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Quantification of diffuse myocardial fibrosis in patients with resistant hypertension undergoing renal denervation versus hypertensive controls - preliminary results


Renal Denervation (RDN) is a novel therapy for patients with resistant hypertension. Its cardiac effects at follow-up are currently unknown. On the other hand, T1 mapping permits the assessment of myocardial extracellular volume (ECV), a parameter proposed to quantify diffuse myocardial fibrosis and independently associated with mortality and hard cardiovascular events. Our aim was to study the effects of RDN on ECV at 6-month follow-up.


14 patients with resistant hypertension undergoing RD (RD group) and 4 resistant hypertensive patients not undergoing RD (control group) were prospectively included. A 1.5T cardiac MR including T1 mapping pre- and post-contrast was performed before the RD procedure and at 6-month follow-up in both groups. Blood hematocrit was determined at both time points. Images were post-processed using commercial software (Qmass, Medis Medical Solutions, the Netherlands), and whole left ventricle (LV) ECV and septal ECV at baseline and at 6-month follow-up were quantified as follows: ECV = (1-hematocrit) * λ, where λ = (1/T1 myocardium post-contrast - 1/T1 myocardium pre-contrast)/(1/T1 blood post-contrast - 1/T1 blood pre-contrast).


No significant differences in whole LV ECV or septal ECV were observed between baseline and 6-month follow-up in the RD group. In contrast, control patients presented an increase in whole LV ECV and septal ECV at 6-month follow-up which did not reach statistical significance (p = 0.14 and p = 0.11, respectively). When the results were expressed as a % of change versus baseline, the % change of ECV septal was significantly different between the RDN and control groups (-5.4 ± 14.4 (-3.8) vs 22.9 ± 4.2 (21.5), respectively, p = 0.02; results expressed as mean ± SD (median)) (Figure 1).

Figure 1
figure 1

Percent ECV-change baseline versus 6-months follow-up in patients with resistant hypertenstion undergoing renal denervation and hypertensive controls.


Extracellular space could increase at follow-up in non-RDN patients, potentially reflecting a progressive increase in myocardial fibrosis content. This effect is not observed in RDN patients, suggesting a beneficial effect of RDN in delaying this fibrotic progression. Our results are preliminary and need to be confirmed in a larger population.



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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Doltra, A., Hassel, JH., Messroghli, D. et al. Quantification of diffuse myocardial fibrosis in patients with resistant hypertension undergoing renal denervation versus hypertensive controls - preliminary results. J Cardiovasc Magn Reson 16 (Suppl 1), O65 (2014).

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