Chen Shao-Liang, Zhang Hang, Xie Du-Jiang, Zhang Juan, Zhou Ling, Rothman Alexander M K, Stone Gregg W
From the Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.-L.C., L.Z.); Division of Cardiology, Stone Cardiac Institute, Nanjing, China (S.-L.C., G.W.S.); Division of Cardiology, Nanjing Heart Center, Nanjing, China (H.Z., D.-J.X., J.Z.); Division of Psychology, Emory College of Arts and Science, Atlanta, GA (M.-X.C.); Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom (A.M.K.R.); and Division of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (G.W.S.).
Circ Cardiovasc Interv. 2015 Nov;8(11):e002837. doi: 10.1161/CIRCINTERVENTIONS.115.002837.
The mechanisms underlying pulmonary arterial hypertension (PAH) are multifactorial. The efficacy of pulmonary artery denervation (PADN) for idiopathic PAH treatment has been evaluated. This study aimed to analyze the hemodynamic, functional, and clinical responses to PADN in patients with PAH of different causes.
Between April 2012 and April 2014, 66 consecutive patients with a resting mean pulmonary arterial pressure ≥25 mm Hg treated with PADN were prospectively followed up. Target drugs were discontinued after the PADN procedure. Hemodynamic response and 6-minute walk distance were repeatedly measured within the 1 year post PADN follow-up. The clinical end point was the occurrence of PAH-related events at the 1-year follow-up. There were no PADN-related complications. Hemodynamic success (defined as the reduction in mean pulmonary arterial pressure by a minimal 10% post PADN) was achieved in 94% of all patients, with a mean absolute reduction in systolic pulmonary arterial pressure and mean pulmonary arterial pressure within 24 hours of -10 mm Hg and -7 mm Hg, respectively. The average increment in 6-minute walk distance after PADN was 94 m. Worse PAH-related events occurred in 10 patients (15%), mostly driven by the worsening of PAH (12%). There were 8 (12%) all-cause deaths, with 6 (9%) PAH-related deaths.
PADN was safe and feasible for the treatment of PAH. The PADN procedure was associated with significant improvements in hemodynamic function, exercise capacity, and cardiac function and with less frequent PAH-related events and death at 1 year after PADN treatment. Further randomized studies are required to confirm the efficacy of PADN for PAH.
URL: http://www.chictr.trc.com.cn. Unique identifier: chiCTR-ONC-12002085.
肺动脉高压（PAH）的发病机制是多因素的。肺动脉去神经支配术（PADN）治疗特发性PAH的疗效已得到评估。本研究旨在分析不同病因PAH患者对PADN的血流动力学、功能及临床反应。
2012年4月至2014年4月，对66例静息平均肺动脉压≥25 mmHg且接受PADN治疗的患者进行前瞻性随访。PADN术后停用靶向药物。在PADN随访的1年内反复测量血流动力学反应和6分钟步行距离。临床终点是1年随访时PAH相关事件的发生情况。未发生与PADN相关的并发症。所有患者中有94%实现了血流动力学成功（定义为PADN术后平均肺动脉压至少降低10%），收缩肺动脉压和平均肺动脉压在术后24小时内的平均绝对降低值分别为-10 mmHg和-7 mmHg。PADN术后6分钟步行距离的平均增加量为94米。10例患者（15%）发生了更严重的PAH相关事件，主要原因是PAH病情恶化（12%）。全因死亡8例（12%），其中PAH相关死亡6例（9%）。
PADN治疗PAH安全可行。PADN手术与血流动力学功能、运动能力和心脏功能的显著改善相关，且在PADN治疗后1年PAH相关事件和死亡的发生率较低。需要进一步的随机研究来证实PADN治疗PAH的疗效。
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