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Aim. To study changes in pulmonary vein ostia strain after radiofrequency (RFA) and cryoballoon ablation (CBA) in patients with paroxysmal atrial fibrillation (AF) by intracardiac echocardiography.Methods. Patients with paroxysmal AF (n=41) aged 60.1±7.1 years and duration of the disease 7.7±4.8 years were included in the study. Pulmonary vein (PV) isolation was performed with RFA (n=23) and CBA (n=18). All patients underwent transthoracic and intraoperative intracardiac echocardiography. Longitudinal strain of PV ostia was assessed before and after isolation.Results. Groups were comparable in main clinical parameters. Regress of PV ostia strain after RFA and CBA was achieved in all of PV, which corresponded to complete PV isolation. Remarked trend toward a more pronounced regression of PV ostia longitudinal strain after CBA compared with RFA for left superior (10±0.7% and 6.1±0.8% respectively, pConclusion. PV isolation is accompanied by a significant change in their longitudinal strain using intracardiac echocardiography both after CBA and after RFA.

Background.The renin-angiotensin-aldosterone system (RAAS) plays a key role in target organ damage in arterial hypertension (HTN), initiating the development of left ventricular hypertrophy (LVH), as well as the heart and vascular wall fibrosis and remodeling. In addition, one of the mechanisms of the cardiovascular disease progression is the angiotensin II-induced inflammation.Objective.To study the changes in renin, aldosterone and high-sensitive C‑reactive protein (CRP) levels two years after sympathetic renal denervation (RDN), to compare these changes with antihypertensive efficacy of the intervention and LVH regression.Design and methods.We included 77 patients with drug-resistant hypertension in the absence of contraindications to renal denervation. All patients underwent renal radiofrequency ablation. The active renin, aldosterone and a high-sensitive CRP concentrations assessment, 24‑hour blood pressure (BP) measurement and echocardiography were performed before, at 6 months, one and two years after the intervention.Results.There was a gradual decrease in CRP levels (the difference was significant after 6 months), aldosterone (significant two years after surgical treatment), and active renin (the difference was the most pronounced after one year). At all follow-up assessments, plasma renin activity correlated with left ventricular mass. At the same time, there were no significant differences between responders and non-responders.Conclusions.RDN leads to a RAAS activity attenuation, manifested by the decrease in both renin and aldosterone and CRP, probably due to angiotensin II proinflammatory effects reduction. Given these effects are long-term, correlate with LVH degree and unrelated to the BP lowering, a direct cardioprotective effect of renal denervation should be considered.

Patients with resistant arterial hypertension have a high prevalence of cardiac pathology. In particular, left ventricular hypertrophy and reduced coronary reserve play independent role in determining the risk of cardiovascular complications. Diagnostic approaches to their detection are currently represented by a wide range of highly informative studies using modern ultrasound equipment, magnetic resonance imaging, computed tomography scanner, and gamma camera. The active study of the involvement of the cascade of pathophysiological mechanisms in the development of cardiac changes in hypertension allows not only to identify the factors associated with the severity of the lesion, but also to find new application points for the cardioprotection and to reduce cardiovascular risk. Along with the pharmacological capabilities, the renal denervation method is currently under active study. Despite high variability of the results and their poor predictability, a number of studies show the efficiency of this method in correcting the structural and functional changes in the heart, which is of important prognostic value for resistant hypertension.

Aim. To study the long-term effect of renal denervation (RDN) on left ventricular mass (LVM) and inflammatory markers in resistant hypertensive patients.Material and methods. Forty-one patients with resistant hypertension and 24-h blood pressure (BP) 158,7±15,8/87,3+14,6 mmHg, aged 56,6+10,2 years, were enrolled in the study and undergone RDN. Mean 24-h BP, left ventricular mass (transthoracic echocardiography), high sensitivity C-reactive protein (hsCRP), interleukin- 1β (IL­1β), IL-6, IL-10) and tumor necrosis factor alpha (TNF- α) were assessed at baseline and 2 years after the RDN.Results. A baseline prevalence of left ventricular hypertrophy (LVH) was 90,2%. Two years after RDN LVM and interventricular septum (IVS) decreased significantly (p0 g) was documented in 24 patients. The regression of LVM was accompanied by a significant decrease in levels of inflammatory markers — hsCRP by 38,3% (p=0,031), TNF-α by 60,7% (p=0,009), IL- 1β — by 71,1% (p=0,001), and IL-10 by 58,2% (p=0,001). In patients in the absence of LVM regression only TNF-α decreased significantly (-68,8%, p=0,001). There was no correlation between changes of LVM and the inflammatory markers at 24 months after RDN.Conclusion. The RDN in RH patients may have long-term cardioprotective effect in terms of significant regress of LVH, which may be partly attributed to the regress in systemic or myocardial inflammation.

Objective To assess whether electrode temperature and impedance change that are typically monitored during radiofrequency renal denervation (RDN) for safety reason may also be used as measures of the procedural success of the intervention. Methods We conducted a prospective clinical study of the radiofrequency RDN in patients meeting criteria of true resistant hypertension. The RDN treatment included the trunk and major branches of the renal artery. To obtain simple easy-to-use electrophysiology measures of the procedural success of RDN we averaged the maximal values of the temperature and change of impedance across all single treatments with a full duration. Then we assessed the relation of the average change in impedance and average maximal electrode temperature during RDN to blood pressure (BP) lowering 6 month post-procedure using a linear regression analysis. Also, we compared the groups with “successful” and “unsuccessful” procedures according to whether the impedance decreased, on average, ≥10% during RDN, and, alternatively, on whether the average maximal temperature of the electrode was ≥50 C. Results Of 65 treated patients 52 with quality recordings of the electrophysiology parameters during RDN completed 6-month follow-up. The mean 24-h systolic BP decreased significantly after RDN by −14.3 mmHg [95% CI: −8.7; −19.9]. The BP lowering was positively and significantly related to the decrease in impedance during RDN, r=0.35, p=0.013 and to less extent to the maximal electrode temperature, r=0.29, p=0.044. The 10% average drop in impedance predicted -9.9 mmHg decrease in 24-h mean systolic BP. According to group analysis the decrease of mean 24-h systolic BP was powerful in those with average decrease in impedance ≥10% during RDN (“successful” procedure), but almost zero otherwise: −19.9 [95% CI: −13.7; −24.5] vs −0.5 [95% CI: −11.9; 12.9] mmHg, respectively (raw estimates), p=0.003. The difference in BP lowering was less pronounced and non-significant when the procedural “success” was defined according to the average maximal electrode temperature. Conclusions The impedance decrease during radiofrequency RDN treatment may be an effective criterion of the procedural success of the intervention. Guiding radiofrequency RDN by the impedance drop 10% or greater may significantly improve the efficacy of the procedure. Funding Acknowledgement Type of funding source: None

Aim To compare the antihypertensive effectivity of renal denervation in patients with diabetes mellitus (DM) and associated refractory arterial hypertension (rfAH) (treated with 5 or more classes of antihypertensive drugs, including a thiazide diuretic and a mineralocorticoid receptor antagonist) and uncontrolled resistant AH (ucAH) (treated with 3-4 drugs).Material and methods This interventional study with renal denervation included 18 DM patients with rfAH and 40 DM patients with ucAH; 16 and 36 of them, respectively, completed the study in 6 months. At baseline, patients were sex- and age-matched. Study methods included measurement of office blood pressure (BP; systolic/diastolic BP, SBP/DBP); outpatient BP monitoring; evaluation of kidney function (estimated glomerular filtration rate by the CKD-EPI formula); diurnal diuresis volume; diurnal urinary excretion of albumin, potassium and sodium; diurnal excretion of metanephrines and normetanephrines; and plasma levels of glucose and glycated hemoglobin, aldosterone, and active renin. Patients were instructed about maintaining compliance with their antihypertensive and hypoglycemic therapy throughout the study.Results At baseline, patients of both groups were comparable by BP and major clinical indexes, except for higher values of nocturnal SBP variability (pConclusion DM patients with rfAH may be the best candidates for the procedure of renal denervation.

Background/Introduction Distal renal denervation (RD) of the segmental branches beyond the bifurcation of the main renal artery is considered more effective treatment than conventional RD of the trunk renal artery. Evidence accumulated over the last decade has shown that global longitudinal strain (GLS) from speckle-tracking analysis of 2-dimensional echocardiography may represent a sensitive parameter of the left ventricular (LV) dysfunction. Purpose We compared cardiac function, structure, and GLS parameters after distal and conventional RD in the double-blind randomized prospective study. Methods The study (NCT01499810) compromised 55 patients who met criteria for resistant hypertension and signed informed consent. Patients were randomized to either endovascular conventional RD of the main renal artery (group 1, n=27) or to distal treatment applied to the segmental branches after the bifurcation of the main renal artery (group 2, n=28). Parameters of GLS from speckle-tracking echocardiography, ejection fraction, thickness of the interventricular septum (IVS) and LV posterior wall (PW), as well as the parameters of the diastolic function of the heart were assessed at baseline and at 12-months follow-up. Reference echocardiographic values were adapted from the ASE/ESC guidelines. Baseline parameters of heart and drug intake did not significantly differ between patients at the time of randomization. Results Drug treatment consisted in combination therapy in the maximum tolerated doses. Patients used different types of drugs, but the number of drug classes did not significantly differ between groups (4.1 in group 1 vs. 4.2 in group 2). Reduction of systolic blood pressure was significantly greater after distal RD vs. conventional RD: −22.1 vs. −11.5 mm Hg, respectively (p Conclusion(s) Compared to conventional RD, distal RD treatment applied to the segmental branches beyond the bifurcation of the main renal artery significantly greater attenuated the LV wall thickness and the number of patients with diastolic dysfunction. At 12-month follow up, the global longitudinal LV function also improved in distal RD patients.

Background Diabetic patients with resistant hypertension (RHT) are characterized by accelerated annual decline in estimated glomerular filtration rate (eGFR) (from 10 to 14 mL/min/1,73m2). The distal renal denervation (RD) can preserve renal function within first year follow-up in these patients. However, whether this effect will persist at a later period is unknown, especially taking into account the potential risks of kidney damage due to deep introduction of the catheter and contrast into the segmental branches of the artery, as well as exposure to radiofrequency energy near to the kidney. In addition, RHT and diabetes mellitus (DM) contribute to impaired renal autoregulation which can lead to a decrease in GFR in response to a decrease in BP, but the long-term safety of a powerful BP reduction for renal function in these patients remains unexplored. The purpose of this study was to assess the renal safety and efficacy of a distal RD compared to conventional intervention in diabetic patients with RHT during 3 years of follow-up. Methods Twenty seven patients with true RHT and type 2 DM were included in single-arm prospective interventional study (number NCT02667912 on ClinicalTrial.gov) (mean age 61.6±7.3 years, mean office (systolic/diastolic) BP 171.8±21.9/87.7±17.7 mmHg, mean eGFR 72.1±19.9 mL/min/1.73m2, 7 patients with CKD (stage 3), 11 patients with albuminuria (>30 mg/day), 8 men), among them 13 – undergone distal RD and 14 – conventional RD. Offices BP, ABPM, renal Doppler ultrasound, renal function (eGFR (CKD-EPI) and 24-hour urinary albumin excretion (UAE)) were assessed at baseline and annually for 3 years follow up. There were no any difference in sex, old, eGFR, UAE, BP level, and frequency both of CKD and albuminuria between distal RD group and conventional RD group. The patients were asked to refrain from changing their medication regimen for the duration of the study. Nineteen patients completed 36 months follow-up (8 treated by distal RD and 11 – by conventional mode). Results The change in eGFR for distal RD during 3 years follow-up was not significant (−5.3±0.4 mL/min/1.73m2, P=0.63) and was comparable with that for conventional RD (−6.7±4.2, P=0.3), (P=0.7 for the between-group difference), despite of a more powerful decrease in 24h-systolic BP and 24h-puls BP in the distal RD group than in the conventional RD group (−25.3±15.3 vs. −4.4±22 mmHg, P=0.04, and −14.3±15.1 vs. 0.1±7.7 mmHg, respectively). The degree of annual decline in GFR for the distal RD was the same as for the conventional RD (p=0.9), and was −2.7±2.4 mL/min/1.73m2/year, and −2.7±4.0 mL/min/1.73m2/year, respectively. There were no significant changes in mean values of renal blood flow, albuminuria, and the numbers of patients with albuminuria and CKD in both groups after 3 years of follow-up. Conclusions Distal RD in diabetic patients with RHT has a good renal safety profile and can slow the progression of CKD within 3 years of follow-up.