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Renal denervation in patients with symptomatic chronic heart failure despite resynchronization therapy - a pilot study.

ABSTRACT: Introduction:Renal denervation (RD) has been shown to decrease sympathetic function in patients with hypertension. Its efficacy in symptomatic chronic heart failure (CHF) patients not responding to cardiac resynchronization therapy (CRT) has not been evaluated. Aim:To assess whether a less invasive treatment method - renal denervation - is safe in symptomatic heart failure patients despite optimal medical treatment and resynchronization therapy and whether it is associated with an improvement in clinical status, exercise capacity and hemodynamic parameters. Material and methods:The study was an open-label, randomized, controlled clinical trial. Patients were divided into an intervention (RD) and a control group. Clinical data collection, blood pressure (BP) measurements, echocardiography, 6-minute walk test (6MWT) and laboratory tests were performed before, 6 and 12 months after RD. The patients were followed-up to 24 months. Results:We included 20 patients aged 52.0 to 86.0 years (median age: 71.5 years), 15 males and 5 females with median left ventricular ejection fraction (LVEF) of 32.5%, body mass index 31.3 kg/m2. Renal denervation was safe, no significant adverse effects were registered. There were no significant differences in LVEF, BP, 6MWT and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration 6 and 12 months after RD or control. Conclusions:Our results indicate that RD in CHF patients not responding to CRT is safe and does not worsen exercise capacity and hemodynamic parameters.

SUBMITTER: Drozdz T

PROVIDER: S-EPMC6727225 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Renal denervation in patients with symptomatic chronic heart failure despite resynchronization therapy - a pilot study.

Drożdż Tomasz T Jastrzębski Marek M Moskal Paweł P Kusiak Aleksander A Bednarek Agnieszka A Styczkiewicz Katarzyna K Jankowski Piotr P Czarnecka Danuta D

Postepy w kardiologii interwencyjnej = Advances in interventional cardiology 20190626 2

<h4>Introduction</h4>Renal denervation (RD) has been shown to decrease sympathetic function in patients with hypertension. Its efficacy in symptomatic chronic heart failure (CHF) patients not responding to cardiac resynchronization therapy (CRT) has not been evaluated.<h4>Aim</h4>To assess whether a less invasive treatment method - renal denervation - is safe in symptomatic heart failure patients despite optimal medical treatment and resynchronization therapy and whether it is associated with an ...[more]

PMID: 31497058

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Project description:The aim of the present study was to determine if renal sympathetic denervation (RSD) may alleviate isoproterenol-induced left ventricle remodeling, and to identify the underlying mechanism. A total of 70 rats were randomly divided into control (n=15), sham operation (n=15), heart failure (HF) with sham operation (HF + sham; n=20) and HF with treatment (HF + RSD; n=20) groups. The HF model was established by subcutaneous injection of isoproterenol; six weeks later, 1eft ventricular internal diameter at end‑systole (LVIDs), left ventricular systolic posterior wall thickness (LVPWs), 1eft ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were measured. Plasma norepinephrine (NE), angiotensin II (Ang II) and aldosterone (ALD) levels were measured by ELISA. Myocardial collagen volume fraction (CVF) was determined by Masson's staining. Reverse transcription‑quantitative polymerase chain reaction was used to determine the mRNA expression levels of ventricular transforming growth factor‑β (TGF‑β), connective tissue growth factor (CTGF) and microRNAs (miRs), including miR‑29b, miR‑30c and miR‑133a. The results demonstrated that LVIDs and LVPWs in the HF + RSD group were significantly decreased compared with the HF + sham group. By contrast, LVFS and LVEF in the HF + RSD group were significantly increased compared with the HF + sham group. RSD significantly reduced the levels of plasma NE, Ang II and ALD. CVF in the HF + RSD group was reduced by 38.1% compared with the HF + sham group. Expression levels of TGF‑β and CTGF were decreased, whereas those of miR‑29b, miR‑30c and miR‑133a were increased, in the HF + RSD group compared with the HF + sham group. These results indicated that RSD alleviates isoproterenol‑induced left ventricle remodeling potentially via downregulation of TGF‑β/CTGF and upregulation of miR‑29b, miR‑30c and miR‑133a. RSD may therefore be an effective non‑drug therapy for the treatment of heart failure.

Dataset Information

Renal denervation in patients with symptomatic chronic heart failure despite resynchronization therapy - a pilot study.

Publications

Renal denervation in patients with symptomatic chronic heart failure despite resynchronization therapy - a pilot study.

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