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Renal Sympathetic Denervation

Does Reduction of Left Ventricular Mass Improve Functional Myocardial Parameters? A Cardiovascular Magnetic Resonance Imaging Pilot Study

Schmidt, Martin MD*; Roessner, Florian MD*; Berger, Manuel MD*; Tesche, Christian MD*; Rieber, Johannes MD*; Bauner, Kerstin MD; Huber, Armin MD; Rummeny, Ernst MD; Hoffmann, Ellen MD*; Ebersberger, Ullrich MD*

doi: 10.1097/RTI.0000000000000399
Original Articles
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Objectives: Left ventricular (LV) hypertrophy in resistant hypertensive patients is associated with a reduced intramyocardial perfusion. Renal sympathetic denervation (RDN) has been shown to reduce blood pressure (BP) and sympathetic tone. We aimed to prospectively investigate the effect of RDN on functional myocardial parameters and myocardial perfusion reserve (MPR) using cardiac magnetic resonance imaging (cMRI) in patients with resistant hypertension.

Methods: A total of 15 resistant hypertensive patients (11 male individuals, mean age 62±13 y) were included. Adenosine stress-induced cMRI was performed at baseline, 3, 6, and 12 months after RDN. RDN was performed using a single soft-tip radiofrequency catheter (Symplicity). cMRI semiquantitative perfusion analysis was performed using the upslope of myocardial signal enhancement to derive the myocardial perfusion reserve index.

Results: Both systolic-BP and diastolic-BP significantly decreased from 148±14 to 133±14 mm Hg and 87±14 to 80±10 mm Hg, respectively (P<0.05). LV septal wall thickness was significantly reduced (P<0.001). LV ejection fraction and MPR lacked significant trends 12 months after RDN.

Conclusions: In this pilot study, RDN significantly reduced LV mass and LV septal wall thickness, as diagnosed by cMRI, with no significant changes in MPR. cMRI may help in diagnosing clinically relevant changes of functional myocardial parameters after interventional therapy in resistant hypertensive patients.

*Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen

Department of Radiology, Klinikum Bogenhausen

Institute of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany

The authors declare no conflicts of interest.

Correspondence to: Martin Schmidt, MD, Kreisklinik Ebersberg, Medizinische Klinik II, Pfarrer-Guggetzer-Str. 3, Ebersberg 85560, Germany (e-mail: mschmidtco@arcor.de).

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