Renal Sympathetic Denervation Reduces Left Ventricular Hypertrophy and Improves Cardiac Function in Patients With Resistant Hypertension

• Published in: Journal of the American College of Cardiology Vol. 59; no. 10; pp. 901 - 909
• Main Authors: Brandt, Mathias C., MD, Mahfoud, Felix, MD, Reda, Sara, MD, Schirmer, Stephan H., MD, PhD, Erdmann, Erland, MD, Böhm, Michael, MD, Hoppe, Uta C., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 06-03-2012; Elsevier; Elsevier Limited
• Subjects: Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure; Body mass index; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular diseases; Denervation; Diastole; diastolic function; Drug therapy; Echocardiography; Female; Follow-Up Studies; Heart; Heart attacks; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Hypertension; Hypertension - complications; Hypertension - physiopathology; Hypertension - therapy; Hypertrophy; Hypertrophy, Left Ventricular - etiology; Hypertrophy, Left Ventricular - physiopathology; Hypertrophy, Left Ventricular - therapy; Internal Medicine; Kidney; Kidney - innervation; Male; Medical sciences; Middle Aged; Mitral valve; Morbidity; Mortality; myocardial mass; Renal Artery - innervation; renal denervation; resistant hypertension; Retrospective Studies; Risk factors; Septum; Sympathectomy - methods; Systole; Treatment Outcome; Ventricle; Ventricular Function, Left - physiology; renal sympathetic denervation; hypertrophy; left ventricle; LV; systolic blood pressure; BP; DBP; diastolic blood pressure; left atrium; BMI; myocardial mass; SBP; blood pressure; renal denervation; body mass index; end-diastolic interventricular septum thickness; resistant hypertension; RWT; RD; diastolic function; left ventricular hypertrophy; LA; IVSTd; relative wall thickness; LVH; Hypertension; Resistance; Cardiac performance; Cardiovascular disease; Circulatory system; Cardiology; Kidney; Left ventricle; Denervation; Hypertrophy
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2011.11.034

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/m2.7 (112.4 ± 33.9 g/m2 ) to 47.0 ± 14.2 g/m2.7 (103.6 ± 30.5 g/m2 ) and 44.7 ± 14.9 g/m2.7 (94.9 ± 29.8 g/m2 ) (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.