Effects of short- and long-term efficacy of percutaneous transluminal renal angioplasty with or without intravascular brachytherapy on regression of left ventricular hypertrophy in patients with renovascular hypertension.
BACKGROUND
The largest group of patients with secondary hypertension comprises individuals with renovascular hypertension resulting from renal artery stenosis that is a potentially removable condition. It is caused by atherosclerosis in 70-80% of patients.


OBJECTIVE
The aim of the study was to evaluate the influence of intravascular brachytherapy (IVBT) procedure performed after percutaneous transluminal renal angioplasty (PTRA) on left ventricular (LV) function, mass regression and type of hypertrophy (LVH) determined on echocardiography during long-term follow-up.


METHODS
Sixty-two patients with atherosclerotic renal artery stenosis complicated by severe hypertension were treated with PTRA and randomly assigned to group 1 (PTRA alone) or group 2 (PTRA followed by IVBT). Subsequent IVBT was performed with the PARIS catheter and the Microselectron HDR (Nucletron) system for peripheral arteries. Treatment outcomes during follow-up were assessed with quantitative coronary angiography. LV mass and mass index (LVM and LVMI) and functional parameters prior to PTRA and during follow-up were determined by echocardiography with regard to the type of procedure.


RESULTS
The degree of renal artery stenosis was significantly different in groups 1 and 2. In both groups elevated LVMI was observed (p = 0.94). There were no significant differences in interventricular septum (IVS) to LV posterior wall (LVPW) ratio, relative LV wall thickness, volumetric parameters and LV ejection fraction between both groups. During follow-up the values of LVMI and IVS to LVPW ratio were significantly lower (p = 0.021 and p = 0.004, respectively) in the PTRA + IVBT group compared to the PTRA group. Analysis of the LV geometry and type of hypertrophy revealed a marked reduction in concentric LVH in the IVBT group during long-term follow-up.


CONCLUSIONS
Echocardiographic evaluation comparing several LV parameters in the PTRA alone and PTRA + IVBT groups showed that PTRA with subsequent brachytherapy were associated with better control of blood pressure and greater LVM regression, especially concentric hypertrophy, during long-term follow-up.
Lekston
Andrzej
A
3rd Department of Cardiology, Silesian Center of Heart Diseases, Zabrze, Poland.
Niklewski
Tomasz
T
Gasior
Mariusz
M
Chudek
Jerzy
J
Wilczek
Krzysztof
K
Wiecek
Andrzej
A
Kokot
Franciszek
F
Fijałkowski
Marek
M
Gierlotka
Marek
M
Osuch
Marcin
M
Maciejewski
Bogusław
B
Poloński
Lech
L
D000800:Angioplasty, Balloon; D001918:Brachytherapy; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006978:Hypertension, Renovascular / Q000150:complications* / Q000628:therapy*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012078:Renal Artery Obstruction / Q000150:complications