Abstract 14508: Favorable Effects of Multi-Electrode Catheter-Based Renal Sympathetic Denervation on Left Ventricular Mass, Diastolic Function and Neurohormonal Activation in Resistant Hypertension
Introduction: The beneficial effects of renal sympathetic denervation (RSD) in resistant hypertensive patients may extend beyond blood pressure (BP) reduction to other cardiac parameters and neurohormonal pathways.
Hypothesis: Multi-electrode catheter-based RSD may have favorable effects on left ventricular structural and functional indices, as well as on neurohormonal activation reflected by N-terminal pro B-type natriuretic peptide (NT-proBNP).
Methods: Twenty patients with resistant hypertension (age: 57±10years, 13 males, office BP: 180/96±19/16 mmHg under 4.4±0.61 medications) that underwent RSD were followed up at 6 months. A full transthoracic echocardiographic study was performed in all patients at both baseline and follow-up. Left ventricular mass was calculated using the Devereux formula and was indexed for body surface area and height, while tissue Doppler imaging indices of diastolic function were measured. Moreover, blood sampling was performed in order to estimate metabolic profile and NT pro-BNP levels.
Results: In addition to reducing average office systolic and diastolic BP by 41 mmHg and 16 mmHg, respectively, (p<0.001), RSD decreased mean interventricular septum thickness from 12.1±1.2 mm to 11.6±1.2 mm (p=0.04) and left ventricular mass index from 136±20 g/m2 (56.5±8.7 g/m2.7) to 123±22 g/m2 (51.2±9.2 g/m2.7) (p=0.004) at 6 months. Left atrial diameter and volume were reduced from 42.1±4.3 mm to 41±3.6 mm (p=0.002) and from 62.3±13.5 ml to 51.7±9.5 ml (p=0.001), respectively. Regarding diastolic function RSD caused an increase in mitral valve E[[Unable to Display Character: ]]/A[[Unable to Display Character: ]] ratio from 0.62±0.28 to 0.82±0.39 (p=0.021) and a decrease in the E/E[[Unable to Display Character: ]] ratio from 14.8±5.9 to 11.7±3.1 (p=0.009), whereas isovolumic relaxation time was shortened from 111.1±17.2 ms to 100.7±16.2 ms (p=0.001). Furthermore, RSD resulted in a statistically significant reduction in NT-proBNP levels from 85±34.4 pg/ml to 58.6±36.9 pg/ml (p<0.001).
Conclusions: In addition to reducing BP in resistant hypertensive patients, RSD results in favorable cardiac remodeling and attenuation of neurohormonal overdrive as reflected by decreased NT-proBNP levels. These results suggest pleiotropic cardiovascular benefits of RSD therapy in the setting of resistant hypertension.
- © 2013 by American Heart Association, Inc.