Effect of a reduction in blood viscosity on maximal myocardial oxygen delivery distal to a moderate coronary stenosis.

Most, Albert S.; Ruocco, Nicholas A.; Gewirtz, Henry

doi:10.1161/01.cir.74.5.1085

Cited by 129 publications

(73 citation statements)

References 23 publications

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“…Anemia has been shown to significantly decrease oxygen delivery to myocardium downstream of coronary stenoses. 3 Anemia also increases myocardial oxygen demand through necessitating a higher stroke volume and heart rate to maintain adequate systemic oxygen delivery. 4 The combination of these processes may explain the pathophysiology underlying the progressively worse outcomes we observed in patients with ACS with lower baseline hemoglobin concentrations.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Anemia has the potential to worsen the myocardial ischemic insult in acute MI and other acute coronary syndromes (ACS), both by decreasing the oxygen content of the blood supplied to the jeopardized myocardium 3 and by increasing myocardial oxygen demand through necessitating a higher cardiac output to maintain adequate systemic oxygen delivery. 4 In animal models, higher hemoglobin concentrations prevent ischemia in the setting of significant coronary artery stenoses.…”

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confidence: 99%

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Association of Hemoglobin Levels With Clinical Outcomes in Acute Coronary Syndromes

et al. 2005

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Background— In the setting of an acute coronary syndrome (ACS), anemia has the potential to worsen myocardial ischemia; however, data relating anemia to clinical outcomes in ACS remain limited. Methods and Results— We examined the association between baseline hemoglobin values and major adverse cardiovascular events through 30 days in 39 922 patients enrolled in clinical trials of ACS. After adjustment for differences in baseline characteristics and index hospitalization treatments, a reverse J-shaped relationship between baseline hemoglobin values and major adverse cardiovascular events was observed. In patients with ST-elevation myocardial infarction, when those with hemoglobin values between 14 and 15 g/dL were used as the reference, cardiovascular mortality increased as hemoglobin levels fell below 14 g/dL, with an adjusted OR of 1.21 (95% CI 1.12 to 1.30, P <0.001) for each 1-g/dL decrement in hemoglobin. At the other end of the range of hemoglobin, patients with hemoglobin values >17 g/dL also had excess mortality (OR 1.79, 95% CI 1.18 to 2.71, P =0.007). In patients with non–ST-elevation ACS, with those with hemoglobin 15 to 16 g/dL used as the reference, the likelihood of cardiovascular death, myocardial infarction, or recurrent ischemia increased as the hemoglobin fell below 11 g/dL, with an adjusted OR of 1.45 (95% CI 1.33 to 1.58, P <0.001) for each 1 g/dL decrement in hemoglobin. Patients with hemoglobin values >16 g/dL also had an increased rate of death or ischemic events (OR 1.31, 95% CI 1.03 to 1.66, P =0.027). Conclusions— Anemia is a powerful and independent predictor of major adverse cardiovascular events in patients across the spectrum of ACS.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Association of Hemoglobin Levels With Clinical Outcomes in Acute Coronary Syndromes

et al. 2005

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“…Two observational studies 1,59 and a number of laboratory studies [81][82][83][84][85][86][87] have established coronary artery disease as a risk factor in anemic patients. In the TRICC trial, 323 volume-resuscitated critically ill patients were diagnosed with cardiovascular disease.…”

Section: Can the Tricc Trial Results Be Applied To Patients With Cardmentioning

confidence: 99%

Transfusion Morbidity and Mortality in the ICU

Hébert¹

2000

Transfus Alt Transfus Med

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Transfusion of red blood cells (RBCThis patient population is affected by complex metabolic, respiratory and cardiovascular pathophysiological processes which predispose this patient population to the adverse consequences of anemia such as the potential risk of myocardial infarction and death. It is also possible that critically ill patients are at increased risks of adverse consequences from allogeneic red cell transfusions, particularly the immunosuppressive [11][12][13][14][15][16] 20 . In this article, the background outlining the divergent risks and benefits of anemia and transfusion will be discussed. Studies describing the epidemiology of anemia and current transfusion practices will also be outlined. Transfusion practice variation in critical careTwo observational studies, a survey of critical care physicians and a large cohort study, were conducted to determine individual and hospital practice variation. In a 1993 Canadian survey of critical care practitioners 27 , we documented that 35% of respondents identified 90 g/L as minimum concentration and an additional 40% selected 100 g/L. Overall baseline transfusion thresholds ranged from a low of 50 g/L to 120 g/L. Thresholds were significantly different (p<0.001) between scenarios ( Figure 1). All clinical characteristics evaluated, except congestive heart failure (p>0.05), significantly (p< 0.0001) changed transfusion thresholds of Canadian critical care practitioners. We also noted significant difference among the four clinical scenarios and a number of potential risk factors. There was a significant association between having an academic affiliation and transfusion practice across all scenarios ( p<0.0001). Physicians with an academic affiliation transfused red cells at a lower transfusion threshold than non-academics. When grouped into 4 major geographic locations (West, Ontario, Quebec, East), with no more than 5 academic centers per region, we noted that there was a statistically significant difference (p<0.01) for baseline transfusion thresholds across all scenarios. In a second study we examined the transfusion practice in a cohort of 5298 consecutive patients treated in six tertiary level intensive care units. Twenty-five percent of the critically ill patients in the cohort study received red cell transfusions. The overall number of transfusions per patient-day in the ICU averaged 0.95±1.39 and ranged from 0.82±1.69 to 1.08±1.27 between institutions (p<0.001). The number of transfusions administered were significantly different between institutions even after multivariate adjustments for age, APACHE II score and within four diagnostic categories (cardiovascular disease, respiratory failure, major surgery and trauma) (p<0.0001). A similar analysis using nadir hemoglobin concentrations, the lowest hemoglobin value prior to the first transfusion or the lowest value recorded during the entire ICU stay also demonstrated that there is significant institutional practice variation (p<0.0001) (Figure 2). Further evaluation of transfusion practice using...

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“…It is a consequence of long-term or sudden cardiac ischemia and may contribute to compensative activation of the sympathetic nervous system, catecholamine surge and increase heart rate. Moreover, the decreased level of Hb stimulates the mechanism of disadvantageous remodeling of cardiac muscle which leads to hypertrophy of the left ventricle, and in the end leads to cardiac failure development [20] . The importance of this problem is also signified by the fact that it was included amongst others in the ESC guidelines of 2012 (European Society of Cardiology) and included in the new definition of myocardial infarction [21] .…”

Section: Discussionmentioning

confidence: 99%

Impact of ventricular arrhythmias on survival in patients after myocardial infarction

Mitręga

Kolczyńska²,

Hanzel³

et al. 2014

IJDI

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Introduction: Despite the continuous development of new methods of pharmacological and invasive treatment for patients with acute myocardial infarction (MI) the prognosis of long-term survival is still uncertain. Therefore, there is still need to look for new noninvasive predictors of death in patients after MI. Aim:To analyze the prognostic value of ventricular arrhythmias in predicting mortality following MI in long-term follow-up. Methods:We analyzed 390 consecutive patients (114 females and 276 males, aged 63.9 ± 11.15 years, mean EF: 43.8 ± 7.9%) with MI treated invasively. On the 5th day after MI 24-hour digital Holter recording was performed to assess the number of premature ventricular beats (VPB) and their sustained forms such as: salvos and nonsustained ventricular tachycardia (nsVT < 30 s). The large numbers of ventricular extrasystoles: ≥ 10 VPB / hour were considered as abnormal. In echocardiography the size of heart cavities and cardiac contractile function were evaluated. Within 30.1 ± 15.1 months of follow-up 38 patients died.Results: In the group of patients with MI the mean value of ventricular ectopy during the day was: 318.8 ± 1447.6. Large numbers of ventricular extrasystoles were observed in 75% patients, while nsVT in 6% patients. Significant differences in the incidence of death after MI were observed in patients with nsVT and ventricular salvos. In the group of patients who died in comparison to the group of patients who survived in long-term follow-up, a significantly less ventricular ectopic incidence was noted (9.83% vs 90.17%, p < 0.01). In patients who died after MI more premature ventricular beats (≥ 10 VPB / h) and a greater nsVT incidence were observed; however not significant. Moreover, in patients with MI the systolic and diastolic LV dimension, decreased values of hemoglobin, salvos and nsVT incidence are the independent risk factors of death. The strongest independent risk factor of death after MI is salvos (HR: 1.32, P < 0.01). Conclusions:In long term follow-up the largest differences in death were observed in patients with ventricular salvos and nsVT. Furthermore, ventricular salvos are the strongest independent risk factor of death in patients with AMI.

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Effect of a reduction in blood viscosity on maximal myocardial oxygen delivery distal to a moderate coronary stenosis.

Cited by 129 publications

References 23 publications

Association of Hemoglobin Levels With Clinical Outcomes in Acute Coronary Syndromes

Association of Hemoglobin Levels With Clinical Outcomes in Acute Coronary Syndromes

Transfusion Morbidity and Mortality in the ICU

Impact of ventricular arrhythmias on survival in patients after myocardial infarction

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