Autonomic regulation therapy in chronic heart failure with preserved/mildly reduced ejection fraction: ANTHEM-HFpEF study results

Kumar, H. Uday; Nearing, Bruce D.; Mittal, Sanjay; Premchand, Rajendra Kumar; Libbus, Imad; DiCarlo, Lorenzo A.; Amurthur, Badri; KenKnight, Bruce H.; Anand, Inder; Verrier, Richard L.

doi:10.1016/j.ijcard.2023.03.030

Cited by 20 publications

(5 citation statements)

References 32 publications

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“…The malfunctioning CANS is heavily remodeled in cardiac diseases such as myocardial ischemia, myocardial infarction, heart failure, and arrhythmias (Francis and Cohn, 1986 ; Tjeerdsma et al, 2001 ; Campelo and Abreu-Lima, 2004 ; Piepoli and Capucci, 2007 ; Hoyer et al, 2008 ; Kardesoglu et al, 2011 ; Phillips, 2012 ; van Bilsen et al, 2017 ; Ali et al, 2018 ; Hadaya and Ardell, 2020 ; Elia and Fossati, 2023 ; Kumar et al, 2023 ). The CPNS is capable of modulating the entire state of the CANS through both direct and indirect afferent pathway modulation that is transmitted to multiple levels of the CANS.…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary nerve stimulation as a novel therapy for cardiac autonomic nervous system modulation

Salavatian,

Spinelli,

Schaefer

et al. 2024

Front. Neurosci.

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Section: Discussionmentioning

confidence: 99%

Cardiopulmonary nerve stimulation as a novel therapy for cardiac autonomic nervous system modulation

Salavatian,

Spinelli,

Schaefer

et al. 2024

Front. Neurosci.

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“…The malfunctioning CANS is heavily remodeled in cardiac diseases such as myocardial ischemia, myocardial infarction, heart failure, and arrhythmias (Francis and Cohn, 1986;Tjeerdsma et al, 2001;Campelo and Abreu-Lima, 2004;Piepoli and Capucci, 2007;Hoyer et al, 2008;Kardesoglu et al, 2011;Phillips, 2012;van Bilsen et al, 2017;Ali et al, 2018;Hadaya and Ardell, 2020;Elia and Fossati, 2023;Kumar et al, 2023). The CPNS is capable of modulating the entire state of the CANS through both direct and indirect afferent pathway modulation that is transmitted to multiple levels of the CANS.…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary nerve stimulation as a novel therapy for cardiac autonomic nervous system modulation

Salavatian,

Spinelli,

Schaefer

et al. 2024

Preprint

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Acute decompensated heart failure (ADHF) carries a significant burden of mortality and morbidity, 30 with few effective treatments available. Cardiopulmonary nerve stimulation (CPNS), which involves targeted electrical stimulation of specific nerves that innervate the heart, is an innovative emerging therapeutic ADHF management strategy. In a recent study, Emani et al. used the CPNS using a low-level stimulation which enhanced cardiac inotropy, decreased energy consumption, and improved patients’ symptoms, function, and quality of life. The mechanism of action of CPNS that drove these promising results was not described by Emani et al. This commentary aims to explore the mechanisms of CPNS, focusing on its neuromodulatory effects on the cardiac autonomic nervous system (CANS) and its potential to revolutionize ADHF therapy.

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“…The recently published ANTHEM‐HFpEF (Autonomic Regulation Therapy to Enhance Myocardial Function in Heart Failure With Preserved Ejection Fraction) trial first investigated the safety and feasibility of chronic VNS in 52 patients with HFpEF/HFmrEF. At the 1‐year follow‐up, VNS showed good tolerance and was associated with significant improvements in NYHA class, 6MWD, QOL, autonomic tone, and cardiac electrical stability, although it did not alter cardiac mechanical function 80 . Low‐level tragus stimulation (LLTS) is a non‐invasive method of percutaneous VNS that has been demonstrated to reduce cardiac inflammation and fibrosis and improve LV diastolic function in a rat model of HFpEF 81,82 .…”

Section: Vagus Nerve Stimulationmentioning

confidence: 99%

“…At the 1‐year follow‐up, VNS showed good tolerance and was associated with significant improvements in NYHA class, 6MWD, QOL, autonomic tone, and cardiac electrical stability, although it did not alter cardiac mechanical function. 80 Low‐level tragus stimulation (LLTS) is a non‐invasive method of percutaneous VNS that has been demonstrated to reduce cardiac inflammation and fibrosis and improve LV diastolic function in a rat model of HFpEF. 81 , 82 Tran et al showed for the first time that LLTS can acutely improve the global longitudinal strain of LV in HFpEF patients by regulating autonomic tone.…”

Section: Vagus Nerve Stimulationmentioning

confidence: 99%

Advances in device‐based treatment of heart failure with preserved ejection fraction: evidence from clinical trials

Wu,

Song,

et al. 2023

ESC Heart Failure

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Heart failure with preserved ejection fraction (HFpEF) is a group of clinical syndromes that exhibit a remarkably heterogeneous phenotype, characterized by symptoms and signs of heart failure, left ventricular diastolic dysfunction, elevated levels of natriuretic peptides, and an ejection fraction greater than or equal to 50%. With the aging of the population and the escalating prevalence of hypertension, obesity, and diabetes, the incidence of HFpEF is progressively rising. Drug therapy options for HFpEF are currently limited, and the associated high risk of cardiovascular mortality and heart failure rehospitalization significantly impact patients' quality of life and longevity while imposing a substantial economic burden on society. Recent research indicates that certain device‐based therapies may serve as valuable adjuncts to drug therapy in patients with specific phenotypes of HFpEF, effectively improving symptoms and quality of life while reducing the risk of readmission for heart failure. These include inter‐atrial shunt and greater splanchnic nerve ablation to reduce left ventricular filling pressure, implantable heart failure monitor to guide diuresis, left atrial pacing to correct interatrial dyssynchrony, cardiac contractility modulation to enhance cardiac calcium handling, as well as renal denervation, baroreflex activation therapy, and vagus nerve stimulation to restore the autonomic imbalance. In this review, we provide a comprehensive overview of the mechanisms and clinical evidence pertaining to these devices, with the aim of enhancing therapeutic strategies for HFpEF.

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Autonomic regulation therapy in chronic heart failure with preserved/mildly reduced ejection fraction: ANTHEM-HFpEF study results

Cited by 20 publications

References 32 publications

Cardiopulmonary nerve stimulation as a novel therapy for cardiac autonomic nervous system modulation

Cardiopulmonary nerve stimulation as a novel therapy for cardiac autonomic nervous system modulation

Cardiopulmonary nerve stimulation as a novel therapy for cardiac autonomic nervous system modulation

Advances in device‐based treatment of heart failure with preserved ejection fraction: evidence from clinical trials

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