Microcirculatory effects of angiotensin II inhibitors in patients with severe heart failure

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dc.contributor.author Salgado, Diamantino Ribeiro
dc.contributor.author Favory, Raphael
dc.contributor.author Rocco, Jose Rodolfo
dc.contributor.author Silva, Eliezer [UNIFESP]
dc.contributor.author Arias Ortiz, Julian
dc.contributor.author Donadello, Katia
dc.contributor.author Creteur, Jacques
dc.contributor.author Vincent, Jean-Louis
dc.contributor.author De Backer, Daniel
dc.date.accessioned 2016-01-24T14:31:07Z
dc.date.available 2016-01-24T14:31:07Z
dc.date.issued 2013-01-01
dc.identifier http://dx.doi.org/10.3233/CH-2012-1569
dc.identifier.citation Clinical Hemorheology and Microcirculation. Amsterdam: Ios Press, v. 54, n. 1, p. 87-98, 2013.
dc.identifier.issn 1386-0291
dc.identifier.uri http://repositorio.unifesp.br/handle/11600/35865
dc.description.abstract CONTEXT: the renin-angiotensin system is activated in patients with acute severe heart failure, and increased levels of angiotensin II could contribute to microcirculatory defects in these patients.OBJECTIVE: To evaluate the microcirculatory effects of angiotensin II antagonists in critically ill patients with severe heart failure.METHODS: After Ethics Committee approval and signed consent, we conducted a prospective observational study using sidestream darkfield (SDF) imaging to evaluate changes in the sublingual microcirculation of 25 adult patients with severe heart failure (ejection fraction < 40% or cardiac index < 2.5 L/min.m(2)) who received angiotensin inhibitors during their ICU stay. SDF images and global hemodynamic data were obtained immediately before and 4 h, 24 h, and 48 h after the first administration of the drug.RESULTS: Already 4 h after administration, there was a significant improvement in the proportion of perfused small (<20 mu m) vessels (PPV) (from 78 [72-84] to 89 [82-94]%, P < 0.05) and the microvascular flow index (MFI) (from 2.25 [1.95-2.50] to 2.80 [2.39-2.95] points, P < 0.05), which persisted over subsequent hours. Large vessel perfusion remained constant. There was no correlation between changes in the PPV and changes in the mean arterial pressure (R-2 0.02, P = 0.50), cardiac output (R-2 0.004, P = 0.85), or central or mixed venous oxygen saturation (R-2 0.03, P = 0.53).CONCLUSIONS: in patients with severe heart failure, introduction of angiotensin antagonist therapy was associated with an early improvement in the microcirculation that persisted over subsequent hours. the microcirculatory effects were independent of global hemodynamic variables. the improvement in microcirculatory perfusion observed with angiotensin inhibitors in patients with severe heart failure may partially explain the beneficial clinical effects of this intervention in such patients. en
dc.description.sponsorship Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
dc.description.sponsorship Federal University of Rio de Janeiro
dc.format.extent 87-98
dc.language.iso eng
dc.publisher Ios Press
dc.relation.ispartof Clinical Hemorheology and Microcirculation
dc.rights Acesso restrito
dc.subject Heart failure en
dc.subject angiotensin II en
dc.subject rennin en
dc.subject angiotensin-converting enzyme antagonists en
dc.subject critically ill en
dc.title Microcirculatory effects of angiotensin II inhibitors in patients with severe heart failure en
dc.type Artigo
dc.rights.license http://www.iospress.nl/service/authors/author-copyright-agreement/
dc.contributor.institution Univ Libre Brussels
dc.contributor.institution Universidade Federal do Rio de Janeiro (UFRJ)
dc.contributor.institution Univ Lille 2
dc.contributor.institution Albert Einstein Hosp
dc.contributor.institution Universidade Federal de São Paulo (UNIFESP)
dc.contributor.institution Univ Costa Rica
dc.description.affiliation Univ Libre Brussels, Dept Intens Care, Erasme Hosp, Brussels, Belgium
dc.description.affiliation Univ Fed Rio de Janeiro, Dept Internal Med, Clementino Fraga Filho Univ Hosp, Rio de Janeiro, Brazil
dc.description.affiliation Univ Lille 2, Dept Intens Care, Calmette Univ Hosp, Lille, France
dc.description.affiliation Albert Einstein Hosp, Intens Care Unit, São Paulo, Brazil
dc.description.affiliation Univ Fed Estado São Paulo, Dept Expt Surg, São Paulo, Brazil
dc.description.affiliation Univ Costa Rica, Intens Care Unit, Calderon Guardia Univ Hosp, San Jose, Costa Rica
dc.description.affiliationUnifesp Univ Fed Estado São Paulo, Dept Expt Surg, São Paulo, Brazil
dc.identifier.doi 10.3233/CH-2012-1569
dc.description.source Web of Science
dc.identifier.wos WOS:000319733600009


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