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
Felix Mahfoud, Daniel Urban, Desiree Teller, Dominik Linz, Philipp Stawowy, Jan-Hendrik Hassel, Peter Fries, Stephan Dreysse, Ernst Wellnhofer, Günther Schneider, Arno Buecker, Christopher Schneeweis, Adelina Doltra, Markus P Schlaich, Murray D Esler, Eckart Fleck, Michael Böhm, Sebastian Kelle, Felix Mahfoud, Daniel Urban, Desiree Teller, Dominik Linz, Philipp Stawowy, Jan-Hendrik Hassel, Peter Fries, Stephan Dreysse, Ernst Wellnhofer, Günther Schneider, Arno Buecker, Christopher Schneeweis, Adelina Doltra, Markus P Schlaich, Murray D Esler, Eckart Fleck, Michael Böhm, Sebastian Kelle
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.
Keywords: Cardiovascular magnetic resonance; Circumferential strain; Left ventricular hypertrophy; Renal nerve ablation; Resistant hypertension.
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Source: PubMed