Impact of Renal Sympathetic Denervation on Left Ventricular Structure and Function at 1-Year Follow-Up

Abstract

BackgroundCatheter-based sympathetic renal denervation (RDN) is a recent therapeutic option for patients with resistant hypertension. However, the impact of RDN in left ventricular (LV) mass and function is not completely established. Our aim was to evaluate the effects of RDN on LV structure and function (systolic and diastolic) in patients with resistant hypertension (HTN).Methods and ResultsFrom a single centre prospective registry including 65 consecutive patients with resistant HTN submitted to RDN between July-2011 and April-2015, 31 patients with baseline and 1-year follow-up echocardiogram were included in this analysis. Mean age was 65±7 years, 48% were males, 71% had type 2 diabetes. Most had hypertension lasting for more than 10 years (90%), and were being treated with a median number of 6 anti-hypertensive drugs, including 74% on spironolactone. At 1-year, there was a significant decrease both on office SBP (176±24 to 149±13mmHg, p<0.001) and DBP (90±14 to 79±11mmHg, p<0.001), and also in 24h ABPM SBP (150±20 to 132±14mmhg, p<0.001) and DBP (83±10 to 74±9mmHg, p<0.001). There was also a significant decrease in LV mass from 152±32 to 136±34g/m2 (p<0.001), an increase in LV end diastolic volume (93±18 to 111±27 mL, p = 0.004), an increase in LV ejection fraction (65±9 to 68±9%, p = 0.001) and mitral valve E deceleration time (225±49 to 247±51ms, p = 0.015) at 1-year follow up. There were no significant changes in left atrium volume index or in the distribution of patients among the different left ventricle geometric patterns and diastolic function subgroups.ConclusionsIn this single centre registry of patients with resistant hypertension, renal denervation was associated with significant reduction in both office and ABPM blood pressure and a significant decrease in left ventricle mass evaluated by transthoracic echocardiogram at 1 year follow-up.

Effects of Renal Denervation on Cardiac Structural and Functional Abnormalities in Patients with Resistant Hypertension or Diastolic Dysfunction

“…With regards to cardiac function, both E/e’ and EF were improved at 6 months, but none of them changed at 12 months. One potential explanation is that the number of trials included at 12 months was too small (only 2) 21 , 24 , and therefore it may be difficult to derive a conclusive analysis. More future studies should consider a longer follow up duration.…”

Device-Based Treatment in Hypertension: At the Forefront of Renal Denervation

“…[37] The difference in BP reduction between the 2 groups was À13 mmHg in favor of the RDN group. Left ventricular hypertrophy and left atrial enlargement are themselves risk factors for the development of atrial fibrillation, but RDN has been reported to improve them [19,[51][52][53][54] and a randomized sham-controlled trial using cardiac MRI showed that the stroke volume index was reduced by 4.7 mL/m 2 in the RDN group (difference between the 2 groups P = 0.008). [55] Furthermore, RDN has significantly improved the 6-minute walk in patients with chronic heart failure.…”

Cardiac pathology in patients with resistant hypertension

“…Коронарный резерв в трансмуральных сосудах, кровоснабжающих субэндокардиальные отделы сердца, даже в норме выраженно снижается по сравнению с субэпикардиальными артериями. Это снижение становится особенно значительным при повышении диастолического дав- [53][54][55][56][57][58][59] ления в ЛЖ у больных АГ и возрастании экстравазальной компрессии вследствие возникновения ГЛЖ [21,22]. Следует учитывать, что изменения трансмурального коронарного кровотока и коронарной микроциркуляции в ответ на действие психоэмоциональных и физических факторов модулируют преимущественно коронарные преартериолы и артериолы диаметром < 500 μm.…”

“…и 74,0 ± 9,0 мм рт. ст., p < 0,001) приводило к значительному уменьшению индекса ММ ЛЖ (152,0 ± 32,0 и 136,0 ± 34,0 г/м 2 ; p < 0,001) [59]. Отчетливый регресс ГЛЖ, по данным МРТ в отечественном исследовании по изучению кардиопротективных эффектов ренальной денервации, выполненном при включении 84 больных, не только не зависел от выраженности антигипертензивного эффекта лечения, но выявлялся и у пациентов с отсутствием должного снижения АД.…”