Clinical Research
Hypertension
Improvements in Left Ventricular Hypertrophy and Diastolic Function Following Renal Denervation: Effects Beyond Blood Pressure and Heart Rate Reduction

https://doi.org/10.1016/j.jacc.2013.10.073Get rights and content
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Objectives

This study sought to investigate the interaction between blood pressure (BP) and heart rate (HR) reduction and changes in left ventricular (LV) structure and function following renal sympathetic denervation (RDN).

Background

Hypertension results in structural and functional cardiac changes. RDN reduces BP, HR, and LV mass and improves diastolic dysfunction.

Methods

We evaluated LV size, mass, and function before and 6 months after RDN in 66 patients with resistant hypertension and analyzed results in relation to systolic BP (SBP) and HR.

Results

SBP decreased by 11 ± 3 mm Hg in the first, 18 ± 5 mm Hg in the second, and 36 ± 7 mm Hg in the third tertile of SBP at baseline (p < 0.001). HR decreased by 13 ± 4 beats/min, 8 ± 3 beats/min, and 11 ± 6 beats/min in tertiles of SBP (p for interaction between tertiles = 0.314). In all SBP tertiles, LV mass index (LVMI) decreased similarly (LVMI −6.3 ± 2.2 g/m2.7, −8.3 ± 2.1 g/m2.7, and −9.6 ± 1.9 g/m2.7; p for interaction = 0.639). LVMI decreased unrelated to HR at baseline (p for interaction = 0.471). The diastolic parameters E-wave deceleration time, isovolumetric relaxation time, and E′-wave velocity improved similarly in all tertiles of SBP and HR. Changes in LV mass and function were also unrelated to reduction in SBP or HR. Vascular compliance improved dependently on BP but independently of HR reduction.

Conclusions

In patients with resistant hypertension, LV hypertrophy and diastolic function improved 6 months after RDN, without significant relation to SBP and HR. These findings suggest a direct effect of altered sympathetic activity in addition to unloading on cardiac hypertrophy and function.

Key Words

echocardiography
heart rate
left ventricular hypertrophy
renal denervation
resistant hypertension

Abbreviations and Acronyms

ABPM
ambulatory blood pressure monitoring
BP
blood pressure
DBP
diastolic blood pressure
DT
deceleration time
E/A
E- to A-wave ratio
EsMWS
end-systolic meridional wall stress
FS
fractional shortening
HR
heart rate
IVRT
isovolumetric relaxation time
LV
left ventricular
LVEDD
left ventricular end-diastolic diameter
LVESD
left ventricular end-systolic diameter
LVH
left ventricular hypertrophy
LVMI
left ventricular mass index
LVOT
left ventricular outflow tract
LVPWs
left ventricular posterior wall during systole
RDN
renal sympathetic denervation
SBP
systolic blood pressure
VCFc
heart rate–corrected left ventricular circumferential fiber shortening

Cited by (0)

Dr. Schirmer is supported by the Deutsche Forschungsgemeinschaft (KFO 196) and the Deutsche Herzstiftung. Dr. Sayed is supported by the Deutsche Akademische Austauschdienst. Dr. Ukena is supported by the Deutsche Forschungsgemeinschaft (KFO 196); and has received speaker honoraria from Medtronic and St. Jude. Dr. Laufs is supported by the Deutsche Forschungsgemeinschaft (KFO 196); and has received speaker honoraria from Medtronic. Dr. Mahfoud is supported by the Hochdruckliga and the Deutsche Gesellschaft für Kardiologie; has received scientific support from Medtronic, St. Jude, ReCor, Vessix Vascular, and Cordis; and has received speaker honoraria from Medtronic, St. Jude, Cordis, and Vessix Vascular. Dr. Böhm is supported by the Deutsche Forschungsgemeinschaft (KFO 196); and has received scientific support and/or speaker honoraria from Medtronic, St. Jude, Cordis, Boston Scientific, and ReCor. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.