Effect of renal denervation on left ventricular mass and function in patients with resistant hypertension: data from a multi-centre cardiovascular magnetic resonance imaging trial
Key result
RDN linked to reduced BP and LVMI and improved LVEF in resistant hypertension, partly independent of BP.
- 7.1% reduction
- P<0.001
- n=72
Why the study?
Sympathetic stimulation induces left ventricular hypertrophy and is associated with increased cardiovascular risk, but the effect of renal denervation on myocardial parameters in resistant hypertension was unclear.
Does catheter-based renal denervation improve left ventricular mass and function in patients with resistant hypertension?
Key Points
- To evaluate the impact of catheter-based renal denervation on anatomical and functional myocardial parameters assessed by cardiac magnetic resonance in patients with resistant hypertension.
- Conducted a multicenter controlled study involving 72 patients with resistant hypertension (mean age 66 ± 10 years), comparing 55 patients undergoing renal denervation against 17 control patients.
- Performed cardiac magnetic resonance imaging at baseline and at 6-month follow-up, with blinded analysis of all clinical and imaging data.
- Renal denervation reduced blood pressure by 22/8 mm Hg and decreased left ventricular mass index by 7.1% (from 46.3 ± 13.6 g/m^1.7 to 43.0 ± 12.6 g/m^1.7, P < 0.001), while controls showed no change (41.9 ± 10.8 g/m^1.7 vs. 42.0 ± 9.7 g/m^1.7, P = 0.653).
- Left ventricular ejection fraction in patients with baseline impairment (<50%) increased from 43% to 50% following renal denervation (P < 0.001).
- Left ventricular circumferential strain improved by 21% in the renal denervation group (-14.8 to -17.9, P = 0.001) compared to no significant difference in controls (-15.5 to -16.4, P = 0.508).
Structured PICO
Does catheter-based renal denervation improve left ventricular mass and function in patients with resistant hypertension?
P
Population
72 patients (mean age 66 years) with resistant hypertension, followed for 6 months.
I
Intervention
Catheter-based renal denervation (RDN)
C
Comparator
Control group (no RDN)
O
Outcome
Anatomic and functional myocardial parameters (including left ventricular mass index, ejection fraction, and circumferential strain) assessed by cardiac magnetic resonance at 6 monthssurrogate
Main Result
Effect estimate: 7.1% reduction
p-value: p=<0.001
Catheter-based renal denervation reduces left ventricular mass and improves systolic and diastolic function in patients with resistant hypertension at 6 months.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“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.”
“Interestingly, the structural and functional cardiac changes occurred partly BP independent, pointing towards a direct role of modulating sympathetic nervous system activity.”
Implication
Hypothesis-generating for BP-independent cardiac benefits in resistant HTN; leaves open outcomes pending randomized trials.
Abstract
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.
Discussion
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Cite This Study
Mahfoud et al. (2014) studied Resistant hypertension (n=72). Catheter-based renal denervation (RDN) vs. Control group was evaluated on Left ventricular mass index (LVMI) (7.1% reduction, p=<0.001). Catheter-based renal denervation significantly reduced left ventricular mass index by 7.1% (P<0.001) and blood pressure compared to controls in patients with resistant hypertension.