Gajewski Piotr, Fudim Marat, Kittipibul Veraprapas, Engelman Zoar J, Biegus Jan, Zymliński Robert, Ponikowski Piotr
Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland.
Institute of Heart Diseases, Medical University, 50-556 Wroclaw, Poland.
J Clin Med. 2022 Feb 18;11(4):1063. doi: 10.3390/jcm11041063.
Permanent ablation of the right greater splanchnic nerve (GSN) has previously been demonstrated to improve quality of life and functional outcomes, as well as reduce abnormally high intracardiac filling pressures, in patients with heart failure with preserved ejection fraction (HFpEF) at 1, 3 and 12 months following the procedure. We hypothesize that hemodynamic changes that ensue from surgical right GSN ablation would be apparent as early as 24 h after the medical intervention.
This is a prespecified analysis of a single-arm, two-center, open-label study evaluating the effects of right GSN ablation via thoracoscopic surgery in HFpEF patients with pulmonary capillary wedge pressure (PCWP) ≥15 mmHg at rest or ≥25 mmHg with supine cycle ergometry. A total of seven patients (median age 67 years, 29% female) underwent GSN removal followed by invasive right heart catheterization within 24 h. GSN ablation resulted in a significant reduction in PCWP 24 h after the procedure compared to baseline for both 20 W exercise (baseline (28.0 ± 4.3 mmHg) to 24 h (19.6 ± 6.9 mmHg); = 0.0124) and peak exercise (baseline (25.6 ± 2.4 mmHg) to 24 h (17.4 ± 5.9 mmHg); = 0.0025). There were no significant changes in resting or leg-up hemodynamics.
Permanent right GSN ablation leads to a reduction in intracardiac filling pressures during exercise, apparent as early as 24 h following the procedure.
先前的研究表明，对于射血分数保留的心力衰竭（HFpEF）患者，永久性消融右侧内脏大神经（GSN）可改善生活质量和功能结局，并降低异常升高的心腔内充盈压，在术后1个月、3个月和12个月时均有此效果。我们假设，手术切除右侧GSN后引起的血流动力学变化在医学干预后24小时就会明显显现。
这是一项对单臂、两中心、开放标签研究的预先设定分析，该研究评估了通过胸腔镜手术对静息时肺毛细血管楔压（PCWP）≥15 mmHg或仰卧位蹬车运动时PCWP≥25 mmHg的HFpEF患者进行右侧GSN消融的效果。共有7名患者（中位年龄67岁，29%为女性）接受了GSN切除，随后在24小时内进行了有创右心导管检查。与基线相比，GSN消融术后24小时，无论是20 W运动（基线（28.0±4.3 mmHg）至24小时（19.6±6.9 mmHg）；P = 0.0124）还是峰值运动时（基线（25.6±2.4 mmHg）至24小时（17.4±5.9 mmHg）；P = 0.0025），PCWP均显著降低。静息或抬腿时的血流动力学无显著变化。
永久性右侧GSN消融可导致运动期间心腔内充盈压降低，在术后24小时就明显可见。
