Pulse pressure and perioperative stroke

Abstract

Purpose of Review: Central pulse pressure, a marker of vascular stiffness, is a novel indicator of risk for perioperative morbidity including ischemic stroke. Appreciation for the mechanism by which vascular stiffness leads to organ dysfunction along with understanding its clinical detection may lead to improved patient management. Recent Findings: Vascular stiffness is associated with increased mortality and neurologic, cardiac and renal injury in non-surgical and surgical patients. Left ventricular hypertrophy and diastolic dysfunction along with microcirculatory changes in the low vascular resistance, high blood flow cerebral and renal vasculature are seen in patients with vascular stiffness. Pulse wave velocity and the augmentation index have higher sensitivity for detecting of vascular stiffness than peripheral pulse pressure as the hemodynamic consequences of vascular stiffness are secondary to alterations in the central vasculature. Vascular stiffness alters cerebral autoregulation resulting in a high likelihood of having a lower limit of autoregulation > 65 mmHg during surgery. Vascular stiffness may predispose to cerebral hypoperfusion increasing vulnerability to ischemic stroke, postoperative delirium, and acute kidney injury. Summary: Vascular stiffness leads to alterations in cerebral, cardiac, and renal hemodynamics increasing the risk of perioperative ischemic stroke and neurologic, cardiac and renal dysfunction.

Wide pulse pressure: A clinical review

“…There is some evidence supporting wide PP as a poor prognostic indicator for percutaneous coronary intervention (PCI) with higher rates of postoperative myocardial infarction and stroke, 61,62 although cases of idiopathic peri‐operative wide PP without adverse clinical outcomes have also been described 63 . In a study of 10 876 patients undergoing PCI, patients with wide PP were more often women with higher rates of hypercholesterolemia, kidney dysfunction, diabetes mellitus, and multiple vessel of left main coronary artery disease 62 .…”

Comorbidity-dependent changes in alpha and broadband electroencephalogram power during general anaesthesia for cardiac surgery

“…The following patient characteristics and comorbidities were obtained using a structured preoperative questionnaire by the responsible attending cardiac anaesthetist and by chart reviewing and recording by a study nurse and coded for analysis as follows: age (in yr as continuous variable), gender (0¼male; 1¼female), anaemia (no/yes, according to WHO haemoglobin thresholds: male <130 g L À1 and female <120 g L À1 ), nasopharyngeal temperature (in degrees Celsius as continuous variable), end-tidal isoflurane concentration converted into minimum alveolar concentration (MAC; not age adjusted), sodium (in mEq L À1 as a continuous variable), pulse pressure (systolic minus diastolic blood pressure in mm Hg on day of admission), 24 extra-cardiac arteriopathy (EA) (0¼no EA; 1¼EA without carotid stenosis [CS]; 2¼EA with CS), aneurysmatic thoracic aorta (no/yes), cerebrovascular insult (CVI) (none¼0; transient ischaemic attack/stroke without hemi-plegia¼1; stroke with hemiplegia¼2), left ventricular ejection fraction (LVEF) (0¼LVEF !40%; 1¼LVEF <40%), coronary artery disease (CAD) (no/yes), acute endocarditis (no/yes), pulmonary arterial hypertension (no/yes; yes¼mean pulmonary artery pressures >30 mm Hg), chronic pulmonary disease (no/yes; yes¼long-term use of bronchodilators or steroids for lung disease), glomerular filtration rate (GFR; ml min À1 as continuous variable), 25 diabetes mellitus (0¼none; 1¼non-insulin dependent; 2¼insulin dependent), and liver disease (0¼none and mild; 1¼moderate or severe; evaluated by magnitude of aminotransferase alteration ['mild' <5 times the upper reference limit; 'moderate' 5e10 times the upper reference limit; 'severe' >10 times the upper reference limit] 26 ).…”

Association of Pulse Pressure Difference and Diabetes Mellitus in Chinese People: A Cohort Study

“…The risk of T2DM incidence was lowest when PP was at about 35mmHg. Pulse pressure (PP), the arithmetic difference between DBP and SBP, is associated with all-cause mortality, cardiovascular events, stroke, kidney injury, severe eye disease, and arterial stiffness [18][19][20][21][22][23] and it is dependent on arterial wall elasticity. A previous study found that relative to BP, PP had higher predictive potential for adverse cardiovascular outcomes in diabetic patients.…”