van Brussel Peter M, Eeftinck Schattenkerk Daan W, Dobrowolski Linn C, de Winter Robbert J, Reekers Jim A, Verberne Hein J, Vogt Liffert, van den Born Bert-Jan H
Department of Cardiology of the Academic Medical Center, University of Amsterdam, The Netherlands.
Department of Vascular Medicine of the Academic Medical Center, University of Amsterdam, The Netherlands.
Int J Cardiol. 2016 Jan 1;202:609-14. doi: 10.1016/j.ijcard.2015.09.025. Epub 2015 Sep 25.
Renal sympathetic denervation (RSD) is currently being investigated in multiple studies of sympathetically driven cardiovascular diseases such as heart failure and arrhythmias. Our aim was to assess systemic and cardiac sympatholytic effects of RSD by the measurement of cardiac sympathetic activity and cardiovascular parameters.
A total of 21 consecutive patients with refractory hypertension (daytime ambulatory blood pressure (BP)≥150/100 mmHg despite the use of 3 or more antihypertensive drugs), no evidence for secondary hypertension and normal renovascular anatomy were included. RSD was performed with the Medtronic Symplicity renal denervation catheter with an average of 4.2 (range 3-6) ablations per renal artery. To assess cardiac sympathetic activity, 123I-mIBG cardiac scintigraphy was performed before and 6 weeks after. In addition, the effect of RSD on peripheral BP and cardiac hemodynamics were assessed non-invasively.
123I-mIBG uptake before and after RSD was 1.7±0.4% vs. 1.7±0.5% at 15 min. and 1.4±0.4% vs. 1.5±0.5% after 4 h. As a consequence, washout rate was similar before (33.7±11.7%) and after RSD (30.1±12.6%, p=0.27). In line with earlier RSD studies, a significant drop in systolic office BP (-12.2 mmHg, p=0.04) was detected, whereas the decrease in ambulatory BP was not significant. No changes were seen in heart rate, stroke volume or left ventricular contractility, both in supine position and after standing.
In concert with previous reports, RSD leads to a significant drop in office BP. However, a reduction in sympathetic activity could not be demonstrated on a cardiac level.
目前，肾交感神经去神经支配术（RSD）正在多项针对诸如心力衰竭和心律失常等交感神经驱动的心血管疾病的研究中接受调查。我们的目的是通过测量心脏交感神经活动和心血管参数来评估RSD的全身和心脏交感神经抑制作用。
连续纳入21例难治性高血压患者（尽管使用了3种或更多种抗高血压药物，日间动态血压（BP）≥150/100 mmHg），无继发性高血压证据且肾血管解剖结构正常。使用美敦力Symplicity肾去神经支配导管进行RSD，每条肾动脉平均消融4.2次（范围3 - 6次）。为评估心脏交感神经活动，在RSD术前和术后6周进行123I - mIBG心脏闪烁显像。此外，以非侵入性方式评估RSD对外周血压和心脏血流动力学的影响。
RSD前后15分钟时123I - mIBG摄取率分别为1.7±0.4%和1.7±0.5%，4小时后分别为1.4±0.4%和1.5±0.5%。因此，洗脱率在RSD术前（33.7±11.7%）和术后（30.1±12.6%，p = 0.27）相似。与早期RSD研究一致，诊室收缩压显著下降（-12.2 mmHg，p = 0.04），而动态血压下降不显著。仰卧位和站立后心率、每搏输出量或左心室收缩性均未见变化。
与先前报道一致，RSD导致诊室血压显著下降。然而，在心脏水平未证实交感神经活动降低。
