Eysenck, W;
van Zalen, J;
Freemantle, N;
Lloyd, G;
Furniss, S;
Sulke, N;
(2019)
The hemodynamic effects of a central iliac arteriovenous anastomosis at 6 months in patients with resistant and uncontrolled hypertension.
The Journal of Clinical Hypertension
, 21
(9)
pp. 1399-1405.
10.1111/jch.13646.
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Abstract
A central iliac arteriovenous anastomosis, termed the “coupler” (ROX Medical), results in a significant reduction in blood pressure (BP) in hypertensive patients. This study assessed functional and hemodynamic changes induced by the device. Twenty‐one patients with resistant and/or uncontrolled hypertension underwent stress echocardiography and cardiopulmonary exercise testing (CPET) at baseline and 6 months post‐coupler implantation. End points were selected to best evaluate cardiac function including Doppler stroke volume (SV), septal and lateral E/E′, and right ventricular systolic velocity S′ (RV S′). CPET VO_{2} peak demonstrated total cardiopulmonary performance. SV increased from 76.4 SD12.2 mL to 92.1 SD22.7 mL 6 months post‐coupler insertion; P = .002. No changes in RV S′, septal or lateral E/E′, or VO_{2} peak were observed. Five patients experienced increased diuretic requirement ≥3 times baseline. RV S′ fell from 19.0 SD1.87 cm/s to 16.80 SD3.43 cm/s in these patients (P > .05). A significant increase in SV 6 months post‐coupler insertion was observed. In patients with increased diuretic requirement, the device was associated with a lower RV S′ suggesting occult RV dysfunction as the mechanism of this pre‐specified adverse outcome.
| Type: | Article |
|---|---|
| Title: | The hemodynamic effects of a central iliac arteriovenous anastomosis at 6 months in patients with resistant and uncontrolled hypertension |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/jch.13646 |
| Publisher version: | https://doi.org/10.1111/jch.13646 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | advanced echocardiography, cardiopulmonary exercise testing, hypertension, iliac arteriovenous fistula |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > Comprehensive CTU at UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10082030 |
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