Impaired cardiac baroreflex sensitivity predicts response to renal sympathetic denervation in patients with resistant hypertension
Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved..
OBJECTIVES: This study sought to evaluate cardiac baroreflex sensitivity (BRS) as a predictor of response to renal sympathetic denervation (RDN).
BACKGROUND: Catheter-based RDN is a novel treatment option for patients with resistant arterial hypertension. It is assumed that RDN reduces efferent renal and central sympathetic activity.
METHODS: Fifty patients (age 60.3 ± 13.8 years [mean ± SD mean systolic blood pressure (BP) on ambulatory blood pressure monitoring (ABPM) 157 ± 22 mm Hg, despite medication with 5.4 ± 1.4 antihypertensive drugs) underwent RDN. Prior to RDN, a 30-min recording of continuous arterial BP (Finapres; TNO-TPD Biomedical Instrumentation, Amsterdam, the Netherlands) and high-resolution electrocardiography (1.6 kHz in orthogonal XYZ leads) was performed in all patients under standardized conditions. Cardiac BRS was assessed by phase-rectified signal averaging (BRSPRSA) according to previously published technologies. Response to RDN was defined as a reduction of mean systolic BP on ABPM by 10 mm Hg or more at 6 months after RDN.
RESULTS: Six months after RDN, mean systolic BP on ABPM was significantly reduced from 157 ± 22 mm Hg to 149 ± 20 mm Hg (p = 0.003). Twenty-six of the 50 patients (52%) were classified as responders. BRSPRSA was significantly lower in responders than nonresponders (0.16 ± 0.75 ms/mm Hg vs. 1.54 ± 1.73 ms/mm Hg; p < 0.001). Receiver-operator characteristics analysis revealed an area under the curve for prediction of response to RDN by BRSPRSA of 81.2% (95% confidence interval: 70.0% to 90.1%; p < 0.001). On multivariable logistic regression analysis, reduced BRSPRSA was the strongest predictor of response to RDN, which was independent of all other variables tested.
CONCLUSIONS: Impaired cardiac BRS identifies patients with resistant hypertension who respond to RDN.
| Errataetall: |
CommentIn: J Am Coll Cardiol. 2013 Dec 3;62(22):2131-3. - PMID 23973687 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2013 |
|---|---|
| Erschienen: |
2013 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:62 |
|---|---|
| Enthalten in: |
Journal of the American College of Cardiology - 62(2013), 22 vom: 03. Dez., Seite 2124-30 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Zuern, Christine S [VerfasserIn] |
|---|
| Links: |
|---|
| Anmerkungen: |
Date Completed 17.02.2014 Date Revised 19.08.2014 published: Print-Electronic CommentIn: J Am Coll Cardiol. 2013 Dec 3;62(22):2131-3. - PMID 23973687 Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.jacc.2013.07.046 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM230295614 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM230295614 | ||
| 003 | DE-627 | ||
| 005 | 20231224084058.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231224s2013 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.jacc.2013.07.046 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0767.xml |
| 035 | |a (DE-627)NLM230295614 | ||
| 035 | |a (NLM)23973686 | ||
| 035 | |a (PII)S0735-1097(13)03077-5 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Zuern, Christine S |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Impaired cardiac baroreflex sensitivity predicts response to renal sympathetic denervation in patients with resistant hypertension |
| 264 | 1 | |c 2013 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 17.02.2014 | ||
| 500 | |a Date Revised 19.08.2014 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: J Am Coll Cardiol. 2013 Dec 3;62(22):2131-3. - PMID 23973687 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVES: This study sought to evaluate cardiac baroreflex sensitivity (BRS) as a predictor of response to renal sympathetic denervation (RDN) | ||
| 520 | |a BACKGROUND: Catheter-based RDN is a novel treatment option for patients with resistant arterial hypertension. It is assumed that RDN reduces efferent renal and central sympathetic activity | ||
| 520 | |a METHODS: Fifty patients (age 60.3 ± 13.8 years [mean ± SD mean systolic blood pressure (BP) on ambulatory blood pressure monitoring (ABPM) 157 ± 22 mm Hg, despite medication with 5.4 ± 1.4 antihypertensive drugs) underwent RDN. Prior to RDN, a 30-min recording of continuous arterial BP (Finapres; TNO-TPD Biomedical Instrumentation, Amsterdam, the Netherlands) and high-resolution electrocardiography (1.6 kHz in orthogonal XYZ leads) was performed in all patients under standardized conditions. Cardiac BRS was assessed by phase-rectified signal averaging (BRSPRSA) according to previously published technologies. Response to RDN was defined as a reduction of mean systolic BP on ABPM by 10 mm Hg or more at 6 months after RDN | ||
| 520 | |a RESULTS: Six months after RDN, mean systolic BP on ABPM was significantly reduced from 157 ± 22 mm Hg to 149 ± 20 mm Hg (p = 0.003). Twenty-six of the 50 patients (52%) were classified as responders. BRSPRSA was significantly lower in responders than nonresponders (0.16 ± 0.75 ms/mm Hg vs. 1.54 ± 1.73 ms/mm Hg; p < 0.001). Receiver-operator characteristics analysis revealed an area under the curve for prediction of response to RDN by BRSPRSA of 81.2% (95% confidence interval: 70.0% to 90.1%; p < 0.001). On multivariable logistic regression analysis, reduced BRSPRSA was the strongest predictor of response to RDN, which was independent of all other variables tested | ||
| 520 | |a CONCLUSIONS: Impaired cardiac BRS identifies patients with resistant hypertension who respond to RDN | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ABPM | |
| 650 | 4 | |a AIC | |
| 650 | 4 | |a AUC | |
| 650 | 4 | |a Akaike information criterion | |
| 650 | 4 | |a BMI | |
| 650 | 4 | |a BP | |
| 650 | 4 | |a BRS | |
| 650 | 4 | |a BRS(PRSA) | |
| 650 | 4 | |a BRS(SEQ) | |
| 650 | 4 | |a CI | |
| 650 | 4 | |a IDI | |
| 650 | 4 | |a MSNA | |
| 650 | 4 | |a PRSA | |
| 650 | 4 | |a RDN | |
| 650 | 4 | |a ROC | |
| 650 | 4 | |a ambulatory blood pressure monitoring | |
| 650 | 4 | |a area under the curve | |
| 650 | 4 | |a arterial hypertension | |
| 650 | 4 | |a baroreflex sensitivity | |
| 650 | 4 | |a blood pressure | |
| 650 | 4 | |a body mass index | |
| 650 | 4 | |a cardiac baroreflex sensitivity assessed by phase-rectified signal averaging | |
| 650 | 4 | |a cardiac baroreflex sensitivity assessed by the sequence method | |
| 650 | 4 | |a confidence interval | |
| 650 | 4 | |a integrated discrimination improvement | |
| 650 | 4 | |a muscle sympathetic nerve activity | |
| 650 | 4 | |a phase-rectified signal averaging | |
| 650 | 4 | |a receiver-operator characteristic | |
| 650 | 4 | |a renal sympathetic denervation | |
| 650 | 4 | |a sympathetic nervous system | |
| 700 | 1 | |a Eick, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Rizas, Konstantinos D |e verfasserin |4 aut | |
| 700 | 1 | |a Bauer, Sarah |e verfasserin |4 aut | |
| 700 | 1 | |a Langer, Harald |e verfasserin |4 aut | |
| 700 | 1 | |a Gawaz, Meinrad |e verfasserin |4 aut | |
| 700 | 1 | |a Bauer, Axel |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of the American College of Cardiology |d 1987 |g 62(2013), 22 vom: 03. Dez., Seite 2124-30 |w (DE-627)NLM012608602 |x 1558-3597 |7 nnns |
| 773 | 1 | 8 | |g volume:62 |g year:2013 |g number:22 |g day:03 |g month:12 |g pages:2124-30 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.jacc.2013.07.046 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 62 |j 2013 |e 22 |b 03 |c 12 |h 2124-30 | ||