1Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland; 2Universitätsmedizin der Johannes Gutenberg-Universität Mainz Kardiologie 1, Zentrum für Kardiologie Mainz, Deutschland
Background: Early reflection of the aortic pulse wave is an important contributor to the pathogenesis of heart failure with preserved ejection fraction (HFpEF), and therapeutic options are scarce. Renal denervation (RDN) has shown beneficial effects in HFpEF on echocardiographic parameters and vascular stiffness in smaller studies. As RDN affects systemic sympathetic activity and blood pressure, beneficial effects on early wave reflection seem also plausible. We aimed to assess the effects of RDN on pulse wave properties in a predefined substudy of a previously published study.
Methods: Patients with therapy resistant arterial hypertension underwent measurement of carotid-femoral pulse-wave-velocity (PWV) and wave analysis before and 3 months after RDN. Patients with and without HFpEF were compared regarding clinical and aortic wave characteristics including PWV, augmentation pressure (AP) and index (Aix), retrograde wave reflection time (Tretro) and pressure (Pretro).
Results: Of the 53 patients available for analysis (mean age 64±9 years, 30% female), 25 were classified as having HFpEF and 28 as non-HFpEF patients. Clinical baseline characteristics were overall balanced between the patients, but patients with HFpEF had a higher Nt-proBNP (467±353 vs. 107±120, p<0.001) and coronary artery disease as well as atrial fibrillation were more frequent in HFpEF. While PWV did not differ significantly between the groups, AP tended to be higher in patients with HFpEF (17±16 vs. 10±12 mmHg, p=0.07). Three months after RDN, PWV, Tretro and Pretro remained unchanged for the overall cohort, while Aix and AP were significantly reduced (13±14 to 10±9 mmHg and 19±17 to 14±17 %, p=0.03 for both). When comparing patients with HFpEF and patients without HFpEF, Aix, AP, were significantly reduced and Tretro was increased in patients with HFpEF (p<0.05 for all) but remained unchanged in patients without HFpEF.
Conclusions: In patients with HFpEF, RDN shows beneficial effects on early wave reflection. This might translate into improved exercise capacity and reduction of heart failure symptoms but warrants confirmation in larger studies.