https://doi.org/10.1007/s00392-025-02625-4
1Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland; 2Herzzentrum Leipzig - Universität Leipzig Klinik für Kinderkardiologie Leipzig, Deutschland
Background:
Patients with aortic coarctation (CoA) are at an increased risk of developing arterial hypertension and heart failure with preserved ejection fraction (HFpEF) over time. This study aimed to investigate whether renal devervation (RDN) reduces the long-term risk of HFpEF in CoA patients with resistant hypertension compared to a matched control group.
Methods:
Eight patients with repaired CoA and resistant hypertension underwent RDN (mean age: 28 ± 6 years). A propensity score-control group of eight patients (mean age: 26 ± 5 years) was retrospectively identified. Clinical and echocardiographic data were collected at baseline and long-term follow-up to evaluate clinical parameters, blood pressure, diastolic function, and HFpEF-related scores.
Results:
At a mean follow-up of 9 ± 1 years in the RDN group and 8 ± 3 years in the control group, differences in blood pressure, diastolic function and HFpEF risk markers were observed. Diastolic blood pressure demonstrated a significant reduction in the RDN group compared to the control group from baseline to follow up (-14 ± 9 mmHg vs. +8 ± 9 mmHg, p = 0.001). Although follow-up systolic blood pressure was lower in the RDN group compared to the control group (132 ± 6 mmHg vs. 140 ± 14 mmHg), this difference was not statistically significant (p = 0.151).
A significant improvement in NYHA functional class was observed in the RDN group, with a greater reduction in NYHA class from baseline to follow-up compared to the control group ( -1 [-1–0] vs. 0 [0–0], p = 0.027).
Markers of diastolic dysfunction displayed favourable trends. At baseline, the E/E’ ratio was slightly higher in the RDN group (9.8 ± 2.9 vs. 8.9 ± 4.7, p = 0.683), but at follow-up, it was lower in the RDN group compared to the control group (8.1 ± 2.6 vs. 10.5 ± 5.4, p = 0.506). Similarily, the H2FPEF score was higher in the control group at follow up (2.6 ± 1.1 vs. 1.9 ± 1.6, p = 0.282).
Conclusion:
Renal denervation in CoA patients with resistant hypertension demonstrates trends toward improved blood pressure control, reductions in diastolic dysfunction markers, and a lower HFpEF risk profil at long-term follow up. These findings suggest a potential protective role of RDN against HFpEF in CoA patients, emphasizing the need for further investigation in larger cohorts.