心不全を合併した腎血管性高血圧に対する経皮的腎動脈形成術の有効性

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  • ショウレイ ホウコク ダイ11カイ ワカテ ショウレイショウ ジュショウ ロンブン シンフゼン オ ガッペイ シタ ジンケッカンセイ コウケツアツ ニ タイスル ケイヒテキジンドウミャク ケイセイジュツ ノ ユウコウセイ
  • Efficacy of percutaneous transluminal renal angioplasty for renovascular hypertension complicated with heart failure
  • シンフゼン オ ガッペイ シタ ジンケッカンセイ コウケツアツ ニ タイスル ケイヒテキ ジンドウミャク ケイセイジュツ ノ ユウコウセイ

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【Background】 Percutaneous transluminal renal angioplasty （PTRA） is recommended for patients with heart failure due to renovascular hypertension ; however, the clinical characteristics of the patients and the effects of PTRA on heart failure and cardiorenal function have not been elucidated. 【Methods】 We retrospectively analyzed data for 4 PTRA-treated patients （male/female, 1/3 ; mean age, 70.0±10 years ; mean left ventricular ejection fraction, 51.5±15.2％） with heart failure due to renovascular hypertension and evaluated the effects of PTRA on heart failure and cardiorenal function 6 months after treatment. 【Results】 All patients had pro-arteriosclerotic diseases including diabetes mellitus, essential thrombocythemia, heparin cofactor II deficency, metabolic syndrome, and familial hypercholesterolemia, and 3 patients had ischemic heart disease. No abdominal bruit was heard and mean plasma renin activity was 4.5±3.6 ng/ml/hr, which was not elevated, contrary to expectation. All contralateral kidneys of PTRA were nonfunctioning, suggesting bilateral kidneys were disturbed in all patients. In all patients, PTRA was successfully performed and resolved heart failure. PTRA resulted in decreases in systolic blood pressure from 157±18 to 124±8.6 mmHg, mean serum creatinine from 3.2±2.6 to 2.7±2.2 mg/dl, and mean BNP from 919±998 to 243±291 pg/ml at 6 months after treatment. PTRA did not change left ventricular ejection fraction, a parameter of systolic fraction evaluated by an echocardiogram ; however, PTRA improved E/e’, a parameter of left ventricular diastolic fraction, from 16.1±5.2 to 9.7±3.7. None of the patients were hospitalized due to heart failure during the 6-month period after PTRA. 【Conclusions】 Patients with heart failure with cardiovascular risk factors should be screened for renovascular hypertension regardless of abdominal bruit or plasma renin activity. PTRA is effective for resolving heart failure and for improving renal and cardiac diastolic functions in patients with renovascular hypertension complicated with heart failure.

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