Cardiology Research Department, Eastbourne General Hospital, East Sussex, UK.
Institute of Clinical Trials and Methodology, University College London, London, UK.
J Clin Hypertens (Greenwich). 2019 Sep;21(9):1399-1405. doi: 10.1111/jch.13646. Epub 2019 Jul 26.
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 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 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.
中央髂动脉动静脉吻合术，称为“耦合器”（ROX Medical），可显著降低高血压患者的血压（BP）。本研究评估了该装置引起的功能和血液动力学变化。21 名患有难治性和/或不受控制的高血压患者在基线和耦合器植入后 6 个月进行了超声心动图和心肺运动测试（CPET）。终点被选择来最好地评估心脏功能，包括多普勒每搏量（SV）、间隔和侧壁 E/E'以及右心室收缩速度 S'（RV S'）。CPET VO 峰值显示了心肺总性能。SV 从耦合器插入后 6 个月的 76.4 SD12.2 mL 增加到 92.1 SD22.7 mL；P = 0.002。未观察到 RV S'、间隔或侧壁 E/E'或 VO 峰值的变化。5 名患者的利尿剂需求增加≥3 倍基线。在这些患者中，RV S'从 19.0 SD1.87 cm/s 下降到 16.80 SD3.43 cm/s（P > 0.05）。耦合器插入后 6 个月 SV 显著增加。在利尿剂需求增加的患者中，该装置与较低的 RV S'相关，表明隐匿性 RV 功能障碍是该预先指定的不良结果的机制。
