The Potential Role of Renal Denervation in the Management of Heart Failure
Abstract
:1. Introduction
2. Sympathetic Activation in Heart Failure
3. Renal Denervation
3.1. Renal Denervation in Heart Failure with Reduced Ejection Fraction
3.2. Renal denervation in Heart Failure with Preserved Ejection Fraction
3.3. Renal Denervation and Cardiac Dysrhythmias in Heart Failure
3.4. Future Directives and Challenges
4. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Study | N, Population | Clinical Findings |
---|---|---|
Gao et al. (2019) [36] | 60, Single-center RCT, EF < 40% | 30 patients in RDN group. At 6 months, compared to control group, RDN was associated with significant increase in LVEF, decrease in NT-ProBNP, BP, and NYHA class. No significant changes in glomerular filtration between two groups. |
Drożdż et al. (2019) [37] | 20, Single-center RCT, EF < 35% | There were no significant differences in LVEF, BP, 6MWT and NT-proBNP concentration at 6 and 12 months after RD or control. |
Chen et al. (2017) [35] | 60, Single-center RCT, EF < 40% | 30 patients RDN group. At 6 months, compared to control group, RDN was associated with significant improvement in symptoms, BP, quality of life, LVEF, NT-ProBNP, and NYHA class. No significant changes in glomerular filtration nor complication of renal artery stenosis were observed. |
Gao et al. (2017) [38] | 14, Single-arm, EF < 45% | There was a significant decrease in symptoms and improvement in 6-min walk test with increase in LVEF at 6 months follow up. No RDN-related complications were observed during the follow-up period. Additionally, there was significant improvement in BP and GFR remained stable. |
Hopper et al. (2017) [39] | 39, Multi-center, Single-arm, EF < 40% | RDN was associated with reductions in NT-proBNP and 120-min glucose tolerance test in HF patients 12 months after RDN treatment. No significant change in LVEF, 6 min walk test of GFR. |
Dai et al. (2015) [40] | 20, Single-center, Single-arm, EF < 40% | No obvious change in heart rate or blood pressure was recorded. Symptoms of heart failure were improved in patients after RDN. No complications were recorded in the study. |
Davis et al. (2013) [34] | 7, Single-center, Single-arm, EF < 40% | Over 6 months there was a non-significant trend in blood pressure reduction. No hypotensive or syncopal episodes were reported. Renal function remained stable. There was a significant improvement in symptoms and a 6-min walk test. |
Xia et al. (2022) [26] | 220, meta-analysis of the above studies | Bilateral RDN increased the LVEF, decreased the LVESD, and decreased the LVEDD. In addition, RDN significantly decreased systolic and diastolic BP and decreased HR. RDN did not significantly change GFR or serum creatinine levels. The mean 6-min walk test was increased and NT-pro BNP was decreased. |
Study | N, Population | Clinical Findings |
---|---|---|
Brandt et al. (2012) [46] | 64, Single-center non-randomized study, EF > 55% | 46 patients and 18 controls. RDN significantly reduced BP, and LV mass and improved diastolic function at 1 and 6 months. |
Mahfoud et al. (2014) [47] | 16, Multi-center non-randomized study, EF > 55% | Significant improvement in global longitudinal strain at 6 months. Reduction in left ventricular mass index suggesting an improved diastolic function. |
Kresoja et al. (2021) [27] | 66, Single center, single-arm, EF > 55% | Patients with HFpEF undergoing RDN showed reduced BP, and increased stroke volume index. LV diastolic stiffness and LV filling pressures as well as NT-proBNP decreased. |
Study | N, Population | Clinical Outcomes |
---|---|---|
UNLOAD-HFpEF | 68, randomized, sham-controlled double-blind design, EF > 55% | Assess the hemodynamic effects of RDN in patients with HFpEF. Effect of RDN on a combination of death, increase in diuretic therapy, hospitalization for heart failure, worsening NYHA-class, change in pulmonary pressure parameters. |
RE-ADAPT-HF | 144, Prospective, randomized, double-blind, sham-controlled, multicenter. EF < 45% | 6-min walk test, Change in NT-pro-BNP, e-GFR, KCCQ at 6 months. |
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Kassab, K.; Soni, R.; Kassier, A.; Fischell, T.A. The Potential Role of Renal Denervation in the Management of Heart Failure. J. Clin. Med. 2022, 11, 4147. https://doi.org/10.3390/jcm11144147
Kassab K, Soni R, Kassier A, Fischell TA. The Potential Role of Renal Denervation in the Management of Heart Failure. Journal of Clinical Medicine. 2022; 11(14):4147. https://doi.org/10.3390/jcm11144147
Chicago/Turabian StyleKassab, Kameel, Ronak Soni, Adnan Kassier, and Tim A. Fischell. 2022. "The Potential Role of Renal Denervation in the Management of Heart Failure" Journal of Clinical Medicine 11, no. 14: 4147. https://doi.org/10.3390/jcm11144147