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dc.contributor.authorWhittle, Jen_US
dc.contributor.authorNelson, Aen_US
dc.contributor.authorOtto, JMen_US
dc.contributor.authorStephens, RCMen_US
dc.contributor.authorMartin, DSen_US
dc.contributor.authorSneyd, JRen_US
dc.contributor.authorStruthers, Ren_US
dc.contributor.authorMinto, Gen_US
dc.contributor.authorAckland, GLen_US
dc.date.accessioned2016-06-20T16:26:38Z
dc.date.available2015-06-18en_US
dc.date.issued2015en_US
dc.date.submitted2016-06-20T10:41:05.193Z
dc.identifier.issn2053-3624en_US
dc.identifier.urihttp://qmro.qmul.ac.uk/xmlui/handle/123456789/12977
dc.description.abstractOBJECTIVE: Recent perioperative trials have highlighted the urgent need for a better understanding of why sympatholytic drugs intended to reduce myocardial injury are paradoxically associated with harm (stroke, myocardial infarction). We hypothesised that following a standardised autonomic challenge, a subset of patients may demonstrate excessive sympathetic activation which is associated with exercise-induced ischaemia and impaired cardiac output. METHODS: Heart rate rise during unloaded pedalling (zero workload) prior to the onset of cardiopulmonary exercise testing (CPET) was measured in 2 observation cohorts of elective surgical patients. The primary outcome was exercise-evoked, ECG-defined ischaemia (>1 mm depression; lead II) associated with an exaggerated increase in heart rate (EHRR ≥12 bpm based on prognostic data for all-cause cardiac death in preceding epidemiological studies). Secondary outcomes included cardiopulmonary performance (oxygen pulse (surrogate for left ventricular stroke volume), peak oxygen consumption (VO2peak), anaerobic threshold (AT)) and perioperative heart rate. RESULTS: EHRR was present in 40.4-42.7% in both centres (n=232, n=586 patients). Patients with EHRR had higher heart rates perioperatively (p<0.05). Significant ST segment depression during CPET was more common in EHRR patients (relative risk 1.7 (95% CI 1.3 to 2.1); p<0.001). EHRR was associated with 11% (95%CI 7% to 15%) lower predicted oxygen pulse (p<0.0001), consistent with impaired left ventricular function. CONCLUSIONS: EHRR is common and associated with ECG-defined ischaemia and impaired cardiac performance. Perioperative sympatholysis may further detrimentally affect cardiac output in patients with this phenotype.en_US
dc.format.extente000268 - ?en_US
dc.languageengen_US
dc.language.isoenen_US
dc.relation.ispartofOpen Hearten_US
dc.rightsCC-BY
dc.subjectMYOCARDIAL ISCHAEMIA AND INFARCTION (IHD)en_US
dc.titleSympathetic autonomic dysfunction and impaired cardiovascular performance in higher risk surgical patients: implications for perioperative sympatholysis.en_US
dc.typeArticle
dc.rights.holder© 2015 British Medical Journal Publishing Group
dc.identifier.doi10.1136/openhrt-2015-000268en_US
pubs.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/26512327en_US
pubs.issue1en_US
pubs.notesNot knownen_US
pubs.publication-statusPublished onlineen_US
pubs.volume2en_US
dcterms.dateAccepted2015-06-18en_US
qmul.funderParasympathetic modulation of perioperative myocardial injury.::Royal College Of Anaesthetists/ British Journal of Anaesthesiaen_US


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