Acute Baroreceptor Activation Therapy Improves Hemodynamics in Heart Failure with Reduced Ejection Fraction: Early Results from a Chronic Pilot Investigation

Background: Prognosis in advanced heart failure with reduced ejection fraction (HFrEF) remains poor despite drug and device therapy innovation. Addressing the chronic hyperadrenergic state that predisposes to pump failure and arrhythmic death is central to improving outcome. Baroreflex Activation Therapy (BAT) has demonstrated therapeutic benefit in preserved-EF HF patients and HFrEF animal models. BAT confers benefit by reducing sympathetic and increasing parasympathetic nerve activity, thereby improving hemodynamics and circulatory efficiency. Methods: Patients enrolled in an open-label evaluation of BAT. Eligibility required NYHA Class III HF, left ventricular EF 6440%, optimized medical management stable 654 weeks, 6-minute walk distance 150-450 m and no active treatment with cardiac resynchronization. Acute BAT hemodynamic effects were measured with a right heart catheter 1 day post-implant. Clinical variables and muscle sympathetic nerve activity (MSNA) will be measured at baseline, 3 and 6 months. Results: To date, 6 patients have been implanted over 6 months. Baseline characteristics: Age 65 \ub1 3.7, LVEF 30 \ub1 3.7% (mean \ub1 SE), exhibiting elevated MSNA (42 \ub1 3 bursts/min), depressed renal function and poor quality of life. Patients were medicated according to treatment guidelines with \u3b2-blockers, ACE-inhibitors and diuretics. Hemodynamics (table) were recorded just after initiating BAT (Baseline) and 14 \ub1 2 min after activation (Sustained BAT).. Conclusion: In medically optimized HFrEF patients, acute BAT improves circulatory performance by significantly decreasing diastolic and mean pulmonary artery pressure as well as mean arterial pressure. Non-significant trends toward increased cardiac output and reduced heart rate and vascular resistance are also observed. Follow-up assessment with clinical variables and MSNA in an expanded cohort will provide insight into the magnitude of long-term improvement that can be expected from BAT in HFrEF

Renal insufficiency following contrast media administration trial II (REMEDIAL II): RenalGuard system in high-risk patients for contrast-induced acute kidney injury: rationale and design

The combined prophylactic strategy of sodium bicarbonate plus N-acetylsyteine (NAC) seems to be effective in preventing contrast induced acute kidney injury (CI-AKI) in patients at low-to-medium risk. However, in patients at high and very high risk the rate of CI-AKI is still high. In this subset of patients the anticipated advantages of the RenalGuard(tm) System should be investigated. The RenalGuard(tm) System (PLC Medical Systems, Inc., Franklin, MA, USA) is a real-time measurement and real time matched fluid replacement device designed to accommodate the RenalGuard therapy, which is based on the theory that creating and maintaining a high urine output is beneficial by allowing a quick elimination of contrast media, and, therefore, reducing its toxic effects