title: Effect of renal artery revascularization upon cardiac structure and function in atherosclerotic renal artery stenosis: cardiac magnetic resonance sub-study of the ASTRAL trial.
abstract: BACKGROUND
  Cardiac abnormalities are frequent in patients with atherosclerotic renovascular disease (ARVD). The Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial studied the effect of percutaneous renal revascularization combined with medical therapy compared with medical therapy alone in 806 patients with ARVD.
  
  
  METHODS
  This was a pre-specified sub-study of ASTRAL (clinical trials registration, current controlled trials number: ISRCTN59586944), designed to consider the effect of percutaneous renal artery angioplasty and stenting on change in cardiac structure and function, measured using cardiac magnetic resonance (CMR) imaging. Fifty-one patients were recruited from six selected ASTRAL centres. Forty-four completed the study (medical therapy n = 21; revascularization n = 23). Full analysis of CMR was possible in 40 patients (18 medical therapy and 22 revascularization). CMR measurements of left and right ventricular end systolic (LV and RVESV) and diastolic volume (LV and RVEDV), ejection fraction (LVEF) and mass (LVM) were made shortly after recruitment and before revascularization in the interventional group, and again after 12 months. Reporting was performed by CMR analysts blinded to randomization arm.
  
  
  RESULTS
  Groups were well matched for mean age (70 versus 72 years), blood pressure (148/71 versus 143/74 mmHg), degree of renal artery stenosis (75 versus 75%) and comorbid conditions. In both randomized groups, improvements in cardiac structural parameters were seen at 12 months, but there were no significant differences between treatment groups. Median left ventricular changes between baseline and 12 months (medical versus revascularization) were LVEDV -1.9 versus -5.8 mL, P = 0.4; LVESV -2.1 versus 0.3 mL, P = 0.7; LVM -5.4 versus -6.3 g, P = 0.8; and LVEF -1.5 versus -0.8%, P = 0.7. Multivariate regression also found that randomized treatment assignment was not associated with degree of change in any of the CMR measurements.
  
  
  CONCLUSIONS
  In this sub-study of the ASTRAL trial, renal revascularization did not offer additional benefit to cardiac structure or function in unselected patients with ARVD.
authors.affiliation: Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: James
authors.initials: J
authors.lastname: Ritchie
authors.affiliation: Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Darren
authors.initials: D
authors.lastname: Green
authors.affiliation: Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Tina
authors.initials: T
authors.lastname: Chrysochou
authors.affiliation: Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Hegarty
authors.affiliation: University of Birmingham, Birmingham, UK.
authors.forename: Kelly
authors.initials: K
authors.lastname: Handley
authors.affiliation: University of Birmingham, Birmingham, UK.
authors.forename: Natalie
authors.initials: N
authors.lastname: Ives
authors.affiliation: University of Birmingham, Birmingham, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Wheatley
authors.affiliation: Ninewells Hospital, Dundee, UK.
authors.forename: Graeme
authors.initials: G
authors.lastname: Houston
authors.affiliation: Central Manchester Foundation Trust, Manchester, UK.
authors.forename: Julian
authors.initials: J
authors.lastname: Wright
authors.affiliation: Central Manchester Foundation Trust, Manchester, UK.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Neyses
authors.affiliation: Central Manchester Foundation Trust, Manchester, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Chalmers
authors.affiliation: Queen Elizabeth University Hospital, Govan, Glasgow, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Mark
authors.affiliation: Queen Elizabeth University Hospital, Govan, Glasgow, UK.
authors.forename: Rajan
authors.initials: R
authors.lastname: Patel
authors.affiliation: Queen Elizabeth University Hospital, Govan, Glasgow, UK.
authors.forename: Jon
authors.initials: J
authors.lastname: Moss
authors.affiliation: Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Giles
authors.initials: G
authors.lastname: Roditi
authors.affiliation: Hull RoyalInfirmary, Hull, UK.
authors.forename: David
authors.initials: D
authors.lastname: Eadington
authors.affiliation: Hull RoyalInfirmary, Hull, UK.
authors.forename: Elena
authors.initials: E
authors.lastname: Lukaschuk
authors.affiliation: Hull RoyalInfirmary, Hull, UK.
authors.forename: John
authors.initials: J
authors.lastname: Cleland
authors.affiliation: Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kalra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D050197:Atherosclerosis / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure; D005260:Female; D005919:Glomerular Filtration Rate; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D012077:Renal Artery / Q000601:surgery; D012078:Renal Artery Obstruction / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: cardiac magnetic resonance (CMR) imaging; coronary artery disease; randomized controlled trial; renal artery stenosis; revascularization