Comparative analysis of cardioprotective effects of two renal denervation techniques

• Published in: Rossiĭskiĭ kardiologicheskiĭ zhurnal Vol. 25; no. 12; p. 3994
• Main Authors: Ripp, T. M., Pekarskiy, S. E., Baev, A. E., Ryabova, T. R., Yaroslavskay, E. I., Falkovskaya, A. Yu, Sitkova, E. S., Lichikaki, V. A., Zubanova, I. V., Manukian, M. A., Gapon, L. I., Mordovin, V. F.
• Format: Journal Article
• Language: English
• Published: FIRMA «SILICEA» LLC 30-12-2020
• Subjects: diastolic function; heart; hypertension; renal denervation
• DOI: 10.15829/1560-4071-2020-3994
• EISSN: 2618-7620
• ISSN: 1560-4071

Aim
. To compare cardioprotective effects of two renal denervation (RD) techniques: main renal artery or its branches after bifurcation in patients with resistant hypertension (RH).
Materials and methods
. This randomized double-blind clinical (ClinicalTrials. gov. identifier: NCT02667912) study with a follow-up of 12,3±1,6 months included 55 patients with RH, which was divided into 2 groups: group 1 (n=27) — main renal artery denervation; group 2 — RD of branches. Mean age of patients was 57,3±9,5 and 56,4±9,3 years, respectively. We assessed structural and functional cardiac characteristics using two-dimensional speckle-tracking echocardiography (STE).
Results
. Initially, the patients in the groups did not differ in terms of studied parameters and therapy. After RD in both groups, the levels of myocardial stress significantly decreased; 95% confidence interval: after main renal artery denervation — systolic [-4802; -2896], diastolic [-3264; -2032] dyne/cm
2
; after RD of branches — [-6324; -5328] and [-4021; -2521] dyne/cm
2
, respectively (p=0,001 and 0,024, respectively). After main renal artery denervation, there was a decrease in the left ventricular (LV) wall thickness (interventricular septum [1,06; -0,62] and posterior wall [0,12; -0,62]) in comparison with RD of branches ([-0,68; -1,28] and [-0,68; -1,06], respectively). These differences were significant: p=0,023 and 0,021, respectively. After distal RD, decrease in the LV mass was observed more often by 21,2%, an increase in the LV mass was 2 times less frequent. Restoration of diastolic function was more common in patients after distal RD than main renal artery denervation (26% vs 13%, respectively). According to pilot analysis, STE parameters was also improved.
Conclusion
. Twelve months after distal RD, compared with the main renal artery denervation, the LV wall thickness, number of patients with LV hypertro -phy, and diastolic dysfunction decreased significantly greater. Two-dimensional STE revealed improvement of cardiac parameters. The results require further research.