Abstract 18628: Effects of Renal Sympathetic Denervation in Resistant Hypertension on Myocardial Structure, Function and Perfusion: A Serial CMR Study
Background: Single arm studies have demonstrated that renal denervation results in a significant reduction in blood pressure in patients with resistant hypertension. Echocardiographic studies have also shown improvements in simple cardiac indices associated with this procedure. However, the potential benefits on myocardial perfusion have never been assessed. This trial studied the effects of renal sympathetic denervation on myocardial structure, function and perfusion using CMR.
Methods: A total of 15 patients with treatment resistant hypertension were recruited for renal sympathetic denervation in this study. Myocardial perfusion was assessed with adenosine stress first pass perfusion imaging, performed at baseline and at six months and analysed using Qmass software v7.2. CMR indices included, LVESVi, LVEDVi, LVEF, LVSV, Left Atrial Volume Index (LAVi’s), and T1 mapping.
Results: Renal denervation resulted in a significant reduction of mean office blood pressures from 183/101 ± 19/14 mmHg to 142/83 ± 22/18 mmHg 6 months after procedure (p < 0.05). Myocardial perfusion reserve index improved from 2.2 ± 1 units at baseline to 2.9 ± 1 units 6 months following renal denervation. There was a decrease in LVESVi from baseline to six months post procedure (25 ± 13 ml/m2 vs 21 ± 9 ml/m2) p=0.03 LVEDVi also decreased, but non-significantly, from 78 ± 18 ml/m2 to 73 ± 17 ml/m2 (p=0.07). Likewise, there was a 10% decline in LAVi from 49 ± 12ml/m2 to 44 ±12 ml/m2 at 6 months (p=0.03). These changes were accompanied by significant improvement in LVEF from 68 ± 10 % to 72 ± 9 % (p=0.01). T1 mapping failed to detect fibrosis in these patients at baseline and therefore there was no change in this parameter during this period.
Conclusion: This study demonstrates that renal sympathetic denervation improves myocardial perfusion as assessed by CMR. Furthermore, there are associated improvements in cardiac volumes and function.
Author Disclosures: R.G. Chokka: None. S. Delacroix: None. S. Sahay: None. A.J. Nelson: None. J. Nimmo: None. D.T. Wong: None. A. Rajwani: None. A. Carbone: None. K. Williams: None. E.O. Lau: Employment; Modest; This study was supported by St.Jude Medical,Inc.,USA. C. Hata: Employment; Modest; This study was supported by St.Jude Medical,Inc.,USA. P. Chen: Employment; Modest; This study was supported by St.Jude Medical,Inc.,USA. K.S. Teo: None. S.G. Worthley: Research Grant; Modest; Moderate. Honoraria; Modest; Moderate. Consultant/Advisory Board; Modest; Moderate.
- © 2014 by American Heart Association, Inc.