Marat Fudim1, Manesh R Patel2, Richard Boortz-Marx3, Barry A Borlaug4, Adam D DeVore2, Arun Ganesh3, Cynthia L Green5, Renato D Lopes6, Robert J Mentz2, Chetan B Patel7, Joseph G Rogers2, G Michael Felker2, Adrian F Hernandez2, Kenji Sunagawa8, Daniel Burkhoff9. 1. Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA. Electronic address: marat.fudim@duke.edu. 2. Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA. 3. Division of Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA. 4. Mayo Clinic, Rochester, Minnesota, USA. 5. Duke Clinical Research Institute, Durham, North Carolina, USA; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA. 6. Duke Clinical Research Institute, Durham, North Carolina, USA. 7. Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA. 8. Center for Disruptive Cardiovascular Medicine, Kyushu University, Fukuoka, Japan. 9. Cardiovascular Research Foundation, New York, New York, USA.
Abstract
OBJECTIVES: The authors estimated changes of stressed blood volume (SBV) induced by splanchnic nerve block (SNB) in patients with either decompensated or ambulatory heart failure with reduced ejection fraction (HFrEF). BACKGROUND: The splanchnic vascular capacity is a major determinant of the SBV, which in turn determines cardiac filling pressures and may be modifiable through SNB. METHODS: We analyzed data from 2 prospective, single-arm clinical studies in decompensated HFrEF (splanchnic HF-1; resting hemodynamics) and ambulatory heart failure (splanchnic HF-2; exercise hemodynamics). Patients underwent invasive hemodynamics and short-term SNB with local anesthetics. SBV was simulated using heart rate, cardiac output, central venous pressure, pulmonary capillary wedge pressure, systolic and diastolic systemic arterial and pulmonary artery pressures, and left ventricular ejection fraction. SBV is presented as ml/70 kg body weight. RESULTS: Mean left ventricular ejection fraction was 21 ± 11%. In patients with decompensated HFrEF (n = 11), the mean estimated SBV was 3,073 ± 251 ml/70 kg. At 30 min post-SNB, the estimated SBV decreased by 10% to 2,754 ± 386 ml/70 kg (p = 0.003). In ambulatory HFrEF (n = 14) patients, the mean estimated SBV was 2,664 ± 488 ml/70 kg and increased to 3,243 ± 444 ml/70 kg (p < 0.001) at peak exercise. The resting estimated SBV was lower in ambulatory patients with HFrEF than in decompensated HFrEF (p = 0.019). In ambulatory patients with HFrEF, post-SNB, the resting estimated SBV decreased by 532 ± 264 ml/70 kg (p < 0.001). Post-SNB, with exercise, there was no decrease of estimated SBV out of proportion to baseline effects (p = 0.661). CONCLUSIONS: The estimated SBV is higher in decompensated than in ambulatory heart failure. SNB reduced the estimated SBV in decompensated and ambulatory heart failure. The reduction in estimated SBV was maintained throughout exercise. (Splanchnic Nerve Anesthesia in Heart Failure, NCT02669407; Abdominal Nerve Blockade in Chronic Heart Failure, NCT03453151).
OBJECTIVES: The authors estimated changes of stressed blood volume (SBV) induced by splanchnic nerve block (SNB) in patients with either decompensated or ambulatory heart failure with reduced ejection fraction (HFrEF). BACKGROUND: The splanchnic vascular capacity is a major determinant of the SBV, which in turn determines cardiac filling pressures and may be modifiable through SNB. METHODS: We analyzed data from 2 prospective, single-arm clinical studies in decompensated HFrEF (splanchnic HF-1; resting hemodynamics) and ambulatory heart failure (splanchnic HF-2; exercise hemodynamics). Patients underwent invasive hemodynamics and short-term SNB with local anesthetics. SBV was simulated using heart rate, cardiac output, central venous pressure, pulmonary capillary wedge pressure, systolic and diastolic systemic arterial and pulmonary artery pressures, and left ventricular ejection fraction. SBV is presented as ml/70 kg body weight. RESULTS: Mean left ventricular ejection fraction was 21 ± 11%. In patients with decompensated HFrEF (n = 11), the mean estimated SBV was 3,073 ± 251 ml/70 kg. At 30 min post-SNB, the estimated SBV decreased by 10% to 2,754 ± 386 ml/70 kg (p = 0.003). In ambulatory HFrEF (n = 14) patients, the mean estimated SBV was 2,664 ± 488 ml/70 kg and increased to 3,243 ± 444 ml/70 kg (p < 0.001) at peak exercise. The resting estimated SBV was lower in ambulatory patients with HFrEF than in decompensated HFrEF (p = 0.019). In ambulatory patients with HFrEF, post-SNB, the resting estimated SBV decreased by 532 ± 264 ml/70 kg (p < 0.001). Post-SNB, with exercise, there was no decrease of estimated SBV out of proportion to baseline effects (p = 0.661). CONCLUSIONS: The estimated SBV is higher in decompensated than in ambulatory heart failure. SNB reduced the estimated SBV in decompensated and ambulatory heart failure. The reduction in estimated SBV was maintained throughout exercise. (Splanchnic Nerve Anesthesia in Heart Failure, NCT02669407; Abdominal Nerve Blockade in Chronic Heart Failure, NCT03453151).
Authors: Marat Fudim; David M Kaye; Barry A Borlaug; Sanjiv J Shah; Stuart Rich; Navin K Kapur; Maria Rosa Costanzo; Michael I Brener; Kenji Sunagawa; Daniel Burkhoff Journal: J Am Coll Cardiol Date: 2022-05-10 Impact factor: 27.203
Authors: Marat Fudim; Piotr P Ponikowski; Daniel Burkhoff; Mark E Dunlap; Paul A Sobotka; Jeroen Molinger; Manesh R Patel; G Michael Felker; Adrian F Hernandez; Sheldon E Litwin; Barry A Borlaug; Anisha Bapna; Horst Sievert; Vivek Y Reddy; Zoar J Engelman; Sanjiv J Shah Journal: Eur J Heart Fail Date: 2021-05-09 Impact factor: 17.349
Authors: Piotr Gajewski; Marat Fudim; Veraprapas Kittipibul; Zoar J Engelman; Jan Biegus; Robert Zymliński; Piotr Ponikowski Journal: J Clin Med Date: 2022-02-18 Impact factor: 4.241
Authors: Olivier C Dams; Marlene A T Vijver; Charlotte L van Veldhuisen; Robert C Verdonk; Marc G Besselink; Dirk J van Veldhuisen Journal: J Clin Med Date: 2022-07-15 Impact factor: 4.964