Effect of Renal Artery Stenting on Left Ventricular Mass: A Randomized Clinical Trial

Background: Whether renal revascularization reduces left ventricular hypertrophy in patients with coronary artery disease is uncertain. Study Design: Randomized clinical trial testing the effect of renal artery stenting versus medical therapy on left ventricular hypertrophy progression in patients affected by ischemic heart disease and renal artery stenosis. Setting & Participants: Incident patients with ischemic heart disease undergoing cardiac catheterization with renal artery stenosis >50%-<= 80%. Intervention: Revascularization plus standard medical therapy versus medical therapy alone. Outcomes: Primary end point was change in echocardiographic left ventricular mass index (LVMI). Measurements: Clinical and echocardiographic studies were performed at baseline and after 1 year. Results: 84 patients were randomly assigned: 43 to revascularization plus standard medical therapy and 41 to medical therapy alone. At baseline, clinical characteristics were similar in the 2 study groups. After 1 year, there was no statistically significant difference between longitudinal change in the medical therapy group versus that in the medical therapy plus revascularization group for LVMI (2.1; 95% CI, -6.1 to 10.3 g/m(2)), blood pressure (systolic, -0.2 [95% CI, -9.1 to 8.8 mm Hg]; diastolic, -3.3 [95% CI, -8.4 to 1.8 mm Hg]), or estimated glomerular filtration rate (1.5; 95% CI, -5.8 to 8.9 mL/min/1.73 m(2)). The number of major cardiovascular events was similar in the 2 groups (revascularization plus standard medical therapy [fatal, n = 2; nonfatal, n = 11] and medical therapy alone [fatal, n = 2; nonfatal, n = 11]). Limitations: Patients with very severe renal artery stenosis were excluded from the study. Conclusions: Our study was unable to detect a clinically significant benefit of renal revascularization on LVMI in patients with coronary artery disease and renal artery stenosis of 50%-80%. Am J Kidney Dis. 60(1): 39-46. (C) 2012 by the National Kidney Foundation, Inc.