title: Renal denervation in heart failure with preserved ejection fraction (RDT-PEF): a randomized controlled trial.
abstract: Heart failure with preserved ejection fraction (HFpEF) is associated with increased sympathetic nervous system (SNS) tone. Attenuating the SNS with renal denervation (RDT) might be helpful and there are no data currently in humans with HFpEF.
  
  
  
  In this single-centre, randomized, open-controlled study we included 25 patients with HFpEF [preserved left ventricular (LV) ejection fraction, left atrial (LA) dilatation or LV hypertrophy and raised B-type natriuretic peptide (BNP) or echocardiographic assessment of filling pressures]. Patients were randomized (2:1) to RDT with the Symplicity™ catheter or continuing medical therapy. The primary success criterion was not met in that there were no differences between groups at 12 months for Minnesota Living with Heart Failure Questionnaire score, peak oxygen uptake (VO2 ) on exercise, BNP, E/e', LA volume index or LV mass index. A greater proportion of patients improved at 3 months in the RDT group with respect to VO2 peak (56% vs. 13%, P = 0.025) and E/e' (31% vs. 13%, P = 0.04). Change in estimated glomerular filtration rate was comparable between groups. Two patients required plain balloon angioplasty during the RDT procedure to treat renal artery wall oedema.
  
  
  
  This study was terminated early because of difficulties in recruitment and was underpowered to detect whether RD improved the endpoints of quality of life, exercise function, biomarkers, and left heart remodelling. The procedure was safe in patients with HFpEF, although two patients did require intraprocedure renal artery dilatation.
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: Hitesh C
authors.initials: HC
authors.lastname: Patel
authors.affiliation: Ealing Hospital, Southall, London, UK.
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Rosen
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: Carl
authors.initials: C
authors.lastname: Hayward
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: Vassilios
authors.initials: V
authors.lastname: Vassiliou
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: Gillian C
authors.initials: GC
authors.lastname: Smith
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: Ricardo R
authors.initials: RR
authors.lastname: Wage
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Bailey
authors.affiliation: Guys and St Thomas' Hospital, London, UK.
authors.forename: Ronak
authors.initials: R
authors.lastname: Rajani
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: Alistair C
authors.initials: AC
authors.lastname: Lindsay
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: Dudley J
authors.initials: DJ
authors.lastname: Pennell
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: S Richard
authors.initials: SR
authors.lastname: Underwood
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Prasad
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: Raad
authors.initials: R
authors.lastname: Mohiaddin
authors.affiliation: Hammersmith Hospital, London, UK.
authors.forename: J Simon R
authors.initials: JS
authors.lastname: Gibbs
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Lyon
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003714:Denervation; D004452:Echocardiography; D017079:Exercise Tolerance; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009929:Organ Size; D010101:Oxygen Consumption; D012077:Renal Artery / Q000294:innervation*; D013318:Stroke Volume; D013562:Sympathectomy
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Heart failure with preserved ejection fraction; Meta-iodo-benzyl-guanidine; Noradrenaline; Renal denervation; Sympathetic nervous system