Oliver Doerr

Neutrophil gelatinase-associated lipocalin (NGAL) for the early detection of contrast-induced nephropathy after percutaneous coronary intervention

Abstract Background. Contrast-induced acute kidney injury (CI-AKI) occurs in up to 13% of patients undergoing percutaneous coronary intervention (PCI). Neutrophil gelatinase-associated lipocalin (NGAL) is an early biomarker for renal impairment. We investigated whether increased urinary NGAL concentrations were predictive of CI-AKI within 2 days after PCI or of a higher re-hospitalization rate within 9 months. Methods. Consecutive patients (n = 128), with stable coronary heart disease and eGFR ≥ 30 mL/min/1.73 m2, undergoing PCI were included. Venous serum samples for measurement of creatinine, blood urea nitrogen, and cystatin C and urine samples for NGAL measurement were collected 4 hours and 1 and 2 days after contrast medium application. Patients were followed over 9 months to determine clinical endpoints. Results. CI-AKI was observed in 14 patients (10.9%) after PCI. NGAL concentrations before PCI were significantly higher in patients with subsequent CI-AKI (19.8 ng/mL [14.4–35.8] vs. 11.6 ng/mL [5.6–28.2]; p = 0.04). There was no significant difference in NGAL concentrations 4 h after PCI between patients with and without CI-AKI. One day after PCI, NGAL concentrations were significant higher in patients developing CI-AKI (100.1 ng/mL [41.5–129.2] vs. 16.6 ng/mL [9.1–28.1]; p < 0.001). Compared to common biomarkers, NGAL best predicted CI-AKI (AUC 0.939 [95% CI 0.89–0.99; p < 0.001]). The re-hospitalization rate due to progressive renal insufficiency within 9 months was higher in the group with CI-AKI than the group without (4 [28.6%] vs. 4 [3.5%], p < 0.01). Conclusion. Urinary NGAL is a biomarker for predicting CI-AKI when measured 1 day after PCI.

Randomized Comparison of Multipolar, Duty-Cycled, Bipolar-Unipolar Radiofrequency Versus Conventional Catheter Ablation for Treatment of Common Atrial Flutter

Comparison of Radiofrequency Versus Conventional Catheter Ablation. Introduction: Radiofrequency (RF) catheter ablation has been established as an effective and curative treatment for atrial flutter (AFL). Approved methods include a drag‐and‐drop method, as well as a point‐by‐point ablation technique. The aim of this study was to compare the acute efficacy and procedural efficiency of a multipolar linear ablation catheter with simultaneous energy delivery to multiple catheter electrodes against conventional RF for treatment of AFL.

Barostim Implantation with Ipsilateral Carotid Endarterectomy as a One-Stage Procedure

Clinical trials have demonstrated significant and lasting reductions in arterial pressure from baroreflex activation therapy (BAT), resulting from electrical stimulation of the carotid sinus in patients with resistant arterial hypertension. Significant carotid atherosclerosis, however, has been a contraindication for ipsilateral implantation due to a potentially increased risk of periprocedural stroke and uncertain antihypertensive efficacy. Here, we describe the first case in which BAT was applied safely and effectively in a patient with distinct cerebral arteriosclerosis after ipsilateral carotid endarterectomy as a one-stage procedure without neurologic complications. BAT resulted in satisfactory blood pressure levels despite distinct cerebral atherosclerosis after an 18-month follow-up period.

ANATOMICAL AND PROCEDURAL DETERMINANTS OF CATHETER-BASED RENAL DENERVATION

Catheter-based renal sympathetic denervation (RDN) can reduce blood pressure (BP) and sympathetic activity in certain patients with uncontrolled hypertension. Less is known about the impact of renal anatomy and procedural parameters on subsequent BP response. A total of 564 patients with resistant

First-in-Man Coronary Sinus Lead Stabilization Using a Bioresorbable Vascular Scaffold System

Cardiac resynchronization therapy has become an integral part of treatment in patients presenting with reduced ventricular function (left ventricular ejection fraction <35%), clinically symptomatic dyspnea (New York Heart Association II–IV), and complete left bundle branch block. Currently, the standard approach of left ventricular lead placement is transvenously via the coronary sinus (CS). Although a wide range of CS leads, sheaths, and subselectors are available, peri- or postinterventional lead dislodgement is still a cause for placement failure. Interventional stabilization by metallic stents of the CS lead has been described, but there are concerns on mid- and long-term effects because of possible mechanical irritation. Here we describe the first case in which a bioresorbable vascular scaffold was used to stabilize a CS lead in a lateral side branch against the vessel wall. A 74-year-old man with dilated cardiomyopathy, New York Heart Association Class III, had an implantable cardioverter defibrillator placed in 2008 for primary prophylaxis of sudden cardiac death. In January 2015, …