arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2014-20-6-559-567arthyper-162Research ArticleОРИГИНАЛЬНАЯ СТАТЬЯORIGINAL ARTICLEКАРДИОПРОТЕКТИВНЫЕ ВОЗМОЖНОСТИ ДЕНЕРВАЦИИ ПОЧЕК ПРИ ЛЕЧЕНИИ РЕЗИСТЕНТНОЙ ГИПЕРТОНИИ, ПОИСК ПРЕДИКТОРОВ ЭФФЕКТИВНОСТИCARDIOPROTECTIVE EFFECTS OF RENAL DENERVATION IN RESISTANT HYPERTENSION: EFFICIENCY PREDICTORSРиппТ. М.RippT. M.

Кандидат медицинских наук, старший научный сотрудник отделения артериальных гипертоний.

Контактная информация: Рипп Татьяна Михайловна, Федеральное государственное бюджетное учреждение «Научно-исследовательский институт кардиологии» Сибирского отделения Российской академии наук, ул. Киевская, д. 111 А, Томск, Россия, 634012. Тел.: +7(3822)55–81–22. E-mail: ripp@cardio-tomsk.ru, rripp@mail.ru

Corresponding author:Tatyana M. Ripp, MD, PhD, Senior Researcher, Research Institute for Сardiology, Department of Arterial Hypertension, 111A Kiyevskaya str., Tomsk, 634012, Russia. Tel.: +7(3822)55–81–22. E‑mail: ripp@cardio-tomsk.ru, rripp@mail.ru

ripp@cardio-tomsk.ruМордовинВ. Ф.MordovinV. F.

Доктор медицинских наук, профессор, руководитель отделения артериальных гипертоний

MD, PhD, Professor, Head, Department of Arterial Hypertension

ripp@cardio-tomsk.ruПекарскийС. Е.PekarskiyS. E.

Кандидат медицинских наук, старший научный сотрудник отделения артериальных гипертоний �АН

MD, PhD, Senior Researcher, Department of Arterial Hypertension

ripp@cardio-tomsk.ruРябоваТ. Р.RyabovaT. P.

Кандидат медицинских наук, старший научный сотрудник отделения функциональных методов исследования

MD, PhD, Senior Researcher, Department of Functional Diagnostics

ripp@cardio-tomsk.ruЗлобинаМ. В.ZlobinaM. Z.

Врач отделения функциональных методов исследования

MD, Department of Functional Diagnostics

ripp@cardio-tomsk.ruСемкеГ. В.SemkeG. V.

Доктор медицинских наук, ведущий научный сотрудник отделения артериальных гипертоний

MD, PhD, DSc, Senior Researcher, Department of Arterial Hypertension

ripp@cardio-tomsk.ruФальковскаяА. Ю.FalkovskayaA. Yu.

Кандидат медицинских наук, научный сотрудник отделения артериальных гипертоний

MD, PhD, Researcher, Department of Arterial Hypertension

ripp@cardio-tomsk.ruСитковаЕ. С.SitkovaE. A.

Научный сотрудник отделения артериальных гипертоний

MD, Researcher, Department of Arterial Hypertension

ripp@cardio-tomsk.ruЛичикакиВ. А.LichikakiV. A.

Аспирант отделения артериальных гипертоний

MD, PhD, Department of Arterial Hypertension

ripp@cardio-tomsk.ruКрыловА. Л.KrylovA. L.

Доктор медицинских наук, профессор, руководитель отделения рентгенохирургических методов диагностики и лечения

MD, PhD, DSc, Professor, Head, Department of X-Ray diagnostic and therapeutical methods

ripp@cardio-tomsk.ruНаучно-исследовательский институт кардиологии Сибирского отделения Российской академии наук, ТомскРоссияResearch Institute for Сardiology, TomskRussian Federation201406032015206559567Copyright © Рипп Т.М., Мордовин В.Ф., Пекарский С.Е., Рябова Т.Р., Злобина М.В., Семке Г.В., Фальковская А.Ю., Ситкова Е.С., Личикаки В.А., Крылов А.Л., 20152015Рипп Т.М., Мордовин В.Ф., Пекарский С.Е., Рябова Т.Р., Злобина М.В., Семке Г.В., Фальковская А.Ю., Ситкова Е.С., Личикаки В.А., Крылов А.Л.Ripp T.M., Mordovin V.F., Pekarskiy S.E., Ryabova T.P., Zlobina M.Z., Semke G.V., Falkovskaya A.Y., Sitkova E.A., Lichikaki V.A., Krylov A.L.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/162

Цель исследования — оценить влияние симпатической денервации почек (СДП) у пациентов с резистентной артериальной гипертензией (РАГ) на структурно-функциональные изменения (СФИ) сердца, определить предикторы эффективности процедуры.

Материалы и методы

Материалы и методы. В анализ включено 60 пациентов (54,6 ± 9,5 года) с РАГ, подписавших информированное согласие для проведения исследований и лечения, получавших максимально переносимые дозы антигипертензивной терапии (4,1 препарата), включающей диуретик. Исследования, включая эхокардиографию с оценкой СФИ сердца, проведены исходно и через 24 недели. СДП проводилась путем эндоваскулярной радиочастотной аблации (РЧА) почечных артерий (ПА). Терапия в процессе наблюдения не менялась.

Результаты

Результаты. После проведения СДП отмечалось значимое снижение офисного артериального давления (АД), регрессия массы миокарда (ММ) левого желудочка (ЛЖ) ≥10 гнаблюдалась у 36,7 %. Диастолическая функция ЛЖ исходно была нарушена у 58,6 %, после процедуры она нормализовалась у 31 %, изменилась степень диастолической дисфункции (ДФ) у 14 % пациентов. При соотносимых параметрах антропометрии, АД, частоты сердечных сокращений, терапии, конечного диастолического размера ЛЖ различия между группами и корреляции с динамикой ММ были определены для исходных размеров стенок ЛЖ.

Заключение

Заключение. Лечение с использованием СДП приводило к снижению ММ и положительным изменениям ДФ ЛЖ у части пациентов. Предикторами значимой регрессии ММ ЛЖ были исходные значения толщины стенок ЛЖ.

Objective

Objective. To assess the impact of renal sympathetic denervation (RSD) in patients with resistant hypertension (RH) on the structural and functional changes (SFC) of the heart, and to determine predictors of the effectiveness of the procedure

Design and methods

Design and methods. Sixty patients (54.6 ± 9.5 years) with RH were included in the analysis. They signed an informed consent for both research and RSD. All of them received full-dose antihypertensive therapy (AHT) (4.1 drugs), including at least one diuretic. BP and heart rate (HR) measurement and cardiac diastolic function (DF) assessment by echocardiography were performed at baseline and after 24 weeks in all subjects. RSD was completed by endovascular radiofrequency ablation of renal arteries. AHT remained unchanged.

Results

Results. There was a significant reduction of office BP, as well as a significant regression of myocardial mass in 36,7 % patients at 24 weeks after the procedure. DF was initially impaired in 58.6 %, and after the procedure it normalized in 31 %, and the diastolic dysfunction decreased in 14 % patients. Blood pressure, HR, ATH and left ventricular volume (LVV) were comparable in subgroups, and the dynamics of MM correlated only with the initial values of LV wall.

Conclusion

Conclusion. Significant positive changes of DF and the decrease of LV MM were registered 24 weeks after RSD. The initial values of LV wall thickness were the only predictor of MM regression.

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The authors declare that there are no conflicts of interest present.