Long term effect of renal denervation on 24 hour abpm blood pressure variability and blood pressure load parameters

The aim of the study was to evaluate the long-term effect of renal sympathetic denervation (RSD) on 24h ambulatory blood pressure measurement (ABPM) and blood pressure load (BP load) in patients with resistant hypertension. The study included 32 patients with treatment-resistant hypertension and performed successful RSD. The effect of renal denervation was significant both in terms of daytime, nighttime and 24-hour arterial pressure, with the most pronounced effect on nocturnal blood pressure. In addition to mean BP reduction we found out a significant improvement of weighted 24 h SD and BP load during follow-up. A long-term effect of the RSD, reported as a reduction in 24-hour systolic blood pressure above 10 mm Hg at month 12, was found in 22 patients (68.8%). In multivariate regression analysis, two parameters remained predictive for successful renal denervation – higher nighttime systolic blood pressure (OR 0.9, 95% CI 0.8-1.005, p = 0.05) and lower pulse pressure (OR 1.13, 95% CI 1.01-1.26, p = 0.03)

Mitral stenosis and percutaneous balloon mitral valvuloplasty

Rheumatic fever, which is the most common etiology of mitral valve stenosis (MS) is significantly decreased in industrialized countries: however, the mitral stenosis still results in significant morbidity and mortality worldwide. MS is a mechanical obstruction of the mitral valve opening  (MVO) causing difficulty in filling the left ventricle (LV) and the only definitive treatment is mechanical removal of the obstruction. Three procedures have proven over time to be effective in providing such therapy. These are: percutaneous balloon mitral valvuloplasty (PBMV), open commissurotomy and mitral valve prosthesis. As clinical studies found that PBMV excels the surgical commissurotomy, the latter procedure is at a large extend not performed. The purpose of this review is the definition of patient selection and description of percutaneous balloon mitral valvuloplasty as the most popular method for the treatment of MS in most parts of the world

Mitral stenosis and Percutaneus Balloon Mitral valvulopasty

Rheumatic fever, which is the predominant aetiology of mitral stenosis (MS), has greatly decreased in industrialized countries: nevertheless, MS still results in significant morbidity and mortality worldwide. Because MS is a mechanical obstruction to forward flow, the only definitive therapy is mechanical relief of this obstruction. Three procedures are effective in providing such therapy. These are Percutaneus Balloon Mitral Valvuloplasty(PBMV), open commissurotomy, and mitral valve replacement. Because clinical trials have found PBMV to be superior to closed surgical commissurotomy, the latter procedure has been largely abandoned except in areas where it is less expensive to perform closed commissurotomy than PBMV. Today, therefore, Inoue`s balloon technique has become the most popular method for performing PBMV in most parts of the world. The following is a review of the PBMV with Inoue`s balloon technique as a gold standart in treatment of mitral stenosis.Key words: Mitral stenosis, Inoue`s balloon techniqu

Abstracts of the 20th annual meeting of the association `Heart - Lung` and 2nd „Varna - Augsburg` conference 30-31 may 2014

Primary tumours of the heart are rare. Metastases are the most frequent tumours of the heart. Anyway, it is generallyagreed that autopsy prevalence of primary cardiac tumors is 1 out of 2,000 and that of secondary cardiactumors is 1 out of 100 autopsies, with a secondary/primary cardiac tumors ratio of 20:1. Cardiac tumors may occurin any cardiac tissue. They can cause valvular or inflow-outflow tract obstruction, thromboembolism, arrhythmias,or pericardial disorders. Symptoms are very variable and can be the result of either local or systemiceffects. Surgery is successful for benign tumours when adequate resection margins are allowed. A number of imagingmodalities are available for the assessment of cardiac tumours; each has advantages and limitations. Thisreport presents our experience in the treatment of tumors of the hear

Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial

<p><b>Background</b> Ivabradine specifically inhibits the I-f current in the sinoatrial node to lower heart rate, without affecting other aspects of cardiac function. We aimed to test whether lowering the heart rate with ivabradine reduces cardiovascular death and morbidity in patients with coronary artery disease and left-ventricular systolic dysfunction.</p> <p><b>Methods</b> Between December, 2004, and December, 2006, we screened 12473 patients at 781 centres in 33 countries. We enrolled 10 917 eligible patients who had coronary artery disease and a left-ventricular ejection fraction of less than 40% in a randomised, double-blind, placebo-controlled, parallel-group trial. 5479 patients received 5 mg ivabradine, with the intention of increasing to the target dose of 7.5 mg twice a day, and 5438 received matched placebo in addition to appropriate cardiovascular medication. The primary endpoint was a composite of cardiovascular death admission to hospital for acute myocardial infarction, and admission to hospital for new onset or worsening heart failure. We analysed patients by intention to treat. The study is registered with ClinicalTrials.gov, number NCT00143507.</p> <p><b>Findings</b> Mean heart rate at baseline was 71.6 (SD 9.9) beats per minute (bpm). Median follow-tip was 19 months (IQR 16-24). Ivabradine reduced heart rate by 6 bpm (S E 0.2) at 12 months, corrected for placebo. Most (87%) patients were receiving beta blockers in addition to study drugs, and no safety concerns were identified. Ivabradine did not affect the primary composite endpoint (hazard ratio 1. 00, 95% CI 0 . 91-1. 1, p=0 . 94). 1233 (22 . 5%) patients in the ivabradine group had serious adverse events, compared with 1239 (22.8%) controls (p=0.70). In a prespecified subgroup of patients with heart rate of 70 bpm or greater, ivabradine treatment did not affect the primary composite outcome (hazard ratio 0 . 91, 95% CI 0 . 81-1.04, p=0.17), cardiovascular death, or admission to hospital for new-onset or worsening heart failure. However, it did reduce secondary endpoints: admission to hospital for fatal and non-fatal myocardial infarction (0 . 64, 95% CI 0 . 49-0 . 84, p=0 . 001) and coronary revascularisation (0. 70, 95% CI 0 . 52-0.93, p=0 .016).</p> <p><b>Interpretation</b> Reduction in heart rate with ivabradine does not improve cardiac outcomes in all patients with stable coronary artery disease and left-ventricular systolic dysfunction, but could be used to reduce the incidence of coronary artery disease outcomes in a subgroup of patients who have heart rates of 70 bprn or greater.</p&gt

Stress neuropeptide levels in adults with chest pain due to coronary artery disease: potential implications for clinical assessment

: Substance P (SP) and neuropeptide Y (NPY) are neuropeptides involved in nociception. The study of biochemical markers of pain in communicating critically ill coronary patients may provide insight for pain assessment and management in critical care. Purpose of the study was to to explore potential associations between plasma neuropeptide levels and reported pain intensity in coronary critical care adults, in order to test the reliability of SP measurements for objective pain assessment in critical care