The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform

Felix Mahfoud - One of the best experts on this subject based on the ideXlab platform.

  • Renal Sympathetic Denervation restores aortic distensibility in patients with resistant hypertension data from a multi center trial
    Clinical Research in Cardiology, 2018
    Co-Authors: Lukas Stoiber, Sebastian Ewen, Markus P Schlaich, Felix Mahfoud, Michael Bohm, Seyedeh Mahsa Zamani, Tomas Lapinskas, Saarraaken Kulenthiran
    Abstract:

    Renal Sympathetic Denervation (RDN) is under investigation as a treatment option in patients with resistant hypertension (RH). Determinants of arterial compliance may, however, help to predict the BP response to therapy. Aortic distensibility (AD) is a well-established parameter of aortic stiffness and can reliably be obtained by CMR. This analysis sought to investigate the effects of RDN on AD and to assess the predictive value of pre-treatment AD for BP changes. We analyzed data of 65 patients with RH included in a multicenter trial. RDN was performed in all participants. A standardized CMR protocol was utilized at baseline and at 6-month follow-up. AD was determined as the change in cross-sectional aortic area per unit change in BP. Office BP decreased significantly from 173/92 ± 24/16 mmHg at baseline to 151/85 ± 24/17 mmHg (p < 0.001) 6 months after RDN. Maximum aortic areas increased from 604.7 ± 157.7 to 621.1 ± 157.3 mm2 (p = 0.011). AD improved significantly by 33% from 1.52 ± 0.82 to 2.02 ± 0.93 × 10−3 mmHg−1 (p < 0.001). Increase of AD at follow-up was significantly more pronounced in younger patients (p = 0.005) and responders to RDN (p = 0.002). Patients with high-baseline AD were significantly younger (61.4 ± 10.1 vs. 67.1 ± 8.4 years, p = 0.022). However, there was no significant correlation of baseline AD to response to RDN. AD is improved after RDN across all age groups. Importantly, these improvements appear to be unrelated to observed BP changes, suggesting that RDN may have direct effects on the central vasculature.

  • beneficial effects of Renal Sympathetic Denervation on cardiovascular inflammation and remodeling in essential hypertension
    Clinical Research in Cardiology, 2015
    Co-Authors: Oliver Dorr, Christoph Liebetrau, Luise Gaede, Helge Möllmann, Christian Troidl, Sebastian Ewen, Felix Mahfoud, Jedrzej Hoffmann, Nikolai Busch, Gerald Laux
    Abstract:

    Renal Sympathetic Denervation (RSD) represents a potential treatment option for certain patients with resistant arterial hypertension (HT). HT is associated with chronic vascular inflammation and remodeling, contributing to progressive vascular damage, and atherosclerosis. The present study aimed to evaluate the influence of RSD on cardiovascular inflammation and remodeling by determining serum levels of interleukin-6 (IL-6), high-sensitive C-reactive protein (hsCRP), matrix metalloproteinases (MMP), and tissue inhibitor of metalloproteinases (TIMP). A total of 60 consecutive patients (age 67.9 ± 9.6 years) undergoing RSD were included. A therapeutic response was defined as an office systolic blood pressure (SBP) reduction of >10 mmHg 6 months after RSD. Venous serum samples for measurement of hsCRP, IL-6, MMP-2, MMP-9, and TIMP-1 were collected prior to and 6 months after RSD. A significant reduction in office SBP of 26.4 mmHg [SBPbaseline 169.3 mmHg (SD 11.3), p < 0.001] was documented 6 months after RSD. The serum levels of hsCRP (p < 0.001) and the pro-inflammatory cytokine IL-6 (p < 0.001) were significantly decreased compared to baseline values. The levels of MMP-9 (p = 0.024) and MMP-2 (p < 0.01) were significantly increased compared to baseline values. In addition to the effective blood pressure reduction in response to RSD, this study demonstrates a positive effect of RSD on biomarkers reflecting vascular inflammation and remodeling. These results suggest a possible prognostic benefit of RSD in high-risk patients for endothelial dysfunction and cardiovascular remodeling as well as end-organ damage.

  • The biophysics of Renal Sympathetic Denervation using radiofrequency energy
    Clinical Research in Cardiology, 2014
    Co-Authors: Hitesh C. Patel, Paramdeep S. Dhillon, Felix Mahfoud, Alistair C. Lindsay, Carl Hayward, Sabine Ernst, Alexander R. Lyon, Stuart D. Rosen, Carlo Mario
    Abstract:

    Renal Sympathetic Denervation is currently performed in the treatment of resistant hypertension by interventionists who otherwise do not typically use radio-frequency (RF) energy ablation in their clinical practice. Adequate RF lesion formation is dependent upon good electrode-tissue contact, power delivery, electrode-tissue interface temperature, target-tissue impedance and the size of the catheter’s active electrode. There is significant interplay between these variables and hence an appreciation of the biophysical determinants of RF lesion formation is required to provide effective and safe clinical care to our patients. In this review article, we summarize the biophysics of RF ablation and explain why and how complications of Renal Sympathetic Denervation may occur and discuss methods to minimise them.

  • effects of Renal Sympathetic Denervation on heart rate and atrioventricular conduction in patients with resistant hypertension
    International Journal of Cardiology, 2013
    Co-Authors: Christian Ukena, Dominik Linz, Felix Mahfoud, Ingrid Kindermann, Hansruprecht Neuberger, Aline Spies, Bodo Cremers, Ulrich Laufs, Michael Bohm
    Abstract:

    Abstract Background Renal Sympathetic Denervation (RDN) reduces Sympathetic activity and blood pressure (BP) in patients with resistant hypertension. The present study aimed to investigate the effects of RDN on HR and other electrocardiographic parameters. Methods 136 patients aged 62.2±0.8years (58% male, BP 177±2/93±1mmHg) with resistant hypertension underwent RDN. BP and a 12-lead electrocardiogram (ECG) were recorded before, 3months (n=127), and 6months (n=88) after RDN. Results After 3months (3M) and 6months (6M), systolic BP was reduced by 25.5±2.4mmHg (p Conclusions Renal Sympathetic Denervation reduced heart rate and the PR interval as indicators of cardiac autonomic activity.

  • ambulatory blood pressure changes after Renal Sympathetic Denervation in patients with resistant hypertension
    Circulation, 2013
    Co-Authors: Felix Mahfoud, Roland E Schmieder, Oliver Vonend, Lars Christian Rump, Christian Ukena, Uta C Hoppe, Bodo Cremers, Joachim Weil, Martin Schmidt, Thomas Zeller
    Abstract:

    Background—Catheter-based Renal Sympathetic Denervation (RDN) reduces office blood pressure (BP) in patients with resistant hypertension according to office BP. Less is known about the effect of RDN on 24-hour BP measured by ambulatory BP monitoring and correlates of response in individuals with true or pseudoresistant hypertension. Methods and Results—A total of 346 uncontrolled hypertensive patients, separated according to daytime ambulatory BP monitoring into 303 with true resistant (office systolic BP [SBP] 172.2±22 mm Hg; 24-hour SBP 154±16.2 mm Hg) and 43 with pseudoresistant hypertension (office SBP 161.2±20.3 mm Hg; 24-hour SBP 121.1±19.6 mm Hg), from 10 centers were studied. At 3, 6, and 12 months follow-up, office SBP was reduced by 21.5/23.7/27.3 mm Hg, office diastolic BP by 8.9/9.5/11.7 mm Hg, and pulse pressure by 13.4/14.2/14.9 mm Hg (n=245/236/90; P for all <0.001), respectively. In patients with true treatment resistance there was a significant reduction with RDN in 24-hour SBP (−10.1/−10...

Oliver Dorr - One of the best experts on this subject based on the ideXlab platform.

  • effect of Renal Sympathetic Denervation on specific micrornas as an indicator of reverse remodeling processes in hypertensive heart disease
    Journal of Clinical Hypertension, 2016
    Co-Authors: Oliver Dorr, Christoph Liebetrau, Luise Gaede, Helge Möllmann, Christian Troidl, Simone Lankes, Denise Guckel, Niklas Boeder, Sandra Voss, Timm Bauer
    Abstract:

    A total of 90 consecutive patients undergoing Renal Sympathetic Denervation (RSD) were included in this study. A significant reduction in office systolic blood pressure (SBP) of 21.1 mm Hg (P<.001) was documented 6 months after RSD. At this time point, circulating concentrations of microRNA (miR)-133a were significantly increased (sevenfold; P<.001) compared with baseline values. Correlation analysis showed a significant relationship between baseline SBP values and SBP reduction (P<.001) as well as between miR-133a baseline levels and the increase in miR-133a expression (P<.001) after the 6-month follow-up. The effect of RSD on miR-133a expression was significantly greater in patients at high risk for hypertensive heart disease. In addition to the effective blood pressure reduction in response to RSD, this study demonstrates an effect of RSD on miR reflecting cardiovascular reverse remodeling processes. Thus, these results provide information on a beneficial effect of RSD on cardiac recovery in patients at high risk for hypertensive heart disease.

  • neuropeptide y as an indicator of successful alterations in Sympathetic nervous activity after Renal Sympathetic Denervation
    Clinical Research in Cardiology, 2015
    Co-Authors: Oliver Dorr, Christoph Liebetrau, Luise Gaede, Helge Möllmann, Christian Troidl, Sebastian Ewen, Dominik Linz, Timm Bauer, Mathias Hohl, Michael Bohm
    Abstract:

    Renal Sympathetic Denervation (RSD) represents a safe and effective treatment option for certain patients with resistant hypertension and has been shown to decrease Sympathetic activity. Neuropeptide Y (NPY) is a neurotransmitter that is co-released with norepinephrine and is up-regulated during increased Sympathetic activity. The aim of the present study was to examine the effect of RSD on NPY and to analyze the association between changes in NPY levels and blood pressure reduction after RSD. A total of 150 consecutive patients (age 64.9 ± 10.2 years) from three clinical centers undergoing RSD were included in this study. Response to RSD was defined as an office systolic blood pressure (SBP) reduction of >10 mmHg 6 months after RSD. Venous blood samples for measurement of NPY were collected prior to and 6 months after RSD. BP and NPY levels were significantly reduced by 23/9 mmHg (p = 0.001/0.001) and 0.24 mg/dL (p  10 mmHg) was associated with a significantly greater reduction in NPY level when compared with BP non-responders (p = 0.001). This study demonstrates an effect of RSD on serum NPY levels, a specific marker for Sympathetic activity. The association between RSD-related changes in SBP and NPY levels provides further evidence of the effect of RSD on the Sympathetic nervous system.

  • beneficial effects of Renal Sympathetic Denervation on cardiovascular inflammation and remodeling in essential hypertension
    Clinical Research in Cardiology, 2015
    Co-Authors: Oliver Dorr, Christoph Liebetrau, Luise Gaede, Helge Möllmann, Christian Troidl, Sebastian Ewen, Felix Mahfoud, Jedrzej Hoffmann, Nikolai Busch, Gerald Laux
    Abstract:

    Renal Sympathetic Denervation (RSD) represents a potential treatment option for certain patients with resistant arterial hypertension (HT). HT is associated with chronic vascular inflammation and remodeling, contributing to progressive vascular damage, and atherosclerosis. The present study aimed to evaluate the influence of RSD on cardiovascular inflammation and remodeling by determining serum levels of interleukin-6 (IL-6), high-sensitive C-reactive protein (hsCRP), matrix metalloproteinases (MMP), and tissue inhibitor of metalloproteinases (TIMP). A total of 60 consecutive patients (age 67.9 ± 9.6 years) undergoing RSD were included. A therapeutic response was defined as an office systolic blood pressure (SBP) reduction of >10 mmHg 6 months after RSD. Venous serum samples for measurement of hsCRP, IL-6, MMP-2, MMP-9, and TIMP-1 were collected prior to and 6 months after RSD. A significant reduction in office SBP of 26.4 mmHg [SBPbaseline 169.3 mmHg (SD 11.3), p < 0.001] was documented 6 months after RSD. The serum levels of hsCRP (p < 0.001) and the pro-inflammatory cytokine IL-6 (p < 0.001) were significantly decreased compared to baseline values. The levels of MMP-9 (p = 0.024) and MMP-2 (p < 0.01) were significantly increased compared to baseline values. In addition to the effective blood pressure reduction in response to RSD, this study demonstrates a positive effect of RSD on biomarkers reflecting vascular inflammation and remodeling. These results suggest a possible prognostic benefit of RSD in high-risk patients for endothelial dysfunction and cardiovascular remodeling as well as end-organ damage.

  • soluble fms like tyrosine kinase 1 and endothelial adhesion molecules intercellular cell adhesion molecule 1 and vascular cell adhesion molecule 1 as predictive markers for blood pressure reduction after Renal Sympathetic Denervation
    Hypertension, 2014
    Co-Authors: Oliver Dorr, Christoph Liebetrau, Luise Gaede, Johannes Rixe, Helge Möllmann, Christian Troidl, Christian W. Hamm
    Abstract:

    Renal Sympathetic Denervation (RSD) is a treatment option for patients with resistant arterial hypertension, but in some patients it is not successful. Predictive parameters on the success of RSD remain unknown. The angiogenic factors soluble fms-like tyrosine kinase-1 (sFLT-1), intercellular cell adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) are known to be associated with endothelial dysfunction, vascular remodeling, and hypertension. We evaluated whether sFLT-1, ICAM-1, and VCAM-1 are predictive markers for blood pressure reduction after RSD. Consecutive patients (n=55) undergoing Renal Denervation were included. Venous serum samples for measurement of sFlt-1, ICAM-1, and VCAM-1 were collected before and 6 months after RSD. A therapeutic response was defined as an office systolic blood pressure reduction of >10 mm Hg 6 months after RSD. A significant mean office systolic blood pressure reduction of 31.2 mm Hg was observed in 46 patients 6 months after RSD. Nine patients were classified as nonresponders, with a mean systolic blood pressure reduction of 4.6 mm Hg. At baseline, sFLT-1 levels were significantly higher in responders than in nonresponders ( P P P P P P =0.01), respectively, demonstrating prediction of an RSD response. Responders showed significantly higher serum levels of sFLT-1, ICAM-1, and VCAM-1 at baseline compared with nonresponders. Thus, this study identified for the first time potential biomarkers with a predictive value indicating a responder or nonresponder before Renal Denervation.

  • soluble fms like tyrosine kinase 1 and endothelial adhesion molecules intercellular cell adhesion molecule 1 and vascular cell adhesion molecule 1 as predictive markers for blood pressure reduction after Renal Sympathetic Denervation
    Hypertension, 2014
    Co-Authors: Oliver Dorr, Christoph Liebetrau, Luise Gaede, Johannes Rixe, Helge Möllmann, Christian Troidl, Christian W. Hamm, Holger Nef
    Abstract:

    Renal Sympathetic Denervation (RSD) is a treatment option for patients with resistant arterial hypertension, but in some patients it is not successful. Predictive parameters on the success of RSD remain unknown. The angiogenic factors soluble fms-like tyrosine kinase-1 (sFLT-1), intercellular cell adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) are known to be associated with endothelial dysfunction, vascular remodeling, and hypertension. We evaluated whether sFLT-1, ICAM-1, and VCAM-1 are predictive markers for blood pressure reduction after RSD. Consecutive patients (n=55) undergoing Renal Denervation were included. Venous serum samples for measurement of sFlt-1, ICAM-1, and VCAM-1 were collected before and 6 months after RSD. A therapeutic response was defined as an office systolic blood pressure reduction of >10 mm Hg 6 months after RSD. A significant mean office systolic blood pressure reduction of 31.2 mm Hg was observed in 46 patients 6 months after RSD. Nine patients were classified as nonresponders, with a mean systolic blood pressure reduction of 4.6 mm Hg. At baseline, sFLT-1 levels were significantly higher in responders than in nonresponders (P<0.001) as were ICAM-1 (P<0.001) and VCAM-1 levels (P<0.01). The areas under the curve for sFLT-1, ICAM-1, and VCAM-1 were 0.82 (interquartile range, 0.718-0.921; P<0.001), 0.754 (0.654-0.854; P<0.001), and 0.684 (0.564-804; P=0.01), respectively, demonstrating prediction of an RSD response. Responders showed significantly higher serum levels of sFLT-1, ICAM-1, and VCAM-1 at baseline compared with nonresponders. Thus, this study identified for the first time potential biomarkers with a predictive value indicating a responder or nonresponder before Renal Denervation.

Vasilios Papademetriou - One of the best experts on this subject based on the ideXlab platform.

  • impact of multi electrode Renal Sympathetic Denervation on short term blood pressure variability in patients with drug resistant hypertension insights from the enlightn i study
    International Journal of Cardiology, 2015
    Co-Authors: Costas Tsioufis, Vasilios Papademetriou, Dimitris Tsiachris, Kyriakos Dimitriadis, A Kasiakogias, Athanasios Kordalis, Costas Thomopoulos, Christodoulos Stefanadis, D Tousoulis, Gianfranco Parati
    Abstract:

    Abstract Background Transluminal Renal Sympathetic Denervation (RDN) has been shown to reduce blood pressure (BP) in patients with treatment-resistant hypertension. Methods We assessed the effect of multi-electrode RDN on short-term BP variability indexes in resistant hypertensives. Thirty-one patients with drug-resistant uncontrolled hypertension, participants in the EnligHTN I study, underwent ambulatory BP measurements at baseline and 6months after RDN using the EnligHTN ablation catheter (St. Jude Medical). Twelve resistant hypertensives matched for office BP served as control group. Results At 6months post-RDN, office BP and 24-hour BP were reduced by 25.6/10.3mmHg and by 10.2/6mmHg (p Conclusions Although standard BP variability indexes remained unchanged, the rate of systolic and diastolic BP variation was significantly decreased 6months after RDN in patients with drug-resistant hypertension. These novel indexes might also be useful as predictors of response.

  • multi electrode Renal Sympathetic Denervation improves heart rate dynamics in patients with drug resistant hypertension
    Journal of the American College of Cardiology, 2014
    Co-Authors: Konstantinos Tsioufis, Vasilios Papademetriou, Dimitris Tsiachris, Kyriakos Dimitriadis, A Kasiakogias, Athanasios Kordalis, Velissarios Antonakis, Anna Kefala, Ioannis Kallikazaros, Elizabeth Lau
    Abstract:

    Transluminal Renal Sympathetic Denervation (RDN) reduces blood pressure (BP) in patients with drug-resistant uncontrolled hypertension. We assessed the effect of RDN on heart rate, cardiac arrhythmias and indexes of heart rate variability (HRV) in patients with drug-resistant uncontrolled

  • Renal and cardiac effects of Renal Sympathetic Denervation and carotid baroreceptor stimulation
    Current Vascular Pharmacology, 2014
    Co-Authors: Costas Tsioufis, Michael Doumas, Vasilios Papademetriou, Kyriakos Dimitriadis, Costas Thomopoulos, Christodoulos Stefanadis
    Abstract:

    Cumulative evidence nowadays supports the dominant role of Sympathetic nervous system (SNS) activation in patients with hypertension, congestive heart failure, and Renal dysfunction. During the last years innovative interventional treatments [Renal Sympathetic Denervation (RSD) and baroreflex activation therapy (BAT)] have emerged and accompanied by sustained reductions of blood pressure (BP) levels. Moreover, these promising therapies are favorable not only on BP regulation but also on the SNS overdrive-related organ damage. The present review focuses on the association of SNS activation with Renal and cardiac diseases and presents the cardioRenal effects of RSD and BAT in experimental and clinical settings.

  • catheter based Renal Sympathetic Denervation exerts acute and chronic effects on Renal hemodynamics in swine
    International Journal of Cardiology, 2013
    Co-Authors: Costas Tsioufis, Vasilios Papademetriou, Dimitris Tsiachris, Kyriakos Dimitriadis, Costas Thomopoulos, Euljoon Park, Cary Hata, Apostolos Papalois, Christodoulos Stefanadis
    Abstract:

    Abstract Objectives We investigated the acute and chronic effects of catheter-based Renal Sympathetic Denervation (RSD) on Renal hemodynamics assessed by average peak velocity (APV), Renal blood flow (RBF), Renal flow reserve (RFR) and resistive index (RI). Background Sympathetic overdrive is accompanied by impaired RBF, whereas there is no data on the effects of transcatheter RSD on Renal hemodynamic balance. Methods Before and post-RSD (acutely and after 1month), in 9 farm swines we measured APV by a 0.014-inch Doppler flow wire placed in the stem of the Renal artery under baseline and hyperemic conditions, induced by intraRenal dopamine (50μg/kg). RFR was calculated as the ratio of hyperemic to basal peak velocity, and RI was estimated as (peak systolic velocity−end-diastolic velocity)/peak systolic velocity. RSD was achieved via the lumen of the main Renal artery with a specifically designed catheter connected to a radiofrequency generator according to prespecified algorithm. Results APV and RBF increased acutely post ablation in all animals, compared to APV and RBF before ablation (61.44±32.6 vs 20.44±6.38cm/s, p Conclusions Catheter-based RSD exerts acute and chronic effects on Renal hemodynamics in a large animal model. If confirmed in humans RBF parameters may be used as direct markers of successful RSD.

  • safety and efficacy of a multi electrode Renal Sympathetic Denervation system in resistant hypertension the enlightn i trial
    European Heart Journal, 2013
    Co-Authors: Stephen G Worthley, Vasilios Papademetriou, Costas Tsioufis, Matthew I Worthley, A Sinhal, Derek P Chew, Ian T Meredith, Yuvaraj Malaiapan
    Abstract:

    Aims Catheter-based Renal artery Sympathetic Denervation has emerged as a novel therapy for treatment of patients with drug-resistant hypertension. Initial studies were performed using a single electrode radiofrequency catheter, but recent advances in catheter design have allowed the development of multi-electrode systems that can deliver lesions with a pre-determined pattern. This study was designed to evaluate the safety and efficacy of the EnligHTN™ multi-electrode system. Methods and results We conducted the first-in-human, prospective, multi-centre, non-randomized study in 46 patients (67% male, mean age 60 years, and mean baseline office blood pressure 176/96 mmHg) with drug-resistant hypertension. The primary efficacy objective was change in office blood pressure from baseline to 6 months. Safety measures included all adverse events with a focus on the Renal artery and other vascular complications and changes in Renal function. Renal artery Denervation, using the EnligHTN™ system significantly reduced the office blood pressure from baseline to 1, 3, and 6 months by −28/10, −27/10 and −26/10 mmHg, respectively ( P < 0.0001). No acute Renal artery injury or other serious vascular complications occurred. Small, non-clinically relevant, changes in average estimated glomerular filtration rate were reported from baseline (87 ± 19 mL/min/1.73 m2) to 6 months post-procedure (82 ± 20 mL/min/1.73 m2). Conclusion Renal Sympathetic Denervation, using the EnligHTN™ multi-electrode catheter results in a rapid and significant office blood pressure reduction that was sustained through 6 months. The EnligHTN™ system delivers a promising therapy for the treatment of drug-resistant hypertension.

Helge Möllmann - One of the best experts on this subject based on the ideXlab platform.

  • effect of Renal Sympathetic Denervation on specific micrornas as an indicator of reverse remodeling processes in hypertensive heart disease
    Journal of Clinical Hypertension, 2016
    Co-Authors: Oliver Dorr, Christoph Liebetrau, Luise Gaede, Helge Möllmann, Christian Troidl, Simone Lankes, Denise Guckel, Niklas Boeder, Sandra Voss, Timm Bauer
    Abstract:

    A total of 90 consecutive patients undergoing Renal Sympathetic Denervation (RSD) were included in this study. A significant reduction in office systolic blood pressure (SBP) of 21.1 mm Hg (P<.001) was documented 6 months after RSD. At this time point, circulating concentrations of microRNA (miR)-133a were significantly increased (sevenfold; P<.001) compared with baseline values. Correlation analysis showed a significant relationship between baseline SBP values and SBP reduction (P<.001) as well as between miR-133a baseline levels and the increase in miR-133a expression (P<.001) after the 6-month follow-up. The effect of RSD on miR-133a expression was significantly greater in patients at high risk for hypertensive heart disease. In addition to the effective blood pressure reduction in response to RSD, this study demonstrates an effect of RSD on miR reflecting cardiovascular reverse remodeling processes. Thus, these results provide information on a beneficial effect of RSD on cardiac recovery in patients at high risk for hypertensive heart disease.

  • neuropeptide y as an indicator of successful alterations in Sympathetic nervous activity after Renal Sympathetic Denervation
    Clinical Research in Cardiology, 2015
    Co-Authors: Oliver Dorr, Christoph Liebetrau, Luise Gaede, Helge Möllmann, Christian Troidl, Sebastian Ewen, Dominik Linz, Timm Bauer, Mathias Hohl, Michael Bohm
    Abstract:

    Renal Sympathetic Denervation (RSD) represents a safe and effective treatment option for certain patients with resistant hypertension and has been shown to decrease Sympathetic activity. Neuropeptide Y (NPY) is a neurotransmitter that is co-released with norepinephrine and is up-regulated during increased Sympathetic activity. The aim of the present study was to examine the effect of RSD on NPY and to analyze the association between changes in NPY levels and blood pressure reduction after RSD. A total of 150 consecutive patients (age 64.9 ± 10.2 years) from three clinical centers undergoing RSD were included in this study. Response to RSD was defined as an office systolic blood pressure (SBP) reduction of >10 mmHg 6 months after RSD. Venous blood samples for measurement of NPY were collected prior to and 6 months after RSD. BP and NPY levels were significantly reduced by 23/9 mmHg (p = 0.001/0.001) and 0.24 mg/dL (p  10 mmHg) was associated with a significantly greater reduction in NPY level when compared with BP non-responders (p = 0.001). This study demonstrates an effect of RSD on serum NPY levels, a specific marker for Sympathetic activity. The association between RSD-related changes in SBP and NPY levels provides further evidence of the effect of RSD on the Sympathetic nervous system.

  • beneficial effects of Renal Sympathetic Denervation on cardiovascular inflammation and remodeling in essential hypertension
    Clinical Research in Cardiology, 2015
    Co-Authors: Oliver Dorr, Christoph Liebetrau, Luise Gaede, Helge Möllmann, Christian Troidl, Sebastian Ewen, Felix Mahfoud, Jedrzej Hoffmann, Nikolai Busch, Gerald Laux
    Abstract:

    Renal Sympathetic Denervation (RSD) represents a potential treatment option for certain patients with resistant arterial hypertension (HT). HT is associated with chronic vascular inflammation and remodeling, contributing to progressive vascular damage, and atherosclerosis. The present study aimed to evaluate the influence of RSD on cardiovascular inflammation and remodeling by determining serum levels of interleukin-6 (IL-6), high-sensitive C-reactive protein (hsCRP), matrix metalloproteinases (MMP), and tissue inhibitor of metalloproteinases (TIMP). A total of 60 consecutive patients (age 67.9 ± 9.6 years) undergoing RSD were included. A therapeutic response was defined as an office systolic blood pressure (SBP) reduction of >10 mmHg 6 months after RSD. Venous serum samples for measurement of hsCRP, IL-6, MMP-2, MMP-9, and TIMP-1 were collected prior to and 6 months after RSD. A significant reduction in office SBP of 26.4 mmHg [SBPbaseline 169.3 mmHg (SD 11.3), p < 0.001] was documented 6 months after RSD. The serum levels of hsCRP (p < 0.001) and the pro-inflammatory cytokine IL-6 (p < 0.001) were significantly decreased compared to baseline values. The levels of MMP-9 (p = 0.024) and MMP-2 (p < 0.01) were significantly increased compared to baseline values. In addition to the effective blood pressure reduction in response to RSD, this study demonstrates a positive effect of RSD on biomarkers reflecting vascular inflammation and remodeling. These results suggest a possible prognostic benefit of RSD in high-risk patients for endothelial dysfunction and cardiovascular remodeling as well as end-organ damage.

  • soluble fms like tyrosine kinase 1 and endothelial adhesion molecules intercellular cell adhesion molecule 1 and vascular cell adhesion molecule 1 as predictive markers for blood pressure reduction after Renal Sympathetic Denervation
    Hypertension, 2014
    Co-Authors: Oliver Dorr, Christoph Liebetrau, Luise Gaede, Johannes Rixe, Helge Möllmann, Christian Troidl, Christian W. Hamm
    Abstract:

    Renal Sympathetic Denervation (RSD) is a treatment option for patients with resistant arterial hypertension, but in some patients it is not successful. Predictive parameters on the success of RSD remain unknown. The angiogenic factors soluble fms-like tyrosine kinase-1 (sFLT-1), intercellular cell adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) are known to be associated with endothelial dysfunction, vascular remodeling, and hypertension. We evaluated whether sFLT-1, ICAM-1, and VCAM-1 are predictive markers for blood pressure reduction after RSD. Consecutive patients (n=55) undergoing Renal Denervation were included. Venous serum samples for measurement of sFlt-1, ICAM-1, and VCAM-1 were collected before and 6 months after RSD. A therapeutic response was defined as an office systolic blood pressure reduction of >10 mm Hg 6 months after RSD. A significant mean office systolic blood pressure reduction of 31.2 mm Hg was observed in 46 patients 6 months after RSD. Nine patients were classified as nonresponders, with a mean systolic blood pressure reduction of 4.6 mm Hg. At baseline, sFLT-1 levels were significantly higher in responders than in nonresponders ( P P P P P P =0.01), respectively, demonstrating prediction of an RSD response. Responders showed significantly higher serum levels of sFLT-1, ICAM-1, and VCAM-1 at baseline compared with nonresponders. Thus, this study identified for the first time potential biomarkers with a predictive value indicating a responder or nonresponder before Renal Denervation.

  • soluble fms like tyrosine kinase 1 and endothelial adhesion molecules intercellular cell adhesion molecule 1 and vascular cell adhesion molecule 1 as predictive markers for blood pressure reduction after Renal Sympathetic Denervation
    Hypertension, 2014
    Co-Authors: Oliver Dorr, Christoph Liebetrau, Luise Gaede, Johannes Rixe, Helge Möllmann, Christian Troidl, Christian W. Hamm, Holger Nef
    Abstract:

    Renal Sympathetic Denervation (RSD) is a treatment option for patients with resistant arterial hypertension, but in some patients it is not successful. Predictive parameters on the success of RSD remain unknown. The angiogenic factors soluble fms-like tyrosine kinase-1 (sFLT-1), intercellular cell adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) are known to be associated with endothelial dysfunction, vascular remodeling, and hypertension. We evaluated whether sFLT-1, ICAM-1, and VCAM-1 are predictive markers for blood pressure reduction after RSD. Consecutive patients (n=55) undergoing Renal Denervation were included. Venous serum samples for measurement of sFlt-1, ICAM-1, and VCAM-1 were collected before and 6 months after RSD. A therapeutic response was defined as an office systolic blood pressure reduction of >10 mm Hg 6 months after RSD. A significant mean office systolic blood pressure reduction of 31.2 mm Hg was observed in 46 patients 6 months after RSD. Nine patients were classified as nonresponders, with a mean systolic blood pressure reduction of 4.6 mm Hg. At baseline, sFLT-1 levels were significantly higher in responders than in nonresponders (P<0.001) as were ICAM-1 (P<0.001) and VCAM-1 levels (P<0.01). The areas under the curve for sFLT-1, ICAM-1, and VCAM-1 were 0.82 (interquartile range, 0.718-0.921; P<0.001), 0.754 (0.654-0.854; P<0.001), and 0.684 (0.564-804; P=0.01), respectively, demonstrating prediction of an RSD response. Responders showed significantly higher serum levels of sFLT-1, ICAM-1, and VCAM-1 at baseline compared with nonresponders. Thus, this study identified for the first time potential biomarkers with a predictive value indicating a responder or nonresponder before Renal Denervation.

Christoph Liebetrau - One of the best experts on this subject based on the ideXlab platform.

  • effect of Renal Sympathetic Denervation on specific micrornas as an indicator of reverse remodeling processes in hypertensive heart disease
    Journal of Clinical Hypertension, 2016
    Co-Authors: Oliver Dorr, Christoph Liebetrau, Luise Gaede, Helge Möllmann, Christian Troidl, Simone Lankes, Denise Guckel, Niklas Boeder, Sandra Voss, Timm Bauer
    Abstract:

    A total of 90 consecutive patients undergoing Renal Sympathetic Denervation (RSD) were included in this study. A significant reduction in office systolic blood pressure (SBP) of 21.1 mm Hg (P<.001) was documented 6 months after RSD. At this time point, circulating concentrations of microRNA (miR)-133a were significantly increased (sevenfold; P<.001) compared with baseline values. Correlation analysis showed a significant relationship between baseline SBP values and SBP reduction (P<.001) as well as between miR-133a baseline levels and the increase in miR-133a expression (P<.001) after the 6-month follow-up. The effect of RSD on miR-133a expression was significantly greater in patients at high risk for hypertensive heart disease. In addition to the effective blood pressure reduction in response to RSD, this study demonstrates an effect of RSD on miR reflecting cardiovascular reverse remodeling processes. Thus, these results provide information on a beneficial effect of RSD on cardiac recovery in patients at high risk for hypertensive heart disease.

  • neuropeptide y as an indicator of successful alterations in Sympathetic nervous activity after Renal Sympathetic Denervation
    Clinical Research in Cardiology, 2015
    Co-Authors: Oliver Dorr, Christoph Liebetrau, Luise Gaede, Helge Möllmann, Christian Troidl, Sebastian Ewen, Dominik Linz, Timm Bauer, Mathias Hohl, Michael Bohm
    Abstract:

    Renal Sympathetic Denervation (RSD) represents a safe and effective treatment option for certain patients with resistant hypertension and has been shown to decrease Sympathetic activity. Neuropeptide Y (NPY) is a neurotransmitter that is co-released with norepinephrine and is up-regulated during increased Sympathetic activity. The aim of the present study was to examine the effect of RSD on NPY and to analyze the association between changes in NPY levels and blood pressure reduction after RSD. A total of 150 consecutive patients (age 64.9 ± 10.2 years) from three clinical centers undergoing RSD were included in this study. Response to RSD was defined as an office systolic blood pressure (SBP) reduction of >10 mmHg 6 months after RSD. Venous blood samples for measurement of NPY were collected prior to and 6 months after RSD. BP and NPY levels were significantly reduced by 23/9 mmHg (p = 0.001/0.001) and 0.24 mg/dL (p  10 mmHg) was associated with a significantly greater reduction in NPY level when compared with BP non-responders (p = 0.001). This study demonstrates an effect of RSD on serum NPY levels, a specific marker for Sympathetic activity. The association between RSD-related changes in SBP and NPY levels provides further evidence of the effect of RSD on the Sympathetic nervous system.

  • beneficial effects of Renal Sympathetic Denervation on cardiovascular inflammation and remodeling in essential hypertension
    Clinical Research in Cardiology, 2015
    Co-Authors: Oliver Dorr, Christoph Liebetrau, Luise Gaede, Helge Möllmann, Christian Troidl, Sebastian Ewen, Felix Mahfoud, Jedrzej Hoffmann, Nikolai Busch, Gerald Laux
    Abstract:

    Renal Sympathetic Denervation (RSD) represents a potential treatment option for certain patients with resistant arterial hypertension (HT). HT is associated with chronic vascular inflammation and remodeling, contributing to progressive vascular damage, and atherosclerosis. The present study aimed to evaluate the influence of RSD on cardiovascular inflammation and remodeling by determining serum levels of interleukin-6 (IL-6), high-sensitive C-reactive protein (hsCRP), matrix metalloproteinases (MMP), and tissue inhibitor of metalloproteinases (TIMP). A total of 60 consecutive patients (age 67.9 ± 9.6 years) undergoing RSD were included. A therapeutic response was defined as an office systolic blood pressure (SBP) reduction of >10 mmHg 6 months after RSD. Venous serum samples for measurement of hsCRP, IL-6, MMP-2, MMP-9, and TIMP-1 were collected prior to and 6 months after RSD. A significant reduction in office SBP of 26.4 mmHg [SBPbaseline 169.3 mmHg (SD 11.3), p < 0.001] was documented 6 months after RSD. The serum levels of hsCRP (p < 0.001) and the pro-inflammatory cytokine IL-6 (p < 0.001) were significantly decreased compared to baseline values. The levels of MMP-9 (p = 0.024) and MMP-2 (p < 0.01) were significantly increased compared to baseline values. In addition to the effective blood pressure reduction in response to RSD, this study demonstrates a positive effect of RSD on biomarkers reflecting vascular inflammation and remodeling. These results suggest a possible prognostic benefit of RSD in high-risk patients for endothelial dysfunction and cardiovascular remodeling as well as end-organ damage.

  • soluble fms like tyrosine kinase 1 and endothelial adhesion molecules intercellular cell adhesion molecule 1 and vascular cell adhesion molecule 1 as predictive markers for blood pressure reduction after Renal Sympathetic Denervation
    Hypertension, 2014
    Co-Authors: Oliver Dorr, Christoph Liebetrau, Luise Gaede, Johannes Rixe, Helge Möllmann, Christian Troidl, Christian W. Hamm
    Abstract:

    Renal Sympathetic Denervation (RSD) is a treatment option for patients with resistant arterial hypertension, but in some patients it is not successful. Predictive parameters on the success of RSD remain unknown. The angiogenic factors soluble fms-like tyrosine kinase-1 (sFLT-1), intercellular cell adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) are known to be associated with endothelial dysfunction, vascular remodeling, and hypertension. We evaluated whether sFLT-1, ICAM-1, and VCAM-1 are predictive markers for blood pressure reduction after RSD. Consecutive patients (n=55) undergoing Renal Denervation were included. Venous serum samples for measurement of sFlt-1, ICAM-1, and VCAM-1 were collected before and 6 months after RSD. A therapeutic response was defined as an office systolic blood pressure reduction of >10 mm Hg 6 months after RSD. A significant mean office systolic blood pressure reduction of 31.2 mm Hg was observed in 46 patients 6 months after RSD. Nine patients were classified as nonresponders, with a mean systolic blood pressure reduction of 4.6 mm Hg. At baseline, sFLT-1 levels were significantly higher in responders than in nonresponders ( P P P P P P =0.01), respectively, demonstrating prediction of an RSD response. Responders showed significantly higher serum levels of sFLT-1, ICAM-1, and VCAM-1 at baseline compared with nonresponders. Thus, this study identified for the first time potential biomarkers with a predictive value indicating a responder or nonresponder before Renal Denervation.

  • soluble fms like tyrosine kinase 1 and endothelial adhesion molecules intercellular cell adhesion molecule 1 and vascular cell adhesion molecule 1 as predictive markers for blood pressure reduction after Renal Sympathetic Denervation
    Hypertension, 2014
    Co-Authors: Oliver Dorr, Christoph Liebetrau, Luise Gaede, Johannes Rixe, Helge Möllmann, Christian Troidl, Christian W. Hamm, Holger Nef
    Abstract:

    Renal Sympathetic Denervation (RSD) is a treatment option for patients with resistant arterial hypertension, but in some patients it is not successful. Predictive parameters on the success of RSD remain unknown. The angiogenic factors soluble fms-like tyrosine kinase-1 (sFLT-1), intercellular cell adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) are known to be associated with endothelial dysfunction, vascular remodeling, and hypertension. We evaluated whether sFLT-1, ICAM-1, and VCAM-1 are predictive markers for blood pressure reduction after RSD. Consecutive patients (n=55) undergoing Renal Denervation were included. Venous serum samples for measurement of sFlt-1, ICAM-1, and VCAM-1 were collected before and 6 months after RSD. A therapeutic response was defined as an office systolic blood pressure reduction of >10 mm Hg 6 months after RSD. A significant mean office systolic blood pressure reduction of 31.2 mm Hg was observed in 46 patients 6 months after RSD. Nine patients were classified as nonresponders, with a mean systolic blood pressure reduction of 4.6 mm Hg. At baseline, sFLT-1 levels were significantly higher in responders than in nonresponders (P<0.001) as were ICAM-1 (P<0.001) and VCAM-1 levels (P<0.01). The areas under the curve for sFLT-1, ICAM-1, and VCAM-1 were 0.82 (interquartile range, 0.718-0.921; P<0.001), 0.754 (0.654-0.854; P<0.001), and 0.684 (0.564-804; P=0.01), respectively, demonstrating prediction of an RSD response. Responders showed significantly higher serum levels of sFLT-1, ICAM-1, and VCAM-1 at baseline compared with nonresponders. Thus, this study identified for the first time potential biomarkers with a predictive value indicating a responder or nonresponder before Renal Denervation.