LEFT ATRIAL FUNCTION IN CONGESTIVE HEART FAILURE

ΣΤΗ ΣΥΜΦΟΡΙΤΙΚΗ ΚΑΡΔΙΑΚΗ ΑΝΕΠΑΡΚΕΙΑ(ΣΚΑ) Ο ΑΡΙΣΤΕΡΟΣ ΚΟΛΠΟΣ ΑΦ'ΕΝΟΣ ΜΕΝ ΣΥΜΒΑΛΕΙ ΣΤΗΝ ΠΛΗΡΩΣΗ ΤΗΣ ΑΝΕΠΑΡΚΟΥΣΑΣ ΑΡΙΣΤΕΡΑΣ ΚΟΙΛΙΑΣ ΑΦ'ΕΤΕΡΟΥ ΑΝΑΠΤΥΣΕΙ ΚΑΙ Ο ΙΔΙΟΣ ΑΝΕΠΑΡΚΕΙΑ.ΜΕ ΤΗΝ ΧΡΗΣΙΜΟΠΟΙΗΣΗ ΣΥΝΔΥΑΣΜΟΥ ΤΕΧΝΙΚΩΝ ΗΧΟΚΑΡΔΙΟΓΡΑΦΗΜΑΤΟΣ(ΓΙΑ ΤΗΝ ΜΕΤΡΗΣΗ ΤΩΝ ΔΙΑΣΤΑΣΕΩΝ ΤΟΥ ΑΡΙΣΤΕΡΟΥ ΚΟΛΠΟΥ) ΚΑΙ ΔΕΞΙΟΥ ΚΑΘΕΤΗΡΙΑΣΜΟΥ ~ ΠΑΛΛΙΝΔΡΟΜΟΥ ΚΑΘΕΤΗΡΙΑΣΜΟΥ ΤΟΥ ΑΡΙΣΤΕΡΟΥ ΚΟΛΠΟΥ(ΓΙΑ ΤΗΝ ΜΕΤΡΗΣΗ ΤΩΝ ΠΙΕΣΕΩΝ)ΜΕΛΕΤΗΘΗΚΕ Η ΛΕΙΤΟΥΡΓΙΑ ΤΟΥ ΑΡΙΣΤΕΡΟΥ ΚΟΛΠΟΥ ΣΕ ΥΓΙΕΙΣ ΚΑΙ ΣΕ ΑΣΘΕΝΕΙΣ ΜΕ ΣΚΑ ΣΤΗΝ ΗΡΕΜΙΑ ΚΑΙ ΜΕ ΤΗΝ ΕΠΙΔΡΑΣΗ ΔΙΑΦΟΡΩΝ ΦΑΡΜΑΚΟΛΟΓΙΚΩΝ ΠΑΡΑΓΟΝΤΩΝ ΠΟΥ ΧΡΗΣΙΜΟΠΟΙΟΥΝΤΑΙ ΣΤΗΝ ΚΑΘΗΜΕΡΙΝΗ ΚΛΙΝΙΚΗ ΠΡΑΞΗ ΚΑΙ ΠΡΟΚΑΛΟΥΝ ΟΥΣΙΩΔΗΣ ΑΙΜΟΔΥΝΑΜΙΚΕΣ ΜΕΤΑΒΟΛΕΣ.ΤΑ ΚΥΡΙΑ ΕΥΡΗΜΑΤΑ ΑΥΤΗΣ ΤΗΣ ΜΕΛΕΤΗΣ ΕΙΝΑΙ ΟΤΙ:*Η ΜΕΤΑΒΟΛΗ ΤΗΣ ΠΛΗΡΩΣΗΣ ΤΗΣ ΑΡΙΣΤΕΡΑΣ ΚΟΙΛΙΑΣ ΣΤΗΝ ΣΥΜΦΟΡΗΤΙΚΗ ΚΑΡΔΙΑΚΗ ΑΝΕΠΑΡΚΕΙΑ ΜΕ ΤΗ ΔΡΑΣΗ ΔΙΑΦΟΡΩΝ ΦΑΡΜΑΚΩΝ ΕΞΗΓΕΙΤΑΙ ΟΧΙ ΜΟΝΟ ΑΠΟ ΤΗΝ ΒΕΛΤΙΩΣΗ ΤΗΣ ΔΙΑΣΤΟΛΙΚΗΣ ΛΕΙΤΟΥΡΓΙΑΣ ΤΗΣ ΑΡΙΣΤΕΡΑΣ ΚΟΙΛΙΑΣ ΑΛΛΑ ΕΠΙΣΗΣ ΑΠΟ ΕΠΙΠΛΕΟΝ ΠΡΟΣΑΡΜΟΣΤΙΚΕΣ ΜΕΤΑΒΟΛΕΣ ΣΤΗΝ ΛΕΙΤΟΥΡΓΙΑ ΤΟΥ ΑΡΙΣΤΕΡΟΥ ΚΟΛΠΟΥ.*ΑΣΘΕΝΕΙΣ ΜΕ ΣΥΜΦΟΡΗΤΙΚΗ ΚΑΡΔΙΑΚΗ ΑΝΕΠΑΡΚΕΙΑ ΕΧΟΥΝ ΑΥΞΗΜΕΝΟΥΣ ΟΓΚΟΥΣ ΑΡΙΣΤΕΡΟΥ ΚΟΛΠΟΥ ΚΑΙ ΜΕΙΩΜΕΝΗ ΛΕΙΤΟΥΡΓΙΚΟΤΗΤΑ ΟΠΩΣ ΥΠΟΔΕΙΚΝΥΕΤΑΙ ΑΠΟ ΤΟ ΧΑΜΗΛΟ ΚΛΑΣΜΑ ΕΝΕΡΓΗΤΙΚΗΣ ΚΕΝΩΣΗΣ.*Η ΑΠΩΛΕΙΑ ΤΗΣ ΑΝΤΙΣΤΑΘΜΙΣΤΙΚΗΣ ΛΕΙΤΟΥΡΓΙΑΣ ΑΝΤΙΚΑΤΟΠΤΡΙΖΕΙ ΤΟ ΑΥΞΗΜΕΝΟ ΦΟΡΤΙΟ ΠΟΥ ΔΕΧΕΤΑΙ ΤΟ ΜΥΟΚΑΡΔΙΟ ΤΟΥ ΑΡΙΣΤΕΡΟΥ ΚΟΛΠΟΥ ΠΟΥ ΜΠΟΡΕΙ ΝΑ ΟΔΗΓΗΣΕΙ ΣΤΗΝ ΔΙΑΤΑΣΗ ΤΟΥ ΚΑΙ ΣΤΗΝ ΕΝΔΟΓΕΝΗ ΔΥΣΛΕΙΤΟΥΡΓΙΑ.*Η ΔΙΑΤΑΡΑΧΗ ΤΗΣ ΛΕΙΤΟΥΡΓΙΑΣ ΤΟΥ ΑΡΙΣΤΕΡΟΥ ΚΟΛΠΟΥ ΑΠΟΤΕΛΕΙ ΔΥΝΗΤΙΚΟΥ ΜΗΧΑΝΙΣΜΟ ΤΗΣ ΜΕΙΩΜΕΝΗΣ ΠΛΗΡΩΣΗΣ ΤΗΣ ΑΡΙΣΤΕΡΑΣ ΚΟΙΛΙΑΣ ΣΕ ΑΣΘΕΝΕΙΣ ΜΕ ΣΥΜΦΟΡΗΤΙΚΗ ΚΑΡΔΙΑΚΗ ΑΝΕΠΑΡΚΕΙΑ ΚΑΙ ΕΠΗΡΕΑΣΜΕΝΗ ΚΟΙΛΙΑΚΗ ΛΕΙΤΟΥΡΓΙΑ.IN CONGESTIVE HEART FAILURE(CHF)LEFT ATRIAL CONTRIBUTE TO THE FAILING LEFT VENTRICLE FILLING AND UNDERGO ITSELF FAILURE.USING COMBINED TECHNIQUES OF ECHOCARDIOGRAM(FOR LEFT ATRIAL DIMENSION MEASUREMENT)AND RIGHT HEART CATHETERIZATION OR RETROGRADE NON-TRANSSEPTAL LEFT ATRIAL CATHETERIZATION(FOR PRESSURE MEASUREMENTS)LEFT ATRIAL FUNCTION WAS EVALUATED IN NORMAL SUBJECTS AND IN PATIENTS WITH CHF AT REST AND AFTER PHARMACOLOGICAL INTERVENTIONS THAT ARE COMMON IN THE CLINICAL PRACTISE.THE MAIN FINDINGS OF THIS STUDY IN CHF WERE:*CHANGESIN LEFT VENTRICULAR FILLING AFTER PHARMACOLOGICAL INTERVENTIONS ARE ATTRIBUTED NOT ONLY TO LEFT VENTRICULAR DIASTOLIC FUNCTION CHANGES BUT ALSO TO CO-ORDINATED CHANGES IN LEFT ATRIAL FUNCTION.*INVASIVE AND NON-INVASIVE INDICES OF LEFT ATRIAL SYSTOLIC AND DIASTOLIC FUNCTION CAN EVALUATE THE ATRIO-VENTRICULARCOUPLING.*IN GONGESTIVE HEART FAILURE LEFT ATRIAL VOLUME WAS INCREASED BUT LEFT ATRIAL EJECTION FRACTION WAS DECREASED.THUS,THE EMPTYING VOLUME REMAINEDCONSTANT OR MIGHT INCREASE.*THE PATTERN OF MITRAL FLOW VELOCITY WAS SIGNIFICANTLY ALTERED DURING HEMODYNAMIC INTERVENTIONS.ATRIAL KICK WAS A COMPENSATORYRESPONSE TO THE DECREASED EARLY FILLING.LOSE OF THIS ATRIAL FUNCTION MAY BE DUE TO THE INCREASED LOAD OF THE LEFT ATRIUM WHICH MAY CAUSE INTRINSIC LEFT ATRIAL DYSFUNCTION.*LEFT ATRIAL DYSFUNCTION DETERIORATE THE DECREASE LEFT VENTRICULAR FILLING IN PATIENTS WITH CHF.*NON.INVASIVE INDICES WHICH DISCRIMINATE INTRINSIC MYOCARDIAL DYSFUNCTION AND EXTRINSIC FACTORS (LOADING CONDITIONS)MIGHT BE THE LEFT ATRIAL EJECTION FORCE AND THE PR

B-type natriuretic peptide predicts postoperative cardiac events and mortality after elective open abdominal aortic aneurysm repair

Objective: The aim of this study was to determine if a single preoperative B-type natriuretic peptide (BNP) level correlated with perioperative cardiac events, cardiac death, and all-cause mortality in elective open abdominal aortic aneurysm (AAA) repair in the short term, intermediate term, and long term.<p></p> Methods: A prospective, 2-year multicenter observational cohort study in the three vascular units in Glasgow was performed. All patients who were admitted for elective open AAA repair were recruited. Preoperative BNP levels were performed and batch analyzed at the end of the study. Postoperative screening for cardiac events (nonfatal myocardial infarction and cardiac death) was performed at 2, 5, and 30 days. Follow-up for all-cause mortality was sustained to a minimum of 3 years, where possible.<p></p> Results: A total of 106 of 111 patients were recruited. Median BNP concentrations were higher in the 16 patients (15%) with immediate postoperative cardiac events (P = .001) and the five with cardiac death (P = .043). Area under the receiver-operating characteristic (AUC) curve analysis indicated BNP concentrations of 99.5 pg/mL best predicted cardiac events (AUC, 0.927), and 448 pg/mL predicted cardiac death (AUC, 0.963). BNP also predicted all-cause mortality in the short-term (P = .028), intermediate-term (P < .001), and long-term (P < .001) postoperative periods.<p></p> Conclusions: Preoperative serum BNP concentration predicted postoperative cardiac events, cardiac death, and all-cause mortality in patients undergoing elective open AAA repair on short-term, intermediate-term, and long-term follow-up on an individual basis with greater accuracy than currently available risk prediction tools.<p></p&gt

Psychological stress and arterial stiffness in Korean Americans

OBJECTIVE: Arterial stiffness is identified as a causative factor for hypertension. The purpose of this study was to explore the relationship between psychological stress and arterial stiffness in Korean Americans. METHODS: A convenience sample of 102 Korean Americans (aged 21–60 years, 60% women) was recruited from North Carolina. Psychological stress was measured by the Perceived Stress Scale, the Social, Attitudinal, Familiar, and Environmental (SAFE) Acculturative Stress Scale, and the Spielberger’s State-Trait Anxiety Inventory. Arterial stiffness was measured by carotid-femoral pulse wave velocity (cfPWV) using the SphygmoCor system (AtCor Medical, Australia). RESULTS: This study shows that the emotional stress response, measured by anxiety, significantly predicted arterial stiffness (β= .25, p=.008), independently of such confounding factors as age, mean arterial pressure (MAP), gender, body mass index, smoking, education, and income. Anxiety was neither related to age (r=.12, p=.212) nor MAP (r=.14, p=.151). Additionally, this sample of Korean Americans had higher levels of psychological stress when compared to previous findings from studies of other racial/ethnic groups in the U.S. CONCLUSION: Findings demonstrate that anxiety is a significant and independent determinant of arterial stiffness. Given that anxiety was not related to MAP, these findings suggest that arterial stiffness may be a pathway to explain the connection between anxiety and hypertension risk. Studies that scrutinize the relationship between anxiety and arterial stiffness are an important next step for future research. Further studies are also recommended to explore cultural factors and individual characteristics that may affect anxiety in Korean Americans