Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Kordalis Athanasios
Dissertation committee:
Κωνσταντίνος Τσιούφης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χριστόδουλος Στεφανάδης, Ομότιμος και Επίτιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ελευθέριος Τσιάμης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Δημήτριος Τούσουλης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γεώργιος Στεργίου, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνα Αγγέλη, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ευστάθιος Μανιός, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Επίδραση της ενδοαυλικής κατάλυσης της συμπαθητικής νεύρωσης του νεφρού στις βλάβες στα όργανα στόχους σε ασθενείς με ανθεκτική υπέρταση
Translated title:
Effect of transcatheter renal sympathetic denervation on target organ damage in patients with resistant hypertension
Summary:
Objective: This study investigated the effect of renal denervation (RDN) on target organ damage (TOD), especially cardiac adaptations, in patients with resistant hypertension (RH). We also performed a systematic review and metaanalysis of the literature regarding RDN and regression of TOD.
Methods: Cohort study: Eighteen patients with RH [age: 56±10 years, 12 men, BMI: 33.6±5.4 kg/m2, office blood pressure (BP): 182±19/97±18mmHg and ambulatory BP:153±16/87±15mmHg receiving 4.5 antihypertensive drugs/day and left ventricular hypertrophy underwent RDN. Metaanalysis: We searched literature for studies with eligible content and performed random-effect meta-analyses for the following outcomes: left ventricular mass index (LVMI), left atrial volume index (LAVI), E to A wave velocities of trans-mitral inflow (E/A) and E wave velocity to Em velocity from tissue Doppler imaging (E/Em), central augmentation index (AIx) and carotid-femoral pulse wave velocity (PWV).
Results: Cohort study: RDN contributed to regression of LVMI from 140.0±17.0 g/m2 (57.9±7.9 g/m2.7) to 126.7±19.2 g/m2 (52.6±8.4 g/m2.7) (P<0.01 for both) and left atrial diameter from 42.4±4.3 to 40.6±3.6mm (P=0.004) at 6 months. Mitral lateral E/E’ ratio decreased from 14.8±6.1 to 12.0±3.2 (P=0.016); isovolumic relaxation time shortened from 109.8±16.2 to 100.8±17.1 ms (P=0.003); and N-terminal pro B-type natriuretic peptide levels reduced from 84.9±35.9 to 57.2±38.8 pg/ml (P<0.001) at 6 months post-RDN. At 24 months after RDN, the LVMI reduced significantly by 15.5% and the mitral lateral E/E’ by 29.7%. Meta-analysis: Seventeen studies (n=698 patients) were incorporated in the present meta-analysis. RDN led to a regression of LVMI by 14.17 g/m2 (95% CI -18.33 to -10.01, P<0.001) and by 4.75 g/m2 (95% CI -7.83 to -1.67, P=0.003) for echocardiography and cardiac magnetic resonance, respectively. The pooled effect of RDN to E/A was not significant [0.04 (95% CI -0.03 to 0.12, P=0.252)], whereas a decline of E/Em [-0.73 (95% CI -1.38 to -0.08, P=0.03)] was observed. The pooled effect to LAVI [-1.67 ml/m2 (95% CI -4.60 to 1.27, P=0.266)] reached statistical significance only in sensitivity analysis. RDN had beneficial effects in both AIx [-7.05 (95% CI -9.12 to -4.98, P<0.001)] and PWV [1.54 m/s (95% CI -2.16 to -0.92, P<0.001)]. Metaregression analysis revealed an independent effect of RDN on TOD regarding baseline blood pressure and blood pressure reduction.
Conclusion: RDN contributes to the regression of TOD in patients with RH, independent of BP reduction.
Main subject category:
Health Sciences
Keywords:
Arterial Hypertension, Sympathetic Nervous System, Renal Denervation, Target Organ Damage
Number of references:
324
