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Effects of catheter-based renal denervation on cardiac sympathetic activity and innervation in patients with resistant hypertension

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Abstract

Objectives

To investigate, whether renal denervation (RDN) has a direct effect on cardiac sympathetic activity and innervation density.

Background

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.

Methods

Eleven patients with resistant hypertension (mean office systolic BP 180 ± 18 mmHg, mean antihypertensive medications 6.0 ± 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.

Results

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 ± 0.5 versus 2.6 ± 0.4, p = 0.285). Cardiac sympathetic activity was significantly reduced by 67 % (WOR decreased from 24.1 ± 12.7 to 7.9 ± 25.3 %, p = 0.047). Both, responders and non-responders experienced a reduction of cardiac sympathetic activity.

Conclusion

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.

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Authors and Affiliations

  1. Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Kirrberger Str. 1, Geb. 40., 66421, Homburg/Saar, Germany

    Luca Donazzan, Felix Mahfoud, Sebastian Ewen, Christian Ukena, Bodo Cremers & Michael Böhm

  2. Interdisciplinary Medical Research Center South Tyrol (IMREST), Bolzano, Italy

    Luca Donazzan

  3. Klinik für Nuklearmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany

    Carl-Martin Kirsch, Dirk Hellwig, Tareq Eweiwi & Samer Ezziddin

  4. Abteilung für Nuklearmedizin, Universitätsklinikum Regensburg, Regensburg, Germany

    Dirk Hellwig

  5. Baker IDI Heart and Diabetes Institute, Melbourne, Australia

    Murray Esler

Authors
  1. Luca Donazzan
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  2. Felix Mahfoud
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  3. Sebastian Ewen
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  4. Christian Ukena
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  6. Carl-Martin Kirsch
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  10. Murray Esler
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  11. Michael Böhm
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Corresponding author

Correspondence to Michael Böhm.

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Conflict of interest

Felix Mahfoud and Michael Böhm received speaker honorarium and consultancy fees from Medtronic/Ardian. Christian Ukena and Bodo Cremers received speaker honorarium from Medtronic. Murray Esler received honoraria for consultancy and educational activities from Medtronic; holds no shares in the company or patents for renal denervation. All other authors declare no conflicts.

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Donazzan, L., Mahfoud, F., Ewen, S. et al. Effects of catheter-based renal denervation on cardiac sympathetic activity and innervation in patients with resistant hypertension. Clin Res Cardiol 105, 364–371 (2016). https://doi.org/10.1007/s00392-015-0930-4

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  • DOI: https://doi.org/10.1007/s00392-015-0930-4

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