Trimetazidine in the prevention of contrast-induced nephropathy in chronic kidney disease.

BACKGROUND: Contrast induced nephropathy (CIN) may be defined as Acute Renal Failure (ARF) that occurs within 24-72h of exposure to intra-venous or intra-arterial iodinated contrast media that cannot be attributed to other causes. CIN occurs in up to 5% of hospitalized patients with normal renal function prior to injection of contrast media. It occurs more frequently in patients with renal impairment particularly if associated with diabetic nephropathy. Among all procedures utilizing contrast agents for either diagnostic or therapeutic purposes, coronary angiography and percutaneous coronary interventions are associated with the highest rates of CIN. Trimetazidine has been described as a cellular anti-ischemic agent. Previous studies demonstrated that Trimetazidine prevents the deleterious effects of ischemia-reperfusion at both the cellular and mitochondrial levels and exerts an anti-oxidant effect. It inhibits excess release of oxygen free radicals, limits cellular acidosis, protects Adenosine Triphosphate (ATP) stores, reduces membrane lipid peroxidation and inhibits neutrophil infiltration. AIM: To evaluate the role of Trimetazidine (TMZ) in prevention of contrast induced nephropathy (CIN) in patients with renal impairment undergoing coronary angiography. METHODS AND RESULTS: This study was conducted on one hundred patients having a basal creatinine clearance below 90ml/min and presenting for coronary angiography procedures. The patients were divided into two equal groups each including fifty patients where both groups received parenteral hydration in the form of isotonic saline at a rate of 1mg/kg body weight per hour starting 12h before angiography and up to 12h thereafter. In Group 1, patients received additional medication in the form of trimetazidine 35mg twice daily for 72h and starting 48h before the procedure which was not received in group 2 (control). There was a significant difference regarding the rate of CIN among TMZ versus control groups (10% vs. 26%). The amount of contrast was significantly higher in the CIN group (165.00±108.41 vs 89.85±38.60, P=0.000). CONCLUSION: Administration of trimetazidine in a dose of 35mg twice daily orally in conjunction with standard early saline hydration is an effective method to prevent or reduce the incidence of contrast-induced renal dysfunction following the administration of contrast media during coronary angiography procedures in patients with mild-moderate basal renal insufficiency.

Antihypertensive treatment and blood pressure control in patients with hypertension in daily clinical practice: a cross-sectional, multicenter, observational study in Egypt.

OBJECTIVE: Management of hypertension in Egypt is difficult because of various reasons. This real-life study was conducted to determine BP control rate, treatment modalities, factors influencing the choice of antihypertensive drugs, physicians' satisfaction with the treatment, and demographics of patients with uncontrolled BP who were treated for hypertension in daily clinical practice in Egypt. METHODS: This was a cross-sectional, multicenter, observational study conducted in patients treated for hypertension in out-patient private clinics in Egypt, during October 2011 to June 2012. RESULTS: Of 4139 patients with hypertension, 1509 (36.5%) had controlled BP and 2630 (63.5%) had uncontrolled BP. In BP controlled vs. uncontrolled groups, respectively, beta-blockers (41.7% vs. 41.0%) were the most frequently used antihypertensive agents, followed by diuretics (40% vs. 37.8%), angiotensin-converting enzyme inhibitors (35.3% vs. 34.9%), angiotensin receptor blockers (31.1% vs.19.4%), and calcium channel blockers (21.3% vs. 19.4%); the factors influencing the choice of antihypertensive therapy were "add-on therapy" (1.5% vs. 32.4%) and "change the current medication" (9.3% vs. 50.8%); physicians' satisfaction with treatment was rated as "excellent" (31.6% vs. 3.2%) and "poor" (1.6% vs. 58%). CONCLUSION: The majority of patients from Egypt had uncontrolled hypertension even after receiving treatment. This might increase awareness among physicians and enable them to prescribe appropriate treatment to patients with uncontrolled BP. Key limitations: The questionnaire used in the study for the evaluation of patient/physician satisfaction level was not standardized and was based on the choice and practice of the physicians.

Assessment of coronary flow parameters by transesophageal echocardiography in patients with isolated coronary artery ectasia: effect of intravenous nitroglycerin.

BACKGROUND: We sought to assess coronary flow parameters in patients with isolated coronary artery ectasia (CAE) as compared to subjects with normal coronaries. METHODS: Consecutively, we enrolled 30 patients with ectasia of the left anterior descending (LAD) coronary artery (study group), and 10 subjects with normal coronaries (control group). All patients underwent transesophageal echocardiography to visualize the LAD. Spectral recordings of proximal LAD flow velocities were made and velocity time integrals were calculated. The diameter of the proximal LAD was measured and LAD blood flow was calculated. Nitroglycerin (0.3 mg) was administered intravenously and measurements were repeated 5 minutes later. RESULTS: The mean age of the whole series was 48.6 ± 8 years, 39 (97.5%) being males. A significantly higher baseline systolic, diastolic, and total coronary blood flow was found in the study group as compared to the control group (46.1 ± 34.3 vs. 23.1 ± 8.2, 123.9 ± 73.3 vs. 68.1 ± 21.6, 170.1 ± 97.9 vs. 91.1 ± 26.8 cm(3) /min, respectively, P < 0.05 for all). Within the study group, nitroglycerin administration caused a significant decrease in peak diastolic velocity; systolic, diastolic, and total velocity time integrals; and both diastolic and total coronary blood flow (P < 0.05 for all). Meanwhile, within the control group, nitroglycerin administration caused a significant increase in the total coronary blood flow (P < 0.05). CONCLUSIONS: Patients with CAE have higher resting coronary blood flow in comparison with subjects with normal coronaries. Intravenous nitroglycerin administration causes significant reduction of coronary blood flow in ectatic coronary arteries.

Prevalence and predictors of renal artery stenosis in hypertensive patients undergoing elective coronary procedures.

This study explored the prevalence and predictors of renal artery stenosis in a cohort of 525 hypertensive patients referred for elective coronary procedures. Patients underwent coronary and renal arteriography. The study defined renal artery stenosis as > or =60% luminal obstruction (physiologic or hemodynamic significance was not tested). Patients were classified into groups of those with normal renal arteries, those with insignificant renal artery stenosis, and individuals with significant renal artery stenosis. The mean age was 52.6+/-8.5 years, and 403 (76.8%) were males. Significant renal artery stenosis was found in 3.6%. It correlated significantly with hypertension duration (P=.005), history of cerebrovascular stroke (P=.01), history of angioplasty to >1 coronary vessel (P=.003), and 3-vessel coronary disease (P=.0003). Multivariate regression analysis identified 2-vessel and 3-vessel coronary artery disease as independent predictors of renal artery stenosis, with odds ratios of 4.9 and 12.1, respectively. It was concluded that invasive screening for renal artery stenosis was probably warranted only in hypertensive patients with multivessel coronary disease referred for elective coronary procedures.