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