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Baik J, Kim H, Lee S, Park DH, Do MT, Lee HY, Choi EK, Yang S, Jeong CW, Park SM. Laparoscopic Ablation System for Complete Circumferential Renal Sympathetic Denervation. IEEE Trans Biomed Eng 2021; 68:3217-3227. [PMID: 33687832 DOI: 10.1109/tbme.2021.3064567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
GOAL The catheter-based renal denervation (RDN) showed promising results for patients in lowering BP, but there were also many non-responders. One of the possible reasons was the incomplete neural ablation due to the ablation of renal nerves at random sites resulting in asymmetric innervation patterns along the renal artery. METHODS We developed a laparoscopic ablation system that is optimized for complete RDN regardless of renal arterial innervation and size. To demonstrate its effectiveness, we evaluated the system using computational simulation and 28-day survival model using pigs. RESULTS The ablations were focused around the tunica externa, and the ablation patterns could be predicted numerically during RDN treatment. In the animal study, the mean reduction of systolic BP and diastolic BP in the bilateral main renal arteries was 22.8 mmHg and 14.4 mmHg (P<0.001), respectively. The respond to immunostaining targeting tyrosine hydroxylase was significantly reduced at treatment site (108.2 ± 7.5 (control) vs. 63.4 ± 8.7 (treatment), P<0.001), and an increased degree of sympathetic signals interruption to kidneys was associated with the efficacy of RDN. CONCLUSION The laparoscopic ablation system achieved complete circumferential RDN at the treatment site and could numerically predict the ablation patterns. SIGNIFICANCE These findings clearly suggest that the proposed system can significantly improve the RDN effectiveness by reducing the variation to the percentage of injured nerves and open up a new opportunity to treat uncontrolled hypertension.
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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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Renal sympathetic denervation restores aortic distensibility in patients with resistant hypertension: data from a multi-center trial. Clin Res Cardiol 2018. [PMID: 29520698 PMCID: PMC6060801 DOI: 10.1007/s00392-018-1229-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Renal sympathetic denervation (RDN) is under investigation as a treatment option in patients with resistant hypertension (RH). Determinants of arterial compliance may, however, help to predict the BP response to therapy. Aortic distensibility (AD) is a well-established parameter of aortic stiffness and can reliably be obtained by CMR. This analysis sought to investigate the effects of RDN on AD and to assess the predictive value of pre-treatment AD for BP changes. We analyzed data of 65 patients with RH included in a multicenter trial. RDN was performed in all participants. A standardized CMR protocol was utilized at baseline and at 6-month follow-up. AD was determined as the change in cross-sectional aortic area per unit change in BP. Office BP decreased significantly from 173/92 ± 24/16 mmHg at baseline to 151/85 ± 24/17 mmHg (p < 0.001) 6 months after RDN. Maximum aortic areas increased from 604.7 ± 157.7 to 621.1 ± 157.3 mm2 (p = 0.011). AD improved significantly by 33% from 1.52 ± 0.82 to 2.02 ± 0.93 × 10−3 mmHg−1 (p < 0.001). Increase of AD at follow-up was significantly more pronounced in younger patients (p = 0.005) and responders to RDN (p = 0.002). Patients with high-baseline AD were significantly younger (61.4 ± 10.1 vs. 67.1 ± 8.4 years, p = 0.022). However, there was no significant correlation of baseline AD to response to RDN. AD is improved after RDN across all age groups. Importantly, these improvements appear to be unrelated to observed BP changes, suggesting that RDN may have direct effects on the central vasculature.
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Feyz L, van Dalen BM, Geleijnse ML, Van Mieghem NM, van Domburg RT, Daemen J. Effect of catheter-based renal denervation on left ventricular function, mass and (un)twist with two-dimensional speckle tracking echocardiography. J Echocardiogr 2017; 15:158-165. [PMID: 28497431 PMCID: PMC5674115 DOI: 10.1007/s12574-017-0336-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 04/13/2017] [Accepted: 04/24/2017] [Indexed: 11/25/2022]
Abstract
Background Speckle tracking echocardiography (STE) is an echocardiography modality that is able to measure left ventricular (LV) characteristics, including rotation, strain and strain rate. Strain measures myocardial fibre contraction and relaxation. This study aims to assess the effect of renal sympathetic denervation (RDN) on functional myocardial parameters, including STE, and to identify potential differences between responders and non-responders. Methods The study population consisted of 31 consecutive patients undergoing RDN in the context of treatment for resistant hypertension. Patients were included between December 2012 and June 2014. Transthoracic echocardiography and speckle tracking analysis was performed at baseline and at 6 months follow-up. Results The study population consisted of 31 patients with treatment-resistant hypertension treated with RDN (mean age 64 ± 10 years, 15 men). The total study population could be divided into responders (n = 19) and non-responders (n = 12) following RDN. RDN reduced office blood pressure by 18.9 ± 26.8/8.5 ± 13.5 mmHg (p < 0.001). A significant decrease was seen in LV posterior wall thickness (LVPWd) (0.47 ± 1.0 mm; p = 0.020), without a significant change in the LV mass index (LVMI). In the total cohort, only peak late diastolic filling velocity (A-wave velocity) decreased significantly by 5.3 ± 13.2 cm/s (p = 0.044) and peak untwisting velocity decreased significantly by 14.5 ± 28.9°/s (p = 0.025). Conclusion RDN reduced blood pressure and significantly improved functional myocardial parameters such as A-wave velocity and peak untwisting velocity in patients with treatment-resistant hypertension, suggesting a potential beneficial effect of RDN on myocardial mechanics.
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Affiliation(s)
- Lida Feyz
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Bas M van Dalen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marcel L Geleijnse
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Ron T van Domburg
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Lu D, Wang K, Wang S, Zhang B, Liu Q, Zhang Q, Geng J, Shan Q. Beneficial effects of renal denervation on cardiac angiogenesis in rats with prolonged pressure overload. Acta Physiol (Oxf) 2017; 220:47-57. [PMID: 27575955 DOI: 10.1111/apha.12793] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/20/2016] [Accepted: 08/29/2016] [Indexed: 01/20/2023]
Abstract
AIM Renal denervation (RDN) has beneficial effects on cardiac remodelling and function in resistant hypertension. We aimed to investigate the impact of RDN on cardiac angiogenesis during prolonged pressure overload. METHODS Cardiac pressure overload was reproduced by transverse aorta constriction (TAC) procedure in adult Sprague Dawley male rats (n = 35). RDN/sham-RDN procedure was performed in surviving rats at 5 weeks after TAC. RESULTS Five weeks post-TAC, transthoracic echocardiography revealed that myocardial hypertrophy occurred in TAC rats, with ejection fraction and fractional shortening not significantly changed. At the end of 10 weeks, cardiac systolic function was preserved in RDN group, but not in sham group. CD31 immunohistochemical staining showed that RDN-treated rats had higher cardiac capillary density than sham rats. However, no significant between-group difference was observed in the kidneys. A decreased protein expression of left ventricle vascular endothelial growth factor (VEGF) was observed in sham group, while RDN attenuated this decrease. Compared with sham, RDN resulted in a higher protein expression of VEGF receptor 2 (VEGFR2) and phosphorylated endothelial nitric oxide synthase (p-eNOS) in the heart. CONCLUSION Renal denervation benefits cardiac angiogenesis during sustained pressure overload, involving regulation of VEGF and VEGFR2 expression as well as activation of eNOS.
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Affiliation(s)
- D. Lu
- Department of Cardiology; The First Affiliated Hospital of Nanjing Medical University; Nanjing Jiangsu China
| | - K. Wang
- Department of Cardiology; The First Affiliated Hospital of Nanjing Medical University; Nanjing Jiangsu China
| | - S. Wang
- Department of Cardiology; The First Affiliated Hospital of Nanjing Medical University; Nanjing Jiangsu China
| | - B. Zhang
- Department of Cardiology; The First Affiliated Hospital of Nanjing Medical University; Nanjing Jiangsu China
| | - Q. Liu
- Department of Cardiology; The First Affiliated Hospital of Nanjing Medical University; Nanjing Jiangsu China
| | - Q. Zhang
- Department of Cardiology; The First Affiliated Hospital of Nanjing Medical University; Nanjing Jiangsu China
| | - J. Geng
- Department of Cardiology; The First Affiliated Hospital of Nanjing Medical University; Nanjing Jiangsu China
| | - Q. Shan
- Department of Cardiology; The First Affiliated Hospital of Nanjing Medical University; Nanjing Jiangsu China
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Lambert T, Nahler A, Rohla M, Reiter C, Grund M, Kammler J, Blessberger H, Kypta A, Kellermair J, Schwarz S, Starnawski JA, Lichtenauer M, Weiss TW, Huber K, Steinwender C. Endpoint design for future renal denervation trials - Novel implications for a new definition of treatment response to renal denervation. Int J Cardiol 2016; 220:273-8. [PMID: 27390940 DOI: 10.1016/j.ijcard.2016.06.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/12/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Defining an adequate endpoint for renal denervation trials represents a major challenge. A high inter-individual and intra-individual variability of blood pressure levels as well as a partial or total non-adherence on antihypertensive drugs hamper treatment evaluations after renal denervation. Blood pressure measurements at a single point in time as used as primary endpoint in most clinical trials on renal denervation, might not be sufficient to discriminate between patients who do or do not respond to renal denervation. METHODS We compared the traditional responder classification (defined as systolic 24-hour blood pressure reduction of -5mmHg six months after renal denervation) with a novel definition of an ideal respondership (based on a 24h blood pressure reduction at no point in time, one, or all follow-up timepoints). RESULTS We were able to re-classify almost a quarter of patients. Blood pressure variability was substantial in patients traditionally defined as responders. On the other hand, our novel classification of an ideal respondership seems to be clinically superior in discriminating sustained from pseudo-response to renal denervation. CONCLUSION Based on our observations, we recommend that the traditional response classification should be reconsidered and possibly strengthened by using a composite endpoint of 24h-BP reductions at different follow-up-visits.
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Affiliation(s)
- Thomas Lambert
- Department of Cardiology, Kepler University Hospital Linz, Johannes Kepler University Linz, Austria.
| | - Alexander Nahler
- Department of Cardiology, Kepler University Hospital Linz, Johannes Kepler University Linz, Austria
| | - Miklos Rohla
- 3rd Medical Department - Cardiology and Intensive Care Medicine, Wilhelminenhospital Vienna, Austria
| | - Christian Reiter
- Department of Cardiology, Kepler University Hospital Linz, Johannes Kepler University Linz, Austria
| | - Michael Grund
- Department of Cardiology, Kepler University Hospital Linz, Johannes Kepler University Linz, Austria
| | - Jürgen Kammler
- Department of Cardiology, Kepler University Hospital Linz, Johannes Kepler University Linz, Austria
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital Linz, Johannes Kepler University Linz, Austria
| | - Alexander Kypta
- Department of Cardiology, Kepler University Hospital Linz, Johannes Kepler University Linz, Austria
| | - Jörg Kellermair
- Department of Cardiology, Kepler University Hospital Linz, Johannes Kepler University Linz, Austria
| | - Stefan Schwarz
- Department of Cardiology, Kepler University Hospital Linz, Johannes Kepler University Linz, Austria
| | - Jennifer A Starnawski
- Department of Cardiology, Kepler University Hospital Linz, Johannes Kepler University Linz, Austria
| | - Michael Lichtenauer
- Clinic of Internal Medicine II - Department of Cardiology, Paracelsus Medical University of Salzburg, Austria
| | - Thomas W Weiss
- 3rd Medical Department - Cardiology and Intensive Care Medicine, Wilhelminenhospital Vienna, Austria
| | - Kurt Huber
- 3rd Medical Department - Cardiology and Intensive Care Medicine, Wilhelminenhospital Vienna, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital Linz, Johannes Kepler University Linz, Austria
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Lu J, Wang Z, Zhou T, Chen S, Chen W, Du H, Tan Z, Yang H, Hu X, Liu C, Ling Z, Liu Z, Zrenner B, Woo K, Yin Y. Selective proximal renal denervation guided by autonomic responses evoked via high-frequency stimulation in a preclinical canine model. Circ Cardiovasc Interv 2016; 8:CIRCINTERVENTIONS.115.001847. [PMID: 26058393 DOI: 10.1161/circinterventions.115.001847] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Electric stimulation has been proved to be available to monitor the efficacy of renal denervation (RDN). This study was to evaluate the effectiveness of high-frequency stimulation (HFS)-guided proximal RDN. METHODS AND RESULTS A total of 13 Chinese Kunming dogs were included and allocated to proximal RDN group (n=8) and control group (n=5). HFS (20 Hz, 8 V, pulse width 2 ms) was performed from proximal to distal renal artery in all dogs. Radiofrequency ablations were delivered in proximal RDN group and only at the proximal positive sites where systolic blood pressure (BP) increased ≥10 mm Hg during HFS. Postablation HFS was performed over the previously stimulated sites. BP, heart rate, and plasma norepinephrine were analyzed. In 8 denervated dogs, preablation HFS caused significant BP increases of 6.0±5.0/3.4±5.5, 16.9±11.7/11.1±8.5, and 17.1±8.4/8.5±5.3 mm Hg during the first, second, and third 20 s of HFS at the proximal positive sites. After ablation, these sites showed a negative response to postablation HFS with increases of BP by 1.3±3.0/1.0±2.5, 0.8±3.9/1.5±3.4, and 1.5±4.5/0.7±3.8 mm Hg. Of note, no radiofrequency applications were delivered at the positive sites of middle renal artery, repeated HFS increased BP only by 3.3±5.3/2.8±4.2, 5.3±6.6/3.8±4.7, and 2.9±4.6/1.3±3.2 mm Hg, failed to reproduce the previous BP increases of 6.2±5.6/5.3±4.4, 15.0±9.3/10.2±6.2, and 14.9±7.7/8.4±4.7 mm Hg. At 3 months, BP and plasma norepinephrine substantially decreased in proximal RDN group. Whereas controls showed minimal BP decreases and had similar plasma norepinephrine concentrations as baseline. CONCLUSIONS Renal afferent nerves can be mapped safely, and HFS-guided targeted proximal RDN can achieve apparent BP reduction and sympathetic inhibition.
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Affiliation(s)
- Jiayi Lu
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China (J.L., Z.W., T.Z., S.C., W.C., H.D., Z.T., H.Y., X.H., C.L., Z.L., Z.L., Y.Y.); Medizinische Klinik I, Krankenhaus Landshut/Achdorf, Landshut, Germany (B.Z.); and School of Life Sciences, the Chinese University of Hong Kong, Hong Kong, China (K.W.)
| | - Zhenglong Wang
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China (J.L., Z.W., T.Z., S.C., W.C., H.D., Z.T., H.Y., X.H., C.L., Z.L., Z.L., Y.Y.); Medizinische Klinik I, Krankenhaus Landshut/Achdorf, Landshut, Germany (B.Z.); and School of Life Sciences, the Chinese University of Hong Kong, Hong Kong, China (K.W.)
| | - Tingquan Zhou
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China (J.L., Z.W., T.Z., S.C., W.C., H.D., Z.T., H.Y., X.H., C.L., Z.L., Z.L., Y.Y.); Medizinische Klinik I, Krankenhaus Landshut/Achdorf, Landshut, Germany (B.Z.); and School of Life Sciences, the Chinese University of Hong Kong, Hong Kong, China (K.W.)
| | - Shaojie Chen
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China (J.L., Z.W., T.Z., S.C., W.C., H.D., Z.T., H.Y., X.H., C.L., Z.L., Z.L., Y.Y.); Medizinische Klinik I, Krankenhaus Landshut/Achdorf, Landshut, Germany (B.Z.); and School of Life Sciences, the Chinese University of Hong Kong, Hong Kong, China (K.W.)
| | - Weijie Chen
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China (J.L., Z.W., T.Z., S.C., W.C., H.D., Z.T., H.Y., X.H., C.L., Z.L., Z.L., Y.Y.); Medizinische Klinik I, Krankenhaus Landshut/Achdorf, Landshut, Germany (B.Z.); and School of Life Sciences, the Chinese University of Hong Kong, Hong Kong, China (K.W.)
| | - Huaan Du
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China (J.L., Z.W., T.Z., S.C., W.C., H.D., Z.T., H.Y., X.H., C.L., Z.L., Z.L., Y.Y.); Medizinische Klinik I, Krankenhaus Landshut/Achdorf, Landshut, Germany (B.Z.); and School of Life Sciences, the Chinese University of Hong Kong, Hong Kong, China (K.W.)
| | - Zhen Tan
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China (J.L., Z.W., T.Z., S.C., W.C., H.D., Z.T., H.Y., X.H., C.L., Z.L., Z.L., Y.Y.); Medizinische Klinik I, Krankenhaus Landshut/Achdorf, Landshut, Germany (B.Z.); and School of Life Sciences, the Chinese University of Hong Kong, Hong Kong, China (K.W.)
| | - Hanxuan Yang
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China (J.L., Z.W., T.Z., S.C., W.C., H.D., Z.T., H.Y., X.H., C.L., Z.L., Z.L., Y.Y.); Medizinische Klinik I, Krankenhaus Landshut/Achdorf, Landshut, Germany (B.Z.); and School of Life Sciences, the Chinese University of Hong Kong, Hong Kong, China (K.W.)
| | - Xinyu Hu
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China (J.L., Z.W., T.Z., S.C., W.C., H.D., Z.T., H.Y., X.H., C.L., Z.L., Z.L., Y.Y.); Medizinische Klinik I, Krankenhaus Landshut/Achdorf, Landshut, Germany (B.Z.); and School of Life Sciences, the Chinese University of Hong Kong, Hong Kong, China (K.W.)
| | - Chang Liu
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China (J.L., Z.W., T.Z., S.C., W.C., H.D., Z.T., H.Y., X.H., C.L., Z.L., Z.L., Y.Y.); Medizinische Klinik I, Krankenhaus Landshut/Achdorf, Landshut, Germany (B.Z.); and School of Life Sciences, the Chinese University of Hong Kong, Hong Kong, China (K.W.)
| | - Zhiyu Ling
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China (J.L., Z.W., T.Z., S.C., W.C., H.D., Z.T., H.Y., X.H., C.L., Z.L., Z.L., Y.Y.); Medizinische Klinik I, Krankenhaus Landshut/Achdorf, Landshut, Germany (B.Z.); and School of Life Sciences, the Chinese University of Hong Kong, Hong Kong, China (K.W.)
| | - Zengzhang Liu
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China (J.L., Z.W., T.Z., S.C., W.C., H.D., Z.T., H.Y., X.H., C.L., Z.L., Z.L., Y.Y.); Medizinische Klinik I, Krankenhaus Landshut/Achdorf, Landshut, Germany (B.Z.); and School of Life Sciences, the Chinese University of Hong Kong, Hong Kong, China (K.W.)
| | - Bernhard Zrenner
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China (J.L., Z.W., T.Z., S.C., W.C., H.D., Z.T., H.Y., X.H., C.L., Z.L., Z.L., Y.Y.); Medizinische Klinik I, Krankenhaus Landshut/Achdorf, Landshut, Germany (B.Z.); and School of Life Sciences, the Chinese University of Hong Kong, Hong Kong, China (K.W.)
| | - Kamsang Woo
- From the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias Therapeutic Service Center, Chongqing, China (J.L., Z.W., T.Z., S.C., W.C., H.D., Z.T., H.Y., X.H., C.L., Z.L., Z.L., Y.Y.); Medizinische Klinik I, Krankenhaus Landshut/Achdorf, Landshut, Germany (B.Z.); and School of Life Sciences, the Chinese University of Hong Kong, 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, Chongqing, China (J.L., Z.W., T.Z., S.C., W.C., H.D., Z.T., H.Y., X.H., C.L., Z.L., Z.L., Y.Y.); Medizinische Klinik I, Krankenhaus Landshut/Achdorf, Landshut, Germany (B.Z.); and School of Life Sciences, the Chinese University of Hong Kong, Hong Kong, China (K.W.).
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Editorial: renal sympathetic denervation: a true lack of efficacy, or the victim of a "perfect storm"? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 15:61-2. [PMID: 24684755 DOI: 10.1016/j.carrev.2014.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tzafriri AR, Keating JH, Markham PM, Spognardi AM, Stanley JRL, Wong G, Zani BG, Highsmith D, O'Fallon P, Fuimaono K, Mahfoud F, Edelman ER. Arterial microanatomy determines the success of energy-based renal denervation in controlling hypertension. Sci Transl Med 2016; 7:285ra65. [PMID: 25925684 DOI: 10.1126/scitranslmed.aaa3236] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Renal denervation (RDN) is a treatment option for patients with hypertension resistant to conventional therapy. Clinical trials have demonstrated variable benefit. To understand the determinants of successful clinical response to this treatment, we integrated porcine and computational models of intravascular radiofrequency RDN. Controlled single-electrode denervation resulted in ablation zone geometries that varied in arc, area, and depth, depending on the composition of the adjacent tissue substructure. Computational simulations predicted that delivered power density was influenced by tissue substructure, and peaked at the conductivity discontinuities between soft fatty adventitia and water-rich tissues (media, lymph nodes, etc.), not at the electrode-tissue interface. Electrode irrigation protected arterial wall tissue adjacent to the electrode by clearing heat that diffuses from within the tissue, without altering periarterial ablation. Seven days after multielectrode treatments, renal norepinephrine and blood pressure were reduced. Blood pressure reductions were correlated with the size-weighted number of degenerative nerves, implying that the effectiveness of the treatment in decreasing hypertension depends on the extent of nerve injury and ablation, which in turn are determined by the tissue microanatomy at the electrode site. These results may explain the variable patient response to RDN and suggest a path to more robust outcomes.
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Affiliation(s)
- Abraham R Tzafriri
- Departments of Applied Sciences and Pathology, CBSET, Lexington, MA 02421, USA.
| | - John H Keating
- Departments of Applied Sciences and Pathology, CBSET, Lexington, MA 02421, USA
| | - Peter M Markham
- Departments of Applied Sciences and Pathology, CBSET, Lexington, MA 02421, USA
| | | | - James R L Stanley
- Departments of Applied Sciences and Pathology, CBSET, Lexington, MA 02421, USA
| | - Gee Wong
- Departments of Applied Sciences and Pathology, CBSET, Lexington, MA 02421, USA
| | - Brett G Zani
- Departments of Applied Sciences and Pathology, CBSET, Lexington, MA 02421, USA
| | - Debby Highsmith
- Biosense Webster Inc., a Johnson & Johnson Company, Irwindale, CA 91765, USA
| | - Patrick O'Fallon
- Biosense Webster Inc., a Johnson & Johnson Company, Irwindale, CA 91765, USA
| | - Kristine Fuimaono
- Biosense Webster Inc., a Johnson & Johnson Company, Irwindale, CA 91765, USA
| | - Felix Mahfoud
- Department of Internal Medicine III, Saarland University, Homburg/Saar 66421, Germany
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, MIT, Cambridge, MA 02139 , USA. Brigham and Women's Hospital, Boston, MA 02115, USA
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Pathak A, Coleman L, Roth A, Stanley J, Bailey L, Markham P, Ewen S, Morel C, Despas F, Honton B, Senard JM, Fajadet J, Mahfoud F. Renal sympathetic nerve denervation using intraluminal ultrasound within a cooling balloon preserves the arterial wall and reduces sympathetic nerve activity. EUROINTERVENTION 2015; 11:477-84. [DOI: 10.4244/eijv11i4a96] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lambert T, Nahler A, Reiter C, Gammer V, Blessberger H, Kammler J, Grund M, Saleh K, Schwarz S, Steinwender C. Influence of pseudo-resistance on the effect of renal denervation on 24-hour ambulatory blood pressure levels. Catheter Cardiovasc Interv 2015; 86:E126-30. [PMID: 26033366 DOI: 10.1002/ccd.26030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 04/14/2015] [Accepted: 04/28/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Renal denervation (RDN) is a promising treatment option in addition to medical antihypertensive treatment in patients suffering from resistant hypertension. Despite the growing interest in RDN, the negative result of the Symplicity HTN-3 trial led to a debate on the efficacy of RDN. METHODS We systematically investigated the effects of RDN, evaluated by 24-hr ambulatory blood pressure measurements (ABPM), in a consecutive series of patients with resistant hypertension, which was defined by a mean office systolic blood pressure (SBP) >160 mm Hg (>150 mm Hg in patients with diabetes). Patients with a mean 24-hr SBP of less than 130 mm Hg at baseline were classified as pseudo-resistant, while all other patients were classified as true-resistant. After six months, we analyzed the response rates in true-resistant and in pseudo-resistant patients, respectively, by the means of 24-hr ABPM. Thereby, patients with a reduction of more than 5 mm Hg in 24-hr SBP were classified as responders. RESULTS RDN was performed in 106 patients. By 24-hr ABPM, 20 patients (18.9%) were classified as pseudo-resistant patients. In this cohort, we only found two responders (response rate 10%) six months after RDN. By contrast, in true-resistant patients, the response rate was almost 60% and the mean BP reduction was -18.6/-9 mm Hg in 24-hr ABPM. CONCLUSIONS We found a significant BP reduction in almost 60% of patients with true-resistant hypertension, but only in 10% in patients with pseudo-resistant hypertension. According to our results, patient selection seems to be crucial for acceptable response rates after RDN.
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Affiliation(s)
- Thomas Lambert
- 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria
| | - Alexander Nahler
- 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria
| | - Christian Reiter
- 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria
| | - Verena Gammer
- 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria
| | - Hermann Blessberger
- 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria
| | - Jürgen Kammler
- 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria
| | - Michael Grund
- 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria
| | - Karim Saleh
- 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria
| | - Stefan Schwarz
- 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria
| | - Clemens Steinwender
- 1st Medical Department-Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria
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Pöss J, Ewen S, Schmieder RE, Muhler S, Vonend O, Ott C, Linz D, Geisel J, Rump LC, Schlaich M, Böhm M, Mahfoud F. Effects of renal sympathetic denervation on urinary sodium excretion in patients with resistant hypertension. Clin Res Cardiol 2015; 104:672-8. [PMID: 25715938 DOI: 10.1007/s00392-015-0832-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 02/19/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sympathetic overactivity increases sodium retention and contributes to the pathophysiology of hypertension. Renal sympathetic denervation lowers blood pressure and reduces sympathetic activity in certain patients with resistant hypertension. METHODS AND RESULTS This study aimed to assess the effect of renal denervation on urinary sodium excretion. 24-h urinary sodium excretion was estimated at baseline and after 6 months using the Kawasaki formula in 137 patients with resistant hypertension undergoing renal denervation. Sodium excretion was adjusted for cystatin C GFR and fractional sodium excretion was assessed. Mean office systolic blood pressure at baseline was 171 ± 2 mmHg despite an intake of 5.2 ± 0.1 antihypertensive drugs. Six months after renal denervation, systolic and diastolic BP decreased by 18 ± 2 mmHg (p < 0.0001) and 10 ± 1 mmHg (p < 0.001). 90 patients (65.7%) had SBP reductions ≥ 10 mmHg (responders). After 6 months, 24-h UNa increased by 13% compared to baseline (236 ± 9 vs. 268 ± 9 mmol/day, p < 0.003). This increase was most pronounced in patients with less response in BP. These findings were paralleled by a significant increase in fractional sodium excretion (1.19 ± 0.11 vs. 1.64 ± 0.14%, p < 0.0001) and were observed independently of the intake of antihypertensive drugs affecting sodium balance, such as mineralocorticoid receptor antagonists or diuretics. CONCLUSION RDN lowered BP and increased estimated UNa and fractional sodium excretion in patients with resistant hypertension independently of renal function and antihypertensive therapy.
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Affiliation(s)
- Janine Pöss
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40, 66421, Homburg/Saar, Germany,
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14
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Lambert T, Gammer V, Nahler A, Blessberger H, Kammler J, Grund M, Kerschner K, Buchmayr G, Saleh K, Kypta A, Hönig S, Wichert-Schmitt B, Schwarz S, Sihorsch K, Reiter C, Steinwender C. Individual-patient visit-by-visit office and ambulatory blood pressure measurements over 24months in patients undergoing renal denervation for hypertension. Int J Cardiol 2015; 181:96-101. [DOI: 10.1016/j.ijcard.2014.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 11/26/2014] [Accepted: 12/01/2014] [Indexed: 11/30/2022]
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15
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Tzafriri AR, Mahfoud F, Keating JH, Markham PM, Spognardi A, Wong G, Fuimaono K, Böhm M, Edelman ER. Innervation patterns may limit response to endovascular renal denervation. J Am Coll Cardiol 2015; 64:1079-87. [PMID: 25212640 DOI: 10.1016/j.jacc.2014.07.937] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 07/01/2014] [Accepted: 07/07/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND Renal denervation is a new interventional approach to treat hypertension with variable results. OBJECTIVES The purpose of this study was to correlate response to endovascular radiofrequency ablation of renal arteries with nerve and ganglia distributions. We examined how renal neural network anatomy affected treatment efficacy. METHODS A multielectrode radiofrequency catheter (15 W/60 s) treated 8 renal arteries (group 1). Arteries and kidneys were harvested 7 days post-treatment. Renal norepinephrine (NEPI) levels were correlated with ablation zone geometries and neural injury. Nerve and ganglion distributions and sizes were quantified at discrete distances from the aorta and were compared with 16 control arteries (group 2). RESULTS Nerve and ganglia distributions varied with distance from the aorta (p < 0.001). A total of 75% of nerves fell within a circumferential area of 9.3, 6.3, and 3.4 mm of the lumen and 0.3, 3.0, and 6.0 mm from the aorta. Efficacy (NEPI 37 ng/g) was observed in only 1 of 8 treated arteries where ablation involved all 4 quadrants, reached a depth of 9.1 mm, and affected 50% of nerves. In 7 treated arteries, NEPI levels remained at baseline values (620 to 991 ng/g), ≤20% of the nerves were affected, and the ablation areas were smaller (16.2 ± 10.9 mm(2)) and present in only 1 to 2 quadrants at maximal depths of 3.8 ± 2.7 mm. CONCLUSIONS Renal denervation procedures that do not account for asymmetries in renal periarterial nerve and ganglia distribution may miss targets and fall below the critical threshold for effect. This phenomenon is most acute in the ostium but holds throughout the renal artery, which requires further definition.
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Affiliation(s)
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie, und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | | | | | | | - Gee Wong
- CBSET Inc., Lexington, Massachusetts
| | | | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie, und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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16
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Zannad F, Stough WG, Mahfoud F, Bakris GL, Kjeldsen SE, Kieval RS, Haller H, Yared N, De Ferrari GM, Piña IL, Stein K, Azizi M. Design Considerations for Clinical Trials of Autonomic Modulation Therapies Targeting Hypertension and Heart Failure. Hypertension 2015; 65:5-15. [DOI: 10.1161/hypertensionaha.114.04057] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Faiez Zannad
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Wendy Gattis Stough
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Felix Mahfoud
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - George L. Bakris
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Sverre E. Kjeldsen
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Robert S. Kieval
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Hermann Haller
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Nadim Yared
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Gaetano M. De Ferrari
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Ileana L. Piña
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Kenneth Stein
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
| | - Michel Azizi
- From the Department of Cardiology, INSERM, Center d’Investigation Clinique 9501 and Unité 961, Center Hospitalier Universitaire, Nancy University, Université de Lorraine, Nancy, France (F.Z.); Departments of Pharmacy Practice and Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC (W.G.S.); Klinik für Innere Medizin III, Universtitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M.); Harvard-MIT Biomedical Engineering, Institute of Medical Engineering
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Abstract
Hypertension has wide (30-45 %) prevalence in the general population and is related to important increases in overall cardiovascular morbidity and mortality. Despite lifestyle modifications and optimal medical therapy (three drugs, one being diuretic), about 5-20 % of hypertensives are affected by resistant hypertension. Chronic high blood pressure has adverse effects on the heart and other organs such as the kidneys and vasculature. Renal sympathetic denervation and baroreceptor stimulation are invasive approaches initially investigated to treat resistant hypertension. Their pleiotropic effects appear promising in cardiovascular remodeling, heart failure and arrhythmias and could potentially affect cardiovascular morbidity and mortality.
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18
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Lambert T, Schützenberger W, Steinwender C. Renal denervation in the treatment of resistant arterial hypertension. Wien Med Wochenschr 2014; 164:515-8. [DOI: 10.1007/s10354-014-0330-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
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19
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Catheter-based renal denervation is no simple matter: lessons to be learned from our anatomy? J Am Coll Cardiol 2014; 64:644-6. [PMID: 25125293 DOI: 10.1016/j.jacc.2014.05.037] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/01/2014] [Accepted: 05/05/2014] [Indexed: 11/21/2022]
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20
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Ewen S, Ukena C, Linz D, Kindermann I, Cremers B, Laufs U, Wagenpfeil S, Schmieder RE, Böhm M, Mahfoud F. Reduced effect of percutaneous renal denervation on blood pressure in patients with isolated systolic hypertension. Hypertension 2014; 65:193-9. [PMID: 25331843 DOI: 10.1161/hypertensionaha.114.04336] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal denervation can reduce blood pressure in certain patients with resistant hypertension. The effect in patients with isolated systolic hypertension (ISH, ≥140/<90 mm Hg) is unknown. This study investigated the effects of renal denervation in 126 patients divided into 63 patients with ISH and 63 patients with combined hypertension (CH, ≥140/≥90 mm Hg) defined as baseline office systolic blood pressure (SBP) ≥140 mm Hg despite treatment with ≥3 antihypertensive agents. Renal denervation significantly reduced office SBP and diastolic blood pressure (DBP) at 3, 6, and 12 months by 17/18/17 and 5/4/4 mm Hg in ISH and by 28/27/30 and 13/16/18 mm Hg in CH, respectively. The reduction in SBP and DBP in ISH was lower compared with patients with CH at all observed time points (P<0.05 for SBP/DBP intergroup comparison). The nonresponder rate (change in office SBP <10 mm Hg) after 6 months was 37% in ISH and 21% in CH (P<0.001). Mean 24-hour ambulatory SBP and DBP after 3, 6, and 12 months were significantly reduced by 10/13/15 and 6/6/9 mm Hg in CH, respectively. In patients with ISH the reduction in systolic ambulatory blood pressure was 4/8/7 mm Hg (P=0.032/P<0.001/P=0.009) and 3/4/2 mm Hg (P=0.08/P<0.001/P=0.130) in diastolic ambulatory blood pressure after 3, 6, and 12 months, respectively. The ambulatory blood pressure reduction was significantly lower after 3 and 12 months in SBP and after 12 months in ambulatory DBP, respectively. In conclusion, renal denervation reduces office and ambulatory blood pressure in patients with ISH. However, this reduction is less pronounced compared with patients with CH.
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Affiliation(s)
- Sebastian Ewen
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin (S.E., C.U., D.L., I.K., B.C., U.L., M.B., F.M.) and Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik (S.W.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; and Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany (R.E.S.).
| | - Christian Ukena
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin (S.E., C.U., D.L., I.K., B.C., U.L., M.B., F.M.) and Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik (S.W.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; and Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany (R.E.S.)
| | - Dominik Linz
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin (S.E., C.U., D.L., I.K., B.C., U.L., M.B., F.M.) and Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik (S.W.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; and Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany (R.E.S.)
| | - Ingrid Kindermann
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin (S.E., C.U., D.L., I.K., B.C., U.L., M.B., F.M.) and Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik (S.W.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; and Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany (R.E.S.)
| | - Bodo Cremers
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin (S.E., C.U., D.L., I.K., B.C., U.L., M.B., F.M.) and Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik (S.W.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; and Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany (R.E.S.)
| | - Ulrich Laufs
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin (S.E., C.U., D.L., I.K., B.C., U.L., M.B., F.M.) and Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik (S.W.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; and Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany (R.E.S.)
| | - Stefan Wagenpfeil
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin (S.E., C.U., D.L., I.K., B.C., U.L., M.B., F.M.) and Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik (S.W.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; and Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany (R.E.S.)
| | - Roland E Schmieder
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin (S.E., C.U., D.L., I.K., B.C., U.L., M.B., F.M.) and Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik (S.W.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; and Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany (R.E.S.)
| | - Michael Böhm
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin (S.E., C.U., D.L., I.K., B.C., U.L., M.B., F.M.) and Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik (S.W.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; and Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany (R.E.S.)
| | - Felix Mahfoud
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin (S.E., C.U., D.L., I.K., B.C., U.L., M.B., F.M.) and Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik (S.W.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; and Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany (R.E.S.).
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21
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Aronow HD, Li J, Parikh SA. Where and when device therapy may be useful in the management of drug-resistant hypertension. Curr Cardiol Rep 2014; 16:546. [PMID: 25326400 DOI: 10.1007/s11886-014-0546-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Device therapy for the treatment of uncontrolled and resistant hypertension has evolved significantly over the past several decades. Both renal artery disease and sympathetic hyperactivity have been linked to resistant hypertension. This manuscript will review the current evidence base supporting device therapy (e.g., renal artery revascularization, sympathetic nervous system modulation) for resistant hypertension.
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Affiliation(s)
- Herbert D Aronow
- Michigan Heart, 5325 Elliott Dr., Ste. #202, Ypsilanti, MI, 48197, USA,
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22
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Böhm M, Linz D, Ukena C, Esler M, Mahfoud F. Renal Denervation for the Treatment of Cardiovascular High Risk-Hypertension or Beyond? Circ Res 2014; 115:400-9. [DOI: 10.1161/circresaha.115.302522] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Michael Böhm
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (M.B., D.L., C.U., F.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.E.)
| | - Dominik Linz
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (M.B., D.L., C.U., F.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.E.)
| | - Christian Ukena
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (M.B., D.L., C.U., F.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.E.)
| | - Murray Esler
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (M.B., D.L., C.U., F.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.E.)
| | - Felix Mahfoud
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (M.B., D.L., C.U., F.M.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.E.)
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23
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Esler MD, Böhm M, Sievert H, Rump CL, Schmieder RE, Krum H, Mahfoud F, Schlaich MP. Catheter-based renal denervation for treatment of patients with treatment-resistant hypertension: 36 month results from the SYMPLICITY HTN-2 randomized clinical trial. Eur Heart J 2014; 35:1752-9. [PMID: 24898552 DOI: 10.1093/eurheartj/ehu209] [Citation(s) in RCA: 192] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIM The aim of this study was to determine long-term results of renal artery denervation for treatment of treatment-resistant hypertension in the SYMPLICITY HTN-2 study. METHODS SYMPLICITY HTN-2 randomized 106 subjects with treatment-resistant hypertension to renal denervation or medical therapy alone. At 6 months, 37 control subjects crossed over to renal denervation. Office blood pressure measurements, antihypertensive medication use, and safety events were followed every 6 months through 3 years. RESULTS Follow-up was available at 36 months in 40 of 52 subjects in the initial renal denervation group and at 30 months in 30 of 37 subjects who crossed over and received renal denervation at 6 months. Baseline blood pressure was 184 ± 19/99 ± 16 mmHg in all treated subjects. At 30-month post-procedure, systolic blood pressure decreased 34 mmHg (95% CI: -40, -27, P < 0.01) and diastolic blood pressure decreased 13 mmHg (95% CI: -16, -10, P < 0.01). The systolic and diastolic blood pressure reduction at 36 months for the initial renal denervation group was -33 mmHg (95% CI: -40, -25, P < 0.01) and -14 mmHg (95% CI: -17, -10, P < 0.01), respectively. Procedural complications included one haematoma, and one renal artery dissection before energy delivery that was treated successfully. Later complications included two cases of acute renal failure, which fully resolved, 15 hypertensive events requiring hospitalization, and three deaths. CONCLUSION Renal denervation resulted in sustained lowering of blood pressure at 3 years in a selected population of subjects with severe, treatment-resistant hypertension without serious safety concerns. CLINICAL TRIAL REGISTRATION NCT00888433.
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Affiliation(s)
- Murray D Esler
- Baker IDI Heart and Diabetes Institute, Monash University, 75 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Michael Böhm
- Universitätsklinium des Saarlandes, Homburg/Saar, Germany
| | | | - Christian L Rump
- Department of Nephrology, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany
| | - Roland E Schmieder
- Department of Nephrology, Hypertension of the University Hospital, Clinical Research Competence Center of Hypertension and Vascular Medicine, Erlangen, Germany
| | - Henry Krum
- Monash Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Felix Mahfoud
- Universitätsklinium des Saarlandes, Homburg/Saar, Germany
| | - Markus P Schlaich
- Baker IDI Heart and Diabetes Institute, Monash University, 75 Commercial Road, Melbourne, Victoria 3004, Australia
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24
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Lambert T, Blessberger H, Gammer V, Nahler A, Grund M, Kerschner K, Buchmayr G, Saleh K, Kammler J, Steinwender C. Effects of renal denervation on ambulatory blood pressure measurements in patients with resistant arterial hypertension. Clin Cardiol 2014; 37:307-11. [PMID: 24700288 DOI: 10.1002/clc.22269] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/28/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The sympathetic nervous system is an important factor in hypertension. In patients suffering from resistant hypertension, transfemoral renal sympathetic denervation (RDN) reduces office blood pressure (BP) values. HYPOTHESIS Ambulatory BP measurement (ABPM) is a better predictor than office BP of cardiovascular morbidity and mortality. We thus believe that ABPM should be added to the systematic evaluation and follow-up protocol when treating patients with resistant hypertension with RDN. Therefore, we evaluated the effect of RDN on mean 24-hour BP by the use of ABPM. METHODS Patients with resistant hypertension (office systolic BP >160 mm Hg, or >150 mm Hg in patients with diabetes) have been treated with RDN. Ambulatory BP measurement was performed at baseline and at 3 and 6 months after RDN. Patients with a 24-hour systolic BP reduction of ≥5 mm Hg were classified as responders. RESULTS Of 86 patients initially enrolled in the study, 5 had to be excluded from the analysis because of <70% valid ABPM recordings. Out of the 81 studied patients, we found 49 responders (60.5%). In all patients, office BP decreased from 169.9/87.8 mm Hg to 153.5/86.3 mm Hg (P < 0.001/P = not significant [NS]) and 24-hour BP decreased from 144.3/86.0 mm Hg to 139.9/84.0 mm Hg (P = 0.025/P = NS) 6 months after RDN. In responders, office BP decreased from 169.6/90.3 mm Hg to 143.7/79.7 mm Hg (P < 0.001/P < 0.001). The ABPM levels started at 144.3/84.7 mm Hg and decreased to 138.3/81.5 mm Hg (P = 0.025/P = 0.045). In nonresponders, office BP was 150.2/84.0 mm Hg and 24-hour BP was 144.5/84.7 mm Hg at baseline; at 6 months, office BP was 168.7/96.4 mm Hg (P < 0.001/P = NS) and 24-hour BP was 142.2/81.5 mm Hg (P = NS/P = NS). CONCLUSIONS Office BP and AMBP levels can be significantly lowered by RDN in patients with resistant hypertension.
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Affiliation(s)
- Thomas Lambert
- Cardiovascular Division, Linz General Hospital, Linz, Austria
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25
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Ewen S, Mahfoud F, Linz D, Pöss J, Cremers B, Kindermann I, Laufs U, Ukena C, Böhm M. Effects of Renal Sympathetic Denervation on Exercise Blood Pressure, Heart Rate, and Capacity in Patients With Resistant Hypertension. Hypertension 2014; 63:839-45. [DOI: 10.1161/hypertensionaha.113.01985] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal denervation reduces office blood pressure in patients with resistant hypertension. This study investigated the effects of renal denervation on blood pressure, heart rate, and chronotropic index at rest, during exercise, and at recovery in 60 patients (renal denervation group=50, control group=10) with resistant hypertension using a standardized bicycle exercise test protocol performed 6 and 12 months after renal denervation. After renal denervation, exercise blood pressure at rest was reduced from 158±3/90±2 to 141±3/84±4 mm Hg (
P
<0.001 for systolic blood pressure/
P
=0.007 for diastolic blood pressure) after 6 months and 139±3/83±4 mm Hg (
P
<0.001/
P
=0.022) after 12 months. Exercise blood pressure tended to be lower at all stages of exercise at 6- and 12-month follow-up in patients undergoing renal denervation, although reaching statistical significance only at mild-to-moderate exercise levels (75–100 W). At recovery after 1 minute, blood pressure decreased from 201±4/95±2 to 177±4/88±2 (
P
<0.001/
P
=0.066) and 188±6/86±2 mm Hg (
P
=0.059/
P
=0.01) after 6 and 12 months, respectively. Heart rate was reduced after renal denervation from 71±3 bpm at rest, 128±5 bpm at maximum workload, and 96±5 bpm at recovery after 1 minute to 66±2 (
P
<0.001), 115±5 (
P
=0.107), and 89±3 bpm (
P
=0.008) after 6 months and to 69±3 (
P
=0.092), 122±7 (
P
=0.01), and 93±4 bpm (
P
=0.032) after 12 months. Mean exercise time increased from 6.59±0.33 to 8.4±0.32 (
P
<0.001) and 9.0±0.41 minutes (
P
=0.008), and mean workload increased from 93±2 to 100±2 (
P
<0.001) and 101±3 W (
P
=0.007) at 6- and 12-month follow-up, respectively. No changes were observed in the control group. In conclusion, renal denervation reduced blood pressure and heart rate during exercise, improved mean workload, and increased exercise time without impairing chronotropic competence.
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Affiliation(s)
- Sebastian Ewen
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Felix Mahfoud
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Dominik Linz
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Janine Pöss
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Bodo Cremers
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Ingrid Kindermann
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Ulrich Laufs
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Christian Ukena
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Michael Böhm
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
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26
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Ewen S, Ukena C, Pöss J, Linz D, Böhm M, Mahfoud F. [Interventional hypertension therapy in diabetes mellitus. Effects on blood pressure and glucose metabolism?]. Herz 2014; 39:325-30. [PMID: 24671666 DOI: 10.1007/s00059-014-4088-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Hypertension is the most common chronic cardiovascular disease with increasing prevalence all over the world. Despite the availability of many effective antihypertensive drugs, blood pressure control to target values remains low. In the pathophysiology of therapy resistant hypertension, increased activity of the sympathetic nervous system with an imbalance between sympathetic and parasympathetic activity has been identified as a main contributor to the development and maintenance of hypertension. Catheter-based denervation of the renal sympathetic nerves has been described as reducing blood pressure and decreasing sympathetic activity in patients with resistant hypertension. Supplementary beneficial effects on common cardiovascular comorbidities, such as diabetes type 2, have been reported. The present review aims to give an overview about percutaneous renal denervation for treatment of hypertension and potential new therapeutic options to improve glycemic control.
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Affiliation(s)
- S Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40, 66421, Homburg/Saar, Deutschland
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27
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Abstract
Despite advances in nonpharmacologic and pharmacologic therapy, blood pressure control rates in hypertension are low. About 10 % of patients with hypertension fulfill the criteria of therapy resistance, which is defined as noncontrolled blood pressure despite treatment with ≥3 antihypertensive drugs of different classes, including a diuretic, at optimal or maximal tolerated doses. Although the pathogenesis of resistant hypertension is multifactorial, an interaction between renal afferent and efferent sympathetic nerves and the central nervous system plays a key role, leading to increased renal and central sympathetic activity. Catheter-based renal sympathetic denervation (RDN) is a novel therapeutic technique for the treatment of resistant hypertension. Clinical trials of RDN have shown a significant and sustained reduction of blood pressure as well as renal and central sympathetic activity. In clinical practice, appropriate patient selection is crucial to ensure successful and safe treatment. Beyond hypertension, RDN was associated with reduction of heart rate, regression of left ventricular mass, and improvements in glucose metabolism and severity of sleep apnea. Further studies addressing open questions in the treatment of resistant hypertension and evaluating potential new indications such as metabolic syndrome or heart failure (RE-ADAPT-HF) are necessary to prove effectiveness and safety of RDN in these patients. By modulating sympathetic activity, RDN has the potential to provide benefit in a variety of diseases, but these concepts have to be evaluated in well-designed prospective controlled clinical trials.
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28
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Mahfoud F, Urban D, Teller D, Linz D, Stawowy P, Hassel JH, Fries P, Dreysse S, Wellnhofer E, Schneider G, Buecker A, Schneeweis C, Doltra A, Schlaich MP, Esler MD, Fleck E, Böhm M, Kelle S. Effect of renal denervation on left ventricular mass and function in patients with resistant hypertension: data from a multi-centre cardiovascular magnetic resonance imaging trial. Eur Heart J 2014; 35:2224-31b. [PMID: 24603307 DOI: 10.1093/eurheartj/ehu093] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIMS Sympathetic stimulation induces left ventricular hypertrophy and is associated with increased cardiovascular risk. Catheter-based renal denervation (RDN) has been shown to reduce sympathetic outflow and blood pressure (BP). The present multi-centre study aimed to investigate the effect of RDN on anatomic and functional myocardial parameters, assessed by cardiac magnetic resonance (CMR), in patients with resistant hypertension. METHODS AND RESULTS Cardiac magnetic resonance was performed in 72 patients (mean age 66 ± 10 years) with resistant hypertension (55 patients underwent RDN, 17 served as controls) at baseline and after 6 months. Clinical data and CMR results were analysed blindly. Renal denervation significantly reduced systolic and diastolic BP by 22/8 mm Hg and left ventricular mass index (LVMI) by 7.1% (46.3 ± 13.6 g/m(1.7) vs. 43.0 ± 12.6 g/m(1.7), P < 0.001) without changes in the control group (41.9 ± 10.8 g/m(1.7) vs. 42.0 ± 9.7 g/m(1.7), P = 0.653). Ejection fraction (LVEF) in patients with impaired LVEF at baseline (<50%) significantly increased after RDN (43% vs. 50%, P < 0.001). Left ventricular circumferential strain as a surrogate of diastolic function in the subgroup of patients with reduced strain at baseline increased by 21% only in the RDN group (-14.8 vs. -17.9; P = 0.001) and not in control patients (-15.5 vs. -16.4, P = 0.508). CONCLUSIONS Catheter-based RDN significantly reduced BP and LVMI and improved EF and circumferential strain in patients with resistant hypertension, occurring partly BP independently.
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Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Daniel Urban
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Desiree Teller
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Dominik Linz
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Philipp Stawowy
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Jan-Hendrik Hassel
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Peter Fries
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Stephan Dreysse
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Ernst Wellnhofer
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Günther Schneider
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Arno Buecker
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | | | - Adelina Doltra
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Murray D Esler
- Baker IDI Heart & Diabetes Institute, Melbourne, Australia
| | - Eckart Fleck
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Sebastian Kelle
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
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Kapil V, Jain AK, Lobo MD. Renal Sympathetic Denervation - A Review of Applications in Current Practice. Interv Cardiol 2014; 9:54-61. [PMID: 29588780 PMCID: PMC5808654 DOI: 10.15420/icr.2011.9.1.54] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/18/2014] [Indexed: 02/07/2023] Open
Abstract
Resistant hypertension is associated with high morbidity and mortality despite numerous pharmacological strategies. A wealth of preclinical and clinical data have demonstrated that resistant hypertension is associated with elevated renal and central sympathetic tone. The development of interventional therapies to modulate the sympathetic nervous system potentially represents a paradigm shift in the strategy for blood pressure control in this subset of patients. Initial first-in-man and pivotal, randomised controlled trials of endovascular, radio-frequency renal sympathetic denervation have spawned numerous iterations of similar technology, as well as many novel concepts for achieving effective renal sympatholysis. This review details the current knowledge of these devices and the evidence base behind each technology.
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Affiliation(s)
- Vikas Kapil
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Barts Hypertension Clinic, Department of Clinical Pharmacology, Barts Health NHS Trust, London, UK
| | - Ajay K Jain
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK
| | - Melvin D Lobo
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Barts Hypertension Clinic, Department of Clinical Pharmacology, Barts Health NHS Trust, London, UK
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30
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Sathananthan J, Watson T, Whitbourn RJ, Stewart JT, Doughty RN, Ormiston JA, Webster MWI. Renal sympathetic denervation: indications, contemporary devices and future directions. Interv Cardiol 2014. [DOI: 10.2217/ica.13.82] [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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31
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Xiao Y, Zhou S, Liu Q. Renal denervation: the potential causes of non-response. Int J Cardiol 2014; 172:e217. [PMID: 24447734 DOI: 10.1016/j.ijcard.2013.12.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 12/27/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Yichao Xiao
- Department of Cardiology, Second Xiangya Hospital, Central South University, China
| | - Shenghua Zhou
- Department of Cardiology, Second Xiangya Hospital, Central South University, China
| | - Qiming Liu
- Department of Cardiology, Second Xiangya Hospital, Central South University, China.
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32
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33
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Linz D, Mahfoud F, Ewen S, Schirmer SH, Reil J, Ukena C, Böhm M. Application in Hypertension of Renal Sympathetic Denervation - A Review. Interv Cardiol 2013; 8:124-126. [PMID: 29588764 DOI: 10.15420/icr.2013.8.2.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Afferent and efferent sympathetic nerves of the kidney located in the adventitia of the renal artery are involved in the regulation of blood pressure and play a pathophysiological role in the progression and maintenance of hypertension. Renal sympathetic denervation is a potent and safe catheter-based therapeutic approach for the treatment of patients with resistant hypertension. Clinical trials of renal sympathetic denervation have shown significant reduction in blood pressure, which was associated with a reduction in local renal norepinephrine spillover as well as a reduction of whole body sympathetic activation in resistant hypertensive patients.
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Affiliation(s)
- Dominik Linz
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Felix Mahfoud
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Sebastian Ewen
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Stephan H Schirmer
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Jan Reil
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Christian Ukena
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Michael Böhm
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
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34
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Abstract
Renal afferent and efferent sympathetic nerves are involved in the regulation of blood pressure and have a pathophysiological role in hypertension. Renal sympathetic denervation is a novel therapeutic technique for the treatment of patients with resistant hypertension. Clinical trials of renal sympathetic denervation have shown significant reductions in blood pressure in these patients. Renal sympathetic denervation also reduces heart rate, which is a surrogate marker of cardiovascular risk. Conditions that are comorbid with hypertension, such as heart failure and myocardial hypertrophy, obstructive sleep apnoea, atrial fibrillation, renal dysfunction, and metabolic syndrome are closely associated with enhanced sympathetic activity. In experimental models and case-control studies, renal denervation has had beneficial effects on these conditions. Renal denervation could become a commonly used procedure to treat resistant hypertension and chronic diseases associated with enhanced sympathetic activation. Current work is focused on refining the techniques and interventional devices to provide safe and effective renal sympathetic denervation. Controlled studies in patients with mild-to-moderate, nonresistant hypertension and comorbid conditions such as heart failure, diabetes mellitus, sleep apnoea, and arrhythmias are needed to investigate the capability of renal sympathetic denervation to improve cardiovascular outcomes.
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