Abstract 15206: Sustained Beneficial Effects of Multi-Electrode Renal Sympathetic Denervation on Cardiac Adaptations in Resistant Hypertension: A 24-months Follow-Up Study

Introduction: The favorable impact of renal sympathetic denervation (RDN) on cardiac parameters such as on left ventricular (LV) morphology, geometry and function has been shown up to 6 months after the procedure using diverse ablation systems. Hypothesis: Multi-electrode catheter-based renal sympathetic RDN may have favorable effects on LV structural and functional indices in patients with resistant hypertension after a follow-up of 24 months. Methods: Twenty patients with resistant hypertension [age: 57±10 years, 13 males, office blood pressure (BP): 182/97±19/18 mmHg under 4.5±0.6 drugs] who underwent RDN were followed-up for 24 months. A full transthoracic echocardiographic study was performed in all patients and LV mass was calculated using the Devereux formula and was indexed for body surface area and height. Results: Average office BP was reduced to 148±21/85±14 mmHg at 12 months and to 143±23/80±14 mmHg at 24 months (p<0.001 for all). In the RDN group, LV mass index was significantly reduced from 136±20.1 g/m 2 (56.5±8.7 g/m 2.7 ) to 121±16.6 g/m 2 (50.6±6 g/m 2.7 ) at 12 months and to 115.6±23.3 g/m 2 (48.8±9.3 g/m 2.7 ) at 24 months (p<0.01 for all). RDN decreased mean interventricular septum thickness from 12.1±1.2 mm to 11.4±0.9 mm at 12 months and to 11.3±0.9 mm at 24 months (p<0.05 for all). After RDN, the number of patients with concentric LV hypertrophy (i.e. relative wall thickness >0.42 and LV mass >48 g/m 2.7 for male and >44 g/m 2.7 for female) decreased from 16 patients (80%) at baseline to 10 patients (50%) at 12 months, and to 7 patients (36.8%) at 24 months. Regarding diastolic function RDN caused an increase in mitral valve E'/A' ratio from 0.62±0.28 to 0.70±0.25 at 12 months and to 0.84±0.32 at 24 months (p<0.05 for all) and a decrease in the E/E' ratio from 14.8±6.1 to 11.8±3.7 at 12 months and to 9.7±4 at 24 months (p<0.05 for all). Conclusions: This the first study to show that multi-electrode RDN results in a significant and sustained improvement of diastolic function and attenuation of LV mass index in increased cardiovascular risk resistant hypertensive patients after a follow-up of 24 months. These results suggest long-term pleiotropic cardiovascular benefits of RDN therapy in the setting of resistant hypertension.