Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya, 467-8601, Japan.
Heart Fail Rev. 2017 Nov;22(6):657-664. doi: 10.1007/s10741-017-9629-0.
Despite the recent advances in the management of heart failure, the mortality of heart failure patients remains high. It is of urgent need to develop new therapy for heart failure. Heart failure is characterized by increased sympathetic activity, and chronic sympathetic activation is involved in the maintenance of the pathological state. Catheter-based renal denervation (RDN) has emerged as an invasive but safe approach that can reduce sympathetic activation. Studies have reported inconsistent results regarding the effect of RDN in heart failure patients due to limited power with small sample sizes. We aimed to conduct a meta-analysis of the effect of RDN on heart failure patients with reduced left ventricular (LV) ejection fraction (EF). An electronic search for studies examining the effect of RDN on LV function in heart failure patients with reduced EF was conducted. Two controlled (80 patients) and 2 uncontrolled studies (21 patients) were included in this meta-analysis. In the pooled analysis, 6 months after RDN, there was a greater increase in EF (weighted mean difference [95% CI] = 8.63 [6.02, 11.24] %) and a greater decrease in LV end-diastolic diameter (-0.58 [-0.83, -0.34] cm) in RDN group than in control group. No serious adverse events such as acute renal artery stenosis and dissection occurred. Our meta-analysis of feasibility studies suggests that RDN may improve LV function in heart failure patients with reduced EF, providing the rationale to conduct next phase trials to confirm the observed potential benefits of RDN.
尽管心力衰竭的治疗近年来取得了进展，但心力衰竭患者的死亡率仍然很高。迫切需要开发心力衰竭的新疗法。心力衰竭的特征是交感神经活性增加，慢性交感神经激活参与维持病理状态。基于导管的肾脏去神经支配（RDN）已成为一种侵入性但安全的方法，可以减少交感神经激活。由于样本量小，研究功率有限，研究报告了 RDN 对心力衰竭患者的影响结果不一致。我们旨在对 RDN 对射血分数降低的心力衰竭患者的影响进行荟萃分析。对检查 RDN 对射血分数降低的心力衰竭患者左心室（LV）功能影响的研究进行了电子检索。这项荟萃分析纳入了 2 项对照研究（80 例患者）和 2 项非对照研究（21 例患者）。在汇总分析中，RDN 治疗 6 个月后，RDN 组的 EF 增加更大（加权均数差 [95% CI] = 8.63 [6.02, 11.24]%），LV 舒张末期直径减小更多（-0.58 [-0.83, -0.34] cm）。没有发生严重不良事件，如急性肾动脉狭窄和夹层。我们对可行性研究的荟萃分析表明，RDN 可能改善射血分数降低的心力衰竭患者的 LV 功能，为进行下一阶段试验以证实 RDN 观察到的潜在益处提供了依据。
