TCT CONNECT-422 Effect of Sympathetic Renal Denervation on Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis

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Journal of the American College of Cardiology


BACKGROUND Increased sympathetic activity is thought to be involved in the pathogenesis of congestive heart failure and associated end-organ damage. Renal sympathetic denervation (RDN) is a treatment strategy to mitigate this effect and potentially improve outcomes in these patients. We performed a systematic review and meta-analysis of clinical trials to evaluate the effects of RDN on patients with heart failure with reduced ejection fraction (HFrEF). METHODS We searched PubMed, Embase, MEDLINE, and Cochrane databases from inception to February 2020 for all clinical trials. Four studies with a total of 160 patients met our inclusion criteria. Eighty patients received RDN in addition to optimal medical therapy, and 80 patients received optical medical therapy only. The primary outcome was change in ejection fraction (EF) at the 6-month follow-up. The secondary outcomes assessed were left ventricular end-diastolic diameter (LVEDD), 6- minute walk test (6MWT), systolic blood pressure, and heart rate. An inverse variance random-effects model was used to calculate the mean difference (MD) and 95% confidence intervals (CIs). RESULTS EF significantly improved at the 6-month follow-up in the RDN group (MD ¼ 5.60; 95% confidence interval: 1.73 to 9.47; p ¼ 0.005]. LVEDD was also reduced in the RDN group compared with the control group (MD ¼ 0.49; 95% CI: 0.72 to 0.27; p < 0.0001), but there was no significant improvement in the 6MWT (MD ¼ 33.29; 95% CI: 51.65 to 118.22; p < 0.0001]. Systolic blood pressure was similar among the 2 groups, but there was greater heart rate reduction in RDN patients (MD ¼ 7.40; 95% CI: 13.10 to 1.71; p ¼ 0.01).CONCLUSION Patients with HFrEF may benefit from RDN as manifested by improvement in EF and LVEDD. However, no significant change in 6MWT was detected, making the clinical benefit questionable. Larger randomized studies are needed to further study the efficacy and safety of RDN in HFrEF.




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