Aim To evaluate the endothelial function using an Endo-PAT2000 instrument before and after mental stress tests in patients with Tacotsubo syndrome (TS) during acute and long-term periods and to compare the obtained results with laboratory markers of endothelial dysfunction (ED).Material and methods This study included 45 patients with TS (mean age, 63.5±13.7 years) and 40 healthy volunteers (control group, CG). All patients of the main group during the acute period (first 7–14 days) and long-term period (at 1 and 2 years), as well as CG subjects, underwent evaluation of the endothelial function with an Endo-PAT 2000 instrument, and the reactive hyperemia index (RHI) was determined before and after mental stress tests. Also, concentrations of endothelin 1 (ET-1) and numbers of circulating endothelial cells (CEC) were measured after a two-year follow-up of TS patients.Results During the acute period of disease, all TS patients (n=45) had ED: RHI was below the threshold level of 1.67; furthermore, 42 (93.3 %) patients retained a lower RHI following mental stress. At one year (n=40), 16 (40%) patients showed ED at rest along with a significantly increased mean RHI. Mental stress produced at one year was associated with ED in 28 (70 %) TS patients. At two years (n=44), resting RHI was lower than normal in 19 (43.2 %) patients. Mental stress tests performed at two years were associated with ED in 29 (65.9 %) patients (RHI ≤1.67). Only 10% of CG subjects had a lower-than-normal RHI, which was significantly less than in the main group of TS patients during the acute and long-term periods (p<0.05). Mean values of laboratory markers for ED also were significantly different between TS patients during the long-term period of disease (n=41) and CG subjects (n=40; p<0.01).Conclusion During acute and long-term periods of disease, most of TS patients had impaired vascular reactivity both at rest and during mental stress. The laboratory markers of ED, ET-1 and CEC can be used in clinical practice for evaluation of the risk for TS.
BACKGROUND: The clinical features of vasospastic angina are well known, but pathogenesis remains a subject of discussion. Changes in the autonomic regulation of coronary artery tone and endothelial function that contribute to the development of vasospasm are not well understood. The data on the subject from the published studies are contradictory. AIM: To evaluate features of endothelial function and autonomic regulation of heart rhythm in patients with vasospastic angina. MATERIALS AND METHODS: The study included 16 patients with proven vasospastic angina. All the patients have been evaluated for the heart rate variability at rest and vegetative tests (deep breathing, and active standing tests). Endothelial function has been assessed in terms of reactive hyperemia index by peripheral arterial tonometry using an Endo-PAT 2000 device. RESULTS: The baseline of the total heart rate variability was borderline with the normal parameters SDNN 50 (32.5; 50) ms in the patients with vasospastic angina. There were 14 patients who have demonstrated an imbalance of the autonomic nervous system at rest, mainly due to an increase of parasympathetic influences. The appropriate reaction of the autonomic nervous system, characterized by an increase of vagal influences, has been determined in 13 patients in the deep-breathing test. A paradoxical reaction, characterized by an increase of vagal influences on the heart rhythm, has been registered in 13 patients in the active standing tests. Endothelial dysfunction has been observed in half of the studied patients. Furthermore, a combination of both pathophysiological mechanisms, i.e., endothelial and autonomic dysfunctions have been observed in all the patients with a reduced reactive hyperemia index. CONCLUSIONS: According to the results of our study, the parasympathetic influences of the autonomic nervous system on the heart rhythm were predominant in the patients with vasospastic angina, which is not typical for coronary heart disease. All the patients had autonomic or endothelial dysfunction. A combination of both pathophysiological mechanisms has been observed in half of the examined patients.
Purpose of the study. To assess the sensitivity, specificity and diagnostic accuracy of the method for non-invasive differential diagnosis of liver diseases by polyhepatography.Materials and methods. A random sampling method examined 45 primary patients. Polygepatography was performed on all patients to detect disorders of intrahepatic microcirculation during primary contacting. Based on the detected changes in intrahepatic hemodynamics and based on the morphofunctional hemodynamic model, a conclusion was made about the violation of intrahepatic blood flow and an assumption was made about the etiology and stage of liver disease. Subsequently, the diagnosis of liver diseases was verified after a detailed study of clinical-laboratory, instrumental and morphological data generally accepted in hepatology. Puncture liver biopsy by the Mancini method was performed in 11.1 % of the subjects.Results. All subjects were divided into three groups based on the data obtained on impaired intrahepatic hemodynamics during polyhepatography (PHG). The group I consisted of patients with impaired venous inflow, the group II included patients with impaired arteriovenous inflow, and group III — with impaired venous outflow. The obtained polyhepatographic data were compared with the results of clinical-laboratory, instrumental and morphological data. The high sensitivity, sufficient specificity and accuracy of the polyhepatography method in the diagnosis of chronic liver diseases have been determined.Conclusion. The studies carried out indicate that PHG is a simple, accessible and not burdensome examination method for the patient, which makes it possible to assess the localization of intrahepatic blood flow disorders, and, with a certain degree of probability, to assume the etiological factor of the disease and the stage of the disease. Given the specificity of changes in liver hemodynamics, de pending on the etiological factor and stage of the disease, assessment of intrahepatic hemodynamics by polyhepatography can be recommended as a screening method for examining patients with liver diseases, which will shorten the diagnostic search time.
Objective. The purpose of the work was to assess the application of modified ways of polyhepatography (PHG) and peripheral arterial tonometry (PAT) in the evaluation of regulation of peripheral circulation (capillary blood flow).Design and methods. We included 150 people, divided into four groups. The first group (n = 40) includes patients with stage II hypertension, moderate and high risk of cardiovascular complications. The second group (n = 40) includes patients with stable forms of coronary heart disease in combination with hypertension. The third group (n = 40) includes patients with chronic liver diseases. The fourth group (n = 30) consisted of subjects without anamnestic and objective data of pathology. All subjects underwent a comprehensive clinical and laboratory examination, an assessment of intrahepatic hemodynamics by the PGG method, an assessment of the endothelial function by the PAT method. A modified method of PAT was used to evaluate the central reaction of the peripheral blood flow regulation system (endothelium-independent vasodilation).Results. Endothelial dysfunction was found in patients with cardiovascular pathology and in patients with chronic liver diseases. A modified method of PAT showed a multidirectional reaction of peripheral blood flow to the test with local ischemia. A number of features were identified in the study groups when assessing disorders of intrahepatic microcirculation. Patients of group I had multidirectional disorders of arteriovenous inflow (45% cases, confidence interval (CI) from 27 % to 63 %) and outflow (37,5 %, CI from 22 % to 56 %) in the liver, while in patients of group II and group III, disorders of arteriovenous inflow were more common, 85 % (CI from 70 % to 95%) and 90% (82 % to 94%), respectively. Rheographic signs of bile passage disorders were more common in groups II and III. A significant negative relationship was established between endothelial dysfunction and the severity of intrahepatic microcirculation disorders (r = –0,35, p < 0,001).Conclusions. Modified methods of peripheral arterial tone and PHG enable assessment of local and central mechanisms of blood flow regulation at the microvascular level in patients with hypertension, coronary heart disease and chronic liver diseases. The relationship between impaired endothelial function and intrahepatic microcirculation allows us to consider the liver as a target organ in cardiovascular pathology.
The article presents a new method for determining diastolic function of the right ventricle in patients with essential hypertension through evaluation of intrahepatic blood flow by the method of polyhepatography.
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