TY - JOUR
T1 - Renal sympathetic nerve activity after catheter-based renal denervation
AU - Dobrowolski, Linn C.
AU - Eeftinck Schattenkerk, Daan W.
AU - Paul Krediet, C. T.
AU - van Brussel, Peter M.
AU - Vogt, Liffert
AU - Bemelman, Frederike J.
AU - Reekers, Jim A.
AU - van den Born, Bert-Jan H.
AU - Verberne, Hein J.
PY - 2018
Y1 - 2018
N2 - Background: Catheter-based renal sympathetic denervation (RDN) has been considered a potential treatment for therapy resistant hypertension (RHT). However, in a randomized placebo-controlled trial, RDN did not lead to a substantial blood pressure (BP) reduction. We hypothesized that variation in the reported RDN efficacy might be explained by incomplete nerve disruption as assessed by renal I-123-meta-iodobenzylguanidine (I-123-mIBG) scintigraphy. Methods: In 21 RHT patients (median age 60 years), we performed I-123-mIBG scintigraphy before and 6 weeks after RDN. Additionally, we assessed changes in BP (24 h day, night, and average), plasma- and urinary-catecholamines and plasma renin activity (PRA) before and after RDN. Planar scintigraphy was performed at 15 min and 4 h after I-123-mIBG administration. The ratio of the mean renal (specific) counts vs. muscle (non-specific) counts represented I-123-mIBG uptake. Renal I-123-mIBG washout was calculated between 15 min and 4 h. Results: After RDN office-based systolic BP decreased from 172 to 153 mmHg (p = 0.036), while diastolic office BP (p = 0.531), mean 24 h systolic and diastolic BP (p = 0.602, p = 0.369, respectively), PRA (p = 0.409) and plasma catecholamines (p = 0.324) did not significantly change post-RDN. Following RDN, I-123-mIBG renal uptake at 15 min was 3.47 (IQR 2.26-5.53) compared to 3.08 (IQR 2.79-4.95) before RDN (p = 0.289). Renal I-123-mIBG washout did not change post-RDN (p = 0.230). In addition, there was no significant correlation between the number of denervations and the renal I-123-mIBG parameters. Conclusions: No changes were observed in renal I-123-mIBG uptake or washout at 6 weeks post-RDN. These observations support incomplete renal denervation as a possible explanation for the lack of RDN efficacy
AB - Background: Catheter-based renal sympathetic denervation (RDN) has been considered a potential treatment for therapy resistant hypertension (RHT). However, in a randomized placebo-controlled trial, RDN did not lead to a substantial blood pressure (BP) reduction. We hypothesized that variation in the reported RDN efficacy might be explained by incomplete nerve disruption as assessed by renal I-123-meta-iodobenzylguanidine (I-123-mIBG) scintigraphy. Methods: In 21 RHT patients (median age 60 years), we performed I-123-mIBG scintigraphy before and 6 weeks after RDN. Additionally, we assessed changes in BP (24 h day, night, and average), plasma- and urinary-catecholamines and plasma renin activity (PRA) before and after RDN. Planar scintigraphy was performed at 15 min and 4 h after I-123-mIBG administration. The ratio of the mean renal (specific) counts vs. muscle (non-specific) counts represented I-123-mIBG uptake. Renal I-123-mIBG washout was calculated between 15 min and 4 h. Results: After RDN office-based systolic BP decreased from 172 to 153 mmHg (p = 0.036), while diastolic office BP (p = 0.531), mean 24 h systolic and diastolic BP (p = 0.602, p = 0.369, respectively), PRA (p = 0.409) and plasma catecholamines (p = 0.324) did not significantly change post-RDN. Following RDN, I-123-mIBG renal uptake at 15 min was 3.47 (IQR 2.26-5.53) compared to 3.08 (IQR 2.79-4.95) before RDN (p = 0.289). Renal I-123-mIBG washout did not change post-RDN (p = 0.230). In addition, there was no significant correlation between the number of denervations and the renal I-123-mIBG parameters. Conclusions: No changes were observed in renal I-123-mIBG uptake or washout at 6 weeks post-RDN. These observations support incomplete renal denervation as a possible explanation for the lack of RDN efficacy
U2 - https://doi.org/10.1186/s13550-018-0360-1
DO - https://doi.org/10.1186/s13550-018-0360-1
M3 - Article
C2 - 29374335
SN - 2191-219X
VL - 8
SP - 8
JO - EJNMMI Research
JF - EJNMMI Research
IS - 1
ER -