The impact of renal denervation treatment on left ventricular remodeling in patients with resistant hypertension

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Moiseeva ◽  
A Caraus ◽  
A Ciobanu ◽  
V Moscalu ◽  
M Abras ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Left Ventricle ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Concentric Hypertrophy ◽  
Superior Effect

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Agency for Research an Development OnBehalf HIPERDIAB Background Increased blood pressure is considered the major determinant for structural alterations of the left ventricle resulting in increased myocardial mass and pathological remodeling. Renal denervation is a novel treatment for hypertensive patients with promising results on blood pressure levels. Purpose Evaluation of impact of renal denervation treatment on indices of left ventricular remodeling in patients with resistant hypertension. Methods 75 patients with resistant hypertension  after a 3-week standardized treatment with Losartan 100 mg, Amlodipine 10 mg and Indapamid 1,5 mg were randomly assigned into three equal groups, depending on medication supplemented to previously administered: IM group -  Moxonidine, IIB group - Bisoprolol and IIID group – renal artery denervation (RDN). Patients were assessed by echocardiographic exam at baseline and 6 months follow-up. Renal denervation was performed with a Symplicity Spyral catheter. Results Increased at the baseline in all three groups (170,96 ± 11,69 g/m2  in IM versus 156,5 ± 11,08 g/m2  in IIB and 164,94 ± 9,61 g/m2  in IIID groups) left ventricular mass index at 6 months of evaluation noted a statistically authentic reduction in all three groups, the group of patients treated with Moxonidine and RDN having a comparable and superior effect to the group treated with Bisoprolol (159,02 ± 10,34 g/m2 versus 150,5 ± 10,51 g/m2 and 149,15 ± 9,31 g/m2 in IM, IIB and IIID groups, p > 0,05). Simultaniously with the regression of left ventricular myocardial hypertrophy all three treatment regimens induced the improvement of its geometry, renal denervation group demonstrated a superior effect in ameliorating of this parameter (Tab.). Conclusion The data obtained confirmed the benefit of RDN treatment in patients with resistant hypertension in inducing reverse-remodeling of the LV, the beneficial effect being superior to both pharmacotherapeutic regimens. Geometric pattern of the left ventricle Group IM Group IIB Group IIID χ2 p baseline Concentric remodeling 5 (20%) 5 (20%) 4 (16%) 0,71 > 0,05 Concentric hypertrophy 13 (52%) 15 (60%) 14 (56%) Excentric hypertrophy 7 (28%) 5 (20%) 7 (28%) Normal geometry - - - 6 months Concentric remodeling 3 (12%) 7 (28%) 7 (28%) 4,61 < 0,05 Concentric hypertrophy 13 (52%) 13 (52%) 10 (40%) Excentric hypertrophy 8 (32%) 5 (20%) 5 (20%) Normal geometry 1 (4%) - 3 (12%)

scholarly journals GENDER FEATURES OF STRUCTURAL-GEOMETRIC REMODELING OF THE LEFT VENTRICLE IN PATIENTS WITH MYOCARDIAL INFARCTION WITHOUT ELEVATION OF ST SEGMENT

2021 ◽  
pp. 51-55
Author(s):  
V. I. Maslovskyi
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricle ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Concentric Hypertrophy ◽  
St Segment ◽  
Echocardiographic Parameters ◽  
The Right

Recently, there has been a tendency to increase the incidence of myocardial infarction without elevation of the ST segment, which, according to some data, accounts for about half of all registered MI. The main problem with this type of infarction is that the long-term prognosis in these patients remains unsatisfactory, and mortality one year after the catastrophe is equal to or even higher than mortality from ST-segment elevation myocardial infarction, which encourages continued predictors of unfavorable prognosis. Objective: to determine the gender characteristics of the structural and geometric remodeling of the left ventricle in patients with myocardial infarction without ST segment elevation. Materials and methods. We conducted a comprehensive study of 200 patients with acute myocardial infarction without ST-segment elevation (NSTEMI) aged 38 to 80 (mean 62.0 ± 0.71, median 62 and interquartile range 55 and 70). The structural and functional state of the myocardium and types of left ventricular remodeling according to transthoracic echocardiography were studied. Results. Analysis of the obtained data shows that echocardiographic parameters in patients with NSTEMI depending on gender did not reveal significant differences between different groups. The exception was the size of the right atrium, which was significantly higher in the group of men compared to women with comparable values of the size of the right ventricle and the ratio of the size of the left to the right atrium. Analysis of the nature of structural and geometric remodeling of the left ventricle in general by groups showed that almost half of the subjects registered concentric hypertrophy of the left ventricle. Concentric left ventricle remodeling was observed in one third of patients and in other patients - normal geometry and eccentric left ventricle hypertrophy. Thus, it was found that concentric models of left ventricle – concentric hypertrophy and concentric remodeling – were registered in the vast majority of patients with NSTEMI. The latter can be explained by a significant proportion of hypertension which was identified by us in most patients and, of course, contributed to the development of concentric models of left ventricle. Analysis of the nature of structural and geometric remodeling of the left ventricle depending on gender showed that in the group of men, compared with women, there was a significant increase in the incidence of concentric remodeling. At the same time, in women, compared with men, there was a significant increase in cases of more severe types of structural remodeling - concentric and eccentric hypertrophy. Thus, we found that gender differences in echocardiographic parameters in patients with NSTEMI relate exclusively to indicators of structural and geometric remodeling of the left ventricle. Signs of concentric and eccentric left ventricular hypertrophy predominate in women, and indicators of normal geometry and concentric left ventricular remodeling in men. This distribution of types of remodeling indicates a more severe course and unfavorable prognosis of NSTEMI in women.

scholarly journals Effectiveness of bone marrow mononuclear cells delivered through a graft vessel for patients with previous myocardial infarction and chronic heart failure: an echocardiographic study of left ventricular remodeling.

2015 ◽  
Vol 17 (2) ◽  
pp. 160 ◽  
Author(s):  
Fujian Duan ◽  
Zhi Qi ◽  
Sheng Liu ◽  
Xiuzhang Lu ◽  
Hao Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Lv Mass

Aims: The graft of stem cells to treat ischemic cardiomyopathy is popular in many clinical trials. The aim of this study was to evaluate the effectiveness of isolated coronary artery bypass graft combined with bone marrow mononuclear cells (BMMNC) delivered through graft vessels to improve left ventricular remodeling of patients with previous myocardial infarc- tion and chronic heart failure using echocardiography. Material and methods: Patients with previous myocardial infarction and chronic heart failure were randomly allocated to one of the two groups: CABG only (18 patients), or CABG with BMMNC transplantation (24 patients). Echocardiographic parameters were measured on B-mode imaging, 3D imaging and color flow imaging. Results Post-operative LVEDD (end-diastolic dimension of left ventricle), LVESD (end-systolic dimension of left ventricle), LVEDV (end-diastolic volume of left ventricle), LVESV (end-systolic volume of left ventricle), LVEDVI (LVEDV indexed to body surface area), LVESVI (LVESV indexed to body surface area), LV-mass (mass of left ventricle) and LV- massI (LV-mass indexed to body surface area) were significantly improved compared with those obtained prior to operation in CABG+BMMNC group (al p0.05). Postoperative mitral regurgitation score was not significantly different from those prior to opera- tion in both groups (al p>0.05). In Chi-square tests, LVEDD, LVESD, LVEDV, LVESV, LVEDVI, LVESVI, LV-mass, LV- massI were determinants of the left ventricular remodeling. Conclusion: The improvement of left ventricular remodeling in CABG+BMMNC group was better than in the CABG group and this improvement was verified by echocardiography.

scholarly journals Low Plasma Volume and Increased Pressure Load Relate to Concentric Left Ventricular Remodeling After Preeclampsia: A Longitudinal Study

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Nicolette M. Breetveld ◽  
Robert‐Jan Alers ◽  
Lauren Geerts ◽  
Sander M. J. van Kuijk ◽  
Arie P. van Dijk ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Pressure ◽  
Plasma Volume ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Pressure Load ◽  
Volume Load ◽  
Low Volume ◽  
Increased Pressure

Background During uncomplicated pregnancy, left ventricular remodeling occurs in an eccentric way. In contrast, during preeclamptic gestation, the left ventricle hypertrophies concentrically, concurrent with loss in circulatory volume and increased blood pressure. Concentric cardiac structure persists in a substantial proportion of women and may be associated with pressure and volume load after preeclampsia. We hypothesize that low volume load, as indicated by plasma volume (PV) after preeclampsia and increased pressure load, is associated with remote concentric remodeling. Methods and Results In this longitudinal cohort study, we included 100 formerly preeclamptic women. Two visits were performed: at 0.8 years postpartum and at 4.8 years postpartum. During visit 1, we measured blood pressure and PV (I 125 dilution technique, low PV ≤48 mL/kg lean body mass). During the second visit, we assessed cardiac geometry by cardiac ultrasound. Concentric remodeling was defined as relative wall thickness >0.42 and left ventricular mass index ≤95 g/m 2 . We adjusted multivariable analysis for primiparity, systolic blood pressure, PV mL/kg lean body mass, and antihypertensive medication at visit 1. Low PV is associated with remote concentric remodeling (odds ratio [OR], 4.37; 95% CI, 1.06–17.40; and adjusted OR, 4.67; 95% CI, 1.02–21.42). Arterial pressure load (systolic, diastolic, and mean arterial pressure) is also associated with development of concentric remodeling (OR, 1.15 [95% CI, 0.99–1.35]; OR, 1.24 [95% CI, 0.98–1.58]; and OR, 1.20 [95% CI, 0.98–1.47], respectively). Conclusions In former preeclamptic women, development toward left ventricular concentric remodeling is associated with low volume load and increased pressure load.

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