RENAL DENERVATION: NEW OPTION OF NON-PHARMACOLOGICAL TREATMENT IN PATIENTS WITH ADVANCED HEART FAILURE

Introduction: At present, even at maximum optimal pharmacotherapy the perspective of patients with advanced heart failure (NYHA III, IV) who are not indicated for cardiac resynchronization therapy (CRT) ,ventricular assist devices (VAD) or heart transplant (HTx), is very limited. The annual mortality of these patients is 20-50%.

Aim of the study: The aim was to evaluate in a pilot study the effect of catheter renal denervation (RDN) in patients with heart failure NYHA III (IV) not indicated for CRT. The primary endpoint was combined: 12-month number of rehospitalizations for heart failure, left ventricular end-diastolic dimension (LVEDD) and complications of RDN.

Methods: 51 patients with advanced heart failure, NYHA III (IV) were randomized to perform either RDN + standard medical therapy or only standard medical therapy. RDN was realised in pts with previous CT angiography of renal arteries (RA), exclusion of secondary etilogy of hypertension and consent of the patient to participate in the study using catheter Simplicity 4 F (Medtronic, Inc.). The average number of lesions was 6.2 ±1.8 on the right RA, 5.9 ± 2.0 on the left RA . In patients a standard echocardiographic examination was realised before RDN, then at 6 and 12 months and three-month intervals were regularly followed in outpatient heart failure department.

Results: The was a significat improvement of  LV systolic function in pts with RDN (LVEF 25±12 x 31±14 at 12 M, p< 0.05) compared to the standard therapy (26 ± 11 28 ±12 at 12 M, p 0.67).

Conclusions: Catheter renal denervation may be a safe and effective alternative of non-pharmacological treatment in patients with advanced heart failure who are not indicated for CRT, VAD, or HTx. Effect of the RDN on the RAAS of these patients must be verified in a large prospective multicenter study.