Right ventricle failure in patients treated with left ventricular assist device

This review article aim to highlight the right ventricular function peri left ventricular assist device implantation, and to assess the incidence, physiopathology, predictors, management and prognosis, of right ventricular failure post-implant.     

Dénervation rénale dans le traitement de l’hypertension artérielle résistante : expérience du CHU de Lyon

Aim

We report the first experience of Lyon's university hospital regarding renal denervation to treat patients with resistant essential hypertension.

Patients and methods

Over a one-year period, 17 patients were treated (12 men, 5 women) with renal denervation. Baseline characteristics were as follows: age 56.5 ± 11.5 years, BMI 33 ± 5 kg/m² and ambulatory blood pressure 157 ± 16/87 ± 13 mmHg with 4.2 ± 1.5 anti-hypertensive treatment.

Results

We did not observe per procedural and early complications. After a median follow-up of 3 months and with the same anti-hypertensive treatment, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) decrease respectively of 20 ± 15 (P < 0.001) and 10 ± 13 mmHg (P = 0.014) (n = 17). After six months of follow-up, ambulatory blood pressure (ABPM) decrease of 17.5 ± 14.9 mmHg (P = 0.027) for SBP and of 10.5 ± 9.6 mmHg (P = 0.029) for DBP (n = 6). Among these patients, five of them were controlled (ABPM inferior to 130/80 mmHg) and electrical left ventricular hypertrophy indexes decreased: R wave in aVL lead of 4 ± 3 mm (P = 0.031), Sokolow index of 3 ± 3 mm (P = 0.205), Cornell voltage criterion of 9 ± 7 mm (P = 0.027) and Cornell product of 1310 ± 1104 (P = 0.027).

Conclusion

Our results are in accordance with data from other centers. On average blood pressure decreases significantly but important inter individual variations are observed. The procedure seems safe.     

Long-term high-intensity interval training associated with lifestyle modifications improves QT dispersion parameters in metabolic syndrome patients

BackgroundQT dispersion (QTd) is a marker of myocardial electrical instability, and is increased in metabolic syndrome (MetS). Moderate intensity continuous exercise (MICE) training was shown to improve QTd in MetS patients.ObjectivesTo describe long-term effects of MICE and high-intensity interval exercise training (HIIT) on QTd parameters in MetS.MethodsSixty-five MetS patients (53 ± 9 years) were assigned to either a MICE (60% of peak power output [PPO]), or a HIIT program (alternating phases of 15–30 s at 80% of PPO interspersed by passive recovery phases of equal duration), twice weekly during 9 months. Ventricular repolarization indices (QT dispersion = QTd, standard deviation of QT = sdQT, relative dispersion of QT = rdQT, QT corrected dispersion = QTcd), metabolic, anthropometric and exercise parameters were measured before and after the intervention.ResultsNo adverse events were noted during exercise. QTd decreased significantly in both groups (51 vs 56 ms in MICE, P < 0.05; 34 vs 38 ms in HIIT, P < 0.05). Changes in QTd were correlated with changes in maximal heart rate (r = ?0.69, P < 0.0001) and in heart rate recovery (r = ?0.49, P < 0.01) in the HIIT group only. When compared to MICE, HIIT training induced a greater decrease in weight, BMI and waist circumference. Exercise capacity significantly improved by 0.82 and 1.25 METs in MICE and HIIT groups respectively (P < 0.0001). Lipid parameters also improved to the same degree in both groups.ConclusionIn MetS, long-term HIIT and MICE training led to comparable effects on ventricular repolarization indices, and HIIT might be associated with greater improvements in certain cardiometabolic risk factors.     

High-risk left main coronary stenting supported by percutaneous Impella Recover LP 2.5 assist device

Percutaneous coronary interventions (PCI) of complex coronary lesions in patients with severely depressed left ventricular (LV) function may increasingly constitute an alternative to surgical revascularization. The availability of hemodynamic support devices offers a promising option to reduce PCI-related complications in such high-risk procedures. We report the case of a successful distal left main coronary artery T-stenting supported by the Impella Recover LP 2.5 assist device in a patient with severe LV dysfunction.     

Vieillissement et régression de l’hypertrophie cardiaque chez l’hypertendu

Objective. -- This study was aimed at determining factors acting on the regression of left ventricular hypertrophy due to essential hypertension.Methods. -- It was a non-randomized, echocardiographic study of 60 previously untreated hypertensive subjects (20 to 75 years of age).Results. -- Following a 5-year therapy, the decrease in the left ventricular mass was 14%. Normalization of blood pressure and reversal of left ventricular hypertrophy were obtained in 50% and 58% of patients, respectively. Patients of the non-responder group (non-response being defined as a less than 10% decrease in the left ventricular mass) were older and had a longer history of high blood pressure. A positive correlation was observed between age and decrease in the left ventricular mass, the latter being less marked in older patients. Antihypertensive drugs classes had no influence on reversal of left ventricular hypertrophy.Conclusion. -- Ageing may be a factor of resistance to the decrease in left ventricular mass with therapy. These results suggest that early screening and management of hypertension are essential.

Résumé

Propos. -- Indépendent de l'élévation de la pression artérielle, le vieillissement est associé à un remodelage concentrique du ventricule gauche qui pourrait moduler avec le temps l'effet des traitements antihypertenseurs sur le cœur. L'objectif de la présente étude était de mettre en évidence les facteurs pouvant influencer la régression de l'hypertrophie ventriculaire gauche chez les hypertendus.Méthodes. -- Il s'agissait d'une étude de suivi, non randomisée, portant sur 60 patients hypertendus, âgés de 20 à 75 ans, jamais traités à l'inclusion et présentant une hypertrophie ventriculaire gauche.Résultats. -- Après 5 ans d'évolution sous traitement antihypertenseur, la diminution de la masse ventriculaire gauche de 14 % est largement significative. La pression artérielle s'était normalisée et l'hypertrophie avait régressé chez, respectivement, 50 et 58 % des patients. Le groupe de patients qui ne répondaient pas au traitement (44 % de la population), dont la diminution de la masse cardiaque, inférieure à 10 %, n'était pas significative, étaient plus âgés, la durée d'évolution de l'hypertension artérielle étant plus longue. Dans l'ensemble de la population, il a été montré l'existence d'une relation positive entre la diminution de la masse cardiaque et l'âge: c'est chez les patients les plus âgés que la diminution de la masse ventriculaire gauche est la moins importante. En revanche, il n'a pas été trouvé de relation avec la classe thérapeutique utilisée.Conclusions. -- La diminution de la masse cardiaque sous traitement antihypertenseur n'est pas seulement le résultat d'une diminution de la pression artérielle, mais fait intervenir d'autres facteurs. Parmi ceux-ci, le vieillissement pourrait être un facteur de résistance à l'action du traitement sur la diminution de la masse ventriculaire gauche. Ces résultats justifient un dépistage et une prise en charge précoce de la maladie hypertensive.     

Arrhythmogenic right ventricular dysplasia and sudden cardiac death

ARVD manifests itself by a wide spectrum of clinical presentations from asymptomatic patients to a broad range of ventricular arrhythmia, extrasystoles, tachycardia, or sudden arrhythmic death which can be the first symptom. It is a major cause for sudden death in young people and sportsmen. In known ARVD the risk of sudden death is not easy to assess from the literature, as its natural history is modulated by the wide variety of antiarrhythmic therapies. Hemodynamically ill tolerated ventricular arrhythmia, left ventricular involvement, sports, a youger age below 35, and uncontrolled therapy seem to predict an adverse outcome for these patients. These data may be helpful to decide for an AICD.