The Open Cardiovascular Medicine Journal最新文献

{"title":"Prognostic Assessment of Diabetics Using Myocardial Perfusion Imaging: Diabetes Mellitus is Still a Coronary Artery Disease Equivalent.","authors":"Andrea De Lorenzo,&nbsp;Victor F Souza,&nbsp;Leticia Glerian,&nbsp;Ronaldo Sl Lima","doi":"10.2174/1874192401711010076","DOIUrl":"https://doi.org/10.2174/1874192401711010076","url":null,"abstract":"<p><strong>Background: </strong>Even though diabetes mellitus (DM) has been considered a \"Coronary Artery Disease (CAD) equivalent\", that is still controversial, especially in a contemporary population subject to optimized treatment.</p><p><strong>Objective: </strong>We aimed to assess the cardiovascular risk of diabetics by myocardial perfusion scintigraphy (MPS).</p><p><strong>Methods: </strong>Consecutive patients who underwent MPS from 2008 to 2012 were studied. Perfusion scores were calculated, and abnormal MPS was defined as a summed stress score >3. Patients were followed for 3±1 years for all-cause death, which was compared between patients with DM (without known CAD) and patients with known CAD but without DM.</p><p><strong>Results: </strong>Among 3409 patients, 471 (13.8%) were diabetics without known CAD (DM group) and 638 (18.7%) had CAD without diabetes (CAD group). Annualized death rates were not significantly different between DM or CAD patients (0.9 <i>vs</i> 1.5%, p=0.09). With normal MPS, death rates were 0.7% for DM and 0.6% for CAD (p=0.8). With abnormal MPS, death rates increased similarly in the DM and CAD groups.</p><p><strong>Conclusions: </strong>In diabetic patients without known CAD, the rate of death was not significantly different from patients with prior CAD and without DM. Abnormal MPS increased risk similarly in diabetic patients and in those with CAD. These findings suggest that DM may still be considered a high-risk condition, comparable to known CAD, and effectively stratified by MPS.</p>","PeriodicalId":504447,"journal":{"name":"The Open Cardiovascular Medicine Journal","volume":"11 ","pages":"76-83"},"PeriodicalIF":0.8,"publicationDate":"2017-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35698932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Perforation of Distal Diagonal Branch Followed by Prolonged Recurrent Cardiac Tamponade Finally Resolved with Pericardiotomy - the Potential Risk of Hydrophilic Guide-Wires.","authors":"Rafał Januszek,&nbsp;Krzysztof Bartuś,&nbsp;Radosław Litwinowicz,&nbsp;Artur Dziewierz,&nbsp;Łukasz Rzeszutko","doi":"10.2174/1874192401711010061","DOIUrl":"https://doi.org/10.2174/1874192401711010061","url":null,"abstract":"<p><strong>Purpose: </strong>Coronary artery perforation (CAP) is a complication of percutaneous coronary interventions (PCIs). Hydrophilic guide-wires have been shown to increase the probability of CAP. Depending on the size of perforations we adopt different treatments.</p><p><strong>Case: </strong>We present the case of a 73-year old male with coronary artery disease and severe aortic valve stenosis. The patient was in the process of qualifying for a transcatheter aortic valve implantation. Unfortunately, CAP of the first diagonal branch of the LAD occurred during PCI. Initially, abrupt bleeding to the pericardial sac was primarily restrained. However, in the following days, pericardial bleeding became silent, prolonged and finally resulted in surgical pericardiotomy and surgical aortic valve replacement.</p><p><strong>Conclusion: </strong>This case depicts that in some cases, more aggressive endovascular treatment of CAP during the acute phase could decrease the probability of future radical surgical treatment. Although, in other cases, avoiding radical endovascular treatment of CAP and secondary necrosis along the distribution of the artery culminates in a higher risk for conversion to a surgical cardiac procedure. Accurate primary assessment of CAP seriousness and careful observation after PCI could improve results and lead to avoiding severe complications.</p>","PeriodicalId":504447,"journal":{"name":"The Open Cardiovascular Medicine Journal","volume":"11 ","pages":"61-65"},"PeriodicalIF":0.8,"publicationDate":"2017-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2174/1874192401711010061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35278544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrocardiographic Changes After Suicidal Digoxin Intoxication in a Healthy Woman.","authors":"Natalia Lorenzo Muñoz,&nbsp;Amparo Benedicto Buendía,&nbsp;Fernando Alfonso Manterola","doi":"10.2174/1874192401711010058","DOIUrl":"https://doi.org/10.2174/1874192401711010058","url":null,"abstract":"<p><strong>Background: </strong>Suicidal digoxin intoxication is a rare clinical entity. Clinical suspicious remains of paramount importance as adequate interpretation of the electrocardiographic changes enable to readily initiate treatment.</p><p><strong>Method: </strong>We describe a case of suicidal attempt after massive digoxin intake that was satisfactory managed with conservative management strategy that involved a close clinical surveillance of the evolving electrocardiographic changes and digoxin serum levels.</p>","PeriodicalId":504447,"journal":{"name":"The Open Cardiovascular Medicine Journal","volume":"11 ","pages":"58-60"},"PeriodicalIF":0.8,"publicationDate":"2017-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35052860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic Factors and Severity of Coronary Artery Disease in Patients Undergoing Coronary Angiography: A Multicentre Study of Arabian Gulf States.","authors":"Amin Daoulah,&nbsp;Osama E Elkhateeb,&nbsp;S Ali Nasseri,&nbsp;Mushabab Al-Murayeh,&nbsp;Salem Al-Kaabi,&nbsp;Amir Lotfi,&nbsp;Mohamed N Alama,&nbsp;Salem M Al-Faifi,&nbsp;Mamdouh Haddara,&nbsp;Ciaran M Dixon,&nbsp;Ibrahim S Alzahrani,&nbsp;Abdullah A Alghamdi,&nbsp;Waleed Ahmed,&nbsp;Adnan Fathey,&nbsp;Ejazul Haq,&nbsp;Alawi A Alsheikh-Ali","doi":"10.2174/1874192401711010047","DOIUrl":"https://doi.org/10.2174/1874192401711010047","url":null,"abstract":"<p><strong>Introduction: </strong>Coronary artery disease (CAD) is a leading cause of death worldwide. The association of socioeconomic status with CAD is supported by numerous epidemiological studies. Whether such factors also impact the number of diseased coronary vessels and its severity is not well established.</p><p><strong>Materials and methods: </strong>We conducted a prospective multicentre, multi-ethnic, cross sectional observational study of consecutive patients undergoing coronary angiography (CAG) at 5 hospitals in the Kingdom of Saudi Arabia and the United Arab Emirates. Baseline demographics, socioeconomic, and clinical variables were collected for all patients. Significant CAD was defined as ≥70% luminal stenosis in a major epicardial vessel. Left main disease (LMD) was defined as ≥50% stenosis in the left main coronary artery. Multi-vessel disease (MVD) was defined as having >1 significant CAD.</p><p><strong>Results: </strong>Of 1,068 patients (age 59 ± 13, female 28%, diabetes 56%, hypertension 60%, history of CAD 43%), 792 (74%) were from urban and remainder (26%) from rural communities. Patients from rural centres were older (61 ± 12 <i>vs</i> 58 ± 13), and more likely to have a history of diabetes (63 <i>vs</i> 54%), hypertension (74 <i>vs</i> 55%), dyslipidaemia (78 <i>vs</i> 59%), CAD (50 <i>vs</i> 41%) and percutaneous coronary intervention (PCI) (27 <i>vs</i> 21%). The two groups differed significantly in terms of income level, employment status and indication for angiography. After adjusting for baseline differences, patients living in a rural area were more likely to have significant CAD (adjusted OR 2.40 [1.47, 3.97]), MVD (adjusted OR 1.76 [1.18, 2.63]) and LMD (adjusted OR 1.71 [1.04, 2.82]). Higher income was also associated with a higher risk for significant CAD (adjusted OR 6.97 [2.30, 21.09]) and MVD (adjusted OR 2.49 [1.11, 5.56]), while unemployment was associated with a higher risk of significant CAD (adjusted OR 2.21, [1.27, 3.85]).</p><p><strong>Conclusion: </strong>Communal and socioeconomic factors are associated with higher odds of significant CAD and MVD in the group of patients referred for CAG. The underpinnings of these associations (<i>e.g.</i> pathophysiologic factors, access to care, and system-wide determinants of quality) require further study.</p>","PeriodicalId":504447,"journal":{"name":"The Open Cardiovascular Medicine Journal","volume":"11 ","pages":"47-57"},"PeriodicalIF":0.8,"publicationDate":"2017-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35035786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Predictive Value of the Syntax Score in Patients With Chronic Coronary Artery Disease Undergoing Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting: A Pilot Study.","authors":"K Papadopoulos,&nbsp;I Lekakis,&nbsp;E Nicolaides","doi":"10.2174/1874192401711010028","DOIUrl":"https://doi.org/10.2174/1874192401711010028","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the usefulness of the SYNTAX score (SS) in predicting 1-year clinical outcomes in a population of patients with chronic coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).</p><p><strong>Background: </strong>Despite the proven prognostic value of the SS in patients with multivessel and/or left main (LM) CAD, its usefulness in other patient subsets remains uncertain.</p><p><strong>Methods: </strong>This was a prospective single centre cohort study conducted from September 2012 to November 2014 at the Nicosia General Hospital, Cyprus. Patients (n=140<i>;</i> 94% men and 6% women) with chronic CAD undergoing revascularization with either PCI or CABG were evaluated.</p><p><strong>Results: </strong>At 1-year, angina occurred in 20 patients (14.3%), myocardial infarction (MI) in 3 patients (2.1%), repeat revascularization procedures in 9 patients (6.4%) and death in 12 patients (8.6%). The SS independently predicted angina (p=0.024) but was not predictive of MI (p=0.964), death (p=0.292) or repeat revascularization (p=0.069).</p><p><strong>Conclusion: </strong>In this patient population, the SS predicted angina in the year following revascularization but was not predictive of MI, death or repeat revascularization.</p>","PeriodicalId":504447,"journal":{"name":"The Open Cardiovascular Medicine Journal","volume":"11 ","pages":"28-32"},"PeriodicalIF":0.8,"publicationDate":"2017-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35047230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Audit of Clinical Practice in a Single Centre in Kuwait: Management of Children on Continuous Subcutaneous Insulin Infusion and Cardiovascular Risk Factors Screening.","authors":"Dina Omar,&nbsp;Hala Alsanae,&nbsp;Mona Al Khawari,&nbsp;Majedah Abdulrasoul,&nbsp;Zahraa Rahme,&nbsp;Faisal Al Refaei,&nbsp;Kazem Behbehani,&nbsp;Azza Shaltout","doi":"10.2174/1874192401711010019","DOIUrl":"https://doi.org/10.2174/1874192401711010019","url":null,"abstract":"<p><strong>Objectives: </strong>To audit the current clinical practice of continuous subcutaneous insulin infusion (CSII) for the treatment of type 1 diabetes mellitus (T1D) in children and adolescents attending a single centre in Kuwait.</p><p><strong>Methods: </strong>A one year retrospective audit was performed in children and adolescents with T1D on CSII, who attended the paediatric diabetes clinic, Dasman Diabetes Institute during 2012. The primary outcome measure was glycaemic control as evidenced by glycated haemoglobin (HbA1c) level and the secondary outcome measures were the frequency of monitoring of the risk for microvascular complications and occurrence of acute complications and adverse events.</p><p><strong>Results: </strong>58 children and adolescents (mean age ± SD: 12.6 ± 4.1 years) were included. Mean HbA1c at baseline was 8.8% (72.7 mmol/mol) and 8.9% (73.8 mmol/mol) at the end of a 12 months observation period. Children with poor control (HbA1c >9.5% (80 mmol/mol) had a significant 1.4% reduction in HbA1c compared with the overall reduction of 0.1% (p=0.7). Rate of screening for cardiovascular risk factors and for long term complications were well documented. However, there was underreporting of acute complications such as severe hypoglycaemia and diabetic ketoacidosis. Only 1.7% of patients discontinued the pump.</p><p><strong>Conclusion: </strong>There was no significant change in HbA1c values at the end of 12 months follow up. However, HbA1c values in poorly controlled children improved. CSII requires care by skilled health professionals as well as education and selection of motivated parents and children.</p>","PeriodicalId":504447,"journal":{"name":"The Open Cardiovascular Medicine Journal","volume":"11 ","pages":"19-27"},"PeriodicalIF":0.8,"publicationDate":"2017-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5362970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34907452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revision of Echocardiographic Indications and Findings in Neurologically Ill Patients.","authors":"Claudia Stöllberger,&nbsp;Christian Wegner,&nbsp;Josef Finsterer","doi":"10.2174/1874192401711010014","DOIUrl":"https://doi.org/10.2174/1874192401711010014","url":null,"abstract":"<p><strong>Background and objective: </strong>Little is known about the general indications for echocardiography and the prevalence of abnormalities detected by echocardiography in patients who are referred from a neurological department. Left ventricular hypertrabeculation/noncompaction (LVHT) is associated with neuromuscular disorders and embolism. The aim of the study was to assess the indications for echocardiography in patients from a neurological department and to review the cine-loops of the examinations in order to assess the frequency of abnormal echocardiographic findings with special regard to LVHT.</p><p><strong>Methods and results: </strong>Included were 126 patients, 58 females (mean age 65 years). Indications were stroke (84%), heart failure (6%), endocarditis (6%) and arrhythmia (3%). The most frequent abnormalities were impaired relaxation (71%) and left ventricular wall thickening (63%). Females were older (68 <i>vs</i>. 62 years, p = 0.0214) and more frequently had normally sized left ventricles than males (98 <i>vs</i>. 88%, p = 0.0376). Patients ≥66 years more frequently had stroke as an indication (91 <i>vs</i>. 77%, p = 0.05), showed a thickened myocardium (72 <i>vs</i>. 53%, p = 0.0272), valvular abnormalities (52 <i>vs</i>. 13%, p = 0.0000) and impaired relaxation (86 <i>vs</i>. 54%, p = 0.0001) than patients <66 years. LVHT was diagnosed in 3 patients; in one of them the diagnosis was already known. In 45% LVHT and in 38% left ventricular thrombus could neither be excluded nor established since the image quality was poor.</p><p><strong>Conclusion: </strong>Care should be taken to visualize the left ventricular apical regions when investigating patients referred from a neurologic department in order not to overlook LVHT and thrombi within the left ventricular apex.</p>","PeriodicalId":504447,"journal":{"name":"The Open Cardiovascular Medicine Journal","volume":"11 ","pages":"14-18"},"PeriodicalIF":0.8,"publicationDate":"2017-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7d/74/TOCMJ-11-14.PMC5362974.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34907450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impaired Myocardial Bioenergetics in HFpEF and the Role of Antioxidants.","authors":"John B Hiebert,&nbsp;Qiuhua Shen,&nbsp;Amanda Thimmesch,&nbsp;Janet Pierce","doi":"10.2174/1874192401610010158","DOIUrl":"https://doi.org/10.2174/1874192401610010158","url":null,"abstract":"<p><p>Heart failure with preserved ejection fraction (HFpEF) is a significant cardiovascular condition for more than 50% of patients with heart failure. Currently, there is no effective treatment to decrease morbidity and mortality rates associated with HFpEF because of its pathophysiological heterogeneity. Recent evidence shows that deficiency in myocardial bioenergetics is one of the key pathophysiological factors contributing to diastolic dysfunction in HFpEF. Another known mechanism for HFpEF is an overproduction of free radicals, specifically reactive oxygen species. To reduce free radical formation, antioxidants are often used. This article is a summative review of the recent relevant literature that addresses cardiac bioenergetics, deficiency in myocardial bioenergetics, and increased reactive oxygen species associated with HFpEF and the promising potential use of antioxidants in managing this condition. </p>","PeriodicalId":504447,"journal":{"name":"The Open Cardiovascular Medicine Journal","volume":"10 ","pages":"158-62"},"PeriodicalIF":0.8,"publicationDate":"2016-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/81/0a/TOCMJ-10-158.PMC4974825.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34711964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the Effects of Dialysis Methods (Haemodialysis vs Peritoneal Dialysis) on Diastolic Left Ventricular Function Dialysis Methods and Diastolic Function.","authors":"Fedoua Ellouali,&nbsp;Fatimazahra Berkchi,&nbsp;Rabia Bayahia,&nbsp;Loubna Benamar,&nbsp;Mohammed Cherti","doi":"10.2174/1874192401610010171","DOIUrl":"https://doi.org/10.2174/1874192401610010171","url":null,"abstract":"<p><strong>Introduction: </strong>In patients undergoing chronic dialysis, several factors appear to influence the occurrence of cardiac abnormalities. The aim of our study was to evaluate the effects of two different methods of renal replacement therapy (chronic haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD)) on left ventricular (LV) diastolic function.</p><p><strong>Patients and methods: </strong>We enrolled 63 patients: 21 patients on CAPD, and 42 age- and gender-matched patients on HD; 35 patients were men (55.6%). Median of age was 46.4 (35-57) years. The median duration of renal replacement therapy was 3(2-5) years.</p><p><strong>Results: </strong>The two groups (HD vs PD) were similar concerning body mass index, dialysis duration and cardiovascular risk factors. The comparison of echocardiographic parameters showed statistically significant differences between two groups, regarding the presence of calcification, cardiac effusion, severely abnormal left ventricular hypertrophy(LVH) and the ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/e') >13 (p= 0.001, p= 0.003, p= 0.02, p= 0.004, respectively). In multivariate analysis, an E/e'>13 was higher in PD group ( OR= 5.8, CI [1.3-25.5], p=0.002).</p><p><strong>Conclusion: </strong>The method of dialysis seems to influence LV diastolic function. We observed a higher prevalence of diastolic LV dysfunction in the PD group. Echocardiographic follow up is essential as this could improve the management of cardiovascular complications in dialysis patients.</p>","PeriodicalId":504447,"journal":{"name":"The Open Cardiovascular Medicine Journal","volume":"10 ","pages":"171-8"},"PeriodicalIF":0.8,"publicationDate":"2016-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/46/e5/TOCMJ-10-171.PMC4974827.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34711966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial Experience with Renal Denervation for the Treatment of Resistant Hypertension - The Utility of Novel Anesthetics and Metaiodobenzylguanidine Scintigraphy (MIBG).","authors":"Antonios Ziakas,&nbsp;Dimitrios Petroglou,&nbsp;Efstratios Moralidis,&nbsp;Konstantinos Tsioufis,&nbsp;Mihalis Doumas,&nbsp;Elena Argiriadou,&nbsp;Christos Savopoulos,&nbsp;Stavros Hadjimiltiades,&nbsp;Ioannis Stiliadis,&nbsp;Antonios Kouparanis,&nbsp;Sotirios Katranas,&nbsp;Leonidas Lillis,&nbsp;Athanasios Koutsakis,&nbsp;Haralambos Karvounis","doi":"10.2174/1874192401610010163","DOIUrl":"https://doi.org/10.2174/1874192401610010163","url":null,"abstract":"<p><strong>Background: </strong>The Symplicity-HTN 3 trial failed to show significant difference in blood pressure (BP) lowering between patients undergoing catheter-based renal denervation (RDN) and the sham-procedure arm of the study. However, there is still optimism about the role of RDN in the treatment of resistant hypertension, because identification of patients with increased sympathetic activity thus being good RDN responders, improvements in the RDN procedure and new technology RDN catheters are all expected to lead to better RDN results. We present our initial experience with RDN for the treatment of resistant hypertension, and the utility of novel anesthetics and cardiac (123)I-metaiodobenzylguanidine scintigraphy ((123)I-MIBG).</p><p><strong>Methods and results: </strong>Seven patients with resistant hypertension underwent RDN and were followed up for 6 months. MIBG was performed before RDN, in order to estimate sympathetic activity and predict the response to RDN. All patients were sedated with dexmedetomidine and remifentanil during RDN. All patients tolerated the procedure well, were hemodynamically stable and their peri-procedural pain was effectively controlled. A median of 7.6 ± 2.1 and 6 ± 1.4 ablations were delivered in the right and left renal artery respectively, making an average of 6.8 burns per artery. No peri-procedural or late complications - adverse events (local or systematic) occurred. At 6 months, mean reduction in office BP was -26.0/-16.3 mmHg (p=0.004/p=0.02), while mean reduction in ambulatory BP was -12.3/-9.2 mmHg (p=0.118/p=0.045). One patient (14.3%) was a non-responder. None of the cardiac (123)I-MIBG imaging indexes(early and late heart-to-mediastinum (H/M) count density ratio, washout rate (WR) of the tracer from the myocardium) were different between responders and non-responders.</p><p><strong>Conclusion: </strong>Patients with resistant hypertension who underwent RDN in our department had a significant reduction in BP 6 months after the intervention. (123)I-MIBG was not useful in predicting RDN response. Dexmedetomidine and remifentanil provided sufficient patient comfort during the procedure, allowing an adequate number of ablations per renal artery to be performed, and this could probably lead to improved RDN results.</p>","PeriodicalId":504447,"journal":{"name":"The Open Cardiovascular Medicine Journal","volume":"10 ","pages":"163-70"},"PeriodicalIF":0.8,"publicationDate":"2016-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d9/be/TOCMJ-10-163.PMC4974823.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34711965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}