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01-10-2018 | Original Paper

Cardiac magnetic resonance assessment of central and peripheral vascular function in patients undergoing renal sympathetic denervation as predictor for blood pressure response

Authors: Karl Fengler, Karl-Philipp Rommel, Stephan Blazek, Maximilian Von Roeder, Christian Besler, Christian Lücke, Matthias Gutberlet, Jennifer Steeden, Michael Quail, Steffen Desch, Holger Thiele, Vivek Muthurangu, Philipp Lurz

Published in: Clinical Research in Cardiology | Issue 10/2018

Abstract

Background

Most trials regarding catheter-based renal sympathetic denervation (RDN) describe a proportion of patients without blood pressure response. Recently, we were able to show arterial stiffness, measured by invasive pulse wave velocity (IPWV), seems to be an excellent predictor for blood pressure response. However, given the invasiveness, IPWV is less suitable as a selection criterion for patients undergoing RDN. Consequently, we aimed to investigate the value of cardiac magnetic resonance (CMR) based measures of arterial stiffness in predicting the outcome of RDN compared to IPWV as reference.

Methods

Patients underwent CMR prior to RDN to assess ascending aortic distensibility (AAD), total arterial compliance (TAC), and systemic vascular resistance (SVR). In a second step, central aortic blood pressure was estimated from ascending aortic area change and flow sequences and used to re-calculate total arterial compliance (cTAC). Additionally, IPWV was acquired.

Results

Thirty-two patients (24 responders and 8 non-responders) were available for analysis. AAD, TAC and cTAC were higher in responders, IPWV was higher in non-responders. SVR was not different between the groups. Patients with AAD, cTAC or TAC above median and IPWV below median had significantly better BP response. Receiver operating characteristic (ROC) curves predicting blood pressure response for IPWV, AAD, cTAC and TAC revealed areas under the curve of 0.849, 0.828, 0.776 and 0.753 (p = 0.004, 0.006, 0.021 and 0.035).

Conclusions

Beyond IPWV, AAD, cTAC and TAC appear as useful outcome predictors for RDN in patients with hypertension. CMR-derived markers of arterial stiffness might serve as non-invasive selection criteria for RDN.

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Title: Cardiac magnetic resonance assessment of central and peripheral vascular function in patients undergoing renal sympathetic denervation as predictor for blood pressure response
Authors: Karl Fengler
Karl-Philipp Rommel
Stephan Blazek
Maximilian Von Roeder
Christian Besler
Christian Lücke
Matthias Gutberlet
Jennifer Steeden
Michael Quail
Steffen Desch
Holger Thiele
Vivek Muthurangu
Philipp Lurz
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: Clinical Research in Cardiology / Issue 10/2018
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-018-1267-6

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