MRI POTENTIAL FOR PREDICTION OF THE ANTIHYPERTENSIVE EFFECT OF RFA IN PATIENTS WITH TREATMENT-RESISTANT HYPERTENSION

Abstract

Objective: 50% of the RFA procedures in patients with treatment-resistant hypertension (TRH) are ineffective or have ambiguous results. The most significant challenge is to find differential diagnostic predictors of the RFA efficacy in these patients. Our purpose was to assess the MRI potential for efficacy prediction and real-world prospective control of the brain as a target organ in patients with RH during a course of treatment. Design and method: We studied 176 patients with RH (124 men and 51 women, aged 55.65 ± 8.99 years). All of them underwent an MRI brain scan before RFA, six months and one year after the procedure. The patients were divided into 2 groups: patients who had the average daytime BP drop by > 10 mmHg (Group 1) and patients whose BP decreased by < 10 mmHg or increased (Group 2). Using brain MRI, the CSF system measurements, including the linear measurements of the cerebral lateral ventricles and the external subarachnoid spaces in 6 regions (in the right and left frontal, parietal, and occipital lobes), sizes of the third and fourth ventricles, dimensions of intracerebral cisterns (quadrigeminal, prepontine, and chiasmatic), the presence of periventricular leukoaraiosis and focal changes in the brain were evaluated. Results: The methodology was based on a logistic regression model. fx180 If the p-value is< 0.5, the prognosis for the patient is “no effect’’; if the p-value is > 0.5, the prognosis is “a positive effect’’. The operating characteristics of the test on the training set amounted to 80.6% sensitivity, 85.4% specificity, and 83.3% diagnostic accuracy. The most significant brain MRI measures in hypertensive patients have been identified, which affect the RFA efficacy: the transverse dimensions of the quadrigeminal and prepontine cisterns and the fourth ventricle, the third ventricle width, the presence of lacunar infarcts, the presence of lacunae in II region—the area of the basal ganglia (thalamus, internal capsule), as well as age, DBP, and SBP. Conclusions: Quantitative indices are suitable for dynamic prospective assessment of the RFA efficacy in patients with TRH. Changes in MRI tomographic indices have prognostic significance.