Renal Sympathetic Denervation Reduces Left Ventricular Hypertrophy and Improves Cardiac Function in Patients With Resistant Hypertension
Renal Sympathetic Denervation Reduces Left Ventricular Hypertrophy and Improves Cardiac Function in Patients With Resistant Hypertension
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DOI：
10.1016/j.jacc.2011.11.034
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发表时间：
2012-03-06
影响因子：
24
通讯作者：
Hoppe, Uta C.
中科院分区：
文献类型：
--
作者：
Brandt, Mathias C.;Mahfoud, Felix;Hoppe, Uta C.
目的 本研究探讨了基于导管的肾交感神经去神经术 (RD) 对难治性高血压患者左心室肥厚 (LVH) 以及收缩和舒张功能的影响。背景 LVH 和舒张功能障碍与交感神经活性升高以及发病率和死亡率增加相关。 RD对左心室肥厚和左心室功能的影响尚不清楚。方法46例患者接受双侧RD，18例作为对照。在基线、1个月和6个月后进行经胸超声心动图检查。 结果 除了收缩压和舒张压降低（1个月时-22.5/-7.2 mm Hg，6个月时-27.8/-8.8 mm Hg，每个时间点p < 0.001）外，RD还显着将平均室间隔厚度从14.1 +/- 1.9 mm降低到13.4 +/- 2.1 mm 和 12.5 +/- 1.4 mm (p = 0.007)，左室质量指数从 53.9 +/- 15.6 g/m(2.7) (112.4 +/- 33.9 g/m(2)) 到 47.0 +/- 14.2 g/m(2).7 (103.6 +/- 30.5) 1 个月和 6 个月时分别为 44.7 +/- 14.9 g/m(2.7) (94.9 +/- 29.8 g/m(2)) (p < 0.001)。 RD 后二尖瓣外侧 E/E' 在 1 个月时从 9.9 +/- 4.0 下降到 7.9 +/- 2.2，在 6 个月时下降到 7.4 +/- 2.7 (p < 0.001)，表明左室充盈压降低。等容舒张时间缩短（基线 109.1 +/- 21.7 毫秒 vs. 6 个月时 85.6 +/- 24.4 毫秒，p = 0.006），而 RD 后射血分数显着增加（基线：63.1 +/- 8.1% 对比 6 个月时 70.1 +/- 11.5%，p < 0.001）。对照组患者没有出现显着变化。 结论 除了已知的对血压的影响外，我们的研究首次表明 RD 显着降低左心室质量并改善舒张功能，这可能对心血管高风险的难治性高血压患者具有重要的预后意义。 （J Am Coll Cardiol 2012；59：901-9）c 2012 年，美国心脏病学会基金会
Objectives This study investigated the effect of catheter-based renal sympathetic denervation (RD) on left ventricular hypertrophy (LVH) and systolic and diastolic function in patients with resistant hypertension.Background LVH and diastolic dysfunction are associated with elevated sympathetic activity and increased morbidity and mortality. The effect of RD on LVH and LV function is unclear.Methods Forty-six patients underwent bilateral RD, and 18 patients served as controls. Transthoracic echocardiography was performed at baseline, and after 1 month and 6 months.Results Besides reduction of systolic and diastolic blood pressure (-22.5/-7.2 mm Hg at 1 month and -27.8/-8.8 mm Hg at 6 months, p < 0.001 at each time point), RD significantly reduced mean interventricular septum thickness from 14.1 +/- 1.9 mm to 13.4 +/- 2.1 mm and 12.5 +/- 1.4 mm (p = 0.007), and LV mass index from 53.9 +/- 15.6 g/m(2.7) (112.4 +/- 33.9 g/m(2)) to 47.0 +/- 14.2 g/m(2).7 (103.6 +/- 30.5 g/m(2)) and 44.7 +/- 14.9 g/m(2.7) (94.9 +/- 29.8 g/m(2)) (p < 0.001) at 1 month and 6 months, respectively. The mitral valve lateral E/E' decreased after RD from 9.9 +/- 4.0 to 7.9 +/- 2.2 at 1 month and 7.4 +/- 2.7 at 6 months (p < 0.001), indicating reduction of LV filling pressures. Isovolumic relaxation time shortened (baseline 109.1 +/- 21.7 ms vs. 85.6 +/- 24.4 ms at 6 months, p = 0.006), whereas ejection fraction significantly increased after RD (baseline: 63.1 +/- 8.1% vs. 70.1 +/- 11.5% at 6 months, p < 0.001). No significant changes were obtained in control patients.Conclusions Besides the known effect on blood pressure, our study showed for the first time that RD significantly reduces LV mass and improves diastolic function, which might have important prognostic implications in patients with resistant hypertension at high cardiovascular risk. (J Am Coll Cardiol 2012; 59: 901-9) c 2012 by the American College of Cardiology Foundation