Background: Renal sympathetic denervation (RSD) has been reported to reduce blood pressure in patients with resistant arterial hypertension. Above all other positive changes after RSD, there is published data about left ventricular (LV) hypertrophy decrease in transthoracic echocardiography. Magnetic resonance imaging (MRI) is often considered to be the gold standard in measuring LV function and morphology. The main aim of study was to evaluate LV parameters using MRI before and after RSD.
Methods: We evaluated 13 patients with resistant arterial hypertension (average age 53.4 ± 7.2 years, mean 24-hour ambulatory blood pressure (BP) 159/95 ± 18/11mm Hg, using 6.2 ± 1.2 antihypertensive drugs), who underwent bilateral RSD. MRI was performed prior to RSD and 6 months after the procedure using Avanto (Siemens) 1.5 T machine with BP recording. LV parameters were evaluated using Argus (Siemens) software including LV ejection fraction (EF), mass and volumes. Also segmental diameters of thoracic aorta were evaluated from contrast enhanced images. Left atrium (LA) area was calculated from 4 chamber view.
Results: Six months after RSD procedure LV mass decreased significantly (from 243.2 ± 93.2 to 215.3 ± 70.5, p <0.05). There was strong correlation between LV mass in MRI and myocardial mass index in echocardiography (r=0.591, p=0.033). LV mass/EDV ratio decreased from 1.4 ± 0.35 to 1.23 ± 0.31 (p <0.1). LA size and LV volumes did not change significantly. LV EF (66.3 ± 8.3 vs. 66.2 ± 8.8) and segmental measurements of thoracic aorta remained constant. Systolic BP recorded during MRI procedures decreased significantly (p<0.05).
Conclusion: In a six month follow-up study RSD resulted in a blood pressure decrease and in LV hypertrophy reduction. MRI appeared to be a reliable tool for evaluating LV mass decrease.
