Assuntos
Pressão Arterial , Ponte Cardiopulmonar , Animais , Hipóxia , Oxigênio , Circulação Renal , Ovinos
4.
Sensors (Basel) ; 21(15)2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34372366

RESUMO

BACKGROUND: We aimed to create a novel model using a deep learning method to estimate stroke volume variation (SVV), a widely used predictor of fluid responsiveness, from arterial blood pressure waveform (ABPW). METHODS: In total, 557 patients and 8,512,564 SVV datasets were collected and were divided into three groups: training, validation, and test. Data was composed of 10 s of ABPW and corresponding SVV data recorded every 2 s. We built a convolutional neural network (CNN) model to estimate SVV from the ABPW with pre-existing commercialized model (EV1000) as a reference. We applied pre-processing, multichannel, and dimension reduction to improve the CNN model with diversified inputs. RESULTS: Our CNN model showed an acceptable performance with sample data (r = 0.91, MSE = 6.92). Diversification of inputs, such as normalization, frequency, and slope of ABPW significantly improved the model correlation (r = 0.95), lowered mean squared error (MSE = 2.13), and resulted in a high concordance rate (96.26%) with the SVV from the commercialized model. CONCLUSIONS: We developed a new CNN deep-learning model to estimate SVV. Our CNN model seems to be a viable alternative when the necessary medical device is not available, thereby allowing a wider range of application and resulting in optimal patient management.


Assuntos
Pressão Arterial , Redes Neurais de Computação , Pressão Sanguínea , Humanos , Volume Sistólico
5.
BMJ Open ; 11(8): e046161, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389562

RESUMO

OBJECTIVE: Previous studies suggested mean arterial pressure (MAP) had moderate predictive values in the first and second trimesters for the prediction of preeclampsia. However, the performance of MAP in Asian women is still unclear. The objective of this study was to examine the predictive values of MAP in Asian population throughout gestation, and to compare the performance of MAP, angiogenic factors and uterine artery Doppler in the prediction of preeclampsia. DESIGN: A prospective cohort study. SETTING: KK Women's and Children's Hospital, Singapore. PARTICIPANTS: A total of 926 women with singleton pregnancy less than 14 weeks of gestation were included in the prospective Neonatal and Obstetrics Risks Assessment cohort between September 2010 and October 2014. Maternal blood pressure levels, uterine artery pulsatility index (UtA-PI), serum soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF) and sFlt-1/PlGF ratio were measured at 11-14, 18-22, 28-32 and 34 weeks onward, respectively. PRIMARY AND SECONDARY OUTCOMES: Preeclampsia was the main pregnancy outcome. RESULTS: A total of 20 women developed preeclampsia, who had significantly lower levels of PlGF, higher levels of sFlt-1/PlGF ratio and MAP throughout pregnancy than women without preeclampsia. Compared with angiogenic factors and UtA-PI, MAP had significantly higher area under the receiver operating characteristic curves (AUCs) for predicting preeclampsia and term preeclampsia throughout gestation. For predicting preeclampsia, MAP had AUCs of 0.86 (95% CI 0.78 to 0.95), 0.87 (95% CI 0.80 to 0.95) and 0.91 (95% CI 0.85 to 0.98) at 11-14, 18-22 and 28-32 weeks, respectively. For predicting term preeclampsia, MAP yielded AUCs of 0.87 (95% CI 0.75 to 0.99), 0.87 (95% CI 0.76 to 0.98) and 0.90 (95% CI 0.80 to 0.99) at 11-14, 18-22 and 28-32 weeks, respectively. For predicting preterm preeclampsia, the performance of MAP and PlGF was similar. CONCLUSION: MAP is a good predictor for preeclampsia, especially term preeclampsia, in Asian women.


Assuntos
Pré-Eclâmpsia , Pressão Arterial , Biomarcadores , Criança , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Estudos Longitudinais , Fator de Crescimento Placentário , Pré-Eclâmpsia/diagnóstico , Gravidez , Estudos Prospectivos , Receptor 1 de Fatores de Crescimento do Endotélio Vascular
6.
Vasc Health Risk Manag ; 17: 431-443, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34366667

RESUMO

In modern laboratory diagnostics of cardiovascular diseases (CVD), there is a clear tendency toward an increase in the sensitivity of methods for determining key CVD biomarkers, among which highly sensitive cardiac troponins (hs-Tn) deserve special attention. The introduction of the latter into clinical practice made it possible not only to improve the early diagnosis of acute myocardial infarction but also to open up a number of additional valuable opportunities for the use of hs-Tn, including the assessment of the risk of developing CVD in a healthy population, detection and monitoring of early myocardial injuries in the early stages of CVD development (for example, with ischemic heart disease and arterial hypertension), with noncardiac pathologies (for example, sepsis, chronic obstructive pulmonary disease, chronic renal failure, stroke, cancer, etc), and diagnostics of CVD by using biological fluids that can be obtained by noninvasive methods. This article discusses in detail the diagnostic value of hs-Tn in serum and urine in cases of arterial hypertension. Also, the paper pays considerable attention to the consideration of the mechanisms underlying the increase in hs-Tn in serum and urine in cases of arterial hypertension.


Assuntos
Pressão Arterial , Cardiopatias/diagnóstico , Hipertensão/diagnóstico , Troponina/sangue , Troponina/urina , Biomarcadores/sangue , Biomarcadores/urina , Cardiopatias/etiologia , Cardiopatias/metabolismo , Cardiopatias/fisiopatologia , Humanos , Hipertensão/complicações , Hipertensão/metabolismo , Hipertensão/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Regulação para Cima
7.
Nutrients ; 13(6)2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34207775

RESUMO

Arterial hypercapnia reduces renal perfusion. Beetroot juice (BRJ) increases nitric oxide bioavailability and may improve renal blood flow. We tested the hypothesis that acute consumption of BRJ attenuates both decreases in blood velocity and increases in vascular resistance in the renal and segmental arteries during acute hypercapnia. In fourteen healthy young adults, blood velocity and vascular resistance were measured with Doppler ultrasound in the renal and segmental arteries during five minutes of breathing a carbon dioxide gas mixture (CO2) before and three hours after consuming 500 mL of BRJ. There was no difference between pre- and post-BRJ consumption in the increase in the partial pressure of end-tidal CO2 during CO2 breathing (pre: +4 ± 1 mmHg; post: +4 ± 2 mmHg, p = 0.4281). Segmental artery blood velocity decreased during CO2 breathing in both pre- (by -1.8 ± 1.9 cm/s, p = 0.0193) and post-BRJ (by -2.1 ± 1.9 cm/s, p = 0.0079), but there were no differences between pre- and post-consumption (p = 0.7633). Segmental artery vascular resistance increased from room air baseline during CO2 at pre-BRJ consumption (by 0.4 ± 0.4 mmHg/cm/s, p = 0.0153) but not post-BRJ (p = 0.1336), with no differences between pre- and post-consumption (p = 0.7407). These findings indicate that BRJ consumption does not attenuate reductions in renal perfusion during acute mild hypercapnia in healthy young adults.


Assuntos
Beta vulgaris , Sucos de Frutas e Vegetais , Hemodinâmica/efeitos dos fármacos , Hipercapnia/fisiopatologia , Rim/irrigação sanguínea , Raízes de Plantas , Adulto , Pressão Arterial , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Dióxido de Carbono , Ingestão de Líquidos/fisiologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Artéria Renal/fisiopatologia , Respiração/efeitos dos fármacos , Volume de Ventilação Pulmonar/efeitos dos fármacos , Ultrassonografia Doppler , Resistência Vascular/efeitos dos fármacos
9.
Am J Physiol Regul Integr Comp Physiol ; 321(3): R385-R395, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34259041

RESUMO

Exercise intolerance is a hallmark symptom of cardiovascular disease and likely occurs via enhanced activation of muscle metaboreflex-induced vasoconstriction of the heart and active skeletal muscle which, thereby limits cardiac output and peripheral blood flow. Muscle metaboreflex vasoconstrictor responses occur via activation of metabolite-sensitive afferent fibers located in ischemic active skeletal muscle, some of which express transient receptor potential vanilloid 1 (TRPV1) cation channels. Local cardiac and intrathecal administration of an ultrapotent noncompetitive, dominant negative agonist resiniferatoxin (RTX) can ablate these TRPV1-sensitive afferents. This technique has been used to attenuate cardiac sympathetic afferents and nociceptive pain. We investigated whether intrathecal administration (L4-L6) of RTX (2 µg/kg) could chronically attenuate subsequent muscle metaboreflex responses elicited by reductions in hindlimb blood flow during mild exercise (3.2 km/h) in chronically instrumented conscious canines. RTX significantly attenuated metaboreflex-induced increases in mean arterial pressure (27 ± 5.0 mmHg vs. 6 ± 8.2 mmHg), cardiac output (1.40 ± 0.2 L/min vs. 0.28 ± 0.1 L/min), and stroke work (2.27 ± 0.2 L·mmHg vs. 1.01 ± 0.2 L·mmHg). Effects were maintained until 78 ± 14 days post-RTX at which point the efficacy of RTX injection was tested by intra-arterial administration of capsaicin (20 µg/kg). A significant reduction in the mean arterial pressure response (+45.7 ± 6.5 mmHg pre-RTX vs. +19.7 ± 3.1 mmHg post-RTX) was observed. We conclude that intrathecal administration of RTX can chronically attenuate the muscle metaboreflex and could potentially alleviate enhanced sympatho-activation observed in cardiovascular disease states.


Assuntos
Débito Cardíaco/efeitos dos fármacos , Diterpenos/farmacologia , Membro Posterior/efeitos dos fármacos , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/metabolismo , Animais , Pressão Arterial/efeitos dos fármacos , Débito Cardíaco/fisiologia , Diterpenos/administração & dosagem , Cães , Coração/efeitos dos fármacos , Coração/fisiopatologia , Membro Posterior/fisiopatologia , Isquemia/fisiopatologia , Contração Muscular/efeitos dos fármacos , Contração Muscular/fisiologia , Fluxo Sanguíneo Regional/efeitos dos fármacos , Sistema Nervoso Simpático/efeitos dos fármacos , Sistema Nervoso Simpático/fisiopatologia , Vasoconstrição/fisiologia
10.
Transfusion ; 61 Suppl 1: S174-S182, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34269446

RESUMO

BACKGROUND: The Compensatory Reserve Measurement (CRM) is a novel method used to provide early assessment of shock based on arterial wave form morphology changes. We hypothesized that (1) CRM would be significantly lower in those trauma patients who received life-saving interventions compared with those not receiving interventions, and (2) CRM in patients who received interventions would recover after the intervention was performed. STUDY DESIGN AND METHODS: We captured vital signs along with analog arterial waveform data from trauma patients meeting major activation criteria using a prospective study design. Study team members tracked interventions throughout their emergency department stay. RESULTS: Ninety subjects met inclusion with 13 receiving a blood product and 10 a major airway intervention. Most trauma was blunt (69%) with motor vehicle collisions making up the largest proportion (37%) of injury mechanism. Patients receiving blood products had lower CRM values just prior to administration versus those who did not (50% versus 58%, p = .045), and lower systolic pressure (SBP; 95 versus 123 mmHg, p = .005), diastolic (DBP; 62 versus 79, p = .007), and mean arterial pressure (MAP; 75 versus 95, p = .006), and a higher pulse rate (HR; 101 versus 89 bpm, p = .039). Patients receiving an airway intervention had lower CRM values just prior to administration versus those who did not (48% versus 58%, p = .062); however, SBP, DBP, MAP, and HR were not statistically distinguishable (p ≥ .645). CONCLUSIONS: Our results support our hypotheses that the CRM distinguished those patients who received blood or an airway intervention from those who did not, and increased appropriately after interventions were performed.


Assuntos
Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia , Adulto , Pressão Arterial , Pressão Sanguínea , Transfusão de Sangue , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Ressuscitação/métodos , Choque Traumático/diagnóstico , Choque Traumático/terapia , Ferimentos e Lesões/fisiopatologia
11.
Medicine (Baltimore) ; 100(22): e26129, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087863

RESUMO

ABSTRACT: Early detection of arterial hypotension during cesarean delivery under spinal anesthesia is important. This study aims to compare the validity of NexfinTM as beat-to-beat noninvasive blood pressure monitoring with conventional intermittent oscillometric measurement of blood pressure during elective cesarean delivery.This open prospective observational bicentric study was performed between January 2013 and December 2015. We simultaneously recorded arterial blood pressure with both techniques in pregnant women undergoing elective cesarean delivery under spinal anesthesia. The primary outcome was a Bland-Altman analysis of systolic blood pressure measurement comparing NexfinTM and a conventional method. The secondary outcomes were the time to detect the first relevant hypotensive episode and the comparison of both devices using a four-quadrant graph.One hundred and seventy-four parturients completed the study, and 2640 pairs of systolic blood pressure measurements were analyzed. Bias was -10 mmHg with upper and lower limits of agreement of -61 and +41 mmHg. In 73.9% of the cases, the two techniques provided the same information (normotension or hypotension), but the conventional method missed 20.8% of measurements, with NexfinTM detecting 16.2% more hypotensive measurements. The median [25-75 percentiles] duration to detect the first hypotensive measurement was 331 [206-480] seconds for NexfinTM and 440 [300-500] s for intermittent oscillometry (P < .001).The agreement between NexfinTM and an intermittent method for the measurement of systolic blood pressure was not in an acceptable range during cesarean delivery, although NexfinTM may detect hypotension earlier than the standard method.Trial registration: Clinicaltrials.gov identifier: NCT01732133; November 22, 2012.


Assuntos
Raquianestesia/efeitos adversos , Determinação da Pressão Arterial/métodos , Cesárea/métodos , Hipotensão/induzido quimicamente , Hipotensão/diagnóstico , Adulto , Índice de Apgar , Pressão Arterial , Determinação da Pressão Arterial/normas , Monitores de Pressão Arterial , Pesos e Medidas Corporais , Feminino , Humanos , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes
12.
Am J Physiol Heart Circ Physiol ; 321(1): H242-H252, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34085841

RESUMO

Disturbed balance between matrix metalloproteinases (MMPs) and their respective tissue inhibitors (TIMPs) is a well-recognized pathophysiological component of pulmonary arterial hypertension (PAH). Both classes of proteinases have been associated with clinical outcomes as well as with specific pathological features of ventricular dysfunction and pulmonary arterial remodeling. The purpose of this study was to evaluate the circulating levels of MMPs and TIMPs in children with PAH undergoing the same-day cardiac magnetic resonance imaging (MRI) and right heart catheterization. Children with PAH (n = 21) underwent a same-day catheterization, comprehensive cardiac MRI evaluation, and blood sample collection for proteomic analysis. Correlative analysis was performed between protein levels and 1) standard PAH indices from catheterization, 2) cardiac MRI hemodynamics, and 3) pulmonary arterial stiffness. MMP-8 was significantly associated with the right ventricular end-diastolic volume (R = 0.45, P = 0.04). MMP-9 levels were significantly associated with stroke volume (R = -0.49, P = 0.03) and pulmonary vascular resistance (R = 0.49, P = 0.03). MMP-9 was further associated with main pulmonary arterial stiffness evaluated by relative area change (R = -0.79, P < 0.01).TIMP-2 and TIMP-4 levels were further associated with the right pulmonary artery pulse wave velocity (R = 0.51, P = 0.03) and backward compression wave (R = 0.52, P = 0.02), respectively. MMPs and TIMPs warrant further clinically prognostic evaluation in conjunction with the conventional cardiac MRI hemodynamic indices.NEW & NOTEWORTHY Metalloproteinases have been associated with clinical outcomes in pulmonary hypertension and with specific pathological features of ventricular dysfunction and pulmonary arterial remodeling. In this study, we demonstrated that plasma circulating levels of metalloproteinases and their inhibitors are associated with standard cardiac MRI hemodynamic indices and with the markers of proximal pulmonary arterial stiffness. Particularly, MMP-9 and TIMP-2 were associated with several different markers of pulmonary arterial stiffness. These findings suggest the interplay between the extracellular matrix (ECM) remodeling and overall hemodynamic status in children with PAH might be assessed using the peripheral circulating MMP and TIMP levels.


Assuntos
Hipertensão Pulmonar/fisiopatologia , Metaloproteinases da Matriz/sangue , Inibidores Teciduais de Metaloproteinases/sangue , Rigidez Vascular/fisiologia , Função Ventricular/fisiologia , Adolescente , Pressão Arterial/fisiologia , Criança , Feminino , Hemodinâmica/fisiologia , Humanos , Hipertensão Pulmonar/sangue , Masculino , Artéria Pulmonar/fisiopatologia
14.
Comput Biol Med ; 135: 104545, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34144269

RESUMO

BACKGROUND: Central aortic pressure (CAP) as the major load on the left heart is of great importance in the diagnosis of cardiovascular disease. Studies have pointed out that CAP has a higher predictive value for cardiovascular disease than peripheral artery pressure (PAP) measured by means of traditional sphygmomanometry. However, direct measurement of the CAP waveform is invasive and expensive, so there remains a need for a reliable and well validated non-invasive approach. METHODS: In this study, a multi-channel Newton (MCN) blind system identification algorithm was employed to noninvasively reconstruct the CAP waveform from two PAP waveforms. In simulation experiments, CAP waveforms were recorded in a previous study, on 25 patients and the PAP waveforms (radial and femoral artery pressure) were generated by FIR models. To analyse the noise-tolerance of the MCN method, variable amounts of noise were added to the peripheral signals, to give a range of signal-to-noise ratios. In animal experiments, central aortic, brachial and femoral pressure waveforms were simultaneously recorded from 2 Sprague-Dawley rats. The performance of the proposed MCN algorithm was compared with the previously reported cross-relation and canonical correlation analysis methods. RESULTS: The results showed that the root mean square error of the measured and reconstructed CAP waveforms and less noise-sensitive using the MCN algorithm was smaller than those of the cross-relation and canonical correlation analysis approaches. CONCLUSION: The MCN method can be exploited to reconstruct the CAP waveform. Reliable estimation of the CAP waveform from non-invasive measurements may aid in early diagnosis of cardiovascular disease.


Assuntos
Pressão Arterial , Determinação da Pressão Arterial , Algoritmos , Animais , Pressão Sanguínea , Humanos , Modelos Cardiovasculares , Artéria Radial , Ratos , Ratos Sprague-Dawley
15.
Medicine (Baltimore) ; 100(26): e26518, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190185

RESUMO

ABSTRACT: Bicuspid aortic valve (BAV) disease has significant gaps in its clinical management practices. To highlight the potential utility of advanced hemodynamic biomarkers in strengthening BAV assessment, we used 4-dimentional flow magnetic resonance imaging to investigate altered hemodynamics in the ascending aorta (AAo).A total of 32 healthy controls and 53 age-matched BAV patients underwent cardiac magnetic resonance imaging at 3T, with cine imaging and 4D-flow. Analysis planes were placed along 3D-segmented aortas at the left ventricular outflow tract (LVOT), sinuses of Valsalva, mid-ascending aorta (MAA), and proximal to the first aortic branch. Locations were analyzed for aortic diameter (normalized to body surface area), pressure drop (PD), viscous energy loss (EL), and wall shear stress (WSS) sub-vectors (axial wall shear stress, circumferential wall shear stress [WSSC], magnitude wall shear stress). Student's t tests, or non-parametric equivalents, compared parameters between cohorts. Univariable and multivariable analyses explored the associations of AAo diameter with hemodynamics within the BAV cohort.Compared to control cohort, BAV patients showed significantly greater PD (MAA: 9.5 ±â€Š8.0 vs 2.8 ±â€Š2.4 mm Hg; P < .01), EL (from LVOT-AA1: 7.39 ±â€Š4.57 mW vs 2.90 ±â€Š1.07 mW; P < .01), and WSSC (MAA: 0.3 ±â€Š0.1 vs 0.2 ±â€Š0.06 Pa; P ≤ .01) throughout the AAo. Correlational analyses revealed an inverse association between AAo diameter and both magnitude wall shear stress and axial wall shear stress.BAV patients exhibited increased PD, EL, and WSSC in the AAo, and an inverse association between AAo diameter and WSS sub-vectors. This demonstrated the impact of PD, EL, and WSS in BAV disease and the importance of altered hemodynamics in aortic remodelling.


Assuntos
Aorta , Valva Aórtica , Doença da Válvula Aórtica Bicúspide , Remodelação Vascular , Adulto , Aorta/diagnóstico por imagem , Aorta/patologia , Aorta/fisiopatologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Pressão Arterial , Doença da Válvula Aórtica Bicúspide/diagnóstico , Doença da Válvula Aórtica Bicúspide/fisiopatologia , Velocidade do Fluxo Sanguíneo , Correlação de Dados , Feminino , Hemodinâmica , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Tamanho do Órgão , Resistência ao Cisalhamento
16.
Clin Interv Aging ; 16: 997-1005, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34113085

RESUMO

Background and Aim: Any single discrete blood pressure (BP) measurement is not enough to estimate adverse cardiovascular events. We aim to comprehensively investigate the association between BP indicators and stroke. Methods: An observational cohort study was conducted among 2888 Shanghai community-aged residents from 2014 to 2018, and a nested case-control study was designed to identify the association between BP indicators and stroke. In total 415 cases of stroke detected during the study period were selected as the case group and 415 non-stroke subjects, matched with factors of age and gender, were randomly selected from the cohort as control group. Results: Multivariate logistic regression analysis revealed that systolic blood pressure (SBP) (adjusted odds ratio [AOR] 1.02, 95% confidence interval [CI] 1.02-1.03), pulse pressure (PP) (AOR 1.03, 95% CI 1.02-1.04), mean arterial pressure (MAP) (AOR1.02, 95% CI 1.01-1.04) and pulse pressure index (PPI) (AOR 25.68, 95% CI 3.19-206.90) increased the risk of stroke, respectively. After fitting both BP indicators and covariates, isolated abnormal SBP (AOR 2.55, 95% CI 1.74-3.72) or PP ≥50 mmHg (AOR 1.66, 95% CI 1.08-2.56) independently increased risk of stroke. Conclusion: Besides SBP, PP and multiple factors, assessment should be taken into account comprehensively for stroke prevention and management.


Assuntos
Pressão Arterial , Hipertensão/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Estudos de Casos e Controles , China , Estudos de Coortes , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Medição de Risco/métodos , Fatores de Risco , Acidente Vascular Cerebral/etiologia
17.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(5): 517-522, 2021 May.
Artigo em Chinês | MEDLINE | ID: mdl-34112285

RESUMO

OBJECTIVE: To investigate the effect of fluid resuscitation and circulatory support, directed by different target mean arterial pressure (MAP), on abdominal blood flow, gastrointestinal function and inflammatory response in septic shock patients with hypertension. METHODS: A prospective randomized controlled study was conducted. Hypertensive patients with septic shock admitted to the department of intensive care unit (ICU) of Liuzhou People's Hospital from January 1, 2019 to May 31, 2020 were enrolled. Patients were randomly divided into the low MAP groups (low standard group, LS group) or high MAP group (high standard group, HS group). According to the Surviving Sepsis Campaign Guidelines in 2016 and the updated guideline in 2018, all patients were given treatment of primary disease, fluid resuscitation, supportive management. The target MAP was 65-70 mmHg (1 mmHg = 0.133 kPa) in LS group, and was 75-80 mmHg in HS group. Acute gastrointestinal function injury (AGI) classification was performed on the 1st, 3rd and 7th day. The mean flow rate (Vm) and resistance index (RI) of superior mesenteric artery were evaluated using ultrasound, and the gastrointestinal function was dynamically evaluated using the modified single section ultrasonic gastric antrum method. The gastric antrum movement index (MI) and gastric empaging time (GET) were recorded. The levels of inflammatory markers in serum were detected by enzyme linked immunosorbent assay (ELISA), such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), procalcitonin (PCT) and vascular endothelial growth factor (VEGF). The target MAP, the days of use of vasopressors and the amount of fluid resuscitation were recorded. RESULTS: A total of 208 hypertensive patients with septic shock were enrolled, including 109 in the LS group and 99 in the HS group. There were no significant differences in gender, age, acute physiology and chronic health evaluation II (APACHE II) score and sequential organ failure assessment (SOFA) score between the two groups when diagnosed. After treatment, there was no significant difference in AGI classification between the LS group and HS group on the 1st day. On the 3rd and 7th day, there were statistical differences between the two groups (3rd day: proportion of I, II, III, IV grades were 25.69%, 56.88%, 11.93%, 5.50% in LS group, 15.15%, 54.55%, 25.25%, 5.05% in HS group, respectively, χ2 = 7.900, P = 0.048; 7rd day: proportion of I, II, III, IV grades were 44.96%, 49.54%, 3.67%, 1.83% in LS group, 31.31%, 52.53%, 11.11%, 5.05% in HS group, respectively, χ2 = 8.178, P = 0.042). The Vm of superior mesenteric artery was higher and the RI was lower in the LS group than those in the HS group on day 1, 3 and 7 [Vm (cm/s): 21.72±3.02 vs. 19.50±2.83, 20.42±2.62 vs. 17.02±1.99, 26.52±2.70 vs. 22.47±4.03; RI: 0.86±0.05 vs. 0.92±0.04, 0.87±0.05 vs. 0.95±0.05, 0.81±0.03 vs. 0.85±0.03, all P < 0.01]. The MI was higher and the GET was shorter in the LS group than those in the HS group on day 3 and day 7 [MI: 3.00±0.33 vs. 2.60±0.29, 4.50±0.51 vs. 3.90±0.33; GET (minutes): 86.01±19.78 vs. 100.99±25.01, 71.00±16.37 vs. 84.98±20.18, all P < 0.01]. In addition, the levels of serum TNF-α, IL-6, PCT, VEGF were lower in the LS group than those in the HS group after 3 days of treatment [TNF-α (ng/L): 147.05±28.32 vs. 256.99±27.04, IL-6 (ng/L): 762.99±57.83 vs. 1 112.30±118.32, PCT (µg/L): 37.00±5.58 vs. 56.00±12.36, VEGF (ng/L): 123.00±19.78 vs. 167.01±21.55, all P < 0.05]. The target MAP was maintained at (68.02±4.71) mmHg in LS group, and (79.04±3.04) mmHg in HS group. The difference between the two groups was statistically significant (P < 0.01). Compared with the HS group, the days of using vasopressors was shorter in LS group (days: 3.50±1.27 vs. 4.55±1.47), and the amountof fluid was reduced significantly (mL: 1 602.29±275.49 vs. 2 000.30±272.59, both P < 0.01). CONCLUSIONS: Maintaining a low target mean arterial pressure (65-70 mmHg) in hypertensive patients with septic shock can improve blood supply of superior mesenteric artery, protect the gastrointestinal function, reduce the level of inflammatory factors, and diminish the duration of using vasopressors and the amount of fluid.


Assuntos
Hipertensão , Choque Séptico , Pressão Arterial , Humanos , Hipertensão/complicações , Hipertensão/terapia , Prognóstico , Estudos Prospectivos , Choque Séptico/complicações , Choque Séptico/terapia , Fator A de Crescimento do Endotélio Vascular
18.
Int J Mol Sci ; 22(10)2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-34065933

RESUMO

Neonicotinoid insecticides are nicotine-derived molecules which exert acute neurotoxic effects over the insect central nervous system by activating nicotinic acetylcholine receptors (nAChRs). However, these receptors are also present in the mammalian central and peripheral nervous system, where the effects of neonicotinoids are faintly known. In mammals, cholinergic synapses are crucial for the control of vascular tone, blood pressure and skeletal muscle contraction. We therefore hypothesized that neonicotinoids could affect cholinergic networks in mammals and sought to highlight functional consequences of acute intoxication in rats with sub-lethal concentrations of the highly used acetamiprid (ACE) and clothianidin (CLO). In this view, we characterized their electrophysiological effects on rat α3ß4 nAChRs, knowing that it is predominantly expressed in ganglia of the vegetative nervous system and the adrenal medulla, which initiates catecholamine secretion. Both molecules exhibited a weak agonist effect on α3ß4 receptors. Accordingly, their influence on epinephrine secretion from rat adrenal glands was also weak at 100 µM, but it was stronger at 500 µM. Challenging ACE or CLO together with nicotine (NIC) ended up with paradoxical effects on secretion. In addition, we measured the rat arterial blood pressure (ABP) in vivo by arterial catheterization. As expected, NIC induced a significant increase in ABP. ACE and CLO did not affect the ABP in the same conditions. However, simultaneous exposure of rats to both NIC and ACE/CLO promoted an increase of ABP and induced a biphasic response. Modeling the interaction of ACE or CLO on α3ß4 nAChR is consistent with a binding site located in the agonist pocket of the receptor. We present a transversal experimental approach of mammal intoxication with neonicotinoids at different scales, including in vitro, ex vivo, in vivo and in silico. It paves the way of the acute and chronic toxicity for this class of insecticides on mammalian organisms.


Assuntos
Epinefrina/metabolismo , Inseticidas/toxicidade , Neonicotinoides/toxicidade , Nicotina/toxicidade , Receptores Nicotínicos/metabolismo , Medula Suprarrenal/efeitos dos fármacos , Medula Suprarrenal/metabolismo , Animais , Pressão Arterial/efeitos dos fármacos , Modelos Animais de Doenças , Agonismo Parcial de Drogas , Gânglios/efeitos dos fármacos , Gânglios/metabolismo , Regulação da Expressão Gênica/efeitos dos fármacos , Guanidinas/toxicidade , Masculino , Ratos , Tiazóis/toxicidade , Testes de Toxicidade Subaguda
19.
Kidney Blood Press Res ; 46(3): 331-341, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34034251

RESUMO

BACKGROUND: Angiotensin II (Ang II) and the renal sympathetic nervous system exert a strong influence on renal sodium and water excretion. We tested the hypothesis that already low doses of an Ang II inhibitor (candesartan) will result in similar effects on tubular sodium and water reabsorption in congestive heart failure (CHF) as seen after renal denervation (DNX). METHODS: Measurement of arterial blood pressure, heart rate (HR), renal sympathetic nerve activity (RSNA), glomerular filtration rate (GFR), renal plasma flow (RPF), urine volume, and urinary sodium. To assess neural control of volume homeostasis, 21 days after the induction of CHF via myocardial infarction rats underwent volume expansion (0.9% NaCL; 10% body weight) to decrease RSNA. CHF rat and controls with or without DNX or pretreated with the Ang II type-1 receptor antagonist candesartan (0.5 ug i.v.) were studied. RESULTS: CHF rats excreted only 68 + 10.2% of the volume load (10% body weight) in 90 min. CHF rats pretreated with candesartan or after DNX excreted from 92 to 103% like controls. Decreases of RSNA induced by volume expansion were impaired in CHF rats but unaffected by candesartan pointing to an intrarenal drug effect. GFR and RPF were not significantly different in controls or CHF. CONCLUSION: The prominent function of increased RSNA - retaining salt and water - could no longer be observed after renal Ang II receptor blockade in CHF rats.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Benzimidazóis/farmacologia , Compostos de Bifenilo/farmacologia , Rim/efeitos dos fármacos , Rim/inervação , Tetrazóis/farmacologia , Angiotensina II/metabolismo , Animais , Pressão Arterial/efeitos dos fármacos , Denervação , Taxa de Filtração Glomerular/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Rim/fisiologia , Masculino , Ratos Sprague-Dawley , Sódio/metabolismo , Água/metabolismo
20.
J Appl Physiol (1985) ; 131(1): 184-191, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33982596

RESUMO

Following aerobic exercise, sustained vasodilation and concomitant reductions in total peripheral resistance (TPR) result in a reduction in blood pressure that is maintained for two or more hours. However, the time course for postexercise changes in reflected wave amplitude and other indices of pulsatile load on the left ventricle have not been thoroughly described. Therefore, we tested the hypothesis that reflected wave amplitude is reduced beyond an hour after cycling at 60% V̇o2peak for 60 min. Aortic pressure waveforms were derived in 14 healthy adults (7 men, 7 women; 26 ± 3 yr) from radial pulse waves acquired via high-fidelity applanation tonometry at baseline and every 20 min for 120 min postexercise. Concurrently, left ventricle outflow velocities were acquired via Doppler echocardiography and pressure-flow analyses were performed. Aortic characteristic impedance (Zc), forward (Pf) and backward (Pb) pulse wave amplitude, reflected wave travel time (RWTT), and wasted pressure effort (WPE) were derived. Reductions in aortic blood pressure, Zc, Pf, and Pb were all sustained postexercise whereas increases in RWTT emerged from 60 to 100 min post exercise (all P < 0.05). WPE was reduced by ∼40% from 40 to 100 min post exercise (all P < 0.02). Stepwise multiple regression analysis revealed that the peak ΔWPE was associated with ΔRWTT (ß = -0.57, P = 0.003) and ΔPb (ß = 0.52, P = 0.006), but not Δcardiac output, ΔTPR, ΔZc, or ΔPf. These results suggest that changes in pulsatile hemodynamics are sustained for ≥100 min following moderate intensity aerobic exercise. Moreover, decreased and delayed reflected pressure waves are associated with decreased left ventricular wasted effort after exercise.NEW & NOTEWORTHY We demonstrate that pulsatile load on the left ventricle is diminished following 60 min of moderate intensity aerobic exercise. During recovery from exercise, the amplitude of the forward and backward traveling pressure waves are attenuated and the arrival of reflected waves is delayed. Thus, the work imposed upon the left ventricle by reflected pressure waves, wasted pressure effort, is decreased after exercise.


Assuntos
Pressão Arterial , Exercício Físico , Adulto , Aorta , Pressão Sanguínea , Feminino , Hemodinâmica , Humanos , Masculino
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