Volume 2 Issue 2
Joao Lucas O'Connell1*, Gabriela C. Borges2, Rodrigo Penha de Almeida1, Rose Mary Ferreira Lisboa da Silva2, Anaisa Silva Roerver-Borges3, Elmiro S. Resende4, Nilson Penha-Silva4, Leonardo Roever4, Gary Tse5,6, Tong Liu7 and Giuseppe Biondi-Zoccai8,9
A lot of studies have shown that the chronic use of beta-blockers causes significant reduction in mortality and hospitalization rates in patients with heart failure. It also causes significant improvement in heart failure symptoms. These effects are obtained not only by the reduction of the detrimental effects of catecholamine on heart rate, but also by various other mechanisms. Beta-blockers cause a decrease in myocardial energy demand, inhibition of the adverse remodeling due to cardiac myocyte hypertrophy and death. They are also associated with the prevention of interstitial fibrosis and, consequently, prevention of arrhythmias. Not only all the above effects, these drugs are also related to the recovery of beta-adrenergic signalling and regulation of other detrimental systems such as the renin-angiotensin-aldosterone axis. The goal of this manuscript is to review the main studies developed for a better understanding of the effect obtained by the use of beta-blockers on heart physiology besides the control of the heart rate alone.
Keywords: Beta-blockers; Catecholamine; Remodelling; Gene polymorphisms
Cite this Article: O'Connell JL, Borges GC, de Almeida RP, Lisboa da Silva RMF, Roerver-Borges AS, et al. Beta blockers: effects Beyond Heart Rate Control. Int J Clin Cardiol Res. 2018;2(2): 053-057.
Published: 18 September 2018
Mark I.M. Noble*
The established treatment for arterial disease, such as coronary disease, is to establish the site of stenosis, to dilate the stenosis with angioplasty or surgery bypass, and to try to maintain the integrity of the arterial lumen with stents, mostly nowadays drug eluting stents, e.g., Percutaneous Coronary Intervention (PCI). The consequence is that a thrombogenic site remains, that has to be counteracted with dual anti-platelet therapy that carries bleeding complications with it. A recent a study showed that heart stents for stable angina show no benefit over placebo [1,2]. It has also been shown that 12% of PCI patients are re-admitted within 30 days .
Cite this Article: Noble MIM. Has Neglect of Haemodynamics led to the Wrong Pathway for Treatment of Arterial disease? Int J Clin Cardiol Res. 2018;2(2): 050-052.
Published: 17 July 2018
Dimitrios G. Mpairaktaris*, Johannes V. Soulis and George D. Giannoglou
Aims: The objective of the study is to study the transport and distribution of Low Density Lipoprotein (LDL) within patient-specific multi-layer arterial wall model under unsteady flow using computational fluid dynamic analysis.
Methods: A Left Coronary Artery (LCA) patient-specific model was incorporated. Both flow-mass transport equations in lumen as well as flow-mass transport equations within the patient-specific multi-layer arterial wall are numerically analyzed.
Results: The lumen-side LDL concentration preferably occurs at the concave geometry parts denoting concentration polarization. The Average Wall Shear Stress (AWSS) is not the only factor that can determine the lumen-side concentration of LDL. Increased time-averaged luminal concentration develops mainly in the proximal rather than to distal segment flow parts. The LDL concentration at the endothelium/intima interface is substantially lower, almost 90 times, than its value at lumen/endothelium interface. The concentration drop across the intima layer is negligible, whereas the concentration reduction across the Internal Elastic Layer (IEL) is remarkable. LDL concentration values at the IEL/media interface are one order of magnitude smaller to ones occurring at the intima layer.
Conclusions: The transportation of LDL through the multi-layer arterial wall is affected by the flow pattern itself, the arterial wall thickness and the physical values of the layers.
Cite this Article: Mpairaktaris DG, Soulis JV, Giannoglou GD. Unsteady LDL Transport through Patient-Specific Multi-Layer Left Coronary Artery. Int J Clin Cardiol Res. 2018;2(2): 039-049.
Published: 25 June 2018
Research Article: Analysis of the Adult Cardiac Surgery Audit on Blood use in a Tertiary Hospital Prior to the Implementation of a Blood Program
Azucena Pajares1*, Ana Tur1, Iratxe Zarragoikoetxea1, Rosario Vicente1, Ignacio Moreno1, Rosa Aparicio1, Pablo Herrera1, Ana-Isabel Aleixandre1, Carmen de la Fuente1, Agustin Soria1, Francisco Ibanez1, Jose-Maria Loro1, Faisa Osseyran1, Joan Porta1, Pilar Argente1, Luis Larrea2
Objective: To analyse the exposure to allogeneic blood transfusion perioperatively in adult patients undergoing cardiac surgery.
Design: Retrospective cohort study of prospectively collected data.
Setting: Data was collected from consecutive adult patients who underwent cardiac surgery in a single university hospital between January 2013 and July 2013.
Participants: Data of 171 patients was collected from hospital records.
Measurements and Main Results: 89.5% of patients received a Blood Component (BC), all the non-transfused patients were men. The average RCC, FFP and PP transfused units per patient was 4.04; 1.02 and 1.12 respectively. Women received more RCC (5.07) than men (3.54). RCC transfused patients had lower height and preoperative haemoglobin; urea levels, Apache II score and EuroSCORE were higher and left ventricular ejection fraction was worse. A TRUST score higher than 2 predicted RCC transfusion. CPB mean time was higher and redo surgery was more common if transfused. RCC transfusion was associated with longer hospital and Critical Care Unit stay. Non-transfused patients had higher nadir (9.48 vs 7.42), post-surgery (10.50 vs 9.42) and hospital discharge (11.22 g/dL vs 10.34) haemoglobin levels. By multivariate regression, predictors of blood transfusion were CPB nadir haemoglobin, preoperative haemoglobin, and transfused plasma units. Patients who survived received fewer RCC units. At hospital discharge 94.5% of patients were anaemic. Anaemic patients were more transfused than non-anaemic patients (5.37 vs 3.28).
Conclusions: We found a high perioperative use of BC in cardiac surgery in our hospital, supporting the implementation of interdisciplinary protocols to reduce their use.
Keywords: Transfusion rate; Blood saving program; Anaemia; Cardiac surgery; Audit; Red blood cell transfusion
Cite this Article: Pajares A, Tur A, Zarragoikoetxea I, Vicente R, Moreno I, et al. Analysis of the Adult Cardiac Surgery Audit on Blood use in a Tertiary Hospital Prior to the Implementation of a Blood Program. Int J Clin Cardiol Res. 2018;2(2): 027-038
Published: 23 May 2018
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