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3. Serial changes in vessel walls of renal arteries after catheter-based renal artery denervation: insights from volumetric computed tomography analysis

Author

Kataoka Y, Delacroix S, Sidharta S, Andrews J, Nicholls SJ, Tsioufis CP, Papademetriou V, and Worthley SG

Subjects
renal artery, blood pressure, resistant hypertension, renal denervation, computed tomography, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Yu Kataoka,1 Sinny Delacroix,2 Samuel Sidharta,2 Jordan Andrews,1 Stephen J Nicholls,1 Costas P Tsioufis,3 Vasilios Papademetriou,4 Stephen G Worthley2 1Vascular Research Center, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, SA, Australia; 2Department of Medicine, Cardiovascular Research Center, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia; 31st Department of Cardiology, University of Athens, Hippokration Hospital, Athens, Greece; 4Center for hypertension, kidney and vascular research, VA and Georgetown University Medical Centers, Washington DC, USA Aim: Radiofrequency ablation of peri-arterial renal autonomic nerves has been studied as a potential therapeutic option for resistant hypertension. While recent clinical trials have reported its efficacy, there is paucity of data addressing the effects of the procedure on renal arteries, such as changes in vessel and lumen areas. Herein, the effect of atheroma burden on renal arteries after renal denervation was assessed using computed tomography (CT) imaging. Materials and methods: Serial renal artery CT imaging was conducted in 38 patients from the EnligHTN™ I study, a prospective, multicenter study evaluating the efficacy of the EnligHTN multi-electrode radiofrequency ablation catheter in resistant hypertensive subjects. Cross-sectional images of renal arteries at 1 mm intervals were acquired using commercially available software (3mensio Structural Heart version 5.1). Vessel and lumen areas were manually traced in each image. Vessel wall volume (VWV) and percent vessel wall volume (P-VWV) were ­calculated. The measurements within the ablation (first 30 mm segments) and the non-ablation (subsequent 30 mm segment after the first bifurcation of renal arteries) zones were compared. Results: On serial evaluation, greater increase in P-VWV and VWV was observed in the ablation zone (change in P-VWV, 6.7%±5.1% vs 3.6%±2.8%, P=0.001; change in VWV, 106.3±87.4 vs 23.0±18.2 mm3, P=0.001). Receiver-operating characteristic analysis demonstrated baseline P-VWV in the ablation zone >37.1% as an optimal cutoff value to predict its substantial progression after the procedure (area under the curve=0.88, sensitivity 89.8%, specificity 79.1%). Conclusion: Change in vessel wall was greater within the segments receiving renal artery denervation. Baseline VWV predicted its substantial increase after the procedure. These observations suggest that atheroma burden within the renal arteries is a potential contributing factor to vascular changes after renal sympathetic denervation. Keywords: renal artery, blood pressure, resistant hypertension, renal denervation, computed tomography

Published
2018

4. Physical Rationale for Proton Therapy and Elements to Build a Clinical Center

Author

Mazal, A., Fournier-Bidoz, N., Goudjil, F., Delacroix, S., Nauraye, C., DeMarzi, L., Mabit, C., Pasquié, I., Robilliard, M., Patriarca, A., Wessels, C., Alapetite, C., Helfre, S., Mammar, H., Bolle, S., Calugarou, V., Feuvret, L., Habrand, J. L., Desjardins, L., Dendale, R., Fourquet, A., Rath, Arabinda Kumar, editor, and Sahoo, Narayan, editor

Published
2016
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7. Renal sympathetic denervation increases renal blood volume per cardiac cycle: a serial magnetic resonance imaging study in resistant hypertension

Author

Delacroix S, Chokka RG, Nelson AJ, Wong DT, Sidharta S, Pederson SM, Rajwani A, Nimmo J, Teo KS, and Worthley SG

Subjects
renal denervation, resistant hypertension, magnetic resonance imaging, renal blood flow, renal physiology, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Sinny Delacroix,1,2 Ramesh G Chokka,1,3 Adam J Nelson,1,2 Dennis T Wong,4 Samuel Sidharta,1,2 Stephen M Pederson,5 Adil Rajwani,1,2 Joanne Nimmo,1,2 Karen S Teo,1,2 Stephen G Worthley1,2 1Cardiovascular Research Centre, Royal Adelaide Hospital, 2Department of Medicine, University of Adelaide, Adelaide, SA, 3South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, SA, 4Monash Medical Centre, Clayton, VIC, 5Bioinformatics Hub, School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia Aim: Preclinical studies have demonstrated improvements in renal blood flow after renal sympathetic denervation (RSDN); however, such effects are yet to be confirmed in patients with resistant hypertension. Herein, we assessed the effects of RSDN on renal artery blood flow and diameter at multiple time points post-RSDN. Methods and results: Patients (n=11) with systolic blood pressures ≥160 mmHg despite taking three or more antihypertensive medications at maximum tolerated dose were recruited into this single-center, prospective, non-blinded study. Magnetic resonance imaging indices included renal blood flow and renal artery diameters at baseline, 1 month and 6 months. In addition to significant decreases in blood pressures (p

Published
2017

11. Does Chemo-Radiotherapy Improve Survival Outcomes vs. Radiotherapy Alone for High-Grade cT1 Urothelial Carcinoma of the Bladder?

Author

Andruska, N., primary, Fischer-Valuck, B.W., additional, Efstathiou, J.A., additional, Smith, Z., additional, Kim, E., additional, Brenneman, R.J., additional, Reimers, M., additional, Gay, H.A., additional, Patel, S.A., additional, Michalski, J.M., additional, Delacroix, S., additional, and Baumann, B.C., additional

Published
2022
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12. INTACT (S/N1806): Phase III Randomized Trial of Concurrent Chemoradiotherapy with or without Atezolizumab in Localized Muscle Invasive Bladder Cancer—Toxicity Update on First 213 Patients

Author

Singh, P., primary, Efstathiou, J.A., additional, Plets, M., additional, Jhavar, S.G., additional, Delacroix, S., additional, Tripathi, A., additional, Gupta, A., additional, Sachdev, S., additional, Jani, A., additional, Kirschner, A.N., additional, Tangen, C., additional, Bangs, R., additional, Joshi, M., additional, Costello, B.A., additional, Thompson, I.L., additional, Feng, F.Y., additional, and Lerner, S., additional

Published
2022
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16. Sex Differences in Baseline Characteristics Do Not Predict Early Outcomes after Percutaneous Coronary Intervention: Results from the Australian GenesisCare Cardiovascular Outcomes Registry (GCOR).

Author

Conradie, A, Delacroix, S, Duong, M, Schwarz, N, Chowdhury, E, Worthley, S, Atherton, J, Eccleston, D, Conradie, A, Delacroix, S, Duong, M, Schwarz, N, Chowdhury, E, Worthley, S, Atherton, J, and Eccleston, D

Abstract

OBJECTIVE: The effect of baseline differences between men and women on early outcomes after percutaneous coronary intervention (PCI). DESIGN, SETTING, PARTICIPANTS: This is an observational study of all participants in the GenesisCare Cardiovascular Outcomes Registry, undergoing PCI. The registry holds data for both emergency and elective procedures. Data was collected on 10,989 consecutive patients from 12 Australian Private Hospitals, including baseline demographics, co-morbidities, risk factors, PCI procedures, and lesion characteristics. MAIN OUTCOME MEASURES: Outcome was measured for complications (in-hospital death, peri-procedural myocardial infarctions, and bleeding events), at discharge and at 30-days for death, myocardial infarction, target lesion revascularisation (TLR), major adverse cardiac events (MACE), and unplanned readmissions. RESULTS: Women represented 23% of the study population, were significantly older, with a higher rate of hypertension and hyperlipidaemia. Heart failure was more common in women and was associated with a significantly higher average ejection fraction than in men. Women had a lower rate of pre-existing coronary artery disease (CAD), had less complex CAD, and needed fewer stents. Periprocedural complications were similar, but major bleeding was more common in women. The 30-day outcome was similar between men and women for death, myocardial infarction, target lesion revascularisation (TLR), major adverse cardiovascular events (MACE), and unplanned readmissions. CONCLUSIONS: Although significant differences were observed between women and men in both clinical presentation and complexity of disease, the 30-day outcome was similar for death and MACE. Women had a higher rate of major bleeding events, and lower adherence to statins and dual antiplatelet therapy (DAPT).

Published
2022

22. Identifying New Factors Associated With Cognitive Decline and Delirium After Transcatheter Aortic Valve Implantation: A Study Protocol

Author

Ghezzi, ES, Psaltis, PJ, Loetscher, T, Davis, D, Montarello, J, Lau, JK, Delacroix, S, Bourke, A, McLoughlin, J, Keage, M, Keage, HAD, Ghezzi, ES, Psaltis, PJ, Loetscher, T, Davis, D, Montarello, J, Lau, JK, Delacroix, S, Bourke, A, McLoughlin, J, Keage, M, and Keage, HAD

Abstract

Background: Transcatheter aortic valve implantation (TAVI) has become the standard-of-care for treatment of severe symptomatic aortic stenosis and is also being increasingly recommended for low-risk patients. While TAVI boasts positive post-procedural outcomes, it is also associated with cognitive complications, namely delirium and cognitive decline. There is a pressing need for accurate risk tools which can identify TAVI patients at risk of delirium and cognitive decline, as risk scores designed for general cardiovascular surgery fall short. The present effect-finding exploratory study will assess the utility of various measures in the context of aging and frailty in predicting who will and who will not develop delirium or cognitive impairment following TAVI. The measures we propose include gait, visual symptoms, voice, swallowing, mood and sleep. Methods: This is an observational prospective cohort study focused on identifying pre-procedural risk factors for the development of delirium and cognitive decline following TAVI. Potential risk factors will be measured prior to TAVI. Primary outcomes will be post-procedure cognitive decline and delirium. Secondary outcomes include activities of daily living, quality of life, and mortality. Delirium presence will be measured on each of the first 2 days following TAVI. All other outcomes will be assessed at 3-, 6-, and 12-months post-operatively. A series of logistic regressions will be run to investigate the relationship between potential predictors and outcomes (presence vs. absence of either delirium or cognitive decline). Discussion: This study will assess the strengths of associations between a range of measures drawn from frailty and aging literature in terms of association with cognitive decline and delirium following TAVI. Identified measures can be used in future development of TAVI risk prediction models, which are essential for the accurate identification of cognitive at-risk patients and successful application

Published
2021

24. 773 2-year Clinical Outcomes of Prasugrel, Ticagrelor or Clopidogrel Therapy Following Percutaneous Coronary Intervention from a Large Multi-Centre Australian Registry.

Author

Worthley S., Delacroix S., Chowdhury E., Pol D., Eccleston D., Worthley S., Delacroix S., Chowdhury E., Pol D., and Eccleston D.

Abstract

Background: Real-world data comparing outcomes for prasugrel, ticagrelor and clopidogrel use in patients undergoing percutaneous coronary intervention (PCI) is lacking. Method(s): Patients discharged following PCI and receiving dual anti-platelet therapy were stratified by thienopyridine received. We assessed the association of thienopyridine type with 1 and 2-year MACE (death, MI, stroke) adjusted for baseline clinical/lesion characteristics using data collected prospectively from 14 Australian sites. Secondary endpoints included safety, specifically the incidence of major bleeding (BARC 3,4 or 5) at discharge. Result(s): Data were available for 12,940 procedures from November 2008 until March 2019. Patients receiving prasugrel were more likely to be male, younger (mean age 62.3+/-8.7 years), obese and present with STEMI than those receiving either ticagrelor or clopidogrel (all p<0.001). At 2 years the primary end point occurred less frequently in the prasugrel group than in patients taking ticagrelor or clopidogrel (p=0.03). Conclusion(s): In a large Australian cohort, patients treated with prasugrel after PCI for any indication had significantly lower 2-year rates of death, myocardial infarction and stroke than those receiving either clopidogrel or ticagrelor. Major bleeding did not differ by type of thienopyridine used. [Formula presented]Copyright © 2020

Published
2020

50. Serial changes in vessel walls of renal arteries after catheter-based renal artery denervation: Insights from volumetric computed tomography analysis

Author

Kataoka, Y. Delacroix, S. Sidharta, S. Andrews, J. Nicholls, S.J. Tsioufis, C.P. Papademetriou, V. Worthley, S.G.

Abstract

Aim: Radiofrequency ablation of peri-arterial renal autonomic nerves has been studied as a potential therapeutic option for resistant hypertension. While recent clinical trials have reported its efficacy, there is paucity of data addressing the effects of the procedure on renal arteries, such as changes in vessel and lumen areas. Herein, the effect of atheroma burden on renal arteries after renal denervation was assessed using computed tomography (CT) imaging. Materials and methods: Serial renal artery CT imaging was conducted in 38 patients from the EnligHTN™ I study, a prospective, multicenter study evaluating the efficacy of the EnligHTN multi-electrode radiofrequency ablation catheter in resistant hypertensive subjects. Cross-sectional images of renal arteries at 1 mm intervals were acquired using commercially available software (3mensio Structural Heart version 5.1). Vessel and lumen areas were manually traced in each image. Vessel wall volume (VWV) and percent vessel wall volume (P-VWV) were calculated. The measurements within the ablation (first 30 mm segments) and the nonablation (subsequent 30 mm segment after the first bifurcation of renal arteries) zones were compared. Results: On serial evaluation, greater increase in P-VWV and VWV was observed in the ablation zone (change in P-VWV, 6.7%±5.1% vs 3.6%±2.8%, P=0.001; change in VWV, 106.3±87.4 vs 23.0±18.2 mm3, P=0.001). Receiver-operating characteristic analysis demonstrated baseline P-VWV in the ablation zone >37.1% as an optimal cutoff value to predict its substantial progression after the procedure (area under the curve=0.88, sensitivity 89.8%, specificity 79.1%). Conclusion: Change in vessel wall was greater within the segments receiving renal artery denervation. Baseline VWV predicted its substantial increase after the procedure. These observations suggest that atheroma burden within the renal arteries is a potential contributing factor to vascular changes after renal sympathetic denervation. © 2018 Kataoka et al.

Published
2018

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