Proof of concept study: Improvement of echocardiographic parameters after renal sympathetic denervation in CKD refractory hypertensive patients - diastolic function

Abstract

Aim: We evaluated the effectiveness of the renal sympathetic denervation (RSD) in diastolic heat and renal functions, in resistant hypertensive CKD patients. Methods and results:Data were obtained at baseline and monthly until 6 th month of follow-up. Twenty-six out of the 45 patients had LVH and nineteen did not present LVH. The LV mass index decreased from 123.70 ± 38.44 g/m 2 at baseline to 106.50 ± 31.88 g/m 2 at the 6 th month after RSD, P<0.0001. The comparison between baseline and the 6 th month post RSD showed that the mitral valve E deceleration time shortened from 242.40 ± 45.11 ms to 214.50 ± 36.40 ms (P<0.0001), and a significant reduction in the isovolumic relaxation time (IVRT) was noted from 126.10 ± 26.56 ms to 107.80 ± 24.53 ms (P<0.0001). Tissue Doppler imaging revealed a significant reduction in the ratio of mitral inflow velocity to annular relaxation velocity (lateral E/e'), a marker of LV diastolic filling pressure, significantly decreased from 9.49 ± 2.57 at baseline to 6.88 ± 1.96 at the 6 th month post procedure (P<0.0001). When the variation between baseline and the 6 th month post RSD in LVH patients and non LVH patients were compared to the same parameters: mitral valve E deceleration time (-29.65 ± 15.80 ms and -25.53 ± 20.04 ms, respectively, P=0.4439), the IVRT (-20.00 ± 13.78 ms and -16.05 ± 12.65 ms, respectively, P=0.3316), and mitral valve lateral E/e' ratio (-2.82 ± 1.21 and -2.32 ± 1.27, respectively, P=0.1900) no significant difference was found. Conclusion:The RSD showed an improvement of diastolic echocardiographic parameters in LVH and non LVH CKD refractory hypertensive patients.