Preliminary effects of renal denervation with saline irrigated catheter on cardiac systolic function in patients with heart failure: A prospective, randomized, controlled, pilot study

Chen, Weijie; Ling, Zhiyu; Xu, Yang; Liu, Zengzhang; Li, Su; Du, Hong; Xiao, Ping; Lan, Xianbin; Shan, Qijun; Yin, Yuehui

doi:10.1002/ccd.26475

Cited by 51 publications

(51 citation statements)

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“…A series of studies have been shown to significantly improve HF outcomes in both HF animal models and patients. [10][11][12] Our previous study also showed that RDN can improve heart function, which may be associated with inhibiting cardio-renal fibrogenesis. 13) All these studies have suggested that RDN is feasible, safe, and effective for the treatment of HF.…”

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confidence: 91%

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

et al. 2018

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SummaryRenal sympathetic denervation (RDN) is currently being investigated in multiple studies of heart failure (HF). Our aim was to assess the safety and effectiveness of RDN in patients with HF, and determine which patients could achieve more beneficial effects of RDN. A total of 17 consecutive patients with HF were enrolled in the study. Clinical symptoms, office blood pressure, and laboratory results were obtained and echocardiography was performed before and 12 months after RDN. Changes from baseline to 12 months were analyzed for all patients and for two subgroups based on HF duration (group 1: HF duration !3 years, n = 9; group 2: HF duration > 3 years, n = 8). The RDN procedure was successful in all patients and no procedure-related complications were documented. In comparison to baseline, there was a significant increase in left ventricular ejection fraction (LVEF) in all patients and group 1 (P < 0.05 for both), which did not happen in group 2. LAD, LVDs, and RVD also showed a significant reduction in group 1 (P < 0.05 for both). At 12 months, the reductions in TNF-α and CRP were significant for all patients and for patients in group 1 separately. No obvious changes in echocardiographic parameters, 6-minute walking distance, TNF-α, or CRP were recorded in group 2. No changes in BNP in either group were observed at the 12th month of follow-up. RDN could improve cardiac function and led to a significant drop in inflammatory markers in patients with HF. We also found that patients in early-stage HF could benefit more from RDN.(Int Heart J 2018; 59: 99-104)

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confidence: 91%

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

et al. 2018

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“…Stimulation of β-adrenergic receptors induces cardiac myocyte apoptosis and fibrosis in the heart [ 6 ].Prolonged stimulation of the β-adrenergic neurohormonal axis has been shown to contribute to the progression of CHF and mortality in both animal models and humans. Amount of studies, whether clinical studies or animal studies showed that RDN could improve cardiac function in heart failure patients or animals by decreasing sympathetic nerve activity [ 7 – 11 ]. Our research group also showed that RDN improved cardiac function by decreasing cardiac oxidative stress [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Renal denervation improves cardiac function by attenuating myocardiocyte apoptosis in dogs after myocardial infarction

Wang

Song

et al. 2018

BMC Cardiovasc Disord

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BackgroundMyocardial apoptosis is important in the pathogenesis and progression of myocardial infarction-induced heart failure (MI-HF). Renal sympathetic denervation (RDN) has become a promising therapeutic strategy for the treatment of HF. Previous studies have shown that RDN could improve heart function Yao et al. (Exp Ther Med 14:4104-4110, 2017). However, whether and how RDN regulates myocardial apoptosis in MI-HF is unclear. This study sought to evaluate the effects of RDN on cardiac function and apoptosis-related gene expression in MI-HF dogs.MethodsEighteen healthy mongrel dogs were randomly divided into control group(n = 6), model group(n = 6) and treatment group(n = 6). MI-HF was established in model group and treatment group by anhydrous alcohol embolization, after heart failure dogs in the treatment group and model group proceeded bilateral renal artery ablation and bilateral renal arteriography, respectively. The cardiac function parameters were evaluated by echocardiographic; the serum NT-BNP level was detected by ELISA; the degree of myocardial fibrosis was observed through masson staining; the expression of MMP-2, MMP-9 in the cardiac were got by immunohistochemistry. TUNEL method was used to observe cardiomyocyte apoptotsis and calculate the apoptosis index (AI). Relative expression of Bcl-2 and Bax, Caspase3 and GRP78 were detected using RT-PCR and Western Blot. Renal artery H&E staining and serum creatinine were conducted to access the efficacy and safety of RDN.ResultsFour weeks after RDN, the LVEDD, LVESD and LVEDP decreased, and the LVEF and LVSP increased in the treatment group compared with those in the control group (all P < 0.05). Moreover, NT-BNP, an indicator of cardiac function was decreased. Additionally, MMP-2 and MMP-9 levels in the myocardium decreased significantly in the treatment group. Furthermore, the levels of Bax, and caspase 3 decreased, while the level of Bcl-2 increased. Thus, myocardial apoptosis was attenuated in RDN treated dogs. We also found that the level of GRP78 which is activated in response to endoplasmic reticulum (ER) stress, was decreased. However, serum creatinine levels were not significantly different between the RND-treated dogs and the control dogs.ConclusionCardiac function was improved by RDN treatment through regulating apoptosis and ER stress in cardiomyocytes in dogs after MI.

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“…People who might respond to RDN should be identified first. Further, the possible value of renal denervation extends beyond the hypertension field, for example to benefits in atrial fibrillation [103,104] and in reducing heart failure recurrence [105].…”

Section: Renal Denervation (Rdn)mentioning

confidence: 99%

Resistant Hypertension: Novel Insights

Lamirault

Artifoni²,

Daniel

et al. 2020

CHYR

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: Hypertension is the most common chronic disease and the leading risk factor for disability and premature deaths in the world, accounting for more than 9 million deaths annually. Resistant hypertension is a particularly severe form of hypertension. It was described 50 years ago and since then has been a very active field of research. This review aims at summarizing the most recent findings on resistant hypertension. : The recent concepts of apparent- and true-resistant hypertension have stimulated a more precise definition of resistant hypertension taking into account not only the accuracy of blood pressure measurement and pharmacological class of prescribed drugs but also patient adherence to drugs and life-style recommendations. : Recent epidemiological studies have reported a 10% prevalence of resistant hypertension among hypertensive subjects and demonstrated the high cardiovascular risk of these patients. In addition, these studies identified subgroups of patients with even higher morbidity and mortality risk, probably requiring a more aggressive medical management. : In the meantime, guidelines provided more standardized clinical work-up to identify potentially reversible causes for resistant hypertension such as secondary hypertension. The debate is however still ongoing on which would be the optimal method(s) to screen for non-adherence to hypertension therapy, recognized as the major cause for (pseudo)-resistance to treatment. : Recent randomized clinical trials have demonstrated the strong benefit of anti-aldosterone drugs (mostly spironolocatone) as fourth-line therapies in resistant hypertension whereas clinical trials with device-based therapies displayed contrasting results. New trials with improved devices and more carefully selected patients with resistant hypertension are ongoing.

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Preliminary effects of renal denervation with saline irrigated catheter on cardiac systolic function in patients with heart failure: A prospective, randomized, controlled, pilot study

Abstract: Results imply that RDN could be safely applied to treatment of HF and probably improve cardiac systolic function and patients' quality of life. © 2016 Wiley Periodicals, Inc.

Cited by 51 publications

References 29 publications

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

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

Renal denervation improves cardiac function by attenuating myocardiocyte apoptosis in dogs after myocardial infarction

Resistant Hypertension: Novel Insights

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