title: Hemodynamic, functional, and clinical responses to pulmonary artery denervation in patients with pulmonary arterial hypertension of different causes: phase II results from the Pulmonary Artery Denervation-1 study.
abstract: BACKGROUND
  The mechanisms underlying pulmonary arterial hypertension (PAH) are multifactorial. The efficacy of pulmonary artery denervation (PADN) for idiopathic PAH treatment has been evaluated. This study aimed to analyze the hemodynamic, functional, and clinical responses to PADN in patients with PAH of different causes.
  
  
  RESULTS
  Between April 2012 and April 2014, 66 consecutive patients with a resting mean pulmonary arterial pressure ≥25 mm Hg treated with PADN were prospectively followed up. Target drugs were discontinued after the PADN procedure. Hemodynamic response and 6-minute walk distance were repeatedly measured within the 1 year post PADN follow-up. The clinical end point was the occurrence of PAH-related events at the 1-year follow-up. There were no PADN-related complications. Hemodynamic success (defined as the reduction in mean pulmonary arterial pressure by a minimal 10% post PADN) was achieved in 94% of all patients, with a mean absolute reduction in systolic pulmonary arterial pressure and mean pulmonary arterial pressure within 24 hours of -10 mm Hg and -7 mm Hg, respectively. The average increment in 6-minute walk distance after PADN was 94 m. Worse PAH-related events occurred in 10 patients (15%), mostly driven by the worsening of PAH (12%). There were 8 (12%) all-cause deaths, with 6 (9%) PAH-related deaths.
  
  
  CONCLUSIONS
  PADN was safe and feasible for the treatment of PAH. The PADN procedure was associated with significant improvements in hemodynamic function, exercise capacity, and cardiac function and with less frequent PAH-related events and death at 1 year after PADN treatment. Further randomized studies are required to confirm the efficacy of PADN for PAH.
  
  
  BACKGROUND
  URL: http://www.chictr.trc.com.cn. Unique identifier: chiCTR-ONC-12002085.
authors.affiliation: From the Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.-L.C., L.Z.); Division of Cardiology, Stone Cardiac Institute, Nanjing, China (S.-L.C., G.W.S.); Division of Cardiology, Nanjing Heart Center, Nanjing, China (H.Z., D.-J.X., J.Z.); Division of Psychology, Emory College of Arts and Science, Atlanta, GA (M.-X.C.); Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom (A.M.K.R.); and Division of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (G.W.S.). chmengx@126.com gstone@crf.org.
authors.forename: Shao-Liang
authors.initials: SL
authors.lastname: Chen
authors.affiliation: From the Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.-L.C., L.Z.); Division of Cardiology, Stone Cardiac Institute, Nanjing, China (S.-L.C., G.W.S.); Division of Cardiology, Nanjing Heart Center, Nanjing, China (H.Z., D.-J.X., J.Z.); Division of Psychology, Emory College of Arts and Science, Atlanta, GA (M.-X.C.); Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom (A.M.K.R.); and Division of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (G.W.S.).
authors.forename: Hang
authors.initials: H
authors.lastname: Zhang
authors.affiliation: From the Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.-L.C., L.Z.); Division of Cardiology, Stone Cardiac Institute, Nanjing, China (S.-L.C., G.W.S.); Division of Cardiology, Nanjing Heart Center, Nanjing, China (H.Z., D.-J.X., J.Z.); Division of Psychology, Emory College of Arts and Science, Atlanta, GA (M.-X.C.); Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom (A.M.K.R.); and Division of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (G.W.S.).
authors.forename: Du-Jiang
authors.initials: DJ
authors.lastname: Xie
authors.affiliation: From the Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.-L.C., L.Z.); Division of Cardiology, Stone Cardiac Institute, Nanjing, China (S.-L.C., G.W.S.); Division of Cardiology, Nanjing Heart Center, Nanjing, China (H.Z., D.-J.X., J.Z.); Division of Psychology, Emory College of Arts and Science, Atlanta, GA (M.-X.C.); Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom (A.M.K.R.); and Division of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (G.W.S.).
authors.forename: Juan
authors.initials: J
authors.lastname: Zhang
authors.affiliation: From the Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.-L.C., L.Z.); Division of Cardiology, Stone Cardiac Institute, Nanjing, China (S.-L.C., G.W.S.); Division of Cardiology, Nanjing Heart Center, Nanjing, China (H.Z., D.-J.X., J.Z.); Division of Psychology, Emory College of Arts and Science, Atlanta, GA (M.-X.C.); Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom (A.M.K.R.); and Division of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (G.W.S.).
authors.forename: Ling
authors.initials: L
authors.lastname: Zhou
authors.affiliation: From the Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.-L.C., L.Z.); Division of Cardiology, Stone Cardiac Institute, Nanjing, China (S.-L.C., G.W.S.); Division of Cardiology, Nanjing Heart Center, Nanjing, China (H.Z., D.-J.X., J.Z.); Division of Psychology, Emory College of Arts and Science, Atlanta, GA (M.-X.C.); Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom (A.M.K.R.); and Division of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (G.W.S.).
authors.forename: Alexander M K
authors.initials: AM
authors.lastname: Rothman
authors.affiliation: From the Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (S.-L.C., L.Z.); Division of Cardiology, Stone Cardiac Institute, Nanjing, China (S.-L.C., G.W.S.); Division of Cardiology, Nanjing Heart Center, Nanjing, China (H.Z., D.-J.X., J.Z.); Division of Psychology, Emory College of Arts and Science, Atlanta, GA (M.-X.C.); Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom (A.M.K.R.); and Division of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (G.W.S.). chmengx@126.com gstone@crf.org.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000328:Adult; D000368:Aged; D003240:Connective Tissue Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D003714:Denervation; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000294:innervation* / Q000601:surgery; D012008:Recurrence; D016896:Treatment Outcome
keywords: arterial pressure; denervation; familial primary pulmonary hypertension; hemodynamics; pulmonary artery