Catheter-based renal denervation reduced blood pressure and left ventricular mass index and improved ejection fraction and strain in resistant hypertension, partly independent of BP.
Does catheter-based renal denervation reduce left ventricular mass and improve cardiac function in patients with resistant hypertension?
Catheter-based renal denervation may provide structural and functional cardiac benefits in resistant hypertension beyond just blood pressure lowering.
AIMS: Sympathetic stimulation induces left ventricular hypertrophy and is associated with increased cardiovascular risk. Catheter-based renal denervation (RDN) has been shown to reduce sympathetic outflow and blood pressure (BP). The present multi-centre study aimed to investigate the effect of RDN on anatomic and functional myocardial parameters, assessed by cardiac magnetic resonance (CMR), in patients with resistant hypertension. METHODS AND RESULTS: Cardiac magnetic resonance was performed in 72 patients (mean age 66 ± 10 years) with resistant hypertension (55 patients underwent RDN, 17 served as controls) at baseline and after 6 months. Clinical data and CMR results were analysed blindly. Renal denervation significantly reduced systolic and diastolic BP by 22/8 mm Hg and left ventricular mass index (LVMI) by 7.1% (46.3 ± 13.6 g/m(1.7) vs. 43.0 ± 12.6 g/m(1.7), P < 0.001) without changes in the control group (41.9 ± 10.8 g/m(1.7) vs. 42.0 ± 9.7 g/m(1.7), P = 0.653). Ejection fraction (LVEF) in patients with impaired LVEF at baseline (<50%) significantly increased after RDN (43% vs. 50%, P < 0.001). Left ventricular circumferential strain as a surrogate of diastolic function in the subgroup of patients with reduced strain at baseline increased by 21% only in the RDN group (-14.8 vs. -17.9; P = 0.001) and not in control patients (-15.5 vs. -16.4, P = 0.508). CONCLUSIONS: Catheter-based RDN significantly reduced BP and LVMI and improved EF and circumferential strain in patients with resistant hypertension, occurring partly BP independently.
“This small study by Mahfoud and colleagues investigating the effect of RDN on cardiac mass and function, as assessed by blinded CMR, is therefore of great interest. In 55 patients treated with the first generation Symplicity device (Medtronic), there was a significant reduction in LV hypertrophy, even in those 'nonresponders' who did not experience a substantial reduction in BP. This raises the intriguing possibility that RDN may have beneficial effects in addition to BP reduction.”
Mahfoud et al. (2014) studied this question. Catheter-based renal denervation reduced blood pressure and left ventricular mass index and improved ejection fraction and strain in resistant hypertension, partly independent of BP.
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