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Published on: November 19, 2020
Effect of renal artery stenting on left ventricular mass: a randomized clinical trial
Carmelita Marcantoni1, Luca Zanoli, Stefania Rastelli
1Division of Nephrology, Cannizzaro Hospital, Catania, Italy. marcantoni.carmelita@gmail.com
Insights
Renal revascularization did not significantly reduce left ventricular mass index in patients with coronary artery disease and moderate renal artery stenosis. This study found no significant benefit of stenting over medical therapy for this patient group.
Area of Science:
- Cardiology
- Nephrology
- Vascular Medicine
Background:
- Left ventricular hypertrophy (LVH) is a significant concern in patients with coronary artery disease (CAD).
- The role of renal revascularization in mitigating LVH in patients with coexisting renal artery stenosis (RAS) remains unclear.
- Ischemic heart disease (IHD) and RAS often coexist, necessitating research into effective treatment strategies.
Purpose of the Study:
- To investigate the effect of renal artery stenting on the progression of left ventricular hypertrophy (LVH) in patients with IHD and RAS.
- To compare the outcomes of revascularization plus medical therapy versus medical therapy alone in managing LVH.
Main Methods:
- A randomized clinical trial was conducted involving patients with IHD and RAS (50%-80% stenosis).
- Participants were assigned to either revascularization plus standard medical therapy or medical therapy alone.
- Left ventricular mass index (LVMI) was assessed using echocardiography at baseline and after one year.
Main Results:
- No statistically significant difference in the change of LVMI was observed between the revascularization group and the medical therapy group after one year (2.1 g/m²; 95% CI, -6.1 to 10.3).
- Blood pressure and estimated glomerular filtration rate changes were also similar between the groups.
- Major cardiovascular event rates were comparable in both treatment arms.
Conclusions:
- Renal revascularization did not demonstrate a clinically significant benefit in reducing LVMI in patients with CAD and moderate RAS (50%-80%).
- The study was limited by the exclusion of patients with very severe renal artery stenosis.
- Further research may be needed to clarify the role of renal revascularization in specific patient subgroups.
Background:
Whether renal revascularization reduces left ventricular hypertrophy in patients with coronary artery disease is uncertain.
Study Design:
Randomized clinical trial testing the effect of renal artery stenting versus medical therapy on left ventricular hypertrophy progression in patients affected by ischemic heart disease and renal artery stenosis.
Setting & Participants:
Incident patients with ischemic heart disease undergoing cardiac catheterization with renal artery stenosis >50%-≤80%.
Intervention:
Revascularization plus standard medical therapy versus medical therapy alone.
Outcomes:
Primary end point was change in echocardiographic left ventricular mass index (LVMI).
Measurements:
Clinical and echocardiographic studies were performed at baseline and after 1 year.
Results:
84 patients were randomly assigned: 43 to revascularization plus standard medical therapy and 41 to medical therapy alone. At baseline, clinical characteristics were similar in the 2 study groups. After 1 year, there was no statistically significant difference between longitudinal change in the medical therapy group versus that in the medical therapy plus revascularization group for LVMI (2.1; 95% CI, -6.1 to 10.3 g/m(2)), blood pressure (systolic, -0.2 [95% CI, -9.1 to 8.8 mm Hg]; diastolic, -3.3 [95% CI, -8.4 to 1.8 mm Hg]), or estimated glomerular filtration rate (1.5; 95% CI, -5.8 to 8.9 mL/min/1.73 m(2)). The number of major cardiovascular events was similar in the 2 groups (revascularization plus standard medical therapy [fatal, n = 2; nonfatal, n = 11] and medical therapy alone [fatal, n = 2; nonfatal, n = 11]).
Limitations:
Patients with very severe renal artery stenosis were excluded from the study.
Conclusions:
Our study was unable to detect a clinically significant benefit of renal revascularization on LVMI in patients with coronary artery disease and renal artery stenosis of 50%-80%.
