Renal sympathetic denervation for treatment of patients with heart failure : summary of the available evidence
Heart failure syndrome results from compensatory mechanisms that operate to restore - back to normal - the systemic perfusion pressure. Sympathetic overactivity plays a pivotal role in heart failure; norepinephrine contributes to maintenance of the systemic blood pressure and increasing preload. Cardiac norepinephrine spillover increases in patients with heart failure; norepinephrine exerts direct toxicity on cardiac myocytes resulting in a decrease of synthetic activity and/or viability. Importantly, cardiac norepinephrine spillover is a powerful predictor of mortality in patients with moderate to severe HF. This provided the rationale for trials that demonstrated survival benefit associated with the use of beta adrenergic blockers in heart failure with reduced ejection fraction. Nevertheless, the MOXCON trial demonstrated that rapid uptitration of moxonidine (inhibitor of central sympathetic outflow) in patients with heart failure was associated with excess mortality and morbidity, despite reduction of plasma norepinephrine. Interestingly, renal norepinephrine spillover was the only independent predictor of adverse outcome in patients with heart failure, in multivariable analysis. Recently, renal sympathetic denervation has emerged as a novel approach for control of blood pressure in patients with treatment-resistant hypertension. This article summarizes the available evidence for the effect of renal sympathetic denervation in the setting of heart failure. Key messages Experimental studies supported a beneficial effect of renal sympathetic denervation in heart failure with reduced ejection fraction. Clinical studies demonstrated improvement of symptoms, and left ventricular function. In heart failure and preserved ejection fraction, renal sympathetic denervation is associated with improvement of surrogate endpoints.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2017 |
|---|---|
| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:49 |
|---|---|
| Enthalten in: |
Annals of medicine - 49(2017), 5 vom: 01. Aug., Seite 384-395 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Nammas, Wail [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Heart failure |
|---|
| Anmerkungen: |
Date Completed 01.03.2018 Date Revised 15.05.2018 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1080/07853890.2017.1282168 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM269680241 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM269680241 | ||
| 003 | DE-627 | ||
| 005 | 20231224225023.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231224s2017 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1080/07853890.2017.1282168 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0898.xml |
| 035 | |a (DE-627)NLM269680241 | ||
| 035 | |a (NLM)28276870 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Nammas, Wail |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Renal sympathetic denervation for treatment of patients with heart failure |b summary of the available evidence |
| 264 | 1 | |c 2017 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 01.03.2018 | ||
| 500 | |a Date Revised 15.05.2018 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Heart failure syndrome results from compensatory mechanisms that operate to restore - back to normal - the systemic perfusion pressure. Sympathetic overactivity plays a pivotal role in heart failure; norepinephrine contributes to maintenance of the systemic blood pressure and increasing preload. Cardiac norepinephrine spillover increases in patients with heart failure; norepinephrine exerts direct toxicity on cardiac myocytes resulting in a decrease of synthetic activity and/or viability. Importantly, cardiac norepinephrine spillover is a powerful predictor of mortality in patients with moderate to severe HF. This provided the rationale for trials that demonstrated survival benefit associated with the use of beta adrenergic blockers in heart failure with reduced ejection fraction. Nevertheless, the MOXCON trial demonstrated that rapid uptitration of moxonidine (inhibitor of central sympathetic outflow) in patients with heart failure was associated with excess mortality and morbidity, despite reduction of plasma norepinephrine. Interestingly, renal norepinephrine spillover was the only independent predictor of adverse outcome in patients with heart failure, in multivariable analysis. Recently, renal sympathetic denervation has emerged as a novel approach for control of blood pressure in patients with treatment-resistant hypertension. This article summarizes the available evidence for the effect of renal sympathetic denervation in the setting of heart failure. Key messages Experimental studies supported a beneficial effect of renal sympathetic denervation in heart failure with reduced ejection fraction. Clinical studies demonstrated improvement of symptoms, and left ventricular function. In heart failure and preserved ejection fraction, renal sympathetic denervation is associated with improvement of surrogate endpoints | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Renal sympathetic denervation | |
| 650 | 4 | |a heart failure | |
| 650 | 4 | |a left ventricular function | |
| 650 | 7 | |a Norepinephrine |2 NLM | |
| 650 | 7 | |a X4W3ENH1CV |2 NLM | |
| 700 | 1 | |a Koistinen, Juhani |e verfasserin |4 aut | |
| 700 | 1 | |a Paana, Tuomas |e verfasserin |4 aut | |
| 700 | 1 | |a Karjalainen, Pasi P |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Annals of medicine |d 1996 |g 49(2017), 5 vom: 01. Aug., Seite 384-395 |w (DE-627)NLM012634972 |x 1365-2060 |7 nnns |
| 773 | 1 | 8 | |g volume:49 |g year:2017 |g number:5 |g day:01 |g month:08 |g pages:384-395 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1080/07853890.2017.1282168 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 49 |j 2017 |e 5 |b 01 |c 08 |h 384-395 | ||