Effect of renal sympathetic denervation used in the treatment of resistant arterial hypertension on left ventricular hypertrophy and diastolic function

Background: Hypertension [HTN] results in structural and functional cardiac changes which increase cardiovascular morbidity and mortality. The effect of renal denervation [RD] on left ventricular hypertrophy [LVH] and left ventricular [LV] diastolic function is still unclear

Objective: This study investigated the effect of catheter-based renal sympathetic denervation on LVH and diastolic function in patients with resistant hypertension

Methods: We evaluated systolic and diastolic blood pressure [SBP and DBP, LV size, mass and diastolic function before and 6 months after RD in 68 patients with resistant hypertension by transthoracic echocardiography and Doppler

Results: SBP and DBP reduced 6 months after RD [-22 +/- 3 mmHg and -10 +/- 12mmHg; P<0.0001 respectively] LV mass index decreased similarly independent on BP response [-19.37 +/- 2.6 gm/m[2]: P<0.0001]. Diastolic parameters E/A ratio, E-wave deceleration time and intra-ventricular relaxation time improved similarly in all patients after 6 months [0.89 +/- 0.04; P=0.001, -24.85 +/- 8.93 ms; P=0.007 and -6.97 +/- 2.57 ms; P=0.012 respectively]

Conclusion: In patients with resistant hypertension and beside blood pressure lowering effect, renal denervation improves left ventricular hypertrophy and diastolic function. The relation of BP reduction effect and the improvement of cardiac hypertrophy and systolic function suggests a direct effect of sympathetic activity on LV remodeling and function which needs to be confirmed in larger prospective cohorts

Early and short term postoperative outcome of mitral valve replacement in patients with rheumatic mitral valve disease at Assiut University Hospitals

Rheumatic heart disease and its consequent valvular lesions is a major health problem in Egypt. Mitral valve replacement [MVR] is a routine procedure in cardiac surgery with considerable benefits in terms of postoperative quality of life and survival. To assess early [30days] and short term [3-6 months] outcome of patients with mitral valve disease undergoing MVR in our locality. This study was conducted on 72 patients [46 women and 26 men, with mean age of 28.2 +/- 12 years] with rheumatic mitral valve disease underwent MVR at Assiut University Hospital from January 2005 to May 2007. Preoperative, operative, and postoperative data were prospectively collected and analyzed as regards structural and hemodynamic outcome using echocardiography with its all modalities. Also, postoperative morbidity and mortality were determined. Fifteen post-operative morbidity occurred in 12 patients [16.6%], 10 occurred early [<30 days] and 5 late [>30 days]. Early post-operative morbidity occurred due to non-valve related causes in 60% of cases as acute heart failure, cardiogenic shock and electrolyte disturbances, and in 40% of cases due to valve related causes as prosthetic valve thrombosis, early prosthetic valve endocarditis and periprosthetic valve leakage. All late post-operative morbidity were caused by valve-related causes as late prosthetic valve endocarditis, prosthetic valve thrombosis and periprosthetic valve leakage. The 30-day hospital mortality was 6.9% [n=5], 60% of deaths were due to non-valve related causes, and 40% with valve related causes were identified as independent risk factors. Late postoperative mortality occurred in 2.8% [n=2] and all of them were due to valve related causes. Mitral valve replacement for patients with rheumatic mitral valve disease offers I satisfactory early and short-term results with excellent symptomatic improvement. Our institutional surgical results are comparable to the international results regarding postoperative morbidity and mortality

Evaluation of serum troponin-tar a new cardiac marker in cases of acute myocardial infarction

The study included 75 consecutive patients with chest pain and suspected for AMI, who comprises 46 patients having sustained AMI, 24 patients with AMI ruled out and 5 patients with non-cardiac chest pain. All were admitted to coronary care unit within 6 hours from the onset of chest pain. For comparative purposes the study also included 17 patients with either polytraumatized muscles or extrathoracic surgery, besides 15 healthy blood donors who were age comparable to patients. Blood samples were obtained from patients with chest pain on admission [0 - 6 hours] and in the range of 12 - 24 hours after onset of chest pain. In case of polytraumatized subjects blood samples were obtained after 12 hours from either the trauma or surgery. A single blood sample was obtained from controls. From each sample, serum was separated and used for determination of troponin-T myoglobin, creatine kinase [CK] and its isoenzyme [CK-MB], lactate dehydrogenase [LDH] and its isoenzyme [LDH-1]. At a cutoff value of 0.2 mug/L cardiac troponin-T measurements [0 - 6 hours and 12 - 24 hours] after the onset of chest pain were significantly higher in patients with AMI than in patients with non-AMI, traumatized patients or healthy controls. Such significant difference was not found in the other biochemical cardiac indices, i.e. myoglobin, CK, CK-MB, LD and LDH-1. Furthermore, cardiac troponin-T had the high sensitivity, specificity and diagnostic efficiency for the diagnosis of AMI in either 0 - 6 or 12 - 24 hours measurements after the onset of chest pain as compared with all the above other biochemical cardiac indices

Expression of ras proto-oncogenes in patients with essential hypertension complicated with left ventricular hypotrophy and in patients with coronary atherosclerotic heart disease

The role of proto-oncogenesis in left ventricular hypertrophy complicating essential hypertension in coronary atherosclerosis was evaluated in this study. To fulfill this aim, the expression of RAS family of proto- oncogenesis was evaluated in the plasma of 16 patients with essential hypertension complicated with left ventricular hypertrophy confirmed by measurement of left ventricular mass in echocardiography and in 19 patients with coronary atherosclerotic heart disease confirmed and scored by coronary angiography. The results obtained were compared with those obtained from 15 age matched controls. Furthermore, the expression of RAS proto-oncogenesis was correlated with other biochemical markers of coronary atherosclerosis i.e. total cholesterol, oxidized low density lipoprotein [LDL], LDL-cholesterol, triglycerides and HDL-cholesterol. The results showed that patients with either essential hypertension or coronary atherosclerosis had significantly higher expression of RAS oncogenesis compared with that of the controls. Meanwhile, hypertensive patients had higher expression compared with coronary atherosclerotic patients and there was high positive correlation between RAS oncoprotein level and left ventricular mass

Echocaridographic evaluation of tricuspid valve diseases

In a trial to elucidate the role of echocardiography in evaluation of tricuspid valve [TV] diseases, sixty-four patients were studied in addition to 20 age-matched control. On clinico-echocardiographic basis, 6 groups of patients were identified. Functional tricuspid regurge [TR] secondary to rheumatic mitral and aortic lesions [51 patients], functional TR associated with atrial septal defect [ASD] [4] with cor pulmonale [4], with pulmonary stenosis [2], organic TR and tricuspid stenosis [TS] of rheumatic aetiology [1] and organic TR due to Ebstein's anomaly [2]. With M-mode study, the anterior and septal leaflets of TV were identified in 39 cases [60.9%] and Ebstein's anomaly was suggested in 2 cases [3.12%]. 2-D echocardiography revealed systolic incoaptation of TV leaflets in 55 cases [85.9%], thickened and limited movement of septal leaflet of TV [TS; in a single case [1.6%], downward displacement of TV, atrialization of RV and huge RA [Ebstein's anomaly] in 2 cases [3.1%] and RA thrombus in a single case [1.6%] using apical-4-chamber view. ASD in 4 cases [6.3%] using subcostal view. It was possible to identify the 3 leaflets in 55 cases [85.9%], the anterior leaflet was best seen in the long axis -view, the septal one in the short axis view and the posterior leaflet was seen only in the long axis view. Measurements of TV annulus, cusp separation, RA and RV dimensions were significantly higher in patients than in controls. Doppler study confirmed the presence of TR in all cases. The regurgitation jet was directed anteriorly in 43 cases [67.2%] denoting anterior leaflet affection and to the interatrial septum in 21 cases [32.8%] denoting septal leaflet affection, confirmed ASD in 4 cases [6.3%], and confirmed TS in a single case [1.6%] and PS in two cases [2.1%] through estimation of maximum pressure gradient across the valve. Moreover, the pulmonary artery systolic pressure was estimated in all cases and it was found to be higher than normal in 52 cases [81.3%] due to rheumatic valvular diseases and in 4 cases [6.3%] due to obstructive lung diseases. These results suggest that echocardiographic study gives clear information about various diseases affecting TV

Systolic time intervals and 24-hours free urinary catecholamines in normo-and hypertensives

QS2 interval was significantly greater in patients with FEH than in both normotensives [P <0.001] and patients with BLH [P <0.01]. No significant difference was found between QS2 interval in patients with BLH and normotensives. There was an insignificant difference between LVET in the three groups investigated. PEP in patients with FEH was significantly greater than both normotensives [P <0.001] and patients with BLH [P <0.001], while PEP in patients with BLH was significantly shorter than in normotensives and in patients with FEH [P <0.001]. PEP/LVET in patients with FEH was significantly greater than in both normotensives and patients with BLH [P <0.001]. In patients with BLH, PEP/LVET was significantly less than in both normotensives and patients with FEH [P <0.001]. 24-hours urinary catecholamines in patients with FEH was significantly greater [P <0.01] than in normotensives but insignificantly different from that in patients with BLH. 24-hours urinary catecholamines in patients with BLH was significantly higher than in normotensives [P <0.001]. The present study showed that myocardial contractility is diminished in patients with fixed essential hypertension, and increased in patients with border line hypertension than in the control subjects. Also, the study proved that the overall activity of the sympathoadrenal systems is increased in patients with both fixed essential and border line hypertension than in the control subjects

Systolic time intervals and 24-hours free urinary catecholamines in normo-and hypertensives

QS2 interval was significantly greater in patients with FEH than in both normotensives [P <0.001] and patients with BLH [P <0.01]. No significant difference was found between QS2 interval in patients with BLH and normotensives. There was an insignificant difference between LVET in the three groups investigated. PEP in patients with FEH was significantly greater than both normotensives [P <0.001] and patients with BLH [P <0.001], while PEP in patients with BLH was significantly shorter than in normotensives and in patients with FEH [P <0.001]. PEP/LVET in patients with FEH was significantly greater than in both normotensives and patients with BLH [P <0.001]. In patients with BLH, PEP/LVET was significantly less than in both normotensives and patients with FEH [P <0.001]. 24-hours urinary catecholamines in patients with FEH was significantly greater [P <0.01] than in normotensives but insignificantly different from that in patients with BLH. 24-hours urinary catecholamines in patients with BLH was significantly higher than in normotensives [P <0.001]. The present study showed that myocardial contractility is diminished in patients with fixed essential hypertension, and increased in patients with border line hypertension than in the control subjects. Also, the study proved that the overall activity of the sympathoadrenal systems is increased in patients with both fixed essential and border line hypertension than in the control subjects

Reactivity of sympathetic nervous system in patients with borderline hypertension

Different components of the sympathetic nervous systems, of patients with border line hypertension, have been studied, by some physiologic, and pharmacologic tests and compared with those of the normotensives control volunteers. The study showed that, patients with border line hypertension, have increased reactivity of various parts of their sympathetic nervous systems including efferent sympathetic fibres, and the adrenergic receptors both alpha and beta

Reactivity of sympathetic nervous system in patients with fixed essential hypertension

The reactivity of different components of the sympathetic nervous system has been achieved through a number of physiologic and pharmacologic tests, in patients with fixed essential hypertension [FEH], and compared with those of the normotensive control subjects. Change of posture [standing], was used to study the whole baroreceptor reflex arc. The cold pressure test was used to test the discharge in the efferent sympathetic fibres. The reactivity of the alpha, and beta adrenergic receptors were studied through their responsiveness to infusions of nor-epinephrine and isoproternol respectively. Beta receptors activity was also investigated by the blocking effect of propranolol hydrochloride injection, through its cardiac slowing effect. The results of the study showed that patients with FEH have significant increase in both the efferent sympathetic fiber discharge [P < .05], and in the reactivity of alpha adrenergic receptors [P < 0.001] than in the normotensive control subjects

Angiotensin infusion test in normo-and hypertensive subjects

The reactivity of vascular smooth muscles in thirty patients with both fixed essential and border line hypertension was studied and compared with fourteen normotensive control subjects. Angiotensin II infusion was given in a concentration of 1 mcg of 5% glucose at a rate of 0.01, then 0.02 mcg/kg/m with frequent recording of BP and heart rate

Tyramine test in normo and hypertensive subjects

The effect of sympathomimetic amine tyramine was studied in 19 patients with fixed essential and border line hypertension compared with 11 normotensive control subjects. After obtaining control measurements, tyramine solution was injected IV in doses of 1, 2 and 3 mg separated by at least nine-ten minutes