- Author
-
P.M. van Brussel
- Title
- Sympathetic crosstalk in the cardiorenal axis
- Supervisors
-
R.J. de Winter
- Co-supervisors
-
B.J.H. van den Born
L. Vogt - Award date
- 19 February 2021
- Number of pages
- 266
- ISBN
- 9789463613934
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
In this thesis, the sympathetic crosstalk of the cardiorenal axis is investigated at multiple levels.
The first part explores the hemodynamic and anti-arrhythmic effects of sympathetic modulation by renal sympathetic nerve ablation (RSD). In concert with previous reports, RSD led to a significant drop in office blood pressure. However, a reduction in sympathetic activity could not be demonstrated on a cardiac level. Also, an evident anti-arrhythmic effect could not be revealed from an extensive literature search. Also, the effects of weight reduction following bariatric surgery is investigated. In morbidly obese normotensive and mildly hypertensive women, gastric bypass surgery led to an improved hemodynamic profile and the enhanced baroreflex sensitivity suggests an altered autonomic balance towards increased parasympathetic heart rate control.
The second part focuses on translating the knowledge from intracoronary hemodynamic measurements - broadly implemented in daily cardiology practice - to the identification of functionally relevant renal artery stenosis. The predictive potentials for treatment outcome of combined measurements of pressure and flow velocity is investigated. Also, we demonstrate that combined measurements of pressure and flow velocity appear feasible and reproducible. A novel method to measure intraglomerular pressure is introduced.
The holy grail would be that these measurements reflecting flow reserve and intraglomerular pressure represent a benchmark for future non-invasive measurements (e.g., computational fluid dynamics). By all means, implementation of these measurements in daily practice will have to be preceded by studies that investigate how to induce hyperaemia with absence of intravascular administration of vasodilators. - Persistent Identifier
- https://hdl.handle.net/11245.1/f1e64c6c-26aa-4335-8d5c-693a7c39ca47
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: Introduction and general outline
Chapter 2: Effects of renal sympathetic denervation on cardiac sympathetic activity and function in patients with therapy resistant hypertension
Chapter 3: Cardio-renal axis and arrythhmias: will renal sympathetic denervation provide additive value to the therapeutic arsenal?
Chapter 4: Blood pressure reduction after gastric bypass surgery is explained by a decrease in cardiac output
Chapter 5: Renal angioplasty for atherosclerotic renal artery stenosis: a comparative case series and systematic review
Chapter 6: Feasibility and reproducibility of renal flow reserve with combined pressure and flow measurements in humans
Chapter 7: Hemodynamic measurements for the selection of patients with renal artery stenosis: a systematic review
Chapter 8: Estimation of intraglomerular pressure using invasive renal arterial pressure and flow velocity measurements in humans
Chapter 9: Summary and general discussion
Chapter 10: Addenda
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