肾去神经支配术中静脉-动脉去甲肾上腺素梯度的降低与血压反应相关。

Intraprocedural reduction of the veno-arterial norepinephrine gradient correlates with blood pressure response after renal denervation.

作者信息

Tiroch Klaus, Sause Armin, Szymanski Jacek, Nover Ina, Leischik Roman, Mann Johannes F E, Vorpahl Marc, Seyfarth Melchior

机构信息

HELIOS Klinikum Wuppertal, University of Witten/Herdecke, Wuppertal, Germany.

出版信息

EuroIntervention. 2015 Nov;11(7):824-34. doi: 10.4244/EIJV11I7A167.

DOI:10.4244/EIJV11I7A167

PMID:26603990

Abstract

AIMS

No intraprocedural assessment is currently available to evaluate the extent of nerve ablation by renal denervation (RDN). We prospectively evaluated the association of intraprocedural reduction of renal veno-arterial norepinephrine gradient with blood pressure (BP) response after RDN.

METHODS AND RESULTS

In 46 consecutive RDN patients, the periprocedural norepinephrine veno-arterial difference was defined as veno-arterial norepinephrine gradient. We observed a reduction of the office systolic BP from 176±19 mmHg to 165±24 mmHg (p=0.02) at three months and 163±22 mmHg (p=0.02) at six months. The mean and maximum systolic ABP decreased by 5 mmHg (p=0.03) and 9 mmHg (p=0.02), respectively. There was a decrease of the norepinephrine RV-RA difference from pre- to post-procedural levels (median 186 pg/ml [54;466] vs. 81 pg/ml [0;182], p=0.02). OBP responders (office systolic BP reduction ≥10 mmHg) showed a greater reduction of the norepinephrine gradient compared to non-responders (-290±450 pg/ml vs. -4±106 pg/ml, p=0.01). Patients with a reduction of norepinephrine gradient in both kidneys showed the most pronounced decrease of the systolic OBP (-24±14 mmHg) compared to patients with a reduction of norepinephrine gradient in only one kidney (-7±15 mmHg) or patients without a norepinephrine reduction (-3±19 mmHg, p=0.03 vs. bilateral reduction).

CONCLUSIONS

Measuring renal norepinephrine gradient during RDN may be a method to gauge the extent of renal nerve ablation.

摘要

目的

目前尚无术中评估方法可用于评估肾去神经支配术（RDN）对神经消融程度的影响。我们前瞻性地评估了术中肾静脉 - 动脉去甲肾上腺素梯度降低与RDN术后血压（BP）反应之间的关联。

方法与结果

在连续46例RDN患者中，围手术期去甲肾上腺素静脉 - 动脉差值定义为静脉 - 动脉去甲肾上腺素梯度。我们观察到，术后3个月时诊室收缩压从176±19 mmHg降至165±24 mmHg（p = 0.02），6个月时降至163±22 mmHg（p = 0.02）。平均收缩期和最大收缩期动态血压分别下降了5 mmHg（p = 0.03）和9 mmHg（p = 0.02）。去甲肾上腺素肾静脉 - 肾动脉差值从术前到术后水平有所下降（中位数186 pg/ml [54;466] 对比 81 pg/ml [0;182]，p = 0.02）。诊室血压反应者（诊室收缩压降低≥10 mmHg）与无反应者相比，去甲肾上腺素梯度降低更明显（-290±450 pg/ml对比-4±106 pg/ml，p = 0.01）。与仅一侧肾脏去甲肾上腺素梯度降低的患者（-7±15 mmHg）或去甲肾上腺素未降低的患者（-3±19 mmHg）相比，双侧肾脏去甲肾上腺素梯度均降低的患者收缩期诊室血压下降最为显著（-24±14 mmHg，与双侧降低相比p = 0.03）。