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Subbotina A, Skjølsvik E, Solbu MD, Miroslawska A, Steigen T. Echocardiographic findings following renal sympathetic denervation for treatment resistant hypertension, the ReShape CV-risk study. Blood Press 2024; 33:2326298. [PMID: 38469724 DOI: 10.1080/08037051.2024.2326298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE The aim of this study was to describe and compare echocardiographic findings before renal sympathetic denervation (RDN) and 6 and 24 months after the procedure. MATERIALS AND METHODS Patients with treatment resistant hypertension (TRH) were included in this non-randomised intervention study. RDN was performed by a single experienced operator using the Symplicity Catheter System. Echocardiographic measurements were performed at baseline, and after 6 and 24 months. RESULTS The cohort consisted of 21 patients with TRH, with a mean systolic office blood pressure (BP) of 163 mmHg and mean diastolic BP 109 mmHg. Mixed model analysis showed no significant change in left ventricular (LV) mass index (LVMI) or left atrium volume index (LAVI) after the RDN procedure. Higher LVMI at baseline was significantly associated with greater reduction in LVMI (p < 0.001). Relative wall thickness (RWT) increased over time (0.48 mm after two years) regardless of change in BP. There was a small but significant reduction in LV end-diastolic (LVIDd) and end-systolic (LVIDs) diameters after RDN, with a mean reduction of 2.6 and 2.4 mm, respectively, after two years. Progression to concentric hypertrophy was observed only in in patients who did not achieve normal BP values, despite BP reduction after RDN. CONCLUSION There was no reduction of LV mass after RDN. We found a small statistically significant reduction in LVIDd and LVIDs, which together with increase in RWT can indicate progression towards concentric hypertrophy. BP reduction after RDN on its own does not reverse concentric remodelling if target BP is not achieved.
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Affiliation(s)
- Anna Subbotina
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
- Clinical Cardiovascular Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Eystein Skjølsvik
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marit Dahl Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Atena Miroslawska
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Terje Steigen
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
- Clinical Cardiovascular Research Group, UiT The Arctic University of Norway, Tromsø, Norway
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Vogt A, Plehn A, Atti C, Nussbaum M, Tongers J, Sedding D, Dutzmann J. Left ventricular structure and function following renal sympathetic denervation in patients with HFpEF: an echocardiographic 9-year long-term follow-up. Front Cardiovasc Med 2024; 11:1408547. [PMID: 38919545 PMCID: PMC11196750 DOI: 10.3389/fcvm.2024.1408547] [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: 03/28/2024] [Accepted: 05/23/2024] [Indexed: 06/27/2024] Open
Abstract
Background High blood pressure is a major risk factor for cardiac remodeling and left ventricular hypertrophy, increasing cardiovascular risk and leading to heart failure with preserved ejection fraction (HFpEF). Since renal sympathetic denervation (RDN) reduces blood pressure in the long term, we aimed to investigate the long-term effect of RDN in patients with HFpEF in the present analysis. Methods Patients previously enrolled in a local RDN registry who underwent high-frequency RDN with the use of the Symplicity Flex® renal denervation system between 2011 and 2014 were followed up. The patients were assessed by 24-h ambulatory blood pressure measurement, transthoracic echocardiography, and laboratory tests. We used the echocardiographic and biomarker criteria of the Heart Failure Association (HFA)-PEFF (Pre-test assessment, Echocardiography and Natriuretic Peptide Score, Funkctional testing, and Final aetiology) score to identify patients with HFpEF. Results Echocardiographic assessment was available for 70 patients at a 9-year long-term follow-up. Of these patients, 21 had HFpEF according to the HFA-PEFF score. We found a significant reduction of the HFA-PEFF score from 5.48 ± 0.51 points at baseline to 4.33 ± 1.53 points at the 9-year follow-up (P < 0.01). This decrease was due to a greater reduction in morphological and biomarker subcategories [from 1.95 ± 0.22 to 1.43 ± 0.51 points (P < 0.01) and from 1.52 ± 0.52 to 0.90 ± 0.63 points (P < 0.01), respectively] than in the functional one. Morphologically, there was a reduction in left ventricular hypertrophy and left atrial dilation. Conclusions The present analysis suggests that RDN may lead to a regression of the extent of HFpEF beyond a reduction in blood pressure and thus possibly contribute to an improvement in prognosis. More detailed information will be provided by ongoing randomized sham-controlled trials.
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Affiliation(s)
- Alexander Vogt
- Department of Internal Medicine III, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Alexander Plehn
- Department of Internal Medicine III, University Hospital Halle (Saale), Halle (Saale), Germany
- Praxisklinik Salzatal, Salzatal, Germany
| | - Carlo Atti
- Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Michael Nussbaum
- Department of Internal Medicine III, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Jörn Tongers
- Department of Internal Medicine III, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Daniel Sedding
- Department of Internal Medicine III, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Jochen Dutzmann
- Department of Internal Medicine III, University Hospital Halle (Saale), Halle (Saale), Germany
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Lauder L, Siwy J, Mavrogeorgis E, Keller F, Kunz M, Wachter A, Emrich IE, Böhm M, Mischak H, Mahfoud F. Impact of Renal Denervation on Urinary Peptide-Based Biomarkers in Hypertension. Hypertension 2024; 81:1374-1382. [PMID: 38572643 DOI: 10.1161/hypertensionaha.124.22819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Catheter-based renal denervation (RDN) reduces blood pressure in hypertension. Urinary peptides are associated with cardiovascular and renal disease and provide prognostic information. We aimed to investigate the effect of RDN on urinary peptide-based classifiers associated with chronic kidney and heart disease and to identify urinary peptides affected by RDN. METHODS This single-arm, single-center study included patients undergoing catheter-based RDN. Urine samples were collected before and 24 months after RDN and were analyzed using capillary electrophoresis coupled with mass spectrometry. Predefined urinary peptide-based classifiers for chronic kidney disease (CKD273), coronary artery disease (CAD238), and heart failure (HF1) were applied. RESULTS This study included 48 patients (33% female) with uncontrolled hypertension. At 24 months after RDN, systolic blood pressure (165±17 versus 148±20 mm Hg; P<0.0001), diastolic blood pressure (90±17 versus 81±13 mm Hg; P<0.0001), and mean arterial pressure (115±15 versus 103±13 mm Hg; P<0.0001) decreased significantly. A total of 103 urinary peptides from 37 different proteins, mostly collagens, altered following RDN. CAD238, a 238 coronary artery-specific polypeptide-based classifier, significantly improved following RDN (Cohen's d, -0.632; P=0.0001). The classification scores of HF1 (P=0.8295) and CKD273 (P=0.6293) did not change significantly. CONCLUSIONS RDN beneficially affected urinary peptides associated with coronary artery disease. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01888315.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany (L.L., M.K., A.W., I.E.E., M.B., F.M.)
| | - Justyna Siwy
- Mosaiques Diagnostics GmbH, Hannover, Germany (J.S., E.M., H.M.)
| | - Emmanouil Mavrogeorgis
- Mosaiques Diagnostics GmbH, Hannover, Germany (J.S., E.M., H.M.)
- Institute for Molecular Cardiovascular Research, Rheinisch-Westfälische Technische Hochschule Aachen University Hospital, Germany (E.M.)
| | - Felix Keller
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Austria (F.K.)
| | - Michael Kunz
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany (L.L., M.K., A.W., I.E.E., M.B., F.M.)
| | - Angelika Wachter
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany (L.L., M.K., A.W., I.E.E., M.B., F.M.)
| | - Insa E Emrich
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany (L.L., M.K., A.W., I.E.E., M.B., F.M.)
| | - Michael Böhm
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany (L.L., M.K., A.W., I.E.E., M.B., F.M.)
| | - Harald Mischak
- Mosaiques Diagnostics GmbH, Hannover, Germany (J.S., E.M., H.M.)
| | - Felix Mahfoud
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany (L.L., M.K., A.W., I.E.E., M.B., F.M.)
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (F.M.)
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Xie L, Li Y, Luo S, Huang B. Impact of renal denervation on cardiac remodeling in resistant hypertension: A meta-analysis. Clin Cardiol 2024; 47:e24222. [PMID: 38402531 PMCID: PMC10823454 DOI: 10.1002/clc.24222] [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: 10/09/2023] [Revised: 12/27/2023] [Accepted: 01/10/2024] [Indexed: 02/26/2024] Open
Abstract
Twelve studies involving 433 patients were included. After RDN treatment, LVMI decreased by 13.08 g/m2 (95% confidence interval [CI]: -18.38, -7.78; p < .00001), PWTd decreased by 0.60 mm (95% CI: -0.87, -0.34; p < .00001), IVSTd decreased by 0.78 mm (95% CI: -1.06, -0.49; p < .00001), and LVEF increased by 1.80% (95% CI: 0.71, 2.90; p = .001). However, there were no statistically significant improvements in LVIDd (95% CI: -1.40, 0.24; p = .17) and diastolic function (E/A) (95% CI: -0.04, 0.14; p = .28). Drug treatment for resistant hypertension (RH) is challenging. Renal denervation (RDN) is one of the most promising treatments for RH. Although studies have shown RDN can control blood pressure, the impacts of RDN on cardiac remodeling and cardiac function are unclear. This meta-analysis evaluated the effect of RDN on cardiac structure and function in patients with RH. PubMed, Embase, and Cochrane were used to conduct a systematic search. The main inclusion criteria were studies on patients with RH who received RDN and reported the changes in echocardiographic parameters before and after RDN. Echocardiographic parameters included left ventricular mass index (LVMI), end-diastolic left ventricular internal dimension (LVIDd), left ventricular end-diastolic posterior wall thickness (PWTd), end-diastolic interventricular septum thickness (IVSTd), E/A, and left ventricular ejection fraction (LVEF). Data was analyzed using RevMan. Twelve studies involving 433 patients were included. After RDN treatment, LVMI decreased by 13.08g/m2 (95%confidence interval [CI]: -18.38, -7.78, p < .00001), PWTd decreased by 0.60mm (95% CI: -0.87, -0.34, p < 0.00001), IVSTd decreased by 0.78mm (95% CI: -1.06, -0.49, p < .00001), and LVEF increased by 1.80% (95% CI: 0.71, 2.90, p = .001). However, there were no statistically significant improvements in LVIDd (95% CI: -1.40, 0.24, p = .17) and diastolic function (E/A) (95% CI: -0.04, 0.14, p =.28). This meta-analysis finds that RDN can improve left ventricular hypertrophy and ejection fraction in patients with RH but has no significant effect on LVIDd and diastolic function. However, more studies are warranted due to the lack of a strict control group, a limited sample size, and research heterogeneity.
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Affiliation(s)
- Linfeng Xie
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Yuanzhu Li
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Suxin Luo
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Bi Huang
- Department of CardiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
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Lauder L, Mahfoud F, Azizi M, Bhatt DL, Ewen S, Kario K, Parati G, Rossignol P, Schlaich MP, Teo KK, Townsend RR, Tsioufis C, Weber MA, Weber T, Böhm M. Hypertension management in patients with cardiovascular comorbidities. Eur Heart J 2022:6808663. [DOI: 10.1093/eurheartj/ehac395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Arterial hypertension is a leading cause of death globally. Due to ageing, the rising incidence of obesity, and socioeconomic and environmental changes, its incidence increases worldwide. Hypertension commonly coexists with Type 2 diabetes, obesity, dyslipidaemia, sedentary lifestyle, and smoking leading to risk amplification. Blood pressure lowering by lifestyle modifications and antihypertensive drugs reduce cardiovascular (CV) morbidity and mortality. Guidelines recommend dual- and triple-combination therapies using renin–angiotensin system blockers, calcium channel blockers, and/or a diuretic. Comorbidities often complicate management. New drugs such as angiotensin receptor-neprilysin inhibitors, sodium–glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and non-steroidal mineralocorticoid receptor antagonists improve CV and renal outcomes. Catheter-based renal denervation could offer an alternative treatment option in comorbid hypertension associated with increased sympathetic nerve activity. This review summarises the latest clinical evidence for managing hypertension with CV comorbidities.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Michel Azizi
- Université Paris Cité, INSERM CIC1418 , F-75015 Paris , France
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department, DMU CARTE , F-75015 Paris , France
- FCRIN INI-CRCT , Nancy , France
| | - Deepak L Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School , Boston, MA , USA
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine , Tochigi , Japan
| | - Gianfranco Parati
- Department of Medicine and Surgery, Cardiology Unit, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS , Milan , Italy
| | - Patrick Rossignol
- FCRIN INI-CRCT , Nancy , France
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques - Plurithématique 14-33 and INSERM U1116 , Nancy , France
- CHRU de Nancy , Nancy , France
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School—Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia , Perth, WA , Australia
- Departments of Cardiology and Nephrology, Royal Perth Hospital , Perth, WA , Australia
| | - Koon K Teo
- Population Health Research Institute, McMaster University , Hamilton, ON , Canada
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Costas Tsioufis
- National and Kapodistrian University of Athens, 1st Cardiology Clinic, Hippocratio Hospital , Athens , Greece
| | | | - Thomas Weber
- Department of Cardiology, Klinikum Wels-Grieskirchen , Wels , Austria
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
- Cape Heart Institute (CHI), Faculty of Health Sciences, University of Cape Town , Cape Town , South Africa
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Renal sympathetic denervation in resistant hypertension: The association between vitamin D and positive early response in systolic blood pressure. Rev Port Cardiol 2022; 41:311-320. [DOI: 10.1016/j.repc.2021.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/14/2021] [Accepted: 02/06/2021] [Indexed: 01/14/2023] Open
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Effect of renal denervation procedure on left ventricular mass, myocardial strain and diastolic function by CMR on a 12-month follow-up. Jpn J Radiol 2019; 37:642-650. [DOI: 10.1007/s11604-019-00854-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022]
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Singh RR, McArdle ZM, Iudica M, Easton LK, Booth LC, May CN, Parkington HC, Lombardo P, Head GA, Lambert G, Moritz KM, Schlaich MP, Denton KM. Sustained Decrease in Blood Pressure and Reduced Anatomical and Functional Reinnervation of Renal Nerves in Hypertensive Sheep 30 Months After Catheter-Based Renal Denervation. Hypertension 2019; 73:718-727. [DOI: 10.1161/hypertensionaha.118.12250] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Reetu R. Singh
- From the Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology (R.R.S., Z.M.M., M.I., L.K.E., H.C.P., K.M.D.), Monash University, Melbourne, Australia
| | - Zoe M. McArdle
- From the Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology (R.R.S., Z.M.M., M.I., L.K.E., H.C.P., K.M.D.), Monash University, Melbourne, Australia
| | - Michael Iudica
- From the Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology (R.R.S., Z.M.M., M.I., L.K.E., H.C.P., K.M.D.), Monash University, Melbourne, Australia
| | - Lawrence K. Easton
- From the Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology (R.R.S., Z.M.M., M.I., L.K.E., H.C.P., K.M.D.), Monash University, Melbourne, Australia
| | - Lindsea C. Booth
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (L.C.B., C.N.M.)
| | - Clive N. May
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (L.C.B., C.N.M.)
| | - Helena C. Parkington
- From the Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology (R.R.S., Z.M.M., M.I., L.K.E., H.C.P., K.M.D.), Monash University, Melbourne, Australia
| | - Paul Lombardo
- Department of Medical Imaging and Radiation Sciences (P.L.), Monash University, Melbourne, Australia
| | - Geoff A. Head
- Baker Heart and Diabetes Institute, Melbourne, Australia (G.A.H., M.P.S.)
| | - Gavin Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia (G.L.)
| | - Karen M. Moritz
- School of Biomedical Sciences, University of Queensland, Brisbane, Australia (K.M.M.)
| | - Markus P. Schlaich
- Baker Heart and Diabetes Institute, Melbourne, Australia (G.A.H., M.P.S.)
- Dobney Hypertension Centre, School of Medicine–Royal Perth Hospital Unit, University of Western Australia (M.P.S.)
| | - Kate M. Denton
- From the Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology (R.R.S., Z.M.M., M.I., L.K.E., H.C.P., K.M.D.), Monash University, Melbourne, Australia
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Nishihara M, Takesue K, Hirooka Y. Olmesartan combined with renal denervation reduces blood pressure in association with sympatho-inhibitory and aldosterone-reducing effects in hypertensive mice with chronic kidney disease. Clin Exp Hypertens 2018; 41:211-219. [DOI: 10.1080/10641963.2018.1465075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Masaaki Nishihara
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Ko Takesue
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yoshitaka Hirooka
- Department of Advanced Cardiovascular Regulation and Therapeutics, Kyushu University, Fukuoka, Japan
- Department of Medical Science Technology, International University of Health and Welfare School of Health Sciences at Fukuoka, Okawa City, Japan
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Effects of Renal Denervation on Cardiac Structural and Functional Abnormalities in Patients with Resistant Hypertension or Diastolic Dysfunction. Sci Rep 2018; 8:1172. [PMID: 29352146 PMCID: PMC5775308 DOI: 10.1038/s41598-017-18671-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 12/04/2017] [Indexed: 11/18/2022] Open
Abstract
The aim of the present study is to systematically evaluate the impact of RDN on cardiac structure and function in patients with resistant hypertension (RH) or diastolic dysfunction. We retrieved Pubmed, Embase and Cocharane Library databases, from inception to April 1st, 2016. Studies reporting left ventricular mass (LVMI) or left ventricular (LV) diastolic function (reflected by the ratio of mitral inflow velocity to annular relaxation velocity [E/e’]) responses to RDN were included. Two randomized controlled trials (RCTs), 3 controlled studies and 11 uncontrolled studies were finally identified. In observational studies, there was a reduction in LVMI, E/e’ and N-terminal pro B-type natriuretic peptide (BNP) at 6 months, compared with pre-RDN values. LV ejection fraction (LVEF) elevated at 6 months following RDN. In RCTs, however, no significant change in LVMI, E/e’, BNP, left atrial volume index or LVEF was observed at 12 months, compared with pharmaceutical therapy. In summary, both LV hypertrophy and cardiac function improved at 6 months after RDN. Nonetheless, current evidence failed to show that RDN was superior to intensive (optimal) drug therapy in improving cardiac remodeling and function.
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Waksman R, Bakris GL, Steinvil A, Garcia-Garcia H, Brown AL, DiFilippo W, Scott T, Singh J, DeBruin V, Jones D, Jolivette D, Bhatt DL. High screen failure rate in patients with resistant hypertension: Findings from SYMPLICITY HTN-3. Am Heart J 2017; 192:76-84. [PMID: 28938966 DOI: 10.1016/j.ahj.2017.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/22/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The SYMPLICITY HTN-3 trial, which randomized subjects to renal denervation (RDN) or sham control, was designed to evaluate the efficacy and safety of RDN for the treatment of resistant hypertension. Outcomes were previously reported. This retrospective analysis evaluated reasons for screen failure (SF) for randomization in the trial. METHODS SYMPLICITY HTN-3 enrolled subjects with office systolic blood pressure (SBP) ≥160 mmHg on stable and maximal doses of ≥3 antihypertensive medication classes. Blood pressure was measured during screening visit (SV) 1 and SV2 a minimum of 2 weeks later to ensure resistant hypertension and to exclude white-coat hypertension. We analyzed baseline characteristics and reasons for SF at each SV and changes in BP between SVs. RESULTS Among 1,415 patients screened, 880 (62%) did not meet criteria for randomization. Compared with randomized patients, those in the SF cohort were more likely to be older (58.7 vs. 57.4 years, P=.029), current smokers (14.5% vs. 10.7%, P=.041), and prescribed fewer antihypertensive medications (4.7 vs. 5.1, P<.001). The predominant reason for SF at SV2 was office SBP <160 mmHg despite office SBP ≥160 mmHg at SV1. CONCLUSION Screening patients with resistant hypertension on maximal doses of ≥3 antihypertensive drugs led to a high SF rate. Screen failures were most common at SV1 and were due to failing the office SBP entry criteria. Not meeting ambulatory SBP criteria at SV2 was a secondary reason for SF, often due to white-coat hypertension; thus, 24-hour ambulatory monitoring is important to validate resistant hypertension.
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Effects of renal denervation on coronary flow reserve and forearm dilation capacity in patients with treatment-resistant hypertension. A randomized, double-blinded, sham-controlled clinical trial. Int J Cardiol 2017; 250:29-34. [PMID: 29042091 DOI: 10.1016/j.ijcard.2017.09.200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/24/2017] [Accepted: 09/26/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Microvascular impairment is well documented in hypertension. We investigated the effect of renal sympathetic denervation (RDN) on cardiac and peripheral microvasculature in patients with treatment-resistant essential hypertension (TRH). METHODS A randomized, single centre, double-blinded, sham-controlled clinical trial. Fifty-eight patients with TRH (ambulatory systolic BP (ASBP) ≥ 145mmHg) despite stable treatment were randomized to RDN or SHAM. RDN was performed with the unipolar Medtronic Flex catheter. Coronary flow reserve (CFR) and coronary- and forearm minimum vascular resistance (C-Rmin and F-Rmin) were determined using transthoracic Doppler echocardiography and F-Rmin with venous occlusion plethysmography at baseline and at six-months follow-up. RESULTS RDN was performed with 5.3±0.2 lesions in the right renal artery and 5.4±0.2 lesions in the left. Baseline ASBP was 152±2mmHg (RDN, n=29) and 154±2mmHg (SHAM, n=29). Similar reductions in MAP were seen at follow up (-3.5±2.0 vs. -3.2±1.8, P=0.92). Baseline CFR was 2.9±0.1 (RDN) and 2.4±0.1 (SHAM), with no significant change at follow-up (0.2±0.2 vs. -0.1±0.2, P=0.57). C-Rmin was 1.9±0.3 (RDN) and 2.7±0.6 (SHAM) (mmHgmin/ml pr. 100g) and did not change significantly (0.3±0.5 vs. -0.4±0.8, P=0.48). F-Rmin was 3.6±0.2 (RDN) and 3.6±0.3 (SHAM) (mmHgmin/ml pr. 100ml tissue) and unchanged at follow-up (4.2±0.4 vs. 3.8±0.2, P=0.17). Left ventricular mass index was unchanged following RDN (-4±7 (RDN) vs. 3±5 (SHAM) (g/m2) P=0.38). CONCLUSION The current study does not support positive effects of RDN on microvascular impairment in TRH.
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Nammas W, Koistinen J, Paana T, Karjalainen PP. Renal sympathetic denervation for treatment of patients with heart failure: summary of the available evidence. Ann Med 2017; 49:384-395. [PMID: 28276870 DOI: 10.1080/07853890.2017.1282168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Heart failure syndrome results from compensatory mechanisms that operate to restore - back to normal - the systemic perfusion pressure. Sympathetic overactivity plays a pivotal role in heart failure; norepinephrine contributes to maintenance of the systemic blood pressure and increasing preload. Cardiac norepinephrine spillover increases in patients with heart failure; norepinephrine exerts direct toxicity on cardiac myocytes resulting in a decrease of synthetic activity and/or viability. Importantly, cardiac norepinephrine spillover is a powerful predictor of mortality in patients with moderate to severe HF. This provided the rationale for trials that demonstrated survival benefit associated with the use of beta adrenergic blockers in heart failure with reduced ejection fraction. Nevertheless, the MOXCON trial demonstrated that rapid uptitration of moxonidine (inhibitor of central sympathetic outflow) in patients with heart failure was associated with excess mortality and morbidity, despite reduction of plasma norepinephrine. Interestingly, renal norepinephrine spillover was the only independent predictor of adverse outcome in patients with heart failure, in multivariable analysis. Recently, renal sympathetic denervation has emerged as a novel approach for control of blood pressure in patients with treatment-resistant hypertension. This article summarizes the available evidence for the effect of renal sympathetic denervation in the setting of heart failure. Key messages Experimental studies supported a beneficial effect of renal sympathetic denervation in heart failure with reduced ejection fraction. Clinical studies demonstrated improvement of symptoms, and left ventricular function. In heart failure and preserved ejection fraction, renal sympathetic denervation is associated with improvement of surrogate endpoints.
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Affiliation(s)
- Wail Nammas
- a Heart Center, Satakunta Central Hospital , Pori , Finland
| | - Juhani Koistinen
- b Department of Cardiology , Vaasa Central Hospital , Vaasa , Finland
| | - Tuomas Paana
- a Heart Center, Satakunta Central Hospital , Pori , Finland
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Zhong M, Kim LK, Swaminathan RV, Feldman DN. Renal Denervation to Modify Hypertension and the Heart Failure State. Interv Cardiol Clin 2017; 6:453-464. [PMID: 28600097 DOI: 10.1016/j.iccl.2017.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sympathetic overactivation of renal afferent and efferent nerves have been implicated in the development and maintenance of several cardiovascular disease states, including resistant hypertension and heart failure with both reduced and preserved systolic function. With the development of minimally invasive catheter-based techniques, percutaneous renal denervation has become a safe and effective method of attenuating sympathetic overactivation. Percutaneous renal denervation, therefore, has the potential to modify and treat hypertension and congestive heart failure. Although future randomized controlled studies are needed to definitively prove its efficacy, renal denervation has the potential to change the way we view and treat cardiovascular disease.
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Affiliation(s)
- Ming Zhong
- Division of Cardiology, Interventional Cardiology and Endovascular Laboratory, Weill Cornell Medical College, New York Presbyterian Hospital, 520 East 70th street, New York, NY 10021, USA
| | - Luke K Kim
- Division of Cardiology, Interventional Cardiology and Endovascular Laboratory, Weill Cornell Medical College, New York Presbyterian Hospital, 520 East 70th street, New York, NY 10021, USA
| | - Rajesh V Swaminathan
- Division of Cardiology, Duke University Medical Center, Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA
| | - Dmitriy N Feldman
- Division of Cardiology, Interventional Cardiology and Endovascular Laboratory, Weill Cornell Medical College, New York Presbyterian Hospital, 520 East 70th street, New York, NY 10021, USA.
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Threats to internal validity in renal sympathetic denervation trials. Rev Port Cardiol 2017; 36:353-355. [PMID: 28495182 DOI: 10.1016/j.repc.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Threats to internal validity in renal sympathetic denervation trials. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sousa H, Branco P, de Sousa Almeida M, de Araújo Gonçalves P, Gaspar A, Dores H, Mesquita J, Andrade MJ, Neuparth N, Aleixo A, Mendes M, Barata JD. Changes in albumin-to-creatinine ratio at 12-month follow-up in patients undergoing renal denervation. Rev Port Cardiol 2017; 36:343-351. [DOI: 10.1016/j.repc.2016.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 11/27/2022] Open
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Sousa H, Branco P, de Sousa Almeida M, de Araújo Gonçalves P, Gaspar A, Dores H, Mesquita J, Andrade MJ, Neuparth N, Aleixo A, Mendes M, Barata JD. Changes in albumin-to-creatinine ratio at 12-month follow-up in patients undergoing renal denervation. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Device Therapies for Resistant Hypertension. Clin Ther 2016; 38:2152-2158. [DOI: 10.1016/j.clinthera.2016.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/21/2016] [Accepted: 08/31/2016] [Indexed: 12/18/2022]
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Reductions of left ventricular mass and atrial size following renal denervation: a meta-analysis. Clin Res Cardiol 2016; 105:648-656. [PMID: 26838292 DOI: 10.1007/s00392-016-0964-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/19/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Renal denervation (RDN), a novel therapy for resistant hypertension, has been shown to have an effect on cardiac remodeling in several small studies. We aimed to pool currently available data to assess the effects of RDN on left ventricular hypertrophy (LVH) and left atrial (LA) enlargement. METHODS AND RESULTS Two investigators independently searched PubMed, EMBASE and Cochrane Library Central Register of Controlled Trials database for studies reporting change in left ventricular mass index (LVMI) or LA size before and after RDN. Twelve publications met our pre-defined inclusion criteria. Echocardiographic data showed that RDN markedly reduced both LVMI [weighted mean difference (WMD) = -15.77 g/m(2); 95 % confidence interval (CI) -22.51 to -9.02 g/m(2)] and LA diameter [WMD = -2.48 mm; 95 % CI -4.12 to -0.83 mm] after 6 months. Data from cardiac magnetic resonance also showed a significant reduction in LVMI [WMD = -5.43 g/m(2), 95 % CI -10.01 to -0.35 g/m(2)) at 6 months. Changes in LVH and LA size at 12 months were more pronounced than those at 6 months. Meta-regression analysis failed to demonstrate a significant relationship between RDN-induced LVMI reduction and BP lowering at 6 months. CONCLUSIONS RDN led to significant regressions of both LVH and LA enlargement at 6 months, which were sustained at least up to 12 months.
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