Name: integration of brain tissue saturation monitoring in cardiopulmonary exercise testing in patients with heart failure
Uploaded: 2019-10-01T15:00:00
Description: Watch this Scientific Journal Video about Integration of Brain Tissue Saturation Monitoring in Cardiopulmonary Exercise Testing in Patients with Heart Failure at JoVE.com

Patienten, der deltog i motion test er dybt værdsat. Denne forskning blev støttet af National Science Council, Taiwan (NMRPG3G6231/2/3), Chang gung Memorial Hospital (Grant No. CMRPG3G0601/2), og sund aging Research Center, Chang gung Universitet og Taiwan undervisningsministeriets videregående uddannelse Deep pløjning program (Grant numre EMRPD1H0351 og EMRPD1H0551).

Følgende protokol blev godkendt af den etiske komité i Chang gung Memorial Hospital, Linkou, Taiwan. Øvelses testen blev udført i et luftkonditioneret laboratorium med en atmosfærisk temperatur på 22-25 °C, tryk på 755 til 770 torr og relativ luftfugtighed på 55-65%. Før hver prøvning blev gasanalysatoren kalibreret efter fabrikantens anvisninger ved hjælp af rum luft og en gasblanding af kendt koncentration (FO2: 0,12; FCO2: 0,05; N2 som saldo). Systemets turbine flowmåler b...

<ol>
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J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinician's+Guide+to+cardiopulmonary+exercise+testing+in+adults:+a+scientific+statement+from+the+American+Heart+Association.">Clinician's Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association.</a> Circulation. 122 (2), 191-225 (2010).</li><li>Corra, U., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiopulmonary+exercise+testing+in+systolic+heart+failure+in+2014:+the+evolving+prognostic+role:+a+position+paper+from+the+committee+on+exercise+physiology+and+training+of+the+heart+failure+association+of+the+ESC.">Cardiopulmonary exercise testing in systolic heart failure in 2014: the evolving prognostic role: a position paper from the committee on exercise physiology and training of the heart failure association of the ESC.</a> European Journal of Heart Failure. 16 (9), 929-941 (2014).</li><li>Malhotra, R., Bakken, K., D'Elia, E., Lewis, G. 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Cerebral iltning overvåges noninvasivt og kontinuerligt af NIRS er blevet anvendt i forskellige scenarier, herunder hjerte-kar-kirurgi13 og hjernens funktionelle analyser som dem, der estimerer neurale aktivitet14. Denne protokol integreret NIRS i konventionelle CPET at identificere inddragelsen af cerebral hæmodynamiske respons i motion intolerance hos patienter med HF. Det øger værdien af motion test til bestemmelse af prognose og sygdoms sværhedsgrad.
<p class="...

Kardiopulmonær motion test (CPET) er blevet anvendt hos patienter med hjertesvigt med reduceret uddrivningsfraktion (HF) for flere formål, herunder kvantificering af kardiopulmonær egnethed, prognose, diagnosticere årsager til motion begrænsninger, og motion recepter1,2,3. Under testen overvåges og analyseres hænodynamiske variabler og data afledt af automatisk gasudveksling. Cerebral væv oxygenmætning (scto2) overvågning har værdi for klassificering prognose og sygdoms sværhedsgrad4,5.
Nær-infrarød spektroskopi (NIRS) bruger infrarødt lys til at trænge ind i kraniet og estimere hjernevæv iltning kontinuerligt og ikke-invasivt6. Da oxyhæmoglobin og deoxyhæmoglobin har forskellige lys absorption spektre og er de primære kromophorer, der absorberer lys, kan deres koncentrationer måles ved hjælp af lystransmission og absorption6,7. Men baggrundslys absorbere også sprede lys og kan påvirke målingen8. Denne undersøgelse vedtog en rumligt løst NIRS at måle SctO2 fra hvile til peak øvelse9. Fire bølgelængder blev udsendt for at kompensere for bølgelængde-afhængige spredning tab og eliminere baggrundsinterferens, dermed øge nøjagtighed10.
SctO2 repræsenterer andelen af ilttilførsel vs. forbrug i cerebralt væv. Cerebral desaturation er forbundet med forstyrret cerebral blodgennemstrømning (CBF), nedsat arteriel iltkoncentration, og øget cerebral væv ilt forbrug11. Bortset fra kardiel output insufficiens, fremskreden HF forårsager cerebral hypoperfusion under motion ved indirekte inducerende cerebral vasokonstriktion via aftagende arterielt partielt tryk af kuldioxid (PaCO2) gennem hyperventilation 12.
Den kliniske betydning af cerebral iltning i HF blev afsløret af Chen et al.4. For det første var SctO2 signifikant reduceret i HF-gruppen sammenlignet med raske kontroller. SctO2 er ikke kun formindsket i hvile, men også faldt yderligere under motion. Det er ikke observeret i den raske gruppe. Anden, SctO2rest og scto2peak var KORRELERET med VO2peak, hjernen NATRIURETISK peptid (BNP), og oxygenoptagelse effektivitet hældning (Oues), som alle er etableret prognostiske markører. Derfor, SctO2rest og scto2peak er meget tilbøjelige til at være prognostisk og AFSPEJLE sygdommens sværhedsgrad hos HF-patienter. En anden undersøgelse af Koike et al. foreslog, at ændringen i cerebral oxyhæmoglobin målt ved panden fra hvile til peak motion var signifikant lavere i ikke-overlevende sammenlignet med, at hos overlevende af patienter med koronararteriesygdom5. Derfor kan cerebral iltning være ansat til stratificere sygdommens sværhedsgrad og prognose af patienter med HF.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Bicycle ergometer</td>
			<td>Ergoline, Germany</td>
			<td>Ergoselect 150P</td>
			<td></td>
		</tr>
		<tr>
			<td>Cardiopulmonary exercise testing gas analysis</td>
			<td>Cardinal-health Germany</td>
			<td>MasterScreen CPX</td>
			<td></td>
		</tr>
		<tr>
			<td>Finger pulse oximetry</td>
			<td>Nonin Onyx, Plymouth, Minnesota</td>
			<td>Model 9500</td>
			<td></td>
		</tr>
		<tr>
			<td>Sphygmomanometer</td>
			<td>SunTech Medical, UK</td>
			<td>Tango</td>
			<td></td>
		</tr>
	</tbody>
</table>

integration of brain tissue saturation monitoring in cardiopulmonary exercise testing in patients with heart failure

Cerebral hypo-oxygenering under hvile eller motion har en negativ indvirkning på udnyttelses evnen hos patienter med hjerteinsufficiens med nedsat uddrivningsfraktion (HF). Men, i klinisk kardiopulmonær motion test (CPET), cerebral hæodynamik er ikke vurderet. NIRS bruges til at måle hjernevæv iltmætning (SctO2) i frontal lap. Denne metode er pålidelig og gyldig og er blevet udnyttet i flere undersøgelser. SctO2 er lavere under både hvile og Peak motion hos patienter med HF end i raske kontroller (66,3 ± 13,3% og 63,4 ± 13,8% vs. 73,1 ± 2,8% og 72 ± 3,2%). SctO2 i hvile er signifikant lineært korreleret med peak VO2 (r = 0,602), oxygen optagelses effektivitet hældning (r = 0,501), og hjernen natriuretisk peptid (r =-0,492), som alle er anerkendt prognostisk og sygdoms alvorligheds markører, hvilket indikerer dens potentielle prognostiske værdi. SctO2 bestemmes hovedsageligt af end-Tidal Co2 tryk, gennemsnitligt arterielt tryk, og hæmoglobin i HF-populationen. Denne artikel viser en protokol, der integrerer SctO2 ved hjælp af NIRS i trinvis CPET på et kalibreret cykel ergometer.

34 HF-patienter og 17 raske Kontroller blev indskrevet på Linkou Chang gung Memorial Hospital, Taiwan. Hvert emne gennemgik kardiopulmonære motion test, der inkorporerede SctO2 overvågning af NIRS. Kort, SctO2 (rest; peak) værdier var signifikant lavere i HF-gruppen (66,3 ± 13,3%; 63,4 ± 13,8%,) end i kontrol (73,1 ± 2,8%; 72 ± 3,2%) gruppe (figur 1). I HF-gruppen var SctO2 i hvile (scto2rest) og Peak scto<s...

Watch this Scientific Journal Video about Integration of Brain Tissue Saturation Monitoring in Cardiopulmonary Exercise Testing in Patients with Heart Failure at JoVE.com

Integration of Brain Tissue Saturation Monitoring in Cardiopulmonary Exercise Testing in Patients with Heart Failure

Denne protokol integreret nær-infrarød spektroskopi i konventionel kardiopulmonær øvelse test for at identificere inddragelsen af den cerebral hæmodynamiske respons i motion intolerance hos patienter med hjertesvigt.

Integration af hjernevæv mætnings overvågning i kardiopulmonær motion test hos patienter med hjertesvigt

Cerebral hypo-oxygenation during rest or exercise negatively impacts the exercise capacity of patients with heart failure with reduced ejection fraction ...

Graden af cerebral vævmætning i hjertesvigt har vist sig at afspejle funktionel kapacitet og sygdomssværhed og har potentiel prognostisk værdi. Radonovervågning under træningstest har klinisk værdi. Cerebral væv ilt mætning målt ved NIRS er enkel og praktisk.Denne protokol-integrerede NIRS i konventionelle CPET at øge værdien af motion test hos patienter med hjertesvigt. Demonstration af proceduren vil være Yu Chen Liu, en tekniker fra vores laboratorium. For at begynde denne procedure, rense patientens pande to gange med en alkohol pad til at fjerne sved og snavs fra huden.Få store NIRS sensorer, hvor afstanden mellem emitteren og detektoren er fem cm og placere sensorer på panden, bilateralt. Sørg for, at sensorerne sidder godt fast. Derefter påføres EKG-elektroder på den forreste brystkasse, bilaterale acromioclavicular led, og lav ryg.Få patienten til at sidde på cykel ergometeret og placere sphygmomanometerets armbind på dem. Bær derefter masken af gasanalyse for patienten placere sensorer til pulsoximeteret på patientens pegefinger. Først, fortælle patienten til at hvile i mindst to minutter for at opnå en stabil baseline værdi, herunder cerebral væv iltmætning og respiratorisk udveksling ratio.Dernæst har patienten fuldføre warm-up fase på cyklus ergometer med en arbejdshastighed på 10 watt i et minut. Øge satsen med 10 watt i minuttet derefter bede patienten om at pedalere på omkring 60 rpm, indtil han undlader at holde op med en kadence på over 50 rpm trods stærk opmuntring. Automatisk gennemsnit cerebral væv ilt mætning værdi hvert sekund fra de data, der scannes med en frekvens på 100 Hz.Automatically måle blodtrykket hvert andet minut med sphygmomanometer.Analysér gaskomponenten, ånde-by-breath, herunder iltoptagelse og det endale kuldioxidtryk. Derefter, har patienten fuldføre inddrivelse fase med en arbejdshastighed på nul watt i to til seks minutter. I denne undersøgelse, både hjertesvigt patienter og sunde kontroller gennemgik kardiopulmonal motion test, der inkorporerer cerebral væv ilt mætning overvågning af NIRS.De cerebrale væv ilt mætning værdier ses at kortvarigt være betydeligt lavere i hjertesvigt gruppe end i kontrolgruppen. I gruppen hjertesvigt er iltmætningen af cerebralt væv i hvile og i toppen lineært korreleret med Brain Natriuretic Peptid, den maksimale iltoptagelse og iltoptagelseseffektivitetsskråningen. Især er cerebral væv ilt mætning i hvile bestemmes af det delvise tryk af end-tidevandet kuldioxid i hvile, hæmoglobin, og gennemsnitlige arterielt tryk i hvile.Proceduren er enkel og bekvem. Patienter med lav cerebral mætning indeks berettiger høj lægehjælp. Integration af NIRS i CPET hjælper afgrænse involvering af cerebral hæmodynamisk undertrykkelse forårsager motion intolerance hos patienter med hjertesvigt.Ud over sin prognoseværdi, det har brug for langsgående forskning for at bekræfte.

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Tachycardia-Induced Cardiomyopathy As a Chronic Heart Failure Model in Swine

Takykardi-induceret kardiomyopati som kronisk hjertesvigt Model hos svin

A stable and reliable model of chronic heart failure is required for many experiments to understand hemodynamics or to test effects of new treatment ...

Implantation of an Isoproterenol Mini-Pump to Induce Heart Failure in Mice

Implantation af en Isoproterenol-mini pumpe for at inducere hjertesvigt i mus

Isoproterenol (ISO), is a non-selective beta-adrenergic agonist, that is used widely to induce cardiac injury in mice. While the acute model mimics ...

Real-Time Monitoring of Neurocritical Patients with Diffuse Optical Spectroscopies

Realtidsovervågning af neurokritiske patienter med diffuse optiske spektroskopier

Neurophysiological monitoring is an important goal in the treatment of neurocritical patients, as it may prevent secondary damage and directly impact ...

A Surgical Model of Heart Failure with Preserved Ejection Fraction in Tibetan Minipigs

En kirurgisk model af hjertesvigt med bevaret udstødningsfraktion hos tibetanske minigrise

More than half of heart failure (HF) cases are classified as heart failure with preserved ejection fraction (HFpEF) worldwide. Large animal models are ...

Predicting Prognosis in Acute Heart Failure Using Phase Angle & BIVA Z-Scores

Clinical Application of Phase Angle and BIVA Z-Score Analyses in Patients Admitted to an Emergency Department with Acute Heart Failure

Unveiling Prognostic Indicators in Heart Failure - The Role of Phase Angle and Bioelectrical Impedance Analysis (Video) | JoVE

Klinisk anvendelse af fasevinkel- og BIVA Z-score-analyser hos patienter indlagt på akutafdeling med akut hjertesvigt

Acute heart failure is characterized by neurohormonal activation, which leads to sodium and water retention and causes alterations in body composition, ...

Developing an Exercise Program for Rheumatoid Arthritis Patients

Evaluation of Changes in Hydration and Body Cell Mass with Bioelectrical Impedance Analysis after Exercise Program for Rheumatoid Arthritis Patients

Implementation of BIVA for Analyzing Disease Risk Factors in Patients with Low Body Cell Mass (Video) | JoVE

Evaluering af ændringer i hydrering og kropscellemasse med bioelektrisk impedansanalyse efter træningsprogram for patienter med reumatoid arthritis

Rheumatoid arthritis (RA) is a debilitating disease that can result in complications such as rheumatoid cachexia. While physical exercise has shown ...

Evaluation of Hydration Status by Bioelectrical Impedance Vector Analysis in Patients with Ischemic Heart Disease Undergoing Exercise Stress Test

Ischemic heart disease (IHD) represents a group of clinical syndromes characterized by myocardial ischemia, leading to an impairment in the myocardial ...