Effects of renal sympathetic denervation on cardiac sympathetic activity and function in patients with therapy resistant hypertension

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• 作者：Peter M. van Brussel^a ; ¹ ; ^{p.m.vanbrussel@amc.uva.nl" class="auth_mail" title="E-mail the corresponding author} ; Daan W. Eeftinck Schattenkerk^b ; ¹ ; Linn C. Dobrowolski^c ; ¹ ; Robbert J. de Winter^a ; ¹ ; Jim A. Reekers^d ; ¹ ; Hein J. Verberne^e ; ¹ ; Liffert Vogt^c ; ¹ ; Bert-Jan H. van den Born^b ; ¹
• 关键词：123I-mIBG ; 123I-metaiodobenzylguanidine ; ABPM ; ambulatory blood pressure monitoring ; BMI ; Body Mass Index ; BP ; blood pressure ; BSA ; body surface area ; CO ; cardiac output ; eGFR ; estimated glomerular filtration rate ; HR ; heart rate ; ICD ; implantable cardioverter-defibrillator ; MAP ; mean arterial pressure ; MSNA ; muscle sympathetic nerve activity ; NE ; norepinephrine ; PRA ; plasma renin activity ; ROI ; region of interest ; RAS ; renin-angiotensin system ; RSD ; renal sympathetic denervation ; SV ; stroke vol
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 January 2016
• 年：2016
• 卷：202
• 期：Complete
• 页码：609-614
• 全文大小：390 K

文摘

Renal sympathetic denervation (RSD) is currently being investigated in multiple studies of sympathetically driven cardiovascular diseases such as heart failure and arrhythmias. Our aim was to assess systemic and cardiac sympatholytic effects of RSD by the measurement of cardiac sympathetic activity and cardiovascular parameters.

Methods

A total of 21 consecutive patients with refractory hypertension (daytime ambulatory blood pressure (BP) ≥ 150/100 mmHg despite the use of 3 or more antihypertensive drugs), no evidence for secondary hypertension and normal renovascular anatomy were included. RSD was performed with the Medtronic Symplicity renal denervation catheter with an average of 4.2 (range 3–6) ablations per renal artery. To assess cardiac sympathetic activity, ¹²³I-mIBG cardiac scintigraphy was performed before and 6 weeks after. In addition, the effect of RSD on peripheral BP and cardiac hemodynamics were assessed non-invasively.

Results

¹²³I-mIBG uptake before and after RSD was 1.7 ± 0.4% vs. 1.7 ± 0.5% at 15 min. and 1.4 ± 0.4% vs. 1.5 ± 0.5% after 4 h. As a consequence, washout rate was similar before (33.7 ± 11.7%) and after RSD (30.1 ± 12.6%, p = 0.27). In line with earlier RSD studies, a significant drop in systolic office BP (− 12.2 mmHg, p = 0.04) was detected, whereas the decrease in ambulatory BP was not significant. No changes were seen in heart rate, stroke volume or left ventricular contractility, both in supine position and after standing.

Conclusion

In concert with previous reports, RSD leads to a significant drop in office BP. However, a reduction in sympathetic activity could not be demonstrated on a cardiac level.