Abstract 17627: Assessment of Stiffness in Patients Undergoing Renal Sympathetic Denervation - Ascending Aortic Distensibility Predicts Blood Pressure Response
Introduction: The effectiveness of catheter-based renal sympathetic denervation (RDN) as a treatment for therapy resistant hypertension has been questioned after the results of the Simplicity-HTN3-trial have been published. The insufficient BP lowering effects in this trial’s cohort might to some extent be explained by a certain proportion of patients not responding to renal denervation. Recently, we were able to show that central arterial stiffness, measured by invasive pulse wave velocity (IPWV) is an excellent predictor for renal denervation success. Since IPWV requires catheterization of the patients, non-invasive measures for aortic and arterial stiffness would be of some value.
Hypothesis: We aimed to investigate the prognostic value of cardiac magnetic resonance (CMR) based measures of arterial stiffness for a successful RDN.
Methods: Patients underwent CMR prior to RDN to assess ascending aortic distensibility (AAD), method of disc and forward flow derived total arterial compliance (TACvol and TACflow), and descending aortic diastolic reverse/forward flow and velocity ratio (RFFR and RFVR). Additionally, IPWV and invasive central aortic pulse pressure (IPP) were acquired immediately before RDN.
Results: Thirty-eight consecutive patients (29 responders and 9 non-responders) were available for this analysis. AAD and TACflow were significantly higher among responders, IPWV and IPP were higher among nonresponders. TACvol, RFFT and RFVR did not differ significantly between the two groups. Receiver operating characteristic (ROC) curves for IPWV and AAD revealed an area under the curve of 0.849 and 0.747 (p = 0.004 and 0.027). ROC curves for IPP and TACflow did not reach statistical significance.
Conclusions: AAD and IPWV are good predictors for successful RDN in patients with therapy resistant hypertension. These findings need to be confirmed in a larger, adequately powered cohort.
Author Disclosures: K. Fengler: None. K. Rommel: None. S. Blazek: None. M. von Roeder: None. G. Schuler: None. P. Lurz: None.
- © 2016 by American Heart Association, Inc.