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1.
Pacing Clin Electrophysiol ; 41(7): 720-726, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29663449

RESUMO

OBJECTIVE: Application of therapeutic mild hypothermia in patients after resuscitation, often accompanied by myocardial infarction, cardiogenic shock, and systemic inflammation may impact on cardiac rhythm. We therefore tested susceptibility to atrial arrhythmias during hyperthermia (HT, 40.5°C), normothermia (NT, 38.0°C), and mild hypothermia (MH, 33.0°C). METHODS: Nine healthy, anesthetized closed-chest landrace pigs were instrumented with a quadripolar stimulation catheter in the high right atrium and a decapolar catheter in the coronary sinus. Twelve-lead surface electrograms were recorded and core body temperature was altered to HT, NT, and MH using external warming or intravascular cooling. Repetitive measurements of effective atrial refractory period (AERP), atrial fibrillation (AF) inducibility, and electrocardiogram (ECG) parameters at different heart rates were performed. RESULTS: During MH, AERP was significantly longer while the inducibility of AF was significantly higher compared to NT and HT (median [range]: HT 18 (0, 80)%; NT 25 (0, 80)%; MH 68 (0, 100)%; P < 0.05 MH vs NT+HT). Mean AF duration did not differ between groups. Arterial potassium levels decreased with falling temperatures (HT: 4.2 ± 0.1 mmol/L; NT: 4.0 ± 0.2 mmol/L; MH: 3.5 ± 0.1 mmol/L; P < 0.001). Surface ECGs during MH showed reduced spontaneous heart rate (HT: 99 ± 13 beats/min; NT: 87 ± 15 beats/min; MH: 66 ± 10 beats/min; P < 0.05), increased PQ, stim-Q, and QT intervals (P < 0.01) but no change in QRS duration or time from peak to end of the T wave interval. CONCLUSION: Our data imply that MH represents an arrhythmic substrate rendering the atria more susceptible to AF although conduction times as well as refractory periods are increased. Further investigations on potential electrophysiological limits of therapeutic cooling in patients are required.


Assuntos
Fibrilação Atrial/etiologia , Modelos Animais de Doenças , Hipotermia Induzida , Suínos , Animais , Hipotermia Induzida/métodos
2.
Clin Chem Lab Med ; 55(7): 1034-1042, 2017 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-28432842

RESUMO

BACKGROUND: Primary hyperparathyroidism (pHPT) is associated with low-grade inflammation, left ventricular hypertrophy and increased cardiovascular mortality, but the association between inflammatory markers and parameters of adverse cardiac remodeling is unknown. We investigated the relationship between C-reactive protein (CRP), the essential amino acid tryptophan and its pro-inflammatory derivatives kynurenine and quinolinic acid (QUIN) with echocardiographic parameters. METHODS: Cross-sectional baseline data from the "Eplerenone in Primary Hyperparathyroidism" trial were analyzed. Patients with any acute illness were excluded. We assessed associations between CRP, serum levels of tryptophan, kynurenine and QUIN and left ventricular mass index (LVMI), left atrial volume index (LAVI) and E/e'. RESULTS: Among 136 subjects with pHPT (79% females), 100 (73%) had arterial hypertension and the prevalence of left ventricular hypertrophy was 52%. Multivariate linear regression analyses with LVMI, LAVI and E/e' as respective dependent variables, and C-reactive protein and tryptophan, kynurenine and QUIN as respective independent variables were performed. Analyses were adjusted for age, sex, blood pressure, parathyroid hormone, calcium and other cardiovascular risk factors. LVMI was independently associated with CRP (adjusted ß-coefficient=0.193, p=0.030) and QUIN (ß=0.270, p=0.007), but not kynurenine. LAVI was related with CRP (ß=0.315, p<0.001), kynurenine (ß=0.256, p=0.005) and QUIN (ß=0.213, p=0.044). E/e' was related with kynurenine (ß=0.221, p=0.022) and QUIN (ß=0.292, p=0.006). Tryptophan was not associated with any of the remodeling parameters. [Correction added after online publication (22 April 2017: The sentence "Among 136 subjects with pHPT (79% females), 100 (73%) had left ventricular hypertrophy." was corrected to "Among 136 subjects with pHPT (79% females), 100 (73%) had arterial hypertension and the prevalence of left ventricular hypertrophy was 52%."] Conclusions: Cardiac remodeling is common in pHPT and is associated with low-grade inflammation and activation of the tryptophan-kynurenine pathway. The potential role of kynurenine and QUIN as cardiovascular risk factors may be further investigated in future studies.


Assuntos
Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/patologia , Cinurenina/sangue , Triptofano/sangue , Remodelação Ventricular , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Estudos Transversais , Ecocardiografia , Feminino , Humanos , Hiperparatireoidismo Primário/complicações , Inflamação/complicações , Masculino , Ácido Quinolínico/sangue
3.
J Electrocardiol ; 50(4): 402-409, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28274541

RESUMO

BACKGROUND: There is controversial evidence if atrial fibrillation (AF) alters outcome after transcatheter aortic valve implantation (TAVI). TAVI itself may promote new-onset AF (NOAF). METHODS: We performed a single-center study including 398 consecutive patients undergoing TAVI. Before TAVI, patients were divided into a sinus rhythm (SR) group (n=226, 57%) and baseline AF group (n=172, 43%) according to clinical records and electrocardiograms. Furthermore, incidence and predictors of NOAF were recorded. RESULTS: Baseline AF patients had a significantly higher 1-year mortality than the baseline SR group (19.8% vs. 11.5%, p=0.02). NOAF occurred in 7.1% of patients with prior SR. Previous valve surgery was the only significant predictor of NOAF (HR 5.86 [1.04-32.94], p<0.05). NOAF was associated with higher rehospitalization rate (62.5 vs. 34.8%, p=0.04), whereas mortality was unaffected. CONCLUSIONS: This study shows that NOAF is associated with higher rates of rehospitalization but not mortality after TAVI. Overall, patients with pre-existing AF have higher mortality.


Assuntos
Fibrilação Atrial/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/mortalidade , Áustria/epidemiologia , Eletrocardiografia , Feminino , Humanos , Incidência , Masculino , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Fatores de Risco , Resultado do Tratamento
4.
Europace ; 18(4): 568-71, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26056191

RESUMO

AIMS: Propafenone is a well-known Class Ic antiarrhythmic agent. It has the typical chemical structure of a beta-blocker, but human studies on its beta-blocking effects revealed conflicting results. METHODS AND RESULTS: Twelve healthy males received single oral doses of 600 mg propafenone and placebo according to a randomized, double-blind, placebo-controlled, cross-over protocol. Four hours following drug intake, heart rate and blood pressure were measured, and plasma concentrations of propafenone were determined at rest, during exercise and after recovery. At exercise, propafenone significantly decreased heart rate (-6%, P < 0.05), systolic blood pressure (-6%, P < 0.05), and the rate-pressure product (-11%, P < 0.05). Plasma concentrations of propafenone increased during exercise (+23%, P < 0.05) and decreased during recovery (-33%, P < 0.05). CONCLUSION: Both effects on heart rate and blood pressure as well as the changes of plasma concentrations of propafenone during exercise represent two particular features of beta-blockers. Therefore, we conclude that propafenone is both a Class Ic and a Class II antiarrhythmic agent, and 600 mg propafenone, i.e. the dose recommended in current guidelines for cardioversion of paroxysmal atrial fibrillation, cause clinically significant beta-blockade. Thus, single oral doses of 600 mg propafenone appear also suitable for cardioversion of paroxysmal atrial fibrillation in patients with structural heart disease since beta-blockers are explicitly indicated in the treatment of both coronary artery disease and heart failure.


Assuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Antiarrítmicos/administração & dosagem , Frequência Cardíaca/efeitos dos fármacos , Propafenona/administração & dosagem , Administração Oral , Antagonistas Adrenérgicos beta/sangue , Antagonistas Adrenérgicos beta/classificação , Antagonistas Adrenérgicos beta/farmacocinética , Adulto , Antiarrítmicos/sangue , Antiarrítmicos/classificação , Antiarrítmicos/farmacocinética , Áustria , Pressão Sanguínea/efeitos dos fármacos , Estudos Cross-Over , Método Duplo-Cego , Monitoramento de Medicamentos , Exercício Físico , Teste de Esforço , Voluntários Saudáveis , Humanos , Masculino , Estrutura Molecular , Propafenona/sangue , Propafenona/classificação , Propafenona/farmacocinética , Recuperação de Função Fisiológica , Relação Estrutura-Atividade , Adulto Jovem
5.
iScience ; 26(4): 106459, 2023 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-37020954

RESUMO

Branched-chain amino acids (BCAAs) are effectors of metabolic diseases, but their impact on mortality is largely unknown. We investigated the association of BCAA with risk factors and mortality in 2,236 participants of the Ludwigshafen Risk and Cardiovascular Health (LURIC) study using linear and Cox regression. Adiponectin, hemoglobin, C-peptide, hemoglobin A1c, and homoarginine showed the strongest association with BCAA concentration (all p < 0.001). During a median follow-up of 10.5 years, 715 participants died, including 450 cardiovascular-related deaths. BCAA concentrations were inversely associated with the risk of all-cause and cardiovascular mortality (HR [95% CI] per 1-SD increase in log-BCAA: 0.75 [0.69-0.82] and 0.72 [0.65-0.80], respectively) after adjustment for potential confounders. BCAAs are directly associated with metabolic risk but inversely with mortality in persons with intermediate-to-high cardiovascular risk. Further studies are warranted to evaluate the diagnostic and therapeutic utility of BCAA in the context of cardiovascular diseases.

6.
J Hypertens ; 37(11): 2290-2297, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31335512

RESUMO

OBJECTIVES: Three recently published sham-controlled studies proved the efficacy of renal denervation (RDN) in hypertensive patients. The study presented here analyzed a nationwide multicentre registry database to clarify which patient subgroups benefit most from radiofrequency RDN. METHODS: This is a post hoc analysis from the multicentre Austrian Transcatheter Renal Denervation Registry hosted by the Austrian Society of Hypertension. We correlated change of SBP after RDN to sex and presence/absence of comorbidities. Univariable correlation and multiple linear regression analyses were performed. RESULTS: Two hundred and ninety-one patients (43% women, median age 64 years) undergoing RDN between April 2011 and September 2014 were included in this analysis. Mean baseline ambulatory 24 h BP (systolic/diastolic) was 150 ±â€Š18/89 ±â€Š14 mmHg and mean baseline office BP was 170 ±â€Š16/94 ±â€Š14 mmHg.After RDN, mean ambulatory 24 h BP reduction was 9 ±â€Š19/6 ±â€Š16 mmHg. The following features were associated with a good response to RDN: high baseline systolic ambulatory BP, high baseline diastolic office BP, female sex, absence of diabetes mellitus, and absence of peripheral artery disease. Multivariable analysis identified female sex and absence of diabetes mellitus as strongest predictors for ambulatory BP reduction, although those groups had the lowest baseline ambulatory BP. DISCUSSION: Ambulatory BP reductions after RDN were substantially more pronounced in female and in nondiabetic patients despite lower baseline BP. It is concluded that in terms of efficacy female patients and nondiabetic patients might benefit more from RDN.


Assuntos
Pressão Sanguínea , Denervação/estatística & dados numéricos , Hipertensão/cirurgia , Sistema de Registros , Artéria Renal/inervação , Idoso , Áustria , Determinação da Pressão Arterial , Feminino , Humanos , Rim , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
7.
Eur Heart J Case Rep ; 2(2): yty041, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31020121

RESUMO

INTRODUCTION: Coronary vasospasm and sudden cardiac death are a frequently reported complication of cocaine abuse. We present a case with uniquely severe clinical and angiographic presentation. CASE PRESENTATION: A 39-year-old patient was presented to the cath lab after out-of-hospital cardiac arrest. Coronary angiography revealed focal coronary vasospasm in the proximal LCx, well responsive for intracoronary nitrates. Accordingly, no coronary intervention was performed and the patient was transferred to the cardiac intensive care unit. There, after systematically cooling sudden haemodynamic deterioration and massive ST-elevation was observed. Repeated coronary angiography revealed subocclusive LAD and LCx vasospasm, which again recovered after intracoronary injection of nitric oxide. DISCUSSION: Coronary-spastic effect of cocaine and its potentially dreadful clinical consequences are well-described phenomena. As novelty this case emphasizes that standard of care, including systematic hypothermia and vasopressor administration after out-of-hospital cardiac arrest can potentiate cocaine-induced coronary spasm with dramatic outcomes.

8.
PLoS One ; 13(12): e0208994, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30532216

RESUMO

BACKGROUND: Catheter ablation of atrial fibrillation (AF) is an established second line therapy for patients with symptomatic paroxysmal AF (PAF) and may be considered as a first line therapy in selected patients who are highly symptomatic, considering patient choice, benefit, and risk, according to recent guidelines. Our study investigated whether a first line vs. second line ablation approach may result in improved sinus rhythm maintenance after ablation. METHODS: A total of 153 patients undergoing pulmonary vein isolation for PAF were included in the study (age 55±12 years, 29% female). Seventy-nine patients underwent first line AF ablation and 74 patients underwent second line AF ablation after failed antiarrhythmic drug therapy. There was no significant difference in baseline characteristics such as age, history of AF, left atrial size or LVEF between groups. Success was defined as atrial tachyarrhythmia free survival during a 12-month follow-up by means of serial ECG Holter monitoring. RESULTS: There was no significant difference in cumulative arrhythmia-free survival between those patients who received AF ablation as a first or second line therapy. Single procedure success was 78% in the first line group vs. 81% in the second line group; multiple procedure success was 90 vs. 91%, (n.s.). Complication rate was 1.3% vs. 1.4% (n.s.). CONCLUSION: Success of AF ablation did not differ between patients who receive ablation as first vs. second line therapy. Based on these data, a trial of AAD therapy before AF ablation may be justified in most patients with symptomatic PAF eligible for rhythm control.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Adulto , Idoso , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/mortalidade , Ablação por Cateter/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/cirurgia , Recidiva , Acidente Vascular Cerebral/etiologia , Taxa de Sobrevida , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia
9.
Heart Rhythm ; 15(9): 1328-1336, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29803020

RESUMO

BACKGROUND: Arterial hypertension (HT) contributes to progression of atrial fibrillation (AF) via unknown mechanisms. OBJECTIVE: We aimed to characterize electrical and structural changes accounting for increased AF stability in a large animal model of rapid atrial pacing (RAP)-induced AF combined with desoxycorticosterone acetate (DOCA)-induced HT. METHODS: Eighteen pigs were instrumented with right atrial endocardial pacemaker leads and custom-made pacemakers to induce AF by continuous RAP (600 beats/min). DOCA pellets were subcutaneously implanted in a subgroup of 9 animals (AF+HT group); the other 9 animals served as controls (AF group). Final experiments included electrophysiology studies, endocardial electroanatomic mapping, and high-density mapping with epicardial multielectrode arrays. In addition, 3-dimensional computational modeling was performed. RESULTS: DOCA implantation led to secondary HT (median [interquartile range] aortic pressure 109.9 [100-137] mm Hg in AF+HT vs 82.2 [79-96] mm Hg in AF; P < .05), increased AF stability (55.6% vs 12.5% of animals with AF episodes lasting >1 hour; P < .05), concentric left ventricular hypertrophy, atrial dilatation (119 ± 31 cm2 in AF+HT vs 78 ± 23 cm2 in AF; P < .05), and fibrosis. Collagen accumulation in the AF+HT group was mainly found in non-intermyocyte areas (1.62 ± 0.38 cm3 in AF+HT vs 0.96 ± 0.3 cm3 in AF; P < .05). Left and right atrial effective refractory periods, action potential durations, endo- and epicardial conduction velocities, and measures of AF complexity were comparable between the 2 groups. A 3-dimensional computational model confirmed an increase in AF stability observed in the in vivo experiments associated with increased atrial size. CONCLUSION: In this model of secondary HT, higher AF stability after 2 weeks of RAP is mainly driven by atrial dilatation.


Assuntos
Fibrilação Atrial/fisiopatologia , Remodelamento Atrial , Pressão Sanguínea/fisiologia , Simulação por Computador , Átrios do Coração/fisiopatologia , Frequência Cardíaca/fisiologia , Hipertensão/complicações , Animais , Fibrilação Atrial/etiologia , Fibrilação Atrial/terapia , Modelos Animais de Doenças , Eletrocardiografia , Átrios do Coração/diagnóstico por imagem , Hipertensão/fisiopatologia , Marca-Passo Artificial , Suínos
10.
Wien Klin Wochenschr ; 129(23-24): 910-912, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29124430

RESUMO

The wearable cardioverter defibrillator (WCD) is a temporary treatment option for patients with potentially reversible risk of sudden cardiac death. This case demonstrates a pitfall during WCD usage in a pacemaker-dependent patient as well as a possible solution allowing continuation of WCD therapy. Bipolar stimulation may lead to double counting of the WCD detection algorithm resulting in false alarm or inappropriate therapy.


Assuntos
Morte Súbita Cardíaca , Desfibriladores Implantáveis , Dispositivos Eletrônicos Vestíveis , Morte Súbita Cardíaca/prevenção & controle , Cardioversão Elétrica , Humanos , Masculino , Pessoa de Meia-Idade
11.
Bone ; 105: 212-217, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28918310

RESUMO

Mineralocorticoid receptor (MR) antagonism may affect bone turnover via direct and indirect pathways involving parathyroid hormone, but randomized controlled trials are lacking. In a pre-specified analysis of the "Eplerenone in primary hyperparathyroidism" placebo-controlled, randomized trial (ISRCTN 33941607), effects of eight weeks MR-blockade with eplerenone on bone turnover markers in 97 patients with primary hyperparathyroidism were tested. Mean age was 67.5±9.5years, and 76 (78.4%) were females. In analysis of covariance with adjustment for baseline values, eplerenone had no significant effect on isoform 5b of the tartrate-resistant acid phosphatase (TRAP), beta-crosslaps, N-terminal propeptide of procollagen type 1 (P1NP), osteocalcin and bone-specific alkaline phosphatase. There was no significant cross-sectional correlation between plasma aldosterone concentration or the aldosterone-to-renin ratio and markers of bone turnover in multivariate linear regression models at baseline. These data provide first evidence from a randomized and placebo-controlled trial that short-term MR antagonism may not affect bone turnover, at least in patients with primary hyperparathyroidism.


Assuntos
Biomarcadores/metabolismo , Remodelação Óssea/efeitos dos fármacos , Hiperparatireoidismo Primário/tratamento farmacológico , Hiperparatireoidismo Primário/metabolismo , Espironolactona/análogos & derivados , Idoso , Estudos de Coortes , Eplerenona , Feminino , Seguimentos , Humanos , Masculino , Placebos , Sistema Renina-Angiotensina , Espironolactona/farmacologia , Espironolactona/uso terapêutico , Resultado do Tratamento
12.
J Clin Hypertens (Greenwich) ; 19(11): 1173-1180, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28834128

RESUMO

Patients with primary hyperparathyroidism are at increased risk for high blood pressure, vascular stiffening, and left ventricular hypertrophy, but previous studies have failed to demonstrate the direct associations with circulating parathyroid hormone (PTH) levels. The authors investigated cross-sectional relationships between PTH and 24-hour pulse wave velocity, nocturnal systolic blood pressure, and left ventricular mass index in patients with primary hyperparathyroidism who were treatment-naive with cinacalcet, renin-angiotensin-aldosterone-system inhibitors, and thiazide or loop diuretics. In 76 patients, mean±SD of pulse wave velocity, nocturnal systolic blood pressure, and left ventricular mass index values were 9.3±1.8 m/s, 116.6±17.0 mm Hg, and 92.8±23.0 g/m². In multivariate linear regression analyses with adjustment for potentially confounding parameters, PTH was independently associated with nocturnal systolic blood pressure (adjusted ß coefficient=.284, P=.040), mean 24-hour pulse wave velocity (ß=.199, P=.001), and left ventricular mass index (ß=.252, P=.025). PTH may promote vascular and cardiac remodeling in primary hyperparathyroidism. Interventional trials are needed to test the antihypertensive and cardioprotective effects of PTH-inhibitory treatment strategies.


Assuntos
Anti-Hipertensivos/farmacologia , Doenças Cardiovasculares , Ventrículos do Coração/patologia , Hiperparatireoidismo Primário , Hipertensão , Hormônio Paratireóideo/sangue , Análise de Onda de Pulso/métodos , Idoso , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial/métodos , Cardiotônicos/farmacologia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Ecocardiografia/métodos , Feminino , Humanos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/fisiopatologia , Hipertensão/sangue , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão
13.
PLoS One ; 12(4): e0173799, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28406904

RESUMO

Observational studies suggested a link between bone disease and left ventricular (LV) dysfunction that may be pronounced in hyperparathyroid conditions. We therefore aimed to test the hypothesis that circulating markers of bone turnover correlate with LV function in a cohort of patients with primary hyperparathyroidism (pHPT). Cross-sectional data of 155 subjects with pHPT were analyzed who participated in the "Eplerenone in Primary Hyperparathyroidism" (EPATH) Trial. Multivariate linear regression analyses with LV ejection fraction (LVEF, systolic function) or peak early transmitral filling velocity (e', diastolic function) as dependent variables and N-terminal propeptide of procollagen type 1 (P1NP), osteocalcin (OC), bone-specific alkaline phosphatase (BALP), or beta-crosslaps (CTX) as the respective independent variable were performed. Analyses were additionally adjusted for plasma parathyroid hormone, plasma calcium, age, sex, HbA1c, body mass index, mean 24-hours systolic blood pressure, smoking status, estimated glomerular filtration rate, antihypertensive treatment, osteoporosis treatment, 25-hydroxy vitamin D and N-terminal pro-brain B-type natriuretic peptide. Independent relationships were observed between P1NP and LVEF (adjusted ß-coefficient = 0.201, P = 0.035) and e' (ß = 0.188, P = 0.042), respectively. OC (ß = 0.192, P = 0.039) and BALP (ß = 0.198, P = 0.030) were each independently related with e'. CTX showed no correlations with LVEF or e'. In conclusion, high bone formation markers were independently and paradoxically related with better LV diastolic and, partly, better systolic function, in the setting of pHPT. Potentially cardio-protective properties of stimulated bone formation in the context of hyperparathyroidism should be explored in future studies.


Assuntos
Remodelação Óssea , Hiperparatireoidismo/sangue , Hiperparatireoidismo/fisiopatologia , Função Ventricular Esquerda , Fatores Etários , Idoso , Fosfatase Alcalina/sangue , Biomarcadores/sangue , Cálcio/sangue , Estudos Transversais , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Osteocalcina/sangue , Hormônio Paratireóideo/sangue , Fragmentos de Peptídeos/sangue , Pró-Colágeno/sangue
14.
PLoS One ; 11(8): e0161250, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27529426

RESUMO

Renal denervation (RDN) is a new procedure for treatment-resistant hypertensive patients. In order to monitor all procedures undergone in Austria, the Austrian Society of Hypertension established the investigator-initiated Austrian Transcatheter Renal Denervation (TREND) Registry. From April 2011 to September 2014, 407 procedures in 14 Austrian centres were recorded. At baseline, office and mean 24-h ambulatory blood pressure (ABP) were 171/94 and 151/89 mmHg, respectively, and patients were taking a median of 4 antihypertensive medications. Mean 24-h ABP changes after 2-6 weeks, 3, 6 and 12 months were -11/-6, -8/-4, -8/-5 and -10/-6 mmHg (p<0.05 at all measurements), respectively. The periprocedural complication rate was 2.5%. Incidence of long-term complications during follow-up (median 1 year) was 0.5%. Office BP and ABP responses showed only a weak correlation (Pearson coefficient 0.303). Based on the data from the TREND registry, ambulatory blood pressure monitoring in addition to office BP should be used for patient selection as well as for monitoring response to RDN. Furthermore, criteria for optimal patient selection are suggested.


Assuntos
Denervação , Documentação , Hipertensão/cirurgia , Sistema de Registros , Artéria Renal/inervação , Artéria Renal/cirurgia , Técnicas de Ablação , Idoso , Áustria , Monitorização Ambulatorial da Pressão Arterial , Denervação/efeitos adversos , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Segurança , Resultado do Tratamento
15.
J Clin Hypertens (Greenwich) ; 18(6): 543-50, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26456544

RESUMO

High parathyroid hormone (PTH) has been linked with high blood pressure (BP), but the relationship with 24-hour ambulatory blood pressure monitoring is largely unknown. The authors therefore analyzed cross-sectional data of 292 hypertensive patients participating in the Styrian Hypertension Study (mean age, 61±11 years; 53% women). Median plasma PTH (interquartile range) determined after an overnight fast was 49 pg/mL (39-61), mean daytime BP was 131/80±12/9 mm Hg, and mean nocturnal BP was 115/67±14/9 mm Hg. In multivariate regression analyses adjusted for BP and PTH-modifying parameters, PTH was significantly related to nocturnal systolic and diastolic BP (adjusted ß-coefficient 0.140 [P=.03] and 0.175 [P<.01], respectively). PTH was not correlated with daytime BP readings. These data suggest a direct interrelationship between PTH and nocturnal BP regulation. Whether lowering high PTH concentrations reduces the burden of high nocturnal BP remains to be shown in future studies.


Assuntos
Ritmo Circadiano/fisiologia , Hipertensão/sangue , Hipertensão/fisiopatologia , Hormônio Paratireóideo/sangue , Idoso , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores de Risco
16.
J Hypertens ; 34(9): 1778-86, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27379537

RESUMO

OBJECTIVES: The high prevalence of arterial hypertension in primary hyperparathyroidism (pHPT) is largely unexplained. Apart from parathyroid hormone (PTH), the mineral hormones fibroblast growth factor (FGF)-23 and aldosterone-to-renin ratio (ARR) are upregulated in pHPT. We aimed to determine whether nocturnal blood pressure (BP) is related with PTH, FGF-23 or ARR in a relatively large sample of pHPT patients. METHODS: Cross-sectional data of the single-center "Eplerenone in Primary Hyperparathyroidism" trial were used. All patients with a biochemical diagnosis of pHPT who had both available 24-h ambulatory BP monitoring and valid laboratory data were included. RESULTS: Full data were available in 136 patients (mean age 67 ±â€Š10 years, 78% women). Median PTH was 99 (interquartile range: 82-124) pg/ml and mean calcium was 2.63 ±â€Š0.15 mmol/l. ARR, but not PTH or FGF-23, was significantly and directly related with nocturnal SBP (Pearson's r = 0.241, P < 0.01) and DBP (r = 0.328, P < 0.01). In multivariate regression analyses, with adjustment for age, sex, PTH, FGF-23, traditional cardiovascular risk factors, antihypertensive medication and parameters of calcium metabolism ARR remained significantly and directly related with nocturnal BP (SBP: adjusted ß-coefficient = 0.289, P < 0.01; DBP: ß = 0.399, P < 0.01). The relationship between ARR and nocturnal SBP was exclusively present in patients with PTH levels above the median of 99 pg/ml. CONCLUSION: ARR, but not FGF-23 or PTH, was independently and directly related with nocturnal BP parameters in patients with pHPT, and this relationship was dependent on pHPT disease severity. Inappropriately, elevated aldosterone may partially explain the high prevalence of arterial hypertension in pHPT.


Assuntos
Aldosterona/sangue , Pressão Sanguínea , Fatores de Crescimento de Fibroblastos/sangue , Hiperparatireoidismo Primário/sangue , Hormônio Paratireóideo/sangue , Renina/sangue , Idoso , Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial , Cálcio/sangue , Ritmo Circadiano , Estudos Transversais , Diástole , Eplerenona , Feminino , Fator de Crescimento de Fibroblastos 23 , Humanos , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/fisiopatologia , Hipertensão/sangue , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Fatores Sexuais , Espironolactona/análogos & derivados , Espironolactona/uso terapêutico , Sístole
17.
J Hypertens ; 34(7): 1347-56, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27065001

RESUMO

BACKGROUND: Accumulating evidence points toward mutual interaction between parathyroid hormone (PTH) and aldosterone as potential mechanism for increasing cardiovascular risk in primary hyperparathyroidism (pHPT). METHODS: The Eplerenone on parathyroid hormone levels in patients with primary hyperparathyroidism (EPATH) trial is a single-center, randomized, double-blind, parallel-group, placebo-controlled trial. The primary aim is to evaluate the effects of the mineralocorticoid receptor antagonist eplerenone on plasma intact PTH (iPTH) concentration in patients with pHPT. Secondary end points comprised surrogate parameters of cardiovascular health [24-h ambulatory SBP and DBP and echocardiographic parameters related to systolic/diastolic function as well as to cardiac dimensions]. RESULTS: We enrolled 110 study participants with pHPT, 25-hydroxyvitamin D at least 20 ng/ml and estimated glomerular filtration rate more than 50 ml/min per 1.73 m. Patients were 1 : 1 randomly assigned to receive either 25 mg eplerenone once daily (up-titration after 4 weeks to 50 mg/day) or matching placebo for a treatment period of 8 weeks.The study was completed by 97 participants [mean (SD) age: 67.5 ±â€Š9.5 years; 78.4% women). The mean treatment effect (95% confidence interval) for iPTH was 1.0 (0.9-1.1; P = 0.777) pg/ml. Mean 24-h ambulatory SBP and DBP decreased significantly [mean change (95% confidence interval) -6.3 (-9.4 to -3.3) and -3.7 (-5.7 to -1.7) mmHg, respectively; P < 0.001]. No differences were seen in any further secondary outcomes or frequency of adverse events. CONCLUSION: In pHPT, treatment with eplerenone compared with placebo had no effect on circulating iPTH levels. Eplerenone treatment was well tolerated and safe and followed by significant decrease of ambulatory blood pressure.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/tratamento farmacológico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Hormônio Paratireóideo/sangue , Espironolactona/análogos & derivados , Idoso , Monitorização Ambulatorial da Pressão Arterial , Diástole , Método Duplo-Cego , Ecocardiografia , Eplerenona , Feminino , Humanos , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Antagonistas de Receptores de Mineralocorticoides/efeitos adversos , Espironolactona/efeitos adversos , Espironolactona/uso terapêutico , Sístole , Vitamina D/análogos & derivados , Vitamina D/sangue
18.
Echocardiography ; 15(7): 635-640, 1998 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11175093

RESUMO

Although pericardiocentesis is a relatively safe procedure, there are some hazards, particularly when hemorrhagic fluid is aspirated. Having the opportunity to outline the space from which the fluid is withdrawn is of particular interest in this situation. A current technique of echocardiography with contrast enhancement involves injection of a few milliliters of agitated saline solution or reinjection of blood-stained fluid. Performing this procedure, we repeatedly observed a weak and inhomogeneous echo contrast; therefore, we evaluated the applicability of the ultrasound contrast medium SH U 454 (Echovist Schering, Berlin, Germany) for contrast enhancement in hemorrhagic pericardiocentesis. In all patients, pericardiocentesis was performed in a supine position by a subxiphoid approach. A Teflon catheter/needle unit attached to a syringe containing a few milliliters of contrast medium was introduced in the usual way. On the return of hemorrhagic fluid, 1-2 ml of Echovist was injected to provide contrast from the space from which it had been aspirated. We observed excellent contrast clearly outlining the pericardial space through the injection of 1-2 ml of contrast medium. No adverse or side effects were seen resulting from Echovist injection to the pericardial sac. In conclusion, contrast echocardiography appears to be a useful tool to secure the correct position of the needle during pericardiocentesis of hemorrhagic or loculated effusions. It is suggested that injection of Echovist should be considered whenever the contrast obtained by the conventional technique is poor and inconclusive.

20.
Wien Klin Wochenschr ; 124(21-22): 789-98, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23184070

RESUMO

Increased activity of the sympathetic nervous system plays a major role in the pathophysiology of primary arterial hypertension. Interventional renal sympathetic denervation (RSD) is a novel percutaneous treatment, decreasing sympathetic activity and consecutively blood pressure by ablating sympathetic nervous fibers located in the adventitia of the renal arteries. The procedure has been tested in several clinical trials in patients with resistant hypertension (defined as systolic office blood pressure > 160 mmHg-in diabetic patients > 150 mmHg-treated with ³ 3 antihypertensive drugs) and caused a meaningful blood pressure reduction, lasting for at least 3 years. So far, no major adverse events have been identified; however, data on the long-term consequences are lacking. The present position paper of the Austrian Society of Hypertension is aiming to assist in choosing possible indications for RSD in clinical routine, based on the available evidence in 2012.


Assuntos
Hipertensão Renal/cirurgia , Rim/inervação , Rim/cirurgia , Guias de Prática Clínica como Assunto , Simpatectomia/métodos , Simpatectomia/normas , Áustria , Humanos
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