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Effect of renal artery revascularization on left ventricular hypertrophy, diastolic function, blood pressure, and the
Daniel Rzeznik1, Tadeusz Przewlocki, Anna Kablak-Ziembicka
1Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital, Krakow, Poland. rzeznikd@poczta.onet.pl
Insights
Renal artery stenting (RAS) reduces left ventricle mass (LVM) and left ventricular mass index (LVMI), independent of blood pressure changes. Higher baseline LVM predicts increased cardiovascular event risk after RAS.
Area of Science:
- Cardiology
- Nephrology
- Vascular Medicine
Background:
- Renal artery stenting (RAS) is a procedure to treat renal artery stenosis.
- The relationship between cardiac remodeling, blood pressure, and cardiovascular events post-RAS requires further investigation.
Purpose of the Study:
- To investigate the interrelations between left ventricle mass (LVM), diastolic function, blood pressure, and cardiovascular events in patients undergoing RAS.
- To assess changes in LVM, diastolic function, systolic blood pressure (SBP), and diastolic blood pressure (DBP) following RAS.
Main Methods:
- Eighty-four patients with renal artery stenosis >60% underwent RAS.
- Echocardiography and 24-hour blood pressure monitoring were performed before and 3 and 12 months after RAS.
- Changes in LVM, LVMI, diastolic function parameters, SBP, and DBP were analyzed.
Main Results:
- A significant reduction in LVM and LVMI was observed 12 months post-RAS (P < .001).
- SBP and DBP also decreased significantly post-RAS (P = .007 and P = .035, respectively).
- Baseline LVM, coronary artery disease severity, and smoking were independent risk factors for cardiovascular events; LVM reduction was independent of blood pressure changes.
Conclusions:
- RAS effectively reduces LVM and LVMI, irrespective of blood pressure modifications.
- Elevated baseline LVM is a significant predictor of increased cardiovascular event risk following RAS.
Objective:
The study aimed to determine the potential interrelations between left ventricle mass (LVM), LV diastolic function, systolic blood pressure (SBP) and diastolic blood pressure (DBP) and cardiovascular events in patients undergoing renal artery stenting [corrected] (RAS).
Methods:
Prior to RAS, 3 and 12 months afterward, the change in LVM, left ventricular mass index (LVMI), diastolic function (E/A ratio, E' wave velocity, isovolumetric relaxation time [IVRT], E/E' ratio) on echocardiography and change in SBP and DBP on 24-hour monitoring were assessed in 84 patients, aged 63.7 ± 10 years, who underwent RAS for renal artery stenosis > 60%.
Results:
During 12 months, 12 (14.3%) cardiovascular (CV) events (five deaths) occurred. At 1 year, the mean LVM decreased from 179 ± 49 g to 141 ± 31 g (P < .001), LVMI in men decreased from 100 ± 20 g/m(2) to 79 ± 18 g/m(2) (P < .001), and the LVMI in women decreased from 96 ± 18 g/m(2) to 80 ± 17 g/m(2) (P < .001). No improvement in diastolic function parameters was seen. The mean SBP and DBP decreased from 133.5 ± 16.9 mm Hg to 127.9 ± 13.2 mm Hg (P = .007) and from 75.4 ± 10.2 mm Hg to 73.1 ± 8.8 mm Hg (P = .035), respectively. On multivariate logistic regression analysis, coronary artery disease (CAD) severity (relative risk [RR], 1.27; P = .023), smoking (RR, 1.29; P = .016), and baseline LVM (RR, 1.21; P = .07) were found as independent CV event risk factors. The independent factors associated with SBP and DBP improvement were grade of renal stenosis (RR, 1.28; P = .006), bilateral RAS procedure (RR, 1.17; P = .07), and baseline DBP value (RR, 1.74; P < .001). LVM reduction was associated with higher baseline ejection fraction (RR, 1.53; P < .001) and baseline LVM (RR, 1.7; P < 0.001). SBP and DBP value changes were independent of LVM change (r = 0.031; P = .796 and r = 0.098; P = .413, respectively).
Conclusions:
RAS induced LVM and LVMI reduction, which is independent of the change in blood pressure. Baseline LVM is associated with higher CV event risk following RAS.
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