血液透析对慢性肾功能衰竭患者心功能和肺弥散功能的影响及其意义

测定２０例慢性肾功能衰竭患者血液透析（血透）前一天下午和血透后１～２小时的心功能及肺弥散功能的变化。发现血透后心排血量（ＣＯ）、心脏指数（ＣＩ）、每搏心排血量（ＳＶ）及每搏指数（ＳＩ）均显著降低，肺一氧化碳弥散量（ＤＬｃｏ）也显著降低，其中ＳＶ和ＳＩ对超滤反应敏感。结果表明，慢性肾功能衰竭患者血透后可由于左室充盈压降低而导致心功能指标出现下降，并有肺弥散功能的损害     

胸阻抗无创血流动力学监测在危重患者的应用研究

目的评价胸阻抗（TEB）无创血流动力学监测在危重患者的应用价值。方法选取2006年10月至2007年8月入住本院综合ICU住院时间超过24h的危重患者48例,所有病例在常规监护基础上进行TEB监测,并在此期间行超声心动图检查,对两种方法同时测得的心输出量（CO）、心脏指数（CI）、每搏播出量（SV）、每搏指数（SI）等结果进行相关性分析。结果TEB法与超声心动图法所测得的CO、CI、SV和SI均具有很好的相关性。结论 TEB法与超声心动图法监测结果有很好的相关性;TEB法可用于危重患者的血流动力学监测。     

应用胸腔阻抗法评估手术和麻醉对患者血流动力学的影响

目的　通过无创心排血量监测仪 ,评价手术和麻醉对腹部择期手术患者血流动力学的影响。方法　应用 He Mo 6 0 1生物阻抗系统 ,分别于术前 1d、术后 4～ 6 h和 2 4 h对 32例腹部择期手术患者进行血流动力学监测 ,并比较心排血量 (CO)、心排指数 (CI)、每搏心排血量 (SV)、每搏心脏做功 (SW)、心脏每分做功(CW、)左室舒张末压 (L VEDP)和心率 (HR)的变化。结果　 CO、CI、CW和 L VEDP在术后 2 4 h内的改变与术前比较均无显著性差异 (P均 >0 .0 5 )。术后 4～ 6 h的 SV和 SW比术前有明显降低 (P均 <0 .0 5 ) ,而术后 2 4 h的 SV和 SW与术前相比则无显著性差异 (P均 >0 .0 5 )。术后 4～ 6 h HR明显快于术前 (P<0 .0 5 ) ,但术后 2 4h HR与术前相比无显著性差异 (P>0 .0 5 )。结论　术后 4～ 6 h SV和 SW值的降低可能与麻醉使心肌收缩力减弱有关 ,HR明显增快则是 SV和 SW降低后机体产生代偿机制的结果。最大程度地保证术中及术后充足的输液量 ,对维持 CO、CI以及维护组织血液灌注具有重要意义。     

Using 100% oxygen does not alter the cardiovascular autonomic regulation during non-invasively simulated haemorrhage in healthy volunteers

We tested the effect of 100% oxygen on heart rate (HR), arterial blood pressure (ABP), cardiac output (CO), stroke volume (SV), total peripheral resistance (TPR), HR variability (HRV), systolic blood pressure variability (SBPV) and baroreflex sensitivity (BRS) in 20 healthy volunteers during simulated haemorrhage induced by -40 mmHg lower body negative pressure (LBNP). HRV in the high frequency region (HRV HF), BRS, ABP and TPR were significantly increased, SBPV in the low frequency region (SBPV LF), CO and SV were unchanged, and HR was significantly decreased by 100% oxygen administration during normovolaemia. HRV HF, BRS, CO and SV were significantly decreased, SBPV LF and ABP were unchanged, and HR and TPR were significantly increased by LBNP during 21% or 100% oxygen administration. There were no significant differences in cardiovascular autonomic and haemodynamic responses to LBNP during 21% or 100% oxygen administration, suggesting that 100% oxygen does not alter normal cardiovascular autonomic responses during simulated haemorrhage.     

Hemodynamic monitoring in obese patients: the impact of body mass index on cardiac output and stroke volume

OBJECTIVE: Interpreting hemodynamic parameters in critically ill obese patients can be difficult as the effects of body mass index (BMI) on cardiac output (CO) and stroke volume (SV) at the extremes of body size remains unknown. We examined the relationship between BMI and both CO and SV for patients with varying body sizes. DESIGN: Retrospective cohort analysis. SETTING: A large tertiary care academic medical center. PATIENTS: A total of 700 consecutive adults who were found to have disease-free coronary arteries and a cardiac output measurement (thermodilution or Fick method) during coronary angiography between July 1, 2000, and July 31, 2004. MEASUREMENTS AND RESULTS: We examined the relationship between BMI (mean, 28 kg/m(2); range, 10.6-91.6 kg/m(2)) and cardiac hemodynamics after adjusting for demographic (age, sex) and clinical (diabetes, smoking status, valvular heart disease, medications, indications for catheterization) characteristics using multivariable regression. Body mass index was positively correlated with CO and SV. Each 1 kg/m increase in BMI was associated with a 0.08 L/min (95% confidence interval [CI], 0.06-0.10; p < .001) increase in CO and 1.35 mL (95% CI, 0.96-1.74; p < .001) increase in SV. There was no significant association between BMI and both cardiac index (0.003 L/min/m(2); 95% CI, -0.008-0.014; p = .571) and stroke volume index (0.17 mL/m(2); 95% CI, -0.03-0.37; p = .094). CONCLUSION: Variations in BMI translate into predictable but only modest differences in CO and SV, even at the extremes of body size. Indexing hemodynamic measurements to body surface area attenuates the effects of BMI. Body habitus should not appreciably complicate the interpretation of hemodynamic measurements.     

Value of Impedance Cardiography during 6‐Minute Walk Test in Pulmonary Hypertension

Background

Methods that predict prognosis and response to therapy in pulmonary hypertension (PH) are lacking. We tested whether the noninvasive estimation of hemodynamic parameters during 6‐minute walk test (6MWT) in PH patients provides information that can improve the value of the test.

Methods

We estimated hemodynamic parameters during the 6MWT using a portable, signal‐morphology‐based, impedance cardiograph (PhysioFlow Enduro) with real‐time wireless monitoring via a bluetooth USB adapter.

Results

We recruited 48 subjects in the study (30 with PH and 18 healthy controls). PH patients had significantly lower maximum stroke volume (SV) and CI and slower cardiac output (CO) acceleration and decelerations slopes during the test when compared with healthy controls. In PH patients, CI change was associated with total distance walked (R = 0.62; P < 0.001) and percentage of predicted (R = 0.4, P = 0.03), HR recovery at 1 minute (0.57, P < 0.001), 2 minutes (0.65, P < 0.001), and 3 minutes (0.66, P < 0.001). Interestingly, in PH patients CO change during the test was predominantly related to an increase in SV instead of HR.

Conclusions

Estimation of hemodynamic parameters such as cardiac index during 6‐minute walk test is feasible and may provide useful information in patients with PH. Clin Trans Sci 2013; Volume #: 1–7     

Presence of mechanical dyssynchrony in duchenne muscular dystrophy

Background

There are physiological reasons for the effects of positioning on hemodynamic variables and cardiac dimensions related to altered intra-abdominal and intra-thoracic pressures. This problem is especially evident in pregnant women due to the additional aorto-caval compression by the enlarged uterus. The purpose of this study was to investigate the effect of postural changes on cardiac dimensions and function during mid and late pregnancy using cardiovascular magnetic resonance (CMR).

Methods

Healthy non-pregnant women, pregnant women at 20^th week of gestation and at 32^nd week of gestation without history of cardiac disease were recruited to the study and underwent CMR in supine and left lateral positions. Cardiac hemodynamic parameters and dimensions were measured and compared between both positions.

Results

Five non-pregnant women, 6 healthy pregnant women at mid pregnancy and 8 healthy pregnant women at late pregnancy were enrolled in the study. In the group of non-pregnant women left ventricular (LV) cardiac output (CO) significantly decreased by 9% (p = 0.043) and right ventricular (RV) end-diastolic volume (EDV) significantly increased by 5% (p = 0.043) from the supine to the left lateral position. During mid pregnancy LV ejection fraction (EF), stroke volume (SV), left atrium lateral diameter and left atrial supero-inferior diameter increased significantly from the supine position to the left lateral position: 8%, 27%, 5% and 11%, respectively (p < 0.05). RV EDV, SV and right atrium supero-inferior diameter significantly increased from the supine to the left lateral position: 25%, 31% and 13% (p < 0.05), respectively. During late pregnancy a significant increment of LV EF, EDV, SV and CO was observed in the left lateral position: 11%, 21%, 35% and 24% (p < 0.05), respectively. Left atrial diameters were significantly larger in the left lateral position compared to the supine position (p < 0.05). RV CO was significantly increased in the left lateral position compared to the supine position (p < 0.05).

Conclusions

During pregnancy positional changes affect significantly cardiac hemodynamic parameters and dimensions. Pregnant women who need serial studies by CMR should be imaged in a consistent position. From as early as 20 weeks the left lateral position should be preferred on the supine position because it positively affects venous return, SV and CO.     

BioZ.com监测腰-硬联合麻醉下剖宫产产妇的血流动力学变化

目的：应用无创血流动力学监测仪BioZ.com,探讨腰-硬联合麻醉下剖宫产围术期产妇血流动力学变化.方法：19例择期在腰-硬联合麻醉下行剖宫产的产妇,ASA Ⅰ～Ⅱ级,连接BioZ.com连续监测血流动力学变化,分别在麻醉前,麻醉后5、15 min,胎儿娩出前1 min,胎儿娩出后3 min,术毕时记录心率（HR）、每搏输出量（SV）、平均动脉压（MAP）、心排量（CO）、心脏指数（CI）、体循环阻力（SVR）、胸腔液体量（TFC）、左室射血时间（LVET）.结果：围术期各时点HR、TFC、LEVT无明显变化（P＞0.05）;麻醉后15 min SVR开始下降,术毕时仍显著低于麻醉前（P＜0.01）,SV、CO、CI在麻醉后15 min开始升高（P＜0.05）;MAP除在术毕时显著低于术前（P＜0.01）外,其他时间点的差异无统计学意义.胎儿娩出前后相比,胎儿娩出后产妇的 HR、MAP基本维持稳定,而SV、CO、CI明显升高,SVR则明显下降（P＜0.05）;SV、CO、CI与SVR呈负相关（P＜0.01）,MAP 与SVR呈正相关（P＜0.01）.结论：应用BioZ.com监测剖宫产围术期产妇的血流动力学变化,可为围术期的处理提供更多可靠的依据.     

MRI-derived left ventricular function parameters and mass in healthy young adults: Relation with gender and body size

Purpose: To obtain normal values of left ventricular (LV) end-diastolic volume (EDV), stroke volume (SV), cardiac output (CO) and LV mass, in relation to gender, weight (W), length (L) and body surface area (BSA). Methods: Sixty-one healthy volunteers (32 male, 22.4 ± 2.2?years) were examined, weight was 70.9 ± 12.2?kg, length was 1.78 ± 0.09?m, BSA was 1.88 ± 0.19 m². Segmented k-space breathhold cine MRI was used to obtain a stack of parallel short-axis images, from which LV volumes and end-diastolic mass were derived by slice summation. Four different body size indices were studied: W, L, L² and BSA. Results: After indexing for L, L² and BSA, the gender differences in all LV parameters are still persisting. After indexing for W, gender differences persist for EDV and EDM, but are no longer observed for SV and CO. Separate regression analyses for males and females were performed. EDV, SV, CO and EDM correlated significantly with each body size index, both in males and in females. L or BSA were in general better predictors for LV parameters than W. Linear regression equations of EDV (ml) vs. L(m) were for males: EDV = 275 × L ? 359 and for females: EDV = 190 × L ? 215. Equations of SV(ml) vs. L were for males: SV = 186 × L ? 237 and for females: SV = 118 × L ? 121. Equations of LV mass(g) vs. L were for males: Mass = 175 × L ? 179 and for females: Mass = 65.8 × L ? 10.9. Conclusion: Most gender differences in LV parameters remain even after correction for body size indices. Normal reference values for LV parameters are given in relation to body size indices, by calculating regression coefficients separately for males and females. These normal values serve to obtain more accurate reference values for a patient with given gender, weight and length, and thus to improve the differentiation between normal and abnormal LV parameters.     

Efficacy of methylene blue in a murine model of amlodipine overdose

IntroductionAmlodipine overdoses have significant cardiac toxicity and are difficult to treat. Methylene blue has potential as a treatment for overdoses.MethodsA randomized controlled study of methylene blue as a treatment for amlodipine toxicity was conducted in C57Bl/6 mice. A baseline echocardiography was followed by gavage administration of amlodipine (90 mg/kg). Five minutes after gavage, animals received either vehicle solution (controls) or methylene blue (20 mg/kg) by intra-peritoneal injection. Animals were continuously monitored, and cardiac parameters were acquired every 15 min up to two hours.ResultsOnly 50% of control animals survived to the two-hour endpoint compared to 83% that received methylene blue. Amlodipine delivery induced significant reduction in left ventricular ejection fraction (EF), fractional shortening (FS), stroke volume (SV), and cardiac output (CO) in the vehicle treated animals relative to animals in the treatment group (p < 0.05 vehicle versus Methylene blue for EF, FS, SV, CO, and HR).DiscussionThe amlodipine dose induced cardiotoxicity that were effects were more pronounced in the untreated group. 50% vehicle controls quickly progressed into heart failure (within 90 min of exposure) and did not survive the two h observation endpoint. Distinctly, only one animal from the Methylene blue treatment group did not survive (83% survival) the study. Additionally, the surviving animals from the Methylene blue group displayed significantly higher ejection fraction, fractional shortening, stroke volume, and cardiac output compared to vehicle group, indicating that methylene blue preserved cardiac function.ConclusionIn this mouse model of amlodipine overdose, methylene blue decreased cardiac toxicity.     

Dobutamine in elderly septic shock patients refractory to dopamine

The hemodynamic effects of dobutamine (2.5–20 g/kg per min) were studied in six elderly patients with septic shock which was refractory to dopamine (15 g/kg per min). Dobutamine infusion resulted in significant increases in cardiac index (CI), stroke index (SI) and left ventricular stroke work index (LVSWI) and similar declines in heart rate (HR), mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP), systemic vascular resistance (SVR) and total pulmonary resistance (TPR). Dose response curves demonstrated a linear rise in CI with increasing doses of dobutamine and parallel decreases in HR and PCWP. MAP was unchanged. These data indicate that dobutamine may be a useful adjunct to dopamine therapy in the management of elderly patients with septic shock.     

不同吸痰方法对PEEP患者血流动力学影响的研究

目的 研究开放式吸痰与密闭式吸痰对人工机械通气使用PEEP患者心率(HR)、无创血压(NBP)、中心静脉压(CVP)、心输出量(CO)、心脏指数(CI)、每搏射血量(SV)、左心室作功(LCW)、左心室每搏作功(LVSW)、预射血间期(PEP)等的影响.方法 收集2010年1～10月应用机械通气使用PEEP患者,随机分...     

The influence of left lateral position on cardiac output changes after head up tilt measured by impedance cardiography

Background.The value of the impedance cardiography (IC) method formeasuring cardiac output (CO) with the subject in the left lateral positionhas not yet been established. We compared the CO after a 30° head-up tiltwith the subjects in the supine and left lateral position. Methods.Thirty healthy young volunteers were placed in the supine horizontalposition. CO, stroke volume (SV) and heart rate (HR) were measured for fiveminutes using impedance cardiography (NCOMM3, BoMed Medical Manufacturing,Location). Then a 30° head-up tilt was done and the measurements werecontinued for an additional five minutes. After that the subjects were placedin the left lateral horizontal position and the measuring procedure wasrepeated. Results.After the tilt, SV and cardiac index (CI) decreasedand HR increased statistically significantly in the supine and in the leftlateral position. SV and CI also decreased statistically significantly but HRdid not change after the shift from the supine to the left lateral position.Although CI was smaller in the left lateral position, the time course of CIchange after the tilt was identical in the supine and in the left lateralposition. Conclusion.When using the IC method of SV measurement, theabsolute value of the CI changes when moving from the supine to lateralpositions. It is not clear whether this change is physiologic or an artifactof the measurement technique. However, changes in CI in response to a 30degree head up tilt are the same in either position. We conclude that changesin CI can be measured with the IC method in the lateral position.     

Mortality rates in major and subthreshold depression: 10-year follow-up of a Singaporean population cohort of older adults

Objectives: To investigate the associations of major and subthreshold depression with all-cause, cardiovascular disease and stroke mortality, and the extent to which health behaviour, medical comorbidity and functional disability explained the associations.

Methods: A cohort of 1070 persons aged ≥60 with Geriatric Mental State (GMS) diagnoses of major and subthreshold depression, and data on health behaviour (smoking, alcohol, physical activity) and physical comorbidity (hypertension, diabetes, cardiovascular disease, stroke, chronic pulmonary disease, multi-comorbidity and activity of daily living disability) at baseline (15 Feb 2003 - 30 Mar 2004) were followed up on mortality from 1 Jan 2005 to 31 Dec 2012.

Results: Major and subthreshold depression was present in 5.1% and 9.9% of the participants at baseline. The all-cause mortality HR adjusted for age, sex, ethnicity and marital status was 1.73 (95% CI, 1.11-2.67) for major depression and 1.38 (95% CI, 0.96-1.97) for subthreshold depression. In hierarchical models, the addition of health behaviour and especially physical comorbidity substantially reduced the HR estimates for all-cause mortality associated with major depression (HR=1.39, 95% CI, 0.89-2.18) and subthreshold depression (HR=0.94, 95% CI, 0.64-1.37). Controlling for the effects of all variables, only major depression was significantly associated with increased cardiovascular disease and stroke mortality (HR=2.10, 95% CI, 1.07-4.11).

Conclusions: Both major and subthreshold depression were associated with increased mortality, largely due to hazardous behaviours and physical comorbidity. Only major depression per se was independently associated with excess cardiovascular disease and stroke mortality.     

维持性血液透析患者血液动力学变化及影响因素研究

目的研究不同心功能状态下维持性血液透析(maintenance hemodialysis,MHD)患者血液透析过程中血液动力学变化及其影响因素。方法用超声稀释法对中国医科大学附属第四医院肾内科2005年9月至2011年9月行MHD患者95例进行检测,包括患者动静脉内瘘(arteriovenous fistula,AVF)、血流量(Qa)和透析后不同时段的血液动力学指标:心输出量(Cardiac output,CO)、心搏出量(stroke volume,SV)、心脏指数(cardiac index,CI)、中心血容量(central blood volume,CBV)、中心血容量指数(central blood volume index,CBVI)、外周血管阻力(peripheral vascular resistance,PR)等参数。结果 95例患者收缩压(SBP)、SV、CO、CI及CBV明显下降,差异有统计学意义(P<0.01);PR增加,而舒张压(DBP)及心率的变化差异无统计学意义。根据透析后1hCI值,将患者分为3组,A组CI<2.5L/(min·m2)、B组CI2.5～4.2L/(min·m2)、C组CI>4.2L/(min·m2)。A、B组患者透析3h后SV、CO、CBV较透析1h明显下降,PR增高(P均<0.01),A组最为明显,而C组前后血液动力学指标无明显差异。结论 MHD患者血液动力学改变表现主要为血压、CO、CI以及CBV降低,PR增高。不同心功能患者血液动力学改变程度不同,CI与Qa、SBP、年龄、糖尿病有相关关系。     

Quantitative cardiovascular magnetic resonance in pregnant women: cross-sectional analysis of physiological parameters throughout pregnancy and the impact of the supine position

Background

There are physiological reasons for the effects of positioning on hemodynamic variables and cardiac dimensions related to altered intra-abdominal and intra-thoracic pressures. This problem is especially evident in pregnant women due to the additional aorto-caval compression by the enlarged uterus. The purpose of this study was to investigate the effect of postural changes on cardiac dimensions and function during mid and late pregnancy using cardiovascular magnetic resonance (CMR).

Methods

Healthy non-pregnant women, pregnant women at 20^th week of gestation and at 32^nd week of gestation without history of cardiac disease were recruited to the study and underwent CMR in supine and left lateral positions. Cardiac hemodynamic parameters and dimensions were measured and compared between both positions.

Results

Five non-pregnant women, 6 healthy pregnant women at mid pregnancy and 8 healthy pregnant women at late pregnancy were enrolled in the study. In the group of non-pregnant women left ventricular (LV) cardiac output (CO) significantly decreased by 9% (p = 0.043) and right ventricular (RV) end-diastolic volume (EDV) significantly increased by 5% (p = 0.043) from the supine to the left lateral position. During mid pregnancy LV ejection fraction (EF), stroke volume (SV), left atrium lateral diameter and left atrial supero-inferior diameter increased significantly from the supine position to the left lateral position: 8%, 27%, 5% and 11%, respectively (p < 0.05). RV EDV, SV and right atrium supero-inferior diameter significantly increased from the supine to the left lateral position: 25%, 31% and 13% (p < 0.05), respectively. During late pregnancy a significant increment of LV EF, EDV, SV and CO was observed in the left lateral position: 11%, 21%, 35% and 24% (p < 0.05), respectively. Left atrial diameters were significantly larger in the left lateral position compared to the supine position (p < 0.05). RV CO was significantly increased in the left lateral position compared to the supine position (p < 0.05).

Conclusions

During pregnancy positional changes affect significantly cardiac hemodynamic parameters and dimensions. Pregnant women who need serial studies by CMR should be imaged in a consistent position. From as early as 20 weeks the left lateral position should be preferred on the supine position because it positively affects venous return, SV and CO.     

Changes in cardiac output and stroke volume as measured by non-invasive CO monitoring in infants with RSV bronchiolitis

Objectives: The primary aim of the study was to determine the changes, if any, in cardiac output (CO) and stroke volume (SV) in normal infants with RSV bronchiolitis. The secondary aim was to determine whether changes in CO (??CO) and SV (??SV) are associated with changes in respiratory rate (??RR). Methods: Non-invasive CO recordings were obtained within 24?h of admission and discharge. Changes in CO, SV, and HR measurements were compared using paired t-tests. The effect of fluid boluses during the first 24?h (<60 or ??60?cc/kg) on CO was assessed by 2 way ANOVA with time and group as main effect. The relationship between ??RR and ??CO or ??SV was assessed by linear regression. Data is presented as Mean?±?SEM and mean differences with 95?% confidence interval (p?Results: 15 infants with RSV bronchiolitis were studied. CO (1.31?±?0.13 to 1.11?±?0.11?l/min (0.21 [0.04?C0.37]) and SV (9.42?±?1.10 to 7.75?±?0.83?ml/beat (1.67 [0.21?C3.12]) decreased significantly while HR (142.1?±?4.0 to 145.2?±?3.1 beats/min 3.0 [?5.3 to 11.3]) was unchanged. SV (p?=?0.02) and CO (p?=?0.04) significantly decreased only in the 7 infants that received ??60?cc/kg. ??RR correlated significantly with ??CO (r ²?=?0.28, p?=?0.04); but not with ??SV (r ²?=?0.20, p?=?0.09). Conclusions: ?CO was related to ??SV and not ?? HR. The ?CO and ??SV were affected by fluid boluses. ??RR correlated with ??CO. Non-invasive CO monitoring can trend CO and SV in infants with bronchiolitis during hospitalization.     

Central hemodynamics in women during labor with combined use of prostaglandin E2 and prolonged epidural analgesia

Changes in central hemodynamics have been studied in 60 women with weak labour efforts treated with prostenon and subject to prolonged epidural analgesia (PEA). It has been established that PEA has a pronounced antihypertensive effect, decreases the heart rate (HR), cardiac index (CI), reserve coefficient (RC) and integral tonic coefficient (ITC) and increases significantly stroke index (SI). Prostenon, having a modulating effect on the cardiovascular system, induces an increase in mean blood pressure (MBP) in hypotensive patients and a decrease in MBP in hypertensive patients, lowers SI and ITC and elevates HR, CI and RC. In combined application, prostenon compensates for a number of hemodynamic shifts caused by PEA. The method of labour stimulation described seems advisable in women with late toxemia of pregnancy, provided labour stimulation is started with prostenon administration.     

Noninvasive Cardiac Output Measurement by Transthoracic Electrical Bioimpedence: Influence of Age and Gender

Background  Thoracic electrical bioimpedance (TEB) as a method of measuring cardiac output (CO) is being explored increasingly over the last two decades, as a non-invasive alternative to the pulmonary artery catheter. The objective of this study was to establish normative data for measurement of CO by TEB and define the effect of age and gender on CO. Method  Stroke volume (SV) of 397 normal individuals (203 men, 194 women) in the age range of 10–77 years was determined using Kubisek and Bernstein formulae by TEB method. Derived cardiac parameters including CO, cardiac index (CI), systemic vascular resistance and resistance index were calculated and analyzed. Results  We found significant difference in CO among age groups and between gender. CO between Kubicek formula and Bernstein formula correlated well, but their means differed significantly. Cardiac indices peak in the third and seventh decade and were comparable between genders. Conclusion  A comprehensive data set of normalized values expressed as 95% confidence interval and mean ± SD in different age groups and different gender was possible for cardiac parameters using TEB. Sathyaprabha TN, Pradhan C, Rashmi G, Thennarasu K, Raju TR. Noninvasive cardiac output measurement by transthoracic electrical bioimpedence: influence of age and gender.     

Long-term follow-up for cardiovascular disease after chemotherapy and/or radiotherapy for breast cancer in an unselected population

Purpose

Whereas earlier research focused on specific patient groups, this study assessed the risk of cardiovascular disease (CVD) in an unselected population curatively treated for breast cancer (BC), compared with an age-matched random sample of controls.

Methods

Risks were determined in BC survivors and controls. CVD was divided into three categories: congestive heart failure, vascular cardiac diseases, and “other” cardiac diseases. Hazard ratios (HRs) and 95 % confidence intervals (95 % CI) adjusted for age, CVD, and CVD risk factors at baseline were determined by Cox regression analyses.

Results

All 561 survivors of BC experienced surgery of whom 229 received (neo)adjuvant radiotherapy, 145 received chemotherapy (with or without radiotherapy), and 187 received no adjuvant therapy. During follow-up (median 9; range 5–57 years), CVD occurred in 176/561 (31 %) survivors and in 398/1,635 (24 %) controls. After radiotherapy, no increased risks of congestive heart failure (HR 0.5; 95 % CI 0.2–1.8), vascular cardiac diseases (HR 1.1; 95 % CI 0.7–1.7), or other cardiac diseases (HR 1.3; 95 % CI 0.8–2.3) were found compared with controls. Similar results were found after chemotherapy for congestive heart failure (HR 1.8; 95 % CI 0.6–5.8), vascular cardiac diseases (HR 1.1; 95 % CI 0.5–2.3), and other cardiac diseases (HR 1.2; 95 % CI 0.3–5.5).

Conclusions

In an unselected population of BC survivors, no significant increased risk of CVD after radiotherapy and/or chemotherapy was found compared with controls. However, the HRs after chemotherapy were in-line with previous studies. Future studies should include more detailed information on treatment and more specific outcome measures.