Elsevier

JACC: Heart Failure

Volume 8, Issue 9, September 2020, Pages 742-752
JACC: Heart Failure

Clinical Research
Splanchnic Nerve Block for Chronic Heart Failure

https://doi.org/10.1016/j.jchf.2020.04.010Get rights and content
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Abstract

Objectives

We hypothesized that splanchnic nerve blockade (SNB) would attenuate increased exercise-induced cardiac filling pressures in patients with chronic HF.

Background

Chronic heart failure (HF) is characterized by limited exercise capacity driven in part by an excessive elevation of cardiac filling pressures.

Methods

This is a prospective, open-label, single-arm interventional study in chronic HF patients. Eligible patients had a wedge pressure ≥15 mm Hg at rest or ≥25 mm Hg with exercise on baseline right heart catheterization. Patients underwent cardiopulmonary exercise testing with invasive hemodynamic assessment, followed by percutaneous SNB with ropivacaine.

Results

Nineteen patients were enrolled, 15 of whom underwent SNB. The average age was 58 ± 13 years, 7 (47%) patients were women and 6 (40%) were black. Left ventricular ejection fraction was ≤35% in 14 (93%) patients. No procedural complications were encountered. SNB reduced mean pulmonary arterial pressure at peak exercise from 54.1 ± 14.4 (pre-SNB) to 45.8 ± 17.7 mm Hg (p < 0.001) (post-SNB). Similarly, SNB reduced exercise-induced wedge pressure from 34.8 ± 10.0 (pre-SNB) to 25.1 ± 10.7 mm Hg (p < 0.001) (post-SNB). The cardiac index changed with peak exercise from 3.4 ± 1.2 (pre-SNB) to 3.8 ± 1.1 l/min/m2 (p = 0.011) (post-SNB). After SNB, patients exercised for approximately the same duration at a greater workload (33 ± 24 W vs. 50 ± 30 W; p = 0.019) and peak oxygen consumption VO2 (9.1 ± 2.5 vs. 9.8 ± 2.7 ml/kg/min; p = 0.053).

Conclusions

SNB reduced resting and exercise-induced pulmonary arterial and wedge pressure with favorable effects on cardiac output and exercise capacity. Continued efforts to investigate short- and long-term effects of SNB in chronic HF are warranted. Clinical Trials Registration (Abdominal Nerve Blockade in Chronic Heart Failure; NCT03453151)

Key Words

congestion
heart failure
splanchnic nerve block
sympathetic nervous system

Abbreviations and Acronyms

AVO2-diff
arterio-venous O2 difference
HF
heart failure
iCPET
invasive cardiopulmonary exercise test
LVEF
left ventricular ejection fraction
mPAP
mean pulmonary arterial pressure
mPCWP
mean pulmonary capillary wedge pressure
NT-proBNP
N-terminal pro–B-type natriuretic peptide
SNB
splanchnic nerve block
TFC
thoracic fluid content

Cited by (0)

Dr. Fudim has received grants from the American Heart Association Grant (17MCPRP33460225), the National Institutes of Health (NIH) (T32 grant 5T32HL007101), the Mario Family Award, and the Translating Duke Health Award; and has received personal fees from Coridea, AxonTherapies, Daxor, Edwards Lifesciences, and Galvani. Dr. DeVore has received grants from the American Heart Association, Amgen, Bayer, IntraCellular Therapies, Lutipold Pharmaceuticals, the National Heart, Lung, and Blood Institute (NHLBI), Novartis, and Patient Centered Outcomes Research Institute; and has received personal fees from Amgen, AstraZeneca, Bayer, InnaMed, LivaNova, Mardil Medical, Novartis, Procyrion, scPharmaceuticals, Zoll, and Abbott. Dr. Gutierrez has received personal fees from Amgen and Janssen Therapeutics. Dr. Jones has received grants from the Agency for Healthcare Research and Quality, AstraZeneca, American Heart Association, Bristol-Myers Squibb, the Doris Duke Charitable Foundation, Patient Centered Outcomes Research Institute; and has received personal fees from the American College of Radiology and Daiichi Sankyo. Dr. Felker has received grants from the NHLBI, the American Heart Association, Amgen, Merck, Cytokinetics, and Roche Diagnostics; and has received personal fees from Novartis, Amgen, Bristol-Myers Squibb, Cytokinetics, Medtronic, Cardionomic, Relypsa, V-Wave, Myokardia, Innolife, EBR Systems, Arena, Abbott, Sphingotec, Roche Diagnostics, Alnylam, LivaNova, Windtree Therapeutics, Rocket Pharma, and SC Pharma. Dr. Hernandez has received grants from AstraZeneca, GlaxoSmithKline, Merck, and Novartis; and has received personal fees from AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Merck, Novartis, and Pfizer. Dr. M.R. Patel has received grants from HeartFlow, Bayer, Janssen, and the NHLBI; and has been on advisory boards for HeartFlow, Bayer, and Janssen. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Barry Greenberg, MD, served as Guest Editor for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Heart Failure author instructions page.