Sesa-Ashton Gianni, Nolde Janis M, Tang Bart, Carnagarin Revathy, Lambert Elisabeth A, Lambert Gavin W, Kiuchi Marcio G, Macefield Vaughan G, Walton Antony, Schultz Carl J, Shetty Sharad, Esler Murray D, Schlaich Markus P
Baker Heart and Diabetes Institute, Melbourne, Australia.
Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, Western Australia, Australia.
J Clin Hypertens (Greenwich). 2025 Aug;27(8):e70112. doi: 10.1111/jch.70112.
Renal denervation (RDN) is an adjunct therapy for resistant hypertension, reducing blood pressure (BP) by inhibiting both afferent sensory and efferent sympathetic renal nerve activity. The resulting reduction in central sympathetic outflow including that directed toward the heart may beneficially impact cardiac remodeling, left ventricular hypertrophy (LVH) and atrial fibrillation (AF). RDN has been shown to reduce left ventricular mass and AF burden but long-term data is sparse. Forty patients (72.5% male, 69.2 ± 9.6 years) underwent 12-lead ECG at baseline prior to RDN and at a mean long-term follow-up (LTFU) of 8.3 ± 0.9 years post-intervention. A 24-h ambulatory blood pressure monitor (ABPM) was obtained at both time points. Cornell voltage indices were calculated at baseline and LTFU, then converted to left ventricular mass based on validated formulae accounting for sex. ECGs underwent cardiologist review for determination of AF at both time-points. There was no difference in Cornell voltages or left ventricular mass index (LVMI) between baseline and long-term follow-up in neither males (p = 0.89) nor females (p = 0.91). BP lowering at LTFU was correlated with a more pronounced reduction in LVMI (r = 0.50, p = 0.0011) No change was observed in the incidence of atrial fibrillation between baseline or long-term follow-up (p = 0.99). There was no reduction in mean Cornell voltage or LVMI across the cohort between baseline and long-term follow-up. However, changes in ambulatory systolic BP correlated with reduction in LVMI suggestive of an RDN-induced BP dependent long-term reduction in LVMI out to eight years post-RDN.
肾去神经支配术（RDN）是一种用于治疗顽固性高血压的辅助疗法，它通过抑制肾传入感觉神经和传出交感神经活动来降低血压（BP）。由此导致的中枢交感神经输出减少，包括指向心脏的交感神经输出减少，可能会对心脏重塑、左心室肥厚（LVH）和心房颤动（AF）产生有益影响。RDN已被证明可减少左心室质量和房颤负担，但长期数据较少。40例患者（男性占72.5%，年龄69.2±9.6岁）在接受RDN之前的基线时以及干预后平均8.3±0.9年的长期随访（LTFU）时进行了12导联心电图检查。在两个时间点均获取了24小时动态血压监测（ABPM）数据。在基线和LTFU时计算康奈尔电压指数，然后根据考虑性别的验证公式将其转换为左心室质量。心电图由心脏病专家进行审查，以确定两个时间点的房颤情况。在男性（p = 0.89）和女性（p = 0.91）中，基线和长期随访之间的康奈尔电压或左心室质量指数（LVMI）均无差异。LTFU时的血压降低与LVMI更显著的降低相关（r = 0.50，p = 0.0011）。在基线或长期随访之间，房颤发生率未观察到变化（p = 0.99）。在整个队列中，基线和长期随访之间的平均康奈尔电压或LVMI没有降低。然而，动态收缩压的变化与LVMI的降低相关，提示RDN诱导的血压依赖性LVMI长期降低可持续至RDN后八年。
