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

Abstract

Whether renal revascularization reduces left ventricular hypertrophy in patients with coronary artery disease is uncertain. 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. Incident patients with ischemic heart disease undergoing cardiac catheterization with renal artery stenosis >50%-≤80%. Revascularization plus standard medical therapy versus medical therapy alone. Primary end point was change in echocardiographic left ventricular mass index (LVMI). Clinical and echocardiographic studies were performed at baseline and after 1 year. 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]). Patients with very severe renal artery stenosis were excluded from the study. 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%.