Renal sympathetic denervation in mild chronic kidney disease patients with chronic heart failure without indication of cardiac resynchronization therapy: a bridge to cardiac transplantation

Márcio Galindo Kiuchi,Helmut Pürerfellner,Shaojie Chen

doi:10.15761/jic.1000201

Abstract

Renal sympathetic denervation in mild chronic kidney disease patients with chronic heart failure without indication of cardiac resynchronization therapy: a bridge to cardiac transplantation

Highlights

Patients with heart failure (HF) are often refractory to pharmacologic treatment, including a combination of suppressive agents of the renin-angiotensin-aldosterone (RAA) system or in several times they do not have an indication of cardiac resynchronization therapy (CRT), remaining symptomatic and in an advanced functional New York Health Association (NYHA) class
They demonstrated that selective denervation of sympathetic nerves in the renal arteries significantly reduced sympathetic cardiac overdrive, as assessed by 123I metaiodobenzylguanidine (MIBG) scintigraphy, positively affecting Heart failure (HF) progression
We evaluated the safety and effectiveness of renal sympathetic denervation (RSD) for improvement of clinical parameters and in reducing damage to the heart, through echocardiographic parameters, and kidneys, by assessing estimated glomerular filtration rate and albumin:creatinine ratio (ACR), in patients with HF and without indication of CRT

Summary

Introduction

Patients with heart failure (HF) are often refractory to pharmacologic treatment, including a combination of suppressive agents of the renin-angiotensin-aldosterone (RAA) system or in several times they do not have an indication of cardiac resynchronization therapy (CRT), remaining symptomatic and in an advanced functional New York Health Association (NYHA) class. They contribute to the highest number of hospitalizations and an increased mortality rate. Adequate control of HF and its progression is sometimes a difficult goal to achieve in this patient population, and in most cases, is only resolved after heart transplantation, which in turn is not accessible. The aim of this study was to evaluate the safety and effects of renal sympathetic denervation (RSD) in reducing lesions on the heart and kidneys in patients with CKD and chronic HF refractory pharmacological therapy and QRS complex width

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Conclusion