Intravascular Ultrasound Pulmonary Artery Denervation to Treat Pulmonary Arterial Hypertension (TROPHY1)

Rothman, Alexander; Vachiéry, Jean‐Luc; Howard, Luke; Mikhail, Ghada; Lang, I. M.; Jonas, Michael; Kiely, David G.; Shav, Dalit; Shabtay, Or; Avriel, Avital; Lewis, Gregory D.; Rosenzweig, Erika; Kirtane, Ajay J.; Kim, Nick H.S.; Mahmud, Ehtisham; McLaughlain, Vallerie V.V.; Chetcuti, Stanley; Leon, Martin; Ben‐Yehuda, Ori; Rubin, Lewis J.

doi:10.1016/j.jcin.2019.12.027

Cited by 55 publications

(55 citation statements)

References 28 publications

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“…A total of 188 articles were retrieved and 8 studies were nally included, which are all prospective studies and involve a total of 213 patients [13,[16][17][18][19][20][21][22]. All patients were treated with PADN and followed up for 1-12 months.…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…Chen et al showed that all variables of right heart catheterization and 6MWD improved signi cantly at 6-month follow-up and were nonsigni cant different between 6-month and 1-year [17]. Current clinical studies have been followed up for up to 1 year, and no effect of PADN has been found to decrease with time [13,17]. Therefore, we selected the data of 6 months and the closest follow-up time for 6 months for meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

“…The results showed that after PADN, the mPAP decreased signi cantly (MD -12.51, 95% CI -17.74 to -7.27, P 0.00001) (mmHg) ( Figure 3A). 8 studies (n = 213) for meta-analysis of PVR [13,[16][17][18][19][20][21][22]. Meta-analysis results showed that there was signi cant heterogeneity between the literatures (P <0.00001, I 2 = 93%), which was analyzed using a random effects model.…”

Section: Hemodynamic Parametersmentioning

confidence: 99%

“…The source of heterogeneity may be related to the different follow-up time and type of PHs between studies. A subgroup analysis of mPAP, PVR, and CO showed that the heterogeneity of 5 studies with a measurement time of 6 months was signi cantly reduced [13,16,17,21,22]. For mPAP, there were homogenous (P = 0.79, I 2 = 0%) of 5 studies with a measurement time of 6 months, and the difference between the two groups was signi cant (MD = -9.0, 95% CI -11.70 to -6.31, P <0.00001) (mmHg) ( Figure 6A).…”

Section: Heterogeneity and Sensitivity Analysismentioning

confidence: 99%

“…Therefore, pulmonary artery denervation (PADN) aimed at reducing SNS activation, has become a novel treatment modality [11,12]. In 2020, A multi-center clinical trial proved that PADN can reduce PVR as well as increase 6-minute walk distance (6MWD) of PAH patients, and no adverse events related to surgery occurred, con rming the effectiveness and safety of PADN [13]. However, another clinical study found that the effect of PADN on some PAH patients is not obvious [14].…”

Section: Introductionmentioning

confidence: 99%

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Meta-analysis of Pulmonary Artery Denervation for Treatment of Pulmonary Hypertension

Zuo

Xiao

Xie

et al. 2020

Preprint

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Objective: Pulmonary artery denervation (PADN) can reduce sympathetic nervous system (SNS) activity in patients with pulmonary hypertension (PH), reduce pulmonary artery pressure (PAP) in PH patients, and improve the quality of life in PH patients. We conducted a systematic meta-analysis of the effectiveness of PADN in the treatment of PH patients. Methods: All public clinical trials investigating the effects of PADN on PH. Outcomes were average pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), cardiac output (CO), right ventricular (RV) Tei index, 6-minute walk distance (6MWD), and New York Heart Association (NYHA) cardiac function grading. Results: A total of eight clinical studies including 213 PH patients with PADN were included. Meta-analysis showed that after PADN, mPAP (MD -12.51, 95% CI -17.74 to -7.27, P＜0.00001) (mmHg) and PVR (MD = -5.17, 95% CI -7.70 to -2.65, P <0.0001) (wood unit) decreased significantly, CO (MD 0.59, 95% CI 0.32 to 0.86, P＜0.0001) (L/min) and 6MWD (MD 107.75, 95% CI 65.64 to 149.86, P ＜0.00001) (meter) increased significantly, and RV Tei index (MD -0.05, 95% CI -0.28 to 0.17, P = 0.63) did not change significantly. And after PADN, the proportion of NYHA cardiac function grading (RR = 0.23, 95% CI 0.14 to 0.37, P <0.00001) III and IV decreased significantly.Conclusion: This meta-analysis supports PADN as a potential new treatment for PH. Further high-quality randomized controlled studies are needed.

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Section: Literature Search Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Hemodynamic Parametersmentioning

confidence: 99%

Section: Heterogeneity and Sensitivity Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Meta-analysis of Pulmonary Artery Denervation for Treatment of Pulmonary Hypertension

Zuo

Xiao

Xie

et al. 2020

Preprint

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The evolving role of interventional cardiology in the treatment of pulmonary hypertension

Gurevich

Prins

2020

Cathet Cardio Intervent

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Pulmonary hypertension (PH) is a heterogeneous group of diseases defined by a mean pulmonary arterial pressure greater than 20 mmHg. Clinically, PH is classified into five groups and the group of PH generally defines the cause of PH and the therapeutic options. Currently, medical therapies that target the prostacyclin, endothelin, and nitric oxide pathways are used in pulmonary arterial hypertension and chronic thromboembolic PH (CTEPH) patients. Moreover, surgery can improve outcomes in PH as pulmonary thromboendarterectomy can be curative for CTEPH and lung transplantation is used for end‐stage PH. Despite these diverse treatment options, PH patients continue to have high symptom burden and poor long‐term outcomes. However, advances in percutaneous technology are opening new avenues for the management of PH. In this review, we discuss the available data supporting the use of four interventional procedures: balloon atrial septostomy, transcatheter Potts shunt, balloon pulmonary angioplasty, and pulmonary artery denervation for the treatment of PH. These procedures provide hemodynamic and functional improvements in PH patients, but they come with their own unique risk profiles. Hopefully, these procedures will continue to be refined and thereby provide a venue for interventional cardiology to safely and effectively improve outcomes for PH moving forward.

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Autonomic nervous modulation: early treatment for pulmonary artery hypertension

Xueyuan,

Yanping,

Jiaoqiong

et al. 2023

ESC Heart Failure

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Pulmonary artery hypertension (PAH) is a chronic vascular disease defined by the elevation of pulmonary vascular resistance and mean pulmonary artery pressure, which arises due to pulmonary vascular remodelling. Prior research has already established a link between the autonomic nervous system (ANS) and PAH. Therefore, the rebalancing of the ANS offers a promising approach for the treatment of PAH. The process of rebalancing involves two key aspects: inhibiting an overactive sympathetic nervous system and fortifying the impaired parasympathetic nervous system through pharmacological or interventional procedures. However, the understanding of the precise mechanisms involved in neuromodulation, whether achieved through medication or intervention, remains insufficient. This limited understanding hinders our ability to determine the appropriate timing and scope of such treatment. This review aims to integrate the findings from clinical and mechanistic studies on ANS rebalancing as a treatment approach for PAH, with the ultimate goal of identifying a path to enhance the safety and efficacy of neuromodulation therapy and improve the prognosis of PAH.

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Intravascular Ultrasound Pulmonary Artery Denervation to Treat Pulmonary Arterial Hypertension (TROPHY1)

Cited by 55 publications

References 28 publications

Meta-analysis of Pulmonary Artery Denervation for Treatment of Pulmonary Hypertension

Meta-analysis of Pulmonary Artery Denervation for Treatment of Pulmonary Hypertension

The evolving role of interventional cardiology in the treatment of pulmonary hypertension

Autonomic nervous modulation: early treatment for pulmonary artery hypertension

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