Key result
Renal artery revascularization added to medical therapy did not significantly improve left ventricular ejection fraction or other echocardiographic parameters of cardiac structure and function at 12 months compared to medical therapy alone.
Why the study?
Following the ASTRAL trial showing no difference in clinical outcomes between medical therapy and revascularization for ARVD, this sub-study assessed whether differences exist in cardiac structure and function at 12 months.
Does renal revascularization improve cardiac structure and function at 12 months compared to medical therapy in patients with atherosclerotic renal vascular disease?
RCT (n=92)
Open-label
1:1
Yes
Does renal revascularization improve cardiac structure and function at 12 months compared to medical therapy in patients with atherosclerotic renal vascular disease?
Absolute Event Rate: -2.8% vs 0.8%
p-value: p=0.05
Renal revascularization does not significantly alter cardiac structure or function at 12 months compared to medical therapy in patients with atherosclerotic renal vascular disease.
No cardiac benefit from revascularization in renal artery stenosis; hypothesis-generating and should not yet change practice.
BACKGROUND: The ASTRAL trial showed no difference in clinical outcomes between medical therapy and revascularization for atherosclerotic renal vascular disease (ARVD). Here we report a sub-study using echocardiography to assess differences in cardiac structure and function at 12 months. METHODS: ASTRAL patients from 7 participating centres underwent echocardiography at baseline and 12 months after randomisation. Changes in left ventricular ejection fraction (LVEF), left ventricular mass (LVM), left atrial diameter (LAD), aortic root diameter (AoRD), E:A, and E deceleration time (EDT) were compared between study arms. Analyses were performed using t-tests and multivariate linear regression. RESULTS: Ninety two patients were included (50 medical versus 42 revascularization). There was no difference between arms in any baseline echocardiographic parameter. Comparisons of longitudinal changes in echocardiographic measurements were: δLVEF medical 0.8 ± 8.7% versus revascularization - 2.8 ± 6.8% (p = 0.05), δLVM - 2.9 ± 33 versus - 1.7 ± 39 g (p = 0.9), δLAD 0.1 ± 0.4 versus 0.01 ± 0.5 cm (p = 0.3), δAoRD 0.002 ± 0.3 versus 0.06 ± 0.3 cm (p = 0.4), δE:A - 0.0005 ± 0.6 versus 0.03 ± 0.7 (p = 0.8), δEDT - 1.1 ± 55.5 versus - 9.0 ± 70.2 ms (p = 0.6). In multivariate models, there were no differences between treatment groups for any parameter at 12 months. Likewise, change in blood pressure did not differ between arms (mean δsystolic blood pressure medical 0 mmHg [range - 56 to + 54], revascularization - 3 mmHg [- 61 to + 59], p = 0.60). CONCLUSIONS: This sub-study did not show any significant differences in cardiac structure and function accompanying renal revascularization in ASTRAL. Limitations include the small sample size, the relative insensitivity of echocardiography, and the fact that a large proportion of ASTRAL patient population had only modest renal artery stenosis as described in the main study.
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Green et al. (2019) conducted an RCT in Atherosclerotic renovascular disease (n=92). Percutaneous renal artery revascularization vs. Medical therapy alone was evaluated on Change in left ventricular ejection fraction (LVEF) at 12 months (p=0.05). Renal artery revascularization added to medical therapy did not significantly improve left ventricular ejection fraction or other echocardiographic parameters of cardiac structure and function at 12 months compared to medical therapy alone.
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