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Aroch, Roman
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Henein, M. Y., Tossavainen, E., Aroch, R., Söderberg, S. & Lindqvist, P. (2019). Can Doppler echocardiography estimate raised pulmonary capillary wedge pressure provoked by passive leg lifting in suspected heart failure?. Clinical Physiology and Functional Imaging, 39(2), 128-134
Åpne denne publikasjonen i ny fane eller vindu >>Can Doppler echocardiography estimate raised pulmonary capillary wedge pressure provoked by passive leg lifting in suspected heart failure?
Vise andre…
2019 (engelsk)Inngår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 39, nr 2, s. 128-134Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

AIMS: Non-invasive estimation of left ventricular filling pressure (LVFP) during stress is important for explaining exertional symptoms in patients with heart failure (HF). The aim of this study was to evaluate ability of Doppler echocardiographic measures of elevated LVFP with passive leg lifting (PLL) in patients with suspected HF.

METHODS: Twenty-nine patients with clinical signs of HF who underwent simultaneous Doppler echocardiography and right heart catheterization (RHC) at rest and during PLL were consecutively investigated. Seventeen patients had normal PCWP (≤15 mmHg) at rest and during PLL and 12 with normal PCWP at rest but >15 mmHg with PLL. Conventional echo and 2D strain were used to assess early diastolic blood flow velocity (E), LV strain rate during early diastole (LVSRe), left atrial SR during atrial contraction (LASRa) and myocardial tissue Doppler velocities to assess lateral e' and further calculate E/e' and E/LVSRe and their relationship with PCWP, at rest and during PLL.

RESULTS: Resting LAVI (β = 0·45, P = 0·009) and LASRa (β = -0·51, P = 0·004) were independently related to PCWP during PLL. Also, LASRa (β = -0·77, P<0·001), E/e' (β = 0·40, P = 0·04) and E/LVSRe (β = 0·47, P = 0·021) during PLL correlated with PCWP during PLL. Multiple regression analysis identified E/LVSRe (β = 0·46, P = 0·001) and LASRa (β = -0·58, P = 0·002) during PLL as being independently associated with PCWP during PLL.

CONCLUSION: Left atrial volume and myocardial contraction (LASRa) at rest both predict unstable LV filling pressures measured as raised PCWP when provoked by PLL. Furthermore, LASRa at PLL seems to have the strongest association to PCWP during PLL.

sted, utgiver, år, opplag, sider
John Wiley & Sons, 2019
Emneord
deformation, passive leg lifting, pulmonary capillary wedge pressures, strain rate
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-152550 (URN)10.1111/cpf.12547 (DOI)000458316200003 ()30298591 (PubMedID)
Forskningsfinansiär
Swedish Heart Lung Foundation
Tilgjengelig fra: 2018-10-11 Laget: 2018-10-11 Sist oppdatert: 2019-05-10bibliografisk kontrollert
Pösö, T., Winsö, O., Aroch, R. & Kesek, D. (2014). Perioperative fluid guidance with transthoracic echocardiography and pulse-contour device in morbidly obese patients. Obesity Surgery, 24(12), 2117-2125
Åpne denne publikasjonen i ny fane eller vindu >>Perioperative fluid guidance with transthoracic echocardiography and pulse-contour device in morbidly obese patients
2014 (engelsk)Inngår i: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 24, nr 12, s. 2117-2125Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background

In bariatric surgery, non-or mini-invasive modalities for cardiovascular monitoring are addressed to meet individual variability in hydration needs. The aim of the study was to compare conventional monitoring to an individualized goal-directed therapy (IGDT) regarding the need of perioperative fluids and cardiovascular stability. 

Methods

Fifty morbidly obese patients were consecutively scheduled for laparoscopic bariatric surgery (ClinicalTrials.gov Identifier: NCT01873183). The intervention group (IG, n=30) was investigated preoperatively with transthoracic echocardiography (TTE) and rehydrated with colloid fluids if a low level of venous return was detected. During surgery, IGDT was continued with a pulse-contour device (FloTrac (TM)). In the control group (CG, n=20), conventional monitoring was conducted. The type and amount of perioperative fluids infused, vasoactive/inotropic drugs administered, and blood pressure levels were registered. 

Results

In the IG, 213 +/- 204 mL colloid fluids were administered as preoperative rehydration vs. no preoperative fluids in the CG (p<0.001). During surgery, there was no difference in the fluids administered between the groups. Mean arterial blood pressures were higher in the IG vs. the CG both after induction of anesthesia and during surgery (p=0.001 and p=0.001). 

Conclusions

In morbidly obese patients suspected of being hypovolemic, increased cardiovascular stability may be reached by preoperative rehydration. The management of rehydration should be individualized. Additional invasive monitoring does not appear to have any effect on outcomes in obesity surgery.

Emneord
bariatric surgery, morbid obesity, rehydration, venous return, transthoracic echocardiography, perioperative monitoring, goal-directed therapy, stroke volume variation, preoperative assessment
HSV kategori
Forskningsprogram
anestesiologi
Identifikatorer
urn:nbn:se:umu:diva-87459 (URN)10.1007/s11695-014-1329-4 (DOI)000346780400017 ()24902655 (PubMedID)
Tilgjengelig fra: 2014-04-02 Laget: 2014-04-01 Sist oppdatert: 2018-06-08bibliografisk kontrollert
Pösö, T., Kesek, D., Aroch, R. & Winsö, O. (2013). Morbid obesity and optimization of preoperative fluid therapy. Obesity Surgery, 23(11), 1799-1805
Åpne denne publikasjonen i ny fane eller vindu >>Morbid obesity and optimization of preoperative fluid therapy
2013 (engelsk)Inngår i: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 23, nr 11, s. 1799-1805Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: Preoperative venous return (VR) optimization and adequate blood volume is essential in management of morbidly obese patients (MO) in order to avoid perioperative circulatory instability. In this study, all subjects underwent a preoperative 3-week preparation by rapid-weight-loss-diet (RWL) as part of their treatment program for bariatric surgery.

METHODS: This is a prospective, observational study of 34 morbidly obese patients consecutively scheduled for bariatric surgery at Sunderby County Hospital, Lulea, Sweden. Preoperative transthoracic echocardiography (TTE) was performed in the awake state before and after intravascular volume challenge (VC) of 6 ml colloids/kg ideal body weight (IBW). Effects of standardized VC were evaluated by TTE. Dynamic and non-dynamic echocardiographic indices for VC were studied. Volume responsiveness and level of VR before and after VC were assessed by TTE. An increase of stroke volume >/=13 % was considered as a volume responder.

RESULTS: Twenty-nine out of 34 patients were volume responders. After VC, a majority of patients (23/34) were euvolemic, and only 2/34 were hypovolemic. Post-VC hypervolemia was observed in 9/34 of patients.

CONCLUSIONS: The IBW-based volume challenge regime was found to be suitable for preoperative rehydration of RWL-prepared MO. Most of the patients were volume responders. Preoperative state of VR was not associated with volume responsiveness. IBW estimates and appropriate monitoring avoids potential hyperhydration in MO. For VC assessment, conventional Doppler indices were found to be more suitable compared to tissue Doppler, giving sufficient information on pressure-volume correlation of the left ventricle in morbidly obese.

sted, utgiver, år, opplag, sider
Springer Science+Business Media B.V., 2013
Emneord
Morbid obesity, Preoperative volume challenge, Transthoracic echocardiography, TTE, Rapid weight loss, Bariatric surgery, Diastolic function, Rehydration, Venous return
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-71363 (URN)10.1007/s11695-013-0987-y (DOI)000325185500012 ()23695437 (PubMedID)
Tilgjengelig fra: 2013-05-27 Laget: 2013-05-27 Sist oppdatert: 2018-06-08bibliografisk kontrollert
Pösö, T., Kesek, D., Aroch, R. & Winsö, O. (2013). Rapid weight loss is associated with preoperative hypovolemia in morbidly obese patients. Obesity Surgery, 23(3), 306-313
Åpne denne publikasjonen i ny fane eller vindu >>Rapid weight loss is associated with preoperative hypovolemia in morbidly obese patients
2013 (engelsk)Inngår i: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 23, nr 3, s. 306-313Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: In morbidly obese patients (MO), adequate levels of venous return (VR) and left ventricular filling pressures (LVFP) are crucial in order to augment perioperative safety. Rapid weight loss (RWL) preparation with very low calorie diet is commonly used aiming to facilitate bariatric surgery. However, the impact of RWL on VR and LVFP is poorly studied.

METHODS: In this prospective, controlled, single-center study, we hypothesized that RWL-prepared MO prior to bariatric surgery can be hypovolemic (i.e., low VR) and compared MO to lean controls with conventional overnight fasting. Twenty-eight morbidly obese patients were scheduled consecutively for bariatric surgery and 19 lean individuals (control group, CG) for elective general surgery. Preoperative assessment of VR, LVFP, and biventricular heart function was performed by a transthoracic echocardiography (TTE) protocol to all patients in the awake state. Assessment of VR and LVFP was made by inferior vena cava maximal diameter (IVCmax) and inferior vena cava collapsibility index- (IVCCI) derived right atrial pressure estimations.

RESULTS: A majority of MO (71.4 %) were hypovolemic vs. 15.8 % of lean controls (p < 0.001, odds ratio = 13.3). IVCmax was shorter in MO than in CG (p < 0.001). IVCCI was higher in MO (62.1 +/- 23 %) vs. controls (42.6 +/- 20.8; p < 0.001). Even left atrium anterior-posterior diameter was shorter in MO compared to CG.

CONCLUSIONS: Preoperative RWL may induce hypovolemia in morbidly obese patients. Hypovolemia in MO was more common vs. lean controls. TTE is a rapid and feasible tool for assessment of preload even in morbid obesity.

sted, utgiver, år, opplag, sider
Springer-Verlag New York, 2013
Emneord
Morbid obesity, Transthoracic echocardiography, TTE, Rapid weight loss, Preoperative assessment, Venous return, Right atrial pressure, Left ventricular filling pressure, Inferior vena cava, IVCCI
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-62758 (URN)10.1007/s11695-012-0790-1 (DOI)000315434100005 ()1708-0428 (Electronic) 0960-8923 (Linking) (ISBN)
Tilgjengelig fra: 2012-12-17 Laget: 2012-12-17 Sist oppdatert: 2018-06-08bibliografisk kontrollert
A'Roch, R., Gustafsson, U., Johansson, G., Poelaert, J. & Haney, M. (2012). Left ventricular strain and peak systolic velocity: responses to controlled changes in load and contractility, explored in a porcine model. Cardiovascular Ultrasound, 10(22)
Åpne denne publikasjonen i ny fane eller vindu >>Left ventricular strain and peak systolic velocity: responses to controlled changes in load and contractility, explored in a porcine model
Vise andre…
2012 (engelsk)Inngår i: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 10, nr 22Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: Tissue velocity echocardiography is increasingly used to evaluate global and regional cardiac function. Previous studies have suggested that the quantitative measurements obtained during ejection are reliable indices of contractility, though their load-sensitivity has been studied in different settings, but still remains a matter of controversy. We sought to characterize the effects of acute load change (both preload and afterload) and change in inotropic state on peak systolic velocity and strain as a measure of LV contractility.

METHODS: Thirteen anesthetized juvenile pigs were studied, using direct measurement of left ventricular pressure and volume and transthoracic echocardiography. Transient inflation of a vena cava balloon catheter produced controlled load alterations. At least eight consecutive beats in the sequence were analyzed with tissue velocity echocardiography during the load alteration and analyzed for change in peak systolic velocities and strain during same contractile status with a controlled load alteration. Two pharmacological inotropic interventions were also included to generate several myocardial contractile conditions in each animal.

RESULTS: Peak systolic velocities reflected the drug-induced changes in contractility in both radial and longitudinal axis. During the acute load change, the peak systolic velocities remain stable when derived from signal in the longitudinal axis and from the radial axis. The peak systolic velocity parameter demonstrated no strong relation to either load or inotropic intervention, that is, it remained unchanged when load was systematically and progressively varied (peak systolic velocity, longitudinal axis, control group beat 1- 5.72 +/- 1.36 with beat 8- 6.49 +/- 1.28 cm/sec, 95% confidence interval), with the single exception of the negative inotropic intervention group where peak systolic velocity decreased a small amount during load reduction (beat 1- 3.98 +/- 0.92 with beat 8- 2.72 +/- 0.89 cm/sec). Systolic strain, however, showed a clear degree of load-dependence.

CONCLUSIONS: Peak systolic velocity appears to be load-independent as tested by beat-to-beat load reduction, while peak systolic strain appears to be load-dependent in this model. Peak systolic velocity, in a controlled experimental model where successive beats during load alteration are assessed, has a strong relation to contractility. Peak systolic velocity, but not peak strain rate, is largely independent of load, in this model. More study is needed to confirm this finding in the clinical setting.

Emneord
Tissue velocities echocardiography; Ventricular function; Load
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-59415 (URN)10.1186/1476-7120-10-22 (DOI)1476-7120 (Electronic) 1476-7120 (Linking) (ISBN)
Merknad

A'roch, Roman Gustafsson, Ulf Johansson, Goran Poelaert, Jan Haney, Michael Journal article Cardiovascular ultrasound Cardiovasc Ultrasound. 2012 May 28;10(1):22.

Tilgjengelig fra: 2012-09-13 Laget: 2012-09-13 Sist oppdatert: 2018-06-08bibliografisk kontrollert
A'Roch, R., Gustafsson, U., Poelaert, J., Johansson, G. & Haney, M. (2012). Left ventricular twist is load-dependent as shown in a large animal model with controlled cardiac load. Cardiovascular Ultrasound, 10(26)
Åpne denne publikasjonen i ny fane eller vindu >>Left ventricular twist is load-dependent as shown in a large animal model with controlled cardiac load
Vise andre…
2012 (engelsk)Inngår i: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 10, nr 26Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: Left ventricular rotation and twist can be assessed noninvasively by speckle tracking echocardiography. We sought to characterize the effects of acute load change and change in inotropic state on rotation parameters as a measure of left ventricular (LV) contractility.

METHODS: Seven anesthetised juvenile pigs were studied, using direct measurement of left ventricular pressure and volume and simultaneous transthoracic echocardiography. Transient inflation of an inferior vena cava balloon (IVCB) catheter produced controlled load reduction. First and last beats in the sequence of eight were analysed with speckle tracking (STE) during the load alteration and analysed for change in rotation/twist during controlled load alteration at same contractile status. Two pharmacological inotropic interventions were also included to examine the same hypothesis in additionally conditions of increased and decreased myocardial contractility in each animal. Paired comparisons were made for different load states using the Wilcoxon's Signed Rank test.

RESULTS: The inferior vena cava balloon occlusion (IVCBO) load change compared for first to last beat resulted in LV twist increase (11.67degrees +/-2.65degrees vs. 16.17degrees +/-3.56degrees respectively, p < 0.004) during the load alteration and under adrenaline stimulation LV twist increase 12.56degrees +/-5.1degrees vs. 16.57degrees +/-4.6degrees (p < 0.013), and though increased, didn't reach significance in negative inotropic condition. Untwisting rate increased significantly at baseline from 41.7degrees/s +/-41.6degrees/s vs.122.6degrees/s +/-55.8degrees/s (P < 0.039) and under adrenaline stimulation untwisting rate increased (55.3degrees/s +/-3.8degrees/s vs.111.4degrees/s +/-24.0degrees/s (p < 0.05), but did not systematically changed in negative inotropic condition.

CONCLUSIONS: Peak systolic LV twist and peak early diastolic untwisting rate are load dependent. Differences in LV load should be included in the interpretation when serial measures of twist are compared.

Emneord
Echocardiography; Ventricular function; Rotation; Torsion; Load
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-59414 (URN)10.1186/1476-7120-10-26 (DOI)1476-7120 (Electronic) 1476-7120 (Linking) (ISBN)
Merknad

A'roch, Roman Gustafsson, Ulf Poelaert, Jan Johansson, Goran Haney, Michael Journal article Cardiovascular ultrasound Cardiovasc Ultrasound. 2012 Jun 25;10(1):26.

Tilgjengelig fra: 2012-09-13 Laget: 2012-09-13 Sist oppdatert: 2018-06-08bibliografisk kontrollert
A'roch, R. (2011). Left ventricular function's relation to load, experimental studies in a porcine model. (Doctoral dissertation). Umeå: Umeå universitet
Åpne denne publikasjonen i ny fane eller vindu >>Left ventricular function's relation to load, experimental studies in a porcine model
2011 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Background: Loading conditions are recognized to influence ventricular function according to the Starling relationship for length/stretch and force.  Many modern echocardiographic parameters which have been announced as describing ventricular function and contractile status, may be confounded by uncontrolled and unmeasured load.  These studies aimed to measure the relation between four differ­ent types of assessments of ventricular dysfunction and degrees of load.  Study examined the ‘myo­cardial performance index’ (MPI).  Study II examined long axis segmental mechanical dyssynchrony.  Study III examined tissue velocities, and Study IV examined ventricular twist.  All studies aimed to describe the relation of these parameters both to load and to inotropic changes.

Methods:  In anesthetized juvenile pigs, left ventricular (LV) pressure and volume were measured continuously and their relationship (LVPVR) was analysed.  Preload alterations were brought about by inflation of a balloon tipped catheter in the inferior vena cava (IVCBO).  Inotropic interventions were brought about by either an overdose of anesthetic (combine intravenous pentobarbital and inhaled isoflurane, Study I), or beta blocker and calcium channel blocker given in combination (Stud­ies III and IV).  In one study (II), global myocardial injury and dysfunction was induced by endotoxin infusion.  MPI measurements were derived from LVPVR heart cycle intervals for isovolumic contrac­tion and relaxation as well as ejection time.  Long axis segmental dyssynchrony was derived by ana­lyzing for internal flow and time with segmental dyssynchronous segment volume change during systole, hourly before and during 3 hours of endotoxin infusion.  Myocardial tissue velocities were measured during IVCBO at control, during positive and then later negative inotropic interventions.  The same for apical and base circumferential rotational velocities by speckle tracking.  Load markers (including end-diastolic volume) were identified for each beat, and the test parameters were analysed together with load for a relation.  The test parameters were also tested during single apneic beats for a relation to inotropic interventions.

Results: MPI demonstrated a strong and linear relationship to both preload and after-load, and this was due to changes in ejection time, and not the isovolumic intervals.  Long axis segmental dyssyn­chrony increased during each hour of endotoxin infusion and global myocardial injury.  This dysyn­chrony parameter was independent of load when tested by IVCBO. Peak systolic velocities were strongly load-independent, though not in all the inotropic situations and by all measurement axes.  Peak systolic strain was load-dependent, and not strongly related to inotropic conditions.  Peak sys­tolic LV twist and untwist were strongly load-dependent.

Conclusions: MPI is strongly load-dependent, and can vary widely in value for the same contractile status if the load is varied.  Mechanical dyssynchrony measures are load-independen in health and also in early global endotoxin myocardial injury and dysfunction.  Peak sytole velocities are a clinically robust parameter of LV regional and global performance under changing load, though peak systolic strain seems to be load-dependent.  Left ventricular twist and untwist are load-dependent in this pig model.

sted, utgiver, år, opplag, sider
Umeå: Umeå universitet, 2011. s. 67
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1425
Emneord
heart function, preload, afterload, contractility, myocardial tissue velocity, speckle tracking
HSV kategori
Forskningsprogram
kardiologi
Identifikatorer
urn:nbn:se:umu:diva-43605 (URN)978-91-7459-225-2 (ISBN)
Disputas
2011-05-27, Sal B, 9 tr, Tandläkarhögskolan, Norrlands Universitetssjukhus, Umeå, 13:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2011-05-06 Laget: 2011-05-04 Sist oppdatert: 2018-06-08bibliografisk kontrollert
A'Roch, R., Steendijk, P., Oldner, A., Weitzberg, E., Konrad, D., Johansson, G. & Haney, M. (2009). Left ventricular mechanical dyssynchrony is load independent at rest and during endotoxaemia in a porcine model. Acta Physiologica, 196(4), 375-383
Åpne denne publikasjonen i ny fane eller vindu >>Left ventricular mechanical dyssynchrony is load independent at rest and during endotoxaemia in a porcine model
Vise andre…
2009 (engelsk)Inngår i: Acta Physiologica, ISSN 1748-1708, E-ISSN 1748-1716, Vol. 196, nr 4, s. 375-383Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

AIM: In diseased or injured states, the left ventricle displays higher degrees of mechanical dyssynchrony. We aimed at assessing mechanical dyssynchrony ranges in health related to variation in load as well as during acute endotoxin-induced ventricular injury.

METHODS: In 16 juvenile anaesthetized pigs, a five-segment conductance catheter was placed in the left ventricle as well as a balloon-tipped catheter in the inferior vena cava. Mechanical dyssynchrony during systole, including dyssynchrony time in per cent during systole and internal flow fraction during systole, were measured at rest and during controlled pre-load reduction sequences, as well as during 3 h of endotoxin infusion (0.25 microg kg(-)1 h(-1)).

RESULTS: Systolic dyssynchrony and internal flow fraction did not change during the course of acute beat-to-beat pre-load alteration. Endotoxin-produced acute pulmonary hypertension by left ventricular dyssynchrony measures was not changed during the early peak of pulmonary hypertension. Endotoxin ventricular injury led to progressive increases in systolic mechanical segmental dyssynchrony (7.9 +/- 1.2-13.0 +/- 1.3%) and ventricular systolic internal flow fraction (7.1 +/- 2.4-16.6 +/- 2.8%), respectively for baseline and then at hour 3. There was no localization of dyssynchrony changes to segment or region in the ventricular long axis during endotoxin infusion.

CONCLUSION: These results suggest that systolic mechanical dyssynchrony measures may be load independent in health and during acute global ventricular injury by endotoxin. More study is needed to validate ranges in health and disease for parameters of mechanical dyssynchrony.

Emneord
endotoxaemia; swine; ventricular function
Identifikatorer
urn:nbn:se:umu:diva-31397 (URN)10.1111/j.1748-1716.2009.01962.x (DOI)19302073 (PubMedID)1748-1716 (Electronic) (ISBN)
Merknad
A'roch, R Steendijk, P Oldner, A Weitzberg, E Konrad, D Johansson, G Haney, M Research Support, Non-U.S. Gov't England Acta physiologica (Oxford, England) Acta Physiol (Oxf). 2009 Aug;196(4):375-83. Epub 2009 Mar 19.Tilgjengelig fra: 2010-02-10 Laget: 2010-02-10 Sist oppdatert: 2018-06-08bibliografisk kontrollert
Haney, M., A'Roch, R., Johansson, G., Poelaert, J. & Biber, B. (2007). Beat-to-beat change in myocardial performance index related to load. Acta Anaesthesiologica Scandinavica, 51(5), 545-552
Åpne denne publikasjonen i ny fane eller vindu >>Beat-to-beat change in myocardial performance index related to load
Vise andre…
2007 (engelsk)Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 51, nr 5, s. 545-552Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: This study was designed to assess the relationship of the "myocardial performance index" (MPI) to the beat-by-beat change in pre-load with static or unchanged contractile status.

METHODS: Eight anesthetized juvenile pigs were studied using direct measurement of the left ventricular pressure and volume. Transient inflation of a vena cava balloon catheter produced controlled pre-load alterations. Consecutive beats were analyzed, grouped for first, second, third, etc. during the pre-load alteration, and evaluated for the change in MPI during the same contractile status with a controlled pre-load alteration. Two pharmacologic inotropic interventions were also included to generate several myocardial conditions in each animal.

RESULTS: MPI demonstrated a strong linear relationship to the pre-load and after-load. MPI increased progressively during decreasing end-diastolic volume, mostly related to changes in ejection time. MPI was observed at the same level for three different myocardial function conditions (all eight animals), with a different relationship between MPI and pre-load noted for each observation.

CONCLUSIONS: MPI is strongly load dependent, and can vary widely in value for the same contractile status if the load is varied. The use of this index in critically ill patients should be limited in this respect. Further work is needed to establish the relationship of MPI to load and contractile status.

Emneord
Animals, Blood Pressure/physiology, Epinephrine/pharmacology, Isoflurane/pharmacology, Myocardial Contraction/*drug effects/physiology, Myocardial Revascularization/methods, Stroke Volume, Swine, Vasoconstrictor Agents/pharmacology
Identifikatorer
urn:nbn:se:umu:diva-7139 (URN)10.1111/j.1399-6576.2007.01287.x (DOI)17430314 (PubMedID)
Tilgjengelig fra: 2008-01-04 Laget: 2008-01-04 Sist oppdatert: 2018-06-09bibliografisk kontrollert
Grenander, A., Bredbacka, S., Rydvall, A., Aroch, R., Edner, G., Koskinen, L.-O. D. & Olivecrona, M. (2001). Antithrombin treatment in patients with traumatic brain injury: a pilot study. J Neurosurg Anesthesiol, 13(1), 49-56
Åpne denne publikasjonen i ny fane eller vindu >>Antithrombin treatment in patients with traumatic brain injury: a pilot study
Vise andre…
2001 (engelsk)Inngår i: J Neurosurg Anesthesiol, Vol. 13, nr 1, s. 49-56Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

This study will determine if early administration of antithrombin concentrate to patients with traumatic brain injury (TBI) can inhibit or significantly shorten the time of coagulopathy. The progress of brain injury monitored by computed tomographic scan (CT) was also assessed, as was the time needed for intensive care and outcome related to Glasgow outcome scale (GOS). Twenty-eight patients with isolated brain trauma verified with CT were included in either of two parallel groups. The Glasgow coma score (GCS) was mean 7.5, and median 7.0; signifying a moderate to severe traumatic brain injury but with a mortality of only 3.5%. The patients randomized to antithrombin treatment received a total of 100 U/kg BW during 24 hours. To measure hypercoagulability, soluble fibrin (SF), D-dimer (D-d), and thrombin-antithrombin complex (TAT) were assessed together with antithrombin (AT) and routine coagulation tests. Before treatment, SF, D-d, and TAT were markedly increased in both groups. Soluble fibrin and D-dimer (measured after treatment began) appeared to decrease faster in the AT group, and there was a statistically significant difference between the groups at 36 hours for SF and at 36 hours, 48 hours, and at Day 3 for D-d. Thrombin-antithrombin complex levels were very high in both groups but, surprisingly, showed no significant difference between the groups. The authors conclude that antithrombin concentrate administered to patients with severe TBI resulted in a marginal reduction of hypercoagulation. We could not detect any obvious influence by antithrombin on brain injury progress, on CT, or on outcome or time needed for intensive care.

Emneord
Adolescent, Adult, Aged, Antithrombins/*therapeutic use, Blood Coagulation Tests, Brain Injuries/*drug therapy, Female, Glasgow Outcome Scale, Humans, Male, Middle Aged, Pilot Projects, Prospective Studies, Serine Proteinase Inhibitors/*therapeutic use
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-31426 (URN)0898-4921 (Print) (ISBN)
Merknad

Grenander, A Bredbacka, S Rydvall, A Aroch, R Edner, G Koskinen, L O Olivecrona, M Clinical Trial Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't United States Journal of neurosurgical anesthesiology J Neurosurg Anesthesiol. 2001 Jan;13(1):49-56.

Tilgjengelig fra: 2010-02-10 Laget: 2010-02-10 Sist oppdatert: 2019-04-17
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