肾去神经术对耐药性高血压中心脏重构的影响：一项荟萃分析。

Impact of renal denervation on cardiac remodeling in resistant hypertension: A meta-analysis.

机构信息

Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

出版信息

Clin Cardiol. 2024 Feb;47(2):e24222. doi: 10.1002/clc.24222.

DOI:10.1002/clc.24222

PMID:38402531

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10823454/

Abstract

Twelve studies involving 433 patients were included. After RDN treatment, LVMI decreased by 13.08 g/m (95% confidence interval [CI]: -18.38, -7.78; p < .00001), PWTd decreased by 0.60 mm (95% CI: -0.87, -0.34; p < .00001), IVSTd decreased by 0.78 mm (95% CI: -1.06, -0.49; p < .00001), and LVEF increased by 1.80% (95% CI: 0.71, 2.90; p = .001). However, there were no statistically significant improvements in LVIDd (95% CI: -1.40, 0.24; p = .17) and diastolic function (E/A) (95% CI: -0.04, 0.14; p = .28). Drug treatment for resistant hypertension (RH) is challenging. Renal denervation (RDN) is one of the most promising treatments for RH. Although studies have shown RDN can control blood pressure, the impacts of RDN on cardiac remodeling and cardiac function are unclear. This meta-analysis evaluated the effect of RDN on cardiac structure and function in patients with RH. PubMed, Embase, and Cochrane were used to conduct a systematic search. The main inclusion criteria were studies on patients with RH who received RDN and reported the changes in echocardiographic parameters before and after RDN. Echocardiographic parameters included left ventricular mass index (LVMI), end-diastolic left ventricular internal dimension (LVIDd), left ventricular end-diastolic posterior wall thickness (PWTd), end-diastolic interventricular septum thickness (IVSTd), E/A, and left ventricular ejection fraction (LVEF). Data was analyzed using RevMan. Twelve studies involving 433 patients were included. After RDN treatment, LVMI decreased by 13.08g/m2 (95%confidence interval [CI]: -18.38, -7.78, p < .00001), PWTd decreased by 0.60mm (95% CI: -0.87, -0.34, p < 0.00001), IVSTd decreased by 0.78mm (95% CI: -1.06, -0.49, p < .00001), and LVEF increased by 1.80% (95% CI: 0.71, 2.90, p = .001). However, there were no statistically significant improvements in LVIDd (95% CI: -1.40, 0.24, p = .17) and diastolic function (E/A) (95% CI: -0.04, 0.14, p =.28). This meta-analysis finds that RDN can improve left ventricular hypertrophy and ejection fraction in patients with RH but has no significant effect on LVIDd and diastolic function. However, more studies are warranted due to the lack of a strict control group, a limited sample size, and research heterogeneity.

摘要

这项荟萃分析评估了 RDN 对 RH 患者心脏结构和功能的影响。检索了 PubMed、Embase 和 Cochrane 数据库，主要纳入标准为接受 RDN 治疗并报告 RDN 前后超声心动图参数变化的 RH 患者的研究。纳入的 12 项研究共 433 例患者，RDN 治疗后左室质量指数（LVMI）降低 13.08g/m²（95%置信区间[CI]：-18.38，-7.78；p<.00001），左室舒张末期内径（LVIDd）无明显变化（95% CI：-1.40，0.24，p=.17），左室后壁厚度（PWTd）降低 0.60mm（95% CI：-0.87，-0.34，p<.00001），室间隔厚度（IVSTd）降低 0.78mm（95% CI：-1.06，-0.49，p<.00001），左室射血分数（LVEF）增加 1.80%（95% CI：0.71，2.90，p=.001）。E/A 比值（舒张功能）无明显变化（95% CI：-0.04，0.14，p=.28）。本荟萃分析发现，RDN 可改善 RH 患者左室肥厚和射血分数，但对 LVIDd 和舒张功能无显著影响。然而，由于缺乏严格的对照组、样本量有限和研究异质性，还需要更多的研究。