Cardiovascular Research Centre, Royal Adelaide Hospital, Adelaide, SA, Australia; Discipline of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia.
Cardiovascular Research Centre, Royal Adelaide Hospital, Adelaide, SA, Australia; Discipline of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia.
Atherosclerosis. 2018 May;272:207-215. doi: 10.1016/j.atherosclerosis.2018.03.022. Epub 2018 Mar 10.
Echocardiographic studies have shown improvements in cardiac indices associated with renal sympathetic denervation (RDN), however, the benefits on myocardial perfusion have never been assessed. This trial was designed to study the effects of RDN on myocardial perfusion using cardiac magnetic resonance (CMR) imaging.
A total of 14 patients with resistant hypertension were recruited for RDN and myocardial perfusion, alongside other CMR indices, was assessed at baseline and at 6 months.
RDN showed significant reduction of mean office blood pressures from 181/100 ± 19/16 mmHg to 147/85 ± 19/17 mmHg, 6 months after the procedure (p < 0.0001). This was combined with significant improvement in regional aortic distensibility (p < 0.02) and associated with trends of improved myocardial perfusion reserve index (baseline = 2.2 ± 1; 6 months = 2.9 ± 1 units) (p = 0.08). Left ventricular end systolic volume index decreased from baseline to 6 months post procedure, 27 ± 13 ml/mvs. 22 ± 10 ml/m (p = 0.03), but there was no significant change in left ventricular end diastolic volume index (p = 0.09). There was significant improvement in mean left ventricular ejection fraction from 68 ± 10% to 72 + 9%, 6 months post procedure (p = 0.04). T1 mapping failed to detect fibrosis in these patients at baseline and therefore no change was noted, however, extracellular volume percent improved from 46 ± 4% at baseline to 41 ± 8% at 6 months (p = 0.002).
This study demonstrates that renal sympathetic denervation increased myocardial perfusion by 32% as assessed by CMR, and, this was associated with improvements in cardiac volumes and function. Larger well controlled and randomized studies are required to assess the clinical significance of these findings.
超声心动图研究表明，肾交感神经去神经支配（RDN）可改善与心脏相关的各项指标，但心肌灌注的改善作用从未被评估过。本试验旨在通过心脏磁共振（CMR）成像来研究 RDN 对心肌灌注的影响。
共招募了 14 名患有难治性高血压的患者进行 RDN 治疗，并在基线和 6 个月时评估其他 CMR 指数和心肌灌注情况。
RDN 术后 6 个月，平均诊室血压从 181/100±19/16mmHg 显著下降至 147/85±19/17mmHg（p＜0.0001）。这与区域性主动脉扩张性的显著改善相关（p＜0.02），并与心肌灌注储备指数的改善趋势相关（基线=2.2±1；6 个月=2.9±1 单位）（p=0.08）。左心室收缩末期容积指数从基线到术后 6 个月下降，27±13ml/m2 降至 22±10ml/m2（p=0.03），但左心室舒张末期容积指数无明显变化（p=0.09）。左心室射血分数从 68±10%改善至 72+9%，术后 6 个月时（p=0.04）有显著改善。T1 映射在基线时未能检测到这些患者的纤维化，因此没有发现变化，但是细胞外容积百分比从基线时的 46±4%改善至 6 个月时的 41±8%（p=0.002）。
本研究表明，CMR 评估显示，肾交感神经去神经支配使心肌灌注增加了 32%，同时还改善了心脏容积和功能。需要更大规模、控制良好和随机的研究来评估这些发现的临床意义。
