Echocardiographic findings following renal sympathetic denervation for treatment resistant hypertension, the ReShape CV-risk study

Abstract

Objective

The aim of this study was to describe and compare echocardiographic findings before renal sympathetic denervation (RDN) and 6 and 24 months after the procedure.

Materials and methods

Patients with treatment resistant hypertension (TRH) were included in this non-randomised intervention study. RDN was performed by a single experienced operator using the Symplicity Catheter System. Echocardiographic measurements were performed at baseline, and after 6 and 24 months.

Results

The cohort consisted of 21 patients with TRH, with a mean systolic office blood pressure (BP) of 163 mmHg and mean diastolic BP 109 mmHg. Mixed model analysis showed no significant change in left ventricular (LV) mass index (LVMI) or left atrium volume index (LAVI) after the RDN procedure. Higher LVMI at baseline was significantly associated with greater reduction in LVMI (p < 0.001). Relative wall thickness (RWT) increased over time (0.48 mm after two years) regardless of change in BP. There was a small but significant reduction in LV end-diastolic (LVIDd) and end-systolic (LVIDs) diameters after RDN, with a mean reduction of 2.6 and 2.4 mm, respectively, after two years. Progression to concentric hypertrophy was observed only in in patients who did not achieve normal BP values, despite BP reduction after RDN.

Conclusion

There was no reduction of LV mass after RDN. We found a small statistically significant reduction in LVIDd and LVIDs, which together with increase in RWT can indicate progression towards concentric hypertrophy. BP reduction after RDN on its own does not reverse concentric remodelling if target BP is not achieved.

Keywords:

• Echocardiography
• hypertension
• resistant hypertension
• renal denervation
• RDN
• ventricular hypertrophy

Author contributions

E.S., A.M., M.D.S. and T.S. contributed to the conception or design of the work. A.S., E.S., A.M., M.D.S. and T.S. contributed to the acquisition, analysis or interpretation of data. A.S. drafted the manuscript. All authors critically revised the manuscript, gave final approval and agreed to be accountable for all aspects of this work, ensuring integrity and accuracy.

Disclosure statement

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Data availability statement

The data that support the findings of this study are available from the corresponding author, [A.S.], upon reasonable request.

Additional information

Funding

A.M., M.S. and T.S. were funded by governmental non-profit organisations in Norway and The Norwegian Diabetes Association. A.M. was funded by the Northern Norway Regional Health Authority. A.S. and T.S. are funded by UiT the Arctic University of Norway. The study was supported by grants from the Northern Norway Regional Health Authority and an unrestricted grant from Medtronic. The funders had no access to the study data, and had no role in the design, conduct or reporting of the study.