Full Text:   <2509>

Summary:  <1845>

CLC number: R543.5

On-line Access: 2016-01-06

Received: 2015-03-23

Revision Accepted: 2015-07-22

Crosschecked: 2015-12-10

Cited: 1

Clicked: 4559

Citations:  Bibtex RefMan EndNote GB/T7714

 ORCID:

Hao-jian Dong

http://orcid.org/0000-0002-8423-0967

-   Go to

Article info.
Open peer comments

Journal of Zhejiang University SCIENCE B 2016 Vol.17 No.1 P.67-75

http://doi.org/10.1631/jzus.B1500071


Concomitant coronary and renal revascularization improves left ventricular hypertrophy more than coronary stenting alone in patients with ischemic heart and renal disease


Author(s):  Hao-jian Dong, Cheng Huang, De-mou Luo, Jing-guang Ye, Jun-qing Yang, Guang Li, Jian-fang Luo, Ying-ling Zhou

Affiliation(s):  Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou 510080, China

Corresponding email(s):   donghaojian@sina.com, zylgdh@163.com

Key Words:  Coronary artery disease (CAD), Heart failure with preserved ejection fraction (HFpEF), Percutaneous transluminal renal artery stenting (PTRAS), Renal artery stenosis


Hao-jian Dong, Cheng Huang, De-mou Luo, Jing-guang Ye, Jun-qing Yang, Guang Li, Jian-fang Luo, Ying-ling Zhou. Concomitant coronary and renal revascularization improves left ventricular hypertrophy more than coronary stenting alone in patients with ischemic heart and renal disease[J]. Journal of Zhejiang University Science B, 2016, 17(1): 67-75.

@article{title="Concomitant coronary and renal revascularization improves left ventricular hypertrophy more than coronary stenting alone in patients with ischemic heart and renal disease",
author="Hao-jian Dong, Cheng Huang, De-mou Luo, Jing-guang Ye, Jun-qing Yang, Guang Li, Jian-fang Luo, Ying-ling Zhou",
journal="Journal of Zhejiang University Science B",
volume="17",
number="1",
pages="67-75",
year="2016",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1500071"
}

%0 Journal Article
%T Concomitant coronary and renal revascularization improves left ventricular hypertrophy more than coronary stenting alone in patients with ischemic heart and renal disease
%A Hao-jian Dong
%A Cheng Huang
%A De-mou Luo
%A Jing-guang Ye
%A Jun-qing Yang
%A Guang Li
%A Jian-fang Luo
%A Ying-ling Zhou
%J Journal of Zhejiang University SCIENCE B
%V 17
%N 1
%P 67-75
%@ 1673-1581
%D 2016
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1500071

TY - JOUR
T1 - Concomitant coronary and renal revascularization improves left ventricular hypertrophy more than coronary stenting alone in patients with ischemic heart and renal disease
A1 - Hao-jian Dong
A1 - Cheng Huang
A1 - De-mou Luo
A1 - Jing-guang Ye
A1 - Jun-qing Yang
A1 - Guang Li
A1 - Jian-fang Luo
A1 - Ying-ling Zhou
J0 - Journal of Zhejiang University Science B
VL - 17
IS - 1
SP - 67
EP - 75
%@ 1673-1581
Y1 - 2016
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1500071


Abstract: 
percutaneous transluminal renal artery stenting (PTRAS) has been proved to have no more benefit than medication alone in treating atherosclerotic renal artery stenosis (ARAS). Whether PTRAS could improve left ventricular hypertrophy (LVH) and reduce adverse events when based on percutaneous coronary intervention (PCI) for patients with coronary artery disease (CAD) and ARAS is still unclear. A retrospective study was conducted, which explored the effect of concomitant PCI and PTRAS versus PCI alone for patients with CAD and ARAS complicated by heart failure with preserved ejection fraction (HFpEF). A total of 228 patients meeting inclusion criteria were divided into two groups: (1) the HFpEF-I group, with PCI and PTRAS; (2) the HFpEF-II group, with PCI alone. Both groups had a two-year follow-up. The left ventricular mass index (LVMI) and other clinical characteristics were compared between groups. During the follow-up period, a substantial decrease in systolic blood pressure (SBP) was observed in the HFpEF-I group, but not in the HFpEF-II group. There was marked decrease in LVMI in both groups, but the HFpEF-I group showed a greater decrease than the HFpEF-II group. Regression analysis demonstrated that PTRAS was significantly associated with LVMI reduction and fewer adverse events after adjusting for other factors. In HFpEF patients with both CAD and ARAS, concomitant PCI and PTRAS can improve LVH and decrease the incidence of adverse events more than PCI alone. This study highlights the beneficial effect of ARAS revascularization, as a new and more aggressive revascularization strategy for such high-risk patients.

冠脉合并肾动脉狭窄同期血运重建术比单纯冠脉介入更能减轻左室肥厚

目的:研究经皮肾动脉支架术(PTRAS)能否在冠脉介入(PCI)基础上进一步改善冠心病合并肾动脉狭窄患者的左室肥厚(LVH)及减少主要心血管不良事件的发生。
创新点:本研究对集中入选全身动脉粥样硬化这类高危患者(冠心病合并肾动脉狭窄(CAD & ARAS))临床诊治进行研究,有别于既往对单纯的肾动脉狭窄(RAS)人群的研究,且入选标准使用选择性动脉造影以排除其他诊断手段可能带来的假阴性或假阳性,并对冠脉狭窄进行血运重建以解决心肌灌注问题,再对PTRAS进行评价;有别于既往对PTRAS较为保守的建议,本研究发现对于CAD & ARAS患者,肾动脉狭窄的血运重建应该更加积极,RAS的介入治疗可能是该类患者一个重要的治疗靶点。
方法:将入选的228名CAD & ARAS患者,分为收缩功能保留性心衰-I(HFpEF-I)组(PCI & PTRAS)以及HFpEF-II组(单纯PCI),术后随访至少两年。随访发现,两组的左室重量指数(LVMI)均较基线明显下降,且HFpEF-I组下降幅达大于HFpEF-II组(Δ=(32.80±12.62) g/m2 vs. Δ=(18.52±8.17) g/m2, P<0.001),回归分析发现PTRAS与LVMI的下降及不良事件的发生减少密切相关。
结论:对于CAD & ARAS并HFpEF患者,同期行PCI及PTRAS可较单纯PCI进一步减轻LVH及降低心血管不良事件发生。对该类高危患者,可予以积极的肾动脉狭窄血运重建治疗。

关键词:经皮肾动脉支架术;冠心病;肾动脉狭窄

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

Reference

[1]Asrar ul Haq, M., Wong, C., Mutha, V., et al., 2014. Therapeutic interventions for heart failure with preserved ejection fraction: a summary of current evidence. World J. Cardiol., 6(2):67-76.

[2]Chábová, V., Schirger, A., Stanson, A.W., et al., 2000. Outcomes of atherosclerotic renal artery stenosis managed without revascularization. Mayo Clin. Proc., 75(5):437-444.

[3]Chobanian, A.V., Bakris, G.L., Black, H.R., et al., 2003. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, 42(6):1206-1252.

[4]Cooper, C.J., Murphy, T.P., Cutlip, D.E., et al., 2014. Stenting and medical therapy for atherosclerotic renal-artery stenosis. N. Engl. J. Med., 370(1):13-22.

[5]Dean, R.H., Kieffer, R.W., Smith, B.M., et al., 1981. Renovascular hypertension: anatomic and renal function changes during drug therapy. Arch. Surg., 116(11):1408-1415.

[6]de Silva, R., Nikitin, N.P., Bhandari, S., et al., 2005. Atherosclerotic renovascular disease in chronic heart failure: should we intervene? Eur. Heart J., 26(16):1596-1605.

[7]Ding, J., Xu, H., Yin, X., et al., 2014. Estrogen receptor α gene PvuII polymorphism and coronary artery disease: a meta-analysis of 21 studies. J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 15(3):243-255.

[8]Folland, E.D., Parisi, A.F., Moynihan, P.F., et al., 1979. Assessment of left ventricular ejection fraction and volumes by real-time, two-dimensional echocardiography. A comparison of cineangiographic and radionuclide techniques. Circulation, 60(4):760-766.

[9]Ghanami, R.J., Rana, H., Craven, T.E., et al., 2011. Diastolic function predicts survival after renal revascularization. J. Vasc. Surg., 54(6):1720-1726.

[10]Groban, L., Kitzman, D.W., 2010. Diastolic function: a barometer for cardiovascular risk? Anesthesiology, 112(6):1303-1306.

[11]Hirsch, A.T., Haskal, Z.J., Hertzer, N.R., et al., 2006. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J. Am. Coll. Cardiol., 47(6):1239-1312.

[12]Kane, G.C., Xu, N., Mistrik, E., et al., 2010. Renal artery revascularization improves heart failure control in patients with atherosclerotic renal artery stenosis. Nephrol. Dial. Transplant., 25(3):813-820.

[13]Levy, D., Garrison, R.J., Savage, D.D., et al., 1990. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N. Engl. J. Med., 322(22):1561-1566.

[14]Little, W.C., Brucks, S., 2005. Therapy for diastolic heart failure. Prog. Cardiovasc. Dis., 47(6):380-388.

[15]Liu, X.B., Jiang, J.B., Zhou, Q.J., et al., 2015. Evaluation of the safety and efficacy of transcatheter aortic valve implantation in patients with a severe stenotic bicuspid aortic valve in a Chinese population. J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 16(3):208-214.

[16]Marcantoni, C., Zanoli, L., Rastelli, S., et al., 2012. Effect of renal artery stenting on left ventricular mass: a randomized clinical trial. Am. J. Kidney Dis., 60(1):39-46.

[17]McMurray, J.J., Adamopoulos, S., Anker, S.D., et al., 2012. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur. J. Heart Fail., 14(8):803-869.

[18]Middleton, R.J., Parfrey, P.S., Foley, R.N., 2001. Left ventricular hypertrophy in the renal patient. J. Am. Soc. Nephrol., 12(5):1079-1084.

[19]Park, S., Jung, J.H., Seo, H.S., et al., 2004. The prevalence and clinical predictors of atherosclerotic renal artery stenosis in patients undergoing coronary angiography. Heart Vessels, 19(6):275-279.

[20]Patel, S.S., Kimmel, P.L., Singh, A., 2002. New clinical practice guidelines for chronic kidney disease: a framework for K/DOQI. Semin. Nephrol., 22(6):449-458.

[21]Przewlocki, T., Kablak-Ziembicka, A., Tracz, W., et al., 2008. Renal artery stenosis in patients with coronary artery disease. Kardiol. Pol., 66(8):856-862, 863-864.

[22]Ronco, C., di Lullo, L., 2014. Cardiorenal syndrome. Heart Fail. Clin., 10(2):251-280.

[23]Simon, J.F., 2010. Stenting atherosclerotic renal arteries: time to be less aggressive. Cleve. Clin. J. Med., 77(3):178-189.

[24]Su, C.S., Liu, T.J., Tsau, C.R., et al., 2013. The feasibility, safety, and mid-term outcomes of concomitant percutaneous transluminal renal artery stenting in acute coronary syndrome patients at high clinical risk of renal artery stenosis. J. Invasive Cardiol., 25(5):212-217.

[25]Wang, X., Shi, L.Z., 2014. Association of matrix metalloproteinase-9 C1562T polymorphism and coronary artery disease: a meta-analysis. J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 15(3):256-263.

[26]Wheatley, K., Ives, N., Gray, R., et al., 2009. Revascularization versus medical therapy for renal-artery stenosis. N. Engl. J. Med., 361(20):1953-1962.

[27]Wright, J.R., Shurrab, A.E., Cooper, A., et al., 2005. Left ventricular morphology and function in patients with atherosclerotic renovascular disease. J. Am. Soc. Nephrol., 16(9):2746-2753.

Open peer comments: Debate/Discuss/Question/Opinion

<1>

Please provide your name, email address and a comment





Journal of Zhejiang University-SCIENCE, 38 Zheda Road, Hangzhou 310027, China
Tel: +86-571-87952783; E-mail: cjzhang@zju.edu.cn
Copyright © 2000 - 2024 Journal of Zhejiang University-SCIENCE