Mechanical circulatory support (MCS) with an implantable left ventricular assist device (LVAD) is an established therapeutic option for advanced heart failure. Most of the currently used LVADs generate a continuous stream of blood that decreases arterial pulse pressure. This study investigated whether a change of the pulse pressure during different pump speed settings would affect cerebral autoregulation and thereby affect cerebral blood flow (CBF). The study included 21 haemodynamically stable outpatients with a continuous-flow LVAD (HeartMate II, Abbott, USA) implanted a median of 6 months before the study (interquartile range 3 to 14 months). Arterial blood pressure (measured by finger plethysmography) was recorded simultaneously with CBF (measured by transcranial Doppler ultrasound) during baseline pump speed (8900 rpm [IQR 8800; 9200]) and during minimum and maximum tolerated pump speeds (8000 rpm [IQR 8000; 8200] and 9800 rpm [IQR 9800; 10 000]). An increase in LVAD pump speed by 800 rpm [IQR 800; 1000] from the baseline lead to a significant decrease in arterial pulse pressure and cerebral blood flow pulsatility (relative change −24 % and −32 %, both p < 0.01), but it did not affect mean arterial pressure and mean CBF velocity (relative change 1 % and −1.7 %, p=0.1 and 0.7). In stable patients with a continuous-flow LVAD, changes of pump speed settings within a clinically used range did not impair static cerebral autoregulation and cerebral blood flow.
Surgical Plethysmographic Index (SPI), calculated from pulse photo-plethysmographic amplitude oscillations, has been proposed as a tool to measure nociception anti-nociception balance during general anesthesia, but it is affected by several confounding factor that alter the autonomic nervous system (ANS) modulation. We hypothesized that SPI may be mainly affected by sympathetic stimulation independently from nociception. We studied the effects of two sympathetic stimuli on SPI, delivered through passive head-up tilt at 45 and 90 degrees angles, in nine awake healthy adults. The sympathetic modulation was assessed by means of heart rate variability (HRV) analysis. Mean (SD) SPI significantly increased from baseline to 45 degrees [from 38.6 (13.7) to 60.8 (7.6), p<0.001)] and to 90 degrees angle tilt [82.3 (5.4), p<0.001]. The electrocardiographic mean R-to-R interval significantly shortened during both passive tilts, whereas systolic arterial pressure did not change during the study protocol. HRV changed significantly during the study protocol towards a predominance of sympathetic modulation during passive tilt. Gravitational sympathetic stimulation at two increasing angles, in absence of any painful stimuli, affects SPI in awake healthy volunteers. SPI seems to reflect the sympathetic outflow directed to peripheral vessels., R. Colombo, A. Marchi, B. Borghi, T. Fossali, E. Tobaldini, S. Guzzetti, F. Raimondi., and Obsahuje bibliografii
Pulse wave analysis permits non-invasive assessment of arterial elasticity indices. The contour varies in different parts of the circulation. It depends on physiological or pathophysiological conditions of the organism. The pathological events like arteriosclerosis or diabetes have a primary effect to the artery elasticity. Hypertension or some heart diseases al so influence the pulse wave velocity and resulted in earlier wave reflections. There are several methods of pulse wave measurements based on different principles and depending on the type of measured pulse wave. The evaluation parameters can be assessed from the time domain, derivations, velocity or frequency domain. The main aim of this review article is to offer a recent overview of pulse wave measurement parameters and main results obtained. The principles of pulse wave measurement and current experience in clinical practice are shortly discussed too., D. Korpas, J. Hálek, L. Doležal., and Obsahuje seznam literatury
The aim of this study was to obtain a detailed analysis of the relationship between the finger arterial compliance C [ml/mm Hg] and the arterial transmural pressure Pt [mm Hg]. We constructed a dynamic plethysmograph enabling us to set up a constant pressure Pcss [mm Hg] and a superimposed fast pressure vibration in the finger cuff (equipped with a source of infra-red light and a photoelectric sensor for the measurement of arterial volume). Pcss could be set on the required time interval in steps ranging between 30 and 170 mm Hg, and on sinusoidal pressure oscillation with an amplitude Pca (2 mm Hg) and a frequency f (20, 25, 30, 35, 40 Hz). At the same time continuous blood pressure BP was measured on the adjacent finger (Portapres). We described the volume dependence of a unitary arterial length on the time-varying transmural pressure acting on the arterial wall (externally Pcss+Pca.sin(2πf), internally BP) by a second-order differential equation for volume. This equation was linearized within a small range of selected BP. In the next step, a Fourier transform was applied to obtain the frequency characteristic in analytic form of a complex linear combination of frequency functions. While series of oscillations [Pca, f] were applied for each Pcss, the corresponding response of the plethysmogram was measured. Amplitude spectra were obtained to estimate coefficients of the frequency characteristic by regression analysis. We determined the absolute value: elastance E, and its inverse value: compliance (C=1/E). Then, C=C(Pt) was acquired by applying sequences of oscillations for different Pcss (and thus Pt) by the above-described procedure. This methodology will be used for the study of finger arterial compliance in different physiological and pathological conditions., J. Moudr, J. Svačinová, E. Závodná, N. Honzíková., and Obsahuje bibliografii