Impact of renal artery stenting on cytokine levels, left ventricle mass and diastolic function

Wstęp: Istotne zwężenie tętnic nerkowych (RAS), powodując wzrost stężenia cytokin oraz wartości skurczowego i rozkurczowegociśnienia tętniczego (SBP, DBP), może prowadzić do przerostu mięśnia lewej komory (LV) i upośledzenia funkcjirozkurczowej (DF) miokardium.Cel: Celem badania była ocena wzajemnych zależności między masą LV (LVM), DF i stężeniem cytokin u chorych poddawanychstentowaniu tętnic nerkowych (PTA).Metody: Do badania włączono 72 chorych (44,4% mężczyzn) w średnim wieku 64,1 ± 9,9 roku, z RAS po zabiegu PTA.U wszystkich chorych określano SBP, DBP, stężenia transformującego czynnika wzrostu beta1 (TGF-β1), aldosteronu, peptydunatriuretycznego (BNP), zmiany LVM i wskaźnika masy lewej komory (LVMI), a także echokardiograficzne parametry DF,tj. (Evel, e’vel, współczynnik E/A, współczynnik E/e’, Artime-Atime) przed, 3 i 12 miesięcy po PTA.Wyniki: Po zabiegu zaobserwowano zmniejszenie stężenia TGF-β1 z 13,3 ± 14.9 do 8,6 ± 8,0 ng/ml (p = 0,027), natomiastwzrost BNP z 89,1 ± 86,3 do 131 ± 105 pmol/ml (p < 0,001). W 12 miesięcy po zabiegu stwierdzono znamienny spadekLVMI zarówno u kobiet (79,4 ± 16,9 vs. 95,7 ± 18,5 g/m2, p < 0,001), jak i u mężczyzn (77,2 ± 16,8 vs. 100,1 ± 19,7 g/m2,p < 0,001) w porównaniu z wartościami sprzed PTA. Stopień redukcji LVM korelował z wyjściową LVM (p < 0,001; r = –0,612)i prędkością e’vel (p = 0,05; r = 0,230), natomiast nie korelował z parametrami BP. Wśród parametrów DF zaobserwowanoistotne zwiększenie prędkości e’vel 12 miesięcy po PTA (5,54 ± 1,57 vs. 5,92 ± 1,65 cm/s; p = 0,039), natomiast współczynniki:A/E, E/e’, Artime-Atime nie zmieniły się istotnie (p = 0,457; p = 0,283; p = 0,258). Czynnikami związanymi ze wzrostemprędkości e’vel ≥ 0,3cm/s 12 miesięcy po PTA były: LVM < 165 g (p = 0,043; RR = 1,39; CI 1,01–1,46), Evel (p = 0,015;RR = 1,26; CI 1,15–1,52) oraz e’vel (p < 0,001; RR = 1,42; CI 1,18–1,7) przed zabiegiem, a także zmniejszenie DBP o conajmniej 10 mm Hg (p = 0,055; RR = 1,2; CI 1,0–1,44) i stężenie TGF-β1 > 8 ng/ml (p = 0,024; RR = 1,24; CI 1,03–1,49)12 miesięcy po PTA.Wnioski: W rocznej obserwacji u chorych poddanych PTA w przebiegu RAS obserwuje się znamienną redukcję LVMI, którajednak jest niezależna od stopnia redukcji BP. Wzrost prędkości e’vel jest niezależnie związany z początkową LVM, Evel, i e’veloraz spadkiem DBP o co najmniej 10 mm Hg 12 miesięcy po PTA.Background: Significant renal artery stenosis (RAS) may lead to left ventricle (LV) hypertrophy and diastolic function (DF) impairmentthrough complex mechanisms: activation of cytokines and/or systolic and diastolic blood pressure (SBP, DBP) increase.Aim: To assess interrelations between LV mass (LVM), DF and cytokines in patients undergoing renal artery stenting (PTA,percutaneous angioplasty of renal artery).Methods: The study group comprised 72 subjects (44.4% men), 64.1 ± 9.9 years with RAS referred to PTA. SBP, DBP, transforminggrowth factor beta1 (TGF-β1), aldosterone, B-type natriuretic peptide (BNP) levels and change in LVM and LVM index(LVMI) and DF (Evel, e’vel, E/A ratio, E/e’ ratio, Artime-Atime) on echocardiography were assessed preprocedurally, and three and12 months postprocedurally.Results: TGF-β1 level decreased from 13.3 ± 14.9 to 8.6 ± 8.0 ng/mL (p = 0.027), while BNP increased from 89.1 ± 86.3 to131 ± 105 pmol/mL (p < 0.001). A significant reduction in LVMI in women (79.4 ± 16.9 vs. 95.7 ± 18.5 g/m2, p < 0.001)and men (77.2 ± 16.8 vs. 100.1 ± 19.7 g/m2, p < 0.001) was found at 12 months vs. baseline. Degree of LVM reductioncorrelated with baseline LVM (p < 0.001; r = –0.612) and e’vel (p = 0.05; r = 0.230), but not with BP values. Among DFparameters, only e’vel increased significantly at 12 months (5.54 ± 1.57 vs. 5.92 ± 1.65 cm/s; p = 0.039), while A/E and E/e’ratio, Artime-Atime remained similar (p = 0.457, p = 0.283 and p = 0.258). Factors associated with e’vel increase ≥ 0.3 cm/s at12 months were baseline LVM < 165 g (p = 0.043, RR = 1.39, CI 1.01–1.46), Evel (p = 0.015, RR = 1.26, CI 1.15–1.52), e’vel(p < 0.001, RR = 1.42, CI 1.18–1.7), DBP decrease > 10 mm Hg (p = 0.055, RR = 1.2, CI 1.0–1.44) and TGF-β1 > 8 ng/mL(p = 0.024, RR = 1.24, CI 1.03–1.49) at 12 months.Conclusions. Significant LVMI reduction was observed after PTA of RAS, but it was independent of BP reduction. e’vel increasewas independently associated with baseline LVM, Evel, e’vel, and 12 month decrease in DBP > 10 mm Hg

Determinants of long-term outcome in patients after percutaneous stent-assisted intervention on renal artery steno-occlusive atherosclerotic disease

Introduction: The effect of stent-assisted percutaneous transluminal angioplasty (PTA) for renal artery stenosis (RAS) on systolic (SBP) and diastolic blood pressure (DBP) as well as renal function, in comparison with medical therapy, is still debatable. Data on determinants of cardiovascular (CV) outcome after PTA are lacking. Objectives: We aimed to identify determinants of major cardiac and cerebral events (MACCEs) following PTA for RAS. Patients and methods: A total of 248 PTAs for RAS were performed in 211 patients with difficult-to-treat hypertension and/or progressive renal impairment. The primary outcomes were procedural success, in-hospital complications, renal function (estimated glomerular filtration rate [eGFR]), change in SBP or DBP, and an incidence of MACCEs during a median of 47 months (interquartile range [IQR], 18–78 months). Results: Procedural success and complication rates were 99.2% and 4.7%, respectively. We observed significant differences in SBP, DBP, and eGFR at 12 months as compared with baseline. A total of 63 MACCEs (30.6%) were noted in 206 patients with available follow-up data. The receiver operating characteristic curve analysis indicated the following best cutoff values for the risk of CV death: an increase in eGFR by at least 11 ml/min/1.73 m2 and a decrease in SBP and DBP by at least 20 mm Hg and 5 mm Hg, respectively. At 12-month follow-up, an increase in eGFR of at least 11 ml/min/1.73 m2 was independently associated with a reduced risk of death (hazard ratio [HR], 0.42; 95% CI, 0.19–0.90; P = 0.02) and MACCEs (HR, 0.54; 95% CI, 0.32–0.93; P = 0.03), while a decrease of DBP by 5 mm Hg or higher, with a reduced risk of stroke (HR, 0.1; 95% CI, 0.02–0.39; P = 0.001). Conclusions: This study confirms the efficacy and safety of PTA as well as its significant effect on changes in blood pressure and eGFR values. Patients with an increase in eGFR of at least 11 ml/min/1.73 m2 have a significant risk reduction of MACCEs and CV death, while those with a decrease in DBP of at least 5 mm Hg, of stroke

The maintained glycemic target goal and renal function are associated with cardiovascular and renal outcomes in diabetic patients following stent-supported angioplasty for renovascular atherosclerotic disease

Patients with type 2 diabetes mellitus (T2DM) constitute a large proportion of patients with atherosclerotic renal artery stenosis (ARAS). However, the mechanism of impaired renal function and hypertension in this subset of patients is multifactorial. We aimed to investigate whether, in diabetic patients, renal function (RF), systolic (SBP) and diastolic blood pressure (DBP) values following stent-supported angioplasty (PTA) for ARAS have an impact on cardiovascular and renal outcomes. Methods: The study group included 93 patients with T2DM and resistant hypertension who underwent PTA for ARAS. The pre- and post-procedure (6 to 12, and 24 months) values of SBP, DBP, eGFR and glycaemia were obtained. The prospective follow-up of median 44 months was performed for combined outcome: major cardiac and cerebral events (MACCE) and progression to renal replacement therapy (RRT). Results: MACCE-RRT occurred in 46 (49.5%) patients, with higher incidence in patients with higher values of SBP (147.8 ± 25.8 vs. 136.7 ± 15.8 mmHg, p = 0.006), DBP (80.8 ± 13.3 vs. 74.4 ± 12.3 mmHg, p = 0.009), chronic kidney disease in stages 3B to 5 (p = 0.029) and those who have not obtained target glycemic goals compared to well-maintained T2DM (p = 0.007) at 24-months. On multivariate Cox analysis, well-maintained T2DM targets [Hazard Ratio (HR):0.27; 95% Confidence Interval (CI):0.13–0.57; p 2 (HR: 2.20; 95%CI: 1.20–4.04; p = 0.011), previous stroke (HR:2.52; 95%CI:1.19–5.34; p = 0.015) retained their associations with MACCE-RRT, while BP values were not associated with the outcome. Conclusions: The post-procedural RF, maintained glycemic target goal and previous stroke are vital for the outcome in patients undergoing PTA for renovascular disease in diabetic patients