Long-term effects of 3-month telemetric blood pressure intervention in patients with inadequately treated arterial hypertension.

BACKGROUND AND AIM: We have shown that better blood pressure (BP) control can be achieved by using 3-month telemetric BP measurement (TBPM) in comparison with a standard-care control group (C-G). The present analysis should clarify if this will also lead to a better middle- and long-term BP control. SUBJECTS AND METHODS: Fifty-seven patients finished the main study. After the 3 months no TBPM was performed. For 40 patients, 18 from the TBPM group (TBPM-G) and 22 from the C-G, we obtained ambulant BP measurements (ABPMs) with a mean follow-up of 20 months. Seventeen patients were lost to follow-up. BP target values were defined as ABPM ≤130/80 or ≤125/75 mm Hg with diabetes or renal failure. RESULTS: At the end of the follow-up, the systolic BP was 121.2±11.2 mm Hg in TBPM-G and 130.7±10.4 mm Hg in C-G, and the diastolic BP was 72.8±10.9 versus 77.0±7.1 mm Hg, respectively. Fifty-six percent in TBPM-G versus 40% in C-G (p=0.024) had a controlled BP as defined by ABPM criteria. CONCLUSIONS: TBPM helps achieve BP target values in patients with previously inadequately treated arterial hypertension, and the benefit is sustained. Beyond its immediate application, in comparison with standard treatment, TBPM allows for a better BP adjustment in the long term as well.

Body weight telemetry is useful to reduce interdialytic weight gain in patients with end-stage renal failure on hemodialysis.

Lacking compliance with liquid intake restrictions is one of the major problems in patients on hemodialysis and causes an increased mortality. In 120 patients on hemodialysis with an average interdialytic weight gain (IWG) exceeding 1.5 kg on at least 2 days during the 4 weeks preceding the intervention, the effect of telemetric body weight measurement (TBWM) on IWG, ultrafiltration rate, and blood pressure was evaluated over a period of 3 months. Patients of the telemetric group (TG) were supplied with automatic scales, which transferred the weight via telemetry on a daily basis. In the case of IWG of more than 0.75 kg/24 h, a telephonic contact was made as required, and in the case of an IWG of more than 1.5 kg, telephonic contacting was obligatory along with the advice of a liquid intake restriction to 0.5 L/day until the next dialysis. The patients of the control group (CG) received standard treatment without telemetric monitoring. We examined specific data of the second interdialytic interval (IDI2) and the average within 1 week. The average difference of IWG between TG and CG was not significant before the start of the study but 0.2 kg (p=0.027) (IDI2)/0.27kg (p=0.001) (WP) at the end of the study, respectively. The average difference in the ultrafiltration rate within 1 week was 19.0 mL/h (p=0.282) (IDI2)/8.2 mL/h (p=0.409) before the start of the study but 28.4 mL/h (p=0.122) (IDI2)/30.9 mL/h (p=0.004) at the end of the study, respectively. Thus, TBWM is a feasible method for optimizing the IWG and reducing the ultrafiltration rate.

[Importance of surfactant proteins B and D for the differential diagnosis of acute dyspnea]. / Bedeutung der Surfactant-Proteine B und D in der Differentialdiagnostik der akuten Dyspnoe.

BACKGROUND AND PURPOSE: The basis for an optimal therapy of cardiopulmonary diseases is the assessment of an early diagnosis. This implies an evaluation of possible differential diagnoses of acute dyspnea. In numerous studies, natriuretic peptides were characterized as additional, meaningful parameters for the assessment of left ventricular function. Current studies could demonstrate that surfactant proteins B (SP-B) and D (SP-D) are of importance for the differentiation of patients with acute dyspnea. The aim of this study was to compare the values of NT-proBNP (N-terminal brain natriuretic peptide) and surfactant proteins for the assessment of a final diagnosis in patients with acute dyspnea. PATIENTS AND METHODS: NT-proBNP, SP-B and SP-D were measured in 81 patients with acute dyspnea in the emergency room and were correlated with clinical and echocardiographic parameters with respect to the final diagnosis. For this, patients were classified with respect to clinical and echocardiographic parameters in different subgroups concerning the final diagnosis of acute dyspnea. RESULTS: In patients with a cardiac origin of acute dyspnea, plasma levels of NT-proBNP were significantly higher as compared to patients with a noncardiac diagnosis (p = 0.04). SP-D was highest in patients with a cardiac origin of acute dyspnea, but after performing regression analysis it seems to be of less importance for the differential diagnosis of acute dyspnea as compared to NT-proBNP. SP-B plasma levels were not different between the four subgroups. CONCLUSION: NT-proBNP is of importance for the differential diagnosis of acute dyspnea. Although SP-D shows similar changes of plasma levels between the four subgroups, it seems to be of less importance for the differential diagnosis of acute dysnea. SP-B occurs to be of no relevance for the differentiation between cardiac and noncardiac origin of acute dyspnea.

Cheyne-stokes respiration and prognosis in modern-treated congestive heart failure.

In patients with congestive heart failure (CHF), a high prevalence of sleep-disordered breathing has been described. Cheyne-Stokes respiration (CSR) is present in up to 40% of patients with CHF. During the last decade, the medical treatment has been substantially improved. This study was designed to analyze the prognosis of CSR in modern-treated patients with CHF. For this purposes, in 57 patients with CHF who received modern treatment, a 5-year follow-up after initial full night polysomnography was performed. The mean follow-up period was 38 +/- 18 months. Mean age was 62 +/- 13 years and the mean ejection fraction was 25 +/- 7 percent. Respiratory polygraphy revealed CSR with a respiratory disturbance index >5 per hour of sleep in 39 of 57 patients. Twelve patients died. CSR was only characterized by a tendency of worsening (log-rank test, p = 0.25). However, there was a significant difference toward positive outcome for patients who received cardiac resynchronization therapy (log-rank test, p = 0.036). Using Multivariate Cox's proportional hazard regression with the factors resynchronization and CSR, the effect of resynchronization was almost significant (p = 0.08). In conclusion, no significant change of Cheyne-Stokes prevalence can be found in our small group of modern-treated patients with CHF. Cardiac resynchronization therapy was associated with improved patient outcome.

Association of Cheyne-Stokes respiration and cardiac cachexia in congestive heart failure.

In patients with congestive heart failure (CHF) cachexia as well as Cheyne-Stokes respiration (CSR) are well known disorders. The relationship between CSR and cardiac cachexia however, remains unclear so far. Clinical as well as full-night polysomnographic data from 12 cachectic patients were compared to 13 non-cachectic patients with CHF. The non-cachectic patients did not differ significantly in age (57.3+/-11.6 vs 64.8+/-14.5 years), body mass index (26.4+/-4.0 vs 25.2+/-3.2 kg m-(2)) or ejection fraction (21.8+/-5 vs 23.3+/-7%) from cachectic patients. The weight loss was 2.1+/-2.3 kg in non-cachectic vs 11.5+/-2.7 kg in cachectic patients (p<0.0001). A significant difference was detected for the prevalence CSR (5 vs 10 patients, p<0.03). In this study a high prevalence of sleep breathing disorders, in particular of CSR in CHF patients with cachexia was detected.

Prevalence of Cheyne-Stokes respiration in modern treated congestive heart failure.

INTRODUCTION: The prevalence of sleep breathing disorders in patients with congestive heart failure is relevantly high. According to historical studies Cheyne-Stokes respiration is an oscillatory ventilation during sleep in up to 40% of patients with congestive heart failure. During the last decade the medical treatment of congestive heart failure has been improved. The aim of this investigation was to analyze the prevalence of Cheyne-Stokes respiration in patients with congestive heart failure and modern medical treatment. RESULTS AND DISCUSSION: In 50 patients with severe congestive heart failure receiving modern medical treatment a full night polysomnography was performed. All patients had ss-blockers and angiotensin-converting-enzyme inhibitors or angiotensin-II-antagonists as standard treatment. The mean age was 63 +/- 12 years and the mean left ventricular ejection fraction was 26 +/- 6%. Respiratory polygraphy revealed Cheyne-Stokes respiration with a respiratory disturbance index of > or =5/h sleep in 32 (64%) of the seven female and 43 male patients. The prevalence of Cheyne-Stokes respiration defined by using the threshold of an apnea index of > or =10/h was 30%. CONCLUSION: Thus, no significant change of Cheyne-Stokes prevalence could be found in our modern treated severe congestive heart failure collective.

Influence of obstructive sleep apnoea in coronary artery disease: A 10-year follow-up.

In patients with coronary artery disease (CAD) the prevalence of obstructive sleep apnoea (OSA) is found to be about 14-65%. In this study, the influence of OSA in 50 patients with CAD was prospectively compared during a follow-up period of 10 years. In the follow-up period 4 of 25 patients with OSA and 5 of the 25 without OSA died by cardiovascular complications. The proportion survival curve showed no significant difference for patients with CAD and with versus without OSA. The results of this rather small 10-year follow-up study failed to give further evidence for an increased mortality in patients with CAD and OSA.

Accidental left ventricular placement of a defibrillator probe due to a patent foramen ovale in arrhythmogenic right ventricular dysplasia.

Arrhythmogenic right ventricular dysplasia (ARVD) is a heart muscle disease characterized pathologically by fibrofatty replacement of right ventricular myocardium. It is further characterized by an electrical instability that precipitates ventricular arrhythmias and sudden death. The prevalence is estimated at 0.4% depending on geographic circumstances. The incidence of sudden death in patients with ARVD is approximately 2.5% a year. The disease is often familial with an autosomal inheritance. We report a case of a 35-year-old woman with ARVD and a patent foramen ovale discovered after accidental placement of the defibrillator probe in the left ventricle. To avoid malpositioning of a defibrillator probe postoperative control should be performed using different diagnostic modalities.