Six-month prognostic impact of hemodynamic profiling by short minimally invasive monitoring after cardiac surgery
| Autor: | Marco Chiostri, Valentina Spini, Niccolò Marchionni, Cristina Giglioli, Salvatore Mario Romano, Giacomo Fortini, Emanuele Cecchi, Pierluigi Stefàno |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Framingham Risk Score Cardiac cycle business.industry Hemodynamics 030208 emergency & critical care medicine hemodynamic profile 030204 cardiovascular system & hematology Logistic regression Cardiac surgery 03 medical and health sciences 0302 clinical medicine cardiac-surgery Internal medicine RC666-701 Cardiology Medicine Arterial pH Diseases of the circulatory (Cardiovascular) system Original Article Observational study Cardiology and Cardiovascular Medicine Adverse effect business clinical six months follow-up |
| Zdroj: | Journal of Cardiovascular and Thoracic Research, Vol 12, Iss 4, Pp 313-320 (2020) Journal of Cardiovascular and Thoracic Research |
| ISSN: | 2008-6830 2008-5117 |
| Popis: | Introduction: Studies have shown that a hemodynamic-guided therapy improves the post operative outcomes of high-risk patients.This study, evaluated if a short period through minimally invasive hemodynamic monitoring, pressure recording analytical method (PRAM), on admission to a post-cardiac surgery step-down unit (SDU), may identify patients at higher risk of 6-month adverse events after cardiac surgery. Methods: From December 2016-May 2017,173 patients were admitted in SDU within 24-48 hours of major cardiac surgery procedure, and submitted to clinical, laboratoristic and echocardiographic evaluation and a 1-hour PRAM recording to obtain a "biohumoral snapshot" of individual patient’s.156 173 patients (17 patients were lost at follow-up) were phone interviewed six months after surgery,to evaluate, as a composite end-point, the adverse events during follow-up. A multivariable logistic regression analysis was used to identify a model clinical-biohumoral (CBM) and clinical-biohumoral hemodynamics (CBHM). Results: No data from past clinical history and no conventional risk score (EuroScore II, STS score)independently predicted the risk of 6-month major events in our study. The risk of adverse events at six-month follow-up was directly related, in the CBM, to sustained post-operative cardiac arrhythmias, higher values of NT-proBNP and of arterial pH; inversely related to values of hs-C-reactive protein (hs-CRP) and, in the CBHM, to low values of cardiac cycle efficiency (CCE) and dP/dtmax. Conclusion: Our study although limited by its observational nature and by the limited number of patients enrolled, showed that a short period of minimally invasive hemodynamic monitoring increased the accuracy to identify patients at major risk of mid-term events after cardiac surgery. |
| Databáze: | OpenAIRE |
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