1201Cardiac function, structure, and speckle-tracking echocardiography-derived parameters after distal and conventional renal denervation: a double-blind randomized study
Authors: Ripp T , Ryabova T , Pekarskiy S , Mordovin V , Buharova E , Anfinogenova Y A , Falkovskaya A , Lichikaky V , Sitkova E , Zubanova I , Popov S 
Published: October 2019

Abstract

Background/Introduction
Distal renal denervation (RD) of the segmental branches beyond the bifurcation of the main renal artery is considered more effective treatment than conventional RD of the trunk renal artery. Evidence accumulated over the last decade has shown that global longitudinal strain (GLS) from speckle-tracking analysis of 2-dimensional echocardiography may represent a sensitive parameter of the left ventricular (LV) dysfunction.

Purpose
We compared cardiac function, structure, and GLS parameters after distal and conventional RD in the double-blind randomized prospective study.

Methods
The study (NCT01499810) compromised 55 patients who met criteria for resistant hypertension and signed informed consent. Patients were randomized to either endovascular conventional RD of the main renal artery (group 1, n=27) or to distal treatment applied to the segmental branches after the bifurcation of the main renal artery (group 2, n=28). Parameters of GLS from speckle-tracking echocardiography, ejection fraction, thickness of the interventricular septum (IVS) and LV posterior wall (PW), as well as the parameters of the diastolic function of the heart were assessed at baseline and at 12-months follow-up. Reference echocardiographic values were adapted from the ASE/ESC guidelines. Baseline parameters of heart and drug intake did not significantly differ between patients at the time of randomization.

Results
Drug treatment consisted in combination therapy in the maximum tolerated doses. Patients used different types of drugs, but the number of drug classes did not significantly differ between groups (4.1 in group 1 vs. 4.2 in group 2). Reduction of systolic blood pressure was significantly greater after distal RD vs. conventional RD: −22.1 vs. −11.5 mm Hg, respectively (p<0.05). Decrease in the LV wall thickness was significantly greater after distal RD then after conventional RD, namely: changes in the IVS thickness were −0.21 (−0.39; 1.2) mm after distal RD vs. 1.21 (−0.44; −2.64) mm after conventional RD, p=0.023; changes in the PW thickness were −0.87 (−2.6; −0.62) mm after distal RD vs. 0.07 (−0.45; 1.25) mm after conventional RD, p=0.021. Normalization of diastolic function was found in 13% ((group 1) and 26% ((group 2) in patients with first and second degrees of LV diastolic dysfunction. Speckle-tracking parameters of the left ventricle and some parameters of the left atrium (reduced size by 18% vs 27% of patients) also improved after DRD.

Conclusion(s)
Compared to conventional RD, distal RD treatment applied to the segmental branches beyond the bifurcation of the main renal artery significantly greater attenuated the LV wall thickness and the number of patients with diastolic dysfunction. At 12-month follow up, the global longitudinal LV function also improved in distal RD patients.