Renal Sympathetic Denervation Reduces Left Ventricular Hypertrophy and Improves Cardiac Function in Patients With Resistant Hypertension
Key result
Renal denervation linked to ~9 g/m2.7 reduction in LVMI in resistant hypertension.
- P<0.001
- n=64
Why the study?
The effect of catheter-based renal sympathetic denervation on left ventricular hypertrophy and left ventricular function in patients with resistant hypertension is unclear.
Does catheter-based bilateral renal sympathetic denervation reduce left ventricular hypertrophy and improve cardiac function in patients with resistant hypertension?
Key Points
- To investigate the effect of catheter-based renal sympathetic denervation on left ventricular hypertrophy and systolic and diastolic function in patients with resistant hypertension.
- Assessed 46 patients undergoing bilateral catheter-based renal sympathetic denervation and 18 control patients.
- Performed transthoracic echocardiography to evaluate cardiac structural and functional parameters at baseline, 1 month, and 6 months.
- Renal denervation reduced blood pressure by -22.5/-7.2 mm Hg at 1 month and -27.8/-8.8 mm Hg at 6 months (p < 0.001 for both).
- Mean interventricular septum thickness decreased from 14.1 ± 1.9 mm to 12.5 ± 1.4 mm at 6 months (p = 0.007), and left ventricular mass index decreased from 53.9 ± 15.6 g/m^2.7 to 44.7 ± 14.9 g/m^2.7 at 6 months (p < 0.001).
- Mitral valve lateral E/E' decreased from 9.9 ± 4.0 to 7.4 ± 2.7 (p < 0.001) and ejection fraction increased from 63.1 ± 8.1% to 70.1 ± 11.5% at 6 months (p < 0.001), with no significant changes observed in controls.
Study Design
Type
Cohort (n=64)
Structured PICO
Does catheter-based bilateral renal sympathetic denervation reduce left ventricular hypertrophy and improve cardiac function in patients with resistant hypertension?
P
Population
64 patients with resistant hypertension (46 undergoing renal denervation and 18 controls) followed for 6 months.
E
Exposure
Bilateral catheter-based renal sympathetic denervation (RD).
C
Comparator
Control group (specific background/matching therapy not stated in the abstract).
O
Outcome
Changes in left ventricular hypertrophy (interventricular septum thickness, LV mass index) and systolic/diastolic function (mitral valve lateral E/E', isovolumic relaxation time, ejection fraction) measured by transthoracic echocardiography at 1 month and 6 months.surrogate
Main Result
p-value: p=<0.001
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
UCUta C. HoppeCardiologist, Paracelsus Medical University Salzburg
“Extrapolating from drug trials, the effect on cardiac remodeling documented in our study suggests a prognostic benefit of [renal denervation] in patients with refractory hypertension, which should be evaluated in future trials”
“It seems likely that both a decrease in LV myocardial load and a decrease in activation of the sympathetic nervous system contribute to these outcomes”
Implication
In patients with resistant hypertension, catheter-based renal sympathetic denervation reduces blood pressure while concurrently regressing left ventricular mass and improving both systolic and diastolic cardiac function.
Abstract
OBJECTIVES: This study investigated the effect of catheter-based renal sympathetic denervation (RD) on left ventricular hypertrophy (LVH) and systolic and diastolic function in patients with resistant hypertension. BACKGROUND: LVH and diastolic dysfunction are associated with elevated sympathetic activity and increased morbidity and mortality. The effect of RD on LVH and LV function is unclear. METHODS: Forty-six patients underwent bilateral RD, and 18 patients served as controls. Transthoracic echocardiography was performed at baseline, and after 1 month and 6 months. RESULTS: Besides reduction of systolic and diastolic blood pressure (-22.5/-7.2 mm Hg at 1 month and -27.8/-8.8 mm Hg at 6 months, p < 0.001 at each time point), RD significantly reduced mean interventricular septum thickness from 14.1 ± 1.9 mm to 13.4 ± 2.1 mm and 12.5 ± 1.4 mm (p = 0.007), and LV mass index from 53.9 ± 15.6 g/m(2.7) (112.4 ± 33.9 g/m(2)) to 47.0 ± 14.2 g/m(2.7) (103.6 ± 30.5 g/m(2)) and 44.7 ± 14.9 g/m(2.7) (94.9 ± 29.8 g/m(2)) (p < 0.001) at 1 month and 6 months, respectively. The mitral valve lateral E/E' decreased after RD from 9.9 ± 4.0 to 7.9 ± 2.2 at 1 month and 7.4 ± 2.7 at 6 months (p < 0.001), indicating reduction of LV filling pressures. Isovolumic relaxation time shortened (baseline 109.1 ± 21.7 ms vs. 85.6 ± 24.4 ms at 6 months, p = 0.006), whereas ejection fraction significantly increased after RD (baseline: 63.1 ± 8.1% vs. 70.1 ± 11.5% at 6 months, p < 0.001). No significant changes were obtained in control patients. CONCLUSIONS: Besides the known effect on blood pressure, our study showed for the first time that RD significantly reduces LV mass and improves diastolic function, which might have important prognostic implications in patients with resistant hypertension at high cardiovascular risk.
Discussion
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Cite This Study
Brandt et al. (2012) conducted a cohort in resistant hypertension (n=64). Catheter-based renal sympathetic denervation (RD) vs. Control patients was evaluated on Left ventricular mass index (p=<0.001). Catheter-based renal sympathetic denervation significantly reduced left ventricular mass index from 53.9 to 44.7 g/m2.7 (P<0.001) at 6 months in patients with resistant hypertension.