Highlights
- •A total 11 studies with 313 patients with heart failure with reduced ejection fraction were included.
- •Renal denervation can increase left ventricular ejection fraction and 6-min walk distance.
- •Renal denervation can improve cardiac structure in people with heart failure.
- •Renal denervation seemed to be a safe treatment for heart failure.
- •This improvement after renal denervation was significant in Asian populations.
Abstract
Background
Some, but not all, recent studies have shown that renal denervation (RDN) can improve
cardiac function and exercise tolerance in people who have heart failure with reduced
ejection fraction (HFrEF). This study assessed the efficacy and safety of RDN as a
treatment for HFrEF.
Methods
The Medline, Cochrane Library, Embase, and PubMed databases were searched through
to September 28, 2022 for clinical studies that evaluated the effect of RDN on HFrEF.
The primary endpoints were changes in left ventricular ejection fraction (LVEF) and
6-min walk distance (6MWD). Secondary endpoints were changes in echocardiographic
parameters, including left ventricular end-diastolic and end-systolic diameters, left
atrial diameter, and interventricular septal thickness. N-terminal pro-B-type natriuretic
peptide (NT-proBNP) levels, New York Heart Association (NYHA) class, heart rate, and
systolic and diastolic blood pressure were also evaluated. Major adverse events were
defined as death and rehospitalization for heart failure during follow-up. The estimated
glomerular filtration rate (eGFR) and serum creatinine level were extracted as measures
of renal function.
Results
Eleven trials comprising 313 patients were eligible for quantitative analysis. Pooled
analyses showed a mean increase in LVEF of 4.25 % (95 % CI 1.77–6.72; p < 0.001, I2 = 69 %) and an increase in 6MWD (mean difference 50.28 m, 95 % CI 8.78–91.78; p = 0.02; I2 = 81 %) after RDN. Left ventricular end-diastolic and end-systolic diameters, left
atrial diameter, and interventricular septal thickness also improved after RDN. NT-proBNP,
NYHA class, and heart rate were significantly decreased after RDN. There were no significant
changes in blood pressure after RDN. Mortality and HF-related hospitalization rates
were relatively low. There was no significant change in eGFR or creatinine after RDN.
Conclusions
Our findings suggest that RDN can effectively increase LVEF and 6MWD in patients with
HFrEF but require confirmation in studies with larger sample sizes and longer follow-up
durations.
Graphical abstract
Graphical Abstract
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure.Eur Heart J. 2021; 42: 3599-3726
- Treatment of HF in an era of multiple therapies: statement from the HF collaboratory.JACC Heart Fail. 2021; 9: 1-12
- Angiotensin receptor-neprilysin inhibition (ARNI) in heart failure.Int J Heart Fail. 2020; 2: 73-90
- Renal denervation and heart failure.Eur J Heart Fail. 2014; 16: 608-613
- First-in-man safety evaluation of renal denervation for chronic systolic heart failure: primary outcome from REACH-pilot study.Int J Cardiol. 2013; 162: 189-192
- Preliminary effects of renal denervation with saline irrigated catheter on cardiac systolic function in patients with heart failure: a prospective, randomized, controlled, pilot study.Catheter Cardiovasc Interv. 2017; 89: 153-161
- Percutaneous renal artery denervation in patients with chronic systolic heart failure: a randomized controlled trial.Cardiol J. 2019; 26: 503-510
- Sympathetic response and outcomes following renal denervation in patients with chronic heart failure: 12-month outcomes from the SymplicityHF feasibility study.J Card Fail. 2017; 23: 702-707
- Renal denervation in patients with symptomatic chronic heart failure despite resynchronization therapy - a pilot study.Postepy Kardiol Interwencyjnej. 2019; 15: 240-246
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.PLoS Med. 2009; 6: 1000100
- The Newcastle–Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis.(Available from:)
- Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range.BMC Med Res Meth. 2014; 14: 135
- Measuring inconsistency in meta-analyses.BMJ. 2003; 327: 557-560
- Renal denervation for the management of refractory ventricular arrhythmias: a systematic review.JACC Clin Electrophysiol. 2021; 7: 100-108
- Haemodynamic changes of interatrial shunting devices for heart failure: a systematic review and meta-analysis.ESC Heart Fail. 2022; 9: 1987-1995
- Renal denervation in patients with heart failure secondary to Chagas' disease: a pilot randomized controlled trial.Catheter Cardiovasc Interv. 2019; 94: 644-650
- Endovascular renal sympathetic denervation to improve heart failure with reduced ejection fraction: the IMPROVE-HF-I study.Neth Heart J. 2022; 30: 149-159
- Renal denervation in patients who do not respond to cardiac resynchronization therapy.Scand Cardiovasc J. 2022; 56: 103-106
- Effect of percutaneous renal sympathetic nerve radiofrequency ablation in patients with severe heart failure.Int J Clin Exp Med. 2015; 8: 9779-9785
- Effects of percutaneous renal sympathetic denervation on cardiac function and exercise tolerance in patients with chronic heart failure.Rev Port Cardiol. 2017; 36: 45-51
- Influence of renal sympathetic denervation in patients with early-stage heart failure versus late-stage heart failure.Int Heart J. 2018; 59: 99-104
- Efficacy and safety of catheter-based renal denervation for heart failure with reduced ejection fraction: a systematic review and meta-analysis.Clin Auton Res. 2020; 30: 521-530
- Effects of catheter-based renal denervation on heart failure with reduced ejection fraction: a meta-analysis of randomized controlled trials.Heart Fail Rev. 2022; 27: 29-36
- Safety and efficacy of renal denervation in patients with heart failure with reduced ejection fraction (HFrEF): a systematic review and meta-analysis.Heliyon. 2022; 8: 08847
- The relation between repeated 6-minute walk test performance and outcome in patients with chronic heart failure.Ann Phys Rehab Med. 2014; 57: 244-253
- Natriuretic peptides, 6-min walk test, and quality-of-life questionnaires as clinically meaningful endpoints in HF trials.J Am Coll Cardiol. 2016; 68: 2690-2707
- Validation of exercise capacity as a surrogate endpoint in exercise-based rehabilitation for heart failure: a meta-analysis of randomized controlled trials.JACC Heart Fail. 2018; 6: 596-604
- Monitoring clinical changes in patients with heart failure: a comparison of methods.Am Heart J. 2005; 150: 707-715
- The prognostic and diagnostic significance of serum BNP level in the classification of heart failure.Chin J Lab Diagn. 2020; 24: 895-899
- Twenty-four-hour heart rate lowering with ivabradine in chronic heart failure: insights from the SHIFT Holter substudy.Eur J Heart Fail. 2015; 17: 518-526
- Heart rate as a risk factor in chronic heart failure (SHIFT): the association between heart rate and outcomes in a randomised placebo-controlled trial.Lancet. 2010; 376: 886-894
- Percutaneous renal artery sympathetic denervation improves cardiac functions in patients with chronic heart failure.J Clin Cardiol. 2015; 31 (In Chinese): 1211-1214
- 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
- Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension.J Am Coll Cardiol. 2012; 59: 901-909
- Renal denervation prevents heart failure progression via inhibition of the renin-angiotensin system.J Am Coll Cardiol. 2018; 72: 2609-2621
- Renal sympathetic denervation in patients with treatment-resistant hypertension (The symplicity HTN-2 Trial): a randomised controlled trial.Lancet. 2010; 376: 1903-1909
- Renal sympathetic denervation for treatment of patients with heart failure: summary of the available evidence.Ann Med. 2017; 49: 384-395
- Changes in sympathetic nervous system activity after renal denervation: results from the randomised Oslo RDN study.Blood Press. 2021; 30: 154-164
- Inflammation as a prognostic marker in heart failure.Cureus. 2022; 14: 28605
- I brazilian registry of heart failure - clinical aspects, care quality and hospitalization outcomes.Arq Bras Cardiol. 2015; 104: 433-442
- Current status and future perspectives of renal denervation.Korean Circ J. 2021; 51: 717-732
- Racial differences in drug response. Altered sensitivity to and clearance of propranolol in men of Chinese descent as compared with American Whites.N Engl J Med. 1989; 320: 565-570
- Renal denervation in Asia: consensus statement of the Asia renal denervation consortium.Hypertension. 2020; 75: 590-602
- Observations on the nature of the enlargement, the regeneration of the nerves, and the function of the canine renal autograft.Br J Exp Path. 1961; 42: 106-113
- Reinnervation following catheter-based radio-frequency renal denervation.Exp Physiol. 2015; 100: 485-490
- Neural degeneration and regeneration in human renal transplants.N Engl J Med. 1970; 283: 222-224
- Long-term outcomes after catheter-based renal artery denervation for resistant hypertension: final follow-up of the randomised SYMPLICITY HTN-3 trial.Lancet. 2022; 400: 1405-1416
- European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions.Eur J Heart Fail. 2016; 18: 613-625
- Renal hemodynamics and renal function after catheter-based renal sympathetic denervation in patients with resistant hypertension.Hypertension. 2012; 60: 419-424
Article info
Publication history
Published online: February 11, 2023
Accepted:
January 2,
2023
Received in revised form:
December 13,
2022
Received:
November 1,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
