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Kawarada O, Kume T, Zen K, Nakamura S, Hozawa K, Akimitsu T, Asano H, Ando H, Yamamoto Y, Yamashita T, Shinozaki N, Odashiro K, Sato T, Yuba K, Sakanoue Y, Uzu T, Okada K, Fitzgerald PJ, Honda Y, Yasuda S. Cardiac function response to stenting in atherosclerotic renal artery disease with and without heart failure: results from the Carmel study. ESC Heart Fail 2019; 6:319-327. [PMID: 30614643 PMCID: PMC6437431 DOI: 10.1002/ehf2.12391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/30/2018] [Accepted: 11/05/2018] [Indexed: 01/20/2023] Open
Abstract
Aims Consensus‐derived guidelines recommend renal stenting for patients with atherosclerotic renal artery disease (ARAD) and heart failure (HF). The aim of this prospective multi‐centre observational study was to verify our hypothesis that changes in E/e′, an echocardiographic correlate of left ventricular (LV) filling pressure, following renal stenting may differ between ARAD patients with and without HF. Methods and results This study enrolled de novo ARAD patients undergoing renal stenting at 14 institutions. The primary endpoint was the difference in E/e′ change between ARAD patients with and without HF. Clinical and echocardiographic data were prospectively collected at baseline, the day following renal stenting, and 1 month and 6 months afterwards. ARAD patients with HF were defined as patients with New York Heart Association (NYHA) Class 2 and more, or a history of HF hospitalization. A total of 76 patients were included, and 39% were ARAD patients with HF. ARAD patients with HF had significantly lower estimated glomerular filtration rate (P = 0.028) and higher NYHA functional class (P < 0.001) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (P = 0.001) than ARAD patients without HF. Also, ARAD patients with HF had significantly lower LV ejection fraction (P = 0.003) and e′‐velocity (P = 0.003) and higher E/e′ ratio (P = 0.001), left atrial volume index (LAVI) (P = 0.046), LV end‐diastolic volume (LVEDV) (P = 0.001), LV end‐systolic volume (LVESV) (P = 0.001), and LV mass index (P = 0.009) than ARAD patients without HF. All procedures were successful. In contrast to blood pressure and renal function, there was a significant interaction in E/e′ (Pinteraction < 0.001) between time and HF, and ARAD patients with HF showed a significant (P < 0.001) decrease in E/e′ albeit those without HF. By the same token, there was a significant interaction in NYHA class (Pinteraction < 0.001), MLHFQ score (Pinteraction = 0.018), E‐velocity (Pinteraction = 0.002), LAVI (Pinteraction = 0.001), LVEDV (Pinteraction = 0.003), and LVESV (Pinteraction = 0.001) between time and HF with a significant improvement in all these variables in ARAD patients with HF (NYHA class, P = 0.001; MLHFQ score, P = 0.002; E‐velocity, P = 0.005; LAVI, P = 0.001; LVEDV, P = 0.017; and LVESV, P = 0.011). Conclusions Change in LV filling pressure after renal stenting differed between ARAD patients with and without HF, with a significant improvement in LV filling pressure in patients with HF‐ARAD. These unique findings might support clinical cardiac benefits of renal stenting in ARAD patients with HF.
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Affiliation(s)
- Osami Kawarada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.,Department of Cardiovascular Medicine, Ikuwakai Memorial Hospital, Osaka, Japan
| | - Teruyoshi Kume
- Department of Cardiology, Kawasaki Medical School Hospital, Okayama, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Koji Hozawa
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | - Hiroshi Asano
- Department of Cardiology, Tosei General Hospital, Aichi, Japan
| | - Hiroshi Ando
- Department of Cardiology, Kasukabe Chuo General Hospital, Saitama, Japan
| | - Yoshito Yamamoto
- Department of Cardiology, Iwaki Kyoritsu Hospital, Fukushima, Japan
| | - Takehiro Yamashita
- Department of Cardiology, Hokkaido Ohno Memorial Hospital, Hokkaido, Japan
| | | | - Keita Odashiro
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Tadaya Sato
- Department of Cardiology, Saka General Hospital, Miyagi, Japan
| | - Kenichiro Yuba
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Yuji Sakanoue
- Department of Cardiology, Higashisumiyoshi Morimoto Hospital, Osaka, Japan
| | - Takashi Uzu
- Division of Nephrology, Nippon Life Hospital, Osaka, Japan
| | - Kozo Okada
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
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Ritchie J, Green D, Chrysochou T, Hegarty J, Handley K, Ives N, Wheatley K, Houston G, Wright J, Neyses L, Chalmers N, Mark P, Patel R, Moss J, Roditi G, Eadington D, Lukaschuk E, Cleland J, Kalra PA. Effect of renal artery revascularization upon cardiac structure and function in atherosclerotic renal artery stenosis: cardiac magnetic resonance sub-study of the ASTRAL trial. Nephrol Dial Transplant 2017; 32:1006-1013. [PMID: 27257278 DOI: 10.1093/ndt/gfw107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/09/2016] [Indexed: 11/13/2022] Open
Abstract
Background Cardiac abnormalities are frequent in patients with atherosclerotic renovascular disease (ARVD). The Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial studied the effect of percutaneous renal revascularization combined with medical therapy compared with medical therapy alone in 806 patients with ARVD. Methods This was a pre-specified sub-study of ASTRAL (clinical trials registration, current controlled trials number: ISRCTN59586944), designed to consider the effect of percutaneous renal artery angioplasty and stenting on change in cardiac structure and function, measured using cardiac magnetic resonance (CMR) imaging. Fifty-one patients were recruited from six selected ASTRAL centres. Forty-four completed the study (medical therapy n = 21; revascularization n = 23). Full analysis of CMR was possible in 40 patients (18 medical therapy and 22 revascularization). CMR measurements of left and right ventricular end systolic (LV and RVESV) and diastolic volume (LV and RVEDV), ejection fraction (LVEF) and mass (LVM) were made shortly after recruitment and before revascularization in the interventional group, and again after 12 months. Reporting was performed by CMR analysts blinded to randomization arm. Results Groups were well matched for mean age (70 versus 72 years), blood pressure (148/71 versus 143/74 mmHg), degree of renal artery stenosis (75 versus 75%) and comorbid conditions. In both randomized groups, improvements in cardiac structural parameters were seen at 12 months, but there were no significant differences between treatment groups. Median left ventricular changes between baseline and 12 months (medical versus revascularization) were LVEDV -1.9 versus -5.8 mL, P = 0.4; LVESV -2.1 versus 0.3 mL, P = 0.7; LVM -5.4 versus -6.3 g, P = 0.8; and LVEF -1.5 versus -0.8%, P = 0.7. Multivariate regression also found that randomized treatment assignment was not associated with degree of change in any of the CMR measurements. Conclusions In this sub-study of the ASTRAL trial, renal revascularization did not offer additional benefit to cardiac structure or function in unselected patients with ARVD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Patrick Mark
- Queen Elizabeth University Hospital, Govan, Glasgow, UK
| | - Rajan Patel
- Queen Elizabeth University Hospital, Govan, Glasgow, UK
| | - Jon Moss
- Queen Elizabeth University Hospital, Govan, Glasgow, UK
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Kawarada O, Kitajima R, Sugano Y, Noguchi T, Anzai T, Ogawa H, Yasuda S. Improvement of left ventricular filling and pulmonary artery pressure following unilateral renal artery total occlusion stenting in a patient with recurrent congestive heart failure complicated by renovascular hypertension and renal failure. ESC Heart Fail 2016; 2:160-163. [PMID: 27774260 PMCID: PMC5057347 DOI: 10.1002/ehf2.12069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 08/23/2015] [Accepted: 08/26/2015] [Indexed: 11/15/2022] Open
Abstract
Recurrent congestive heart failure related to renal artery disease is an important clinical entity that is typically observed in bilateral renal artery stenosis or solitary functioning kidney. However, the relationship between heart failure and unilateral renal artery disease, especially that with total occlusion, remains unclear. We report a successful management by unilateral renal artery total occlusion stenting with an evidence of improvement of left ventricular filling and pulmonary artery pressure in case of a patient suffering from medical therapy resistant recurrent congestive heart failure with preserved ejection fraction.
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Affiliation(s)
- Osami Kawarada
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan
| | - Ryota Kitajima
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan
| | - Yasuo Sugano
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan
| | - Hisao Ogawa
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan; Department of Cardiovascular Medicine, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan
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Gunduz Y, Akdemir R, Sahinkus S, Vatan MB. Successfully treated bilateral renal artery stenosis in a patient with coronary artery disease. BMJ Case Rep 2013; 2013:bcr2012008464. [PMID: 23737568 PMCID: PMC3702814 DOI: 10.1136/bcr-2012-008464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Renal artery stenosis (RAS) is the most common cause of secondary hypertension and accounts for approximately 1-3% of all causes of hypertension. Over 90% of RASs are caused by atherosclerosis; atherosclerotic RAS is increasingly common in aging populations, particularly elderly people with diabetes, hyperlipidaemia, aortoiliac occlusive disease, coronary artery disease or hypertension. Three therapeutic options are currently available for patients with renovascular hypertension: medical antihypertensive therapy, surgical revascularisation and transluminal angioplasty including stent implantation. We present in this report a male patient with bilateral severe ostial stenosis and coronary artery disease, and who was successfully treated with renal stent implantation in one session.
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Affiliation(s)
- Yasemin Gunduz
- Department of Radiology, Sakarya University Medical Faculty, Sakarya, Turkey.
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Randomized trials in angioplasty and stenting of the renal artery: tabular review of the literature and critical analysis of their results. Ann Vasc Surg 2012; 26:434-42. [PMID: 22305685 DOI: 10.1016/j.avsg.2011.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 11/07/2011] [Indexed: 11/23/2022]
Abstract
As the incidence of hypertension (HTN) continues to rise, finding the optimal treatment of this multifactorial disease is critical. Renal artery stenosis (RAS) is a known etiology for HTN and is associated with declining renal function. Other than medications, the original gold standard for treatment of HTN from RAS was with an open surgical revascularization or nephrectomy. Since then, endovascular interventions for RAS have been reported to be technically possible, but their efficacy over medications or surgery has yielded conflicting results in case series and randomized trials. This tabular review summarizes the results of randomized trials that compared the outcomes of endovascular renal artery interventions with nonendovascular techniques (including medical and surgical treatments) for the treatment of HTN and renal dysfunction. Based on these data, the strengths and weaknesses of individual trials are critically analyzed to better define the methods to identify and treat patients with RAS.
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