Splanchnic Nerve Block for Chronic Heart Failure
| Autor: | David F. Kong, Sunil V. Rao, Marat Fudim, Manesh R. Patel, G. Michael Felker, Brian Coyne, Richard L. Boortz-Marx, Amanda Paul, Adrian F. Hernandez, Chetan B. Patel, Todd L. Kiefer, Aubrie Coburn, Joseph G. Rogers, Inneke Johnson, W. Schuyler Jones, Adam D. DeVore, Arun Ganesh, Cynthia L. Green, J. Antonio Gutierrez |
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| Rok vydání: | 2020 |
| Předmět: |
Cardiac output
medicine.medical_specialty Percutaneous Hemodynamics 030204 cardiovascular system & hematology Splanchnic nerves Ventricular Function Left 03 medical and health sciences Oxygen Consumption 0302 clinical medicine Internal medicine medicine Humans Prospective Studies 030212 general & internal medicine Pulmonary wedge pressure Aged Heart Failure Exercise Tolerance Ejection fraction Ropivacaine business.industry Splanchnic Nerves Stroke Volume Middle Aged medicine.disease medicine.anatomical_structure Heart failure Exercise Test Cardiology Female Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | JACC: Heart Failure. 8:742-752 |
| ISSN: | 2213-1779 |
| Popis: | We hypothesized that splanchnic nerve blockade (SNB) would attenuate increased exercise-induced cardiac filling pressures in patients with chronic HF.Chronic heart failure (HF) is characterized by limited exercise capacity driven in part by an excessive elevation of cardiac filling pressures.This is a prospective, open-label, single-arm interventional study in chronic HF patients. Eligible patients had a wedge pressure ≥15 mm Hg at rest or ≥25 mm Hg with exercise on baseline right heart catheterization. Patients underwent cardiopulmonary exercise testing with invasive hemodynamic assessment, followed by percutaneous SNB with ropivacaine.Nineteen patients were enrolled, 15 of whom underwent SNB. The average age was 58 ± 13 years, 7 (47%) patients were women and 6 (40%) were black. Left ventricular ejection fraction was ≤35% in 14 (93%) patients. No procedural complications were encountered. SNB reduced mean pulmonary arterial pressure at peak exercise from 54.1 ± 14.4 (pre-SNB) to 45.8 ± 17.7 mm Hg (p 0.001) (post-SNB). Similarly, SNB reduced exercise-induced wedge pressure from 34.8 ± 10.0 (pre-SNB) to 25.1 ± 10.7 mm Hg (p 0.001) (post-SNB). The cardiac index changed with peak exercise from 3.4 ± 1.2 (pre-SNB) to 3.8 ± 1.1 l/min/mSNB reduced resting and exercise-induced pulmonary arterial and wedge pressure with favorable effects on cardiac output and exercise capacity. Continued efforts to investigate short- and long-term effects of SNB in chronic HF are warranted. Clinical Trials Registration (Abdominal Nerve Blockade in Chronic Heart Failure; NCT03453151). |
| Databáze: | OpenAIRE |
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