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Объем 2, Проблема 3 (2013)

Обзорная статья

Expanding the Targets of Renal Sympathetic Denervation: From Resistant Hypertension to Atrial Fibrillation

Spyridon Koulouris

Atrial fibrillation is the most common cardiac arrhythmia affecting millions of people worldwide. Individuals with atrial fibrillation sustain significant morbidity mainly due to stroke while their mortality risk is twice higher in comparison to those with sinus rhythm. During the recent years radiofrequency ablation has become a standard procedure for the treatment of atrial fibrillation, albeit with moderate efficacy. Among the risk factors of atrial fibrillation, hypertension has a prominent role. Recently Renal Sympathetic Denervation has been proposed as an effective way to control resistant hypertension showing a sustained reduction in blood pressure. Increased sympathetic activity seems necessary to induce and sustain atrial fibrillation. It can also be considered as one of the common pathways connecting hypertension with atrial fibrillation. Given the limitations of the conventional treatment of atrial fibrillation, Renal Sympathetic Denervation has been proposed as a new treatment modality for the management of this common arrhythmia. Hard data are still lacking but the early results are very promising. Two randomized trials are currently conducted and are expected to answer the question whether the targets of Renal Sympathetic Denervation can expand beyond the treatment of resistant hypertension.

исследовательская статья

Continuous Cardiac Stroke Volume Monitoring Leads to Early Detection of Cardiac Tamponade in the Percutaneous intracardiac Intervention

Takahide Murasawa, Katsuhito Fujiu, Jun Yokota, Keigo Iwazaki, Hikaru Tanimoto, Susumu Miyazaki, Kazuo Asada, Kojima Toshiya, Yasushi Imai, Masahiko Sumitani and Issei Komuro

Background: Cardiac tamponade is one of the major complications which can result from catheter-based cardiac management, and if its detection or treatment is delayed, it can be fatal. Detecting cardiac tamponade in the earliest possible stages is crucial for preventing its development into a life threatening condition.

Methods and results: In this study, an internal blood pressure reading was conducted as part of catheter ablation, cardiac electro physiologic study, and bi-ventricular pacing treatments, and this blood pressure wave form was used along with a FloTrac system to produce a continuous estimate of cardiac output. These data were then retrospectively analyzed to determine whether the FloTrac cardiac output showed changes prior to the onset of declining blood pressure, which is the typical indicator used to diagnose cardiac tamponade. The study was conducted on 213 subjects who were undergoing catheter ablation, cardiac electrophysiologic study, and bi-ventricular pacing treatments. Out of this group, 4 (1.9%) were diagnosed with cardiac tamponade. The FloTrac data for all of these cardiac tamponade subjects showed a decline in stroke volume and cardiac output, with the onset of these changes coming an average of 15.5 ± 6.2 minutes and 8.7 ± 1.0 minutes respectively in advance of the onset of declining blood pressure measurements from the internal blood pressure readings.

Conclusion: Continuous cardiac output measurements can be used to detect cardiac tamponade at an earlier stage than continuous internal blood pressure readings, and this could enable accelerated treatment of these complications.

исследовательская статья

Associations of Symptomatic or Asymptomatic Peripheral Arterial Disease with All-Cause and Cardiovascular Mortality after 3 Years Follow Up: The China Ankle-Brachial Index Cohort Study

Xiankai Li, Yidong Wei, DachunXu, Yang Han, Chang Liang, Jianying Shen, Ji Zhang, Yingyi Luo, Dayi Hu, Jue Li and Yawei Xu

Objective: This study aim to investigate all cause and cardiovascular mortality in Chinese in patients with symptomatic or asymptomatic Peripheral Arterial Disease (PAD) in comparison to those without PAD.

Methods: All the subjects were inpatients at high risk of atherosclerosis and consecutively enrolled from July to November, 2004. A total of 3210 were followed up until an end-point was reached or until February 2008.The mean follow-up time was 38 ± 2 months.

Results: Compared with non-PAD, PAD patients had significantly higher frequency of coronary artery disease, hypertension, diabetes mellitus, dyslipidemia, stroke or smoking (all P<0.01). The all cause mortality and cardiovascular mortality in patients with PAD were 25.5% and 15.6%, respectively. Those with symptomatic and asymptomatic PAD had a statistically significant higher all cause and cardiovascular mortality compared to those without PAD (P<0.01).The symptomatic PAD patients were 1.834 times (95% CI: 1.225-2.746) as likely to die as those without PAD, and 1.650 times (95% CI: 1.303-2.088) in asymptomatic PAD patients after adjusting for other factors. Those with symptomatic or asymptomatic PAD had more than twice as likely to die of cardiovascular disease as those without PAD (RR: 2.243, 95% CI: 1.363-3.691 and RR: 2.100, 95% CI: 1.561-2.824, respectively).

Conclusion: In comparison to non-PAD patients, those with PAD were associated with a higher all cause and cardiovascular mortality whether or not PAD is symptomatic. ABI as a marker of atherosclerosis should be routinely done to evaluate PAD in elder patients in China.

Обзорная статья

Transient Hypertension

Nataraj G

Transient high BP recording are quite common. It is important to recognize, whether the recorded high BP is of episodic or primary hypertension. Varieties of stress factors can influence high BP recordings. These reversible factors include smoking, sleeplessness, alcohol, stressful work atmosphere, medications and drug abuse. It is essential to identify above reversible factors, before we label a person said to have Primary hypertension. Correction or elimination of risk factors can normalize BP. Labeling person as Hypertension not only adds increased incidence of disease also subjects for unwarranted treatment and drug toxicities. Periodic follow up and elimination of reversible factors causing high BP, decides further prognosis of transient hypertension.

исследовательская статья

Epidemiological Profile for Acute Coronary Syndrome: The Difference between Genders in an Intensive Care Unit

Vargas LA, Boin AC, Santiago RAB and Correa FG

Background: Acute Myocardial Infarction (ACS), a complication of acute coronary syndrome is a major cause of death in industrialized countries. The incidence of these diseases has increased, but the rate of mortality among patients decreased over the years.The mortality of acute myocardial infarction is higher in men than women, but for female coronary disease is most fatal in relation to the other sex.

Methods: The data was collected between October 2003 and December 2010 from patients who were admitted in the Intensive Care Unit of Hospital Santa Lucia, a private institution in Brasilia-DF, Brazil with the diagnosis of ACS. For the study of in-hospital mortality, we calculated the mortality rate of the years studied and Spearman bivariate correlation was used to determine the level of significance of the values found. By means of the nonparametric Kruskal- Wallis sought to find a statistically significant relationship between deaths per year.Factors with possible influence were analyzed by logistic regression models and were associated as covariates.Statistical analysis was performed using SPSS 20.0 software.

Results: Altogether, 1005 were analyzed from a large database.There was a reduction in the rate of mortality from acute coronary syndromes over the years evaluated, the Spearman bivariate correlation found a significant relationship (p = - 0.059). The highest percentage of deaths was found in 2008 (17.6%), the lowest in 2009 (3.8%). Of the total sample 32.32% were women. The mortality rate of ACS among women (11.8%) was almost double compared with the male sex (7.1%), the bivariate correlation has shown statistically significant (p = 0.078). In logistic regression models the relationship between gender and death has changed in the female gender with age (p = 0.013) and presence of family history (p = 0.018), in the male gender with age (p = 0.017). The others co-variables showed no statistically significant relationship with mortality between genders.

Conclusion: This study showed a statistically significant reduction in hospital mortality from acute coronary syndrome between 2003 and 2010. Our findings indicate that the mortality is higher in women than in men after an episode of acute coronary syndrome. The risk factors such as age and family history are important because their presence influences the mortality of each case.

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