Impact of renal sympathetic denervation on cardiac sympathetic nerve activity evaluated by cardiac MIBG imaging

Aims: The objective of the present study was to investigate an effect of renal artery sympathetic denervation (RASD) on patients with resistant hypertension and RASD effect on cardiac sympathetic nerve activity. It is known that an abnormally activated sympathetic tone is associated with progression of heart failure (BF). Methods and results: We investigated 16 patients with resistant arterial hypertension (mean age 54.88 +/- 7.89 years, mean 24-hr ambulatory blood pressure [BP] systolic 161.07 +/- 20.12 mmHg, diastolic 97.6 +/- 16.25 mmHg, using 6.44 +/- 0.96 antihypertensive drugs), who underwent bilateral RASD. Echocardiography, 24-hr ambulatory BP and I-123-metaiodobenzylguanidine (I-123-MIBG) scintigraphy were performed before and six months after RASD. There were no significant changes in 24-hr ambulatory systolic and diastolic BP before RASD and six months after it: systolic BP before RASD was 161.07 +/- 20.12 mmHg and 144.93 +/- 117.27 mmHg after (p=0.050); diastolic BP before RASD was 97.6 +/- 16.25 mmHg and 89.87 +/- 12.33 mmHg after (p=0.182). We observed a significant change in cardiac sympathetic nerve activity assessed by I-123-MIBG scintigraphy, as an increase of late heart-to-mediastinum (H/M) ratio, varying from 2.21 +/- 0.47 to 2.35 +/- 0.52 m/s (p=0.02). Conclusions: Selective RASD significantly reduces cardiac sympathetic overdrive assessed by I-123-MIBG scintigraphy. Presumably, this positively affects HF progression in patients with resistant arterial hypertension.