International journal of cardiology
-
The identification of patients at risk for worse outcome is still a challenge. We hypothesized that cystatin C, a marker of renal function, and neutrophil gelatinase-associated lipocalin (NGAL), a marker of acute renal injury, would have a role in the prognostic stratification of these patients. ⋯ Serum NGAL, a marker of acute renal injury, is an independent predictor of worse short term prognosis in patients with acute HF. This suggests a role of renal damage, apart from renal function, in the prognosis of these patients.
-
Recently, a chronic total occlusion (CTO) in the non-infarct-related artery (non-IRA) was reported as an independent predictor of clinical outcome in patients with acute ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate the clinical significance of staged revascularization for a CTO in the non-IRA for patients with STEMI. ⋯ Successful revascularization of a CTO in the non-IRA is associated with improved clinical outcomes in patients with STEMI undergoing primary PCI.
-
Prevalence of patent foramen ovale and its impact on oxygen desaturation in obstructive sleep apnea.
A possible association between patent foramen ovale (PFO) and obstructive sleep apnea has been suggested (OSA), whereby right-to-left shunting may exacerbate the severity of nocturnal oxygen desaturation. However, the interaction between these two conditions has not been well characterised. ⋯ A higher prevalence of PFO is found in OSA subjects. However, the degree of right-to-left shunting, characterised by Valsalva provocation, is not associated with an increased severity of nocturnal oxygen desaturation.
-
Resistant hypertension, defined as the failure to achieve target blood pressure despite concurrent use of 3 antihypertensive agents of different classes, is estimated to affect 20-30% of hypertensive patients. These patients are vulnerable to cardiovascular, cerebrovascular and renal complications. There is ample evidence that sympathetic nervous system hyperactivity contributes to the initiation, maintenance and progression of hypertension. ⋯ Traditional surgical sympathectomy proposed in 1940s was halted due to unacceptable operative risk and the emergence of anti-hypertensive medications. Recently, catheter-based renal sympathetic denervation by radiofrequency ablation has shown encouraging intermediate-term results with minimal complications in patients with resistant hypertension. This review summarizes the patho-physiological role of the renal sympathetic nervous system and the potential application of renal denervation therapy for the treatment of resistant hypertension.