Author + information
- Received October 22, 2014
- Revision received January 21, 2015
- Accepted February 12, 2015
- Published online June 1, 2015.
- Stephan H. Schirmer, MD, PhD∗ (, )
- Marwa M.Y.A. Sayed, MD,
- Jan-Christian Reil, MD,
- Daniel Lavall, MD,
- Christian Ukena, MD,
- Dominik Linz, MD PhD,
- Felix Mahfoud, MD and
- Michael Böhm, MD
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
- ↵∗Reprint requests and correspondence:
Dr. Stephan H. Schirmer, Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Kirrberger Straße, Gebäude 40, 66421 Homburg/Saar, Germany.
Objectives This study sought to investigate left atrial (LA) remodeling in relation to blood pressure (BP) and heart rate (HR) after renal sympathetic denervation (RDN).
Background In addition to reducing BP and HR in certain patients with hypertension, RDN can decrease left ventricular (LV) mass and ameliorate LV diastolic dysfunction.
Methods Before and 6 months after RDN, BP, HR, LV mass, left atrial volume index (LAVI), diastolic function (echocardiography), and premature atrial contractions (PAC) (Holter electrocardiogram) were assessed in 66 patients with resistant hypertension.
Results RDN reduced office BP by 21.6 ± 3.0/10.1 ± 2.0 mm Hg (p < 0.001), and HR by 8.0 ± 1.3 beats/min (p < 0.001). At baseline, LA size correlated with LV mass, diastolic function, and pro-brain natriuretic peptide, but not with BP or HR. Six months after RDN, LAVI was reduced by 4.0 ± 0.7 ml/kg/m2 (p < 0.001). LA size decrease was stronger when LAVI at baseline was higher. In contrast, the decrease in LAVI was not dependent on LV mass or diastolic function (E/E′ or E/A) at baseline. Furthermore, LAVI decreased without relation to decrease in systolic BP or HR. Additionally, occurrence of PAC (median of >153 PAC/24 h) was reduced (to 68 PAC/24 h) by RDN, independently of changes in LA size.
Conclusions In patients with resistant hypertension, LA volume and occurrence of PAC decreased 6 months after RDN. This decrease was independent of BP and HR at baseline or the reduction in BP and HR reached by renal denervation. These data suggest that there is a direct, partly BP-independent effect of RDN on cardiac remodeling and occurrence of premature atrial contractions.
Dr. Schirmer and Dr. Böhm are supported by the Deutsche Forschungsgemeinschaft (KFO 196). Dr. Sayed is supported by the Deutsche Akademische Austauschdienst. Dr. Ukena has received speakers honoraria from Medtronic and St. Jude. Drs. Linz and Mahfoud are supported by the Hochdruckliga and the Deutsche Gesellschaft für Kardiologie. Dr. Mahfoud has received scientific support and/or speaker honoraria from Medtronic, St. Jude, and Boston Scientific. Dr. Böhm has served on advisory boards and speakers bureaus for AstraZeneca, Bayer AG, Boehringer Ingelheim, Daiichi-Sankyo, Merck Sharp & Dohme, Novartis, Pfizer, Sanofi-Aventis, and Servier; and has served on speakers bureaus for ArzneimittelWerk Dresden, Berlin-Chemie, Medtronic. Dr. Reil and Dr. Lavall have reported that they have no relationships relevant to the contents of this paper to disclose. None of the supporting companies had any role in the design or conduct of the study or in preparation, review, or approval of the manuscript.
- Received October 22, 2014.
- Revision received January 21, 2015.
- Accepted February 12, 2015.
- American College of Cardiology Foundation