Early Hemodynamic Changes following Surgical Ablation of the Right Greater Splanchnic Nerve for the Treatment of Heart Failure with Preserved Ejection Fraction.

Autor: Gajewski P; Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland.; Institute of Heart Diseases, Medical University, 50-556 Wroclaw, Poland., Fudim M; Duke Clinical Research Institute, Durham, NC 27710, USA.; Division of Cardiology, Duke University Medical Center, Durham, NC 27710, USA., Kittipibul V; Division of Cardiology, Duke University Medical Center, Durham, NC 27710, USA., Engelman ZJ; Coridea LLC, New York, NY 10018, USA., Biegus J; Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland.; Institute of Heart Diseases, Medical University, 50-556 Wroclaw, Poland., Zymliński R; Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland.; Institute of Heart Diseases, Medical University, 50-556 Wroclaw, Poland., Ponikowski P; Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland.; Institute of Heart Diseases, Medical University, 50-556 Wroclaw, Poland.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2022 Feb 18; Vol. 11 (4). Date of Electronic Publication: 2022 Feb 18.
DOI: 10.3390/jcm11041063
Abstrakt: Background: Permanent ablation of the right greater splanchnic nerve (GSN) has previously been demonstrated to improve quality of life and functional outcomes, as well as reduce abnormally high intracardiac filling pressures, in patients with heart failure with preserved ejection fraction (HFpEF) at 1, 3 and 12 months following the procedure. We hypothesize that hemodynamic changes that ensue from surgical right GSN ablation would be apparent as early as 24 h after the medical intervention.
Methods and Results: This is a prespecified analysis of a single-arm, two-center, open-label study evaluating the effects of right GSN ablation via thoracoscopic surgery in HFpEF patients with pulmonary capillary wedge pressure (PCWP) ≥15 mmHg at rest or ≥25 mmHg with supine cycle ergometry. A total of seven patients (median age 67 years, 29% female) underwent GSN removal followed by invasive right heart catheterization within 24 h. GSN ablation resulted in a significant reduction in PCWP 24 h after the procedure compared to baseline for both 20 W exercise (baseline (28.0 ± 4.3 mmHg) to 24 h (19.6 ± 6.9 mmHg); p = 0.0124) and peak exercise (baseline (25.6 ± 2.4 mmHg) to 24 h (17.4 ± 5.9 mmHg); p = 0.0025). There were no significant changes in resting or leg-up hemodynamics.
Conclusions: Permanent right GSN ablation leads to a reduction in intracardiac filling pressures during exercise, apparent as early as 24 h following the procedure.
Databáze: MEDLINE
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