Development of chronic heart failure in a young woman with hypertension associated with renal artery stenosis with preserved renal function

Abstract Introduction Parasympathetic activation by donepezil has been shown to improve prognosis in chronic heart failure (CHF) rats following myocardial infarction. We examined whether donepezil is effective in the treatment of another CHF model complicated with renal artery stenosis (RAS)-induced hypertension. Methods RAS was created by ligating the left renal artery up to 50% in SD rats, at the same time, we implanted a blood pressure (BP) transmitter for confirming RAS-induced hypertension (7-week post-RAS: systolic BP = 154±7 mmHg; diastolic BP = 115±8 mmHg). At the 11th week after induction of RAS, surviving animals were randomly assigned to untreated (UT, n=10) or donepezil treated [DT, n=10, dissolved in drinking water (3mg/kg/day)] group. After a 6-week treatment, the effects of donepezil were evaluated by hemodynamics, blood levels of neurohumoral markers, and morphology. Results Compared with UT, DT significantly prevented the progression of the left kidney atrophy (2.38±0.13 vs. 1.51±0.34 g/kg, P<0.05). DT also significantly improved cardiac remodeling, through suppressing the progression of cardiac hypertrophy (2.30±0.06 vs. 2.57±0.08 g/kg, P<0.01), cardiac dysfunction [cardiac index: 102±3 vs. 86±3ml/min/kg, P<0.05; left ventricular (LV) end-diastolic pressure: 12±2 vs. 20±2 mmHg, P<0.05; LV dp/dtmin: 5856±259 vs. 4924±227 mmHg/sec, P<0.05]. DT not only decreased serum levels of creatinine (0.54±0.02 vs. 0.63±0.03 mg/dl, P<0.05) and uric acid (1.4±0.2 vs. 1.9±0.2 mg/dl, P<0.05); but also decreased plasma levels of norepinephrine (273±38 vs. 846±242, P<0.01), angiotensin II (17±2 vs. 23±2 pg/ml, P<0.05), AVP (2729±347 vs. 4783±695 pg/ml, P<0.05) and BNP (360±13 vs. 460±39 pg/ml, P<0.05), and suppressed the systemic inflammation (CRP: 190±12 vs. 382±58 mg/ml, P<0.01). Conclusions Donepezil treatment markedly prevented the progression of cardiac remodeling and renal dysfunction, and improved the neurohumoral markers in the CHF rat model complicated with RAS-induced hypertension, suggesting that donepezil may be used as a new pharmacotherapy for CHF patients complicated with RAS-induced hypertension.

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Abstract 506: Should Endovascular Therapy for Renal Artery Stenosis Make a Come Back

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.36.suppl_1.506 ◽

2016 ◽

Vol 36 (suppl_1) ◽

Author(s):

Mohammad M Ansari ◽

Daniel Garcia

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Renal Function ◽

Renal Artery ◽

Systolic Blood Pressure ◽

Renal Artery Stenosis ◽

Endovascular Therapy ◽

Random Effect ◽

Artery Stenosis ◽

Apparent Lack

Introduction: Guidelines recommend endovascular therapy (EVT) for severe (>75% on angiography) renal artery stenosis (RAS). We sought to determine whether the populations studied could have influenced the lack of benefit of EVT in RAS. Method: Pub Med, Cochrane and EMBASE were systematically reviewed until November 2015 for all RCTs comparing EVT to medical therapy (MT) for RAS. Primary outcomes: systolic blood pressure and anti-hypertensive medication reduction. Secondary outcomes: worsening renal function, morbidity, mortality, heart failure, and stroke. We used random effect analysis according to the Cochrane-Handbook of Systematic Reviews and RevMan 5.2 for statistical analysis. Results: Seven RCTs with 2126 patients were included: 1036 EVT and 1085 MT. 35-65% of patients did not have severe RAS. There was no difference in change of systolic blood pressure (0.45±1.85, p=0.64). There was a significant decrease in the mean amount of anti-hypertensive medication in the EVT group (0.24±0.12, p<0.001). There were no differences in worsening of renal function, morbidity and mortality, heart failure and stroke (Fig 1). Discussion: Our analysis suggests that the apparent lack of added benefit of EVT for RAS could be largely secondary to selection bias, given the percentage of patients with mild to moderate RAS that were included and treated. Based on available data, trials studying EVT for severe RAS are warranted and should be designed to only include the appropriate patients. These well-designed studies are ultimately likely to “awaken the force”.

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Donepezil markedly prevents the progression of chronic heart failure and renal dysfunction in renal artery stenosis-induced hypertensive rats

European Heart Journal ◽

10.1093/ehjci/ehaa946.1050 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Li ◽

C Zheng ◽

T Kawada ◽

K Uemura ◽

M Inagaki ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Renal Artery ◽

Renal Dysfunction ◽

Renal Artery Stenosis ◽

Left Kidney ◽

Left Ventricular ◽

Artery Stenosis ◽

Blood Levels ◽

Induced Hypertension

Abstract Introduction Parasympathetic activation by donepezil has been shown to improve prognosis in chronic heart failure (CHF) rats following myocardial infarction. We examined whether donepezil is effective in the treatment of another CHF model complicated with renal artery stenosis (RAS)-induced hypertension. Methods RAS was created by ligating the left renal artery up to 50% in SD rats, at the same time, we implanted a blood pressure (BP) transmitter for confirming RAS-induced hypertension (7-week post-RAS: systolic BP = 154±7 mmHg; diastolic BP = 115±8 mmHg). In the 11th week after induction of RAS, surviving animals were randomly assigned to untreated (UT, n=10) or donepezil treated [DT, n=10, dissolved in drinking water (3mg/kg/day)] group. After a 6-week treatment, the effects of donepezil were evaluated by hemodynamics, blood levels of neurohumoral markers, and morphology. Results Compared with UT, DT significantly prevented the progression of the left kidney atrophy (2.38±0.13 vs. 1.51±0.34 g/kg, P<0.05) and kidney fibrosis (left: −64%, P<0.001; right: −55%, P<0.01). DT also significantly prevented the progression of CHF, through suppressing cardiac hypertrophy (2.30±0.06 vs. 2.57±0.08 g/kg, P<0.01), cardiac fibrosis (−70%, P<0.01), and cardiac dysfunction [cardiac index: 102±3 vs. 86±3 ml/min/kg, P<0.05; left ventricular (LV) end-diastolic pressure: 12±2 vs. 20±2 mmHg, P<0.05; LV dp/dtmin: 5856±259 vs. 4924±227 mmHg/sec, P<0.05]. DT not only decreased serum levels of creatinine (0.54±0.02 vs. 0.63±0.03 mg/dl, P<0.05) and uric acid (1.4±0.2 vs. 1.9±0.2 mg/dl, P<0.05); but also decreased plasma levels of norepinephrine (273±38 vs. 846±242, P<0.01), AVP (2729±347 vs. 4783±695 pg/ml, P<0.05), BNP (360±13 vs. 460±39 pg/ml, P<0.05), angiotensin II and aldosteron, and suppressed the systemic inflammation. Conclusions Donepezil treatment markedly prevented the progression of CHF and renal dysfunction, and improved the neurohumoral markers in the CHF rat model complicated with RAS-induced hypertension, suggesting that donepezil may be used as a new pharmacotherapy for CHF patients complicated with RAS-induced hypertension. Funding Acknowledgement Type of funding source: None

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Stent-Supported Angioplasty of Severe Atherosclerotic Renal Artery Stenosis Preserves Renal Function and Improves Blood Pressure Control:Long-term Results From a Prospective Registry of 456 Lesions

Journal of Endovascular Therapy ◽

10.1583/03-1062.1 ◽

2004 ◽

Vol 11 (2) ◽

pp. 95-106 ◽

Cited By ~ 74

Author(s):

Thomas Zeller ◽

Ulrich Frank ◽

Christian Müller ◽

Karlheinz Bürgelin ◽

Lutz Sinn ◽

...

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Artery Stenosis ◽

Atherosclerotic Renal Artery Stenosis

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Clinical response scores to predict blood pressure and renal function improvement following renal artery stenting for atherosclerotic renal artery stenosis

European Heart Journal ◽

10.1093/ehjci/ehaa946.2721 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Kablak-Ziembicka ◽

A Roslawiecka ◽

R Badacz ◽

A Sokolowski ◽

P Musialek ◽

...

Keyword(s):

Blood Pressure ◽

Logistic Regression ◽

Renal Function ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Predictive Models ◽

Artery Stenosis ◽

Atherosclerotic Renal Artery Stenosis ◽

Baseline Serum ◽

Kidney Length

Abstract Background It is little known about predictors of systolic (SBP) and diastolic (DBP) blood pressure or renal function (eGFR) improvement in patients with atherosclerotic renal artery stenosis (ARAS) undergoing stent-assisted angioplasty (PTA). Therefore, we aimed to build a prediction scores that would indicate characteristics of patient subsets with ARAS most likely to have clinical improvement following PTA. Methods 201 patients who underwent PTA for ARAS (2003–2018) were categorized as eGFR or SBP/DBP responders based on eGFR increase of ≥11 ml/min/1.73m2, decrease of SBP ≥20mmHg and DBP ≥5mmHg at 12-months following PTA. The remaining patients were classified as non-responders. The performance of logistic regression models were evaluated by basic decision characteristics. Continuous data have been transformed into binary coding with help of operating characteristic (ROC) curve. Predictive models have been constructed for each followed by construction of predictive models in each of 3 categories. Results Logistic regression analysis showed that: baseline SBP>145 mmHg, DBP >82 mmHg, previous myocardial infarction and Renal-Aotric-Ratio >5.1 were independent influencing factors of SBP response, with relative risk percentage shares of 69.8%; 12.1%; 10.9%; and 7.2%, respectively (sensitivity: 82%, specificity: 86.3%, positive (PPV):82% and negative (NPV) predictive values: 86.3%). The DBP decrease prediction model included baseline SBP >145 mmHg and DBP >82 mmHg, the ARAS progression, index kidney length >106 mm, and bilateral PTA with respective shares of 35.0%; 21.8%; 18.2%; 13.3% and 11.8%. (sensitivity: 76%, specificity: 77.8%, PPV: 80.7% and NPV: 72.6%). The eGFR increase was associated with baseline serum creatinine >122 μmol/L but eGFR greater than 30 ml/min/1.73m2, index kidney length >98 mm, end-diastolic velocity in index renal artery, renal resistive index <0.74, and requirement for >3 BP medications, with respective shares of 24.4%; 24.4%; 21.2%; 15% and 15% (sensitivity: 33.3%, specificity: 93.5%, PPV: 65.6% and NPV: 78.9%). Conclusions Current study identified clinical characteristics of patients who most likely to respond to PTA for ARAS. The sutability of the score should be verified in a prospective cohort of patients referred to PTA of ARAS Funding Acknowledgement Type of funding source: None

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Predictors of improved renal function after percutaneous stent-supported angioplasty of severe atherosclerotic ostial renal artery stenosis

ACC Current Journal Review ◽

10.1016/j.accreview.2003.12.053 ◽

2004 ◽

Vol 13 (2) ◽

pp. 44

Author(s):

T. Zeller ◽

U. Frank ◽

C. Müller

Keyword(s):

Renal Function ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Artery Stenosis

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Predictors for Clinical Success at One Year following Renal Artery Stent Placement

Journal of Endovascular Therapy ◽

10.1177/152660280200900419 ◽

2002 ◽

Vol 9 (4) ◽

pp. 495-502 ◽

Cited By ~ 6

Author(s):

Trude C. Gill-Leertouwer ◽

Elma J. Gussenhoven ◽

Johanna L. Bosch ◽

Jaap Deinum ◽

Hans van Overhagen ◽

...

Keyword(s):

Renal Function ◽

Serum Creatinine ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Stent Placement ◽

Clinical Success ◽

Artery Stenosis ◽

Renal Function Impairment ◽

Function Impairment ◽

Renal Artery Stent

Purpose: To determine pretreatment variables that may predict 1-year clinical outcome of stent placement for renal artery stenosis. Methods: In a prospective study, 40 consecutive patients (29 men; mean age 60 ± 9.1 years) with angiographically proven atherosclerotic renal artery stenosis were treated with stent placement because of drug resistant hypertension (n=14), renal function impairment (n=14), or both (n=12). Clinical success at 1 year was defined as a decrease of diastolic blood pressure ≥10 mmHg or a decrease in serum creatinine ≥20%, depending on the indication for treatment. Regression analysis was performed using anatomical parameters from angiography and intravascular ultrasound, estimates of renal blood flow from renal scintigraphy, and single-kidney renal function measurements. Results: Patients treated for hypertension had better outcome than those treated for renal function impairment, with clinical success rates of 85% and 35%, respectively. Preserved renal function, with low serum creatinine and high 2-kidney glomerular filtration rate at baseline, was associated with clinical success in the entire patient group at follow-up (p=0.02 and p=0.03, respectively). An elevated vein-to-artery renin ratio on the affected side was borderline predictive (p=0.06). In patients treated for renal impairment, lateralization to the affected kidney (affected kidney—to–2-kidney count ratio ≤0.45) on the scintigram emerged as a significant predictor for clinical success, with an odds ratio of 15 (p=0.048). Conclusions: Clinical success of renal artery stent placement is better for the treatment of hypertension than for preserving renal function. In patients with renal function impairment, lateralization to the affected kidney on the scintigram appears to be a predictor of clinical success.

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