SBP Is Superior to MAP to Reflect Tissue Perfusion and Hemodynamic Abnormality Perioperatively

Sun, Jie; Yuan, Jing; Li, Bin

doi:10.3389/fphys.2021.705558

Cited by 13 publications

(10 citation statements)

References 42 publications

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“…Moreover, fluid responsiveness can be evaluated in patients undergoing surgery as PPI reflects cardiac output (23,28). From the perspective of oxygen delivery and tissue perfusion, it is important to maintain adequate cardiac output rather than the more commonly monitored blood pressure, because blood pressure is affected not only by cardiac output, but also by systemic vascular resistance (29). Similarly, in critically ill patients with a low flow state, organ dysfunctions such as AKI are likely to occur due to a decrease in tissue perfusion even if blood pressure is maintained at normal with increased vascular resistance (30,31).…”

Section: Discussionmentioning

confidence: 99%

Association of the perfusion index with postoperative acute kidney injury: a retrospective study

Kang¹,

Park²,

Yoon³

et al. 2023

Korean J Anesthesiol

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Backgrounds: Many studies have examined the risk factors for postoperative acute kidney injury (AKI), but few have focused on intraoperative peripheral perfusion index (PPI), which has recently been shown to be associated with postoperative morbidity and mortality. Therefore, this study aimed to evaluate the relationship between intraoperative PPI and postoperative AKI under the hypothesis that lower intraoperative PPI is associated with AKI occurrence. Methods:We retrospectively searched electronic medical records to identify patients who underwent surgery at the general surgery department from May 2021 to November 2021. Patient baseline characteristics, pre-and post-operative laboratory test results, comorbidities, intraoperative vital signs, and discharge profiles were obtained from the Institutional Clinical Data Warehouse and VitalDB.Intraoperative PPI was the primary exposure variable, and the primary outcome was postoperative AKI.Results: Overall, 2554 patients were identified and 1586 patients were included in our analysis.According to Kidney Disease Improving Global Outcomes criteria, postoperative AKI occurred in 123 (7.8%) patients. We found that risks of postoperative AKI increased (odds ratio 2.00, 95% confidence interval 1.16-3.44, p = 0.012) when PPI was < 0.5 for > 10% of surgery time. Other risk factors for AKI occurrence were male sex, older age, higher American Society of Anesthesiologists status, obesity, underlying renal disease, prolonged operation time, transfusion, and emergent operation. Conclusion:Low intraoperative PPI was independently associated with postoperative AKI.

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Section: Discussionmentioning

confidence: 99%

Association of the perfusion index with postoperative acute kidney injury: a retrospective study

Kang¹,

Park²,

Yoon³

et al. 2023

Korean J Anesthesiol

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“…Low SBP re ects poor cardiac reserve, and is found in individuals with serious heart failure or cardiogenic shock [26-28]. In addition, low BP compromises coronary perfusion and enhances ischemia [29,30]. Initial high admission SBP can reduce the rates of cardiogenic shock and heart failure, and is considered a predictor of better prognosis, while elevated SBP caused by acute stress reaction converts to the normotensive condition or decreased level as a result of increased post-load and failing heart, suggesting the loss of its original bene t for STEMI patients [31].…”

Section: Discussionmentioning

confidence: 99%

Effects of systolic blood pressure and antihypertensive medications on individuals with ST-elevation myocardial infarction

Chen,

Zhang,

Qian

et al. 2023

Preprint

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Background To assess the associations of in-hospital antihypertensive medication use, admission systolic blood pressure (SBP), and 30-day outcome in individuals with ST-elevation myocardial infarction (STEMI). Methods STEMI cases treated in the Affiliated Hospital of Xuzhou Medical University between June 2010 and July 2021 were retrospectively analyzed. The primary outcome was 30-day all-cause mortality. Multivariate logistic regression analysis was performed to evaluate the associations of the number of used antihypertensive medications on 30-day mortality with admission SBP. Results Totally 7510 individuals with STEMI were included. After adjustment for baseline variables, SBP (OR = 1.12, 95%CI 1.08–1.19; P < 0.001), DBP (per 10-mmHg higher, OR = 1.14, 95%CI 1.04–1.22; P = 0.003), age (OR = 1.77, 95%CI 1.62–1.93; P < 0.001), male sex (OR = 1.56, 95%CI 1.31–1.86; P < 0.001), heart rate (OR = 1.19, 95%CI 1.11–1.22; P < 0.001), history of diabetes (OR = 1.50, 95%CI 1.18–1.91; P = 0.001), history of stroke (OR = 1.35, 95%CI 1.05–1.74; P = 0.002), Killip classes II-IV (ORs = 0.30–0.43, all P < 0.01), statin use (OR = 0.54, 95%CI 0.45–0.64; P < 0.001), nitrate use (OR = 0.70, 95%CI 0.53–0.92; P = 0.01), and use of a antihypertensive agent (OR = 9.91, 95%CI 3.86–25.48; P < 0.001) were independent predictors of 30-day mortality. Conclusions The number of antihypertensive medications during hospitalization has a significant association with 30-day mortality in Chinese individuals with STEMI without reperfusion. Trial registration: Not applicable.

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“…Moreover, Namasivayam et al ( 25 ) directly compared BP at peak exercise workload (upright cycle ergometer) between patients with HFrEF and HFpEF, finding that greater increases in systolic and diastolic BP in individuals with HFpEF. Furthermore, they found that pulsatile BP [the ratio of pulse pressure to systolic BP which indicates the power required to deliver blood to target organs ( 51 )] was positively correlated with both arterial stiffness and SV in patients with HFpEF, but only SV in those with HFrEF. These studies indicate that the excessive BP response during dynamic exercise in patients with HFpEF is likely driven by heightened peripheral vascular dysfunction whereas the pressor response in patients with HFrEF is largely driven by cardiac function.…”

Section: Hemodynamicsmentioning

confidence: 99%

Sympathetic and hemodynamic responses to exercise in heart failure with preserved ejection fraction

Manabe

D’Souza

Washio

et al. 2023

Front. Cardiovasc. Med.

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Excessive sympathetic activity during exercise causes heightened peripheral vasoconstriction, which can reduce oxygen delivery to active muscles, resulting in exercise intolerance. Although both patients suffering from heart failure with preserved and reduced ejection fraction (HFpEF and HFrEF, respectively) exhibit reduced exercise capacity, accumulating evidence suggests that the underlying pathophysiology may be different between these two conditions. Unlike HFrEF, which is characterized by cardiac dysfunction with lower peak oxygen uptake, exercise intolerance in HFpEF appears to be predominantly attributed to peripheral limitations involving inadequate vasoconstriction rather than cardiac limitations. However, the relationship between systemic hemodynamics and the sympathetic neural response during exercise in HFpEF is less clear. This mini review summarizes the current knowledge on the sympathetic (i.e., muscle sympathetic nerve activity, plasma norepinephrine concentration) and hemodynamic (i.e., blood pressure, limb blood flow) responses to dynamic and static exercise in HFpEF compared to HFrEF, as well as non-HF controls. We also discuss the potential of a relationship between sympathetic over-activation and vasoconstriction leading to exercise intolerance in HFpEF. The limited body of literature indicates that higher peripheral vascular resistance, perhaps secondary to excessive sympathetically mediated vasoconstrictor discharge compared to non-HF and HFrEF, drives exercise in HFpEF. Excessive vasoconstriction also may primarily account for over elevations in blood pressure and concomitant limitations in skeletal muscle blood flow during dynamic exercise, resulting in exercise intolerance. Conversely, during static exercise, HFpEF exhibit relatively normal sympathetic neural reactivity compared to non-HF, suggesting that other mechanisms beyond sympathetic vasoconstriction dictate exercise intolerance in HFpEF.

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SBP Is Superior to MAP to Reflect Tissue Perfusion and Hemodynamic Abnormality Perioperatively

Cited by 13 publications

References 42 publications

Association of the perfusion index with postoperative acute kidney injury: a retrospective study

Association of the perfusion index with postoperative acute kidney injury: a retrospective study

Effects of systolic blood pressure and antihypertensive medications on individuals with ST-elevation myocardial infarction

Sympathetic and hemodynamic responses to exercise in heart failure with preserved ejection fraction

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