Ingrid Hopper1, Edoardo Gronda2, Uta C Hoppe3, Bengt Rundqvist4, Thomas H Marwick5, Sharad Shetty6, Christopher Hayward7, Thomas Lambert8, Dagmara Hering9, Murray Esler5, Markus Schlaich9, Antony Walton10, Flavio Airoldi11, Mathias C Brandt3, Sidney A Cohen12, Pascalle Reiters13, Henry Krum14. 1. Monash Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia. 2. Cardiovascular Department, IRCCS Multimedica, Milan, Italy. Electronic address: edoardo.gronda@multimedica.it. 3. Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria. 4. Department of Cardiology, Sahlgrenska Universitetssjukhuset, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. 5. Baker IDI Heart and Diabetes Institute, Melbourne, Australia. 6. Department of Cardiology, Royal Perth Hospital, Perth, Australia. 7. Cardiology Department, Saint Vincent's Hospital, Sydney, Australia. 8. Department of Cardiology, Kepler University Hospital, Linz, Austria. 9. Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Dobney Hypertension Centre, University of Western Australia-Royal Perth Hospital Unit, Perth, Australia. 10. The Alfred Hospital, Melbourne, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Australia. 11. Cardiovascular Department, IRCCS Multimedica, Milan, Italy. 12. Clinical Department, Medtronic, Santa Rosa, California; Department of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 13. Medtronic Bakken Research Center, Maastricht, The Netherlands. 14. Monash Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Abstract
BACKGROUND: Heart failure (HF) is associated with chronic sympathetic activation. Renal denervation (RDN) aims to reduce sympathetic activity by ablating the renal sympathetic nerves. We investigated the effect of RDN in patients with chronic HF and concurrent renal dysfunction in a prospective, multicenter, single-arm feasibility study. METHODS AND RESULTS: Thirty-nine patients with chronic systolic HF (left ventricular ejection fraction [LVEF] <40%, New York Heart Association class II-III,) and renal impairment (estimated glomerular filtration rate [eGFR; assessed with the use of the Modification of Diet in Renal Disease equation] < 75 mL • min-1 • 1.73 m-2) on stable medical therapy were enrolled. Mean age was 65 ± 11 years; 62% had ischemic HF. The average number of ablations per patient was 13 ± 3. No protocol-defined safety events were associated with the procedure. One subject experienced a renal artery occlusion that was possibly related to the denervation procedure. Statistically significant reductions in N-terminal pro-B-type natriuretic peptide (NT-proBNP; 1530 ± 1228 vs 1428 ± 1844 ng/mL; P = .006) and 120-minute glucose tolerance test (11.2 ± 5.1 vs 9.9 ± 3.6; P = .026) were seen at 12 months, but there was no significant change in LVEF (28 ± 9% vs 29 ± 11%; P= .536), 6-minute walk test (384 ± 96 vs 391 ± 97 m; P= .584), or eGFR (52.6 ± 15.3 vs 52.3 ± 18.5 mL • min-1 • 1.73 m-2; P= .700). CONCLUSIONS: RDN was associated with reductions in NT-proBNP and 120-minute glucose tolerance test in HF patients 12 months after RDN treatment. There was no deterioration in other indices of cardiac and renal function in this small feasibility study.
BACKGROUND:Heart failure (HF) is associated with chronic sympathetic activation. Renal denervation (RDN) aims to reduce sympathetic activity by ablating the renal sympathetic nerves. We investigated the effect of RDN in patients with chronic HF and concurrent renal dysfunction in a prospective, multicenter, single-arm feasibility study. METHODS AND RESULTS: Thirty-nine patients with chronic systolic HF (left ventricular ejection fraction [LVEF] <40%, New York Heart Association class II-III,) and renal impairment (estimated glomerular filtration rate [eGFR; assessed with the use of the Modification of Diet in Renal Disease equation] < 75 mL • min-1 • 1.73 m-2) on stable medical therapy were enrolled. Mean age was 65 ± 11 years; 62% had ischemic HF. The average number of ablations per patient was 13 ± 3. No protocol-defined safety events were associated with the procedure. One subject experienced a renal artery occlusion that was possibly related to the denervation procedure. Statistically significant reductions in N-terminal pro-B-type natriuretic peptide (NT-proBNP; 1530 ± 1228 vs 1428 ± 1844 ng/mL; P = .006) and 120-minute glucose tolerance test (11.2 ± 5.1 vs 9.9 ± 3.6; P = .026) were seen at 12 months, but there was no significant change in LVEF (28 ± 9% vs 29 ± 11%; P= .536), 6-minute walk test (384 ± 96 vs 391 ± 97 m; P= .584), or eGFR (52.6 ± 15.3 vs 52.3 ± 18.5 mL • min-1 • 1.73 m-2; P= .700). CONCLUSIONS: RDN was associated with reductions in NT-proBNP and 120-minute glucose tolerance test in HF patients 12 months after RDN treatment. There was no deterioration in other indices of cardiac and renal function in this small feasibility study.
Authors: Dominik Linz; Mathias Hohl; Adrian D Elliott; Dennis H Lau; Felix Mahfoud; Murray D Esler; Prashanthan Sanders; Michael Böhm Journal: Clin Auton Res Date: 2018-02-10 Impact factor: 4.435
Authors: Tomasz Drożdż; Marek Jastrzębski; Paweł Moskal; Aleksander Kusiak; Agnieszka Bednarek; Katarzyna Styczkiewicz; Piotr Jankowski; Danuta Czarnecka Journal: Postepy Kardiol Interwencyjnej Date: 2019-06-26 Impact factor: 1.426