Renal Sympathetic Denervation Reduces Left Ventricular Hypertrophy and Improves Cardiac Function in Patients With Resistant Hypertension

Study Questions:

What is the impact of catheter-based renal denervation on left ventricular (LV) hypertrophy and cardiac function?

Methods:

The authors assessed cardiac mass and function in 64 patients (46 who underwent renal denervation and 18 controls) using echocardiography at baseline, and after 1 month and 6 months.

Results:

There was no change in the blood pressure, or measures of LV mass or diastolic function in the control group. Among patients undergoing renal denervation, there was a clinically significant reduction in systolic (-22 mm Hg) and diastolic blood pressure (-7 mm Hg) at 1 month that was sustained at 6 months (-27/-8.8 mm Hg). There was a significant decrease in mean interventricular septum thickness from 14.1 ± 1.9 mm to 13.4 ± 2.1 mm (at 1 month) and 12.5 ± 1.4 mm (p = 0.007) at 6 months. The LV mass index decreased from 53.9 ± 15.6 g/m2.7 to 47.0 ± 14.2 g/m2.7 at 1 month and 44.7 ± 14.9 g/m2.7 at 6 months (p < 0.001). An improvement in filling pressures was seen, with the mitral valve lateral E/E’ decreasing from 9.9 ± 4 to 7.9 ± 2.2 at 1 month and 7.4 ± 2.7 at 6 months (p < 0.001). There was a corresponding reduction in isovolumic relaxation time (from 109 ms at baseline to 85 ms at 6 months) and an increase in ejection fraction (63% at baseline to 70% at 6 months).

Conclusions:

The authors concluded that renal denervation was associated with a significant reduction in blood pressure, which was accompanied by a parallel improvement in LV diastolic function and a reduction in LV mass.

Perspective:

Renal denervation has the promise to radically change the care of patients with resistant hypertension. This study confirms that the reduction in blood pressure following this procedure is associated with significant improvement in diastolic function and reduction in cardiac mass. The ongoing SIMPLICITY-3 trial will provide the definitive answer, but it is quite likely that renal denervation will be an integral component of hypertension therapy in the near future.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Echocardiography/Ultrasound, Hypertension

Keywords: Hypertrophy, Left Ventricular, Denervation, Ventricular Function, Left, Sympathectomy, Blood Pressure, Diastole, Hypertension, Systole, Mitral Valve, Echocardiography


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