title: Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension.
abstract: OBJECTIVE
  This study investigated the effect of catheter-based renal sympathetic denervation (RD) on left ventricular hypertrophy (LVH) and systolic and diastolic function in patients with resistant hypertension.
  
  
  BACKGROUND
  LVH and diastolic dysfunction are associated with elevated sympathetic activity and increased morbidity and mortality. The effect of RD on LVH and LV function is unclear.
  
  
  METHODS
  Forty-six patients underwent bilateral RD, and 18 patients served as controls. Transthoracic echocardiography was performed at baseline, and after 1 month and 6 months.
  
  
  RESULTS
  Besides reduction of systolic and diastolic blood pressure (-22.5/-7.2 mm Hg at 1 month and -27.8/-8.8 mm Hg at 6 months, p < 0.001 at each time point), RD significantly reduced mean interventricular septum thickness from 14.1 ± 1.9 mm to 13.4 ± 2.1 mm and 12.5 ± 1.4 mm (p = 0.007), and LV mass index from 53.9 ± 15.6 g/m(2.7) (112.4 ± 33.9 g/m(2)) to 47.0 ± 14.2 g/m(2.7) (103.6 ± 30.5 g/m(2)) and 44.7 ± 14.9 g/m(2.7) (94.9 ± 29.8 g/m(2)) (p < 0.001) at 1 month and 6 months, respectively. The mitral valve lateral E/E' decreased after RD from 9.9 ± 4.0 to 7.9 ± 2.2 at 1 month and 7.4 ± 2.7 at 6 months (p < 0.001), indicating reduction of LV filling pressures. Isovolumic relaxation time shortened (baseline 109.1 ± 21.7 ms vs. 85.6 ± 24.4 ms at 6 months, p = 0.006), whereas ejection fraction significantly increased after RD (baseline: 63.1 ± 8.1% vs. 70.1 ± 11.5% at 6 months, p < 0.001). No significant changes were obtained in control patients.
  
  
  CONCLUSIONS
  Besides the known effect on blood pressure, our study showed for the first time that RD significantly reduces LV mass and improves diastolic function, which might have important prognostic implications in patients with resistant hypertension at high cardiovascular risk.
authors.affiliation: Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria.
authors.forename: Mathias C
authors.initials: MC
authors.lastname: Brandt
authors.forename: Felix
authors.initials: F
authors.lastname: Mahfoud
authors.forename: Sara
authors.initials: S
authors.lastname: Reda
authors.forename: Stephan H
authors.initials: SH
authors.lastname: Schirmer
authors.forename: Erland
authors.initials: E
authors.lastname: Erdmann
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Uta C
authors.initials: UC
authors.lastname: Hoppe
mesh_terms: D001794:Blood Pressure; D003971:Diastole; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007668:Kidney / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000294:innervation; D012189:Retrospective Studies; D013562:Sympathectomy / Q000379:methods*; D013599:Systole; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*