title: Impact of renal artery stenting on cytokine levels, left ventricle mass and diastolic function.
abstract: BACKGROUND
  Significant renal artery stenosis (RAS) may lead to left ventricle (LV) hypertrophy and diastolic function (DF) impairment through complex mechanisms: activation of cytokines and/or systolic and diastolic blood pressure (SBP, DBP) increase.
  
  
  OBJECTIVE
  To assess interrelations between LV mass (LVM), DF and cytokines in patients undergoing renal artery stenting (PTA, percutaneous angioplasty of renal artery).
  
  
  METHODS
  The study group comprised 72 subjects (44.4% men), 64.1 ± 9.9 years with RAS referred to PTA. SBP, DBP, transforming growth factor beta1 (TGF-β1), aldosterone, B-type natriuretic peptide (BNP) levels and change in LVM and LVM index (LVMI) and DF (E(vel), e'(vel), E/A ratio, E/e' ratio, Ar(time)-A(time)) on echocardiography were assessed preprocedurally, and three and 12 months postprocedurally.
  
  
  RESULTS
  TGF-β1 level decreased from 13.3 ± 14.9 to 8.6 ± 8.0 ng/mL (p = 0.027), while BNP increased from 89.1 ± 86.3 to 131 ± 105 pmol/mL (p < 0.001). A significant reduction in LVMI in women (79.4 ± 16.9 vs. 95.7 ± 18.5 g/m², p < 0.001) and men (77.2 ± 16.8 vs. 100.1 ± 19.7 g/m², p < 0.001) was found at 12 months vs. baseline. Degree of LVM reduction correlated with baseline LVM (p < 0.001; r = -0.612) and e'(vel) (p = 0.05; r = 0.230), but not with BP values. Among DF parameters, only e'(vel) increased significantly at 12 months (5.54 ± 1.57 vs. 5.92 ± 1.65 cm/s; p = 0.039), while A/E and E/e' ratio, Ar(time)-A(time) remained similar (p = 0.457, p = 0.283 and p = 0.258). Factors associated with e'(vel) increase ≥ 0.3 cm/s at 12 months were baseline LVM < 165 g (p = 0.043, RR = 1.39, CI 1.01-1.46), E(vel) (p = 0.015, RR = 1.26, CI 1.15-1.52), e'(vel) (p < 0.001, RR = 1.42, CI 1.18-1.7), DBP decrease > 10 mm Hg (p = 0.055, RR = 1.2, CI 1.0-1.44) and TGF-β1 > 8 ng/mL (p = 0.024, RR = 1.24, CI 1.03-1.49) at 12 months.
  
  
  CONCLUSIONS
  Significant LVMI reduction was observed after PTA of RAS, but it was independent of BP reduction. e'(vel) increase was independently associated with baseline LVM, E(vel), e'(vel), and 12 month decrease in DBP > 10 mm Hg.
authors.affiliation: Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The Pope John Paul II Hospital, Krakow, Poland. rzeznikd@poczta.onet.pl
authors.forename: Daniel
authors.initials: D
authors.lastname: Rzeźnik
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Przewłocki
authors.forename: Anna
authors.initials: A
authors.lastname: Kabłak-Ziembicka
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Rasławiecka
authors.forename: Artur
authors.initials: A
authors.lastname: Kozanecki
authors.forename: Jacek
authors.initials: J
authors.lastname: Łach
authors.forename: Piotr
authors.initials: P
authors.lastname: Podolec
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D016207:Cytokines / Q000378:metabolism*; D003971:Diastole; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000209:etiology / Q000517:prevention & control; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000517:prevention & control*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012078:Renal Artery Obstruction / Q000150:complications* / Q000378:metabolism / Q000628:therapy*; D015607:Stents; D018754:Ventricular Dysfunction / Q000209:etiology / Q000517:prevention & control
chemical_list: D016207:Cytokines