Evidence map›Paper›PMID 26512327›Full record

ArticleOpen heart

Sympathetic autonomic dysfunction and impaired cardiovascular performance in higher risk surgical patients: implications for perioperative sympatholysis.

John Whittle, Alexander Nelson, James M Otto, Robert C M Stephens, Daniel S Martin, J Robert Sneyd, Richard Struthers, Gary Minto, Gareth L Ackland

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Open heart. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.5field-weighted citation impact, top 16% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 11 citations in OpenAlex.

  1. Article
  2. Review
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

John WhittleDivision of Medicine, Department of Clinical Physiology , University College London , London , UK.
Alexander NelsonUCL Medical School, University College London , London , UK.
James M OttoDivision of Surgery and Interventional Science , University College London, Royal Free Hospital , London , UK.
Robert C M StephensDepartment of Anaesthesia , University College London Hospitals NHS Trust , London , UK.
Daniel S MartinDivision of Surgery and Interventional Science , University College London, Royal Free Hospital , London , UK.
J Robert SneydPlymouth University, Peninsula Schools of Medicine and Dentistry, Plymouth , London , UK.
Richard StruthersPlymouth University, Peninsula Schools of Medicine and Dentistry, Plymouth , London , UK.
Gary MintoPlymouth University, Peninsula Schools of Medicine and Dentistry, Plymouth , London , UK.
Gareth L AcklandDivision of Medicine, Department of Clinical Physiology , University College London , London , UK ; Department of Neuroscience, Physiology and Pharmacology , Centre for Cardiovascular and Metabolic Neuroscience, University College London , London , UK ; William Harvey Research Institute, Queen Mary University of London, London, UK.
University College London · GBThe Royal Free Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveRecent 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.

methodsHeart 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.

resultsEHRR 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.

conclusionsEHRR 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.

Indexed as

MYOCARDIAL ISCHAEMIA AND INFARCTION (IHD)

Identifiers

PMID26512327
PMCPMC4620232
OpenAlexW2227300780

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.