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Sympathetic Response and Outcomes Following Renal Denervation in Patients With Chronic Heart Failure: 12-Month Outcomes From the Symplicity HF Feasibility Study

Artikel i vetenskaplig tidskrift
Författare I. Hopper
E. Gronda
U. C. Hoppe
Bengt Rundqvist
T. H. Marwick
S. Shetty
C. Hayward
T. Lambert
D. Hering
M. Esler
M. Schlaich
A. Walton
F. Airoldi
M. C. Brandt
S. A. Cohen
P. Reiters
H. Krum
Publicerad i Journal of Cardiac Failure
Volym 23
Nummer/häfte 9
Sidor 702-707
ISSN 1071-9164
Publiceringsår 2017
Publicerad vid Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 702-707
Språk en
Länkar doi.org/10.1016/j.cardfail.2017.06....
Ämnesord Sympathetic nervous system, chronic kidney disease, renal impairment, left-ventricular hypertrophy, randomized controlled-trial, resistant, hypertension, systolic function, catheter, safety, pilot, Cardiovascular System & Cardiology
Ämneskategorier Kardiologi

Sammanfattning

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.

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