Avaliação clínica e laboratorial hepática em indivíduos com insuficiência cardíaca congestiva

Vasconcelos, Luiz Antônio; Almeida, Eros Antônio de; Bachur, Luiz Felipe

doi:10.1590/s0066-782x2007000500015

Cited by 32 publications

(10 citation statements)

References 10 publications

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“…The study of the age range and left ventricular systolic function variables showed a close concordance with data from the literature [20][21][22][23] . The analysis of age range showed that the mean doses of midazolam and meperidine solution required to achieve the expected level of sedation were progressively lower the higher the age range of the patients studied; the maximum percentage of 36.65% reduction of the amount of sedative solution required was achieved in individuals older than 65 years in relation to those younger than 24 years (p<0.01).…”

Section: Ga -Group A; Gb -Group Bsupporting

confidence: 86%

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Dose efetiva de sedação em ecocardiograma transesofágico: relação com idade, área de superfície e função do ventrículo esquerdo

José¹,

Silva²,

Ferreira³

et al. 2009

Arq. Bras. Cardiol.

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Background: Sedation with midazolam and meperidine is widely used in transesophageal echocardiography. However, no mean dose is established for each individual case.Objective: To correlate the mean midazolam and meperidine doses for proper sedation for transesophageal echocardiography with age range, body surface area, and left ventricular ejection fraction.Methods: Retrospective study comprising 1,841 patients undergoing sedation based on the Ramsay scale, with a solution containing midazolam 1.5 mg (1.5 ml), meperidine 1 mg (1 ml) and distilled water (7.5 ml). Four age groups were analyzed: G1: ≤ 24 years; G2: 25 to 44 years; G3: 45 to 64 years; and G4: ≥ 65 years. Body surface area was calculated using the formula {[(height x 100) 0.725 ] x (weight 0.425 ) x 0.0071}. As regards the left ventricular ejection fraction, two groups were studied: GA: < 55%; and GB: ≥ 55%. The statistical analysis was carried out using the Kruskal-Wallis test for the correlation with age and left ventricular ejection fraction, and simple linear correlation for body surface area.Results: As regards age, the mean doses of sedation required were significantly lower in G3 and G4 (p<0.01). The analysis of left ventricular ejection fraction showed that this was significantly lower in GA (p<0.01). The linear correlation coefficient between dose of sedation and body surface area was 0.09 (null). Conclusion Effective Dose of Sedation in Transesophageal EchocardiographyRelation to Age, Body Surface Area and Left Ventricle FunctionGuilherme Moreira José, Carlos Eduardo Suaide Silva, Luiz Darcy Cortez Ferreira, Yara Prosdossini Soares de Novaes, Claudia Gianini Monaco, Manuel Adán Gil, Renata Rejane Linhares, Marcelo Sgrott Rodrigues, Antônio S. S. de Moraes, Juarez Ortiz. OMNI-CCNI Medicina Diagnóstica de São Paulo, São Paulo, SP -Brazil IntroductionTransesophageal echocardiography is performed via esophageal intubation, using a probe with one or more transducers at its tip. An approximately 5-hour fast is required for all patients undergoing the procedure whether using anesthesia or sedation 1 .The use of a local anesthetic agent (lidocaine hydrochloride 10% spray) and peripheral venipuncture are also recommended; usually, sedatives and analgesic agents are preferably administered intravenously 1 . The tolerance to the procedure, which is almost always uncomfortable, is increased with the use of sedation and analgesia by blocking the response to stress (quite useful in patients with heart diseases), and by reducing the laryngeal activity (very useful in patients with asthma, chronic bronchitis and heart diseases), discomfort and pain. It is also very useful for excessively anxious patients and those with neurological diseases or psychiatric disorders who are unable to cooperate. It can also be performed as per patient . Today, the drugs most frequently used for sedation in transesophageal echocardiography are the benzodiazepines (diazepam and midazolam), and for analgesia, the opioids (meperidine and fentanyl) and propofo...

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Section: Ga -Group A; Gb -Group Bsupporting

confidence: 86%

“…Reduced capacity of biotransformation of drugs with a high percentage of liver participation, such as midazolam and meperidine, is expected in the elderly, and this leads to a prolonged plasma half-life and increased serum levels of their metabolically active molecules [20][21][22] .…”

Section: Ga -Group A; Gb -Group Bmentioning

confidence: 99%

Dose efetiva de sedação em ecocardiograma transesofágico: relação com idade, área de superfície e função do ventrículo esquerdo

José¹,

Silva²,

Ferreira³

et al. 2009

Arq. Bras. Cardiol.

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“…However, no distinction was made for females, who on average usually have lower limits of normal for AST, ALT, ALP and GGT. 20 These values can still be considered appropriate given the male predominance in the cohort studied. A lack of access to all hemodynamic measures, liver imaging or histology prevented the full confirmation of initial diagnosis and subsequent improvement.…”

Section: Discussionmentioning

confidence: 99%

Hepatic dysfunction and survival after orthotopic heart transplantation: Application of the MELD scoring system for outcome prediction

Chokshi

Cheema

Schaefle

et al. 2012

The Journal of Heart and Lung Transplantation

154

138

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BACKGROUND The prevalence of heart failure (HF) is rising and the only corrective treatment is cardiac transplantation. Advanced HF is associated with congestive hepatopathy and progressive functional and ultrastructural changes of the liver. We hypothesized that hepatic dysfunction is associated with impaired clinical outcome after heart transplantation. METHODS Data of 617 adult patients (75% males, mean age of 53±12 years, mean BMI of 25±4 and mean ejection fraction of 19±9%) undergoing orthotopic heart transplantation (OHT) were analyzed retrospectively. Deviation from institutional normal ranges was used to define abnormal liver function. Standard model for end Stage liver disease (MELD) scores were calculated and a modified MELD score with albumin replacing INR (modMELD) was created to eliminate the confounding effects of anticoagulation. RESULTS Before OHT, AST, ALT and total bilirubin were elevated in 20%, 18% and 29% of the population, respectively. Total protein and albumin were decreased in 25 and 52% of the population, respectively. By 2 months post-transplantation, percentages of individuals with pathological values decreased significantly except ALT, total protein and albumin, all of which took longer to normalize. Individuals with a higher pre-transplantation MELD or modMELD score had worse outcome 30 days post-transplant and reduced long-term survival over a 10-year follow-up. CONCLUSIONS In this large, single-center retrospective study, we demonstrate dynamics of liver dysfunction after cardiac transplantation and that elevated MELD scores indicating impaired liver function are associated with poor clinical outcome following OHT. Therefore, preoperative liver dysfunction has a significant impact on survival of patients after cardiac transplantation.

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“…Primary laboratory finding in congestive hepatopathy is represented by mild hyperbilirubinemia, with a predominantly unconjugated fraction [3]. Elevations in markers of cholestasis (alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT) are also characteristic of congestive hepatopathy and have been shown to correlate with right atrial and central venous pressures [10,11].…”

Section: Biochemical Patternmentioning

confidence: 99%

Relationship between Heart Disease and Liver Disease: A Two-Way Street

Hadi

Vincenzo

Rossato

2020

Cells

111

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In clinical practice, combined heart and liver dysfunctions coexist in the setting of the main heart and liver diseases because of complex cardiohepatic interactions. It is becoming increasingly crucial to identify these interactions between heart and liver in order to ensure an effective management of patients with heart or liver disease to provide an improvement in overall prognosis and therapy. In this review, we aim to summarize the cross-talk between heart and liver in the setting of the main pathologic conditions affecting these organs. Accordingly, we present the clinical manifestation, biochemical profiles, and histological findings of cardiogenic ischemic hepatitis and congestive hepatopathy due to acute and chronic heart failure, respectively. In addition, we discuss the main features of cardiac dysfunction in the setting of liver cirrhosis, nonalcoholic fatty liver disease, and those following liver transplantation.

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Avaliação clínica e laboratorial hepática em indivíduos com insuficiência cardíaca congestiva

Abstract: hepatic investigations in individuals with heart failure.

Cited by 32 publications

References 10 publications

Dose efetiva de sedação em ecocardiograma transesofágico: relação com idade, área de superfície e função do ventrículo esquerdo

Dose efetiva de sedação em ecocardiograma transesofágico: relação com idade, área de superfície e função do ventrículo esquerdo

Hepatic dysfunction and survival after orthotopic heart transplantation: Application of the MELD scoring system for outcome prediction

Relationship between Heart Disease and Liver Disease: A Two-Way Street

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