The patient's sex determines the hemodynamic profile in patients with Cushing disease

Background

Cushing disease (CD) may lead to accelerated cardiovascular remodeling and increased mortality. There are suspected differences in the mechanism of cardiovascular dysfunction between males and females with CD. The purpose of this study was to assess the effect of patient sex on the hemodynamic profile assessed via impedance cardiography and echocardiography in patients newly diagnosed with CD.

Material and methods

The 54 patients newly diagnosed with CD (mean age 41 years; 77.8% of females) who were included in this prospective clinical study underwent impedance cardiography to assess specific parameters (including systemic vascular resistance index [SVRI], total arterial compliance index [TACI], Heather index [HI], stroke index [SI], cardiac index [CI], velocity index [VI], and acceleration index [ACI]) and transthoracic echocardiography to assess heart chamber diameters and left ventricular systolic and diastolic function.

Results

Males with CD exhibited higher afterload, with higher SVRI (3,169.3 ± 731.8 vs. 2,339.3 ± 640.8 dyn*s*cm-5*m² in males and females, respectively; p=0.002), lower TACI (0.80 ± 0.30 vs. 1.09 ± 0.30 mL/mmHg*m2; p=0.008), and lower hemodynamic parameters of left ventricular function, with lower HI (9.46 ± 2.86 vs. 14.1 ± 5.06 Ohm/s2; p=0.0007), lower VI (35.1 ± 11.9 vs. 44.9 ± 13.1 1*1000-1*s-1; p=0.009), lower SI (36.5 ± 11.7 vs. 43.6 ± 9.57 mL/m2; p=0.04), lower CI (2.36 ± 0.46 vs. 3.17 ± 0.76 mL*m-2*min-1; p=0.0009), and lower ACI (50.4 ± 19.8 vs. 73.6 ± 25.0 1/100/s2; p=0.006). There were no significant differences between the sexes in left ventricular systolic or diastolic function assessed by echocardiography.

Conclusion

In comparison with females with CD, males with CD have a less favorable hemodynamic profile, with higher afterload and worse left ventricular function. Sex differences in cardiovascular system function should be taken into consideration in designing personalized diagnostic and therapeutic management of patients with CD.

Uncovering the Benefits of the Ketamine-Dexmedetomidine Combination for Procedural Sedation during the Italian COVID-19 Pandemic

This retrospective observational study evaluated the safety and efficacy of the ketamine and dexmedetomidine combination (keta-dex) compared to ketamine or dexmedetomidine alone for sedation of patients with acute respiratory distress due to COVID-19 pneumonia who require non-invasive ventilation. The following factors were assessed: tolerance to the ventilation, sedation level on the Richmond Agitation-Sedation Scale (RASS), hemodynamic and saturation profile, adverse effects, and discontinuation or mortality during ventilation. The study included 66 patients who underwent sedation for non-invasive ventilation using keta-dex (KETA-DEX group, n = 22), ketamine (KET group, n = 22), or dexmedetomidine (DEX group, n = 22). The DEX group showed a slower sedation rate and a significant reduction in blood pressure compared to the KETA-DEX group (p < 0.05). An increase in blood pressure was recorded more frequently in the KET group. No reduction in oxygen saturation and no deaths were observed in any of the groups. None of the patients discontinued ventilation due to intolerance. The mean duration of sedation was 28.12 h. No cases of delirium were observed in any of the groups. Overall, keta-dex was associated with faster sedation rates and better hemodynamic profiles compared to dexmedetomidine alone. Keta-dex is effective and safe for sedation of uncooperative patients undergoing non-invasive ventilation.

Comparison of Laboratory and Hemodynamic Time Series Data Across Original, Alpha, and Delta Variants in Patients With Multisystem Inflammatory Syndrome in Children

OBJECTIVES

To compare the clinical, laboratory, and hemodynamic parameters during hospitalization for patients with multisystem inflammatory syndrome in children (MIS-C), across the Original/Alpha and the Delta variants of severe acute respiratory syndrome coronavirus 2 infection.

DESIGN

Retrospective cohort study.

SETTING

Single-center quaternary children's hospital.

PATIENTS

Children with MIS-C admitted from May 2020 to February 2021(Original and Alpha variant cohort) and August 2021 to November 2021 (Delta variant cohort).

MEASUREMENTS AND MAIN RESULTS

Continuous vital sign measurements, laboratory results, medications data, and hospital outcomes from all subjects were evaluated. Of the 134 patients (102 with Original/Alpha and 32 with Delta), median age was 9 years, 75 (56%) were male, and 61 (46%) were Hispanics. The cohort with Original/Alpha variant had more males (61% vs 41%; p = 0.036) and more respiratory/musculoskeletal symptoms on presentation compared with the Delta variant ( p < 0.05). More patients in the Original/Alpha variant cohort received mechanical ventilation (16 vs 0; p = 0.009). Median hospital length of stay (LOS) was 7 days, and ICU LOS was 3 days for the entire cohort. ICU LOS was shorter in cohort with the Delta variant compared with the Original/Alpha variant (4 vs 2 d; p = 0.001). Only one patient had cardiac arrest, two needed extracorporeal membrane oxygenation, and two needed left ventricular assist device (Impella, Danvers, MA), all in the Original/Alpha variant cohort; no mortality occurred in the entire cohort. MIS-C cohort associated with the Delta variant had lower INR, prothrombin time, WBCs, sodium, phosphorus, and potassium median values ( p < 0.05) during hospitalization compared with the Original/Alpha variants. Hemodynamic assessment showed significant tachycardia in the Original/Alpha variants cohort compared with the Delta variant cohort ( p < 0.05).

INTERVENTIONS

None.

CONCLUSIONS

Patients with MIS-C associated with the Delta variants had lower severity during hospitalization compared with the Original/Alpha variant. Analysis of distinct trends in clinical and laboratory parameters with future variants of concerns will allow for potential modification of treatment protocol.

Comparisons between Bioelectrical Impedance Variables, Functional Tests and Blood Markers Based on BMI in Older Women and Their Association with Phase Angle

The aim of the present study was to compare electrical bioimpedance variables, blood markers and functional tests based on Body Mass Index (BMI) in older women. Associations between Phase Angle (PhA) with functional tests and blood markers were also analyzed. A total of 46 independent elderly people participated in the study, and they were divided into four groups according to BMI values: Group 1 (G1, BMI < 25 kg/m2); Group 2 (G2, BMI > 25−30 kg/m2); Group 3 (G3, BMI > 30−35 kg/m2); Group 4 (G4, BMI > 35 kg/m2). In addition to the weight and height used to calculate the BMI, the following body composition variables were collected: fat mass (FM), fat-free mass, intracellular water (ICW), extracellular water (ECW), total body water (TBW) and PhA (50 kHz) through InBody S10 equipment. Functional capacity was assessed using the Fullerton battery of tests: arm-curl; chair-stand; 6 min walking test (6MWT); time up-and-go test (TUG); standing on one leg (SOOL) and take 10 foot-lines (10FL). The main results showed differences between groups in the tests: 6MWT, SOOL and 10FL between G1 vs. G3 and G2 vs. G3 (p < 0.05); ACT, AIC and AEC between G1 vs. G4 (p < 0.05); FM among all groups (p < 0.05). Negative correlations were found between PhA and the agility test in G1 (r = −0.848; p = 0.008) and G4 (r = −0.909; p = 0.005); PhA and chair-stand in G3 (r = 0.527; p = 0.044); PhA and forearm flexion in G3 (r = 0.641; p = 0.010) and G4 (r = 0.943; p = 0.001); PhA and 6MWT in G4 (r = 0.771; p = 0.042). This study found that there is a clear trend towards better functional capacities with better parameters of body composition. Although there were no differences between groups in PhA, associations were found between different functional tests with PhA, which reveals the importance of this variable as a marker of health status.

The Cardiovascular Conundrum in Ethnic and Sexual Minorities: A Potential Biomarker of Constant Coping With Discrimination

Background: A paradoxical profile of greater elevated sympathetic vasoconstriction (increased total peripheral resistance, TPR) and increased vagally-mediated heart rate variability (HRV) -the so-called Cardiovascular Conundrum- has been reported in African Americans (AAs) both at rest and in response to orthostasis. Whereas some authors have attributed this pattern to genetic factors, others have pointed to the potential role of coping with repeated racial discrimination.

Objective: To disentangle between these alternative explanations, we have examined the hemodynamic profile of another population that is likely to be exposed to episodes of discrimination, i.e., sexual minorities.

Methods: The first study was conducted on a sample of AAs and European Americans (EAs) with the aim of replicating previous results on the Cardiovascular Conundrum. In the second study, lesbian, gay, and bisexual (LGB) people, matched by age and sex with heterosexual participants, underwent a hemodynamic and autonomic assessment at rest and during an emotional (in the experimental group, both LGB-related and non LGB related), and a cognitive stressor.

Results: The first study confirmed a pattern of higher resting HRV, paired with higher TPR, in AAs compared to EAs. In the second study, compared to heterosexuals, the LGB group showed the Cardiovascular Conundrum pattern, characterized by greater HRV and higher TPR at baseline and a more vascular hemodynamic profile and prominent compensation deficit in response to both tasks, and particularly during the LGB-related emotional task. However, in LGB only, the vascular response was negatively correlated with perceived discrimination.

Conclusion: Present preliminary results are discussed in terms of maladaptive physiological consequences of exposure to chronic stress and the chronic use of dysfunctional emotion regulation strategies such as suppression.

Instructed reappraisal and cardiovascular habituation to recurrent stress

Instructed reappraisal has previously been associated with a challenge-oriented cardiovascular response profile, indexed by greater cardiac output (CO) and lower total peripheral resistance (TPR), in response to a single stress exposure. The present study builds on this research by employing a stress habituation paradigm where participants completed a speech task twice; in which prior to the second task participants heard reappraisal instructions (i.e., view feelings of stress arousal as something that is beneficial) or control instructions. This paradigm allowed us to (a) test if reappraisal aids cardiovascular habituation to recurrent stress, and (b) examine if reappraisal leads to a within-participant change in CO/TPR responding from an uninstructed task to an instructed reappraisal task. Habitual use of reappraisal was assessed using the Emotion Regulation Questionnaire. The analyses report upon 173 young adults (121 women, 52 men). Cardiovascular parameters were measured continuously using the Finometer Pro. All participants demonstrated similar cardiovascular habituation during the second stress exposure (lower SBP, CO, and HR); suggesting that reappraisal did not aid cardiovascular habituation to recurrent stress. Reappraisal instructions did not lead to a challenge-oriented response compared to both the control group and responses to the uninstructed task. This study is the first to examine the relationship between instructed reappraisal and cardiovascular habituation and identifies that habitual use of reappraisal does not interact with reappraisal instructions to influence cardiovascular responses to stress.

Effects of Three Months of Detraining on the Health Profile of Older Women after a Multicomponent Exercise Program

Physical exercise results in very important benefits including preventing disease and promoting the quality of life of older individuals. Common interruptions and training cessation are associated with the loss of total health profile, and specifically cardiorespiratory fitness. Would detraining (DT) promote different effects in the cardiorespiratory and health profiles of trained and sedentary older women? Forty-seven older women were divided into an experimental group (EG) and a control group (CG) (EG: n = 28, 70.3 ± 2.3 years; CG: n = 19, 70.1 ± 5.6 years). Oxygen uptake (VO₂₎ and health profile assessments were conducted after the exercise program and after three months of detraining. The EG followed a nine-month multicomponent exercise program before a three-month detraining period. The CG maintained their normal activities. Repeated measures ANOVA showed significant increases in total heath and VO₂ (p < 0.01) profile over a nine-month exercise period in the EG and no significant increases in the CG. DT led to greater negative effects on total cholesterol (4.35%, p < 0.01), triglycerides (3.89%, p < 0.01), glucose (4.96%, p < 0.01), resting heart rate (5.15%, p < 0.01), systolic blood pressure (4.13%, p < 0.01), diastolic blood pressure (3.38%, p < 0.01), the six-minute walk test (7.57%, p < 0.01), Pulmonary Ventilation (VE) (10.16%, p < 0.01), the Respiratory Exchange Ratio (RER) (9.78, p < 0.05), and VO₂/heart rate (HR) (16.08%, p < 0.01) in the EG. DT may induce greater declines in total health profile and in VO₂, mediated, in part, by the effectiveness of multicomponent training particularly developed for older women.