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Dimitriadis K, Iliakis P, Pyrpyris N, Tatakis F, Fragkoulis C, Mantziaris V, Plaitis A, Beneki E, Tsioufis P, Hering D, Kollias A, Konstantinidis D, Tsioufis K. Renal Denervation in Heart Failure Treatment: Data for a Self-Fulfilling Prophecy. J Clin Med 2024; 13:6656. [PMID: 39597800 PMCID: PMC11594571 DOI: 10.3390/jcm13226656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Revised: 11/02/2024] [Accepted: 11/04/2024] [Indexed: 11/29/2024] Open
Abstract
Renal denervation (RDN), a transcatheter renal sympathetic nerve ablation procedure, is a relatively novel established procedure for the treatment of hypertension, with it being recognized as a third option for hypertension management in the most recent European guidelines, together with pharmacotherapy, for achieving blood pressure targets. Given the relationship between both hypertension and sympathetic overdrive and the development of heart failure (HF), even studies at the dawn of research on RDN explored it as a treatment to overcome diuretic resistance in those patients. As it is now recognized that RDN does not only have organ-specific but also systemic effects, several investigators have aimed to delineate whether renal sympathetic denervation could alter the prognosis, symptoms, and adverse events of HF patients. Data are available in both HF patients with reduced and preserved ejection fraction. As the significance of neuromodulation is gaining grounds in the HF therapeutic arsenal, in this review, we aim to provide a rationale for using RDN in HF and an up-to-date overview of available data in both HF phenotypes, as well as discuss the future of neuromodulatory therapy in HF management.
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Affiliation(s)
- Kyriakos Dimitriadis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
| | - Panagiotis Iliakis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
| | - Nikolaos Pyrpyris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
| | - Fotis Tatakis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
| | - Christos Fragkoulis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
| | - Vasileios Mantziaris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
| | - Aristides Plaitis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
| | - Eirini Beneki
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
| | - Panagiotis Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, 80-214 Gdansk, Poland;
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, 115 27 Athens, Greece;
| | - Dimitrios Konstantinidis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (P.I.); (N.P.); (F.T.); (C.F.); (V.M.); (A.P.); (E.B.); (P.T.); (D.K.); (K.T.)
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Cao S, Deng Q, Wang Y, Zhou Y, Zhou Q. Ultrasound-targeted microbubble destruction-mediated Ang1 gene transfection improves left ventricular structural and sympathetic nerve remodeling in canines with myocardial infarction. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:221. [PMID: 33708848 PMCID: PMC7940881 DOI: 10.21037/atm-20-839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The present study aimed to determine whether ultrasound-targeted microbubble destruction (UTMD)-mediated angiopoietin 1 (Ang1) gene transfection can improve angiogenesis and potentially reverse left ventricular (LV) structural and sympathetic nerve remodeling in canines with myocardial infarction (MI). Methods Thirty dogs were randomly divided into groups (n=10/group) as follows: the MI group (MI dogs without UTMD treatment), the UTMD group (MI dogs with UTMD-mediated negative control plasmid treatment), and the UTMD-Ang1 group (MI dogs with UTMD-mediated Ang1 plasmid treatment). LV dimensions, systolic function, and synchrony were used to reflect the structural remodeling. The density of tyrosine hydroxylase (TH)- and growth-associated protein 43 (GAP43)-positive nerve fibers were calculated to assess the sympathetic nerve remodeling. Results One month after treatment, the UTMD-Ang1 group showed lower LV end-diastolic dimension (LVEDD: 31.2±2.3 mm) and higher LV ejection fraction (LVEF: 44.6%±4.3%) than the MI group (LVEDD: 34.5±2.2 mm, t=2.282, P=0.014; LVEF: 37.3%±3.1%, t=3.718, P=0.003) and the UTMD group (LVEDD: 34.1±2.8 mm, t=2.264, P=0.040; LVEF: 39.3%±4.5%, t=2.408, P=0.030). LV synchrony was higher in the UTMD-Ang1 group compared with the MI group by 2-dimensional speckle-tracking echocardiography. Angiogenic density was higher in the UTMD group than the MI group but was highest in the UTMD-Ang1 group according to immunohistochemistry of CD31 and α-smooth muscle actin staining. The density of TH- and GAP43-positive nerve fibers were decreased in the UTMD-Ang1 group (TH: 1,928.2±376.6 μm2/mm2; GAP43: 2,090.8±329.2 μm2/mm2) compared with the MI group (TH: 2916.5±558.4 μm2/mm2, t=4.069, P=0.001; GAP43: 3,275.4±548.6 μm2/mm2, t=5.153, P=0.000) and the UTMD group (TH: 2,552.7±408.1 μm2/mm2, t=3.181, P=0.007; GAP43: 2,630.5±419.3 μm2/mm2, t=2.863, P=0.013). The relative Ang1 and sarcoplasmic reticulum Ca2+-ATPase 2a protein levels were significantly higher in the UTMD-Ang1 group than the UTMD and MI groups by Western blot, while the phospholamban levels exhibited the opposite trend. Plasma norepinephrine and N-terminal pro-B-type-natriuretic peptide were significantly reduced in the UTMD-Ang1 group from day 1 to 1 month after MI. Conclusions UTMD-mediated Ang1 transfection can promote angiogenesis, reverse LV structural and sympathetic nerve remodeling, and improve LV synchrony after MI.
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Affiliation(s)
- Sheng Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing Deng
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yijia Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yanxiang Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
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Luo Q, Jin Q, Zhang N, Huang S, Han Y, Lin C, Ling T, Chen K, Pan W, Wu L. Antifibrillatory effects of renal denervation on ventricular fibrillation in a canine model of pacing-induced heart failure. Exp Physiol 2017; 103:19-30. [PMID: 29094471 DOI: 10.1113/ep086472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/27/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Qingzhi Luo
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Qi Jin
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Ning Zhang
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Shangwei Huang
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Yanxin Han
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Changjian Lin
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Tianyou Ling
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Kang Chen
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Wenqi Pan
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Liqun Wu
- Department of Cardiology, Shanghai Ruijin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
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Liao SY, Zhen Z, Liu Y, Au KW, Lai WH, Tsang A, Tse HF. Improvement of Myocardial Function Following Catheter-Based Renal Denervation in Heart Failure. ACTA ACUST UNITED AC 2017; 2:270-281. [PMID: 30062148 PMCID: PMC6034460 DOI: 10.1016/j.jacbts.2017.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 01/25/2017] [Accepted: 03/05/2017] [Indexed: 01/14/2023]
Abstract
A porcine model of heart failure was induced by myocardial infarction followed by rapid ventricular pacing for 4 weeks. Catheter-based renal denervation was performed using an expandable basket with 4 electrodes to deliver radiofrequency energy. Histological examination showed significant denervation of the renal arteries after the procedure. Compared with the control group, animals that received renal denervation showed significant improvement of cardiac function as determined by LV ejection fraction, maximum rate of LV pressure rise normalized to instantaneous developed pressure, and reduction of myocardial and renal norepinephrine gradient at 10 weeks after procedure.
Renal denervation (RD) is a potential novel nonpharmacological therapy for heart failure (HF). We performed bilateral catheter-based RD in 10 adult pigs and compared them with 10 control subjects after induction of HF to investigate the long-term beneficial effects of RD on left ventricular (LV) function and regional norepinephrine gradient after conventional HF pharmacological therapy. Compared with control subjects, animals treated with RD demonstrated an improvement in LV function and reduction of norepinephrine gradients over the myocardium and kidney at 10-week follow-up. Our results demonstrated that effective bilateral RD decrease regional norepinephrine gradients and improve LV contractile function compared with medical therapy alone.
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Affiliation(s)
- Song-Yan Liao
- Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Zhe Zhen
- Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Yuan Liu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Kai-Wing Au
- Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Wing-Hon Lai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Anita Tsang
- Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China.,Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China.,Shenzhen Institutes of Research and Innovation, University of Hong Kong, Hong Kong, China
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Affiliation(s)
- W.H. Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio
- Center for Clinical Genomics, Cleveland Clinic, Cleveland, Ohio
| | - Mark E. Dunlap
- Heart & Vascular Center, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
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Lu Y, Zhang L, Zhou X, Tang B. Renal sympathetic denervation: A potential alternative strategy for managing patients with heart failure. Int J Cardiol 2015; 201:140-1. [PMID: 26298357 DOI: 10.1016/j.ijcard.2015.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/01/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Yanmei Lu
- Department of Cardiology, First Affiliated Hospital, Xinjiang Medical University, Urumqi 830054, China
| | - Ling Zhang
- Department of Cardiology, First Affiliated Hospital, Xinjiang Medical University, Urumqi 830054, China
| | - Xianhui Zhou
- Department of Cardiology, First Affiliated Hospital, Xinjiang Medical University, Urumqi 830054, China
| | - Baopeng Tang
- Department of Cardiology, First Affiliated Hospital, Xinjiang Medical University, Urumqi 830054, China.
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