scholarly journals Distal renal denervation: cardioprotection in patients with resistant hypertension

2020 ◽  
Vol 19 (4) ◽  
pp. 2225
Author(s):  
E. S. Sitkova ◽  
V. F. Mordovin ◽  
S. E. Pekarsky ◽  
T. M. Ripp ◽  
A. Yu. Falkovskaya ◽  
...  
Keyword(s):  
Renal Artery ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Myocardial Damage ◽  
Left Ventricular ◽  
Double Blind Study ◽  
Double Blind ◽  
Damage Area ◽  
Main Renal Artery ◽  
Group 2

Aim. To study the effectiveness of using the anatomically optimized distal renal denervation (RDN) in comparison with the standard approach for reducing myocardial damage and left ventricular (LV) hypertrophy in patients with resistant hypertension (HTN).Material and methods. The randomized double-blind study of the efficacy and safety of distal RDN compared to conventional main renal artery intervention (ClinicalTrials.gov NCT02667912) for the treatment of resistant HTN included 26 patients. All patients were divided into two groups: group 1 (n=16) — distal RDN, group 2 (n=10) — conventional RDN. In addition to 24-hour blood pressure (BP) monitoring, initially and 12 months after the intervention, contrast- enhanced cardiac magnetic resonance imaging was performed to determine the left ventricular mass and non-coronary myocardial damage area. All patients signed informed consent. Twenty-four patients completed the present study.Results. After 12 months, the mean 24-hour BP significantly decreased after both distal RDN (from 167,2±28,5/93,2±19,3 to 147,0±13,7/81,5±9,3 mm Hg (p<0,05)) and conventional RDN (from 157,5±22,5/90,6±23,9 to 139,9±17,7/80,0±16,7 (p<0,05)). Also in both cases, a trend to LV mass decrease was revealed: from 252,6±85,2 to 221,0±60,3 gm (p=0,096) after the distal RDN; from 214,3±54,1 to 186,4±48,1 gm (p=0,071) after the conventional RDN. In contrast, the myocardial damage area decreased only after distal RDN (from 2,33±1,33 to 1,35±0,67 cm3 (p=0,02)) and did not change after conventional RDN.Conclusion. In comparison with the conventional main renal artery intervention, distal RDN in patients with resistant HTN has an additional cardioprotective effect — a decrease in LV myocardial damage area.

1201Cardiac function, structure, and speckle-tracking echocardiography-derived parameters after distal and conventional renal denervation: a double-blind randomized study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Ripp ◽  
T Ryabova ◽  
S Pekarskiy ◽  
V Mordovin ◽  
E Buharova ◽  
...  
Keyword(s):  
Renal Artery ◽  
Diastolic Dysfunction ◽  
Speckle Tracking ◽  
Renal Denervation ◽  
Speckle Tracking Echocardiography ◽  
Double Blind ◽  
Main Renal Artery ◽  
Group 2 ◽  
Group 1

Abstract Background/Introduction Distal renal denervation (RD) of the segmental branches beyond the bifurcation of the main renal artery is considered more effective treatment than conventional RD of the trunk renal artery. Evidence accumulated over the last decade has shown that global longitudinal strain (GLS) from speckle-tracking analysis of 2-dimensional echocardiography may represent a sensitive parameter of the left ventricular (LV) dysfunction. Purpose We compared cardiac function, structure, and GLS parameters after distal and conventional RD in the double-blind randomized prospective study. Methods The study (NCT01499810) compromised 55 patients who met criteria for resistant hypertension and signed informed consent. Patients were randomized to either endovascular conventional RD of the main renal artery (group 1, n=27) or to distal treatment applied to the segmental branches after the bifurcation of the main renal artery (group 2, n=28). Parameters of GLS from speckle-tracking echocardiography, ejection fraction, thickness of the interventricular septum (IVS) and LV posterior wall (PW), as well as the parameters of the diastolic function of the heart were assessed at baseline and at 12-months follow-up. Reference echocardiographic values were adapted from the ASE/ESC guidelines. Baseline parameters of heart and drug intake did not significantly differ between patients at the time of randomization. Results Drug treatment consisted in combination therapy in the maximum tolerated doses. Patients used different types of drugs, but the number of drug classes did not significantly differ between groups (4.1 in group 1 vs. 4.2 in group 2). Reduction of systolic blood pressure was significantly greater after distal RD vs. conventional RD: −22.1 vs. −11.5 mm Hg, respectively (p<0.05). Decrease in the LV wall thickness was significantly greater after distal RD then after conventional RD, namely: changes in the IVS thickness were −0.21 (−0.39; 1.2) mm after distal RD vs. 1.21 (−0.44; −2.64) mm after conventional RD, p=0.023; changes in the PW thickness were −0.87 (−2.6; −0.62) mm after distal RD vs. 0.07 (−0.45; 1.25) mm after conventional RD, p=0.021. Normalization of diastolic function was found in 13% ((group 1) and 26% ((group 2) in patients with first and second degrees of LV diastolic dysfunction. Speckle-tracking parameters of the left ventricle and some parameters of the left atrium (reduced size by 18% vs 27% of patients) also improved after DRD. Conclusion(s) Compared to conventional RD, distal RD treatment applied to the segmental branches beyond the bifurcation of the main renal artery significantly greater attenuated the LV wall thickness and the number of patients with diastolic dysfunction. At 12-month follow up, the global longitudinal LV function also improved in distal RD patients.

scholarly journals Comparative analysis of cardioprotective effects of two renal denervation techniques

2020 ◽  
Vol 25 (12) ◽  
pp. 3994
Author(s):  
T. M. Ripp ◽  
S. E. Pekarskiy ◽  
A. E. Baev ◽  
T. R. Ryabova ◽  
E. I. Yaroslavskay ◽  
...  
Keyword(s):  
Renal Artery ◽  
Wall Thickness ◽  
Renal Denervation ◽  
Left Ventricular ◽  
Two Dimensional ◽  
Number Of Patients ◽  
Lv Mass ◽  
Main Renal Artery ◽  
Cardioprotective Effects ◽  
Renal Artery Denervation

Aim. To compare cardioprotective effects of two renal denervation (RD) techniques: main renal artery or its branches after bifurcation in patients with resistant hypertension (RH).Materials and methods. This randomized double-blind clinical (ClinicalTrials. gov. identifier: NCT02667912) study with a follow-up of 12,3±1,6 months included 55 patients with RH, which was divided into 2 groups: group 1 (n=27) — main renal artery denervation; group 2 — RD of branches. Mean age of patients was 57,3±9,5 and 56,4±9,3 years, respectively. We assessed structural and functional cardiac characteristics using two-dimensional speckle-tracking echocardiography (STE).Results. Initially, the patients in the groups did not differ in terms of studied parameters and therapy. After RD in both groups, the levels of myocardial stress significantly decreased; 95% confidence interval: after main renal artery denervation — systolic [-4802; -2896], diastolic [-3264; -2032] dyne/cm2; after RD of branches — [-6324; -5328] and [-4021; -2521] dyne/cm2, respectively (p=0,001 and 0,024, respectively). After main renal artery denervation, there was a decrease in the left ventricular (LV) wall thickness (interventricular septum [1,06; -0,62] and posterior wall [0,12; -0,62]) in comparison with RD of branches ([-0,68; -1,28] and [-0,68; -1,06], respectively). These differences were significant: p=0,023 and 0,021, respectively. After distal RD, decrease in the LV mass was observed more often by 21,2%, an increase in the LV mass was 2 times less frequent. Restoration of diastolic function was more common in patients after distal RD than main renal artery denervation (26% vs 13%, respectively). According to pilot analysis, STE parameters was also improved.Conclusion. Twelve months after distal RD, compared with the main renal artery denervation, the LV wall thickness, number of patients with LV hypertro -phy, and diastolic dysfunction decreased significantly greater. Two-dimensional STE revealed improvement of cardiac parameters. The results require further research.

scholarly journals Early Morphologic Alterations in Renal Artery Wall and Renal Nerves in Response to Catheter-Based Renal Denervation Procedure in Sheep: Difference Between Single-Point and Multiple-Point Ablation Catheters

2017 ◽  
pp. 601-614 ◽  
Author(s):  
M. TÁBORSKÝ ◽  
D. RICHTER ◽  
Z. TONAR ◽  
T. KUBÍKOVÁ ◽  
A. HERMAN ◽  
...  
Keyword(s):  
Renal Artery ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Single Point ◽  
Renal Tissue ◽  
Renal Nerves ◽  
Multiple Point ◽  
Renal Nerve ◽  
Jude Medical ◽  
Novel Strategy

Renal sympathetic hyperactivity is critically involved in hypertension pathophysiology; renal denervation (RDN) presents a novel strategy for treatment of resistant hypertension cases. This study assessed effects of two RDN systems to detect acute intravascular, vascular and peri-vascular changes in the renal artery, and renal nerve alterations, in the sheep. The procedures using a single-point or multi-point ablation catheters, Symplicity FlexTM, Medtronic versus EnligHTNTM, St. Jude Medical were compared; the intact contralateral kidneys served as controls. Histopathological and immunohistochemical assessments were performed 48 h after RDN procedures; the kidney and suprarenal gland morphology was also evaluated. Special staining methods were applied for histologic analysis, to adequately score the injury of renal artery and adjacent renal nerves. These were more pronounced in the animals treated with the multi-point compared with the single-point catheter. However, neither RDN procedure led to complete renal nerve ablation. Forty-eight hours after the procedure no significant changes in plasma and renal tissue catecholamines were detected. The morphologic changes elicited by application of both RDN systems appeared to be dependent on individual anatomical variability of renal nerves in the sheep. Similar variability in humans may limit the therapeutic effectiveness of RDN procedures used in patients with resistant hypertension.

Adding herbal extracts to silicone gel on post-sternotomy scar: a prospective randomised double-blind study

2020 ◽  
Vol 29 (Sup4) ◽  
pp. S36-S42
Author(s):  
Palakorn Surakunprapha ◽  
Kengkart Winaikosol ◽  
Bowornsilp Chowchuen ◽  
Kriangsak Jenwitheesuk ◽  
Kamonwan Jenwitheesuk
Keyword(s):  
Aloe Vera ◽  
Median Sternotomy ◽  
Centella Asiatica ◽  
Herbal Extract ◽  
Double Blind Study ◽  
Herbal Extracts ◽  
Double Blind ◽  
Silicone Gel ◽  
Group 2 ◽  
Group 1

Objective: Silicone gel has been shown effective in improving healing post-sternotomy scars. It remains to be determined whether adding herbal extracts to the gel would augment the healing effect. Method: After median sternotomy, patients were randomised into two groups. Group 1: topical silicone gel plus herbal extract gel (Allium cepa, Centella Asiatica, Aloe vera and Paper Mulberry) and Group 2: silicone gel. Patients were treated for six months. The postoperative scars were assessed at three and six months by plastic surgeons using the Vancouver Scar Scale (VSS) and the patient assessment scar scale. Results: Each group comprised 23 patients (n=46 in total). The VSS was significantly lower in Group 1 than in Group 2 (p=0.018 and p=0.051, respectively). In Group 1, the four differences from baseline were vascularity scores at three and six months (–0.391, p=0.025; –0.435, p=0.013, respectively), and pigmentation scores at three and six months (–0.391, p=0.019; –0.609, p=0.000, respectively). In Group 2, differences from baseline were the pigmentation and vascularity score at six months (–0.6609, p=0.000; –0.348, p=0.046, respectively). Conclusion: Our results suggest, post-sternotomy scars trend to have better vascularity and pigmentation when treated with silicone gel plus herbal extracts.

P5266Renal denervation improves diastolic dysfunction in patients with HFpEF - initial results of a multicenter CMR study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Zamani ◽  
F Mahfoud ◽  
L Stoiber ◽  
M Boehm ◽  
B Pieske ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Myocardial Function ◽  
Left Ventricular ◽  
Cine Mri ◽  
Preserved Ejection Fraction

Abstract Introduction Renal denervation (RDN) significantly reduces blood pressure (BP) and improves myocardial function in patients with resistant hypertension. Purpose This multicenter study aimed to investigate the intermediate term effect of RDN on left ventricular global longitudinal strain (GLS), a surrogate for diastolic myocardial function in RDN patients with proven heart failure with preserved ejection fraction (HFpEF), assessed by cardiac magnetic resonance imaging (CMR). Methods We analyzed data from 22 patients with resistant hypertension (mean age 68±6 years). 16 patients underwent renal denervation (RDN) and 6 matched control patients received optimal medical therapy (OMT). Both groups had diastolic dysfunction defined by preserved ejection fraction (EF ≥50%) and pathologically elevated GLS at baseline (GLS >−18%) quantified by cardiac magnetic resonance (CMR). A standardized CMR protocol was performed at baseline (BL) and 6 months follow-up (FU). Left ventricular mass index (LVMI) was quantified in end-diastolic and end-systolic endo- and epicardial contouring in short axis cine-MRI images. GLS was measured by end-diastolic and end-systolic endocardial contouring in 2-, 3- and 4-chamber view cine-MRI images. MRI-Images have been analyzed with Medis, Netherlands. Results GLS following RDN patients significantly improved after 6 months by 21% (−14.21% ±3.19 vs. −17.17%± 3.1; p=0.007). In control patients with OMT, no significant change in GLS was detected (−14.77% ±3.05 vs. −17.39% ± 4.49; p=0.327). LVMI was numerically reduced in the RDN group at follow-up but did not reach statistical significance (58.55 g/m2±11.37 vs. 55.46 g/m2±12.76; p=0.085). There was no such effect in control patients with OMT (49.25 g/m2±8.2 vs. 50.18 g/m2±7.27; p=0.665). (See also: Figure A and B). Conclusions We found significantly improved diastolic function (GLS) in patients with HFpEF and resistant hypertension undergoing RDN. Future studies are needed to determine whether RDN represents a treatment option in patients with HFpEF.

scholarly journals Comparison of Ondansetron with Gabapentin for prevention of intrathecal morphine induced pruritus

2019 ◽  
Vol 2 (3) ◽  
pp. 142-148
Author(s):  
Rohini Sigdel ◽  
Anil Shrestha ◽  
Roshana Amatya
Keyword(s):  
Single Dose ◽  
Intrathecal Morphine ◽  
Double Blind Study ◽  
Physical Status ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Subarachnoid Block ◽  
Significant Difference ◽  
Group 2 ◽  
To Receive

Background: Ondansetron has been used successfully for prophylaxis and treatment of intrathecal morphine induced pruritus. Gabapentin has anxiolytic, antiemetic, antipruritic effects and has also been shown to potentiate the analgesic effect of intrathecally or epidurally administered opioids. Materials and method: We compared the effectiveness of oral gabapentin with intravenous ondansetron to prevent incidence of intrathecal morphine induced pruritus. In a prospective, double-blind study, sixty patients aged 18-65 years with ASA physical status I and II undergoing surgery under subarachnoid block were randomized to receive placebo tablets (ondansetron group) or gabapentin 1200 mg (gabapentin group) 2 hours before surgery. Patients receiving placebo tablets received 8 mg of intravenous ondansetron and those receiving gabapentin received 4 ml of intravenous normal saline just prior to subarachnoid block with 3 ml of 0.5% hyperbaric bupivacaine plus 0.2 mg morphine. The incidence, onset, severity, location of pruritus and incidence of side effects were studied for next 24 hours. Results: The overall incidence of pruritus was 48.3%. The incidence, severity, location of pruritus was comparable between the two groups. There was significant difference between the onset of pruritus between groups (p=0.009). The incidence and grade of nausea vomiting, requirement of intraoperative sedation was comparable between groups. The incidence of urinary retention was significantly high in gabapentin group (p=0.020). Respiratory depression was observed in one patient. Conclusion: A single dose of 1200 mg oral gabapentin 2 hours before, is as effective as prophylactic intravenous ondansetron 8 mg for prevention of intrathecal morphine induced pruritus.

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