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Wang J, Yin Y, Lu C, Lu Z, Hu J, Wang Y, Ge J, Jiang H, Yao C, Yan X, Ma W, Qi X, Dang Y, Chen S, Zhu J, Wang D, Ding C, Wang W, Liu J, Wang Y, Li H, Pan Z, Cui K, Li C, Liang X, Chen W, Sobotka PA, Zhang J, Esler M, Sun N, Chen M, Huo Y. Efficacy and safety of sympathetic mapping and ablation of renal nerves for the treatment of hypertension (SMART): 6-month follow-up of a randomised, controlled trial. EClinicalMedicine 2024; 72:102626. [PMID: 38756107 PMCID: PMC11096821 DOI: 10.1016/j.eclinm.2024.102626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Background Previous trials of renal denervation (RDN) have been designed to investigate reduction of blood pressure (BP) as the primary efficacy endpoint using non-selective RDN without intraoperatively verified RDN success. It is an unmet clinical need to map renal nerves, selectively denervate renal sympathetic nerves, provide readouts for the interventionalists and avoid futile RDN. We aimed to examine the safety and efficacy of renal nerve mapping/selective renal denervation (msRDN) in patients with uncontrolled hypertension (HTN) and determine whether antihypertensive drug burden is reduced while office systolic BP (OSBP) is controlled to target level (<140 mmHg). Methods We conducted a randomized, prospective, multicenter, single-blinded, sham-controlled trial. The study combined two efficacy endpoints at 6 months as primary outcomes: The control rate of patients with OSBP <140 mmHg (non-inferior outcome) and change in the composite index of antihypertensive drugs (Drug Index) in the treatment versus Sham group (superior outcome). This design avoids confounding from excess drug-taking in the Sham group. Antihypertensive drug burden was assessed by a composite index constructed as: Class N (number of classes of antihypertensive drugs) × (sum of doses). 15 hospitals in China participated in the study and 220 patients were enrolled in a 1:1 ratio (msRDN vs Sham). The key inclusion criteria included: age (18-65 years old), history of essential HTN (at least 6 months), heart rate (≥70 bpm), OSBP (≥150 mmHg and ≤180 mmHg), ambulatory BP monitoring (ABPM, 24-h SBP ≥130 mmHg or daytime SBP ≥135 mmHg or nighttime SBP ≥120 mmHg), renal artery stenosis (<50%) and renal function (eGFR >45 mL/min/1.73 m2). The catheter with both stimulation and ablation functions was inserted in the distal renal main artery. The RDN site (hot spot) was selected if SBP increased (≥5 mmHg) by intra-renal artery (RA) electrical stimulation; an adequate RDN was confirmed by repeated electronic stimulation if no increase in BP otherwise, a 2nd ablation was performed at the same site. At sites where there was decreased SBP (≥5 mmHg, cold spot) or no BP response (neutral spot) to stimulation, no ablation was performed. The mapping, ablation and confirmation procedure was repeated until the entire renal main artery had been tested then either treated or avoided. After msRDN, patients had to follow a predefined, vigorous drug titration regimen in order to achieve target OSBP (<140 mmHg). Drug adherence was monitored by liquid chromatography-tandem mass spectrometry analysis using urine. This study is registered with ClinicalTrials.gov (NCT02761811) and 5-year follow-up is ongoing. Findings Between July 8, 2016 and February 23, 2022, 611 patients were consented, 220 patients were enrolled in the study who received standardized antihypertensive drug treatments (at least two drugs) for at least 28 days, presented OSBP ≥150 mmHg and ≤180 mmHg and met all inclusion and exclusion criteria. In left RA and right RA, mapped sites were 8.2 (3.0) and 8.0 (2.7), hot/ablated sites were 3.7 (1.4) and 4.0 (1.6), cold spots were 2.4 (2.6) and 2.0 (2.2), neutral spots were 2.0 (2.1) and 2.0 (2.1), respectively. Hot, cold and neutral spots was 48.0%, 27.5% and 24.4% of total mapped sites, respectively. At 6 M, the Control Rate of OSBP was comparable between msRDN and Sham group (95.4% vs 92.8%, p = 0.429), achieved non-inferiority margin -10% (2.69%; 95% CI -4.11%, 9.83%, p < 0.001 for non-inferiority); the change in Drug Index was significantly lower in msRDN group compared to Sham group (4.37 (6.65) vs 7.61 (10.31), p = 0.010) and superior to Sham group (-3.25; 95% CI -5.56, -0.94, p = 0.003), indicating msRDN patients need significantly fewer drugs to control OSBP <140 mmHg. 24-hour ambulatory SBP decreased from 146.8 (13.9) mmHg by 10.8 (14.1) mmHg, and from 149.8 (12.8) mmHg by 10.0 (14.0) mmHg in msRDN and Sham groups, respectively (p < 0.001 from Baseline; p > 0.05 between groups). Safety profiles were comparable between msRDN and Sham groups, demonstrating the safety and efficacy of renal mapping/selective RDN to treat uncontrolled HTN. Interpretation The msRDN therapy achieved the goals of reducing the drug burden of HTN patients and controlling OSBP <140 mmHg, with only approximately four targeted ablations per renal main artery, much lower than in previous trials. Funding SyMap Medical (Suzhou), LTD, Suzhou, China.
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Affiliation(s)
- Jie Wang
- The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, NY, 10032, USA
| | - Yuehui Yin
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Chengzhi Lu
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, 300190, China
| | - Zhibing Lu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
- Department of Cardiology, Zhongnan Hospital, Wuhan University, Wuhan, 430071, China
| | - Jialu Hu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yue Wang
- The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Chen Yao
- Peking University Health Science Center, Beijing, 100034, China
| | - Xiaoyan Yan
- Peking University Health Science Center, Beijing, 100034, China
| | - Wei Ma
- Department of Cardiology, Peking University First Hospital, Beijing, 100034, China
| | - Xiaoyong Qi
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, 050057, China
| | - Yi Dang
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, 050057, China
| | - Shaoliang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing, 210012, China
| | - Jiancheng Zhu
- Department of Cardiology, Nanjing First Hospital, Nanjing, 210012, China
| | - Dongmei Wang
- Department of Cardiology, Norman Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Chao Ding
- Department of Cardiology, Norman Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Weimin Wang
- Department of Cardiology, Peking University People's Hospital, Beijing, 100044, China
| | - Jian Liu
- Department of Cardiology, Peking University People's Hospital, Beijing, 100044, China
| | - Yanbin Wang
- Department of Cardiology, Taiyuan Central Hospital, Taiyuan, 030009, China
| | - Hui Li
- Department of Cardiology, Daqing Oilfield General Hospital, Daqing, 163458, China
| | - Zhenhua Pan
- Department of Cardiology, Daqing Oilfield General Hospital, Daqing, 163458, China
| | - Kaijun Cui
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 332001, China
| | - Chengzong Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Xinjian Liang
- Department of Cardiology, Shenzhen People's Hospital, Shenzhen, Guangdong, 430060, China
| | - Weijie Chen
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Paul A. Sobotka
- Department of Cardiology, The Ohio State University College of Medicine, Columbus, OH, 43210, USA
| | | | - Murray Esler
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Ningling Sun
- Department of Hypertension, Heart Center, Peking University People's Hospital, Beijing, 100044, China
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, 100034, China
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Adejare A, Oloyo A, Dahud Y, Adeshina M, Agbaje A, Ejim C, Ismail-Badmus K, Jaja S. Renal denervation ameliorated salt-induced hypertension by improving cardiac work, cardiac enzyme and oxidative balance in Sprague-Dawley rats. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 21:200290. [PMID: 38828466 PMCID: PMC11139768 DOI: 10.1016/j.ijcrp.2024.200290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/02/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
Background Hypertension is associated with cardiovascular dysfunction, dysregulation of the antioxidant system and alteration of the level of some enzymes in the metabolic pathway. The possible modulatory effect of acute renal denervation (ARD) on cardiovascular function and the antioxidant system is still a subject of intense debate. This study sought to ascertain the ameliorative effects of ARD on cardiovascular parameters, antioxidant system, creatine kinase and lactate dehydrogenase levels. Methods Thirty-six Sprague-Dawley rats (5-6 weeks old) were divided into 6 groups of 6 animals each consisting of Normal Salt, High Salt, Normal Salt + Sham Denervation, High Salt + Sham Denervation, Normal Salt + Renal Denervation and High Salt + Renal Denervation. Induction of hypertension with 8 % salt in the diet lasted for 8 weeks. Renal or Sham denervation was thereafter done on selected groups. At the end of the experimental period, cardiovascular parameters, plasma antioxidant status, plasma creatine kinase (CK) and lactate dehydrogenase (LDH) levels were assessed. Significance level was set at p < 0.05. Results Salt-loading significantly increased systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MABP), rate pressure product (RPP) while reducing superoxide dismutase (SOD), reduced glutathione (GSH) and catalase (CAT). Acute renal denervation significantly (p < 0.0001) reduced SBP, DBP, MABP, RPP, LDH and norepinephrine level while increasing SOD, GSH and CAT. ARD did not significantly alter CK level. Conclusion Acute renal denervation, by reducing sympathetic activity, ameliorates cardiovascular and antioxidant functions as well as reduces LDH level without significantly altering CK level in salt-induced hypertension.
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Affiliation(s)
- Abdullahi Adejare
- Cardiovascular-Renal Unit, Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Ahmed Oloyo
- Cardiovascular-Renal Unit, Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Yusuf Dahud
- Cardiovascular-Renal Unit, Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Morufat Adeshina
- Cardiovascular-Renal Unit, Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Abiola Agbaje
- Cardiovascular-Renal Unit, Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Clinton Ejim
- Cardiovascular-Renal Unit, Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Khadijah Ismail-Badmus
- Cardiovascular-Renal Unit, Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Smith Jaja
- Cardiovascular-Renal Unit, Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Lagos, Nigeria
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Rosch S, Rommel K, Blazek S, Kresoja K, Schöber A, von Roeder M, Desch S, Thiele H, Lurz P, Fengler K. Twenty-Four-Month Blood Pressure Results After Renal Denervation Using Endovascular Ultrasound. J Am Heart Assoc 2023; 12:e030767. [PMID: 37581398 PMCID: PMC10492948 DOI: 10.1161/jaha.123.030767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/13/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Renal denervation has proven its efficacy to lower blood pressure in comparison to sham treatment in recent randomized clinical trials. Although there is a large body of evidence for the durability and safety of radiofrequency-based renal denervation, there are a paucity of data for endovascular ultrasound-based renal denervation (uRDN). We aimed to assess the long-term efficacy and safety of uRDN in a single-center cohort of patients. METHODS AND RESULTS Data from 2 previous studies on uRDN were pooled. Ambulatory 24-hour blood pressure measurements were taken before as well as 3, 6, 12, and 24 months after treatment with uRDN. A total of 130 patients (mean age 63±9 years, 24% women) underwent uRDN. After 3, 6, 12, and 24 months, systolic mean 24-hour ambulatory blood pressure values were reduced by 10±12, 10±14, 8±15, and 10±15 mm Hg, respectively, when compared with baseline (P<0.001). Corresponding diastolic values were reduced by 6±8, 6±8, 5±9, and 6±9 mm Hg, respectively (P<0.001). Periprocedural adverse events occurred in 16 patients, and all recovered without sequelae. CONCLUSIONS In this single-center study, uRDN effectively lowered blood pressure up to 24 months after treatment.
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Affiliation(s)
- Sebastian Rosch
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Karl‐Philipp Rommel
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Stephan Blazek
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Karl‐Patrik Kresoja
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Anne Schöber
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | | | - Steffen Desch
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Holger Thiele
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Philipp Lurz
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Karl Fengler
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
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Wang J, Sun N, Ge J, Jiang H, Yin Y, Chen M, Wang Y, Yao C, Yan X, Sobotka PA, Huo Y. Rationale and Design of Sympathetic Mapping/Ablation of Renal Nerves Trial (SMART) for the Treatment of Hypertension: a Prospective, Multicenter, Single-Blind, Randomized and Sham Procedure-Controlled Study. J Cardiovasc Transl Res 2023; 16:358-370. [PMID: 36042146 DOI: 10.1007/s12265-022-10307-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/18/2022] [Indexed: 10/14/2022]
Abstract
Renal denervation (RDN) is proposed as a durable and patient compliance independent treatment for hypertension. However, 20-30% non-responder after RDN treatment weakened the therapeutic effect, which may be due to blind ablation. The renal nerve mapping/selective ablation system developed by SyMap Medical Ltd (Suzhou), China, has the function of mapping renal sympathetic/parasympathetic nerve sites and selectively removing renal sympathetic nerves and is expected to meet the urgent unmet clinical need of targeted RDN. The "Sympathetic Mapping/Ablation of Renal Nerves Trial" (SMART) is a prospective, multicenter, randomized, single-blinded, sham procedure-controlled trial, to evaluate the safety and efficacy of targeted renal sympathetic denervation in patients with essential and uncontrolled hypertension. The study is the first clinical registry trial using a targeted RDN for the treatment of uncontrolled hypertension; the dual-endpoint design can answer the question of how many antihypertensive drugs can be reduced in patients after RDN. The trial is registered on clinicaltrials.gov NCT02761811.
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Affiliation(s)
- Jie Wang
- Division of Cardiology, Department of Medicine, College of Physician and Surgeons, Columbia University, New York, NY, 10032, USA.
- Academy of Clinical and Translational Research Jiangsu Province, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China.
| | - Ningling Sun
- Department of Hypertension, Heart Center, Peking University People's Hospital, Beijing, 100044, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yuehui Yin
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Yue Wang
- Academy of Clinical and Translational Research Jiangsu Province, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Chen Yao
- Peking University Clinical Research Institute, Beijing, 100191, China
- Department of Biostatistics, Peking University First Hospital, Beijing, 100034, China
| | - Xiaoyan Yan
- Peking University Clinical Research Institute, Beijing, 100191, China
| | | | - Yong Huo
- Division of Cardiology, Peking University First Hospital, Beijing, 100034, China.
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Xiong B, Chen S, Chen W, Yin Y, Ling Z. Advances in Renal Denervation in the Treatment of Hypertension. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2023. [DOI: 10.15212/cvia.2023.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Hypertension significantly increases the risk of cardiovascular events and it is associated with high rates of disability and mortality. Hypertension is a common cause of cardiovascular and cerebrovascular accidents, which severely affect patients’ quality of life and lifespan. Current treatment strategies for hypertension are based primarily on medication and lifestyle interventions. The renal sympathetic nervous system plays an important role in the pathogenesis of hypertension, and catheter-based renal denervation (RDN) has provided a new concept for the treatment of hypertension. In recent years, studies on RDN have been performed worldwide. This article reviews the latest preclinical research and clinical evidence for RDN.
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Liu H, Li Y, Zhou H, Chen W, Xu Y, Du H, Zhang B, Xia T, Li D, Ou Z, Tang R, Chen Q, Zhao B, Yin Y. Renal nerve stimulation identifies renal innervation and optimizes the strategy for renal denervation in canine. J Transl Med 2023; 21:100. [PMID: 36759871 PMCID: PMC9912587 DOI: 10.1186/s12967-023-03919-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Renal denervation (RDN) was still performed without any intra-procedural method for nerve mapping. Whether renal nerve stimulation (RNS) is an efficient way to identify renal autonomic innervation and optimize the strategy for RDN remain to be worthy for further exploration. METHODS The characteristics of renal autonomic innervation at the sites with different blood pressure (BP) responses to RNS were explored. Then, dogs anatomically eligible for RDN were randomly assigned into elevated BP response ablation group, reduced BP response ablation group, and RNS-control group. The postoperative outcomes were measured at baseline and after 4 weeks follow-up. RESULTS The proportion of afferent sensory nerve was higher at elevated BP response sites (ERS) than reduced BP response sites (RRS) and non-response sites (NRS) (P = 0.012 and P = 0.004). Conversely, the proportion of parasympathetic nerve at RRS was the highest (RRS vs. ERS, P = 0.017; RRS vs. NRS, P = 0.023). More importantly, there was a significant correlation between systolic blood pressure changes and the area ratios of afferent sensory and parasympathetic nerve (R = 0.859; P < 0.001). In addition, ablation at BP-elevation sites can result in a significant decrease in BP and plasma norepinephrine (NE) after 4 weeks (P = 0.002; P = 0.008), while ablation at BP-reduction sites can lead to significant increases in BP and plasma NE (P = 0.016; P = 0.033). CONCLUSIONS RNS is an effective method to identify renal autonomic innervation. It could not only help to identify optimal target sites, but also avoid ablation of sympathetic-inhibitory areas during RDN.
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Affiliation(s)
- Hang Liu
- grid.412461.40000 0004 9334 6536Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China ,Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China
| | - Yidan Li
- grid.412461.40000 0004 9334 6536Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China ,Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China
| | - Hao Zhou
- grid.412461.40000 0004 9334 6536Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China ,Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China
| | - Weijie Chen
- grid.412461.40000 0004 9334 6536Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China ,Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China
| | - Yanping Xu
- grid.412461.40000 0004 9334 6536Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China ,Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China
| | - Huaan Du
- grid.412461.40000 0004 9334 6536Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China ,Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China
| | - Bo Zhang
- grid.412461.40000 0004 9334 6536Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China ,Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China
| | - Tianli Xia
- grid.412461.40000 0004 9334 6536Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China ,Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China
| | - Dan Li
- grid.412461.40000 0004 9334 6536Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China ,Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China
| | - Zhenhong Ou
- grid.412461.40000 0004 9334 6536Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China ,Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China
| | - Ruotian Tang
- grid.412461.40000 0004 9334 6536Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China ,Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China
| | - Qingsong Chen
- grid.412461.40000 0004 9334 6536Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China ,Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China
| | - Binyi Zhao
- grid.412461.40000 0004 9334 6536Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China ,Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China
| | - Yuehui Yin
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. .,Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China. .,Chongqing Key Laboratory of Arrhythmia, Chongqing, China.
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Lai Y, Zhou H, Chen W, Liu H, Liu G, Xu Y, Du H, Zhang B, Li Y, Woo K, Yin Y. The intrarenal blood pressure modulation system is differentially altered after renal denervation guided by different intensities of blood pressure responses. Hypertens Res 2023; 46:456-467. [PMID: 36202981 DOI: 10.1038/s41440-022-01047-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 02/07/2023]
Abstract
The aim of this study was to investigate alterations in the intrarenal blood pressure (BP) regulation system after renal denervation (RDN) guided by renal nerve stimulation (RNS). Twenty-one dogs were randomized to receive RDN at strong (SRA group, n = 7) or weak (WRA group, n = 7) BP-elevation response sites identified by RNS or underwent RNS only (RNS-control, RSC, n = 7). After 4 weeks of follow-up, renal sympathetic components, the main components of renin-angiotensin system (RAS) and the major transporters involved in sodium and water reabsorption were assessed by immunohistochemical analysis. Compared with RSC treatment, RDN therapy significantly reduced renal norepinephrine and tyrosine hydroxylase levels, decreased the renin content and inhibited the onsite generation of angiotensinogen. Moreover, the expression of exciting axis components, including angiotensin-converting enzyme (ACE), angiotensin II and angiotensin II type-1 receptor, was downregulated, while protective axis components for the cardiovascular system, including ACE2 and Mas receptors, were upregulated in both WRA and SRA groups. Moreover, RDN reduced the abundance of aquaporin-1 and aquaporin-2 in kidneys. Although RDN had a minimal effect on overall NKCC2 expression, its activation (p-NKCC2) and directional enrichment in the apical membrane (mNKCC2) were dramatically blunted. All these changes were more obvious in the SRA group than WRA group. Selective RDN guided by RNS effectively reduced systemic BP by affecting the renal neurohormone system, as well as the sodium and water transporter system, and these effects at sites with a strong BP response were more superior.
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Affiliation(s)
- Yinchuan Lai
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Therapeutic Service Center, Chongqing Key Laboratory of Arrhythmia, Chongqing, China
- Department of Cardiology, the Second People's Hospital of Yibin & West China Hospital, Sichuan University Yibin Hospital, Yibin City, Sichuan, China
| | - Hao Zhou
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Therapeutic Service Center, Chongqing Key Laboratory of Arrhythmia, Chongqing, China
| | - Weijie Chen
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Therapeutic Service Center, Chongqing Key Laboratory of Arrhythmia, Chongqing, China
| | - Hang Liu
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Therapeutic Service Center, Chongqing Key Laboratory of Arrhythmia, Chongqing, China
| | - Guangliang Liu
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Therapeutic Service Center, Chongqing Key Laboratory of Arrhythmia, Chongqing, China
| | - Yanping Xu
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Therapeutic Service Center, Chongqing Key Laboratory of Arrhythmia, Chongqing, China
| | - Huaan Du
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Therapeutic Service Center, Chongqing Key Laboratory of Arrhythmia, Chongqing, China
| | - Bo Zhang
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Therapeutic Service Center, Chongqing Key Laboratory of Arrhythmia, Chongqing, China
| | - Yidan Li
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Therapeutic Service Center, Chongqing Key Laboratory of Arrhythmia, Chongqing, China
| | - Kamsang Woo
- Institute of Future Cities, the Chinese University of Hong Kong, Hong Kong, China
| | - Yuehui Yin
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Therapeutic Service Center, Chongqing Key Laboratory of Arrhythmia, Chongqing, China.
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8
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Huang H, Cheng H, Chia Y, Li Y, Van Minh H, Siddique S, Sukonthasarn A, Tay JC, Turana Y, Verma N, Kario K, Wang T. The role of renal nerve stimulation in percutaneous renal denervation for hypertension: A mini-review. J Clin Hypertens (Greenwich) 2022; 24:1187-1193. [PMID: 36196464 PMCID: PMC9532907 DOI: 10.1111/jch.14554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022]
Abstract
Recent trials have demonstrated the efficacy and safety of percutaneous renal sympathetic denervation (RDN) for blood pressure (BP)-lowering in patients with uncontrolled hypertension. Nevertheless, major challenges exist, such as the wide variation of BP-lowering responses following RDN (from strong response to no response) and lack of feasible and reproducible peri-procedural predictors for patient response. Both animal and human studies have demonstrated different patterns of BP responses following renal nerve stimulation (RNS), possibly related to varied regional proportions of sympathetic and parasympathetic nerve tissues along the renal arteries. Animal studies of RNS have shown that rapid electrical stimulation of the renal arteries caused renal artery vasoconstriction and increased norepinephrine secretion with a concomitant increase in BP, and the responses were attenuated after RDN. Moreover, selective RDN at sites with strong RNS-induced BP increases led to a more efficient BP-lowering effect. In human, when RNS was performed before and after RDN, blunted changes in RNS-induced BP responses were noted after RDN. The systolic BP response induced by RNS before RDN and blunted systolic BP response to RNS after RDN, at the site with maximal RNS-induced systolic BP response before RDN, both correlated with the 24-h ambulatory BP reductions 3-12 months following RDN. In summary, RNS-induced BP changes, before and after RDN, could be used to assess the immediate effect of RDN and predict BP reductions months following RDN. More comprehensive, large-scale and long term trials are needed to verify these findings.
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Affiliation(s)
- Hui‐Chun Huang
- Cardiovascular Center and Division of CardiologyDepartment of Internal MedicineNational Taiwan University HospitalNational Taiwan University College of MedicineTaipeiTaiwan
- Graduate Institute of Epidemiology and Preventive MedicineCollege of Public HealthNational Taiwan UniversityTaipeiTaiwan
| | - Hao‐min Cheng
- Department of MedicineTaipei Veterans General HospitalMedical Education and ResearchNational Yang‐Ming UniversityTaipeiTaiwan
| | - Yook‐Chin Chia
- Department of Medical SciencesSchool of Healthcare and Medical SciencesSunway UniversityBandar SunwayMalaysia
- Department of Primary Care MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Yan Li
- Department of Cardiovascular MedicineShanghai Institute of HypertensionShanghai Key Laboratory of HypertensionState Key Laboratory of Medical GenomicsNational Research Centre for Translational MedicineRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Huynh Van Minh
- Department of CardiologyUniversity of Medicine and PharmacyHue UniversityHue CityThua Thien‐HueVietnam
| | - Saulat Siddique
- Department of CardiologyFatima Memorial HospitalLahorePakistan
| | - Apichard Sukonthasarn
- Cardiology DivisionDepartment of Internal MedicineFaculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Jam Chin Tay
- Department of General MedicineTan Tock Seng HospitalSingaporeSingapore
| | - Yuda Turana
- Faculty of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Narsingh Verma
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineShimotsukeTochigiJapan
| | - Kazuomi Kario
- Department of PhysiologyKing George's Medical UniversityLucknowIndia
| | - Tzung‐Dau Wang
- Cardiovascular Center and Division of CardiologyDepartment of Internal MedicineNational Taiwan University HospitalNational Taiwan University College of MedicineTaipeiTaiwan
- Division of Hospital MedicineDepartment of Internal MedicineNational Taiwan University HospitalNational Taiwan University College of MedicineTaipeiTaiwan
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9
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Present Evidence of Determinants to Predict the Efficacy of Renal Denervation. Int J Hypertens 2022; 2022:5694127. [PMID: 35992203 PMCID: PMC9391193 DOI: 10.1155/2022/5694127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Sympathetic overactivation is one of the main contributors to development and progress of hypertension. Renal denervation (RDN) has been evidenced by series of clinical trials for its efficacy and safety to treat overactivated sympathetic nervous system induced diseases. However, the results were inconsistent and not all patients benefited from RDN. Appropriate patient selection and intraoperative factors to improve the efficacy of RDN need to be solved urgently. Over the decade, research studies on the correlations between indicators and the antihypertensive effects have been conducted and made a fairly well progress. Herein, we comprehensively reviewed the research studies on how to make RDN more predictable or improve the efficacy of RDN and summarized these potential indicators or devices which might be applied in clinical settings.
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10
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Arunothayaraj S, Whitbourn R, Barlis P, Mahfoud F. Renal Denervation for Resistant Hypertension. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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11
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Okamura K, Satou S, Kato Y, Kogata Y, Matsushima M, Shirai K, Urata H. Intravascular Ultrasound Can Be Used to Locate Nerves, but not Confirm Ablation, During Renal Sympathetic Denervation. J Clin Med Res 2022; 13:556-562. [PMID: 35059074 PMCID: PMC8734512 DOI: 10.14740/jocmr4597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background No methods exist for confirming nerve ablation in catheter-based renal sympathetic denervation (RDN). Methods We investigated the feasibility of using intravascular ultrasound (IVUS) to locate nerves and observe nerve integrity changes during RDN in a pig. To confirm our observations, we used post-RDN histological sections matched anatomically to the IVUS images. Results IVUS revealed multiple hypoechoic structures along the renal artery, whose locations matched those of nerves in the histological sections. Nerves clustered near the junction between the renal artery and vein. Histology confirmed necrosis of nerve bundles at RDN ablation sites, but no changes in echogenicity were observed using IVUS. Conclusions Although IVUS cannot currently be used to confirm ablation during RDN, it clearly reveals some clusters of renal sympathetic nerves. It remains to be demonstrated how IVUS can guide RDN devices and potentially improve ablation success.
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Affiliation(s)
- Keisuke Okamura
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Shunsuke Satou
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Yusuke Kato
- Otsuka Medical Devices Co., Ltd, Tokyo, Japan
| | | | - Masatoshi Matsushima
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Kazuyuki Shirai
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Hidenori Urata
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Japan
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12
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Hoogerwaard AF, Adiyaman A, de Jong MR, Smit JJJ, Heeg JE, van Hasselt BAAM, Elvan A. Renal nerve stimulation: complete versus incomplete renal sympathetic denervation. Blood Press 2021; 30:376-385. [PMID: 34647513 DOI: 10.1080/08037051.2021.1982376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Blood pressure (BP) reduction after renal sympathetic denervation (RDN) is highly variable. Renal nerve stimulation (RNS) can localize sympathetic nerves. The RNS trial aimed to investigate the medium-term BP-lowering effects of the use of RNS during RDN, and explore if RNS can check the completeness of the denervation. MATERIAL AND METHODS Forty-four treatment-resistant hypertensive patients were included in the prospective, single-center RNS trial. The primary study endpoint was change in 24-h BP at 6- to 12-month follow-up after RDN. The secondary study endpoints were the acute procedural RNS-induced BP response before and after RDN; number of antihypertensive drugs at follow-up; and the correlation between the RNS-induced BP increase before versus after RDN (delta [Δ] RNS-induced BP). RESULTS Before RDN, the RNS-induced systolic BP rise was 43(±21) mmHg, and decreased to 9(±12) mmHg after RDN (p < 0.001). Mean 24-h systolic/diastolic BP decreased from 147(±12)/82(±11) mmHg at baseline to 135(±11)/76(±10) mmHg (p < 0.001/<0.001) at follow-up (10 [6-12] months), with 1 antihypertensive drug less compared to baseline. The Δ RNS-induced BP and the 24-h BP decrease at follow-up were correlated for systolic (R = 0.44, p = 0.004) and diastolic (R = 0.48, p = 0.003) BP. Patients with ≤0 mmHg residual RNS-induced BP response after RDN had a significant lower mean 24-h systolic BP at follow-up compared to the patients with >0 mmHg residual RNS-induced BP response (126 ± 4 mmHg versus 135 ± 10 mmHg, p = 0.04). 83% of the patients with ≤0 mmHg residual RNS-induced BP response had normal 24-h BP at follow-up, compared to 33% in the patients with >0 mmHg residual RNS-induced BP response (p = 0.023). CONCLUSION The use of RNS during RDN leads to clinically significant and sustained lowering of 24-h BP with fewer antihypertensive drugs at follow-up. RNS-induced BP changes were correlated with 24-h BP changes at follow-up. Moreover, patients with complete denervation had significant lower BP compared to the patients with incomplete denervation.
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Affiliation(s)
| | - Ahmet Adiyaman
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Mark R de Jong
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Jaap-Jan J Smit
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Jan-Evert Heeg
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | | | - Arif Elvan
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
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13
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Saxena M, Schmieder RE, Kirtane AJ, Mahfoud F, Daemen J, Basile J, Lurz P, Gosse P, Sanghvi K, Fisher NDL, Rump LC, Pathak A, Blankestijn PJ, Mathur A, Wang Y, Weber MA, Sharp ASP, Bloch MJ, Barman NC, Claude L, Song Y, Azizi M, Lobo MD. Predictors of blood pressure response to ultrasound renal denervation in the RADIANCE-HTN SOLO study. J Hum Hypertens 2021; 36:629-639. [PMID: 34031548 PMCID: PMC9287166 DOI: 10.1038/s41371-021-00547-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/09/2021] [Accepted: 04/23/2021] [Indexed: 02/03/2023]
Abstract
The blood pressure (BP) lowering response to renal denervation (RDN) remains variable with about one-third of patients not responding to ultrasound or radiofrequency RDN. Identification of predictors of the BP response to RDN is needed to optimize patient selection for this therapy. This is a post-hoc analysis of the RADIANCE-HTN SOLO study. BP response to RDN was measured by the change in daytime ambulatory systolic blood pressure (dASBP) at 2 months post procedure. Univariate regression was used initially to assess potential predictors of outcome followed by multivariate regression analysis. In the univariate analysis, predictors of response to RDN were higher baseline daytime ambulatory diastolic blood pressure (dADBP), the use of antihypertensive medications at screening, and presence of orthostatic hypertension (OHTN) whilst the presence of untreated accessory arteries was a negative predictor of response. Multivariate analysis determined that dADBP and use of antihypertensive medications were predictors of response to RDN with a trend for OHTN to predict response. Obese females also appeared to be better responders to RDN in an interaction model. RDN is more effective in patients with elevated baseline dADBP and those with OHTN, suggesting increased peripheral vascular resistance secondary to heightened sympathetic tone. These assessments are easy to perform in clinical setting and may help in phenotyping patients who will respond better to RDN.
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Affiliation(s)
- Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK.
| | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Ajay J Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
| | - Felix Mahfoud
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany
| | - Joost Daemen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, NL, The Netherlands
| | - Jan Basile
- Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | | | - Lars C Rump
- University Clinic Dusseldorf, Dusseldorf, Germany
| | - Atul Pathak
- Department of Cardiovascular Medicine, Princess Grace Hospital, Monaco, Monaco
| | | | - Anthony Mathur
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff, UK.,University of Exeter, Exeter, UK
| | - Michael J Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno, NV, USA
| | | | | | - Yang Song
- Baim Institute for Clinical Research, Boston, MA, USA
| | - Michel Azizi
- Université de Paris, Paris, France.,Hypertension Department and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France.,INSERM, CIC1418, Paris, France
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
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14
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Versaci F, Sciarretta S, Scappaticci M, Calcagno S, di Pietro R, Sbandi F, Dei Giudici A, Del Prete A, de Angelis S, Biondi-Zoccai G. Renal arteries denervation with second generation systems: a remedy for resistant hypertension? Eur Heart J Suppl 2020; 22:L160-L165. [PMID: 33239993 PMCID: PMC7673618 DOI: 10.1093/eurheartj/suaa158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Initial studies on renal denervation (RDN) for the treatment of non-controlled arterial hypertension (HTN) through radiofrequency ablation of renal arteries demonstrated that RDN is an effective therapeutic strategy to reduce arterial blood pressure (BP). Nonetheless, the first randomized study, SYMPLICITY-HTN-3, failed to demonstrate a clear benefit for RND over the control group. Technologic evolution, with the introduction of new second generation multi-electrode devices, allowed deep energy delivery along the full circumference of the vessel. Two recent randomized studies involving patients assuming (SPYRAL HTN-ON MED) or not (SPYRAL HTN-OFF MED) antihypertensive pharmacologic treatment, demonstrated the efficacy and safety of RDN using second generation systems for radiofrequency ablation. Another recent randomized study demonstrated that RDN with ultrasounds (RADIANCE-HTN SOLO) of the main renal arteries led to a significant BP reduction compared to the control group. These studies have once again raised the interest of the scientific community towards attempting to define the appropriate role of RDN in the treatment of hypertension. Nonetheless, larger and longer clinical trials will be necessary to draw further conclusions.
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Affiliation(s)
- Francesco Versaci
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Sebastiano Sciarretta
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy.,Department of Medico-Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Latina, Italy
| | | | - Simone Calcagno
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | | | - Francesca Sbandi
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | | | - Armando Del Prete
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | | | - Giuseppe Biondi-Zoccai
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy.,Department of Medico-Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
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15
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Extended Renal Artery Denervation Is Associated with Artery Wall Lesions and Acute Systemic and Pulmonary Hemodynamic Changes: A Sham-Controlled Experimental Study. Cardiovasc Ther 2020; 2020:8859663. [PMID: 33193811 PMCID: PMC7644331 DOI: 10.1155/2020/8859663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/05/2020] [Accepted: 10/18/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives We sought to assess acute changes in systemic and pulmonary hemodynamics and microscopic artery lesions following extended renal artery denervation (RDN). Background RDN has been proposed to reduce sympathetic nervous system hyperactivation. Although the effects of RDN on systemic circulation and overall sympathetic activity have been studied, data on the impact of RDN on pulmonary hemodynamics is lacking. Methods The study comprised 13 normotensive Landrace pigs. After randomization, 7 animals were allocated to the group of bilateral RDN and 6 animals to the group of a sham procedure (SHAM). Hemodynamic measures, cannulation, and balloon-based occlusion of the renal arteries were performed in both groups. In the RDN group, radiofrequency ablation was performed in all available arteries and their segments. An autopsy study of the renal arteries was carried out in both groups. Results The analysis was performed on 12 pigs (6 in either group) since pulmonary thromboembolism occurred in one case. A statistically significant drop in the mean diastolic pulmonary artery pressure (PAP) was detected in the RDN group when compared with the SHAM group (change by 13.0 ± 4.4 and 10.0 ± 3.0 mmHg, correspondingly; P = 0.04). In 5 out of 6 pigs in the RDN group, a significant decrease in systemic systolic blood pressure was found, when compared with baseline (98.8 ± 17.8 vs. 90.2 ± 12.6 mmHg, P = 0.04), and a lower mean pulmonary vascular resistance (PVR) (291.0 ± 77.4 vs. 228.5 ± 63.8 dyn∗sec∗cm−5, P = 0.03) after ablation was found. Artery dissections were found in both groups, with prevalence in animals after RDN. Conclusions Extensive RDN leads to a rapid and significant decrease in PAP. In the majority of cases, RDN is associated with an acute lowering of systolic blood pressure and PVR. Extended RDN is associated with artery wall lesions and thrombus formation underdiagnosed by angiography.
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16
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Kiuchi MG, Chen S, Villacorta H, Carnagarin R, Nolde JM, Matthews VB, Schlaich MP. Renal denervation as a synergistic tool for the treatment of polymorphic ventricular ectopic beats: A case report. Medicine (Baltimore) 2020; 99:e21098. [PMID: 32702857 PMCID: PMC7373520 DOI: 10.1097/md.0000000000021098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Ventricular ectopic beats (VEBs) are very common and often occur in hypertensive or obese individuals, as well as in patients presenting with either sleep apnea or structural cardiac disease. Sympathetic overactivity plays a crucial role in the development, continuation, and exacerbation of ventricular arrhythmias. Recent studies have reported the relevance of sympathetic activation in patients with ventricular arrhythmias and suggested a potential role for catheter-based renal denervation (RDN) in reducing the arrhythmic burden. PATIENT CONCERNS We describe a 38-year-old female symptomatic patient that at the time of presentation was complaining of fatigue in response to minor and medium efforts and not tolerating any physical activity, and episodes of tachycardia associated with dyspnoea, pre-syncope, and syncope. DIAGNOSIS She had a high incidence of polymorphic VEBs on 24-hour-Holter monitoring who also presented with left ventricular (LV) hypertrophy for which she was treated with bisoprolol 10 mg/d. The 24-hour-Holter on bisoprolol at baseline showed sinus rhythm with an average heart rate of 92 bpm. There were 44,743 isolated VEBs. A total of 2538 nonsustained ventricular tachycardia events were registered. Her cardiac magnetic resonance imaging showed an increase in LV diastolic diameter and impairment of the right ventricle. INTERVENTIONS The patient underwent endocardial ablation of the right ventricular outflow tract and the LV free lateral wall, and concomitantly underwent bilateral RDN. OUTCOMES Three months post-procedure, her 24-hour-Holter off medication demonstrated an average heart rate 72 bpm and a substantially reduced number of 2823 isolated monomorphic VEBs. Thus far, 18-months follow-up, she has been asymptomatic and doing physical exercises. CONCLUSION In our current patient, we used RDN as a synergistic method to attenuate the sympathetic overactivity, which is narrowly linked to VEBs appearance. Our case report highlighted that RDN may become a potential adjuvant treatment for VEBs in the future.
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Affiliation(s)
- Márcio Galindo Kiuchi
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, University of Western Australia, Crawley, Australia
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Humberto Villacorta
- Cardiology Division, Department of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, University of Western Australia, Crawley, Australia
| | - Janis M. Nolde
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, University of Western Australia, Crawley, Australia
| | - Vance B. Matthews
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, University of Western Australia, Crawley, Australia
| | - Markus P. Schlaich
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, University of Western Australia, Crawley, Australia
- Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
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17
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Kario K, Kim BK, Aoki J, Wong AYT, Lee YH, Wongpraparut N, Nguyen QN, Ahmad WAW, Lim ST, Ong TK, Wang TD. Renal Denervation in Asia: Consensus Statement of the Asia Renal Denervation Consortium. Hypertension 2020; 75:590-602. [PMID: 32008432 PMCID: PMC8032219 DOI: 10.1161/hypertensionaha.119.13671] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The Asia Renal Denervation Consortium consensus conference of Asian physicians actively performing renal denervation (RDN) was recently convened to share up-to-date information and regional perspectives, with the goal of consensus on RDN in Asia. First- and second-generation trials of RDN have demonstrated the efficacy and safety of this treatment modality for lowering blood pressure in patients with resistant hypertension. Considering the ethnic differences of the hypertension profile and demographics of cardiovascular disease demonstrated in the SYMPLICITY HTN (Renal Denervation in Patients With Uncontrolled Hypertension)-Japan study and Global SYMPLICITY registry data from Korea and Taiwan, RDN might be an effective hypertension management strategy in Asia. Patient preference for device-based therapy should be considered as part of a shared patient-physician decision process. A practical population for RDN treatment could consist of Asian patients with uncontrolled essential hypertension, including resistant hypertension. Opportunities to refine the procedure, expand the therapy to other sympathetically mediated diseases, and explore the specific effects on nocturnal and morning hypertension offer a promising future for RDN. Based on available evidence, RDN should not be considered a therapy of last resort but as an initial therapy option that may be applied alone or as a complementary therapy to antihypertensive medication.
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Affiliation(s)
- Kazuomi Kario
- From the Department of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tokyo, Japan (K.K.)
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (B.-K.K.)
| | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan (J.A.)
| | - Anthony Yiu-tung Wong
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, HKSAR (A.Y.-T.W.)
| | - Ying-Hsiang Lee
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan (Y.-H.L.)
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan (Y.-H.L.)
| | - Nattawut Wongpraparut
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (N.W.)
| | - Quang Ngoc Nguyen
- Department of Cardiology, Hanoi Medical University, Vietnam (Q.N.N.)
| | - Wan Azman Wan Ahmad
- Division of Cardiology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia (W.A.W.A)
| | - Soo Teik Lim
- Department of Cardiology, National Heart Center, Singapore (S.T.L.)
| | - Tiong Kiam Ong
- Department of Cardiology, Sarawak Heart Centre, Malaysia (T.K.O.)
| | - Tzung-Dau Wang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-D.W.)
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18
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Selective renal denervation guided by renal nerve stimulation: mapping renal nerves for unmet clinical needs. J Hum Hypertens 2019; 33:716-724. [DOI: 10.1038/s41371-019-0244-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 07/10/2019] [Accepted: 07/29/2019] [Indexed: 01/01/2023]
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19
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Liu H, Chen W, Lai Y, Du H, Wang Z, Xu Y, Ling Z, Fan J, Xiao P, Zhang B, Wang J, Gyawali L, Zrenner B, Woo K, Yin Y. Selective Renal Denervation Guided by Renal Nerve Stimulation in Canine. Hypertension 2019; 74:536-545. [DOI: 10.1161/hypertensionaha.119.12680] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Renal nerve stimulation (RNS) can result in substantial blood pressure (BP) elevation, and the change was significantly blunted when repeated stimulation after ablation. However, whether RNS could provide a meaningful renal nerve mapping for identification of optimal ablation targets in renal denervation (RDN) is not fully clear. Here, we compared the antihypertensive effects of selective RDN guided by two different BP responses to RNS and explored the nerve innervations at these sites in Kunming dogs. Our data indicated that ablation at strong-response sites showed a more systolic BP-lowering effect than at weak-response sites (
P
=0.002), as well as lower levels of tyrosine hydroxylase and norepinephrine in kidney and a greater reduction in plasma norepinephrine (
P
=0.004 for tyrosine hydroxylase,
P
=0.002 for both renal and plasma norepinephrine). Strong-response sites showed a greater total area and mean number of renal nerves than weak-response sites (
P
=0.012 for total area and
P
<0.001 for mean number). Systolic BP-elevation response to RNS before RDN and blunted systolic BP-elevation to RNS after RDN were correlated with systolic BP changes at 4 weeks follow-up (
R
=0.649;
P
=0.012 and
R
=0.643;
P
=0.013). Changes of plasma norepinephrine and renal norepinephrine levels at 4 weeks were also correlated with systolic BP changes at 4 weeks (
R
=0.837,
P
<0.001 and
R
=0.927,
P
<0.001). These data suggest that selective RDN at sites with strong BP-elevation response to RNS could lead to a more efficient RDN. RNS is an effective method to identify the nerve-enriched area during RDN procedure and improve the efficacy of RDN.
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Affiliation(s)
- Hang Liu
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, China (H.L., Y.L., W.C., H.D., Z.W., Y.X., Z.L., J.F., P.X., B.Z., L.G., Y.Y.)
| | - Weijie Chen
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, China (H.L., Y.L., W.C., H.D., Z.W., Y.X., Z.L., J.F., P.X., B.Z., L.G., Y.Y.)
| | - Yinchuan Lai
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, China (H.L., Y.L., W.C., H.D., Z.W., Y.X., Z.L., J.F., P.X., B.Z., L.G., Y.Y.)
| | - Huaan Du
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, China (H.L., Y.L., W.C., H.D., Z.W., Y.X., Z.L., J.F., P.X., B.Z., L.G., Y.Y.)
| | - Zihao Wang
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, China (H.L., Y.L., W.C., H.D., Z.W., Y.X., Z.L., J.F., P.X., B.Z., L.G., Y.Y.)
| | - Yanping Xu
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, China (H.L., Y.L., W.C., H.D., Z.W., Y.X., Z.L., J.F., P.X., B.Z., L.G., Y.Y.)
| | - Zhiyu Ling
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, China (H.L., Y.L., W.C., H.D., Z.W., Y.X., Z.L., J.F., P.X., B.Z., L.G., Y.Y.)
| | - Jinqi Fan
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, China (H.L., Y.L., W.C., H.D., Z.W., Y.X., Z.L., J.F., P.X., B.Z., L.G., Y.Y.)
| | - Peilin Xiao
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, China (H.L., Y.L., W.C., H.D., Z.W., Y.X., Z.L., J.F., P.X., B.Z., L.G., Y.Y.)
| | - Bo Zhang
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, China (H.L., Y.L., W.C., H.D., Z.W., Y.X., Z.L., J.F., P.X., B.Z., L.G., Y.Y.)
| | - Jie Wang
- Department of Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY (J.W.)
| | - Laxman Gyawali
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, China (H.L., Y.L., W.C., H.D., Z.W., Y.X., Z.L., J.F., P.X., B.Z., L.G., Y.Y.)
| | - Bernhard Zrenner
- Medizinische Klinik I, Krankenhaus Landshut/Achdorf, Germany (B.Z.)
| | - Kamsang Woo
- Institute of Future Cities, the Chinese University of Hong Kong, China (K.W.)
| | - Yuehui Yin
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, China (H.L., Y.L., W.C., H.D., Z.W., Y.X., Z.L., J.F., P.X., B.Z., L.G., Y.Y.)
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20
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Waldron NH, Fudim M, Mathew JP, Piccini JP. Neuromodulation for the Treatment of Heart Rhythm Disorders. JACC Basic Transl Sci 2019; 4:546-562. [PMID: 31468010 PMCID: PMC6712352 DOI: 10.1016/j.jacbts.2019.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 12/13/2022]
Abstract
Derangement of autonomic nervous signaling is an important contributor to cardiac arrhythmogenesis. Modulation of autonomic nervous signaling holds significant promise for the prevention and treatment of cardiac arrhythmias. Further clinical investigation is necessary to establish the efficacy and safety of autonomic modulatory therapies in reducing cardiac arrhythmias.
There is an increasing recognition of the importance of interactions between the heart and the autonomic nervous system in the pathophysiology of arrhythmias. These interactions play a role in both the initiation and maintenance of arrhythmias and are important in both atrial and ventricular arrhythmia. Given the importance of the autonomic nervous system in the pathophysiology of arrhythmias, there has been notable effort in the field to improve existing therapies and pioneer additional interventions directed at cardiac-autonomic targets. The interventions are targeted to multiple and different anatomic targets across the neurocardiac axis. The purpose of this review is to provide an overview of the rationale for neuromodulation in the treatment of arrhythmias and to review the specific treatments under evaluation and development for the treatment of both atrial fibrillation and ventricular arrhythmias.
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Key Words
- AERP, atrial effective refractory period
- AF, atrial fibrillation
- AGP, autonomic ganglionic plexus
- ANS, autonomic nervous system
- CABG, coronary artery bypass grafting
- HRV, heart rate variability
- ICD, implantable cardioverter-defibrillator
- LLVNS, low-level vagal nerve stimulation
- OSA, obstructive sleep apnea
- POAF, post-operative atrial fibrillation
- PVI, pulmonary vein isolation
- RDN, renal denervation
- SCS, spinal cord stimulation
- SGB, stellate ganglion blockade
- SNS, sympathetic nervous system
- VF, ventricular fibrillation
- VNS, vagal nerve stimulation
- VT, ventricular tachycardia
- arrhythmia
- atrial fibrillation
- autonomic nervous system
- ganglionated plexi
- neuromodulation
- ventricular arrhythmias
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Affiliation(s)
- Nathan H Waldron
- Department of Anesthesia, Duke University Medical Center, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, North Carolina.,Electrophysiology Section, Duke University Medical Center, Durham, North Carolina
| | - Joseph P Mathew
- Department of Anesthesia, Duke University Medical Center, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Durham, North Carolina.,Electrophysiology Section, Duke University Medical Center, Durham, North Carolina
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21
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Electrical stimulation-based renal nerve mapping exacerbates ventricular arrhythmias during acute myocardial ischaemia. J Hypertens 2019; 36:1342-1350. [PMID: 29621066 DOI: 10.1097/hjh.0000000000001712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Blood pressure elevation in response to transient renal nerve stimulation (RNS) has been used to determine the ablation target and endpoint of renal denervation. This study aimed to evaluate the safety of transient RNS in canines with normal or ischaemic hearts. METHODS In ten normal (Group 1) and six healed myocardial infarction (HMI) (Group 2) canines, a large-tip catheter was inserted into the left or right renal artery to perform transient RNS. The left stellate ganglion neural activity (LSGNA) and ventricular electrophysiological parameters were measured at baseline and during transient RNS. In another 20 acute myocardial infarction (AMI) canines, RNS (Group 3, n = 10) or sham RNS (Group 4, n = 10) was intermittently (1 min ON and 4 min OFF) performed for 1 h following AMI induction. The LSGNA and AMI-induced ventricular arrhythmias were analysed. RESULTS In normal and HMI canines, although transient RNS significantly increased the LSGNA and facilitated the action potential duration (APD) alternans, it did not induce any ventricular arrhythmias and did not change the ventricular effective refractory period, APD or maximum slope of the APD restitution curve. In AMI canines, transient RNS significantly exacerbated LSG activation and promoted the incidence of ventricular arrhythmias. CONCLUSION Transient RNS did not increase the risk of ventricular arrhythmias in normal or HMI hearts, but it significantly promoted the occurrence of ventricular arrhythmias in AMI hearts. Therefore, electrical stimulation-based renal nerve mapping may be unsafe in AMI patients and in patients with a high risk for malignant ventricular arrhythmias.
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22
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Enhanced arrhythmogenic potential induced by renal autonomic nerve stimulation: Role of renal artery catheter ablation. Heart Rhythm 2019; 17:133-141. [PMID: 31369871 DOI: 10.1016/j.hrthm.2019.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Renal artery catheter ablation has been reported as a possible therapeutic option for drug-refractory ventricular arrhythmias (VAs) associated with structural heart diseases. OBJECTIVE To further clarify its therapeutic background, we examined the relationship between electrical nerve stimulation (ENS)-induced blood pressure (BP) elevation and occurrence of VAs by using an acute canine model of renal artery ablation. METHODS Using a decapolar electrode catheter, ENS was successively applied from the distal, mid, and proximal segments of the renal artery in 8 beagles. The same ENS was repeated after accomplishment of radiofrequency ablation at the ostial site of the renal artery by using an irrigation catheter. RESULTS Before ablation, ENS increased BP from 140 ± 11/77 ± 11 to 167 ± 20/98 ± 16 mm Hg and heart rate from 100 ± 21 to 131±33 beats/min as well as induced VAs in 20 of the 45 ENS applications. Occurrence of VAs was associated with a greater magnitude of sympathetic nerve augmentation, and VAs were more frequently observed by ENS at the distal (67%) rather than mid/proximal segments of the renal artery (33%). Renal artery ablation was accomplished without any angiographic stenosis, and ENS-induced BP elevation, heart rate acceleration, and VAs occurrence were attenuated not only at the close segment (proximal) but also at the remote segments (mid/distal) of the renal artery. CONCLUSION The renal autonomic nerves are considered as one of the therapeutic targets for suppression of frequent VAs because its activation has arrhythmogenic potential and induces premature ventricular beats.
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23
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Hoogerwaard AF, Elvan A. Is renal denervation still a treatment option in cardiovascular disease? Trends Cardiovasc Med 2019; 30:189-195. [PMID: 31147257 DOI: 10.1016/j.tcm.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 11/19/2022]
Abstract
The role of renal sympathetic denervation (RDN) has been the topic of ongoing debate ever since the impressive initial results. The rationale of RDN is strong and supported by non-clinical studies, which lies in uncoupling the autonomic nervous crosstalk between the kidneys and the central nervous system. Since we know that cardiovascular diseases, such as hypertension, atrial, ventricular arrhythmias and heart failure (HF) are related to sympathetic (over)activity, modulation of the renal nerve activity appears to be a reasonable and attractive therapeutic target in these patients. This review will focus on the existing evidence and potential future perspectives for RDN as treatment option in cardiovascular disease.
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Affiliation(s)
- Annemiek F Hoogerwaard
- Department of Cardiology, Isala Heart Centre, Isala Hospital, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Arif Elvan
- Department of Cardiology, Isala Heart Centre, Isala Hospital, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands.
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24
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Affiliation(s)
- Reetu R Singh
- From the Department of Physiology, Cardiovascular Disease Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Kate M Denton
- From the Department of Physiology, Cardiovascular Disease Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
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25
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Observation of renal sympathetic nerves by intravascular ultrasound. Hypertens Res 2019; 42:1092-1094. [PMID: 30765879 DOI: 10.1038/s41440-019-0232-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 11/08/2022]
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26
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Chen S, Kiuchi MG, Yin Y, Liu S, Schratter A, Acou WJ, Meyer C, Pürerfellner H, Chun KRJ, Schmidt B. Synergy of pulmonary vein isolation and catheter renal denervation in atrial fibrillation complicated with uncontrolled hypertension: Mapping the renal sympathetic nerve and pulmonary vein (the pulmonary vein isolation plus renal denervation strategy)? J Cardiovasc Electrophysiol 2019; 30:658-667. [PMID: 30680830 DOI: 10.1111/jce.13858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Disturbance of sympathetic and vagal nervous system participates in the pathogenesis of hypertension and atrial fibrillation (AF). Renal denervation (RDN) can modulate autonomic nervous activity and reduce blood pressure (BP) in hypertensive patients. We aimed to evaluate the effect of RDN combined with pulmonary vein isolation (PVI) in patients with AF and hypertension. METHODS Clinical trials including randomized data comparing PVI plus RDN vs PVI alone were enrolled. Primary outcome was incidence of AF recurrence after procedure. RESULTS A total of 387 patients, of them 252 were randomized and were enrolled. Mean age was 57 ± 10 years, 71% were male, and mean left ventricular ejection fraction was 57.4% ± 6.9%. Follow-up for randomized data was 12 months. Overall comparison for primary outcome showed that PVI + RDN was associated with significantly lower AF recurrence as compared with PVI alone (35.8% vs 55.4%, P < 0.0001). This advantageous effect was consistently maintained among randomized patients (37.3% vs 61.9%, odds ratio = 0.37, P = 0.0001), and among patients with implanted devices for detection of AF recurrence (38.9% vs 61.6%, P = 0.007). Post-hoc sensitivity and regression analysis demonstrated very good stability of this primary result. Pooled Kaplan-Meier analysis further showed that PVI + RDN was associated with significantly higher freedom from AF recurrence as compared with PVI alone (log-rank test, P = 0.001). Besides, RDN resulted in significant BP reduction without additionally increasing the risk of adverse events. CONCLUSIONS RDN may provide synergetic effects with PVI to reduce the burden of AF and improve BP control in patients with AF and uncontrolled hypertension.
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Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Frankfurt Academy For Arrhythmias (FAFA), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Marcio G Kiuchi
- School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Yuehui Yin
- Department of Cardiology, Chongqing Cardiac Arrhythmia Service Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shaowen Liu
- Department of Cardiology, Shanghai First People's Hospital/Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Alexandra Schratter
- Medizinische Abteilung mit Kardiologie, Krankenhaus Hietzing Wien, Vienna, Austria
| | | | - Christian Meyer
- Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Helmut Pürerfellner
- Abteilung der kardialen Elektrophysiologie/Kardiologie, Akademisches Lehrkrankenhaus der Elisabethinen, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Frankfurt Academy For Arrhythmias (FAFA), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Frankfurt Academy For Arrhythmias (FAFA), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt, Germany
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27
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28
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Tsioufis KP, Feyz L, Dimitriadis K, Konstantinidis D, Tousoulis D, Voskuil M, Mahfoud F, Daemen J. Safety and performance of diagnostic electrical mapping of renal nerves in hypertensive patients. EUROINTERVENTION 2018; 14:e1334-e1342. [DOI: 10.4244/eij-d-18-00536] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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29
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Jiman AA, Chhabra KH, Lewis AG, Cederna PS, Seeley RJ, Low MJ, Bruns TM. Electrical stimulation of renal nerves for modulating urine glucose excretion in rats. Bioelectron Med 2018; 4:7. [PMID: 32232083 PMCID: PMC7098252 DOI: 10.1186/s42234-018-0008-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/17/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The role of the kidney in glucose homeostasis has gained global interest. Kidneys are innervated by renal nerves, and renal denervation animal models have shown improved glucose regulation. We hypothesized that stimulation of renal nerves at kilohertz frequencies, which can block propagation of action potentials, would increase urine glucose excretion. Conversely, we hypothesized that low frequency stimulation, which has been shown to increase renal nerve activity, would decrease urine glucose excretion. METHODS We performed non-survival experiments on male rats under thiobutabarbital anesthesia. A cuff electrode was placed around the left renal artery, encircling the renal nerves. Ureters were cannulated bilaterally to obtain urine samples from each kidney independently for comparison. Renal nerves were stimulated at kilohertz frequencies (1-50 kHz) or low frequencies (2-5 Hz), with intravenous administration of a glucose bolus shortly into the 25-40-min stimulation period. Urine samples were collected at 5-10-min intervals, and colorimetric assays were used to quantify glucose excretion and concentration between stimulated and non-stimulated kidneys. A Kruskal-Wallis test was performed across all stimulation frequencies (α = 0.05), followed by a post-hoc Wilcoxon rank sum test with Bonferroni correction (α = 0.005). RESULTS For kilohertz frequency trials, the stimulated kidney yielded a higher average total urine glucose excretion at 33 kHz (+ 24.5%; n = 9) than 1 kHz (- 5.9%; n = 6) and 50 kHz (+ 2.3%; n = 14). In low frequency stimulation trials, 5 Hz stimulation led to a lower average total urine glucose excretion (- 40.4%; n = 6) than 2 Hz (- 27.2%; n = 5). The average total urine glucose excretion between 33 kHz and 5 Hz was statistically significant (p < 0.005). Similar outcomes were observed for urine flow rate, which may suggest an associated response. No trends or statistical significance were observed for urine glucose concentrations. CONCLUSION To our knowledge, this is the first study to investigate electrical stimulation of renal nerves to modulate urine glucose excretion. Our experimental results show that stimulation of renal nerves may modulate urine glucose excretion, however, this response may be associated with urine flow rate. Future work is needed to examine the underlying mechanisms and identify approaches for enhancing regulation of glucose excretion.
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Affiliation(s)
- Ahmad A. Jiman
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI USA
| | - Kavaljit H. Chhabra
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI USA
| | - Alfor G. Lewis
- Department of Surgery, University of Michigan, Ann Arbor, MI USA
| | - Paul S. Cederna
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA
- Department of Surgery, Plastic Surgery Section, Michigan Medicine, Ann Arbor, MI USA
| | - Randy J. Seeley
- Department of Surgery, University of Michigan, Ann Arbor, MI USA
| | - Malcolm J. Low
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI USA
| | - Tim M. Bruns
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI USA
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30
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Hoogerwaard AF, Adiyaman A, de Jong MR, Smit JJJ, Delnoy PPHM, Heeg JE, van Hasselt BAAM, Ramdat Misier AR, Rienstra M, Elvan A. Changes in arterial pressure hemodynamics in response to renal nerve stimulation both before and after renal denervation. Clin Res Cardiol 2018; 107:1131-1138. [DOI: 10.1007/s00392-018-1287-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/22/2018] [Indexed: 12/26/2022]
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31
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Tsioufis C, Dimitriadis K, Tsioufis P, Patras R, Papadoliopoulou M, Petropoulou Z, Konstantinidis D, Tousoulis D. ConfidenHT™ System for Diagnostic Mapping of Renal Nerves. Curr Hypertens Rep 2018; 20:49. [DOI: 10.1007/s11906-018-0847-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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32
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Okamura K, Satou S, Setojima K, Shono S, Miyajima S, Ishii T, Shirai K, Urata H. Reduction of Blood Pressure Following After Renal Artery Adventitia Stripping During Total Nephroureterectomy: Potential Effect of Renal Sympathetic Denervation. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:567-572. [PMID: 29765015 PMCID: PMC5983072 DOI: 10.12659/ajcr.908891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Case series Patients: Male, 85 • Male, 89 Final Diagnosis: Essential hypertension Symptoms: High blood pressure Medication: Anti-hypertensive agents Clinical Procedure: Operation Specialty: Cardiology and Hypertension
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Affiliation(s)
- Keisuke Okamura
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Shunsuke Satou
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan.,Clinical Engineering Center, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Keita Setojima
- Clinical Engineering Center, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Shinjiro Shono
- Department of Anesthesiology, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Shigero Miyajima
- Department of Urology, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Tatsu Ishii
- Department of Urology, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Kazuyuki Shirai
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Hidenori Urata
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
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33
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Fudim M, Sobotka AA, Yin YH, Wang JW, Levin H, Esler M, Wang J, Sobotka PA. Selective vs. Global Renal Denervation: a Case for Less Is More. Curr Hypertens Rep 2018; 20:37. [PMID: 29717380 DOI: 10.1007/s11906-018-0838-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Review the renal nerve anatomy and physiology basics and explore the concept of global vs. selective renal denervation (RDN) to uncover some of the fundamental limitations of non-targeted renal nerve ablation and the potential superiority of selective RDN. RECENT FINDINGS Recent trials testing the efficacy of RDN showed mixed results. Initial investigations targeted global RDN as a therapeutic goal. The repeat observation of heterogeneous response to RDN including non-responders with lack of a BP reduction, or even more unsettling, BP elevations after RDN has raised concern for the detrimental effects of unselective global RDN. Subsequent studies have suggested the presence of a heterogeneous fiber population and the potential utility of renal nerve stimulation to identify sympatho-stimulatory fibers or "hot spots." The recognition that RDN can produce heterogeneous afferent sympathetic effects both change therapeutic goals and revitalize the potential of therapeutic RDN to provide significant clinical benefits. Renal nerve stimulation has emerged as potential tool to identify sympatho-stimulatory fibers, avoid sympatho-inhibitory fibers, and thus guide selective RDN.
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Affiliation(s)
- Marat Fudim
- Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | | | - Yue-Hui Yin
- The 2nd Affiliated Hospital of Chongqing Medical University, Chongqin, China
| | | | | | - Murray Esler
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Jie Wang
- Columbia University, New York, NY, USA.,SyMap Medical Ltd., Suzhou, China
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34
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de Jong MR, Hoogerwaard AF, Adiyaman A, Smit JJJ, Heeg JE, van Hasselt BAAM, Misier ARR, Elvan A. Renal nerve stimulation identifies aorticorenal innervation and prevents inadvertent ablation of vagal nerves during renal denervation. Blood Press 2018; 27:271-279. [DOI: 10.1080/08037051.2018.1463817] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Mark R. de Jong
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | | | - Ahmet Adiyaman
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Jaap Jan J. Smit
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Jan-Evert Heeg
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | | | | | - Arif Elvan
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
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Morganti A, Mancia G. Resistant hypertension: Renal denervation or intensified medical treatment? Eur J Intern Med 2018; 50:6-11. [PMID: 29287767 DOI: 10.1016/j.ejim.2017.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 12/27/2022]
Abstract
Resistant hypertension (RH) can be diagnosed if blood pressure (BP) is not controlled with the combination of three antihypertensive drugs, including a diuretic, all at effective doses. Patients affected by this condition exhibit a marked increase in the risk of cardiovascular and renal morbid and fatal events. They also exhibit an increased activity of the sympathetic nervous system which is likely to importantly contribute at the renal and other vascular levels to the hypertensive state. Almost 10years ago renal denervation (RDN) by radiofrequency thermal energy delivery to the walls of the renal arteries was proposed for the treatment of RH. Several uncontrolled studies initially reported that this procedure substantially reduced the elevated BP values but this conclusion has not been supported by a recent randomized control trial, which has almost marginalized this therapeutic approach. A revival, however, is under way because of recent positive findings and technical improvement that hold promise to make renal denervation more complete. The antihypertensive efficacy and overall validity of RDN will have to be tested against drug treatment of RH. Several studies indicate that an excess of aldosterone production contributes to RH and recent evidence documents indisputably that anti-aldosterone agents such as spironolactone can effectively control BP in many RH patients, although with some side effects that require close patients' monitoring. At present, it is advisable to treat RH with the addition of an anti-aldosterone agent. If BP control is not achieved or serious side effects become manifest RDN may then be considered.
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Affiliation(s)
- Alberto Morganti
- Centro Fisiologia Clinica e Ipertensione, Ospedale Policlinico, Università Milano, Milan, Italy
| | - Giuseppe Mancia
- Università degli Studi di Milano-Bicocca, Milano, Italy; Policlinico di Monza, Istituto di Ricovero e Cura ad Alta Specializzazione, Monza, Italy.
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Hoogerwaard AF, de Jong MR, Elvan A. Renal Nerve Stimulation as Procedural End Point for Renal Sympathetic Denervation. Curr Hypertens Rep 2018; 20:24. [PMID: 29556850 DOI: 10.1007/s11906-018-0821-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Renal sympathetic denervation (RDN) as treatment option for hypertension has a strong rationale; however, variable effects on blood pressure (BP) have been reported ranging from non-response to marked reductions in BP. The absence of a procedural end point for RDN is one of the potential factors associated with the variable response. Studies have suggested the use of renal nerve stimulation (RNS) to adequately address this issue. This review aims to provide an overview of the clinical and experimental data available regarding the effects of RNS in the setting of RDN. RECENT FINDINGS Animal studies have shown that high-frequency electrical stimulation of the sympathetic nerves in the adventitia of the renal arteries elicits an increase in BP and leads to an increased norepinephrine spillover as a marker of increased sympathetic activity and these effects of stimulation were attenuated or blunted after RDN. In a human feasibility study using RNS both before and after RDN, similar BP responses were observed. Moreover, in patients with resistant hypertension, RNS-induced changes in BP appeared to be correlated with 24-h BP response after RDN. These data suggest that RNS is a useful tool to identify renal sympathetic nerve fibers in patients with treatment-resistant hypertension undergoing RDN, and to predict the likely effectiveness of RDN treatments. In acute procedural settings both in animal and human models, RNS elicits increase in BP and HR before RDN and these effects are blunted after RDN. Up to now, there is preliminary evidence that the RNS-induced BP changes predict 24-h ABPM outcome at follow-up in patients with resistant hypertension. Of note, studies are small sized and results of large trials comparing conventional RDN to RNS-guided RDN are warranted.
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Affiliation(s)
- Annemiek F Hoogerwaard
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Mark R de Jong
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Arif Elvan
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
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Luo Q, Jin Q, Zhang N, Huang S, Han Y, Lin C, Ling T, Chen K, Pan W, Wu L. Antifibrillatory effects of renal denervation on ventricular fibrillation in a canine model of pacing-induced heart failure. Exp Physiol 2017; 103:19-30. [PMID: 29094471 DOI: 10.1113/ep086472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/27/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Qingzhi Luo
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Qi Jin
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Ning Zhang
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Shangwei Huang
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Yanxin Han
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Changjian Lin
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Tianyou Ling
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Kang Chen
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Wenqi Pan
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Liqun Wu
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
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Jamali HK, Waqar F, Gerson MC. Cardiac autonomic innervation. J Nucl Cardiol 2017; 24:1558-1570. [PMID: 27844333 DOI: 10.1007/s12350-016-0725-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Abstract
The autonomic nervous system plays a key role in regulating changes in the cardiovascular system and its adaptation to various human body functions. The sympathetic arm of the autonomic nervous system is associated with the fight and flight response, while the parasympathetic division is responsible for the restorative effects on heart rate, blood pressure, and contractility. Disorders involving these two divisions can lead to, and are seen as, a manifestation of most common cardiovascular disorders. Over the last few decades, extensive research has been performed establishing imaging techniques to quantify the autonomic dysfunction associated with various cardiovascular disorders. Additionally, several techniques have been tested with variable success in modulating the cardiac autonomic nervous system as treatment for these disorders. In this review, we summarize basic anatomy, physiology, and pathophysiology of the cardiac autonomic nervous system including adrenergic receptors. We have also discussed several imaging modalities available to aid in diagnosis of cardiac autonomic dysfunction and autonomic modulation techniques, including pharmacologic and device-based therapies, that have been or are being tested currently.
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Affiliation(s)
- Hina K Jamali
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, P.O. Box 670542, Cincinnati, OH, USA
| | - Fahad Waqar
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, P.O. Box 670542, Cincinnati, OH, USA
| | - Myron C Gerson
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, P.O. Box 670542, Cincinnati, OH, USA.
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Abstract
Purpose of Review The etiology of hypertension, a critical public health issue affecting one in three US adults, involves the integration of the actions of multiple organ systems, including the renal sympathetic nerves. The renal sympathetic nerves, which are comprised of both afferent (sensory input) and efferent (sympathetic outflow) arms, have emerged as a major potential therapeutic target to treat hypertension and disease states exhibiting excess renal sympathetic activity. Recent Findings This review highlights recent advances in both clinical and basic science that have provided new insight into the distribution, function, and reinnervation of the renal sympathetic nerves, with a focus on the renal afferent nerves, in hypertension and hypertension-evoked disease states including salt-sensitive hypertension, obesity-induced hypertension, and chronic kidney disease. Summary Increased understanding of the differential role of the renal afferent versus efferent nerves in the pathophysiology of hypertension has the potential to identify novel targets and refine therapeutic interventions designed to treat hypertension.
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Changes in renal artery dimensions are associated with clinical response to radiofrequency renal denervation: a series of studies using quantitative angiography and intravascular ultrasound. J Hypertens 2017; 35:2069-2076. [PMID: 28505064 DOI: 10.1097/hjh.0000000000001409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Renal denervation (RDN) can cause focal (notches) and global (spasms) changes in renal artery dimensions. We quantified these changes and related them to renal norepinephrin tissue content in animals and to blood pressure (BP) changes in patients. METHODS We measured renal artery dimensions pre-RDN and post-RDN, utilizing quantitative renal angiography (QRA) in a porcine model and in a retrospective patient cohort, and intravascular ultrasound (IVUS) in a prospective patient cohort. Focal and global measurements were minimum and mean diameter/area/volume with QRA, minimum lumen/vessel/wall area and volume with IVUS. BP was assessed with 24-h ambulatory monitoring, norepinephrin content with liquid chromatography. RESULTS In 36 pigs treated unilaterally with RDN, norepinephrin content of the treated right kidney was 48.2% of the untreated left kidney. QRA measurements following RDN were associated with norepinephrin content only of the (treated) right kidney. In the human QRA study (n = 43 patients), mean 24-h BP fell by 8/4 and 12/6 mmHg at 1 and 12 months, respectively. More pronounced changes in QRA measurements were associated with a more pronounced BP drop. In multiple regression models, the change in minimum diameter was independently associated with BP changes at 12 months. In the prospective IVUS study (n = 17 patients), a larger decrease in minimum lumen/vessel area and larger increase of wall area/volume were associated with a larger BP drop. CONCLUSION Focal and global changes in renal arteries following RDN can be quantified, using QRA or IVUS, and may serve as markers of a successful procedure.
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The future of renal denervation. Auton Neurosci 2017; 204:131-138. [DOI: 10.1016/j.autneu.2016.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/21/2016] [Accepted: 08/01/2016] [Indexed: 12/17/2022]
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Hoogerwaard AF, de Jong MR, Adiyaman A, Smit JJJ, Delnoy PP, Heeg JE, van Hasselt BA, Ramdat Misier AR, Elvan A. Renal vascular calcification and response to renal nerve denervation in resistant hypertension. Medicine (Baltimore) 2017; 96:e6611. [PMID: 28445258 PMCID: PMC5413223 DOI: 10.1097/md.0000000000006611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Renal sympathetic nerve denervation (RDN) is accepted as a treatment option for patients with resistant hypertension. However, results on decline in ambulatory blood pressure (BP) measurement (ABPM) are conflicting. The high rate of nonresponders may be related to increased systemic vascular stiffness rather than sympathetic overdrive. A single center, prospective registry including 26 patients with treatment resistant hypertension who underwent RDN at the Isala Hospital in the Netherlands. Renal perivascular calcium scores were obtained from noncontrast computed tomography scans. Patients were divided into 3 groups based on their calcium scores (group I: low 0-50, group II: intermediate 50-1000, and group III: high >1000). The primary end point was change in 24-hour ABPM at 6 months follow-up post-RDN compared to baseline. Seven patients had low calcium scores (group I), 13 patients intermediate (group II), and 6 patients had high calcium scores (group III). The groups differed significantly at baseline in age and baseline diastolic 24-hour ABPM. At 6-month follow-up, no difference in 24-hour systolic ABPM response was observed between the 3 groups; a systolic ABPM decline of respectively -9 ± 12, -6 ± 12, -12 ± 10 mm Hg was found. Also the decline in diastolic ambulatory and office systolic and diastolic BP was not significantly different between the 3 groups at follow-up. Our preliminary data showed that the extent of renal perivascular calcification is not associated with the ABPM response to RDN in patients with resistant hypertension.
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George C, Bhambhvani PG, Oparil S. 123I-mIBG scintigraphy: Clinical tool for assessing renal sympathetic activity? J Nucl Cardiol 2017; 24:372-376. [PMID: 28039676 DOI: 10.1007/s12350-016-0764-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 11/28/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Christopher George
- University of Alabama at Birmingham, Zeigler Research Building 1034 703 19th St S, Birmingham, AL, 35233, USA
| | - Pradeep G Bhambhvani
- University of Alabama at Birmingham, Zeigler Research Building 1034 703 19th St S, Birmingham, AL, 35233, USA
| | - Suzanne Oparil
- University of Alabama at Birmingham, Zeigler Research Building 1034 703 19th St S, Birmingham, AL, 35233, USA.
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Gosse P, Cremer A, Pereira H, Bobrie G, Chatellier G, Chamontin B, Courand PY, Delsart P, Denolle T, Dourmap C, Ferrari E, Girerd X, Michel Halimi J, Herpin D, Lantelme P, Monge M, Mounier-Vehier C, Mourad JJ, Ormezzano O, Ribstein J, Rossignol P, Sapoval M, Vaïsse B, Zannad F, Azizi M. Twenty-Four-Hour Blood Pressure Monitoring to Predict and Assess Impact of Renal Denervation: The DENERHTN Study (Renal Denervation for Hypertension). Hypertension 2017; 69:494-500. [PMID: 28115517 DOI: 10.1161/hypertensionaha.116.08448] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/09/2016] [Accepted: 12/07/2016] [Indexed: 11/16/2022]
Abstract
The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure (BP) lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report here the effect of denervation on 24-hour BP and its variability and look for parameters that predicted the BP response. Patients with resistant hypertension were randomly assigned to denervation plus stepped-care treatment or treatment alone (control). Average and standard deviation of 24-hour, daytime, and nighttime BP and the smoothness index were calculated on recordings performed at randomization and 6 months. Responders were defined as a 6-month 24-hour systolic BP reduction ≥20 mm Hg. Analyses were performed on the per-protocol population. The significantly greater BP reduction in the denervation group was associated with a higher smoothness index (P=0.02). Variability of 24-hour, daytime, and nighttime BP did not change significantly from baseline to 6 months in both groups. The number of responders was greater in the denervation (20/44, 44.5%) than in the control group (11/53, 20.8%; P=0.01). In the discriminant analysis, baseline average nighttime systolic BP and standard deviation were significant predictors of the systolic BP response in the denervation group only, allowing adequate responder classification of 70% of the patients. Our results show that denervation lowers ambulatory BP homogeneously over 24 hours in patients with resistant hypertension and suggest that nighttime systolic BP and variability are predictors of the BP response to denervation. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01570777.
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Affiliation(s)
- Philippe Gosse
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.).
| | - Antoine Cremer
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Helena Pereira
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Guillaume Bobrie
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Gilles Chatellier
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Bernard Chamontin
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Pierre-Yves Courand
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Pascal Delsart
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Thierry Denolle
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Caroline Dourmap
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Emile Ferrari
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Xavier Girerd
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Jean Michel Halimi
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Daniel Herpin
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Pierre Lantelme
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Matthieu Monge
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Claire Mounier-Vehier
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Jean-Jacques Mourad
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Olivier Ormezzano
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Jean Ribstein
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Patrick Rossignol
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Marc Sapoval
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Bernard Vaïsse
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Faiez Zannad
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
| | - Michel Azizi
- From the Hopital Saint André, University Hospital of Bordeaux, France (P.G., A.C.); Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigations Cliniques 1418, Paris, France (H.P., G.C., M.A.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (G.B., M.M., M.A.); Paris-Descartes University, Paris, France (G.C., M.A.); Service de médecine Interne et Hypertension artérielle Pole Cardiovasculaire et métabolique, University Hospital Rangueil, Toulouse, France (B.C.); Cardiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C.); Hôpital Cardiologique, Service de médecine vasculaire et HTA, University Hospital Lille, France (P.D., P.L., C.M.-V.); Arthur Gardiner Hospital, Dinard, France (T.D.); University Hospital of Rennes, France (C.D.); Department of Cardiology, University Hospital Nice, France (E.F.); Unité de Prévention Cardio Vasculaire, University Hospital Pitié-Salpêtrière, Paris, France (X.G.); Service de Néphrologie-Immunologie clinique, University hospital Tours et EA4245 Université François-Rabelais, Tours, France (J.M.H.); Department of Cardiology, University Hospital Poitiers, France (D.H.); University Hospital Avicenne-APHP, Bobigny, France (J.-J.M.); Department of Cardiology, University Hospital and INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France (O.O.); Department of Medicine and Hypertension, University Hospital of Montpellier, France (J.R.); INSERM, Centre d'Investigations Cliniques, Plurithématique 14-33, and INSERM U1116, and University Hospital Nancy and Université de Lorraine and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (P.R., F.Z.); Vascular and Oncological Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France (M.S.); and University Hospital La Timone, Marseille, France (B.V.)
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45
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Patel HC, Hayward C, Ewen S, Mahfoud F. Renal Denervation for Resistant Hypertension. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hitesh C. Patel
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London UK
| | - Carl Hayward
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London UK
| | - Sebastian Ewen
- Universitätsklinikum des Saarlandes; Homburg-Saar Germany
| | - Felix Mahfoud
- Universitätsklinikum des Saarlandes; Homburg-Saar Germany
- Harvard-MIT Biomedical Engineering; Institute of Medical Engineering and Science; Cambridge MA USA
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46
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de Jong MR, Adiyaman A, Gal P, Smit JJJ, Delnoy PPH, Heeg JE, van Hasselt BA, Lau EO, Persu A, Staessen JA, Ramdat Misier AR, Steinberg JS, Elvan A. Renal Nerve Stimulation–Induced Blood Pressure Changes Predict Ambulatory Blood Pressure Response After Renal Denervation. Hypertension 2016; 68:707-14. [DOI: 10.1161/hypertensionaha.116.07492] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/19/2016] [Indexed: 11/16/2022]
Abstract
Blood pressure (BP) response to renal denervation (RDN) is highly variable and its effectiveness debated. A procedural end point for RDN may improve consistency of response. The objective of the current analysis was to look for the association between renal nerve stimulation (RNS)–induced BP increase before and after RDN and changes in ambulatory BP monitoring (ABPM) after RDN. Fourteen patients with drug-resistant hypertension referred for RDN were included. RNS was performed under general anesthesia at 4 sites in the right and left renal arteries, both before and immediately after RDN. RNS-induced BP changes were monitored and correlated to changes in ambulatory BP at a follow-up of 3 to 6 months after RDN. RNS resulted in a systolic BP increase of 50±27 mm Hg before RDN and systolic BP increase of 13±16 mm Hg after RDN (
P
<0.001). Average systolic ABPM was 153±11 mm Hg before RDN and decreased to 137±10 mm Hg at 3- to 6-month follow-up (
P
=0.003). Changes in RNS-induced BP increase before versus immediately after RDN and changes in ABPM before versus 3 to 6 months after RDN were correlated, both for systolic BP (
R
=0.77,
P
=0.001) and diastolic BP (
R
=0.79,
P
=0.001). RNS-induced maximum BP increase before RDN had a correlation of
R
=0.61 (
P
=0.020) for systolic and
R
=0.71 (
P
=0.004) for diastolic ABPM changes. RNS-induced BP changes before versus after RDN were correlated with changes in 24-hour ABPM 3 to 6 months after RDN. RNS should be tested as an acute end point to assess the efficacy of RDN and predict BP response to RDN.
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Affiliation(s)
- Mark R. de Jong
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Ahmet Adiyaman
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Pim Gal
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Jaap Jan J. Smit
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Peter Paul H.M. Delnoy
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Jan-Evert Heeg
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Boudewijn A.A.M. van Hasselt
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Elizabeth O.Y. Lau
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Alexandre Persu
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Jan A. Staessen
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Anand R. Ramdat Misier
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Jonathan S. Steinberg
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Arif Elvan
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
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Zheng H, Patel KP. Integration of renal sensory afferents at the level of the paraventricular nucleus dictating sympathetic outflow. Auton Neurosci 2016; 204:57-64. [PMID: 27527558 DOI: 10.1016/j.autneu.2016.08.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/01/2016] [Accepted: 08/05/2016] [Indexed: 02/07/2023]
Abstract
The sympathetic nervous system has been identified as a major contributor to the pathophysiology of chronic heart failure (CHF) and other diseases such as hypertension and diabetes, both in experimental animal models and patients. The kidneys have a dense afferent sensory innervation positioning it to be the origin of multimodal input to the central nervous system. Afferent renal nerve (ARN) signals are centrally integrated, and their activation results in a general increase in sympathetic tone, which is directed toward the kidneys as well as other peripheral organs innervated by the sympathetic nerves. In the central nervous system, stimulation of ARN increases the neuronal discharge frequency and neuronal activity in the paraventricular nucleus (PVN) of the hypothalamus. The activity of the neurons in the PVN is attenuated during iontophoretic application of glutamate receptor blocker, AP5. An enhanced afferent renal input to the PVN may be critically involved in dictating sympathoexcitation in CHF. Furthermore, renal denervation abrogates the enhanced neuronal activity within the PVN in rats with CHF, thereby possibly contributing to the reduction in sympathetic tone. Renal denervation also restores the decreased endogenous levels of neuronal nitric oxide synthase (nNOS) in the PVN of rats with CHF. Overall, these data demonstrate that sensory information originating in the kidney excites pre-autonomic sympathetic neurons within the PVN and this "renal-PVN afferent pathway" may contribute to elevated sympathetic nerve activity in hyper-sympathetic disease conditions such as CHF and hypertension.
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Affiliation(s)
- Hong Zheng
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE 68198-5850, United States
| | - Kaushik P Patel
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE 68198-5850, United States.
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Chinushi M, Suzuki K, Saitoh O, Furushima H, Iijima K, Izumi D, Sato A, Sugai M, Iwafuchi M. Electrical stimulation–based evaluation for functional modification of renal autonomic nerve activities induced by catheter ablation. Heart Rhythm 2016; 13:1707-15. [DOI: 10.1016/j.hrthm.2016.04.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Indexed: 11/15/2022]
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NAKSUK NIYADA, KILLU AMMARM, YOGESWARAN VIDHUSHEI, DESIMONE CHRISTOPHERV, SUDDENDORF SCOTTH, LADEWIG DOROTHYJ, POWERS JOANNEM, WEBER SARAH, MADHAVAN MALINI, CHA YONGMEI, KAPA SURAJ, ASIRVATHAM SAMUELJ. Blood Pressure Responses to Endovascular Stimulation: A Potential Therapy for Autonomic Disorders With Vasodilatation. J Cardiovasc Electrophysiol 2016; 27:1078-85. [DOI: 10.1111/jce.13018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/06/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
Affiliation(s)
- NIYADA NAKSUK
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota USA
| | - AMMAR M. KILLU
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota USA
| | | | | | | | - DOROTHY J. LADEWIG
- Mayo Clinic Ventures; Mayo Clinic; Rochester Minnesota USA
- Department of Cardiovascular Surgery; Mayo Clinic; Rochester Minnesota USA
| | | | - SARAH WEBER
- Student Scholar Program; Mayo Clinic; Rochester Minnesota USA
| | - MALINI MADHAVAN
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota USA
| | - YONG-MEI CHA
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota USA
| | - SURAJ KAPA
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota USA
| | - SAMUEL J. ASIRVATHAM
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota USA
- Department of Pediatrics and Adolescent Medicine; Mayo Clinic; Rochester Minnesota USA
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