Effects of Renal Denervation on Cardiac Structural and Functional Abnormalities in Patients with Resistant Hypertension or Diastolic Dysfunction

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.

sST2 Predicts Short Term Therapy Success in Patients with Therapy Resistant Hypertension after Renal Sympathetic Denervation

“…Schirmer et al reported a reduction in the LVM index at six months, showing that the effect of LVH regression was independent of BP reduction [22]. Due to the heterogeneity of trials, meta-analyses may add more reliable data for a prediction of the potential effect of RSD on LVH [23,24]. Wang et al analyzed 14 observational studies (11 uncontrolled, 3 controlled) and 2 randomized controlled trials investigating LV structural changes after RSD with different follow-up intervals [24].…”

“…Due to the heterogeneity of trials, meta-analyses may add more reliable data for a prediction of the potential effect of RSD on LVH [23,24]. Wang et al analyzed 14 observational studies (11 uncontrolled, 3 controlled) and 2 randomized controlled trials investigating LV structural changes after RSD with different follow-up intervals [24]. The authors found that observational studies using TTE reported an average reduction in the LVM index of −13.88 g/m 2 (the 95% confidence interval CI ranging from −19.94 to −7.82 g/m 2 ) at 6 months and −16.67 g/m 2 at 12 months (95% CI −25.38 to −7.97 g/m 2 ).…”