Improvements in Left Ventricular Hypertrophy and Diastolic Function Following Renal Denervation: Effects Beyond Blood Pressure and Heart Rate Reduction

• Published in: Journal of the American College of Cardiology Vol. 63; no. 18; pp. 1916 - 1923
• Main Authors: SCHIRMER, Stephan H, SAYED, Marwa M. Y. A, REIL, Jan-Christian, UKENA, Christian, LINZ, Dominik, KINDERMANN, Michael, LAUFS, Ulrich, MAHFOUD, Felix, BÖHM, Michael
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 13.05.2014
• Subjects: Aged; Biological and medical sciences; Blood Pressure - physiology; Cardiology. Vascular system; Diastole - physiology; Female; Follow-Up Studies; Heart; Heart Rate - physiology; Humans; Hypertrophy, Left Ventricular - physiopathology; Hypertrophy, Left Ventricular - surgery; Kidney - innervation; Kidney - physiology; Kidney - surgery; Male; Medical sciences; Middle Aged; Prospective Studies; Single-Blind Method; Sympathectomy - trends; Treatment Outcome; Cardiac frequency; Cardiovascular disease; Kidney; Heart rate; Improvement; Reduction; Urinary system; Arterial pressure; Blood pressure; Hemodynamics; Circulatory system; Cardiology; Left ventricle performance; Denervation; Hypertrophy; heart rate; left ventricular hypertrophy; renal denervation; resistant hypertension; echocardiography
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2013.10.073

This study sought to investigate the interaction between blood pressure (BP) and heart rate (HR) reduction and changes in left ventricular (LV) structure and function following renal sympathetic denervation (RDN). Hypertension results in structural and functional cardiac changes. RDN reduces BP, HR, and LV mass and improves diastolic dysfunction. We evaluated LV size, mass, and function before and 6 months after RDN in 66 patients with resistant hypertension and analyzed results in relation to systolic BP (SBP) and HR. SBP decreased by 11 ± 3 mm Hg in the first, 18 ± 5 mm Hg in the second, and 36 ± 7 mm Hg in the third tertile of SBP at baseline (p < 0.001). HR decreased by 13 ± 4 beats/min, 8 ± 3 beats/min, and 11 ± 6 beats/min in tertiles of SBP (p for interaction between tertiles = 0.314). In all SBP tertiles, LV mass index (LVMI) decreased similarly (LVMI -6.3 ± 2.2 g/m(2.7), -8.3 ± 2.1 g/m(2.7), and -9.6 ± 1.9 g/m(2.7); p for interaction = 0.639). LVMI decreased unrelated to HR at baseline (p for interaction = 0.471). The diastolic parameters E-wave deceleration time, isovolumetric relaxation time, and E'-wave velocity improved similarly in all tertiles of SBP and HR. Changes in LV mass and function were also unrelated to reduction in SBP or HR. Vascular compliance improved dependently on BP but independently of HR reduction. In patients with resistant hypertension, LV hypertrophy and diastolic function improved 6 months after RDN, without significant relation to SBP and HR. These findings suggest a direct effect of altered sympathetic activity in addition to unloading on cardiac hypertrophy and function.