Effects of catheter-based renal denervation on cardiac sympathetic activity and innervation in patients with resistant hypertension
Effects of catheter-based renal denervation on cardiac sympathetic activity and innervation in patients with resistant hypertension
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DOI：
10.1007/s00392-015-0930-4
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发表时间：
2016-04-01
影响因子：
5
通讯作者：
Boehm, Michael
中科院分区：
文献类型：
--
作者：
Donazzan, Luca;Mahfoud, Felix;Boehm, Michael
目的：研究去肾神经（RDN）对心脏交感神经活性和神经密度的影响，RDN不仅能降低血压，还能减少心脏肥大和心律失常。11例顽固性高血压患者（平均诊室收缩压180 +/-A18 mmHg，平均降压药6.0 +/-A1.5）接受了I-123-mIBG血管造影以排除嗜铬细胞瘤。我们测量了心脏交感神经支配和活动之前和9个月后RDN。心脏交感神经支配通过心脏与纵隔比率（H/M）和交感神经活性通过洗脱比率（WOR）来评估。记录了24小时动态血压监测对诊室血压的影响，诊室收缩压和平均动态收缩压分别从180 mmHg降至141 mmHg（p = 0.006）和从149 mmHg降至129 mmHg（p = 0.014）。RDN前后心脏神经支配保持不变（H/M 2.5 +/- A 0.5 vs 2.6 +/- A 0.4，p = 0.285）。心脏交感神经活性显著降低67%（WOR从24.1 +/- A 12.7降至7.9 +/- A 25.3%，p = 0.047）。反应者和非反应者都经历了心脏交感神经活动的减少，RDN显著减少了心脏交感神经活动，从而证明了对心脏的直接影响。这些变化的发生独立于BP的影响，并为研究RDN对心律失常和心力衰竭的潜在影响提供了病理生理学基础。
To investigate, whether renal denervation (RDN) has a direct effect on cardiac sympathetic activity and innervation density.RDN demonstrated its efficacy not only in reducing blood pressure (BP) in certain patients, but also in decreasing cardiac hypertrophy and arrhythmias. These pleiotropic effects occur partly independent from the observed BP reduction.Eleven patients with resistant hypertension (mean office systolic BP 180 +/- A 18 mmHg, mean antihypertensive medications 6.0 +/- A 1.5) underwent I-123-mIBG scintigraphy to exclude pheochromocytoma. We measured cardiac sympathetic innervation and activity before and 9 months after RDN. Cardiac sympathetic innervation was assessed by heart to mediastinum ratio (H/M) and sympathetic activity by wash out ratio (WOR). Effects on office BP, 24 h ambulatory BP monitoring, were documented.Office systolic BP and mean ambulatory systolic BP were significantly reduced from 180 to 141 mmHg (p = 0.006) and from 149 to 129 mmHg (p = 0.014), respectively. Cardiac innervation remained unchanged before and after RDN (H/M 2.5 +/- A 0.5 versus 2.6 +/- A 0.4, p = 0.285). Cardiac sympathetic activity was significantly reduced by 67 % (WOR decreased from 24.1 +/- A 12.7 to 7.9 +/- A 25.3 %, p = 0.047). Both, responders and non-responders experienced a reduction of cardiac sympathetic activity.RDN significantly reduced cardiac sympathetic activity thereby demonstrating a direct effect on the heart. These changes occurred independently from BP effects and provide a pathophysiological basis for studies, investigating the potential effect of RDN on arrhythmias and heart failure.