First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
Department of Cardiology, Helena Venizelou Hospital, Athens, Greece.
J Cardiol. 2021 Oct;78(4):314-321. doi: 10.1016/j.jjcc.2021.05.002. Epub 2021 Jun 1.
Renal sympathetic denervation (RDN) is a safe device-based option for the treatment of hypertension although current guidelines do not recommend its use in routine clinical practice. In this meta-analysis, we investigated the effects of RDN in cardiac magnetic resonance (CMR)-derived cardiac indices.
This meta-analysis was performed in accordance with the PRISMA statement. A comprehensive systematic search of MEDLINE database and Cochrane library through to January 2021 was performed. The inclusion criteria were studies that enrolled patients undergoing RDN in whom CMR data were provided for left ventricular end-diastolic volume indexed to body surface area (BSA) (LVEDVI), left ventricular end-systolic volume indexed (LVESVI), left ventricular mass indexed (LVMI), and left ventricular ejection fraction (LVEF) pre and post RDN. A random effects model was used for the analyses.
Our search strategy revealed 9 studies that were finally included in the meta-analysis (n=300 patients, mean age: 60 years old, males: 59%). Compared to control group, RDN patients showed significantly lower values in the attained volumes (LVEDVI: -6.70 ml/m, p=0.01; LVESVI: -3.63 ml/m, p=0.006). Moreover, RDN group achieved a statistically significant higher attained LVEF (3.49%, p=0.01). A non-significant difference was found in the attained LVMI between RDN and control groups (-2.59 g/m, p=0.39). Compared to pre-RDN values, RDN reduces significantly the LVMI, the LVEDVI, and the LVESVI while a non-significant change of LVEF was found.
In conclusion, the current study demonstrates the potential beneficial role of RDN in CMR-derived cardiac indices that reflect adverse remodeling. However, large, randomized studies are needed to elucidate the role of RDN in cardiac remodeling in hypertension, heart failure, and other clinical settings.
尽管目前的指南不建议将肾交感神经去神经术（RDN）常规应用于临床实践中，但它是一种安全的基于设备的高血压治疗选择。在这项荟萃分析中，我们研究了 RDN 对心脏磁共振（CMR）衍生的心脏指数的影响。
本荟萃分析按照 PRISMA 声明进行。通过全面系统地检索 MEDLINE 数据库和 Cochrane 图书馆，检索时间截至 2021 年 1 月。纳入标准为接受 RDN 治疗且提供 CMR 数据的患者，这些数据包括左心室舒张末期容积指数（LVEDVI）、左心室收缩末期容积指数（LVESVI）、左心室质量指数（LVMI）和左心室射血分数（LVEF）等。采用随机效应模型进行分析。
我们的检索策略共发现 9 项研究，最终有 300 例患者纳入荟萃分析（平均年龄 60 岁，男性占 59%）。与对照组相比，RDN 组的容积指标明显更低（LVEDVI：-6.70ml/m，p=0.01；LVESVI：-3.63ml/m，p=0.006）。此外，RDN 组的 LVEF 也显著升高（3.49%，p=0.01）。RDN 组与对照组的 LVMI 无显著差异（-2.59g/m，p=0.39）。与 RDN 前相比，RDN 显著降低了 LVMI、LVEDVI 和 LVESVI，而 LVEF 无明显变化。
综上所述，本研究表明 RDN 在 CMR 衍生的心脏指数方面具有潜在的有益作用，这些指数反映了不良重塑。然而，需要进行大型随机研究来阐明 RDN 在高血压、心力衰竭和其他临床环境中的心脏重塑作用。
