射血分数保留的心力衰竭患者的肾交感神经去神经支配
Renal Sympathetic Denervation in Patients With Heart Failure With Preserved Ejection Fraction.
作者信息
Kresoja Karl-Patrik, Rommel Karl-Philipp, Fengler Karl, von Roeder Maximilian, Besler Christian, Lücke Christian, Gutberlet Matthias, Desch Steffen, Thiele Holger, Böhm Michael, Lurz Philipp
机构信息
Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany.
Leipzig Heart Institute, Heart Center Leipzig, Germany (K.-P.K., K.-P.R., P.L.).
出版信息
Circ Heart Fail. 2021 Mar;14(3):e007421. doi: 10.1161/CIRCHEARTFAILURE.120.007421. Epub 2021 Mar 12.
BACKGROUND
Arterial hypertension is the most common comorbidity in patients with heart failure with preserved ejection fraction (HFpEF) and mediates adverse hemodynamics through related aortic stiffness and increased pulsatile load. We aimed to investigate the clinical and hemodynamic implications of renal sympathetic denervation (RDN) in patients with HFpEF and uncontrolled arterial hypertension.
METHODS
Patients undergoing RDN between 2011 and 2018 in a single-center were retrospectively analyzed and classified as HFpEF (n=99) or no HF (n=65). Stroke volume index and aortic distensibility were measured through cardiac magnetic resonance imaging, and left ventricular (LV) systolic and diastolic properties were assessed echocardiographically.
RESULTS
At baseline, patients with HFpEF had higher stroke volume index (median 40 [interquartile range, 33-48] versus 33 [26-40] mL/m, =0.002), pulse pressure (69 [63-77] versus 61 [55-67] mm Hg, <0.001), but lower LV-VPES (18 [10-28] versus 24 [15-40] mL, =0.007) and aortic distensibility (1.5 [1.1-2.6] versus 2.7 [1.1-3.5] 10 mm Hg, =0.013) as compared to no-HF patients. Systolic blood pressure decreased comparable in patients with HFpEF and no-HF patients following RDN (-9 [-16 to -2], <0.001). After RDN stroke volume index (-3 [-9 to +3] mL/m, =0.011) decreased and aortic distensibility (0.2 [-0.1 to +1.1] 10 mm Hg, =0.007) and systolic stiffness (<0.001) increased in HFpEF patients. LV diastolic stiffness and LV filling pressures as well as NT-proBNP (N-terminal pro-B-type natriuretic peptide) decreased after RDN in patients with HFpEF (=0.032, =0.043, and <0.001, respectively).
CONCLUSIONS
Patients with HFpEF undergoing RDN showed increased stroke volume index, vascular, and LV stiffness as compared to no-HF patients. Following RDN those hemodynamic alterations and reduced systolic and diastolic LV stiffness were partly normalized, implying RDN might be a potential therapeutic strategy for arterial hypertension and HFpEF.
背景
动脉高血压是射血分数保留的心力衰竭（HFpEF）患者中最常见的合并症，通过相关的主动脉僵硬度增加和搏动负荷介导不良血流动力学。我们旨在研究肾交感神经去神经支配（RDN）对HFpEF和未控制的动脉高血压患者的临床和血流动力学影响。
方法
对2011年至2018年在单中心接受RDN的患者进行回顾性分析，并分为HFpEF组（n = 99）和非HF组（n = 65）。通过心脏磁共振成像测量每搏输出量指数和主动脉扩张性，并通过超声心动图评估左心室（LV）的收缩和舒张特性。
结果
基线时，HFpEF患者的每搏输出量指数较高（中位数40[四分位间距，33 - 48]对33[26 - 40]mL/m，P = 0.002），脉压较高（69[63 - 77]对61[55 - 67]mmHg，P < 0.001），但LV - VPES较低（18[10 - 28]对24[15 - 40]mL，P = 0.007），主动脉扩张性较低（1.5[1.1 - 2.6]对2.7[1.1 - 3.5]×10⁻⁶mmHg⁻¹，P = 0.013），与非HF患者相比。RDN后，HFpEF患者和非HF患者的收缩压下降程度相当（-9[-16至-2]mmHg，P < 0.001）。RDN后，HFpEF患者的每搏输出量指数下降（-3[-9至+3]mL/m，P = 0.011），主动脉扩张性增加（0.2[-0.1至+1.1]×10⁻⁶mmHg⁻¹，P = 0.007），收缩期僵硬度增加（P < 0.001）；LV舒张期僵硬度、LV充盈压以及NT - proBNP（N末端B型利钠肽原）在HFpEF患者RDN后下降（分别为P = 0.032、P = 0.043和P < 0.001）。
结论
与非HF患者相比，接受RDN的HFpEF患者的每搏输出量指数、血管和LV僵硬度增加。RDN后，这些血流动力学改变以及LV收缩期和舒张期僵硬度的降低部分恢复正常，这意味着RDN可能是治疗动脉高血压和HFpEF的潜在策略。
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