Y. Malaiapan

Catheter-Based Renal Denervation for Resistant HypertensionNovelty and Significance: 12-Month Results of the EnligHTN I First-in-Human Study Using a Multielectrode Ablation System

Renal denervation has emerged as a novel approach for the treatment of patients with drug-resistant hypertension. To date, only limited data have been published using multielectrode radiofrequency ablation systems. In this article, we present the 12-month data of EnligHTN I, a first-in-human study using a multielectrode ablation catheter. EnligHTN I enrolled 46 patients (average age, 60±10 years; on average 4.7±1.0 medications) with drug-resistant hypertension. Eligible patients were on ≥3 antihypertensive medications and had a systolic blood pressure (BP) ≥160 mm Hg (≥150 mm Hg for diabetics). Bilateral renal artery ablation was performed using a percutaneous femoral approach and standardized techniques. The average baseline office BP was 176/96 mm Hg, average 24-hour ambulatory BP was 150/83 mm Hg, and average home BP was 158/90 mm Hg. The average reductions (mm Hg) at 1, 3, 6, and 12 months were as follows: office: −28/−10, −27/−10, −26/−10, and −27/−11 mm Hg ( P <0.001 for all); 24-hour ambulatory: −10/−5, −10/−5, −10/−6 ( P <0.001 for all), and −7/−4 for 12 months ( P <0.0094). Reductions in home measurements (based on 2-week average) were −9/−4, −8/−5,−10/−7, and −11/−6 mm Hg ( P <0.001 at 12 months). At 12 months, there were no signals of worsening renal function and no new serious or life-threatening adverse events. One patient with baseline nonocclusive renal artery stenosis progressed to 75% diameter stenosis, requiring renal artery stenting. The 12-month data continue to demonstrate safety and efficacy of the EnligHTN ablation system in patients with drug-resistant hypertension. Home BP measurements parallel measurements obtained with 24-hour ambulatory monitoring. # Novelty and Significance {#article-title-41}Renal denervation has emerged as a novel approach for the treatment of patients with drug-resistant hypertension. To date, only limited data have been published using multielectrode radiofrequency ablation systems. In this article, we present the 12-month data of EnligHTN I, a first-in-human study using a multielectrode ablation catheter. EnligHTN I enrolled 46 patients (average age, 60±10 years; on average 4.7±1.0 medications) with drug-resistant hypertension. Eligible patients were on ≥3 antihypertensive medications and had a systolic blood pressure (BP) ≥160 mm Hg (≥150 mm Hg for diabetics). Bilateral renal artery ablation was performed using a percutaneous femoral approach and standardized techniques. The average baseline office BP was 176/96 mm Hg, average 24-hour ambulatory BP was 150/83 mm Hg, and average home BP was 158/90 mm Hg. The average reductions (mm Hg) at 1, 3, 6, and 12 months were as follows: office: −28/−10, −27/−10, −26/−10, and −27/−11 mm Hg (P<0.001 for all); 24-hour ambulatory: −10/−5, −10/−5, −10/−6 (P<0.001 for all), and −7/−4 for 12 months (P<0.0094). Reductions in home measurements (based on 2-week average) were −9/−4, −8/−5,−10/−7, and −11/−6 mm Hg (P<0.001 at 12 months). At 12 months, there were no signals of worsening renal function and no new serious or life-threatening adverse events. One patient with baseline nonocclusive renal artery stenosis progressed to 75% diameter stenosis, requiring renal artery stenting. The 12-month data continue to demonstrate safety and efficacy of the EnligHTN ablation system in patients with drug-resistant hypertension. Home BP measurements parallel measurements obtained with 24-hour ambulatory monitoring.

Catheter-Based Renal Denervation for Resistant Hypertension

Renal denervation has emerged as a novel approach for the treatment of patients with drug-resistant hypertension. To date, only limited data have been published using multielectrode radiofrequency ablation systems. In this article, we present the 12-month data of EnligHTN I, a first-in-human study using a multielectrode ablation catheter. EnligHTN I enrolled 46 patients (average age, 60±10 years; on average 4.7±1.0 medications) with drug-resistant hypertension. Eligible patients were on ≥3 antihypertensive medications and had a systolic blood pressure (BP) ≥160 mm Hg (≥150 mm Hg for diabetics). Bilateral renal artery ablation was performed using a percutaneous femoral approach and standardized techniques. The average baseline office BP was 176/96 mm Hg, average 24-hour ambulatory BP was 150/83 mm Hg, and average home BP was 158/90 mm Hg. The average reductions (mm Hg) at 1, 3, 6, and 12 months were as follows: office: −28/−10, −27/−10, −26/−10, and −27/−11 mm Hg ( P <0.001 for all); 24-hour ambulatory: −10/−5, −10/−5, −10/−6 ( P <0.001 for all), and −7/−4 for 12 months ( P <0.0094). Reductions in home measurements (based on 2-week average) were −9/−4, −8/−5,−10/−7, and −11/−6 mm Hg ( P <0.001 at 12 months). At 12 months, there were no signals of worsening renal function and no new serious or life-threatening adverse events. One patient with baseline nonocclusive renal artery stenosis progressed to 75% diameter stenosis, requiring renal artery stenting. The 12-month data continue to demonstrate safety and efficacy of the EnligHTN ablation system in patients with drug-resistant hypertension. Home BP measurements parallel measurements obtained with 24-hour ambulatory monitoring. # Novelty and Significance {#article-title-41}Renal denervation has emerged as a novel approach for the treatment of patients with drug-resistant hypertension. To date, only limited data have been published using multielectrode radiofrequency ablation systems. In this article, we present the 12-month data of EnligHTN I, a first-in-human study using a multielectrode ablation catheter. EnligHTN I enrolled 46 patients (average age, 60±10 years; on average 4.7±1.0 medications) with drug-resistant hypertension. Eligible patients were on ≥3 antihypertensive medications and had a systolic blood pressure (BP) ≥160 mm Hg (≥150 mm Hg for diabetics). Bilateral renal artery ablation was performed using a percutaneous femoral approach and standardized techniques. The average baseline office BP was 176/96 mm Hg, average 24-hour ambulatory BP was 150/83 mm Hg, and average home BP was 158/90 mm Hg. The average reductions (mm Hg) at 1, 3, 6, and 12 months were as follows: office: −28/−10, −27/−10, −26/−10, and −27/−11 mm Hg (P<0.001 for all); 24-hour ambulatory: −10/−5, −10/−5, −10/−6 (P<0.001 for all), and −7/−4 for 12 months (P<0.0094). Reductions in home measurements (based on 2-week average) were −9/−4, −8/−5,−10/−7, and −11/−6 mm Hg (P<0.001 at 12 months). At 12 months, there were no signals of worsening renal function and no new serious or life-threatening adverse events. One patient with baseline nonocclusive renal artery stenosis progressed to 75% diameter stenosis, requiring renal artery stenting. The 12-month data continue to demonstrate safety and efficacy of the EnligHTN ablation system in patients with drug-resistant hypertension. Home BP measurements parallel measurements obtained with 24-hour ambulatory monitoring.

Catheter-Based Renal Denervation for Resistant HypertensionNovelty and Significance

Renal denervation has emerged as a novel approach for the treatment of patients with drug-resistant hypertension. To date, only limited data have been published using multielectrode radiofrequency ablation systems. In this article, we present the 12-month data of EnligHTN I, a first-in-human study using a multielectrode ablation catheter. EnligHTN I enrolled 46 patients (average age, 60±10 years; on average 4.7±1.0 medications) with drug-resistant hypertension. Eligible patients were on ≥3 antihypertensive medications and had a systolic blood pressure (BP) ≥160 mm Hg (≥150 mm Hg for diabetics). Bilateral renal artery ablation was performed using a percutaneous femoral approach and standardized techniques. The average baseline office BP was 176/96 mm Hg, average 24-hour ambulatory BP was 150/83 mm Hg, and average home BP was 158/90 mm Hg. The average reductions (mm Hg) at 1, 3, 6, and 12 months were as follows: office: −28/−10, −27/−10, −26/−10, and −27/−11 mm Hg ( P <0.001 for all); 24-hour ambulatory: −10/−5, −10/−5, −10/−6 ( P <0.001 for all), and −7/−4 for 12 months ( P <0.0094). Reductions in home measurements (based on 2-week average) were −9/−4, −8/−5,−10/−7, and −11/−6 mm Hg ( P <0.001 at 12 months). At 12 months, there were no signals of worsening renal function and no new serious or life-threatening adverse events. One patient with baseline nonocclusive renal artery stenosis progressed to 75% diameter stenosis, requiring renal artery stenting. The 12-month data continue to demonstrate safety and efficacy of the EnligHTN ablation system in patients with drug-resistant hypertension. Home BP measurements parallel measurements obtained with 24-hour ambulatory monitoring. # Novelty and Significance {#article-title-41}Renal denervation has emerged as a novel approach for the treatment of patients with drug-resistant hypertension. To date, only limited data have been published using multielectrode radiofrequency ablation systems. In this article, we present the 12-month data of EnligHTN I, a first-in-human study using a multielectrode ablation catheter. EnligHTN I enrolled 46 patients (average age, 60±10 years; on average 4.7±1.0 medications) with drug-resistant hypertension. Eligible patients were on ≥3 antihypertensive medications and had a systolic blood pressure (BP) ≥160 mm Hg (≥150 mm Hg for diabetics). Bilateral renal artery ablation was performed using a percutaneous femoral approach and standardized techniques. The average baseline office BP was 176/96 mm Hg, average 24-hour ambulatory BP was 150/83 mm Hg, and average home BP was 158/90 mm Hg. The average reductions (mm Hg) at 1, 3, 6, and 12 months were as follows: office: −28/−10, −27/−10, −26/−10, and −27/−11 mm Hg (P<0.001 for all); 24-hour ambulatory: −10/−5, −10/−5, −10/−6 (P<0.001 for all), and −7/−4 for 12 months (P<0.0094). Reductions in home measurements (based on 2-week average) were −9/−4, −8/−5,−10/−7, and −11/−6 mm Hg (P<0.001 at 12 months). At 12 months, there were no signals of worsening renal function and no new serious or life-threatening adverse events. One patient with baseline nonocclusive renal artery stenosis progressed to 75% diameter stenosis, requiring renal artery stenting. The 12-month data continue to demonstrate safety and efficacy of the EnligHTN ablation system in patients with drug-resistant hypertension. Home BP measurements parallel measurements obtained with 24-hour ambulatory monitoring.

PRE-HOSPITAL NOTIFICATION OF STEMI (PNS): COLLABORATION BETWEEN THE VICTORIAN CARDIAC CLINICAL NETWORK, AMBULANCE VICTORIA AND PARTICIPATING HOSPITALS

Previous studies have shown that PNS by emergency medical services (EMS) reduces time to reperfusion. PNS was introduced into all PCI capable public and one private hospital in the state of Victoria, Australia in early 2010. We report on the outcomes. STEMI patients were taken to the nearest PCI-

TCT-235 Accuracy of 320 computed tomography coronary angiography in detection of functionally significant stenoses - comparison with FFR

Fractional flow reserve assessment (FFR) may identify functionally significant coronary lesions which may benefit from revascularisation. It is predominantly performed upon identification of ≥50% stenosis on invasive angiography (ICA). The accuracy of 320-detector computed tomography coronary

Novel Thrombus Burden Guided Thrombus Aspiration Catheter Use During Primary Percutaneous Coronary Intervention in the Management of ST Elevation Myocardial Infarction

index derived. Troponin (TnT) was measured at admission, and daily until peak. Results: Infarct size mean 20± 11% (range 0–48.3%), Edema volume 35± 12.9% of LVmass. Myocardial salvage 15.59± 12.5% (range−1 to 46.5%).Myocardial hemorrhage present in 12 (20%), only in the largest 2 quartiles of IS. Infarct size correlated with peak Tn, as is well-recognized, p= 00001. The difference between Admission and Peak troponin (delta-Tn) correlated to the degree of myocardial salvage, p= 0.04. Admission troponin correlated with perfusion score, p= 0.016, as has been previously demonstrated by our group. Conclusions: CMR provides a powerful tool for quantitation of myocardial salvage. Delta-Tn correlates to myocardial salvage by CMR, whereas admission troponin correlates more strongly to resting perfusion defect. This sheds greater light on the relationship between biomarkers and myocardial salvage after STEMI. doi:10.1016/j.hlc.2010.06.738

Assessment of Coronary Plaque Presence and Composition by 320-Slice Cardiac Computed Tomography: A Comparative Study Using Intravascular Ultrasound

Background: Non-invasive determination of coronary plaque burden and composition may be important for the predictionof future cardiovascular events.Wedetermined the diagnostic accuracy of latest generation 320-slice CT angiography for thedetectionandcharacterisationof coronary plaque on a per-segment basis compared with gold standard intravascular ultrasound (IVUS). Methods: We analysed the datasets of 13 patients with suspected or known coronary artery disease who underwent both 320-slice CT with 350ms gantry rotation, 320mm× 0.5mmcollimation (AquilionOne, Toshiba Japan), 60–90mls contrast agent and IVUS (iLab, Boston Scientific USA) within a 4-week time period. Diagnostic image quality was achieved in all segments on CT. The arteries were divided into coronary segments using the AHA 17-segment coronary model referenced to fiduciary landmarks on both modalities. CT and IVUS studies were interpreted by independent blinded expert observers as computed tomography (MDCT) in assessing global LV function, and no data exists regarding its ability to assess LV regional wall motion (RWM). Methods: We evaluated 50 consecutive patients (mean age 60± 14 years, 66% male) who underwent 320-slice MDCT (dose-modulated retrospective electrocardiogram-triggering) and 2D-echocardiography within 30 days for investigation of known or suspected coronary disease. Two blinded cardiologists measured LV volumes on MDCT and visually assessed RWM with a 4-point scale using a 17-segment model. A separate experienced echocardiologist, blinded to MDCT findings, assessed LV RWM on 2D-echocardiograms and determined LV volumes and LV ejection fraction (LVEF) using the Simpson’s biplane method. 2D-echocardiography served as the reference standard. Results: Mean LVEF was 59± 8% (range 26–75%) on 2D-echocardiography and 60± 9% (range 27–76%) on MDCT. Using linear regression analysis, MDCT agreed very well with 2D-echocardiography for assessment of LVEDV (r= 0.94; P< 0.001), LVESV (r= 0.97; P< 0.001) and LVEF (r= 0.95; P< 0.001). Mean differences (±S.D.) of 14± 13ml, 5± 7ml and 1± 3% were observed between MDCT and 2D-echocardiography for LVEDV, LVESV and LVEF, respectively. 81/850 (9.5%) LV segments had abnormal RWM on 2D-echocardiography. Agreement for assessment of RWM between 2D-echocardiography and