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

Ingrid Hopper, Edoardo Gronda, Uta C. Hoppe, Bengt Rundqvist, Thomas H. Marwick, Sharad Shetty, Christopher Hayward, Thomas Lambert, Dagmara Hering, Murray Esler, Markus Schlaich, Antony Walton, Flavio Airoldi, Mathias C. Brandt, Sidney A. Cohen, Pascalle Reiters, Henry Krum

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)702-707
Number of pages6
JournalJournal of Cardiac Failure
Volume23
Issue number9
DOIs
Publication statusPublished - Sep 1 2017

Keywords

  • chronic kidney disease
  • renal impairment
  • Sympathetic nervous system

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Hopper, I., Gronda, E., Hoppe, U. C., Rundqvist, B., Marwick, T. H., Shetty, S., Hayward, C., Lambert, T., Hering, D., Esler, M., Schlaich, M., Walton, A., Airoldi, F., Brandt, M. C., Cohen, S. A., Reiters, P., & Krum, H. (2017). Sympathetic Response and Outcomes Following Renal Denervation in Patients With Chronic Heart Failure: 12-Month Outcomes From the Symplicity HF Feasibility Study. Journal of Cardiac Failure, 23(9), 702-707. https://doi.org/10.1016/j.cardfail.2017.06.004