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Renal Denervation for Congestive Heart Failure

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Renal Denervation

Abstract

Chronic heart failure remains a condition with a high mortality and symptom burden. Patients have excess sympathetic tone. Pharmacological treatments targeting the sympathetic nervous system and the reninangiotensin-aldosterone system have been shown to have prognostic benefit in systolic heart failure. Renal sympathetic denervation offers the potential to intervene much earlier in the pathway, reducing sympathetic over activity. Pilot data has demonstrated procedural safety in this population. Trials are underway to assess the effect of renal sympathetic denervation in both systolic heart failure and heart failure.

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References

  1. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith Jr SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B, American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to update the 2001 guidelines for the evaluation and management of heart failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005;112:e154–235.

    Article  PubMed  Google Scholar 

  2. Allman KC, Shaw LJ, Hachamovitch R, et al. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a metaanalysis. J Am Coll Cardiol. 2002;39:1151–8.

    Article  PubMed  Google Scholar 

  3. Shah AB, Morrissey RP, Baraghoush A, Bharadwaj P, Phan A, Hamilton M, Kobashigawa J, Schwarz ER. Failing the failing heart: a review of palliative care in heart failure. Rev Cardiovasc Med. 2013;14:41–8.

    Article  PubMed  Google Scholar 

  4. Schowalter M, Gelbrich G, Störk S, Langguth JP, Morbach C, Ertl G, Faller H, Angermann CE. Generic and disease-specific health-related quality of life in patients with chronic systolic heart failure: impact of depression. Clin Res Cardiol. 2013;102:269–78.

    Article  PubMed  Google Scholar 

  5. Bhatia RS, Tu JV, Lee DS, et al. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006;355:260–9.

    Article  CAS  PubMed  Google Scholar 

  6. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355:251–9.

    Article  CAS  PubMed  Google Scholar 

  7. Kaye DM, Lambert GW, Lefkovits J, Morris M, Jennings G, Esler MD. Neurochemical evidence of cardiac sympathetic activation and increased central nervous system norepinephrine turnover in severe congestive heart failure. J Am Coll Cardiol. 1994;23:570–8.

    Article  CAS  PubMed  Google Scholar 

  8. Eisenhofer G, Friberg P, Rundqvist B, Quyyumi AA, Lambert G, Kaye DM, Kopin IJ, Goldstein DS, Esler MD. Cardiac sympathetic nerve function in congestive heart failure. Circulation. 1996;93:1667–76.

    Article  CAS  PubMed  Google Scholar 

  9. Doi T, Nakata T, Hashimoto A, Yuda S, Wakabayashi T, Kouzu H, Kaneko N, Hase M, Tsuchihashi K, Miura T. Synergistic prognostic values of cardiac sympathetic innervation with left ventricular hypertrophy and left atrial size in heart failure patients without reduced left ventricular ejection fraction: a cohort study. BMJ Open. 2012;2(6):e001015. doi:10.1136/bmjopen-2012-001015.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Grassi G, Seravalle G, Cattaneo BM, Lanfranchi A, Vailati S, Giannattasio C, Del Bo A, Sala C, Bolla GB, Pozzi M. Sympathetic activation and loss of reflex sympathetic control in mild congestive heart failure. Circulation. 1995;92:3206–11.

    Article  CAS  PubMed  Google Scholar 

  11. Rundqvist B, Elam M, Bergmann-Sverrisdottir Y, Eisenhofer G, Friberg P. Increased cardiac adrenergic drive precedes generalized sympathetic activation in human heart failure. Circulation. 1997;95:169–75.

    Article  CAS  PubMed  Google Scholar 

  12. Triposkiadis F, Karayannis G, Giamouzis G, Skoularigis J, Louridas G, Butler J. The sympathetic nervous system in heart failure physiology, pathophysiology, and clinical implications. J Am Coll Cardiol. 2009;54:1747–62.

    Article  CAS  PubMed  Google Scholar 

  13. Packer M. The neurohormonal hypothesis: a theory to explain the mechanism of disease progression in heart failure. J Am Coll Cardiol. 1992;20:248–54.

    Article  CAS  PubMed  Google Scholar 

  14. Schrier RW, Abraham WT. Hormones and hemodynamics in heart failure. N Engl J Med. 1999;341:577–85.

    Article  CAS  PubMed  Google Scholar 

  15. Sobotka PA, Krum H, Böhm M, Francis DP, Schlaich MP. The role of renal denervation in the treatment of heart failure. Curr Cardiol Rep. 2012;14:285–92.

    Article  PubMed  Google Scholar 

  16. Osterziel KJ, Hänlein D, Willenbrock R, Eichhorn C, Luft F, Dietz R. Baroreflex sensitivity and cardiovascular mortality in patients with mild to moderate heart failure. Br Heart J. 1995;73:517–22.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Jessup M, Costanzo MR. The cardiorenal syndrome: do we need a change of strategy or a change of tactics? J Am Coll Cardiol. 2009;53:597–9.

    Article  PubMed  Google Scholar 

  18. Schrier RW. Body fluid volume regulation in health and disease: a unifying hypothesis. Ann Intern Med. 1990;113:155–9.

    Article  CAS  PubMed  Google Scholar 

  19. Hasking GJ, Esler MD, Jennings GL, Burton D, Johns JA, Korner PI. Norepinephrine spillover to plasma in patients with congestive heart failure: evidence of increased overall and cardiorenal sympathetic nervous activity. Circulation. 1986;73:615–21.

    Article  CAS  PubMed  Google Scholar 

  20. Cohn JN, Levine TB, Olivari MT, Garberg V, Lura D, Francis GS, Simon AB, Rector T. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med. 1984;311:819–23.

    Article  CAS  PubMed  Google Scholar 

  21. Petersson M, Friberg P, Eisenhofer G, Lambert G, Rundqvist B. Long-term outcome in relation to renal sympathetic activity in patients with chronic heart failure. Eur Heart J. 2005;26:906–13.

    Article  PubMed  Google Scholar 

  22. Notarius CF, Ando S, Rongen GA, Senn B, Floras JS. Resting muscle sympathetic nerve activity and peak oxygen uptake in heart failure and normal subjects. Eur Heart J. 1999;20:880–7.

    Article  CAS  PubMed  Google Scholar 

  23. Kraemer MD, Kubo SH, Rector TS, Brunsvold N, Bank AJ. Pulmonary and peripheral vascular factors are important determinants of peak oxygen uptake in patients with heart failure. J Am Coll Cardiol. 1993;21:641–8.

    Article  CAS  PubMed  Google Scholar 

  24. Tomaselli GF, Zipes DP. What causes sudden death in heart failure? Circ Res. 2004;95:754–63.

    Article  CAS  PubMed  Google Scholar 

  25. Mortara A, La Rovere MT, Signorini MG, Pantaleo P, Pinna G, Martinelli L, Ceconi C, Cerutti S, Tavazzi L. Can power spectral analysis of heart rate variability identify a high risk subgroup of congestive heart failure patients with excessive sympathetic activation? A pilot study before and after heart transplantation. Br Heart J. 1994;71:422–30.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Woo MA, Stevenson WG, Moser DK, Middlekauff HR. Complex heart rate variability and serum norepinephrine levels in patients with advanced heart failure. J Am CollCardio. 1994;23:565–9.

    Article  CAS  Google Scholar 

  27. Benedict CR, Francis GS, Shelton B, Johnstone DE, Kubo SH, Kirlin P, Nicklas J, Liang CS, Konstam MA, Greenberg B. Effect of long-term enalapril therapy on neurohormones in patients with left ventricular dysfunction. SOLVD Investigators. Am J Cardiol. 1995;75:1151–7.

    Article  CAS  PubMed  Google Scholar 

  28. SOLVD The Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325:293–302.

    Article  Google Scholar 

  29. The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. 1987;316:1429–35.

    Article  Google Scholar 

  30. Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, Palensky J, Wittes J. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized aldactone evaluation study investigators. N Engl J Med. 1999;341:709–17.

    Article  CAS  PubMed  Google Scholar 

  31. McMurray JJ, Pitt B, Latini R, Maggioni AP, Solomon SD, Keefe DL, Ford J, Verma A, Lewsey J, Aliskiren Observation of Heart Failure Treatment (ALOFT) Investigators. Effects of the oral direct renin inhibitor aliskiren in patients with symptomatic heart failure. Circ Heart Fail. 2008;1:17–24.

    Article  CAS  PubMed  Google Scholar 

  32. Gheorghiade M, Böhm M, Greene SJ, Fonarow GC, Lewis EF, Zannad F, Solomon SD, Baschiera F, Botha J, Hua TA, Gimpelewicz CR, Jaumont X, Lesogor A, Maggioni AP, ASTRONAUT Investigators and Coordinators. Effect of aliskiren on postdischarge mortality and heart failure readmissions among patients hospitalized for heart failure: the ASTRONAUT randomized trial. JAMA. 2013;309:1125–35.

    Article  CAS  PubMed  Google Scholar 

  33. Just H. Pathophysiological targets for beta-blocker therapy in congestive heart failure. Eur Heart J. 1996;17(Suppl B):2–7.

    Article  CAS  PubMed  Google Scholar 

  34. CIBIS Investigators and Committees. A randomized trial of beta-blockade in heart failure. The Cardiac Insufficiency Bisoprolol Study (CIBIS). Circulation. 1994;90:1765–73.

    Article  Google Scholar 

  35. CIBIS-II Investigators and Committees. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet. 1999;353:9–13.

    Article  Google Scholar 

  36. Fung JW, Yu CM, Yip G, Chan S, Yandle TG, Richards AM, Nicholls MG, Sanderson JE. Effect of beta blockade (carvedilol or metoprolol) on activation of the renin-angiotensin-aldosterone system and natriuretic peptides in chronic heart failure. Am J Cardiol. 2003;92:406–10.

    Article  CAS  PubMed  Google Scholar 

  37. Azevedo ER, Newton GE, Parker JD. Cardiac and systemic sympathetic activity in response to clonidine in human heart failure. J Am Coll Cardiol. 1999;33:186–91.

    Article  CAS  PubMed  Google Scholar 

  38. Cohn JN, Pfeffer MA, Rouleau J, Sharpe N, Swedberg K, Straub M, Wiltse C, Wright TJ, MOXCON Investigators. Adverse mortality effect of central sympathetic inhibition with sustained-release moxonidine in patients with heart failure (MOXCON). Eur J Heart Fail. 2003;5:659–67.

    Article  CAS  PubMed  Google Scholar 

  39. Pérez-Calvo JI, Montero-Pérez-Barquero M, Formiga F. Diagnosis of heart failure with preserved ejection fraction: still a challenge. J Am Coll Cardiol. 2013;61:1748–9.

    Article  PubMed  Google Scholar 

  40. Cleland JG, Tendera M, Adamus J, Freemantle N, Polonski L, Taylor J, PEP-CHF Investigators. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J. 2006;27:2338–45.

    Article  CAS  PubMed  Google Scholar 

  41. Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR, Anderson S, Donovan M, Iverson E, Staiger C, Ptaszynska A, I-PRESERVE Investigators. Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med. 2008;359:2456–67.

    Article  CAS  PubMed  Google Scholar 

  42. Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J, CHARM Investigators and Committees. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet. 2003;362:777–81.

    Article  CAS  PubMed  Google Scholar 

  43. van Veldhuisen DJ, Cohen-Solal A, Böhm M, Anker SD, Babalis D, Roughton M, Coats AJ, Poole-Wilson PA, Flather MD, SENIORS Investigators. Beta-blockade with nebivolol in elderly heart failure patients with impaired and preserved left ventricular ejection fraction: data from seniors (study of effects of nebivolol intervention on outcomes and rehospitalization in seniors with heart failure). J Am Coll Cardiol. 2009;53:2150–8.

    Article  PubMed  Google Scholar 

  44. Ahmed A, Rich MW, Fleg JL, Zile MR, Young JB, Kitzman DW, Love TE, Aronow WS, Adams Jr KF, Gheorghiade M. Effects of digoxin on morbidity and mortality in diastolic heart failure: the ancillary digitalis investigation group trial. Circulation. 2006;114:397–403.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  45. Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997;336:525–33.

    Article  Google Scholar 

  46. Schlaich MP, Lambert E, Kaye DM, Krozowski Z, Campbell DJ, Lambert G, Hastings J, Aggarwal A, Esler MD. Sympathetic augmentation in hypertension: role of nerve firing norepinephrine reuptake, and angiotensin neuromodulation. Hypertens. 2004;43:169–75.

    Article  CAS  Google Scholar 

  47. Schlaich MP, Sobotka PA, Krum H, Lambert E, Esler MD. Renal sympathetic-nerve ablation for uncontrolled hypertension. N Engl J Med. 2009;361:932–4.

    Article  CAS  PubMed  Google Scholar 

  48. Heywood JT, Fonarow GC, Costanzo MR, Mathur VS, Wigneswaran JR, Wynne J, ADHERE Scientific Advisory Committee and Investigators. High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. J Card Fail. 2007;13:422–30.

    Article  PubMed  Google Scholar 

  49. Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52:1527–39.

    Article  PubMed  Google Scholar 

  50. Ponikowski P, Chua TP, Anker SD, Francis DP, Doehner W, Banasiak W, Poole-Wilson PA, et al. Peripheralchemoreceptor hypersensitivity: an ominous sign in patients with chronic heart failure. Circulation. 2001;104:544–9.

    Article  CAS  PubMed  Google Scholar 

  51. Wensel R, Francis DP, Georgiadou P, Scott A, Genth-Zotz S, Anker SD, Coats AJ, Piepoli MF. Exercise hyperventilation in chronic heart failure is not caused by systemic lactic acidosis. Eur J Heart Fail. 2005;7:1105–11.

    Article  PubMed  Google Scholar 

  52. Wensel R, Georgiadou P, Francis DP, Bayne S, Scott AC, Genth-Zotz S, Anker SD, Coats AJ, Piepoli MF. Differential contribution of dead space ventilation and low arterial pCO2 to exercise hyperpnea in patients with chronic heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 2004;93:318–23.

    Article  PubMed  Google Scholar 

  53. Giannoni A, Emdin M, Bramanti F, Iudice G, Francis DP, Barsotti A, Piepoli M, Passino C. Combined increased chemosensitivity to hypoxia and hypercapnia as a prognosticator in heart failure. J Am Coll Cardiol. 2009;53:1975–80.

    Article  PubMed  Google Scholar 

  54. Campese VM. Neurogenic factors and hypertension in chronic renal failure. J Nephrol. 1997;10:184.

    CAS  PubMed  Google Scholar 

  55. Ye S, Zhong H, Yanamadala V, Campese VM. Renal injury caused by intrarenal injection of phenol increases afferent and efferent renal sympathetic nerve activity. Am J Hypertens. 2002;15:717–24.

    Article  CAS  PubMed  Google Scholar 

  56. DiBona GF, Sawin LL. Role of renal nerves in sodium retention of cirrhosis and congestive heart failure. Am J Physiol. 1991;260:R298–305.

    CAS  PubMed  Google Scholar 

  57. Clayton SC, Haack KK, Zucker IH. Renal denervation modulates angiotensin receptor expression in the renal cortex of rabbits with chronic heart failure. Am J Physiol Renal Physiol. 2011;300:F31–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  58. Davies JE, Manisty CH, Petraco R, Barron AJ, Unsworth B, Mayet J, Hamady M, et al. First-in-man safety evaluation of renal denervation for chronic systolic heart failure: primary outcome from REACH-Pilot study. Int J Cardiol. 2013;162:189–92.

    Article  PubMed  Google Scholar 

  59. Taborsky M, Lazarova ML, Vaclavik J. The effect of renal denervation in patients with advanced heart failure. Eur Heart J. 2012;33:A517.

    Google Scholar 

  60. Brandt MC, Mahfoud F, Reda S, Schirmer SH, Erdmann E, Böhm M, Hoppe UC. Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J Am Coll Cardiol. 2012;59:901–9.

    Article  PubMed  Google Scholar 

  61. Medtronic Vascular. Renal denervation in patients with chronic heart failure & renal impairment clinical trial (SymplicityHF). In: Clinical Trials.gov [Internet]. Bethesda: National Library of Medicine (US); 2000, [20140903]. Available from: URL of the record NLM Identifier: NCT01392196.

    Google Scholar 

  62. Imperial College London. Renal Artery Denervation in Chronic Heart Failure study (REACH). In: Clinical Trials.gov [Internet]. Bethesda: National Library of Medicine (US); 2000, [20140903]. Available from: URL of the record NLM Identifier: NCT 01639378.

    Google Scholar 

  63. Royal Brompton & Harefield NHS Foundation Trust. Renal denervation in heart failure with preserved ejection fraction (RDT-PEE). In: Clinical Trials.gov [Internet]. Bethesda: National Library of Medicine (US); 2000, [20140903]. Available from: URL of the record NLM Identifier: NCT 01840059.

    Google Scholar 

  64. University Hospital, Saarland. Influence of Catheter-based renal denervation in disease with increased sympathetic activity. In: Clinical Trials.gov [Internet]. Bethesda: National Library of Medicine (US); 2000, [20140903]. Available from: URL of the record NLM Identifier: NCT 01888315.

    Google Scholar 

  65. Zuern CS, Eick C, Rizas KD, Bauer S, Langer H, Gawaz M, Bauer A. Impaired cardiac baroreflex sensitivity predicts response to renal sympathetic denervation in patients with resistant hypertension. J Am Coll Cardiol. 2013;62:2124–30. pii: S0735-1097(13)03077-5.

    Article  PubMed  Google Scholar 

  66. Bristow JD, Honour AJ, Pickering GW, Sleight P, Smyth HS. Diminished baroreflex sensitivity in high blood pressure. Circulation. 1969;39:48–54.

    Article  CAS  PubMed  Google Scholar 

  67. Kassis E. Baroreflex control of the circulation in patients with congestive heart failure. Dan Med Bull. 1989;36:195–211.

    CAS  PubMed  Google Scholar 

  68. Hering D, Lambert EA, Marusic P, et al. Substantial reduction in single sympathetic nerve firing after renal denervation in patients with resistant hypertension. Hypertens. 2013;61:457–64.

    Article  CAS  Google Scholar 

  69. Francis DP, Shamim W, Davies LC, Piepoli MF, Ponikowski P, Anker SD, Coats AJ. Cardiopulmonary exercise testing for prognosis in chronic heart failure: continuous and independent prognostic value from VE/VCO(2)slope and peak VO(2). Eur Heart J. 2000;21:154–61.

    Article  CAS  PubMed  Google Scholar 

  70. Ponikowski P, Francis DP, Piepoli MF, Davies LC, Chua TP, Davos CH, Florea V, Banasiak W, Poole-Wilson PA, Coats AJ, Anker SD. Enhanced ventilatory response to exercise in patients with chronic heart failure and preserved exercise tolerance: marker of abnormal cardiorespiratory reflex control and predictor of poor prognosis. Circulation. 2001;103:967–72.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Claire E. Raphael MA, BSc, MRCP .

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Raphael, C.E., Davies, J.E. (2015). Renal Denervation for Congestive Heart Failure. In: Heuser, R., Schlaich, M., Sievert, H. (eds) Renal Denervation. Springer, London. https://doi.org/10.1007/978-1-4471-5223-1_20

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