Skin Blood Flow Abnormal in Metabolic Syndrome — plus — Preoperative Assessment of Endothelial Function for Prediction of Adverse Events After Cardiovascular Surgery

Circ J. 2017 Aug 3. doi: 10.1253/circj.CJ-17-0567. [Epub ahead of print]

Preoperative Assessment of Endothelial Function for Prediction of Adverse Events After Cardiovascular Surgery.

Saito Y1, Kitahara H1, Matsumiya G2, Kobayashi Y1.

Author information

1
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine.
2
Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine.

Abstract

BACKGROUND:

Cardiovascular surgery is one of the highest risk procedures in the field of surgery. Preoperative assessment of endothelial function has been reported as useful for predicting postoperative adverse events (AEs). The aim of this study was to investigate the relationship between endothelial function assessed by reactive hyperemia index (RHI) and AEs after cardiovascular surgery.Methods and Results:A prospective observational study of 197 patients who underwent cardiovascular surgery was conducted. RHI was measured before the surgery. The primary endpoint was a composite of postoperative death, reoperation, stroke, newly required dialysis, deep sternum infection, and prolonged ventilation within 30 days. The secondary endpoint was new-onset atrial fibrillation (AF) within 30 days. Following cardiovascular surgery, 19 patients (9.6%) had AEs. New-onset AF was documented in 42 (25.9%) of 162 patients without a prior history of AF. In the receiver-operating characteristic curve analysis, RHI significantly predicted AEs (area under the curve [AUC] 0.67, best cutoff value 1.64, P=0.03), whereas RHI did not predict new-onset AF (AUC 0.53, P=0.93). Patients with RHI ≤1.64 had more AEs than those with RHI >1.64 (16.3% vs. 4.5%, P=0.005). Multiple logistic regression analysis showed the number of surgical procedures and RHI ≤1.64 as significant predictors of AEs.

CONCLUSIONS:

Preoperative endothelial dysfunction assessed by RHI was associated with postoperative AEs in patients with cardiovascular surgery.

KEYWORDS:

Cardiovascular surgery; Endothelial function; Outcomes; Reactive hyperemia index

Clin Hemorheol Microcirc. 2017 Aug 11. doi: 10.3233/CH-170247. [Epub ahead of print]

Relationship between Skin Blood Flow Regulation Mechanisms and Vascular Endothelial Growth Factor in Patients with Metabolic Syndrome

Smirnova E1,2, Shulkina S1,2, Loran E1,2, Podtaev S2, Antonova N3.

Author information

Abstract

The focus of this paper is the determination of endothelial dysfunction in patients with metabolic syndrome (MetS) and the establishment of a relationship between the traditional biomarkers of endothelial dysfunction and the vascular tone regulation indices obtained from indirect cold tests in MetS patients. Our investigation was conducted on 30 patients aged 45.5±9 years. The control group comprised 14 healthy subjects aged 48.2±2.4 years. The mechanism of vascular tone regulation was investigated using the wavelet analysis of skin temperature oscillations (WAST). The degrees of microvascular vasoconstriction and vasodilatation were determined during contralateral cold tests in the endothelial (0.02-0.0095 Hz), neurogenic (0.05-0.02 Hz) and myogenic (0.05-0.14 Hz) frequency ranges. In MetS patients, vasoconstriction indices were higher and vasodilatation indices were lower than in the subjects of the control group, which is indicative of disorders in the mechanisms of microvascular tone regulation. These indices correlate with the metabolic parameters and VEGF (vascular endothelial growth factor) levels. The correlation of vasoconstriction and vasodilatation indices with the main factors of the metabolic syndrome testifies that the biological and functional aspects of the endothelial dysfunction are closely related.

KEYWORDS:

Endothelial dysfunction; metabolic syndrome; wavelet analysis of skin temperature oscillations


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