Effects of renal denervation on vascular remodelling in patients with heart failure and preserved ejection fraction: A randomised control trial

Abstract

ObjectiveTo assess the effect of renal denervation (RDT) on micro- and macro-vascular function in patients with heart failure with preserved ejection fraction (HFpEF).DesignA prospective, randomised, open-controlled trial with blinded end-point analysis.SettingA single-centre London teaching hospital.ParticipantsTwenty-five patients with HFpEF who were recruited into the RDT-PEF trial.Main outcome measuresMacro-vascular: 24-h ambulatory pulse pressure, aorta distensibilty (from cardiac magnetic resonance imaging (CMR), aorta pulse wave velocity (CMR), augmentation index (peripheral tonometry) and renal artery blood flow indices (renal MR). Micro-vascular: endothelial function (peripheral tonometry) and urine microalbuminuria.ResultsAt baseline, 15 patients were normotensive, 9 were hypertensive and 1 was hypotensive. RDT did not lower any of the blood pressure indices. Though there was evidence of abnormal vascular function at rest, RDT did not affect these at 3 or 12 months follow-up.ConclusionsRDT did not improve markers of macro- and micro-vascular function.

Endothelial, Vascular and Sympathetic Alterations as Therapeutic Targets in Chronic Heart Failure

“…The procedure, which, in resistant hypertensive patients, is capable of reducing blood pressure, thus inhibiting the sympathetic overactivity typical of the disease [ 57 ], is still under investigation in CHF. At present, no data on sympathetic responses to the procedure in CHF are available, while some evidence suggests the lack of any favourable vascular or endothelial effect in the same pathological state [ 58 ].…”

Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction

“…Examples are whole-body vibration therapy to potentially improve overall fitness in patients with exercise intolerance ( 75 ) and renal nerve denervation ( 76 ) or splanchnic nerve resection ( 77 ) to reduce sympathetic stimulation. Resection of the splanchnic nerve was hypothesized to reduce venous return and thus central vascular congestion in HFpEF; however, a study in 25 patients showed no significant changes in either microvascular or macrovascular function using this approach ( 78 ). Finally, the CardioMEMS HF System (Abbott) is a device that allows remote monitoring of changes in pulmonary artery pressure, allowing for personalized patient management.…”

Reconsidering Renal Sympathetic Denervation for Heart Failure

“…Similar findings were described recently in 2 Chinese cohorts of patients with chronic systolic HF receiving RSD using different RSD catheter systems, one of them in a randomized comparison with a control group 14 , 15 . However, the follow-up Symplicity-HF study (Renal Denervation in Patients With Chronic Heart Failure & Renal Impairment Clinical Trial) ( NCT01392196 ) was terminated last year due to a “lack of a physiologic response despite no safety concerns up to 24 months.” Another study looking at potential efficacy of RSD in patients with HF with preserved ejection fraction also showed no effects on macrovascular or microvascular function (16) . Several clinical studies are still ongoing, albeit with limited sample sizes and study duration ( Table 1 ).…”