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Panprom C, Pattanapon N, Petchdee S. The effects of anesthetic drug choice on heart rate variability and echocardiography parameters in cats. Sci Rep 2024; 14:316. [PMID: 38172353 PMCID: PMC10764780 DOI: 10.1038/s41598-024-51162-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/01/2024] [Indexed: 01/05/2024] Open
Abstract
Heart rate variability (HRV) is one of the assessments of cardiovascular risk during general anesthesia. This study aimed to assess the effects of an anesthetic drug on HRV in cats and to provide information for clinical applications. Twenty-four healthy client-owned cats of various breeds, 12 females and 12 males scheduled for elective surgery, were enrolled in this study. The cats were premedicated and induced with 4 protocols: protocol 1, diazepam (0.3 mg/kg) and propofol (2-4 mg/kg) IV; protocol 2, diazepam (0.3 mg/kg) and alfaxalone (1-3 mg/kg) IV; protocol 3, diazepam (0.3 mg/kg) and ketamine (3-5 mg/kg) IV; and protocol 4, xylazine (1 mg/kg) and tiletamine/zolazepam (Zoletil) (5 mg/kg) IM. The heart rate and HRV of the 24 cats were collected before and at least 1 h after administering the anesthetic drugs. Echocardiography was performed to evaluate heart function. Oscillometric blood pressure monitoring was used to obtain the mean blood pressure. After anesthetic drug administration, higher heart rates were found in cats premedicated and induced with alfaxalone (p = 0.045) than in the other protocols. The lowest heart rate (HR) values were found in cats in protocol 4 using xylazine and Zoletil. The HRV low frequency (LF) and high frequency (HF) power ratios increased in all protocols except for cats premedicated and intubated with propofol. The standard deviation of the regular sinus beats (SDNN) was higher in cats premedicated and induced with ketamine than in other anesthetic protocols (p = 0.015). An increase in sympathetic activity and reduced HRV is associated with high blood pressure and left atrial dimension. The percentage of fractional shortening (FS) decreased in cats premedicated with ketamine. The results showed that the anesthesia method using diazepam and propofol caused the least disturbance of HRV compared with other anesthesia methods that were used in this study.
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Affiliation(s)
- Chattida Panprom
- Kasetsart University Veterinary Teaching Hospital Kamphaeng Saen Campus, Faculty of Veterinary Medicine, Kasetsart University, Kamphaeng Saen Campus, Nakorn Pathom, Thailand
| | - Nakrob Pattanapon
- Kasetsart University Veterinary Teaching Hospital Kamphaeng Saen Campus, Faculty of Veterinary Medicine, Kasetsart University, Kamphaeng Saen Campus, Nakorn Pathom, Thailand
| | - Soontaree Petchdee
- Department of Large Animal and Wildlife Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, Kamphaeng Saen Campus, Nakorn Pathom, 73140, Thailand.
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Wang MD, Tian J, Zhang JH, Zhao SY, Song MJ, Wang ZX. Human Galectin-7 Gene LGALS7 Promoter Sequence Polymorphisms and Risk of Spontaneous Intracerebral Hemorrhage: A Prospective Study. Front Mol Neurosci 2022; 15:840340. [PMID: 35401111 PMCID: PMC8984465 DOI: 10.3389/fnmol.2022.840340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background and purposeDespite evidence for the role of genetic factors in stroke, only a small proportion of strokes have been clearly attributed to monogenic factors, due to phenotypic heterogeneity. The goal of this study was to determine whether a significant relationship exists between human galectin-7 gene LGALS7 promoter region polymorphisms and the risk of stroke due to non-traumatic intracerebral hemorrhage (ICH).MethodsThis two-stage genetic association study included an initial exploratory stage followed by a discovery stage. During the exploratory stage, transgenic galectin-7 mice or transgenic mice with the scrambled sequence of the hairpin structure –silenced down gene LGALS7—were generated and then expressed differentially expressed proteins and galectin-7-interacting proteins were identified through proteomic analysis. During the discovery stage, a single-nucleotide polymorphism (SNP) genotyping approach was used to determine associations between 2 LGALS7 SNPs and ICH stroke risk for a cohort of 24 patients with stroke of the Chinese Han population and 70 controls.ResultsDuring the exploratory phase, LGALS7 expression was found to be decreased in TGLGALS–DOWN mice as compared to its expression in TGLGALS mice. During the discovery phase, analysis of LGALS7 sequences of 24 non-traumatic ICH cases and 70 controls led to the identification of 2 ICH susceptibility loci: a genomic region on 19q13.2 containing two LGALS7 SNPs, rs567785577 and rs138945880, whereby the A allele of rs567785577 and the T allele of rs138945880 were associated with greater risk of contracting ICH [for T and A vs. C and G, unadjusted odds ratio (OR) = 13.5; 95% CI = 2.249–146.5; p = 0.002]. This is the first study to genotype the galectin-7 promoter in patients with hemorrhagic stroke. Genotype and allele association tests and preliminary analysis of patients with stroke revealed that a single locus may be a genetic risk factor for hemorrhagic stroke.ConclusionA and T alleles of two novel SNP loci of 19q13.2, rs567785577 and rs138945880, respectively, were evaluated for associations with susceptibility to ICH. Further studies with expanded case numbers that include subjects of other ethnic populations are needed to elucidate mechanisms underlying associations between these SNPs and ICH risk.
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Affiliation(s)
- Ming-Dong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jing Tian
- Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, China National Clinical Research Center of Respiratory Disease, Beijing, China
| | - John H. Zhang
- Physiology Program, Department of Anesthesiology, Neurosurgery, Neurology, and Physiology, Center for Neuroscience Research, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Shun-Ying Zhao
- Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, China National Clinical Research Center of Respiratory Disease, Beijing, China
- *Correspondence: Shun-Ying Zhao,
| | - Ming-Jing Song
- Medical School, Huanghe Science and Technology University, Zhengzhou, China
- Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China
- Ming-Jing Song,
| | - Zhan-Xiang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Zhan-Xiang Wang,
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Vernooij LM, van Klei WA, Moons KG, Takada T, van Waes J, Damen JA. The comparative and added prognostic value of biomarkers to the Revised Cardiac Risk Index for preoperative prediction of major adverse cardiac events and all-cause mortality in patients who undergo noncardiac surgery. Cochrane Database Syst Rev 2021; 12:CD013139. [PMID: 34931303 PMCID: PMC8689147 DOI: 10.1002/14651858.cd013139.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Revised Cardiac Risk Index (RCRI) is a widely acknowledged prognostic model to estimate preoperatively the probability of developing in-hospital major adverse cardiac events (MACE) in patients undergoing noncardiac surgery. However, the RCRI does not always make accurate predictions, so various studies have investigated whether biomarkers added to or compared with the RCRI could improve this. OBJECTIVES Primary: To investigate the added predictive value of biomarkers to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. Secondary: To investigate the prognostic value of biomarkers compared to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. Tertiary: To investigate the prognostic value of other prediction models compared to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. SEARCH METHODS We searched MEDLINE and Embase from 1 January 1999 (the year that the RCRI was published) until 25 June 2020. We also searched ISI Web of Science and SCOPUS for articles referring to the original RCRI development study in that period. SELECTION CRITERIA We included studies among adults who underwent noncardiac surgery, reporting on (external) validation of the RCRI and: - the addition of biomarker(s) to the RCRI; or - the comparison of the predictive accuracy of biomarker(s) to the RCRI; or - the comparison of the predictive accuracy of the RCRI to other models. Besides MACE, all other adverse outcomes were considered for inclusion. DATA COLLECTION AND ANALYSIS We developed a data extraction form based on the CHARMS checklist. Independent pairs of authors screened references, extracted data and assessed risk of bias and concerns regarding applicability according to PROBAST. For biomarkers and prediction models that were added or compared to the RCRI in ≥ 3 different articles, we described study characteristics and findings in further detail. We did not apply GRADE as no guidance is available for prognostic model reviews. MAIN RESULTS We screened 3960 records and included 107 articles. Over all objectives we rated risk of bias as high in ≥ 1 domain in 90% of included studies, particularly in the analysis domain. Statistical pooling or meta-analysis of reported results was impossible due to heterogeneity in various aspects: outcomes used, scale by which the biomarker was added/compared to the RCRI, prediction horizons and studied populations. Added predictive value of biomarkers to the RCRI Fifty-one studies reported on the added value of biomarkers to the RCRI. Sixty-nine different predictors were identified derived from blood (29%), imaging (33%) or other sources (38%). Addition of NT-proBNP, troponin or their combination improved the RCRI for predicting MACE (median delta c-statistics: 0.08, 0.14 and 0.12 for NT-proBNP, troponin and their combination, respectively). The median total net reclassification index (NRI) was 0.16 and 0.74 after addition of troponin and NT-proBNP to the RCRI, respectively. Calibration was not reported. To predict myocardial infarction, the median delta c-statistic when NT-proBNP was added to the RCRI was 0.09, and 0.06 for prediction of all-cause mortality and MACE combined. For BNP and copeptin, data were not sufficient to provide results on their added predictive performance, for any of the outcomes. Comparison of the predictive value of biomarkers to the RCRI Fifty-one studies assessed the predictive performance of biomarkers alone compared to the RCRI. We identified 60 unique predictors derived from blood (38%), imaging (30%) or other sources, such as the American Society of Anesthesiologists (ASA) classification (32%). Predictions were similar between the ASA classification and the RCRI for all studied outcomes. In studies different from those identified in objective 1, the median delta c-statistic was 0.15 and 0.12 in favour of BNP and NT-proBNP alone, respectively, when compared to the RCRI, for the prediction of MACE. For C-reactive protein, the predictive performance was similar to the RCRI. For other biomarkers and outcomes, data were insufficient to provide summary results. One study reported on calibration and none on reclassification. Comparison of the predictive value of other prognostic models to the RCRI Fifty-two articles compared the predictive ability of the RCRI to other prognostic models. Of these, 42% developed a new prediction model, 22% updated the RCRI, or another prediction model, and 37% validated an existing prediction model. None of the other prediction models showed better performance in predicting MACE than the RCRI. To predict myocardial infarction and cardiac arrest, ACS-NSQIP-MICA had a higher median delta c-statistic of 0.11 compared to the RCRI. To predict all-cause mortality, the median delta c-statistic was 0.15 higher in favour of ACS-NSQIP-SRS compared to the RCRI. Predictive performance was not better for CHADS2, CHA2DS2-VASc, R2CHADS2, Goldman index, Detsky index or VSG-CRI compared to the RCRI for any of the outcomes. Calibration and reclassification were reported in only one and three studies, respectively. AUTHORS' CONCLUSIONS Studies included in this review suggest that the predictive performance of the RCRI in predicting MACE is improved when NT-proBNP, troponin or their combination are added. Other studies indicate that BNP and NT-proBNP, when used in isolation, may even have a higher discriminative performance than the RCRI. There was insufficient evidence of a difference between the predictive accuracy of the RCRI and other prediction models in predicting MACE. However, ACS-NSQIP-MICA and ACS-NSQIP-SRS outperformed the RCRI in predicting myocardial infarction and cardiac arrest combined, and all-cause mortality, respectively. Nevertheless, the results cannot be interpreted as conclusive due to high risks of bias in a majority of papers, and pooling was impossible due to heterogeneity in outcomes, prediction horizons, biomarkers and studied populations. Future research on the added prognostic value of biomarkers to existing prediction models should focus on biomarkers with good predictive accuracy in other settings (e.g. diagnosis of myocardial infarction) and identification of biomarkers from omics data. They should be compared to novel biomarkers with so far insufficient evidence compared to established ones, including NT-proBNP or troponins. Adherence to recent guidance for prediction model studies (e.g. TRIPOD; PROBAST) and use of standardised outcome definitions in primary studies is highly recommended to facilitate systematic review and meta-analyses in the future.
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Affiliation(s)
- Lisette M Vernooij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Wilton A van Klei
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Anesthesiologist and R. Fraser Elliott Chair in Cardiac Anesthesia, Department of Anesthesia and Pain Management Toronto General Hospital, University Health Network and Professor, Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Karel Gm Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Toshihiko Takada
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Judith van Waes
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Johanna Aag Damen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Scoping review of the association between postsurgical pain and heart rate variability parameters. Pain Rep 2021; 6:e977. [PMID: 35155967 PMCID: PMC8824397 DOI: 10.1097/pr9.0000000000000977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/07/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. This scoping review provides some evidence of a possible association between heart rate variability and postsurgical pain, although significant variability exists among included studies. Surgical interventions can elicit neuroendocrine and sympathovagal responses, leading to cardiac autonomic imbalance. Cardiac complications account for approximately 30% of postoperative complications. Altered heart rate variability (HRV) was initially described in the 1970s as a predictor of acute coronary syndromes and has more recently been shown to be an independent predictor of postoperative morbidity and mortality after noncardiac surgery. In general, HRV reflects autonomic balance, and altered HRV measures have been associated with anesthetic use, chronic pain conditions, and experimental pain. Despite the well-documented relationship between altered HRV and postsurgical outcomes and various pain conditions, there has not been a review of available evidence describing the association between postsurgical pain and HRV. We examined the relationship between postsurgical pain and HRV. MEDLINE and EMBASE databases were searched until December 2020 and included all studies with primary data. Two reviewers independently assessed risk of bias for each study using the criteria outlined in the Cochrane Handbook for Systematic Review of Interventions. A total of 8 studies and 1002 participants were included. Studies examined the association of postsurgical pain and HRV or analgesia nociception index derived from HRV. There was a statistically significant association between HRV measures and postsurgical pain in 6 of 8 studies. Heterogeneity of studies precluded meta-analyses. No studies reported cardiovascular outcomes. There is a potential association between postsurgical pain and HRV or analgesia nociception index, although results are likely impacted by confounding variables. Future studies are required to better delineate the relationship between postsurgical pain and HRV and impacts on cardiovascular outcomes.
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So V, Klar G, Leitch J, McGillion M, Devereaux PJ, Arellano R, Parlow J, Gilron I. Association between postsurgical pain and heart rate variability: protocol for a scoping review. BMJ Open 2021; 11:e044949. [PMID: 33849852 PMCID: PMC8051399 DOI: 10.1136/bmjopen-2020-044949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Surgical interventions can elicit neuroendocrine responses and sympathovagal imbalance, ultimately affecting cardiac autonomic function. Cardiac complications account for 30% of postoperative complications and are the leading cause of morbidity and mortality following non-cardiac surgery. One cardiovascular parameter, heart rate variability (HRV), has been found to be predictive of postoperative morbidity and mortality. HRV is defined as variation in time intervals between heartbeats and is affected by cardiac autonomic balance. Furthermore, altered HRV has been shown to predict cardiovascular events in non-surgical settings. In multiple studies, experimentally induced pain in healthy humans leads to reduced HRV suggesting a causal relationship. In a different studies, chronic pain has been associated with altered HRV, however, in the setting of clinical pain conditions, it remains unclear how much HRV impairment is due to pain itself versus autonomic changes related to analgesia. We aim to review the available evidence describing the association between postsurgical pain and HRV alterations in the early postoperative period. METHODS AND ANALYSIS We will conduct a scoping review of relevant studies using detailed searches of MEDLINE and EMBASE, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Included studies will involve participants undergoing non-cardiac surgery and investigate outcomes of (1) measures of pain intensity; (2) measures of HRV and (3) statistical assessment of association between #1 and #2. As secondary review outcomes included studies will also be examined for other cardiovascular events and for their attempts to control for analgesic treatment and presurgical HRV differences among treatment groups in the analysis. This work aims to synthesise available evidence to inform future research questions related to postsurgical pain and cardiac complications. ETHICS AND DISSEMINATION Ethics review and approval is not required for this review. The results will be submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Vincent So
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Gregory Klar
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Jordan Leitch
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Michael McGillion
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - P J Devereaux
- Division of Cardiology, Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Ramiro Arellano
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Joel Parlow
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
- Departments of Biomedical and Molecular Sciences, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Ian Gilron
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
- Departments of Biomedical and Molecular Sciences, Centre for Neuroscience Studies, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
- School of Policy Studies, Queen's University, Kingston, Ontario, Canada
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Ernst G, Watne LO, Frihagen F, Wyller TB, Dominik A, Rostrup M. Low Heart Rate Variability Predicts Stroke and Other Complications in the First Six Postoperative Months After a Hip Fracture Operation. Front Cardiovasc Med 2021; 8:640970. [PMID: 33829048 PMCID: PMC8019729 DOI: 10.3389/fcvm.2021.640970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/01/2021] [Indexed: 12/15/2022] Open
Abstract
Background: One-year mortality after hip fractures is underestimated and is reported as 25%. An improved risk stratifying could contribute to a better follow up of these patients. Heart Rate Variability (HRV) is an easy point-of-care investigation and is been used in cardiology, endocrinology, and perioperative care. This observational study intended to explore relevant associations between HRV parameters and 6-months mortality and morbidity after a hip fracture. Methods: One hundred and sixty-five patients admitted to two hospitals were included, and short-time HRV measurements (5 min, and 10 min at the two hospitals, respectively) were obtained. Mortality data were gathered by means of the Norwegian central address register. Patients, close relatives of patients, and in some cases their general physicians or nursery home physicians were interviewed 6 months postoperatively regarding the incidence of pneumonia, cardiac events, or stroke. Results: One and hundred fifty-seven (95.2%) patients were followed up after 6 months post-surgery. Twenty-one (13%) died during this period. Twenty patients (13%) developed pneumonia, eight (5 %) stroke, and four (2%) myocardial infarction. No HRV parameter was associated with 6-month general mortality. However, patients who developed stroke had significantly lower High Frequency Power (HF, p < 0.001) and lower Very Low Frequency Power (VLF, p = 0.003) at inclusion compared to patients without complications. Patients who developed pneumonia had at the inclusion lower root mean square of successive differences (RMSSD, p = 0.044). Patients with a history of coronary heart disease (n = 41) showed a mortality of 7%. Mortality in this group was associated with standard deviation of beat-to-beat intervals (SDNN, p = 0.006), Total Power (TP, p = 0.009), HF (p = 0.026), and Low Frequency Power (LF, p = 0.012). Beta-blocker intake was associated with lower heart rate, but not with differences in HRV parameters. Conclusion: In this exploratory study, we present for the first-time significant associations between different preoperative HRV parameters and stroke, myocardial infarction, and pneumonia during a 6-month period after hip fracture. HRV might be a simple and effective tool to identify patients at risk that would warrant better follow-up.
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Affiliation(s)
- Gernot Ernst
- Department of Anesthesiology, Kongsberg Hospital, Kongsberg, Norway.,Section of Cardiovascular and Renal Research, University of Oslo, Oslo, Norway
| | - Leiv Otto Watne
- Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.,Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Frede Frihagen
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Torgeier Bruun Wyller
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Andreas Dominik
- Technische Hochschule Mittelhessen (THM) University of Applied Sciences, Kompetenzzentrum für Informationstechnologie (KITE), Giessen, Germany
| | - Morten Rostrup
- Section of Cardiovascular and Renal Research, University of Oslo, Oslo, Norway.,Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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Added value of frailty and social support in predicting risk of 30-day unplanned re-admission or death for patients with heart failure: An analysis from OPERA-HF. Int J Cardiol 2019; 278:167-172. [DOI: 10.1016/j.ijcard.2018.12.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/16/2018] [Accepted: 12/10/2018] [Indexed: 01/15/2023]
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Page T, Rugg-Gunn FJ. Bitemporal seizure spread and its effect on autonomic dysfunction. Epilepsy Behav 2018; 84:166-172. [PMID: 29803947 DOI: 10.1016/j.yebeh.2018.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/27/2018] [Accepted: 03/08/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Autonomic dysregulation is a possible pathomechanism of sudden unexpected death in epilepsy (SUDEP). Cardiac arrhythmias and autonomic symptoms are most commonly associated with seizures arising from the temporal lobes. The aim of this study was to investigate whether simultaneous seizure activity in both temporal lobes affects the autonomic nervous system differently from seizure activity in one temporal lobe as assessed by heart rate variability (HRV). METHODS Electrocardiography (ECG) and intracranial electroencephalography (iEEG) data from 13 patients with refractory temporal lobe epilepsy who had seizures that propagated electrically from one temporal lobe to the other during video-EEG-ECG monitoring were retrospectively reviewed. The time domain, frequency domain, and nonlinear parameters of HRV were evaluated by analyzing 4-minute-long ECG epochs, sampling from baseline, preictal and postictal periods as well as epochs constituting unitemporal and bitemporal ictal activity. RESULTS Heart rate was significantly higher during bitemporal ictal activity compared with all other time points. The time domain and nonlinear parameters of HRV were significantly decreased during bitemporal activity compared with baseline, and multiple components of HRV (standard deviation of RR intervals (SDNN), coefficient of variation (CV), root mean square of successive differences (RMSSD), and standard deviation of short-term variability (SD1)) were significantly lower during bitemporal activity compared with unitemporal activity. Frequency domain analysis showed no significant differences. CONCLUSION This study shows that bitemporal seizure activity significantly increases heart rate and decreases HRV, indicating increased autonomic imbalance with a shift towards sympathetic predominance, and this may increase the risk of SUDEP.
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Affiliation(s)
- Thomas Page
- Dept. of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, United Kingdom
| | - Fergus J Rugg-Gunn
- Dept. of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, United Kingdom; Dept. of Clinical and Experimental Epilepsy, National Hospital for Neurology & Neurosurgery, National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, United Kingdom; Epilepsy Society Research Centre, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, United Kingdom.
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Reimer P, Máca J, Szturz P, Jor O, Kula R, Ševčík P, Burda M, Adamus M. Role of heart-rate variability in preoperative assessment of physiological reserves in patients undergoing major abdominal surgery. Ther Clin Risk Manag 2017; 13:1223-1231. [PMID: 29033572 PMCID: PMC5614745 DOI: 10.2147/tcrm.s143809] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Major abdominal surgery (MAS) is associated with increased morbidity and mortality. The main objective of our study was to evaluate the predictive value of heart-rate variability (HRV) concerning development of postoperative complications in patients undergoing MAS. The secondary objectives were to identify the relationship of HRV and use of vasoactive drugs during anesthesia, intensive care unit length of stay (ICU-LOS), and hospital length of stay (H-LOS). Patients and methods Sixty-five patients scheduled for elective MAS were enrolled in a prospective, single-center, observational study. HRV was measured by spectral analysis (SA) preoperatively during orthostatic load. Patients were divided according to cardiac autonomic reactivity (CAR; n=23) and non-cardiac autonomic reactivity (NCAR; n=30). Results The final analysis included 53 patients. No significant difference was observed between the two groups regarding type of surgery, use of minimally invasive techniques or epidural catheter, duration of surgery and anesthesia, or the amount of fluid administered intraoperatively. The NCAR group had significantly greater intraoperative blood loss than the CAR group (541.7±541.9 mL vs 269.6±174.3 mL, p<0.05). In the NCAR group, vasoactive drugs were used during anesthesia more frequently (n=21 vs n=4; p<0.001), and more patients had at least one postoperative complication compared to the CAR group (n=19 vs n=4; p<0.01). Furthermore, the NCAR group had more serious complications (Clavien–Dindo ≥ Grade III n=6 vs n=0; p<0.05) and a greater number of complications than the CAR group (n=57 vs n=5; p<0.001). Significant differences were found for two specific subgroups of complications: hypotension requiring vasoactive drugs (NCAR: n=10 vs CAR: n=0; p<0.01) and ileus (NCAR: n=11 vs CAR: n=2; p<0.05). Moreover, significant differences were found in the ICU-LOS (NCAR: 5.7±3.5 days vs CAR: 2.6±0.7 days; p<0.0001) and H-LOS (NCAR: 12.2±5.6 days vs CAR: 7.2±1.7 days; p<0.0001). Conclusion Preoperative HRV assessment during orthostatic load is objective and useful for identifying patients with low autonomic physiological reserves and high risk of poor post-operative course.
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Affiliation(s)
- Petr Reimer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava
| | - Jan Máca
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava
| | - Pavel Szturz
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava
| | - Ondřej Jor
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava
| | - Roman Kula
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava
| | - Pavel Ševčík
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava
| | - Michal Burda
- Institute for Research and Applications of Fuzzy Modeling, Centre of Excellence IT4Innovations, University of Ostrava, Ostrava
| | - Milan Adamus
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Olomouc, Czech Republic
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10
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Ernst G, Watne LO, Frihagen F, Wyller TB, Dominik A, Rostrup M. Decreases in heart rate variability are associated with postoperative complications in hip fracture patients. PLoS One 2017; 12:e0180423. [PMID: 28742855 PMCID: PMC5526500 DOI: 10.1371/journal.pone.0180423] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/15/2017] [Indexed: 11/18/2022] Open
Abstract
Background To explore relevant associations between deviations in linear and nonlinear heart rate variability (HRV) scores, and short-term morbidity and mortality in patients undergoing hip-surgery after a fracture. Methods 165 patients with hip fractures being admitted for surgery at two hospitals were included in a prospective cohort study. A short-term ECG was recorded within 24 hours of arrival. 15 patients had to be excluded due to insufficient quality of the ECG recordings. 150 patients were included in the final analysis. Linear parameters were calculated in time domain: standard deviation of NN intervals (SDNN), root mean square of successive differences (rMSSD); and frequency domain: Total Power (TP), High Frequency Power (HF), Low Frequency Power (LF), Very Low Frequency Power (VLF), and the ratio of LF/HF. Postoperative outcome was evaluated at the time of discharge. This included occurrence of pneumonia, overall infection rate, stroke, myocardial infarction, and all-cause mortality. Results Patients experiencing complications had significantly lower rMSSD (p = 0.04), and TP (p = 0.03) preoperatively. Postoperative infections were predicted by decreased VLF preoperatively (p = 0.04). There was a significant association between pneumonia and LF/HF<1 (p = 0.03). The likelihood ratio to develop pneumonia when LF/HF < 1 was 6,1. Conclusion HRV seems to reflect the general frailty of the patient with hip fracture and might be used to identify patients in need of increased surveillance or prophylactic treatment.
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Affiliation(s)
- Gernot Ernst
- Department of Anaesthesiology, Kongsberg hospital, Kongsberg, Norway
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway
- * E-mail:
| | - Leiv Otto Watne
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Frede Frihagen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Torgeir Bruun Wyller
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Morten Rostrup
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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11
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Low pre-operative heart rate variability and complexity are associated with hypotension after anesthesia induction in major abdominal surgery. J Clin Monit Comput 2017; 32:245-252. [DOI: 10.1007/s10877-017-0012-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/07/2017] [Indexed: 10/20/2022]
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12
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Optimal Testing Intervals in the Squatting Test to Determine Baroreflex Sensitivity. NEUROPHYSIOLOGY+ 2015. [DOI: 10.1007/s11062-015-9479-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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14
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15
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Lack of circadian variation and reduction of heart rate variability in women with breast cancer undergoing lumpectomy: a descriptive study. Breast Cancer Res Treat 2013; 140:317-22. [DOI: 10.1007/s10549-013-2631-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 07/04/2013] [Indexed: 10/26/2022]
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16
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Chong C, Lam Q, Ryan J, Sinnappu R, Lim WK. Impact of troponin 1 on long-term mortality after emergency orthopaedic surgery in older patients. Intern Med J 2011; 40:751-6. [PMID: 19811558 DOI: 10.1111/j.1445-5994.2009.02063.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the association between post-operative troponin rises and longer term (2-year) mortality after emergency orthopaedic surgery in patients over 60 years of age. METHODS One hundred and two patients were recruited in 2006 and had inpatient troponin 1 measurements. These patients were followed up by a telephone call annually for complications. RESULTS At 2 years, 29.4% (30/102) of patients had died. Twenty-five patients (25/54 or 49.3%) with a troponin rise were dead at 2 years compared with five patients without a troponin rise (5/48 or 10.4%), which was significantly different P < 0.0001. Patients with a higher troponin level (>0.1 µg/L) were more likely to be dead at 2 years compared with those with a lower level of troponin. However, when adjusted for other comorbidities the association between troponin elevation and death at 2 years did not persist. Using Cox regression multivariate analysis, only one factor, sustaining an in-hospital cardiac event odds ratio 4.3 (95% confidence interval 1.8-10.3, P = 0.001), was associated with 2 years all-cause mortality . Furthermore, patients who sustained a symptomatic troponin rise (P < 0.0001) or asymptomatic troponin rise (P = 0.004) were more likely to have died at 2 years compared with those with no troponin rise. Three factors were significantly associated with a cardiac event during the second year: (i) post-operative troponin rise (P = 0.05); (ii) pre-morbid atrial fibrillation (P = 0.04); and (iii) post-operative renal failure (P < 0.001). CONCLUSION Elevated post-operative troponin levels are predictive of 1-year but not 2-year mortality in older patients undergoing emergency orthopaedic surgery.
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Affiliation(s)
- C Chong
- Department of Aged Care, The Northern Hospital, Epping, Victoria, Australia.
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17
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Pasquier P, Ausset S, Lenoir B. Perioperative cardiac complications: are we enjoying a smooth sailing on the Titanic? Acta Anaesthesiol Scand 2010; 54:389-91. [PMID: 20415953 DOI: 10.1111/j.1399-6576.2009.02185.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Bonnet F, Berger J. Risque et conséquences à court et à long terme de l’anesthésie. Presse Med 2009; 38:1586-90. [DOI: 10.1016/j.lpm.2009.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 08/06/2009] [Indexed: 10/20/2022] Open
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Roggenbach J, Böttiger BW, Teschendorf P. [Perioperative myocardial damage in non-cardiac surgery patients]. Anaesthesist 2009; 58:665-76. [PMID: 19554269 DOI: 10.1007/s00101-009-1577-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Perioperative myocardial damage occurs with a high incidence depending on the operative procedure and the patients examined and is considered to be among the most relevant risk factors for increased perioperative morbidity and mortality in patients undergoing non-cardiac surgery. The pathophysiology of myocardial damage in the perioperative period is still not well understood. Both ischemia with and without acute coronary occlusion and non-ischemic stimuli can put a substantial strain on the heart in the perioperative period. However, in many cases the clinical presentation does not allow a clear differentiation between ischemic and non-ischemic myocardial damage. In the majority of cases perioperative myocardial infarctions occur with only mild or even without any clinical symptoms. This is probably due to a considerable difference in phenotype and pathophysiology between perioperative and non-perioperative myocardial infarctions. As a result of this unexplained etiology of perioperative myocardial infarction it remains an open question whether the contemporary diagnostic and therapeutic recommendations for the acute coronary syndrome can be extrapolated to the perioperative situation. The present review reflects the current state of knowledge and presents an optional approach to the diagnosis and therapy of perioperative myocardial injury.
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Affiliation(s)
- J Roggenbach
- Klinik für Anaesthesiologie und Intensivmedizin, Klinikum der Universität Heidelberg, Im Neuenheimer Feld 110, 69115, Heidelberg.
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20
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Godet G, Bernard M, Ben Ayed S. [Cardiac biomarkers for diagnosis of myocardial infarction]. ACTA ACUST UNITED AC 2009; 28:321-31. [PMID: 19304448 DOI: 10.1016/j.annfar.2009.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 01/14/2009] [Indexed: 11/29/2022]
Abstract
Diagnosis of postoperative myocardial infarction is often difficult, based on tools with a low sensitivity (clinical symptoms, EKG), or with a low specifity (old biomarkers, echocardiographic abnormalities) or inadequate for clinical practice (scintigraphy). Since 1995, clinicians may use more cardiospecific markers (troponin) allowing to modify strategy for postoperative myocardial infarction diagnosis. The aim of this review is to resume such an attitude.
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Affiliation(s)
- G Godet
- Département d'anesthésie et réanimation 2, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex, France.
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21
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Chong CP, Lam QT, Ryan JE, Sinnappu RN, Lim WK. Incidence of post-operative troponin I rises and 1-year mortality after emergency orthopaedic surgery in older patients. Age Ageing 2009; 38:168-74. [PMID: 19008306 DOI: 10.1093/ageing/afn231] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES to determine the incidence of post-operative troponin I rises and its association with 1-year all-cause mortality and cardiac events after emergency orthopaedic-geriatric surgery, which has not been studied before. METHODS one hundred and two patients over the age of 60 were recruited and followed up at 1 year. All consented to serial troponin I measurements peri-operatively. RESULTS the incidence of a troponin I rise post-operatively was 52.9%. Post-operative acute myocardial infarction was diagnosed in 9.8% and at 1 year, 70% of these patients were dead. At 1 year, 32.4% (33/102) had sustained a cardiac event (myocardial infarction, congestive cardiac failure, atrial fibrillation or major arrhythmia) and using multivariate analysis, post-operative troponin rise (OR 3.9, 95% CI 1.4-10.7, P = 0.008) was an independent predictor of this. Half of the patients with a troponin rise had a cardiac event compared to 18.8% without a rise. All-cause mortality was 20.6% at 1 year; 37% with an associated post-operative troponin rise died versus 2.1% without a rise (P < 0.0001). Using multivariate analysis, only two factors were associated with 1-year all-cause mortality: post-operative troponin rise (OR 12.0, 95% CI 1.4-104.8, P = 0.025) and sustaining a post-operative in-hospital cardiac event (OR 6.6, 95% CI 1.7-25.6, P = 0.006). Furthermore, patients with higher troponin levels had significantly worse survival. CONCLUSIONS there is a high incidence of post-operative troponin I rises in older patients undergoing emergency orthopaedic surgery with 1-year mortality and cardiac events being significantly increased in these patients. Future studies are needed to determine whether any intervention can improve outcome for these patients.
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Affiliation(s)
- Carol P Chong
- Department of Aged Care, The Northern Hospital, Epping, Victoria, Australia.
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22
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Chang YJ, Jung WS, Byun JS, Kim HS, Lee KC. Effects of pneumoperitoneum and position changes on blood pressure variability and heart rate variability during laparoscopy-assisted vaginal hysterectomy. Korean J Anesthesiol 2009; 57:314-319. [DOI: 10.4097/kjae.2009.57.3.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yong Jin Chang
- Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Wol Seon Jung
- Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Jong Soon Byun
- Department of Anesthesiology and Pain Medicine, Seoul Medical Center, Seoul, Korea
| | - Hong Sun Kim
- Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Kyung Cheon Lee
- Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
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23
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Hanss R, Block D, Bauer M, Ilies C, Magheli A, Schildberg-Schroth H, Renner J, Scholz J, Bein B. Use of heart rate variability analysis to determine the risk of cardiac ischaemia in high-risk patients undergoing general anaesthesia. Anaesthesia 2008; 63:1167-73. [PMID: 18822095 DOI: 10.1111/j.1365-2044.2008.05602.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to investigate the use of pre-operative heart rate variability analysis to predict postoperative cardiac events (identified by 24 h Holter-ECG recording and an increase of creatine kinase MB) in high-risk cardiac patients. Length of hospital stay, the incidence of postoperative cardiac ischaemia and cardiac events after discharge were recorded. Fifty patients were assigned by the presence of cardiac events and the heart rate variability in 17 patients with an event was compared with 33 patients without. Total power was identified as a predictive parameter. The usefulness of this test was assessed in a second group of 50 patients. The incidence of cardiac events detected by Holter-ECG recording or an increased creatine kinase MB was greater and the duration of hospital stay longer in the 26 patients with total power < 400 ms(2).Hz(-1) compared with those with total power > 400 ms(2).Hz(-1) (eight and four patients and 10 (7) days (mean (SD)), vs 1 (p < 0.05) and 0 (p < 0.05) patients and 6 (2) days (p < 0.05), respectively). The total power of high-risk cardiac patients predicted postoperative cardiac events and extended length of hospital stay.
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Affiliation(s)
- R Hanss
- Department of Anaesthesiology and Intensive Care Medicine, University-Hospital Schleswig-Holstein, Campus Kiel.
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van Zyl LT, Hasegawa T, Nagata K. Effects of antidepressant treatment on heart rate variability in major depression: a quantitative review. Biopsychosoc Med 2008; 2:12. [PMID: 18590531 PMCID: PMC2478652 DOI: 10.1186/1751-0759-2-12] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 06/30/2008] [Indexed: 01/09/2023] Open
Abstract
Background The literature measuring effects of antidepressant and electroconvulsive therapy (ECT) for major depression on heart rate variability (HRV) in medically well individuals was reviewed. Methods Fourteen studies evaluating HRV were included. Twenty three pre-post or within group comparisons were available. Treatment impact on measures of HRV was pooled over studies. We examined different classes of antidepressants, and for short and long electrocardiogram (ECG) recordings separately. Results Tricyclic antidepressants (TCAs) were associated with declines in most measures of HRV and significant increase in heart rate (HR) in studies with short recording intervals. No significant changes were found for longer recording times. Treatment effects with selective serotonin reuptake inhibitors (SSRIs) were more variable. Short-recording studies revealed a significant decrease in HR and an increase in one HRV measure. In two 24-hour recording studies no significant changes were observed. No relationship between ECT and HRV has been established in the literature. The effects of other drugs are reported. Limitations Few studies measure the effects of treatment of depression on HRV. Existing studies have generally used very small samples, employing a variety of measurements and methodologies. Conclusion We confirm that TCAs are associated with a large decrease in HRV and increase HR. However, data for SSRIs is not clear. Although the effect of SSRIs on HRV is weaker than for TCAs, evidence shows that SSRIs are associated with a small decrease in HR, and an increase in one measure of HRV. The use of TCAs in depression leads to changes in HRV that are associated with increased risk of mortality.
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Affiliation(s)
- Louis T van Zyl
- Hamamatsu University, School of Medicine, Japan, Hamamatsu University School of Medicine, 1-20-1, Handayama, Hamamatsu City, 431-3192, Japan
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25
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Hanss R, Renner J, Ilies C, Moikow L, Buell O, Steinfath M, Scholz J, Bein B. Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients?*. Anaesthesia 2008; 63:129-35. [DOI: 10.1111/j.1365-2044.2007.05321.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Hwang GS. Anesthesia and autonomic nervous system: is measurement of heart rate variability, blood pressure variability and baroreflex sensitivity useful in anesthesiology specialty? Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.55.3.265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Gyu Sam Hwang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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27
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Laitio T, Jalonen J, Kuusela T, Scheinin H. The Role of Heart Rate Variability in Risk Stratification for Adverse Postoperative Cardiac Events. Anesth Analg 2007; 105:1548-60. [DOI: 10.1213/01.ane.0000287654.49358.3a] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Davenport DL, Ferraris VA, Hosokawa P, Henderson WG, Khuri SF, Mentzer RM. Multivariable Predictors of Postoperative Cardiac Adverse Events after General and Vascular Surgery: Results from the Patient Safety in Surgery Study. J Am Coll Surg 2007; 204:1199-210. [PMID: 17544078 DOI: 10.1016/j.jamcollsurg.2007.02.065] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Accepted: 02/26/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiac adverse events (CAEs) are relatively infrequent, but highly lethal, after noncardiac operations. The value of available risk scoring systems is uncertain and these systems can be outdated. We used the Patient Safety in Surgery Study database to develop and test a model to predict patient risk for CAEs after general and vascular surgical operations. STUDY DESIGN As part of the Patient Safety in Surgery Study, following the National Surgical Quality Improvement Program's protocol, multiple demographic, preoperative, perioperative, and outcomes variables were measured during a 3-year period. Data from 128 Veterans Affairs medical center hospitals and from 14 academic medical centers on 183,069 patients were used in a logistic regression analysis to model multivariable predictors of serious CAEs (cardiac arrest or acute myocardial infarction within 30 days of operation). RESULTS CAEs occurred in 2,362 patients (1.29%) and of these, 59.44% expired. Multivariable stepwise logistic regression identified 20 independent predictors of CAEs, which excluded most cardiac-specific risk factors. The most important multivariable predictors of CAE were American Society of Anesthesiologists physical status classification, work relative value units of the most complex procedure, age, and type of operation. A risk prediction scoring system using the logistic regression odds ratios proved to be a useful prediction tool when tested using a random sample from the database. CONCLUSIONS CAEs after noncardiac operations are relatively infrequent but highly lethal. Operation type and urgency and American Society of Anesthesiologists physical status assessment are important independent predictors of cardiac morbidity, but angina, recent MI, and earlier cardiac operation are not. A prediction scoring system based on the Patient Safety in Surgery Study multivariable odds ratios is likely to be predictive of future events in a similar population requiring noncardiac procedures. This risk model can also serve as a tool to measure quality and effectiveness of care by providers who perform noncardiac operations.
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Affiliation(s)
- Daniel L Davenport
- Department of Surgery, University of Kentucky, Lexington, KY 40536-0298, USA.
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Jeger RV, Seeberger MD, Keller U, Pfisterer ME, Filipovic M. Oral Hypoglycemics: Increased Postoperative Mortality in Coronary Risk Patients. Cardiology 2007; 107:296-301. [PMID: 17264509 DOI: 10.1159/000099065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Accepted: 08/30/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Diabetes mellitus (DM), particularly if insulin-dependent, is a predictor of increased perioperative risk, whereas stringent metabolic control with insulin is beneficial in the critically ill. METHODS The impact of oral hypoglycemics (OH) vs. insulin on outcome was determined as a secondary retrospective analysis of a cohort study in patients with coronary artery disease (CAD) and DM undergoing major non-cardiac surgery. Primary end-point was 2-year all-cause mortality; secondary endpoints were perioperative myocardial ischemia and 2-year cardiac mortality. RESULTS Of 173 patients, DM was diagnosed in 42 (24%) based on pre-existing treatment with OH (15%) or insulin (9%). During follow-up, 40/173 (23%) patients died. All-cause mortality was similar in the non-diabetic (20%) and insulin groups (19%) but significantly higher in the OH group (42%; p = 0.025). Cardiac mortality tended to be higher in the OH group compared with the insulin and non-diabetic groups (27 vs. 19% and 11%, respectively; p = 0.066). Multivariate analysis revealed renal failure (odds ratio [OR] = 4.9, 95% confidence interval [CI] = 1.8-13.0), treatment with OH (OR = 3.3, 95% CI = 1.2-9.0), peripheral vascular surgery (OR = 2.7, 95% CI = 1.2-6.0), and prior diuretic therapy (OR = 2.6, 95% CI = 1.1-5.7) being independently associated with 2-year all-cause death. No difference existed in postoperative ischemia among the different groups. CONCLUSIONS Long-term mortality after major non-cardiac surgery is elevated in patients with CAD and diabetes mellitus only if they are treated with OH, but not if they are treated with insulin. Further evaluation of the impact of perioperative anti-diabetic treatment on morbidity and mortality in CAD is warranted.
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Affiliation(s)
- Raban V Jeger
- Department of Cardiology, University Hospital, Basel, Switzerland
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Lucreziotti S, Carletti F, Santaguida G, Fiorentini C. Myocardial infarction in major noncardiac surgery: Epidemiology, pathophysiology and prevention. Heart Int 2006; 2:82. [PMID: 21977256 PMCID: PMC3184667 DOI: 10.4081/hi.2006.82] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The number of subjects undergoing major noncardiac surgery who are at risk for perioperative myocardial infarction (MI) is growing worldwide. It has been estimated that 500,000 to 900,000 patients suffer major perioperative cardiovascular complications every year, with consequent heavy, long-term prognostic implications and costs. It is well known that perioperative MIs don’t share the same pathophysiology as nonsurgical MIs but the relative role of the different, potential triggers has not been completely clarified. Many aspects of the perioperative management, including risk-stratification and prophylactic or postoperative interventions have also not been completely defined. Throughout recent years many resources have been invested to clarify these aspects and experts have developed indices and algorithm-based strategies to better assess the cardiac risk and to guide the perioperative management. The scope of the present review is to discuss the main aspects of perioperative MI in noncardiac surgery, with particular regard to epidemiology, pathophysiology, preoperative risk stratification, prophylaxis and therapy.
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Affiliation(s)
- Stefano Lucreziotti
- Unità Operativa di Cardiologia, Azienda Ospedaliera S. Paolo, Polo Universitario, Milano - Italy
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Jeger RV, Probst C, Arsenic R, Lippuner T, Pfisterer ME, Seeberger MD, Filipovic M. Long-term prognostic value of the preoperative 12-lead electrocardiogram before major noncardiac surgery in coronary artery disease. Am Heart J 2006; 151:508-13. [PMID: 16442922 DOI: 10.1016/j.ahj.2005.04.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Accepted: 04/28/2005] [Indexed: 12/16/2022]
Abstract
BACKGROUND Knowledge of the prognostic information of preoperative 12-lead electrocardiogram (ECG) recordings in patients with coronary artery disease (CAD) undergoing noncardiac surgery is limited. METHODS The prognostic information derived from the preoperative ECGs of 172 CAD patients undergoing major noncardiac surgery was analyzed to determine its predictive value for long-term outcome. Primary end point was all-cause mortality; secondary end point was major adverse cardiac events (MACE) at 2 years. RESULTS Prevalence of ECG abnormalities was 53% for T-wave alterations; 46% for Q waves; 38% for ST deviations; and, depending on the criterion used, 2% to 19% for left ventricular hypertrophy. During follow-up, 40 (23%) patients died and 31 (18%) had MACE. After adjustment for clinical baseline findings, including current medication with beta-blockers, ST depressions (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.9-10.5) and faster heart rate (HR) (OR 1.6, 95% CI 1.1-2.4, per 10 beats per minute [bpm] increase) were independent predictors of all-cause mortality. Faster HR (OR 1.7, 95% CI 1.1-2.6, per 10-bpm increase) was also an independent predictor of MACE. The predictive value of ECG variables did not change after adjustment for occurence of perioperative ischemia. CONCLUSION In CAD patients, the preoperative ECG contains important prognostic information and is predictive of long-term outcome independent of clinical findings and perioperative ischemia.
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Affiliation(s)
- Raban V Jeger
- Division of Cardiology, University Hospital, Basel, Switzerland
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Kelly RF, McFalls EO. Preoperative evaluation and treatment of stable CAD in patients scheduled for major elective vascular surgery. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2006; 8:59-66. [PMID: 16401384 DOI: 10.1007/s11936-006-0026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
One of the most controversial topics in clinical cardiology is the extent of preoperative studies that is required among patients scheduled for major elective noncardiac operations. Patients in need of an elective operation for either an expanding aortic aneurysm or lower limb ischemia have the highest risk of postoperative cardiac complications because of the high prevalence of coronary artery disease and the hemodynamic stresses associated with the vascular procedures. The decision to perform preoperative coronary angiography should be reserved for only those patients who are deemed clinically unstable or are functionally limited by cardiac symptoms. Among patients with minimal symptoms, preoperative coronary artery revascularization with either coronary artery bypass graft surgery or percutaneous coronary interventions delays the needed operation and does not improve short-term outcomes or long-term survival.
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Affiliation(s)
- Rosemary F Kelly
- Division of Cardiology, VA Medical Center, University of Minnesota, 1 Veterans Drive, 111C, Minneapolis, MN 55414, USA
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Lucreziotti S, Carletti F, Santaguida G, Fiorentini C. Myocardial Infarction in Major Noncardiac Surgery: Epidemiology, Pathophysiology and Prevention. Heart Int 2006. [DOI: 10.1177/182618680600200203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Stefano Lucreziotti
- Unità Operativa di Cardiologia, Azienda Ospedaliera S. Paolo, Polo Universitario, Milano - Italy
| | - Francesca Carletti
- Unità Operativa di Cardiologia, Azienda Ospedaliera S. Paolo, Polo Universitario, Milano - Italy
| | | | - Cesare Fiorentini
- Cattedra di Cardiologia, Università degli Studi di Milano, IRCCS Centro Cardiologico Monzino, Milano - Italy
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Devereaux PJ, Goldman L, Yusuf S, Gilbert K, Leslie K, Guyatt GH. Surveillance and prevention of major perioperative ischemic cardiac events in patients undergoing noncardiac surgery: a review. CMAJ 2005; 173:779-88. [PMID: 16186585 PMCID: PMC1216320 DOI: 10.1503/cmaj.050316] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
This is the second of 2 articles evaluating cardiac events in patients undergoing noncardiac surgery. Unrecognized myocardial infarctions (MIs) are common, and up to 50% of perioperative MIs may go unrecognized if physicians rely only on clinical signs or symptoms. In this article, we summarize the evidence regarding monitoring strategies for perioperative MI in patients undergoing noncardiac surgery. Perioperative troponin measurements and 12-lead electrocardiograms can detect clinically silent MIs and provide independent prognostic information. Currently, there are no standard diagnostic criteria for perioperative MIs in patients undergoing noncardiac surgery. We propose diagnostic criteria that reflect the unique features of perioperative MIs. Finally, we review the evidence for perioperative prophylactic cardiac interventions. There is encouraging evidence that some perioperative interventions (e.g., beta-blockers, alpha2-adrenergic agonists, statins) may prevent major cardiac ischemic events, but firm conclusions await the results of large definitive trials. The best evidence does not support a management strategy of preoperative coronary revascularization before noncardiac surgery.
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Affiliation(s)
- P J Devereaux
- Department of Medicine, McMaster University, Hamilton, Ont.
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Lunn JN. There is nothing new under the sun. Anaesthesia 2005; 60:510; author reply 510-1. [PMID: 15819775 DOI: 10.1111/j.1365-2044.2005.04196.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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