Improvement of Myocardial Function Following Catheter-Based Renal Denervation in Heart Failure

Figure 1. Renal Denervation Procedure and Histological Assessment (A) Renal angiogram of left renal artery in anteroposterior view before renal denervation (RD). (B) A 5-F quadripolar multiple electrode array ablation catheter (EnligHTNTM, St. Jude Medical, St. Paul, Minnesota) that consists of an expandable basket with 4 electrodes was used for RD. (C) An example of acute gross histology after RD to show the placement of lesions inside the renal artery. (D) Percentage area of left ventricular infarct as measured by histological examination in the control group (n = 10) and RD group (n = 10).

Figure 2. Hemodynamic Assessment Serial changes in (A) resting heart rate; (B) corrected QT interval; (C) systolic and diastolic blood pressure; (D) pulmonary capillary wedge pressure; (E) + maximum rate of left ventricular pressure rise (dP/dtmax); (F) −dP/dtmax; (G) +dP/dtmax normalized to instantaneous developed pressure (IP) (dP/dtmax/IP); and (H) stroke volume index at baseline, post myocardial infarction (post-MI), after induction of heart failure (MI + HF), and at 10-week follow-up in the control group (n = 10) and renal denervation (RD) group (n = 10).

Figure 3. Echocardiographic and Neurohormonal Parameters Serial changes in (A) left ventricular (LV) end-diastolic and -systolic diameter; (B) LV ejection fraction; and serum levels of (C) brain natriuretic peptide and (D) peripheral blood norepinephrine at baseline, post-MI, after MI + HF, and at 10-week follow-up in the control group (n = 10) and RD group (n = 10). (E) Changes in the venoarterial gradients of norepinephrine over the myocardium and left and right kidney during MI + HF and at 10-week follow-up in the control group (n = 10) and RD group (n = 10). Serial changes in serum levels of (F) angiotensin II and (G) creatinine at baseline, post-MI, after MI + HF, and at 10-week follow-up in the control group (n = 10) and RD group (n = 10). Abbreviations as in Figure 2.

Figure 4. Histological Assessment of Renal Denervation (A) Representative histological image of the renal sympathetic nerve as determined by tyrosine hydroxylase (TH) staining (red arrows) to show its distribution at the proximal, mid, and distal segments of renal arteries in the control and renal denervation (RD) groups. (B) Histological examination on the renal sympathetic nerve as determined by the immunofluorescence staining of TH-positive nerve in the control and RD groups. (Top) The percent area of TH-positive nerve at the proximal, mid, and distal segments of the renal arteries in the control and RD groups. (Bottom) The representative image of the immunofluorescence staining of TH-positive nerve (red arrows) at the proximal, mid, and distal segments of the renal arteries in the control and RD groups.