Cardiac structure and function after revascularization versus medical therapy for renal artery stenosis: the ASTRAL heart echocardiographic sub-study

• Published in: BMC nephrology Vol. 20; no. 1; p. 220
• Main Authors: Green, Darren, Vassallo, Diana, Handley, Kelly, Ives, Natalie, Wheatley, Keith, Chrysochou, Constantina, Hegarty, Janet, Wright, Julian, Moss, Jon, Patel, Rajan K, Deighan, Chris, Webster, John, Rowe, Peter, Carr, Sue, Cross, Jenny, O'Driscoll, Jamie, Sharma, Raj, Mark, Patrick, Kalra, Philip A
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 14.06.2019; BioMed Central; BMC
• Subjects: Aorta; Arterial stenosis; Arteriosclerosis; Blood pressure; Cardiovascular disease; Care and treatment; Clinical trials; Comparative analysis; Echocardiography; Edema; Ethics; Heart; Heart failure; Hypertension; Left ventricular hypertrophy; Medical examination; Morbidity; Nephrology; Patient outcomes; Patients; Randomized controlled trial; Renal artery; Renal artery obstruction; Renal artery stenosis; Renal function; Revascularization; Stenosis; Structure-function relationships; Vascular diseases; Vascular surgery; Ventricle; United Kingdom; United Kingdom > UK; Echocardiography; Randomized controlled trial; Renal artery stenosis; Left ventricular hypertrophy; Revascularization
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-019-1406-y

The ASTRAL trial showed no difference in clinical outcomes between medical therapy and revascularization for atherosclerotic renal vascular disease (ARVD). Here we report a sub-study using echocardiography to assess differences in cardiac structure and function at 12 months. ASTRAL patients from 7 participating centres underwent echocardiography at baseline and 12 months after randomisation. Changes in left ventricular ejection fraction (LVEF), left ventricular mass (LVM), left atrial diameter (LAD), aortic root diameter (AoRD), E:A, and E deceleration time (EDT) were compared between study arms. Analyses were performed using t-tests and multivariate linear regression. Ninety two patients were included (50 medical versus 42 revascularization). There was no difference between arms in any baseline echocardiographic parameter. Comparisons of longitudinal changes in echocardiographic measurements were: δLVEF medical 0.8 ± 8.7% versus revascularization - 2.8 ± 6.8% (p = 0.05), δLVM - 2.9 ± 33 versus - 1.7 ± 39 g (p = 0.9), δLAD 0.1 ± 0.4 versus 0.01 ± 0.5 cm (p = 0.3), δAoRD 0.002 ± 0.3 versus 0.06 ± 0.3 cm (p = 0.4), δE:A - 0.0005 ± 0.6 versus 0.03 ± 0.7 (p = 0.8), δEDT - 1.1 ± 55.5 versus - 9.0 ± 70.2 ms (p = 0.6). In multivariate models, there were no differences between treatment groups for any parameter at 12 months. Likewise, change in blood pressure did not differ between arms (mean δsystolic blood pressure medical 0 mmHg [range - 56 to + 54], revascularization - 3 mmHg [- 61 to + 59], p = 0.60). This sub-study did not show any significant differences in cardiac structure and function accompanying renal revascularization in ASTRAL. Limitations include the small sample size, the relative insensitivity of echocardiography, and the fact that a large proportion of ASTRAL patient population had only modest renal artery stenosis as described in the main study.