Splanchnic nerve block for decompensated chronic heart failure: splanchnic-HF

<p>This first-in-man proof-of-concept study tested a new therapeutic approach</p> <p>to the treatment of ADHF. This study supports the splanchnic</p> <p>nerve as a potential therapeutic target in ADHF.</p><p><br></p><p>Thirteen patients were enrolled and 11 underwent the procedure.</p><p>No procedural or haemodynamic complications were observed for</p><p>48 h. The average age was 64± 13 years, 8 of 11 patients were male</p><p>and 6 of 11 were black. Ischaemic disease was present in seven</p><p>patients. All patients had advanced systolic/diastolic HF with a left</p><p>ventricular ejection fraction (LVEF) of <_30% in 10 of 11 patients and</p><p>an LVEF of 45% in one patient. Six patients were on inotropic agents</p><p>(milrinone or dobutamine).</p><p>Bilateral SNB resulted in temporary reduction of invasive haemodynamics</p><p>such as mean PCWPs from 30± 7mmHg at baseline to</p><p>22± 7mmHg at 30 min, P < 0.001 (Figure 1B). The cardiac index</p><p>increased from 2.17 ± 0.74 L/min/m2 at baseline to 2.59 ± 0.65 L/min/</p><p>m2 at 30min (P=0.007).</p><p>Splanchnic nerve block temporarily reduced the cardiac sympathetic</p><p>tone as measured by heart rate variability parameters at 30min</p><p>without significant changes at the end of the 90min (Figure 1C).</p><p>Similar changes were observed for surrogate markers of the sympathetic</p><p>tone such as catecholamines. Following SNB, we observed a</p><p>trend towards a decrease in central vascular pulse wave velocity, an</p><p>index of vascular stiffness and thoracic fluid content, measured with</p><p>bioelectrance technology (Figure 1C).</p><p>There was a decrease in mean left atrial volume index following</p><p>SNB (76 ± 23mL vs. 64 ± 12mL; P= 0.043) without changes in left</p><p>ventricular size or diastolic function. Finally, patients reported an</p><p>acute improvement in symptoms during the procedure (Figure 1D)</p><p>and had an increase in average 6-min walk distance of 8.7± 51.6 m</p><p>(range -115 to 71 m) from before to after the procedure (P=0.606)</p><p>and 24.7± 31.2 m (range -28 to 71 m) 24 h after the procedure</p><p> </p><p>(P= 0.045).</p>

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