Influence of Renal Sympathetic Denervation in Patients with Early-Stage Heart Failure Versus Late-Stage Heart Failure

Chen, Chun; Zhou, Xiujuan; Qian, Wei; Shan, Qijun

doi:10.1536/ihj.16-413

Cited by 11 publications

(15 citation statements)

References 21 publications

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“…However, 6-minute walk distance is an independent predictor of hospital readmission in patients with chronic heart failure. 37,38) Similar studies also confirmed that the average time of the ivabradine-treated group increased from 328 seconds to 497 seconds (P < 0.0235). 15) The study by Abdel-Salam 32) showed that the proportion of patients with an exercise tolerance of > 6 minutes walking time was significantly higher in the ivabradine group (P < 0.05).…”

Section: Improved Cardiopulmonary Functionsupporting

confidence: 54%

Ivabradine Improves Cardiac Function and Increases Exercise Capacity in Patients with Chronic Heart Failure

et al. 2019

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To systematically review and conduct a meta-analysis of the ivabradine-induced improvement in cardiopulmonary function, exercise capacity, and primary composite endpoints in patients with chronic heart failure (CHF). This study was a systematic review and meta-analysis. Databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Clinical Trials and European Union Clinical Trials, were searched for randomized placebo-controlled trials. The efficacy and safety of ivabradine treatment in patients with CHF were assessed and compared to those of the standard anti-heart failure treatment. Review Manager 5.3 software was used to analyze the relative risk (RR) for dichotomous data and the mean difference (MD) for continuous data. In total, 22 studies with 24,562 patients were included. Cardiopulmonary function analysis showed that treatment with added ivabradine reduced the heart rate (MD = −17.30, 95% confidence interval (CI): 19.52-−15.08, P < 0.00001), significantly increased the left ventricular ejection fraction (LVEF) (MD = 3.90, 95% CI: 0.40-7.40, P < 0.0001), and led to a better New York Heart Association (NYHA) classification. Ivabradine significantly reduced the minute ventilation/carbon dioxide production (VE/VCO2) (MD = −2.68, 95% CI: −4.81-−0.55, P = 0.01) and improved the peak VO2 (MD = 2.80, 95% CI: 1.05-4.55, P = 0.002) and the exercise capacity, including the exercise duration with a submaximal load (MD = 7.82, 95% CI: −2.57-−18.21, P < 0.00001) and the 6-minute walk distance. The RR of cardiovascular death or worsening heart failure was significantly decreased (RR = 0.93, 95% CI: 0.87-−0.98, P = 0.01) in the patients treated with ivabradine. Additionally, the RRs of heart failure and hospitalization also decreased (RR = 0.91, 95% CI: 0.85-−0.97, P = 0.006; RR = 0.86, 95% CI: 0.79-−0.93, P = 0.0002). Safety analysis showed no significant difference in the RR of severe adverse events between the ivabradine group and the standard anti-heart failure treatment group (P = 0.40). However, ivabradine significantly increased the RR of visual symptoms in CHF patients (RR = 3.82, 95% CI: 1.80-−8.13, P = 0.0005). Existing evidence showed that adding ivabradine treatment significantly improved the cardiopulmonary function and increased the exercise capacity of patients with CHF. Adding ivabradine to the standard anti-heart failure treatment reduced the mortality and hospitalization risk and improved the quality of life. Finally, ivabradine significantly increased the RR of visual symptoms in CHF patients. This is the first systematic review and meta-analysis to focus on the efficacy of ivabradine, which improved the cardiac function and increased the exercise capacity in patients with chronic heart failure (CHF). Therefore, this study will help evaluate the quality of life after adding ivabradine to the treatment of patients with CHF, even though there are differences in the standard for resting heart rate, left ventricular ejection fraction (LVEF), and New York Heart Associati...

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Section: Improved Cardiopulmonary Functionsupporting

confidence: 54%

Ivabradine Improves Cardiac Function and Increases Exercise Capacity in Patients with Chronic Heart Failure

et al. 2019

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“…Renal nerve ablation has been tried in patients suffering from CHF with positive [13][14][15][16] and negative results [17,18]. Reviews and meta-analyses on renal nerve ablation in heart failure suggest a potential benefit of the intervention for patients with heart disease, but there is a lack of larger prospective studies [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

AT II Receptor Blockade and Renal Denervation: Different Interventions with Comparable Renal Effects?

Rodionova

Hindermann

Hilgers

et al. 2021

Kidney Blood Press Res

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Background: Angiotensin II (Ang II) and the renal sympathetic nervous system exert a strong influence on renal sodium and water excretion. We tested the hypothesis that already low doses of an Ang II inhibitor (candesartan) will result in similar effects on tubular sodium and water reabsorption in congestive heart failure (CHF) as seen after renal denervation (DNX). Methods: Measurement of arterial blood pressure, heart rate (HR), renal sympathetic nerve activity (RSNA), glomerular filtration rate (GFR), renal plasma flow (RPF), urine volume, and urinary sodium. To assess neural control of volume homeostasis, 21 days after the induction of CHF via myocardial infarction rats underwent volume expansion (0.9% NaCL; 10% body weight) to decrease RSNA. CHF rat and controls with or without DNX or pretreated with the Ang II type-1 receptor antagonist candesartan (0.5 ug i.v.) were studied. Results: CHF rats excreted only 68 + 10.2% of the volume load (10% body weight) in 90 min. CHF rats pretreated with candesartan or after DNX excreted from 92 to 103% like controls. Decreases of RSNA induced by volume expansion were impaired in CHF rats but unaffected by candesartan pointing to an intrarenal drug effect. GFR and RPF were not significantly different in controls or CHF. Conclusion: The prominent function of increased RSNA – retaining salt and water – could no longer be observed after renal Ang II receptor blockade in CHF rats.

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“…In our study, included patients had late‐stage heart failure with markedly depressed left ventricular function, as well as high levels of circulating brain‐type natriuretic peptide, catecholamines, and elevated plasma renin activity. It is interesting to note that the lack of improvement after renal denervation might have been related to the elevated‐risk profile of the study population, as recent suggested by a study showing that patients in late‐stage heart failure could benefit less from renal denervation …”

Section: Discussionmentioning

confidence: 94%

“…It is interesting to note that the lack of improvement after renal denervation might have been related to the elevated-risk profile of the study population, as recent suggested by a study showing that patients in late-stage heart failure could benefit less from renal denervation. 24 Compensatory overactivation of autonomic sympathetic nervous pathways is a primary component in the pathogenesis of heart failure secondary to reduced systolic function. [25][26][27] Accordingly, downregulation of abnormally high neurohormonal activity is currently a key therapeutic strategy for patients with heart failure.…”

Section: Discussionmentioning

confidence: 99%

Renal denervation in patients with heart failure secondary to Chagas' disease: A pilot randomized controlled trial

Spadaro

Bocchi

Souza

et al. 2019

Cathet Cardio Intervent

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Introduction Chagas disease is one of the most relevant endemic parasitic diseases in Latin America, affecting approximately 6 million people. Overt Chagas heart disease is an ominous condition, occurring in 20–30% of infected individuals, which has besides the persistent myocarditis a peculiar intracardiac ganglionic neuronal depletion and dysautonomy. This study aims to evaluate the safety and feasibility of renal denervation for patients with advanced symptomatic Chagas cardiomyopathy. Methods Open‐label prospective pilot study that randomized patients with Chagas heart disease to either renal denervation or conservative treatment (2:1 ratio). The primary endpoint was the incidence of major adverse events at 9 months, defined as a composite of all‐cause death, myocardial infarction, stroke, need for renal artery invasive treatment, or worsening renal function. Results A total of 17 patients were allocated for renal denervation (n = 11) or conservative treatment (n = 6). Included patients had severe symptomatic heart disease, with markedly depressed left ventricular function (average ejection fraction 26.7 ± 4.9%). For patients randomized to renal denervation, the procedure was performed successfully and uneventfully. After 9 months, the primary endpoint occurred in 36.4% of patients in the renal denervation group and 50.0% in the control arm (p = .6). After 9 months, clinical, laboratory, functional, echocardiographic, and quality of life parameters were similar between groups. Conclusions This pilot study suggests that renal denervation is safe and feasible in patients with Chagas cardiomyopathy, warranting future studies to better evaluate the clinical efficacy of the interventional strategy in improving the prognosis of this high‐risk population.

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Influence of Renal Sympathetic Denervation in Patients with Early-Stage Heart Failure Versus Late-Stage Heart Failure

Cited by 11 publications

References 21 publications

Ivabradine Improves Cardiac Function and Increases Exercise Capacity in Patients with Chronic Heart Failure

Ivabradine Improves Cardiac Function and Increases Exercise Capacity in Patients with Chronic Heart Failure

AT II Receptor Blockade and Renal Denervation: Different Interventions with Comparable Renal Effects?

Renal denervation in patients with heart failure secondary to Chagas' disease: A pilot randomized controlled trial

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