New opportunities of renal denervation Agaeva, R A; Danilov, N M; Shelkova, G V ...
Terapevtic̆eskii arhiv,
2020-Jul-09, Volume:
92, Issue:
6
Journal Article
Peer reviewed
Open access
Radiofrequency renal artery denervation (RND) was introduced as a method of interventional treatment of resistant hypertension almost ten years ago. The first studies demonstrated the effectiveness ...of this procedure. This has led to growing interest in this area and the rapid development of the method. However, the results of the first randomized trial of SYMPLICITY HTN-3 questioned the role of RND in the treatment of resistant hypertension, this fact conducted to the decrease in the recommendation class and level of evidence in the Guidelines of the European Society of Cardiology and the European Society of Hypertension in 2018. To date, the medical community is actively discussing the results of recently published trials such as SPYRAL HTN-OFF MED, SPYRAL HTN-ON MED, RADIANCE-HTN SOLO and RADIOSOUND-HTN.
ABSTRACT Objective: the aim of our study was to determine the optimal instantaneous wave-free ratio (iFR) cut-off points in assessing the functional significance of intermediate coronary artery ...stenoses in patients with chronic coronary artery diseases (CAD) using non-invasive methods of myocardial ischemia verification as reference. Methods: 60 patients with chronic CAD or suspected CAD and intermediate coronary stenoses (50-70%) were included in the study. 92 borderline coronary stenoses were investigated. iFR measurement was carried out within 10 days after the non-invasive stress test (a combination of stress echocardiography and SPECT). Results: stress-induced myocardial ischemia was detected in 18 patients (30%). iFR values are in the range 0.68 to 1.0, median of iFR - 0.95 0.9; 0.99. Area under iFR ROC-curve - 0.95 ± 0.02 (95%CI: 0.885-0.985). The iFR cut-off point 0.92 is optimal and has a sensitivity of 100%, a specificity of 83% and a negative predictive value (NPV) of 100%. The iFR cut-off point 0.86 is associated with a specificity of 100%, a sensitivity of 33% and a positive predictive value of 100%. The values of iFR «grey» zone ranged from 0.87 to 0.92. Conclusion: using non-invasive methods of verification of myocardial ischemia as a reference, iFR cut-off point 0.92 excludes the functional significance of coronary artery stenosis with a NPV of 100%. iFR cut-off point 0.86 confirms the functional significance of the stenosis with a PPV of 100%. It is recommended to measure the fractional flow reserve in the case of obtaining the iFR values of «grey» zone (0,87-0,92). Key words: iFR, CAD, stress-echo, SPECT.
To compare the diagnostic accuracy of instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) with noninvasive methods in assessment of the functional significance of moderate coronary ...stenoses in patients with chronic ischemic heart disease (IHD).
We included in this study 50 patients with chronic or suspected IHD and moderate coronary stenoses (50-70%; 74 stenoses). Values of iFR and FFR were determined within 10 days after noninvasive stress tests (combination of stress-echo and SPECT). The values of iFR and FFR were compared with the results of noninvasive methods by ROC-analysis. Coronary artery stenosis was considered functionally important if at least one of noninvasive tests (stress-echo or SPECT) demonstrated positive result.
The results of noninvasive stress-tests were positive in 14 patients (28%). ROC area under the curve (AUC) for iFR - 0.961±0.019 (95%CI 0.888-0.992). The best cut-off point for iFR is 0.92 (sensitivity 100, specificity 84%). ROC AUC for FFR - 0.893±0.041 (95%CI 0.79-0.96). The best cut-off point for FFR is 0.81 (sensitivity 100% and specificity 69%). There was no significant difference between iFR and FFR ROC-curves (р=0.0845).
The values of iFR and FFR have equivalent agreement with the results of noninvasive tests commonly used to detect myocardial ischemia in patients with moderate coronary stenoses.
The review presents data on the effectiveness of lipid profile correction with maximum doses of statins, primarily atorvastatin, and lipoprotein apheresis. The results of large-scale studies and ...meta-analyses evaluating the use of statins before and after coronary artery bypass surgery and stenting to reduce the risk of both early and late cardiovascular complications, and the need for revascularization of the myocardium, were analyzed. Lipid apheresis in patients with coronary artery disease who underwent coronary stenting or bypass surgery, and with hypercholesterolemia refractory to lipotropic therapy, is associated with reduced risk of in-stent restenosis, as well as destruction of bypass. Therefore, this method can be recommended to be used in patients with refractory hyperlipidemia undergoing myocardial revascularization.
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