February 1, 1996HeartOpen Access

Effect of acute alterations in afterload on left ventricular function in patients with combined coronary artery and peripheral vascular disease.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Combined coronary artery and peripheral vascular disease (n=41). Intervention: Aortoiliac clamping during peripheral vascular surgery vs. Preoperative/preclamping state and normal controls. Primary outcome: Left ventricular long axis function and transmitral Doppler flow (p=<0.001).

Q: What does this research mean for the field?

Acute alterations in afterload caused by aortoiliac clamping significantly worsen left ventricular long axis function in patients with combined coronary artery and peripheral vascular disease, but this function promptly improves after unclamping. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate how acute afterload alterations induced by aortoiliac clamping during peripheral vascular surgery impact left ventricular systolic and diastolic function.

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Key result

Acute alterations in afterload by aortoiliac clamping significantly worsened left ventricular long axis function (P<0.001), which promptly improved after unclamping.

Why the study?

Does aortoiliac clamping during peripheral vascular surgery alter left ventricular function in patients with combined coronary artery and peripheral vascular disease?

Population

20 patients with significant aortoiliac disease and documented coronary artery disease and 21 normal…

Comparison

Acute alterations in afterload by aortoiliac… vs Preoperative state, preclamping state, and…

Design

Cohort

Follow-up

5 days after unclamping

Authors

MHMichael Y. HeneinCardiac Imaging SDSaroj DasNirma University COChristine A. O’SullivanSydney South West Area Health Service

Discussion

Member takes

Implication

Acute afterload changes during aortoiliac clamping may impair LV function in CAD/PVD; leaves open need for targeted perioperative strategies in prospective trials.

Key Points

To evaluate how acute afterload alterations induced by aortoiliac clamping during peripheral vascular surgery impact left ventricular systolic and diastolic function.
Prospective study of 20 patients (11 men; mean age 61 years) with aortoiliac and coronary artery disease alongside 21 age-matched normal controls.
Left ventricular long axis function and transmitral Doppler flow were evaluated preoperatively, before clamping, during clamping, and at 5 minutes, 15 minutes, and 5 days post-unclamping.
Preoperatively, patients showed marked impairments compared with controls, including reduced long axis excursion, delayed onset of shortening, abnormal isovolumic shortening, and reduced peak lengthening rate (P < 0.001 for all).
Arterial clamping significantly exacerbated systolic and diastolic long axis abnormalities despite no significant changes in arterial blood pressure or heart rate.
Unclamping rapidly restored systolic and diastolic function toward baseline within 5 to 15 minutes (P < 0.001), with sustained functional improvement over preoperative values observed at 5 days.

Study Design

Type

Observational (n=41)

Multicenter

Structured PICO

Does aortoiliac clamping during peripheral vascular surgery alter left ventricular function in patients with combined coronary artery and peripheral vascular disease?

Population

20 patients with significant aortoiliac disease and documented coronary artery disease (11 men; mean age 61 ± 8 years) and 21 normal controls of similar age.

Intervention

Acute alterations in afterload by aortoiliac clamping during peripheral vascular surgery.

Comparator

Preoperative state, preclamping state, and normal controls.

Outcome

Left ventricular long axis function and transmitral Doppler flow.surrogate

Main Result

p-value: p=<0.001

Resting subendocardial function in patients with combined coronary and peripheral vascular disease is labile and deteriorates with acute afterload increases during aortic clamping, but improves following successful revascularization.

Cite This Study

Henein et al. (1996) conducted an observational in Combined coronary artery and peripheral vascular disease (n=41). Aortoiliac clamping during peripheral vascular surgery vs. Preoperative/preclamping state and normal controls was evaluated on Left ventricular long axis function and transmitral Doppler flow (p=<0.001). Acute alterations in afterload by aortoiliac clamping significantly worsened left ventricular long axis function (P<0.001), which promptly improved after unclamping.

synapsesocial.com/papers/6a158cac79ff98d0de4ecc36 https://doi.org/10.1136/hrt.75.2.151

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February 1, 1996HeartOpen Access

Effect of acute alterations in afterload on left ventricular function in patients with combined coronary artery and peripheral vascular disease.

View Full Paper

Ask AI

Bookmark

Key result

Acute alterations in afterload by aortoiliac clamping significantly worsened left ventricular long axis function (P<0.001), which promptly improved after unclamping.

Why the study?

Does aortoiliac clamping during peripheral vascular surgery alter left ventricular function in patients with combined coronary artery and peripheral vascular disease?

Population

20 patients with significant aortoiliac disease and documented coronary artery disease and 21 normal…

Comparison

Acute alterations in afterload by aortoiliac… vs Preoperative state, preclamping state, and…

Design

Cohort

Follow-up

5 days after unclamping

Authors

MHMichael Y. HeneinCardiac Imaging SDSaroj DasNirma University COChristine A. O’SullivanSydney South West Area Health Service

Discussion

Member takes

Implication

Acute afterload changes during aortoiliac clamping may impair LV function in CAD/PVD; leaves open need for targeted perioperative strategies in prospective trials.

Key Points

To evaluate how acute afterload alterations induced by aortoiliac clamping during peripheral vascular surgery impact left ventricular systolic and diastolic function.
Prospective study of 20 patients (11 men; mean age 61 years) with aortoiliac and coronary artery disease alongside 21 age-matched normal controls.
Left ventricular long axis function and transmitral Doppler flow were evaluated preoperatively, before clamping, during clamping, and at 5 minutes, 15 minutes, and 5 days post-unclamping.
Preoperatively, patients showed marked impairments compared with controls, including reduced long axis excursion, delayed onset of shortening, abnormal isovolumic shortening, and reduced peak lengthening rate (P < 0.001 for all).
Arterial clamping significantly exacerbated systolic and diastolic long axis abnormalities despite no significant changes in arterial blood pressure or heart rate.
Unclamping rapidly restored systolic and diastolic function toward baseline within 5 to 15 minutes (P < 0.001), with sustained functional improvement over preoperative values observed at 5 days.

Study Design

Type

Observational (n=41)

Multicenter

Structured PICO

Does aortoiliac clamping during peripheral vascular surgery alter left ventricular function in patients with combined coronary artery and peripheral vascular disease?

Population

20 patients with significant aortoiliac disease and documented coronary artery disease (11 men; mean age 61 ± 8 years) and 21 normal controls of similar age.

Intervention

Acute alterations in afterload by aortoiliac clamping during peripheral vascular surgery.

Comparator

Preoperative state, preclamping state, and normal controls.

Outcome

Left ventricular long axis function and transmitral Doppler flow.surrogate

Main Result

p-value: p=<0.001

Cite This Study

synapsesocial.com/papers/6a158cac79ff98d0de4ecc36 https://doi.org/10.1136/hrt.75.2.151

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