Effects of short- and long‑term efficacy of percutaneous transluminal renal angioplasty with or without intravascular brachytherapy on regression of left ventricular hypertrophy
in patients with renovascular hypertension

Andrzej Lekston, Tomasz Niklewski, Mariusz Gąsior, Jerzy Chudek, Krzysztof Wilczek, Andrzej Więcek, Franciszek Kokot, Marek Fijałkowski, Marek Gierlotka, Marcin Osuch, Bogusław Maciejewski, Lech Poloński

Abstrakt
Introduction The largest group of patients with secondary hypertension comprises individuals with renovascular hypertension resulting from renal artery stenosis that is a potentially removable condition. It is caused by atherosclerosis in 70–80% of patients. Objectives The aim of the study was to evaluate the influence of intravascular brachytherapy (IVBT) procedure performed after percutaneous transluminal renal angioplasty (PTRA) on left ventricular (LV) function, mass regression and type of hypertrophy (LVH) determined on echocardiography during long‑term follow‑up. Patients and methods Sixty‑two patients with atherosclerotic renal artery stenosis complicated by severe hypertension were treated with PTRA and randomly assigned to group 1 (PTRA alone) or group 2 (PTRA followed by IVBT). Subsequent IVBT was performed with the PARIS® catheter and the Microselectron HDR (Nucletron™) system for peripheral arteries. Treatment outcomes during follow‑up were assessed with quantitative coronary angiography. LV mass and mass index (LVM and LVMI) and functional parameters prior to PTRA and during follow‑up were determined by echocardiography with regard to the type of procedure. Results The degree of renal artery stenosis was significantly different in groups 1 and 2. In both groups elevated LVMI was observed (p = 0.94). There were no significant differences in interventricular septum (IVS) to LV posterior wall (LVPW) ratio, relative LV wall thickness, volumetric parameters and LV ejection fraction between both groups. During follow‑up the values of LVMI and IVS to LVPW ratio were significantly lower (p = 0.021 and p = 0.004, respectively) in the PTRA + IVBT group compared to the PTRA group. Analysis of the LV geometry and type of hypertrophy revealed a marked reduction in concentric LVH in the IVBT group during long-term follow‑up. Conclusions Echocardiographic evaluation comparing several LV parameters in the PTRA alone and PTRA + IVBT groups showed that PTRA with subsequent brachytherapy were associated with better control of blood pressure and greater LVM regression, especially concentric hypertrophy, during long‑term follow‑up.

Słowa kluczowe
brachytherapy, hypertension, left ventricular hypertrophy

Pol Arch Med Wewn, 2009; 119 (4): 211-218

PMID: 19413179

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