Xu Hai, Jiang Zhixin, Jiang Wanying, Huo Junyu, Shan Qijun
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 222007, China.
Department of Cardiovascular, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Nanjing, Jiangsu 211103, China.
Evid Based Complement Alternat Med. 2022 May 28;2022:2268591. doi: 10.1155/2022/2268591. eCollection 2022.
Renal artery denervation (RDN) can treat hypertension and paroxysmal atrial fibrillation (PAF). Hypertension and PAF can affect cardiac diastolic function. The study aimed to evaluate the effect of RDN on cardiac diastolic function in patients with refractory hypertension and PAF.
190 consecutive patients with hypertension and PAF were recruited. The levels of NT-proBNP and metrics of echocardiography were measured before and after RDN in patients with refractory hypertension and PAF. The 190 patients were divided into the decreasing HR and nondecreasing HR group, the decreasing MAP and nondecreasing MAP group, the HFPEF group, and the normal diastolic function group, respectively.
Before RDN, the indices about cardiac diastolic function were out of the normal range. After RDN, the diastolic function improved in the indices of NT-proBNP, /', '. The diastolic function about the indices of NT-proBNP, /', ' was improved in the decreasing HR group, the decreasing mean arterial pressure (MAP) group, and the HFPEF group, correspondingly compared to the nondecreasing HR group, the non-decreasing MAP group, and the preoperative normal diastolic function group. In the multivariate analysis, the MAP and HR were the only two indicators significantly associated with the improvement of diastolic function.
RDN could improve the diastolic function in patients with refractory hypertension and PAF. Patients with HFPEF could receive benefits through RDN. It was speculated that RDN improved the diastolic function mainly through decreasing HR and MAP.
肾动脉去神经支配术(RDN)可治疗高血压和阵发性心房颤动(PAF)。高血压和PAF会影响心脏舒张功能。本研究旨在评估RDN对难治性高血压合并PAF患者心脏舒张功能的影响。
连续纳入190例高血压合并PAF患者。测量难治性高血压合并PAF患者RDN术前和术后的N末端B型利钠肽原(NT-proBNP)水平及超声心动图指标。将190例患者分别分为心率降低组和心率未降低组、平均动脉压降低组和平均动脉压未降低组、射血分数保留的心力衰竭(HFpEF)组和舒张功能正常组。
RDN术前,心脏舒张功能指标超出正常范围。RDN术后,NT-proBNP等指标的舒张功能得到改善。与心率未降低组、平均动脉压未降低组及术前舒张功能正常组相比,心率降低组、平均动脉压降低组和HFpEF组中NT-proBNP等指标的舒张功能相应改善。多因素分析中,平均动脉压和心率是仅有的两个与舒张功能改善显著相关的指标。
RDN可改善难治性高血压合并PAF患者的舒张功能。HFpEF患者可通过RDN获益。推测RDN主要通过降低心率和平均动脉压改善舒张功能。