Journal articles: 'Haemodynamic testing'

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McClarty, Davis, Maral Ouzounian, Mingyi Tang, Daniella Eliathamby, David Romero, Elsie Nguyen, Craig A. Simmons, Cristina Amon, and Jennifer Chia-Ying Chung. "Ascending aortic aneurysm haemodynamics are associated with aortic wall biomechanical properties." European Journal of Cardio-Thoracic Surgery 61, no. 2 (October 29, 2021): 367–75. http://dx.doi.org/10.1093/ejcts/ezab471.

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Abstract OBJECTIVES The effect of aortic haemodynamics on arterial wall properties in ascending thoracic aortic aneurysms (ATAAs) is not well understood. We aim to delineate the relationship between shear forces along the aortic wall and loco-regional biomechanical properties associated with the risk of aortic dissection. METHODS Five patients with ATAA underwent preoperative magnetic resonance angiogram and four-dimensional magnetic resonance imaging. From these scans, haemodynamic models were constructed to estimate maximum wall shear stress (WSS), maximum time-averaged WSS, average oscillating shear index and average relative residence time. Fourteen resected aortic samples from these patients underwent bi-axial tensile testing to determine energy loss (ΔUL) and elastic modulus (E10) in the longitudinal (ΔULlong, E10long) and circumferential (ΔULcirc, E10circ) directions and the anisotropic index (AI) for each parameter. Nine resected aortic samples underwent peel testing to determine the delamination strength (Sd). Haemodynamic indices were then correlated to the biomechanical properties. RESULTS A positive correlation was found between maximum WSS and ΔULlong rs=0.75, P = 0.002 and AIΔUL (rs=0.68, P=0.01). Increasing maximum time-averaged WSS was found to be associated with increasing ΔULlong (rs=0.73, P = 0.003) and AIΔUL (rs=0.62, P=0.02). Average oscillating shear index positively correlated with Sd (rs=0.73,P=0.04). No significant relationship was found between any haemodynamic index and E10, or between relative residence time and any biomechanical property. CONCLUSIONS Shear forces at the wall of ATAAs are associated with local degradation of arterial wall viscoelastic hysteresis (ΔUL) and delamination strength, a surrogate for aortic dissection. Haemodynamic indices may provide insights into aortic wall integrity, ultimately leading to novel metrics for assessing risks associated with ATAAs.

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Oliveira, Rudolf K. F., Aaron B. Waxman, Manyoo Agarwal, Roza Badr Eslam, and David M. Systrom. "Pulmonary haemodynamics during recovery from maximum incremental cycling exercise." European Respiratory Journal 48, no. 1 (April 28, 2016): 158–67. http://dx.doi.org/10.1183/13993003.00023-2016.

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Assessment of cardiac function during exercise can be technically demanding, making the recovery period a potentially attractive diagnostic window. However, the validity of this approach for exercise pulmonary haemodynamics has not been validated.The present study, therefore, evaluated directly measured pulmonary haemodynamics during 2-min recovery after maximum invasive cardiopulmonary exercise testing in patients evaluated for unexplained exertional intolerance. Based on peak exercise criteria, patients with exercise pulmonary hypertension (ePH; n=36), exercise pulmonary venous hypertension (ePVH; n=28) and age-matched controls (n=31) were analysed.By 2-min recovery, 83% (n=30) of ePH patients had a mean pulmonary artery pressure (mPAP) <30 mmHg and 96% (n=27) of ePVH patients had a pulmonary arterial wedge pressure (PAWP) <20 mmHg. Sensitivity of pulmonary hypertension-related haemodynamic measurements during recovery for ePH and ePVH diagnosis was ≤25%. In ePVH, pulmonary vascular compliance (PVC) returned to its resting value by 1-min recovery, while in ePH, elevated pulmonary vascular resistance (PVR) and decreased PVC persisted throughout recovery.In conclusion, we observed that mPAP and PAWP decay quickly during recovery in ePH and ePVH, compromising the sensitivity of recovery haemodynamic measurements in diagnosing pulmonary hypertension. ePH and ePVH had different PVR and PVC recovery patterns, suggesting differences in the underlying pulmonary hypertension pathophysiology.

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Kovacs, Gabor, Philippe Herve, Joan Albert Barbera, Ari Chaouat, Denis Chemla, Robin Condliffe, Gilles Garcia, et al. "An official European Respiratory Society statement: pulmonary haemodynamics during exercise." European Respiratory Journal 50, no. 5 (November 2017): 1700578. http://dx.doi.org/10.1183/13993003.00578-2017.

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There is growing recognition of the clinical importance of pulmonary haemodynamics during exercise, but several questions remain to be elucidated. The goal of this statement is to assess the scientific evidence in this field in order to provide a basis for future recommendations.Right heart catheterisation is the gold standard method to assess pulmonary haemodynamics at rest and during exercise. Exercise echocardiography and cardiopulmonary exercise testing represent non-invasive tools with evolving clinical applications. The term “exercise pulmonary hypertension” may be the most adequate to describe an abnormal pulmonary haemodynamic response characterised by an excessive pulmonary arterial pressure (PAP) increase in relation to flow during exercise. Exercise pulmonary hypertension may be defined as the presence of resting mean PAP <25 mmHg and mean PAP >30 mmHg during exercise with total pulmonary resistance >3 Wood units. Exercise pulmonary hypertension represents the haemodynamic appearance of early pulmonary vascular disease, left heart disease, lung disease or a combination of these conditions. Exercise pulmonary hypertension is associated with the presence of a modest elevation of resting mean PAP and requires clinical follow-up, particularly if risk factors for pulmonary hypertension are present. There is a lack of robust clinical evidence on targeted medical therapy for exercise pulmonary hypertension.

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PIÉRARD, L. A., C. BERTHE, A. ALBERT, J. CARLIER, and H. E. KULBERTUS. "Haemodynamic alterations during ischaemia induced by dobutamine stress testing." European Heart Journal 10, no. 9 (September 1989): 783–90. http://dx.doi.org/10.1093/oxfordjournals.eurheartj.a059571.

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Tavernarakis, A., N. Michelakakis, G. Ifantis, S. Dervenagas, D. Sionis, C. Papapioannou, D. Tsigas, and C. D. Michalopoulos. "Ventricular extrasystolic arrhythmias in exercise testing II. Haemodynamic correlations." European Heart Journal 8, suppl D (August 2, 1987): 61–63. http://dx.doi.org/10.1093/eurheartj/8.suppl_d.61.

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Szydzik, Crispin, Rose J. Brazilek, Khashayar Khoshmanesh, Farzan Akbaridoust, Markus Knoerzer, Peter Thurgood, Ineke Muir, et al. "Elastomeric microvalve geometry affects haemocompatibility." Lab on a Chip 18, no. 12 (2018): 1778–92. http://dx.doi.org/10.1039/c7lc01320e.

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Krzesiński, Paweł, Jacek Marczyk, Bartosz Wolszczak, and Grzegorz Gielerak. "Quantitative Complexity Theory Used in the Prediction of Head-Up Tilt Testing Outcome." Cardiology Research and Practice 2021 (September 23, 2021): 1–10. http://dx.doi.org/10.1155/2021/8882498.

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Background. Head-up tilt testing (HUTT), a well-established tool in the diagnosis of vasovagal syncope, is time-consuming, and every provoked vasovagal reaction may result in consolidating the reflex mechanism. Therefore, identification of parameters that could shorten the duration of HUTT and prevent fainting is desirable. Quantitative complexity theory (QCT) may provide holistic information on the cardiovascular reaction in HUTT. The aim of the present article was to evaluate the prognostic value of complexity in comparison with traditional haemodynamic parameters (HR and BP) in predicting the HUTT outcome. Methods. Eighty-one healthy volunteers (74 men; mean age: 37.8 years) were included in this retrospective analysis of data collected within the project realized in Department of Cardiology and Internal Diseases, Military Institute of Medicine between January 2012 and October 2014. The subjects underwent HUTT, with beat-to-beat haemodynamic monitoring with a Niccomo™. The chosen haemodynamic parameters (including BP, HR, stroke volume, cardiac output, systemic vascular resistance) have been used in complexity analysis. Results. HUTT was positive in 54 (66.7%) study participants. The values of complexity were already higher in fainting subjects than those were in nonfainting ones 300 s before HUTT termination (HUTT_end), with a significant upward trend starting 150 s before (pre)syncope. An area under the curve (AUC) over 0.700 was observed for complexity from 120 s before HUTT_end, with a sensitivity of 63% and specificity of 78% at this time point. The prognostic value of complexity was superior to that of the HR and mean arterial pressure (MAP). Conclusions. Complexity has been shown to be a sensitive marker of cardiovascular haemodynamic response to orthostatic stress and proved to be superior over HR and BP in predicting HUTT outcomes.

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Yozgat, Yilmaz, Cem Karadeniz, Rahmi Ozdemir, Onder Doksoz, Mehmet Kucuk, Utku Karaarslan, Timur Mese, and Nurettin Unal. "Different haemodynamic patterns in head-up tilt test on 400 paediatric cases with unexplained syncope." Cardiology in the Young 25, no. 5 (July 15, 2014): 911–17. http://dx.doi.org/10.1017/s1047951114001176.

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AbstractObjective: To assess haemodynamic patterns in head-up tilt testing on 400 paediatric cases with unexplained syncope. Methods: Medical records of 520 children who underwent head-up tilt testing in the preceding year were retrospectively evaluated, and 400 children, 264 (66%) girls and 136 (34%) boys, aged 12.6±2.6 years (median 13; range 5–18), with unexplained syncope were enrolled in the study. Age, sex, baseline heart rate, baseline blood pressure, frequency of symptoms, and/or fainting attacks were recorded. The test protocol consisted of 25 minutes of supine resting followed by 20 minutes of 70° upright positioning. Subjects were divided into nine groups according to their differing haemodynamic patterns. Results: There were no statistically significant differences between the groups with regard to age, gender, baseline blood pressure, and frequency of syncope (p>0.05). The response was compatible with orthostatic intolerance in 28 cases (7.0%), postural orthostatic tachycardia syndrome in 24 cases (6.0%), asymptomatic postural orthostatic tachycardia syndrome in 26 cases (6.5%), orthostatic hypotension in seven cases (1.7%), vasovagal syncope in 38 cases (9.5%), and negative in 274 cases (69.2%). Vasovagal syncope response patterns were of type 3 in nine cases (2.2%), type 2A in 10 cases (2.5%), type 2B in two cases (0.5%), and type 1 (mixed) in 17 cases (4.25%). Conclusions: In the 400 paediatric cases with unexplained syncope, nine different haemodynamic response patterns to head-up tilt testing were discerned. Children with orthostatic intolerance syndromes are increasingly referred to hospitals because of difficulty in daily activities. Therefore, there is need for further clinical trials in these patient groups.

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Sutton, Richard, Artur Fedorowski, Brian Olshansky, J. Gert van Dijk, Haruhiko Abe, Michele Brignole, Frederik de Lange, et al. "Tilt testing remains a valuable asset." European Heart Journal 42, no. 17 (February 24, 2021): 1654–60. http://dx.doi.org/10.1093/eurheartj/ehab084.

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Abstract Head-up tilt test (TT) has been used for >50 years to study heart rate/blood pressure adaptation to positional changes, to model responses to haemorrhage, to assess orthostatic hypotension, and to evaluate haemodynamic and neuroendocrine responses in congestive heart failure, autonomic dysfunction, and hypertension. During these studies, some subjects experienced syncope due to vasovagal reflex. As a result, tilt testing was incorporated into clinical assessment of syncope when the origin was unknown. Subsequently, clinical experience supports the diagnostic value of TT. This is highlighted in evidence-based professional practice guidelines, which provide advice for TT methodology and interpretation, while concurrently identifying its limitations. Thus, TT remains a valuable clinical asset, one that has added importantly to the appreciation of pathophysiology of syncope/collapse and, thereby, has improved care of syncopal patients.

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Oliveira, Rudolf K. F., Manyoo Agarwal, Julie A. Tracy, Abbey L. Karin, Alexander R. Opotowsky, Aaron B. Waxman, and David M. Systrom. "Age-related upper limits of normal for maximum upright exercise pulmonary haemodynamics." European Respiratory Journal 47, no. 4 (December 17, 2015): 1179–88. http://dx.doi.org/10.1183/13993003.01307-2015.

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The exercise definition of pulmonary hypertension was eliminated from the pulmonary hypertension guidelines in part due to uncertainty of the upper limits of normal (ULNs) for exercise haemodynamics in subjects >50 years old.The present study, therefore, evaluated the pulmonary haemodynamic responses to maximum upright incremental cycling exercise in consecutive subjects who underwent an invasive cardiopulmonary exercise testing for unexplained exertional intolerance, deemed normal based on preserved exercise capacity and normal resting supine haemodynamics. Subjects aged >50 years old (n=41) were compared with subjects ≤50 years old (n=25). ULNs were calculated as mean+2sd.Peak exercise mean pulmonary arterial pressure was not different for subjects >50 and ≤50 years old (23±5 versus 22±4 mmHg, p=0.22), with ULN of 33 and 30 mmHg, respectively. Peak cardiac output was lower in older subjects (median (interquartile range): 12.1 (9.4–14.2) versus 16.2 (13.8–19.2) L·min−1, p<0.001). Peak pulmonary vascular resistance was higher in older subjects compared with younger subjects (mean±sd: 1.20±0.45 versus 0.82±0.26 Wood units, p<0.001), with ULN of 2.10 and 1.34 Wood units, respectively.We observed that subjects >50 and ≤50 years old have different pulmonary vascular responses to exercise. Older subjects have higher pulmonary vascular resistance at peak exercise, resulting in different exercise haemodynamics ULNs compared with the younger population.

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Day, Ronald W. "Acute vasodilator testing following Fontan palliation: an opportunity to guide precision care?" Cardiology in the Young 30, no. 6 (May 22, 2020): 829–33. http://dx.doi.org/10.1017/s1047951120001110.

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AbstractBackground:Pulmonary vasodilators improve the functional capacity of some patients with pulmonary arterial hypertension. However, pulmonary vasodilators frequently fail to improve unequivocal endpoints of efficacy in patients with lower pulmonary arterial pressures who have been palliated with a Fontan procedure.Objective:Haemodynamic measurements and the results of acute vasodilator testing in a subset of patients were reviewed to determine whether some patients acutely respond more favourably to sildenafil and might be candidates for precision care with a phosphodiesterase V inhibitor long term.Materials and Methods:Heart catheterisation was performed in 11 patients with a Fontan procedure. Haemodynamic measurements were performed before and after treatment with intravenous sildenafil (mean 0.14, range 0.05–0.20 mg/kg). Results (mean ± standard deviation) were compared by paired and unpaired t-tests to identify statistically significant changes.Results:Sildenafil was acutely associated with changes in mean pulmonary arterial pressure, transpulmonary gradient, indexed blood flow, and indexed vascular resistance. Changes in mean pulmonary arterial pressure were greater for patients with a mean pulmonary arterial pressure greater than 14 mmHg compared to patients with a lower mean pulmonary arterial pressure. Changes in transpulmonary gradient were greater for patients with a transpulmonary gradient greater than 5 mmHg compared to patients with a lower transpulmonary gradient.Conclusion:Sildenafil acutely decreases mean pulmonary arterial pressure and transpulmonary gradient and causes greater acute changes in patients with higher mean pulmonary arterial pressures and transpulmonary gradients. Haemodynamic measurements and vasodilator testing might help to guide precision care following Fontan palliation.

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Lau, Edmund M. T., Vivek Thakkar, Marc Humbert, and Philippe Herve. "To stress or not to stress? Exercise pulmonary haemodynamic testing in systemic sclerosis." European Respiratory Journal 48, no. 6 (November 30, 2016): 1549–52. http://dx.doi.org/10.1183/13993003.01809-2016.

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Zimmermann, Paul, and Christoph Lutter. "Haemodynamic effects of paroxysmal supraventricular tachycardia in an endurance athlete during exercise testing." BMJ Case Reports 12, no. 10 (October 2019): e231659. http://dx.doi.org/10.1136/bcr-2019-231659.

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Jovic, M., Zoran Popovic, Dusko Nezic, V. Ilic, Sinisa Gradinac, M. Babic, A. Kenkovski, and Bosko Radomir. "Uloga Swan-Ganz PA katetera u proceni hemodinamskih promena tokom hirurske revaskularizacije miokarda u bolesnika sa oslabljenom funkcijom leve komore." Acta chirurgica Iugoslavica 49, no. 1 (2002): 27–35. http://dx.doi.org/10.2298/aci0201027j.

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Coronary artery bypass surgery in patient with bad left ventricular function is a challenge for surgical time. Specially important is monitoring of haemodynamics. We performed this open, prospective, randomized study with the aim to assess haemodynamics and oxygen profile monitoring. 34 pts for coronary surgery (EF < 40%) were divided in two groups. Group A, 17 pts. Received glucose-insulin-potassium (GIK) solution. Group B, 127 pts. Received Ringer solution. Haemodynamic and oxygen metabolism parameters were measured in four time points. I after the induction in anesthesia; II after the operation; III 6 hours post op.; IV 24 hour post op. Data are expressed as mean +/-SD, ANOVA for repeated measures followed by Newman-Keuls testing were used. In both groups were evident deterioration of cardiac function during first 6h as well as VO2 and DO:, more prominent in Group B. Significant recovery and improvement of cardiac function were evident in Group A after 24 h. CI during the time in Group A improves significantly (2.14+/-0.36 v. 3.05+/-0.55; p=0.0002) and difference during the time between groups was p=0,005. LVSWI improved significantly during the time him Group A (AIII vs. AIV) p=0.007. Simultaneously. VO improves significantly in Group A (103+/-21 vs. 164+/-30, p=0.00001) while difference between groups in DO was p=0.037. Importance of oxygen metabolism monitoring for both, left ventricular function and haemodynamics assessment was evident in our study.

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Scriven, J. M., V. Bianchi, T. Hartshorne, and N. J. M. London. "Tourniquets Cannot Identify Superficial Venous Reflux Nor Predict the Haemodynamic Outcome of Saphenous Vein Surgery." Phlebology: The Journal of Venous Disease 16, no. 4 (December 2001): 154–59. http://dx.doi.org/10.1177/026835550101600406.

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Objective: To evaluate the ability of tourniquets or manual venous compression to predict the haemodynamic outcome of saphenous vein surgery. Design: Prospective, observational study using colour duplex scanning and photoplethysmography (PPG) in patients undergoing saphenous vein surgery. Patients and methods: Twenty-six patients (26 limbs) undergoing saphenous vein surgery underwent colour duplex and PPG assessment before and after the application of tourniquets or manual venous compression. The effect of compression on the superficial and deep veins was assessed by colour duplex scanning. The haemodynamic effect of compression was measured using PPG 90% refill times (PPGRT90) and the results compared with the postoperative PPGRT90. Results: Pneumatic tourniquets occluded 27% of saphenous veins. Manual compression significantly lengthened PPGRT90 compared with pneumatic tourniquets but neither method could usefully predict the postoperative PPGRT90. Conclusion: Neither pneumatic tourniquets nor manual venous compression predict postoperative venous refill times. We advise caution in the interpretation of tourniquet testing.

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REYBROUCK, T. "1461 Response to repeated tilt testing in different haemodynamic types of neurally mediated syncope." European Heart Journal 24, no. 5 (March 2003): 266. http://dx.doi.org/10.1016/s0195-668x(03)94631-8.

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Simeonov, Lyudmil, Dimitar Pechilkov, and Anna Kaneva. "Cardiopulmonary exercise testing in children with congenital heart disease." Bulgarian Cardiology 28, no. 1 (April 6, 2022): 34–44. http://dx.doi.org/10.3897/bgcardio.28.e81196.

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Exercise capacity assessment in patients with congenital heart disease (CHD) is essential for cardiovascular adaptation and is a key parameter in quality of life assessment. In daily practice, the majority of tests are performed at rest, and some even require sedation. Cardiopulmonary exercise testing (CPET) allows the assessment of the patient's haemodynamic status during exercise and provides important information about heart rate, rhythm, ST-segment analysis, arterial pressure, and parameters such as oxygen consumption, oxygen pulse and the ratio of minute ventilation to carbon dioxide produced, which helps to describe in detail the physiology of the patient in a dynamic state. This allows for assessment of aerobic capacity and helps to distinguish the causes of its limitation - cardiovascular, pulmonary or deconditioning. Objectification of exercise capacity provides a basis for better decision-making regarding follow-up plans, exercise recommendations and future interventions. This review will discuss in detail CPET and its implementation in children with CHD.

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Pontoriero, Antonella D., Peter H. Charlton, and Jordi Alastruey. "Alzheimer’s Disease: A Step Towards Prognosis Using Smart Wearables." Proceedings 4, no. 1 (November 14, 2018): 8. http://dx.doi.org/10.3390/ecsa-5-05742.

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Alzheimer’s disease (AD) is the most common cause of dementia. Several haemodynamic risk factors for AD have been identified, including ageing, increased arterial stiffness, high systolic blood pressure (BP) and brain hypoperfusion. We propose a novel approach for assessing haemodynamic risk factors by analysing arterial pulse waves (PWs). The aim of this feasibility study was to determine whether features extracted from PWs measured by wearable sensors might have utility for stratifying patients at risk of AD. A numerical model of PW propagation was used to simulate PWs for virtual subjects of each age decade from 25 to 75 years (16 subjects in total), with subjects at each age exhibiting normal variation in arterial stiffness. Several PW features were extracted, and their relationships with AD risk factors were investigated. PWs at the wrist were found to exhibit changes with age and arterial stiffness, indicating that it may be possible to identify changes in risk factors from smart wearables. Several candidate PW features were identified which changed significantly with age for future testing. This study demonstrates the potential feasibility of assessing haemodynamic risk factors for AD from non-invasive PWs. These factors could be assessed from the PPG PW, which can be acquired by smart watches and phones. If the findings are replicated in clinical studies, then this may provide opportunities for patients to assess their own risk and make lifestyle changes accordingly.

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Rivasi, Giulia, Parisa Torabi, Gianmarco Secco, Andrea Ungar, Richard Sutton, Michele Brignole, and Artur Fedorowski. "Age-related tilt test responses in patients with suspected reflex syncope." EP Europace 23, no. 7 (February 10, 2021): 1100–1105. http://dx.doi.org/10.1093/europace/euab024.

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Abstract Aims Tilt testing (TT) is recognized to be a valuable contribution to the diagnosis and the pathophysiology of vasovagal syncope (VVS). This study aimed to assess the influence of age on TT responses by examination of a large patient cohort. Methods and results Retrospective data from three experienced European Syncope Units were merged to include 5236 patients investigated for suspected VVS by the Italian TT protocol. Tilt testing-positivity rates and haemodynamics were analysed across age-decade subgroups. Of 5236 investigated patients, 3129 (60%) had a positive TT. Cardioinhibitory responses accounted for 16.5% of positive tests and were more common in younger patients, decreasing from the age of 50–59 years. Vasodepressor (VD) responses accounted for 24.4% of positive tests and prevailed in older patients, starting from the age of 50–59. Mixed responses (59.1% of cases) declined slightly with increasing age. Overall, TT positivity showed a similar age-related trend (P = 0.0001) and was significantly related to baseline systolic blood pressure (P < 0.001). Tilt testing was positive during passive phase in 18% and during nitroglycerine (TNG)-potentiated phase in 82% of cases. Positivity rate of passive phase declined with age (P = 0.001), whereas positivity rate during TNG remained quite stable. The prevalence of cardioinhibitory and VD responses was similar during passive and TNG-potentiated TT, when age-adjusted. Conclusions Age significantly impacts the haemodynamic pattern of TT responses, starting from the age of 50. Conversely, TT phase—passive or TNG-potentiated—does not significantly influence the type of response, when age-adjusted. Vagal hyperactivity dominates in younger patients, older patients show tendency to vasodepression.

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Sandroni, Claudio, Peter Fenici, Fabio Cavallaro, Maria Grazia Bocci, Andrea Scapigliati, and Massimo Antonelli. "Haemodynamic effects of mental stress during cardiac arrest simulation testing on advanced life support courses." Resuscitation 66, no. 1 (July 2005): 39–44. http://dx.doi.org/10.1016/j.resuscitation.2004.12.021.

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Chenzbraun, Adrian. "Non-ischaemic cardiac conditions: role of stress echocardiography." Echo Research and Practice 1, no. 1 (August 2014): R1—R7. http://dx.doi.org/10.1530/erp-14-0030.

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Stress echocardiography (SE) has a unique ability for simultaneous assessment of both functional class and exercise-related haemodynamic changes and as such is increasingly recognised for the evaluation of non-coronary artery disease pathologies. Some indications such as valvular heart disease or hypertrophic cardiomyopathy have been well established already, while others such as diastolic exercise testing are emerging of late. This paper addresses the main and best established indications for SE in non-ischaemic conditions, providing a practical perspective correlated with updated guidelines.

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Gopalan, Deepa, Marion Delcroix, and Matthias Held. "Diagnosis of chronic thromboembolic pulmonary hypertension." European Respiratory Review 26, no. 143 (March 15, 2017): 160108. http://dx.doi.org/10.1183/16000617.0108-2016.

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Chronic thromboembolic pulmonary hypertension (CTEPH) is the only potentially curable form of pulmonary hypertension. Rapid and accurate diagnosis is pivotal for successful treatment. Clinical signs and symptoms can be nonspecific and risk factors such as history of venous thromboembolism may not always be present. Echocardiography is the recommended first diagnostic step. Cardiopulmonary exercise testing is a complementary tool that can help to identify patients with milder abnormalities and chronic thromboembolic disease, triggering the need for further investigation. Ventilation/perfusion (V′/Q′) scintigraphy is the imaging methodology of choice to exclude CTEPH. Single photon emission computed tomography V′/Q′ is gaining popularity over planar imaging. Assessment of pulmonary haemodynamics by right heart catheterisation is mandatory, although there is increasing interest in noninvasive haemodynamic evaluation. Despite the status of digital subtraction angiography as the gold standard, techniques such as computed tomography (CT) and magnetic resonance imaging are increasingly used for characterising the pulmonary vasculature and assessment of operability. Promising new tools include dual-energy CT, combination of rotational angiography and cone beam CT, and positron emission tomography. These innovative procedures not only minimise misdiagnosis, but also provide additional vascular information relevant to treatment planning. Further research is needed to determine how these modalities will fit into the diagnostic algorithm for CTEPH.

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Shrestha, Gentle Sunder, Megha Koirala, Prakash Karki, Navindra Raj Bista, Gopal Sedain, and Moda Nath. "Anaesthesia for awake craniotomy with the use of dexmedetomidine in combination with propofol infusion and ProSeal laryngeal mask airway." Journal of Society of Anesthesiologists of Nepal 2, no. 2 (September 30, 2015): 84–86. http://dx.doi.org/10.3126/jsan.v2i2.13539.

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Awake craniotomy for resection of tumour in the eloquent cortex aims to maximize tumour resection while sparing important areas of the brain. It poses several challenges to an anaesthesiologist. The goal is to provide adequate sedation, analgesia, and respiratory and haemodynamic control, but also an awake and cooperative patient for neurological testing. Here we report a case of awake craniotomy conducted safely with asleep-awake-asleep technique using dexmedetomidine infusion, scalp block and controlled ventilation with ProSeal laryngeal mask airway.Journal of Society of Anesthesiologists of Nepal 2015; 2(2): 84-86

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Siebert, J., D. Zielińska, B. Trzeciak, and S. Bakuła. "HAEMODYNAMIC RESPONSE DURING EXERCISE TESTING IN PATIENTS WITH CORONARY ARTERY DISEASE UNDERGOING A CARDIAC REHABILITATION PROGRAMME." Biology of Sport 28, no. 3 (September 14, 2011): 189–93. http://dx.doi.org/10.5604/959285.

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Sperling, Milena Pelosi Rizk, Flávia Cristina Rossi Caruso, Renata Gonçalves Mendes, Daniela Bassi Dutra, Vivian Maria Arakelian, José Carlos Bonjorno, Aparecida Maria Catai, Ross Arena, and Audrey Borghi-Silva. "Relationship between non-invasive haemodynamic responses and cardiopulmonary exercise testing in patients with coronary artery disease." Clinical Physiology and Functional Imaging 36, no. 2 (October 13, 2014): 92–98. http://dx.doi.org/10.1111/cpf.12197.

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Moloney, M. Clarke, G. M. Lyons, M. Egan, F. Wallis, P. E. Burke, E. Kavanagh, and P. A. Grace. "Does size matter? The impact of calf muscle volume on venous return in patients with venous leg ulcers." Phlebology: The Journal of Venous Disease 22, no. 2 (April 1, 2007): 65–69. http://dx.doi.org/10.1258/026835507780346169.

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Objectives: The calf muscle pump is recognized as an integral component of effective venous return from the lower limbs. The aim of this study was to determine if there is a correlation between calf muscle volume and venous blood flow among patients with venous leg ulcers. Methods: Nine patients with venous leg ulceration were recruited for this study. These patients underwent haemodynamic testing using duplex ultrasound to measure peak venous velocities in response to voluntary maximum plantar flexion, with and without compression bandaging. Each patient then had magnetic resonance imaging (MRI) of the lower limbs. Calf muscle volume was calculated from the MRI images using a specially designed Matlab computer program to identify and count muscle pixels. Analyses applied Pearson's correlation coefficient to determine correlation between calf muscle volume and mean peak venous velocities in response to voluntary contraction. Results: No correlation was seen between calf muscle volume and haemodynamic venous return in response to voluntary contraction, with or without compression bandaging. Conclusion: The volume of calf muscle available for promoting venous return alone may not be an accurate indicator of muscle functioning capability.

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Ouweneel, Dagmar M., Bimmer E. Claessen, Krischan D. Sjauw, and José PS Henriques. "The Role of Percutaneous Haemodynamic Support in High-risk Percutaneous Coronary Intervention and Cardiogenic Shock." Interventional Cardiology Review 10, no. 1 (2015): 39. http://dx.doi.org/10.15420/icr.2015.10.1.39.

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The experience and usage of percutaneous cardiac assist devices in cardiogenic shock as well as high-risk percutaneous coronary intervention have increased over the years. Nonetheless, there is still little evidence of clinical benefit of these devices other than immediate haemodynamic improvement. Despite the fact that these devices are used to treat a rather complex patient population, clinical testing remains important in order to evaluate their true impact on clinical outcome before being adopted into clinical practice. Therefore, this review shows an overview of the current experience and evidence of the available percutaneous cardiac assist devices.

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Critoph, Christopher H., Vimal Patel, Bryan Mist, and Perry M. Elliott. "Cardiac output response and peripheral oxygen extraction during exercise among symptomatic hypertrophic cardiomyopathy patients with and without left ventricular outflow tract obstruction." Heart 100, no. 8 (January 21, 2014): 639–46. http://dx.doi.org/10.1136/heartjnl-2013-304914.

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ObjectiveReduction of left ventricular outflow tract obstruction (LVOTO) often improves symptoms in hypertrophic cardiomyopathy (HCM), but the correlation between exercise performance and measured LVOT gradients is weak. We investigated the relationship between LVOTO and cardiorespiratory responses during exercise.MethodsThe study cohort included 70 patients with HCM (32 with LVOTO, 55 male, age 47±13) attending a dedicated cardiomyopathy clinic and 28 normal volunteers. All underwent cardiopulmonary exercise testing with simultaneous non-invasive haemodynamic assessment using finger plethysmography. Main outcome measures were peak oxygen consumption, cardiac index and arteriovenous oxygen difference.ResultsWhen compared with controls, patients had reduced peak exercise oxygen consumption (22.4±6.1 vs 34.7±7.7 mL/kg/min, p<0.0001) and cardiac index (5.5±1.9 vs 9.4±2.9 L/min/m2, p<0.0001). At all workloads, stroke volume index (SVI) was lower and arteriovenous oxygen difference greater in patients. During all stages of exercise, LVOTO in patients was associated with failure to augment SVI and higher oxygen consumption; cardiac reserve (4.4±2.7 vs 6.3±3.6 L/min, p=0.025) and peak mean arterial pressure (104±16 vs 112±16 mm Hg, p=0.033) were lower. Multivariable predictors of cardiac output response were age (β: −0.11; CI −0.162 to −0.057; p<0.0001), peak LVOT gradient (β: −0.018; CI −0.034 to −0.002; p=0.031) and gender (β: −2.286; CI −0.162 to −0.577; p=0.01). Within the obstructive cohort, different patterns of SV response were elicited in patients with similar clinical features.ConclusionsCardiac reserve is reduced in HCM because of failure of SV augmentation. LVOTO exacerbates this abnormal response, but haemodynamic responses vary significantly. Non-invasive exercise haemodynamic assessment may improve understanding of symptoms and help tailor therapy.

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Sadek, Mouhannad M., Robert D. Schaller, Gregory E. Supple, David S. Frankel, Michael P. Riley, Mathew D. Hutchinson, Fermin C. Garcia, et al. "Ventricular Tachycardia Ablation – The Right Approach for the Right Patient." Arrhythmia & Electrophysiology Review 3, no. 3 (2014): 161. http://dx.doi.org/10.15420/aer.2014.3.3.161.

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Scar-related reentry is the most common mechanism of monomorphic ventricular tachycardia (VT) in patients with structural heart disease. Catheter ablation has assumed an increasingly important role in the management of VT in this setting, and has been shown to reduce VT recurrence and implantable cardioverter defibrillator (ICD) shocks. The approach to mapping and ablation will depend on the underlying heart disease etiology, VT inducibility and haemodynamic stability. This review explores pre-procedural planning, approach to ablation of both mappable and unmappable VT, and post-procedural testing. Future developments in techniques and technology that may improve outcomes are discussed.

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Gerges, Christian, Mario Gerges, Pierre Fesler, Anna Maria Pistritto, Nicholas P. Konowitz, Johannes Jakowitsch, David S. Celermajer, and Irene M. Lang. "In-depth haemodynamic phenotyping of pulmonary hypertension due to left heart disease." European Respiratory Journal 51, no. 5 (March 29, 2018): 1800067. http://dx.doi.org/10.1183/13993003.00067-2018.

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The commonest cause of pulmonary hypertension (PH) is left heart disease (LHD). The current classification system for definitions of PH-LHD is under review. We therefore performed prospective in-depth invasive haemodynamic phenotyping in order to assess the site of increased pulmonary vascular resistance (PVR) in PH-LHD subsets.Based on pulmonary artery occlusion waveforms yielding an estimate of the effective capillary pressure, we partitioned PVR in larger arterial (Rup, upstream resistance) and small arterial plus venous components (Rds, downstream resistance). In the case of small vessel disease, Rup decreases and Rds increases. Inhaled nitric oxide (NO) testing was used to assess acute vasoreactivity.Right ventricular afterload (PVR, pulmonary arterial compliance and effective arterial elastance) was significantly higher in combined post- and pre-capillary PH (Cpc-PH, n=35) than in isolated post-capillary PH (Ipc-PH, n=20). Right ventricular afterload decreased during inhalation of NO in Cpc-PH and idiopathic pulmonary arterial hypertension (n=31), but remained unchanged in Ipc-PH. Rup was similar in Cpc-PH (66.8±10.8%) and idiopathic pulmonary arterial hypertension (65.0±12.2%; p=0.530) suggesting small vessel disease, but significantly higher in Ipc-PH (96.5±4.5%; p<0.001) suggesting upstream transmission of elevated left atrial pressure.Right ventricular afterload is driven by elevated left atrial pressure in Ipc-PH and is further increased by elevated small vessel resistance in Cpc-PH. Cpc-PH is responsive to inhaled NO. Our data support current definitions of PH-LHD subsets.

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Kanter, Ronald J. "Sudden cardiac arrest in patients following surgery for CHD." Cardiology in the Young 27, S1 (January 2017): S68—S74. http://dx.doi.org/10.1017/s1047951116002262.

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AbstractThe prevalence of sudden cardiac arrest after surgery for CHD is primarily related to the complexity of the congenital defect and the presence of residual defects, especially ventricular dysfunction. Among all causes of death in patients having CHD, about 19% lead to sudden mortality. The specific risk factors associated with the various congenital defects are poorly understood. The lone exception is tetralogy of Fallot, largely due to its high prevalence and the historically high post-operative survival rate. In tetralogy of Fallot, historical, haemodynamic, and electrical features contribute to risk, and electrophysiologic testing may be helpful, particularly to rule out risk. An implantable cardioverter–defibrillator is highly effective for secondary prevention in most forms of CHD, and future advances will improve its role in primary prevention.

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Bolognese, Leonardo. "Late primary angioplasty (beyond 12 h): are we sure it should be avoided?" European Heart Journal Supplements 23, Supplement_E (October 1, 2021): E36—E39. http://dx.doi.org/10.1093/eurheartj/suab086.

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Abstract Optimal management for patients with ST-segment elevation myocardial infarction (STEMI) who arrive at a hospital late remains uncertain since evidence and real-world data are limited. Patients who present late with a STEMI are a heterogeneous population, and the clinical decision regarding percutaneous coronary intervention (PCI) should not be the same for all. One randomized clinical trial, multiple mechanistic studies, and contemporary registries suggest a presumed benefit for a prompt restoration of coronary flow even in late presenting STEMI. Crucial elements in decision-making are the presence of haemodynamic or electrical instability, and ongoing ischaemic signs or symptoms to tip the scales toward PCI. Among clinically stable, late-presenting patients, myocardial viability assessment and functional testing can identify yet another subgroup that may benefit from late PCI

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Petersen, Bodil, Thilo Busch, Katharina Noreikat, Lorenz Homeister, Ralf Regenthal, and Udo X. Kaisers. "Search for an animal model to investigate selective pulmonary vasodilation." Laboratory Animals 51, no. 4 (November 25, 2016): 376–87. http://dx.doi.org/10.1177/0023677216675384.

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Pulmonary arterial hypertension is a life-threatening disease with a poor prognosis. Oral treatment with vasodilators is often limited by systemic hypotension. Inhalation of vasodilators offers the opportunity for selective pulmonary vasodilation. Testing selective pulmonary vasodilation by inhaled nitric oxide or alternative substances in animal models requires an increased pulmonary vascular tone. The aim of this study was to identify animal models that are suitable for investigating selective pulmonary vasodilation. To do so, a haemodynamic stable pulmonary hypertension was initiated, with a 30 min duration deemed to be a sufficient time interval before and after a possible intervention. In anaesthetized and mechanically-ventilated Sprague–Dawley rats pulmonary hypertension was induced either by acute hypoxia due to reduction of the inspired oxygen fraction from 0.21 to 0.1 ( n = 6), a fixed infusion rate of the thromboxane analogue U46619 (240 ng/min; n = 6) or a monocrotaline injection (MCT; 60 mg/kg applied 23 days before the investigation; n = 7). The animals were instrumented to measure right ventricular and systemic arterial pressures. Acute hypoxia caused a short, and only transient, increase of pulmonary artery pressure as well as profound systemic hypotension which suggested haemodynamic instability. U46619 infusion induced variable changes in the pulmonary and systemic vascular tone without sufficient stabilization within 30 min. MCT provoked sustained pulmonary hypertension with normal systemic pressure values and inhalation of nitric oxide caused selective pulmonary vasodilation. In conclusion, out of the three examined rat animal models only MCT-induced pulmonary hypertension is a solid and reliable model for investigating selective pulmonary vasodilation.

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Jakovljevic, Djordje G., Petar M. Seferovic, David Nunan, Gay Donovan, Michael I. Trenell, Richard Grocott-Mason, and David A. Brodie. "Reproducibility of cardiac power output and other cardiopulmonary exercise indices in patients with chronic heart failure." Clinical Science 122, no. 4 (October 14, 2011): 175–81. http://dx.doi.org/10.1042/cs20110355.

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Cardiac power output is a direct measure of overall cardiac function that integrates both flow- and pressure-generating capacities of the heart. The present study assessed the reproducibility of cardiac power output and other more commonly reported cardiopulmonary exercise variables in patients with chronic heart failure. Metabolic, ventilatory and non-invasive (inert gas re-breathing) central haemodynamic measurements were undertaken at rest and near-maximal exercise of the modified Bruce protocol in 19 patients with stable chronic heart failure. The same procedure was repeated 7 days later to assess reproducibility. Cardiac power output was calculated as the product of cardiac output and mean arterial pressure. Resting central haemodynamic variables demonstrate low CV (coefficient of variation) (ranging from 3.4% for cardiac output and 5.6% for heart rate). The CV for resting metabolic and ventilatory measurements ranged from 8.2% for respiratory exchange ratio and 14.2% for absolute values of oxygen consumption. The CV of anaerobic threshold, peak oxygen consumption, carbon dioxide production and respiratory exchange ratio ranged from 3.8% (for anaerobic threshold) to 6.4% (for relative peak oxygen consumption), with minute ventilation having a CV of 11.1%. Near-maximal exercise cardiac power output and cardiac output had CVs of 4.1 and 2.2%, respectively. Cardiac power output demonstrates good reproducibility suggesting that there is no need for performing more than one cardiopulmonary exercise test. As a direct measure of cardiac function (dysfunction) and an excellent prognostic marker, it is strongly advised in the assessment of patients with chronic heart failure undergoing cardiopulmonary exercise testing.

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Nitsche, Christian, Andreas A. Kammerlander, Christina Binder, Franz Duca, Stefan Aschauer, Matthias Koschutnik, Amir Snidat, et al. "Native T1 time of right ventricular insertion points by cardiac magnetic resonance: relation with invasive haemodynamics and outcome in heart failure with preserved ejection fraction." European Heart Journal - Cardiovascular Imaging 21, no. 6 (September 9, 2019): 683–91. http://dx.doi.org/10.1093/ehjci/jez221.

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Abstract Aims Increased afterload to the right ventricle (RV) has been shown to induce myocardial fibrosis at the RV insertion points (RVIPs). Such changes can be discrete but potentially detected by cardiac magnetic resonance (CMR) T1-mapping. Whether RVIP fibrosis is associated with prognosis in heart failure with preserved ejection fraction (HFpEF) is unknown. Methods and results We prospectively investigated 167 consecutive HFpEF patients, a population frequently suffering from post-capillary pulmonary hypertension, who underwent CMR including T1-mapping. About 92.8% also underwent right heart catheterization for haemodynamic assessment. Native T1 times were 995 ± 73 ms at the anterior and 1040 ± 90 ms at the inferior RVIP. By Spearman’s rank order testing, RVIP T1 times were significantly correlated with pulmonary artery pressure (mean PAP, r = 0.313 and 0.311 for anterior and inferior RVIP), pulmonary artery wedge pressure (r = 0.301 and 0.251) and right atrial pressure (r = 0.245 and 0.185; P for all <0.05). During a mean follow-up of 43.2 ± 22.6 months, 30 (18.0%) subjects died. By multivariable Cox regression, NTproBNP [Hazard ratio (HR) 2.105, 95% confidence interval (CI) 1.332–3.328; P = 0.001], systolic PAP (HR 1.618, 95% CI 1.175–2.230; P = 0.003), and native T1 time of the anterior RVIP (HR 1.659, 95% CI 1.125–2.445; P = 0.011) were significantly associated with outcome. Also, by Kaplan–Meier analysis, T1 times at the anterior RVIPs had a significant effect on survival (log-rank, P = 0.002). Conclusion Interstitial expansion of the anterior RVIP as detected by CMR T1-mapping reflects haemodynamic alterations, and is independently related with prognosis in HFpEF.

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Ariyaratnam, J., R. Mishima, O. McNamee, K. Kadhim, M. Emami, V. Malik, J. Fitzgerald, et al. "Invasive Haemodynamic Testing with Fluid Challenge to Explore the Relationship Between Heart Failure with Preserved Ejection Fraction in Atrial Fibrillation." Heart, Lung and Circulation 31 (2022): S39. http://dx.doi.org/10.1016/j.hlc.2022.06.007.

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Levy, R. D., L. M. Shapiro, C. Wright, L. Mockus, and K. M. Fox. "Haemodynamic response to myocardial ischaemia during unrestricted activity, exercise testing, and atrial pacing assessed by ambulatory pulmonary artery pressure monitoring." Heart 56, no. 1 (July 1, 1986): 12–18. http://dx.doi.org/10.1136/hrt.56.1.12.

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Patel, Roshan, and Rohit Malliwal. "Severe hyponatraemia and autonomic dysreflexia in a quadriplegic person." BMJ Case Reports 12, no. 6 (June 2019): e228209. http://dx.doi.org/10.1136/bcr-2018-228209.

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Spinal cord injury (SCI) is associated with a range of secondary health issues. Altered neurological function can complicate diagnosis, which may have serious consequences. Here we present the case of a tetraplegic person presenting with confusion and bradycardia. Initial testing revealed severe hyponatraemia (sodium 96 mmol/L) and ST elevation associated with labile blood pressure. Delayed further investigation identified sigmoid volvulus—endoscopic decompression led to resolution of haemodynamic lability and a diagnosis of autonomic dysreflexia. Low mood and poor documentation in the community were found to contribute to poor compliance with an established bowel management plan. Inpatient care involved electrolyte correction and establishment of regular bowel motions. The patient was discharged at baseline neurology with psychological support. This case highlights poor awareness of the secondary health issues affecting those with SCI and the complex relationship between mental and physical health.

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Reybrouck, Tony, Luc Mertens, Steven Brown, Benedicte Eyskens, Willem Daenen, and Marc Gewillig. "Long-term assessment and serial evaluation of cardiorespiratory exercise performance and cardiac function in patients with atrial switch operation for complete transposition." Cardiology in the Young 11, no. 1 (January 2001): 17–24. http://dx.doi.org/10.1017/s1047951100012373.

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AbstractBackground: At present, a considerable number of patients survive who underwent an atrial switch operation for correction of complete transposition. Our study aimed to assess their long-term exercise performance and the serial evolution of cardiac function.Methods: We studied 22 patients 5 to 17 years after an atrial switch operation, and followed them serially for 3.5 ± 2 years after the first evaluation. Cardiorespiratory exercise function was assessed by analysis of gas exhange and by determination of the ventilatory anaerobic threshold. Echocardiography was performed on all evaluations.Results: All patients were in Class I of the classification of the New York Heart Association at all assessments. Ventilatory anaerobic threshold, however, was significantly lower than normal. It averaged 77.9% ± 13.7 of the normal mean value at the initial evaluation, and remained stable when re-evaluated later (76.2 ± 13.7%). At the initial study, the increase in oxygen uptake during graded exercise was below the 95% confidence limit in 6 of the patients, and was below this level in 10 patients at re-assessment. The subnormal values for oxygen uptake during submaximal exercise were associated with moderate to severe haemodynamic dysfunction. At echocardiography, 15 of 17 patients studied twice had mild to moderate right ventricular dilation and tricuspidregurgiation, which remained virtually the same at reasssesment. A stable sinus rhythm was initially present in 17 patients, and persisted in 15 patients during follow-up.Conclusion: At medium term follow-up, cardiorespiratory exercise performance remains stable in patients after atrial switch repair. Serial exercise testing appears useful, because in individual patients in the present study, a decreasing exercise tolerance correlated with development of haemodynamic sequels.

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Bracke, F. A., P. Houthuizen, B. M. Rahel, and B. M. van Gelder. "Left ventricular endocardial pacing improves the clinical efficacy in a non-responder to cardiac resynchronization therapy: role of acute haemodynamic testing." Europace 12, no. 7 (March 2, 2010): 1032–34. http://dx.doi.org/10.1093/europace/euq043.

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Oh, H. W., E. S. Yoon, M. R. Park, K. Sun, and C. M. Hwang. "Hydrodynamic design and performance analysis of a centrifugal blood pump for cardiopulmonary circulation." Proceedings of the Institution of Mechanical Engineers, Part A: Journal of Power and Energy 219, no. 7 (November 1, 2005): 525–32. http://dx.doi.org/10.1243/095765005x31108.

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This paper presents the hydrodynamic design and performance analysis method for a miniaturized centrifugal blood pump using three-dimensional computational fluid dynamics (CFD) code. In order to obtain the hydraulically high efficient configuration of a miniaturized centrifugal blood pump for cardiopulmonary circulation, well-established commercial CFD codes were incorporated considering detailed flow dynamic phenomena in the blood pump system. A prototype of centrifugal blood pump developed by the present design and analysis method has been tested in the mock circulatory system. Predicted results by the CFD code agree very well with in vitro hydraulic performance data for a centrifugal blood pump over the entire operating conditions. Preliminary in vivo animal testing has also been conducted to demonstrate the haemodynamic feasibility for use of centrifugal blood pump as a mechanical circulatory support. A miniaturized centrifugal blood pump developed by the hydraulic design optimization and performance prediction method, presented herein, shows the possibility of a good candidate for intra and extracorporeal cardiopulmonary circulation pump in the near future.

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van der Feen, Diederik E., Beatrijs Bartelds, Rudolf A. de Boer, and Rolf M. F. Berger. "Assessment of reversibility in pulmonary arterial hypertension and congenital heart disease." Heart 105, no. 4 (November 22, 2018): 276–82. http://dx.doi.org/10.1136/heartjnl-2018-314025.

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Pulmonary arterial hypertension (PAH) in congenital heart disease (CHD) can be reversed by early shunt closure, but this potential is lost beyond a certain point of no return. Therefore, it is crucial to accurately assess the reversibility of this progressive pulmonary arteriopathy in an early stage. Reversibility assessment is currently based on a combination of clinical symptoms and haemodynamic variables such as pulmonary vascular resistance. These measures, however, are of limited predictive value and leave many patients in the grey zone. This review provides a concise overview of the mechanisms involved in flow-dependent progression of PAH in CHD and evaluates existing and future alternatives to more directly investigate the stage of the pulmonary arteriopathy. Structural quantification of the pulmonary arterial tree using fractal branching algorithms, functional imaging with intravascular ultrasound, nuclear imaging, putative new blood biomarkers, genetic testing and the potential for transcriptomic analysis of circulating endothelial cells and educated platelets are being reviewed.

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Vachiéry, Jean-Luc, Ryan J. Tedford, Stephan Rosenkranz, Massimiliano Palazzini, Irene Lang, Marco Guazzi, Gerry Coghlan, Irina Chazova, and Teresa De Marco. "Pulmonary hypertension due to left heart disease." European Respiratory Journal 53, no. 1 (January 2019): 1801897. http://dx.doi.org/10.1183/13993003.01897-2018.

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Pulmonary hypertension (PH) is frequent in left heart disease (LHD), as a consequence of the underlying condition. Significant advances have occurred over the past 5 years since the 5th World Symposium on Pulmonary Hypertension in 2013, leading to a better understanding of PH-LHD, challenges and gaps in evidence. PH in heart failure with preserved ejection fraction represents the most complex situation, as it may be misdiagnosed with group 1 PH. Based on the latest evidence, we propose a new haemodynamic definition for PH due to LHD and a three-step pragmatic approach to differential diagnosis. This includes the identification of a specific “left heart” phenotype and a non-invasive probability of PH-LHD. Invasive confirmation of PH-LHD is based on the accurate measurement of pulmonary arterial wedge pressure and, in patients with high probability, provocative testing to clarify the diagnosis. Finally, recent clinical trials did not demonstrate a benefit in treating PH due to LHD with pulmonary arterial hypertension-approved therapies.

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Aghamohammadzadeh, Reza, Suhaib Magdi El-Omar, Derek Rowlands, and Magdi El-Omar. "ST elevation in recovery post exercise with normal coronary arteries." BMJ Case Reports 12, no. 7 (July 2019): e229766. http://dx.doi.org/10.1136/bcr-2019-229766.

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We present the case of a 45-year-old healthy man who successfully completed three stages of the Bruce protocol but developed inferolateral ST segment elevation in the recovery phase. The ECG change was associated with a marked drop in blood pressure. He underwent emergency coronary angiography which revealed normal coronary arteries. It is likely that post-exercise hypotension triggered coronary spasm which caused the ST segment elevation. Alternatively, coronary spasm may have been the primary event, inducing sufficient myocardial ischaemia to cause a marked drop in blood pressure. Exercise tolerance testing is often a reliable test to rule out reversible myocardial ischaemia. While the physician is focused on ischaemic changes or rhythm abnormalities developing during the exercise phase, the recovery period is just as important and requires as much vigilance. Coronary vasospasm can result in significant ST changes and haemodynamic compromise at any point during the test, and the ECG traces can be indistinguishable from a classic ST elevation myocardial infarction, as in the present case.

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Matteucci, Elena, and Ottavio Giampietro. "Activity of Erythrocyte Sodium-Hydrogen Exchange in Normal Pregnancy." Clinical Science 93, no. 5 (November 1, 1997): 431–34. http://dx.doi.org/10.1042/cs0930431.

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1. Pregnancy is associated with a 30–50% rise in cardiac output and a 50% increase in blood volume. The contribution of changes in the activity of primary and secondary active transporters to these haemodynamic adaptations remains unknown. For the first time, we measured sodium—hydrogen exchange activity over the course of normal pregnancy. 2. Eighteen healthy pregnant women were studied at 14, 24 and 33 weeks of gestation and compared with 18 non-pregnant healthy women. None of the pregnancies was complicated by hypertension. At each antenatal visit, body weight and blood pressure were recorded, blood and 24 h-urine samples were taken to control renal function and metabolic equilibrium, maternal glucose tolerance was evaluated by oral glucose test and glycated haemoglobin testing, and erythrocyte sodium-hydrogen antiport was also measured. 3. Erythrocyte antiport activity values were 10.0 ± 3.0, 9.6 ± 2.9 and 8.4 ± 3.5 mmol h−1 (litre of cells)−1 in the three gestational trimesters respectively, significantly higher at each trimester than in control women [6.8 ± 2.5 mmol h−1 (litre of cells)−1]. The clearances of urea and creatinine were constantly elevated in pregnant women; at each trimester their serum concentrations were lower than in non-pregnant women. Serum potassium significantly decreased during pregnancy. Serum total cholesterol and triacylglycerol levels, already above the normal range from the first trimester, further increased until the third trimester. The area under the glycaemic curve became larger during pregnancy, and the area under the insulinaemic curve increased to a lesser extent. There was a significant association between antiport activity and serum triacylglycerol levels. 4. The observed hyperactivity of the transporter, peaking at the fourteenth week of gestation, may be a contributing factor to the haemodynamic adjustments attending upon normal pregnancy.

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Vriesendorp, Michiel D., Rob A. F. de Lind van Wijngaarden, Vivek Rao, Michael G. Moront, Himanshu J. Patel, Edward Sarnowski, Sepehr Vatanpour, and Robert J. M. Klautz. "An in vitro comparison of internally versus externally mounted leaflets in surgical aortic bioprostheses." Interactive CardioVascular and Thoracic Surgery 30, no. 3 (November 28, 2019): 417–23. http://dx.doi.org/10.1093/icvts/ivz277.

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Abstract OBJECTIVES To improve haemodynamic performance, design modifications of prosthetic valves have been proposed with each new generation of valves. These different designs also impact the amount of mechanical wear, because mechanical stresses are distributed differently. Because long-term evidence for new prosthetic valves is lacking, this in vitro study compared hydrodynamic performance and durability among 3 currently available bioprosthetic valves with internally (IMLV) or externally mounted leaflets (EMLV). METHODS Prostheses of the internally mounted Medtronic Avalus and Carpentier-Edwards Perimount Magna Ease valves were compared to prostheses of the externally mounted Abbott Trifecta valve. For each labelled size (e.g. 19, 21 and 23) of the 3 types, 3 valves underwent accelerated wear testing for up to 600 million cycles, corresponding to ∼15 years of simulated wear. The valves underwent hydrodynamic testing and visual inspection. RESULTS EMLV had the largest effective orifice area and lowest pressure gradient for each labelled size at baseline and 600 million cycles; the effective orifice area and the pressure gradient were equivalent for the 2 types of IMLV. Five of 9 EMLVs had at least 1 hole or tear in the leaflet tissue around the stent posts, which resulted in severe regurgitation at 500 million cycles in 2 cases. All IMLVs were intact at 600 million cycles with minimal tissue wear. CONCLUSIONS EMLV showed superior hydrodynamic performance but inferior mechanical durability compared to IMLV after 600 million cycles of testing. The primary failures were because of significant mechanical abrasion in the commissural region, which may warrant close monitoring of EMLV during long-term follow-up.

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van Le, Douet, Gunnar Vagn Hagemann Jensen, Steen Carstensen, and Lars Kjøller-Hansen. "Cardiopulmonary Exercise Testing in Patients with Asymptomatic or Equivocal Symptomatic Aortic Stenosis: Feasibility, Reproducibility, Safety and Information Obtained on Exercise Physiology." Cardiology 133, no. 3 (November 20, 2015): 147–56. http://dx.doi.org/10.1159/000441292.

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Objective: The aim of this study was to determine the feasibility, reproducibility, safety and information obtained on exercise physiology from cardiopulmonary exercise testing (CPX) in patients with aortic stenosis. Methods: Patients with an aortic valve area (AVA) <1.3 cm2 who were judged asymptomatic or equivocal symptomatic underwent CPX and an inert gas rebreathing test. Only those where comprehensive evaluation of CPX results indicated haemodynamic compromise from aortic stenosis were referred for valve replacement. Results: The mean patient age was 72 (±9) years; an AVA index <0.6 cm2/m2 and equivocal symptomatic status were found in 90 and 70%, respectively. CPX was feasible in 130 of the 131 patients. The coefficients of repeatability by test-retest were 5.4% (pVO2) and 4.6% (peak O2 pulse). A pVO2 <83% of the expected was predicted by a lower stroke volume at exercise, lower peak heart rate and FEV1, and higher VE/VCO2, but not by AVA index. Equivocal symptomatic status and a low gradient but high valvulo-arterial impedance were associated with a lower pVO2, but not with an inability to increase stroke volume. In total, 18 patients were referred for valve replacement. At 1 year, no cardiovascular deaths had occurred. Conclusions: CPX was feasible and reproducible and provided comprehensive data on exercise physiology. A CPX-guided treatment strategy was safe up to 1 year.

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Solonin, Yuriy, Igorʼ Garnov, Tatʼyana Loginova, and Aleksandr Markov. "Cardiorespiratory System During Bicycle Ergometer Testing in Biathletes and Cross-Country Skiers of the Komi Republic." Journal of Medical and Biological Research, no. 3 (October 5, 2021): 305–15. http://dx.doi.org/10.37482/2687-1491-z068.

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The purpose of this paper was to compare the physiological parameters of the cardiorespiratory system at rest and during the bicycle ergometer test to exhaustion in biathletes and cross-country skiers to identify the difference in the aerobic performance of athletes of two closely related winter sports. Materials and methods: 18 biathletes and 28 male cross-country skiers aged 17–21 years, all with the rank of the Candidate for Master of Sport, were examined. Bicycle ergometer testing to exhaustion was used (Oxycon Pro, Germany), cardiorespiratory parameters were analysed, maximal oxygen consumption (VO2 max) was determined, and the physiological cost of a unit of work was calculated. Results. At rest, a statistically significantly higher level of fitness was revealed in crosscountry skiers compared with biathletes according to such haemodynamic parameters as systolic blood pressure, pulse pressure, and double product. At maximal load, an increased degree of fitness was found in cross-country skiers in terms of power and duration of bicycle ergometer exercise, cardiac and pulse cost per unit of work, as well as gross and specific VO2 max. The body of cross-country skiers under the test to exhaustion (according to oxygen pulse value) functions more efficiently than the body of biathletes. Thus, higher level of fitness among cross-country skiers of the Komi Republic is manifested in the economization of cardiorespiratory functions both at rest and at maximal ergometric loads, as well as in the value of specific physiological cost per unit of work. Increased functionality (or reserves) of cross-country skiers is indicated by such parameters as systolic blood pressure, pulse pressure, double product, respiratory minute volume, oxygen consumption, and energy expenditure. It can be assumed that the aerobic performance of biathletes is lower than that of cross-country skiers as the former receive less training in cross-country skiing.

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Solonin, Yuriy, Igorʼ Garnov, Tatʼyana Loginova, and Aleksandr Markov. "Cardiorespiratory System During Bicycle Ergometer Testing in Biathletes and Cross-Country Skiers of the Komi Republic." Journal of Medical and Biological Research, no. 3 (October 5, 2021): 305–15. http://dx.doi.org/10.37482/2687-1491-z068.

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The purpose of this paper was to compare the physiological parameters of the cardiorespiratory system at rest and during the bicycle ergometer test to exhaustion in biathletes and cross-country skiers to identify the difference in the aerobic performance of athletes of two closely related winter sports. Materials and methods: 18 biathletes and 28 male cross-country skiers aged 17–21 years, all with the rank of the Candidate for Master of Sport, were examined. Bicycle ergometer testing to exhaustion was used (Oxycon Pro, Germany), cardiorespiratory parameters were analysed, maximal oxygen consumption (VO2 max) was determined, and the physiological cost of a unit of work was calculated. Results. At rest, a statistically significantly higher level of fitness was revealed in crosscountry skiers compared with biathletes according to such haemodynamic parameters as systolic blood pressure, pulse pressure, and double product. At maximal load, an increased degree of fitness was found in cross-country skiers in terms of power and duration of bicycle ergometer exercise, cardiac and pulse cost per unit of work, as well as gross and specific VO2 max. The body of cross-country skiers under the test to exhaustion (according to oxygen pulse value) functions more efficiently than the body of biathletes. Thus, higher level of fitness among cross-country skiers of the Komi Republic is manifested in the economization of cardiorespiratory functions both at rest and at maximal ergometric loads, as well as in the value of specific physiological cost per unit of work. Increased functionality (or reserves) of cross-country skiers is indicated by such parameters as systolic blood pressure, pulse pressure, double product, respiratory minute volume, oxygen consumption, and energy expenditure. It can be assumed that the aerobic performance of biathletes is lower than that of cross-country skiers as the former receive less training in cross-country skiing.

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Chung, I., D. Goyal, R. J. MacFadyen, and G. Y. H. Lip. "The effects of maximal treadmill graded exercise testing on haemorheological, haemodynamic and flow cytometry platelet markers in patients with systolic or diastolic heart failure." European Journal of Clinical Investigation 38, no. 3 (March 2008): 150–58. http://dx.doi.org/10.1111/j.1365-2362.2008.01909.x.

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Journal articles on the topic 'Haemodynamic testing'

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