Does renal artery stenting impacts left ventricle mass and function, blood pressure values, renal function and cytokine concentration?

Abstract

The benefit of renal angioplasty (PTA) in patients with atherosclerotic renal artery stenosis (RAS) is controversial. The study aimed to search for associations between echocardiographic left ventricle mass (LVM), LVM index (LVMI) and diastolic function (DF), cytokines level, systolic and diastolic blood pressure (SBP, DBP) values, as well as renal function. Methods: A 24-hour ambulatory blood pressure monitoring, echocardiographic LVM, LVMI and DF (Tissue Doppler septal e' wave velocity), levels of serum creatinine (CR), Neutrophil Gelatinase-Associated Lipocalin (NGAL), transforming growth factor beta 1 (TGF-β1) and BNP were assessed in 104 (49 men) subjects, age 64±10,6y, prior to PTA of RAS >60%, then 12 months afterwards. Results: PTA was technically successful in all patients. A significant reduction in mean SBP (135.8±19.3 vs 130.2±15; p=0.006) and DBP (76.1±11.1 vs. 73.8±9; p=0.032) was observed at 12 months. The mean LVM decreased from 182±48g before PTA to 152.9±39g at 12-months (p<0.001). The LVMI in women and in men decreased from 94.6±18.6g/m2 to 79.5±15g/m2 (p<0.001) and from 104.3±22.2 to 86.2±20 g/m2 after 12-months (p<0.001). Improvement in DF was seen on 12-month F-U: a septal e' velocity increased from 5.57±1.58 to 5.94±1.8cm/s (p=0.031). The mean levels of TGF-β1, BNP, NGAL and CR before PTA vs. at 12 months after PTA changed respectively from 19.1±32ng/mL to 15.4±15ng/mL (p=0.340), 50.4±72pg/mL to 68.1±84 pg/mL (p=0.005), from 51.0±27ng/mL to 57.6±30ng/mL (p=0.053) and 122.0±54 to 115.0±60 (p=0.109) respectively. There was no correlation between the degree of LVM regression and the mean SBP, DBP reduction, change of: CR, NGAL, TGF-β1 and BNP on 12 month F-U (p=0.747, p=0.615, p=0.921, p=0.599 and p=0.116), respectively. There was correlation between the increase in e' velocity and DBP load change and change TGF-β1 12 month after PTA (r= -0.248, p=0.014 and r= -0.248, p=0.027). There was correlation between the change of CR and change with: SBP, DBP and TGF-β1 (r= 0.193, p=0.057; r=0.240, p=0.017 and r=0.342, p=0.002) respectively. Conclusions: PTA induces regression of LVM, LVMI and decrease of SBP and DBP. There was no correlation between the degree of LVM regression and the mean SBP and DBP reduction. The main parameter of DF was improved after PTA. CR, TGF-β1 levels decreased no significantly. Renal function improvement is associated with reduction in blood pressure and decrease in marker of nefron's fibrosis - TGF-β1.