Renal denervation in patients with symptomatic chronic heart failure despite resynchronization therapy – a pilot study

Introduction
Renal denervation (RD) has been shown to decrease sympathetic function in patients with hypertension. Its efficacy in symptomatic chronic heart failure (CHF) patients not responding to cardiac resynchronization therapy (CRT) has not been evaluated.

Aim
To assess whether a less invasive treatment method – renal denervation – is safe in symptomatic heart failure patients despite optimal medical treatment and resynchronization therapy and whether it is associated with an improvement in clinical status, exercise capacity and hemodynamic parameters.

Material and methods
The study was an open-label, randomized, controlled clinical trial. Patients were divided into an intervention (RD) and a control group. Clinical data collection, blood pressure (BP) measurements, echocardiography, 6-minute walk test (6MWT) and laboratory tests were performed before, 6 and 12 months after RD. The patients were followed-up to 24 months.

Results
We included 20 patients aged 52.0 to 86.0 years (median age: 71.5 years), 15 males and 5 females with median left ventricular ejection fraction (LVEF) of 32.5%, body mass index 31.3 kg/m2. Renal denervation was safe, no significant adverse effects were registered. There were no significant differences in LVEF, BP, 6MWT and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration 6 and 12 months after RD or control.

Conclusions
Our results indicate that RD in CHF patients not responding to CRT is safe and does not worsen exercise capacity and hemodynamic parameters.