Rommel Karl-Philipp, Pagoulatou Stamatia, Kresoja Karl-Patrik, Rosch Sebastian, Schöber Anne Rebecca, von Roeder Maximilian, Thiele Holger, Fengler Karl, Stergiopulos Nikolaos, Lurz Philipp
Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Germany (K.-P.R., K.-P.K., S.R., A.R.S., M.v.R., H.T., K.F., P.L.).
Cardiovacular Research Foundation, New York, NY (K.-P.R.).
Circ Heart Fail. 2023 Oct;16(10):e010543. doi: 10.1161/CIRCHEARTFAILURE.123.010543. Epub 2023 Aug 30.
Arterial stiffening contributes to hemodynamic derangements in heart failure with preserved ejection fraction (HFpEF). We sought to investigate the impact of renal denervation on pulsatile left ventricular loading in patients with HFpEF and hypertensive patients without heart failure (control).
Patients underwent renal denervation for treatment of hypertension and were followed up at 3 months at a single center. A validated computer model of the arterial tree, noninvasive aortic flow curves, left ventricular volumes, and E/e' as inputs were used to determine key parameters of left ventricular vascular load.
In comparison to controls (n=30), patients with HFpEF (n=30) demonstrated lower total arterial compliance (mean difference, -0.41 [95% CI, -0.72 to -0.10] mL/mm Hg), higher impedance of the proximal aorta (Zc: 0.02; 0.01 to 0.04 mHg·s/mL), premature wave reflections (shorter backward wave transit time normalized to ejection time: -3.5; -6.5% to -0.5%), and higher wave reflection magnitude (reflection coefficient: 7.3; 2.8% to 11.9%). Overall, daytime systolic (-9.2; -12.2 to -6.2 mm Hg) and diastolic blood pressures (-5.9; -7.6 to -4.1 mm Hg) as well as blood pressure variability (-2.0; -3.0 to -0.9 mm Hg) decreased after renal denervation. In patients with HFpEF, total arterial compliance (0.42; 0.17 to 0.67 mL/mm Hg) and backward transit time normalized to ejection time (1.7; 0.4% to 3.0%) increased; Zc (-0.01; -0.02 to -0.01 mm Hg·s/mL) and reflection coefficient (-2.6; -5.0% to -0.3%) decreased after renal denervation. This was accompanied by a symptomatic improvement in patients with HFpEF.
HFpEF is characterized by heightened aortic stiffness and unfavorable pulsatile left ventricular load. These abnormalities are partly normalized after renal denervation.
动脉僵硬度增加会导致射血分数保留的心力衰竭（HFpEF）患者出现血流动力学紊乱。我们试图研究肾去神经支配对HFpEF患者和无心力衰竭的高血压患者（对照组）搏动性左心室负荷的影响。
患者接受肾去神经支配治疗高血压，并在单一中心进行3个月的随访。使用经过验证的动脉树计算机模型、无创主动脉血流曲线、左心室容积和E/e'作为输入，以确定左心室血管负荷的关键参数。
与对照组（n = 30）相比，HFpEF患者（n = 30）的总动脉顺应性较低（平均差异，-0.41 [95% CI，-0.72至-0.10] mL/mm Hg），主动脉近端阻抗较高（Zc：0.02；0.01至0.04 mHg·s/mL），过早的波反射（归一化至射血时间的较短反向波传播时间：-3.5；-6.5%至-0.5%），以及较高的波反射幅度（反射系数：7.3；2.8%至11.9%）。总体而言，肾去神经支配后，白天收缩压（-9.2；-12.2至-6.2 mm Hg）和舒张压（-5.9；-7.6至-4.1 mm Hg）以及血压变异性（-2.0；-3.0至-0.9 mm Hg）均降低。在HFpEF患者中，总动脉顺应性（0.42；0.17至0.67 mL/mm Hg）和归一化至射血时间的反向传播时间（1.7；0.4%至3.0%）增加；肾去神经支配后Zc（-0.01；-0.02至-0.01 mm Hg·s/mL）和反射系数（-2.6；-5.0%至-0.3%）降低。这伴随着HFpEF患者症状的改善。
HFpEF的特征是主动脉僵硬度增加和搏动性左心室负荷不利。肾去神经支配后，这些异常部分得到改善。
