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Myocardial salvage is increased after sympathetic renal denervation in a pig model of acute infarction

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Abstract

Rationale

Despite advances in treatment of acute myocardial infarction (AMI), many patients suffer significant myocardial damage with cardiac dysfunction. Sympathetic renal denervation (RD) may reduce adrenergic activation following AMI.

Objective

To investigate the potential role of RD limiting myocardial damage and remodeling when performed immediately after AMI.

Methods and results

Sixteen farm pigs underwent 90 min left anterior descending artery balloon occlusion. Eight pigs underwent RD immediately after reperfusion. LV function, extent of myocardium at risk, and myocardial necrosis were quantified by cardiac magnetic resonance 5 and 30 days after AMI. 123I-MIBG scintigraphy was performed 31 days after AMI to image myocardial sympathetic innervation. Heart norepinephrine was quantified (from necrotic, border and remote zone). RD and control did not differ in myocardium at risk extent (59 ± 9 vs 55 ± 11% of LV mass) at 5 days. At 30 days CMR, RD pigs had smaller necrotic areas than control as assessed by gadolinium delay enhancement (18 ± 7 vs 30 ± 12% of LV mass, p = 0.021) resulting in improved myocardial salvage index (60 ± 11 vs 44 ± 27%, p < 0.001). RD pigs had higher cardiac output (3.7 ± 0.8 vs 2.66 ± 0.7 L/min, p < 0.001) and lower LV end diastolic volume (98 ± 16 vs 113 ± 31 ml, p = 0.041). 123I-MIBG defect extension was smaller in RD than control (60 ± 28 vs 78 ± 17%, p < 0.05) with significant reduction in the difference between innervation and perfusion defects (25 ± 12 vs 36 ± 30%, p = 0.013). NE content from necrotic area (238; IQR 464 vs 2546; IQR 1727 ng/g in RD and control, respectively, p < 0.001) and from border zone (295; IQR 264 vs 837; IQR 207 in RD and control, respectively, p = 0.031) was significantly lower in RD than control.

Conclusions

RD results in increased myocardial salvage and better cardiac function, when performed immediately after AMI. Reduction of sympathetic activation with preservation of cardiac sympathetic functionality warranted by RD may sustain these effects.

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Abbreviations

AMI:

Acute myocardial infarction

CMR:

Cardiac magnetic resonance

LAD:

Left anterior descending

LV:

Left ventricle

DE:

Delayed enhancement

NE:

Norepineprhine

RAAS:

Renin–angiotensin–aldosterone system

RD:

Renal denervation

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Funding

This work was supported by research funding from Life Science Institute–Scuola Superiore Sant’Anna Pisa.

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Authors and Affiliations

  1. Fondazione G. Monasterio CNR-Regione Toscana, Massa, Pisa, Italy

    Luigi Emilio Pastormerlo, Silvia Burchielli, Marco Ciardetti, Giovanni Donato Aquaro, Chrysantos Grigoratos, Assuero Giorgetti, Paolo Marzullo, Eleonora Benelli, Silvia Masotti, Veronica Musetti, Sergio Berti, Claudio Passino & Michele Emdin

  2. Life Sciences Institute, Scuola Superiore Sant’Anna, Pisa, Italy

    Luigi Emilio Pastormerlo, Chrysantos Grigoratos, Vincenzo Castiglione, Fabio Bernini, Claudio Passino & Michele Emdin

  3. Institute of Clinical Pathology, University of Pisa, Pisa, Italy

    Angela Pucci & Maria Franzini

  4. Division of Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi 1, 56124, Pisa, Italy

    Luigi Emilio Pastormerlo

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  1. Luigi Emilio Pastormerlo
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Correspondence to Luigi Emilio Pastormerlo.

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Pastormerlo, L.E., Burchielli, S., Ciardetti, M. et al. Myocardial salvage is increased after sympathetic renal denervation in a pig model of acute infarction. Clin Res Cardiol 110, 711–724 (2021). https://doi.org/10.1007/s00392-020-01685-y

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