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Cardiac magnetic resonance assessment of central and peripheral vascular function in patients undergoing renal sympathetic denervation as predictor for blood pressure response

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Abstract

Background

Most trials regarding catheter-based renal sympathetic denervation (RDN) describe a proportion of patients without blood pressure response. Recently, we were able to show arterial stiffness, measured by invasive pulse wave velocity (IPWV), seems to be an excellent predictor for blood pressure response. However, given the invasiveness, IPWV is less suitable as a selection criterion for patients undergoing RDN. Consequently, we aimed to investigate the value of cardiac magnetic resonance (CMR) based measures of arterial stiffness in predicting the outcome of RDN compared to IPWV as reference.

Methods

Patients underwent CMR prior to RDN to assess ascending aortic distensibility (AAD), total arterial compliance (TAC), and systemic vascular resistance (SVR). In a second step, central aortic blood pressure was estimated from ascending aortic area change and flow sequences and used to re-calculate total arterial compliance (cTAC). Additionally, IPWV was acquired.

Results

Thirty-two patients (24 responders and 8 non-responders) were available for analysis. AAD, TAC and cTAC were higher in responders, IPWV was higher in non-responders. SVR was not different between the groups. Patients with AAD, cTAC or TAC above median and IPWV below median had significantly better BP response. Receiver operating characteristic (ROC) curves predicting blood pressure response for IPWV, AAD, cTAC and TAC revealed areas under the curve of 0.849, 0.828, 0.776 and 0.753 (p = 0.004, 0.006, 0.021 and 0.035).

Conclusions

Beyond IPWV, AAD, cTAC and TAC appear as useful outcome predictors for RDN in patients with hypertension. CMR-derived markers of arterial stiffness might serve as non-invasive selection criteria for RDN.

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Abbreviations

AAD:

Ascending aortic distensibility

AUC:

Area under the curve

ABPM:

Ambulatory blood pressure measurement

BP:

Blood pressure

CMR:

Cardiac magnetic resonance imaging

cTAC:

Central pressure total arterial compliance

IPP:

Invasive pulse pressure

IPWV:

Invasive pulse wave velocity

MRI:

Magnetic resonance imaging

RDN:

Renal sympathetic denervation

ROC:

Receiver operator characteristic

TAC:

Total arterial compliance

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Authors and Affiliations

  1. Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Strümpellstraße 39, 04289, Leipzig, Germany

    Karl Fengler, Karl-Philipp Rommel, Stephan Blazek, Maximilian Von Roeder, Christian Besler, Steffen Desch, Holger Thiele & Philipp Lurz

  2. Department of Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Leipzig, Germany

    Christian Lücke & Matthias Gutberlet

  3. Center for Cardiovascular Imaging, University College London, London, UK

    Jennifer Steeden, Michael Quail & Vivek Muthurangu

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PL is consultant to ReCor Medical and Medtronic. The other authors declare that they have no competing interests.

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392_2018_1267_MOESM1_ESM.tif

Supplemental Figure 1 Bland-Altman plot for inter-observer (A) and intra-observer (B) variability for stroke volume and ascending aortic distensibility (AAD) measurements (TIF 585 KB)

392_2018_1267_MOESM2_ESM.tif

Supplemental Figure 2 Different markers of vascular stiffness by tertiles and change in daytime systolic blood pressure (in mmHg) 3 months after renal denervation: Ascending aortic distensibility (A), invasive pulse wave velocity (B), peripheral pressure total arterial compliance (C), central pressure total arterial compliance (D) and systemic vascular resistance (E). Error bars indicate 95% confidence intervals (TIF 957 KB)

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Fengler, K., Rommel, KP., Blazek, S. et al. Cardiac magnetic resonance assessment of central and peripheral vascular function in patients undergoing renal sympathetic denervation as predictor for blood pressure response. Clin Res Cardiol 107, 945–955 (2018). https://doi.org/10.1007/s00392-018-1267-6

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