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

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journal contribution
posted on 2019-03-10, 14:29 authored by Marat Fudim, Arun Ganesh, cynthia green, W Schuyler Jones, Michael Blazing, Adam Devore, G. Michael Felker, Todd Kiefer, David Kong, Richard Boortz-Marx, Adrian F. Hernandez, Manesh R. Patel

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

(P= 0.045).


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