Splanchnic nerve block for decompensated chronic heart failure: splanchnic-HF

Abstract

This first-in-man proof-of-concept study tested a new therapeutic approach to the treatment of ADHF. This study supports the splanchnic nerve as a potential therapeutic target in ADHF.<br>Thirteen patients were enrolled and 11 underwent the procedure.No procedural or haemodynamic complications were observed for48 h. The average age was 64± 13 years, 8 of 11 patients were maleand 6 of 11 were black. Ischaemic disease was present in sevenpatients. All patients had advanced systolic/diastolic HF with a leftventricular ejection fraction (LVEF) of an LVEF of 45% in one patient. Six patients were on inotropic agents(milrinone or dobutamine).Bilateral SNB resulted in temporary reduction of invasive haemodynamicssuch as mean PCWPs from 30± 7mmHg at baseline to22± 7mmHg at 30 min, P &lt; 0.001 (Figure 1B). The cardiac indexincreased from 2.17 ± 0.74 L/min/m2 at baseline to 2.59 ± 0.65 L/min/m2 at 30min (P=0.007).Splanchnic nerve block temporarily reduced the cardiac sympathetictone as measured by heart rate variability parameters at 30minwithout significant changes at the end of the 90min (Figure 1C).Similar changes were observed for surrogate markers of the sympathetictone such as catecholamines. Following SNB, we observed atrend towards a decrease in central vascular pulse wave velocity, anindex of vascular stiffness and thoracic fluid content, measured withbioelectrance technology (Figure 1C).There was a decrease in mean left atrial volume index followingSNB (76 ± 23mL vs. 64 ± 12mL; P= 0.043) without changes in leftventricular size or diastolic function. Finally, patients reported anacute improvement in symptoms during the procedure (Figure 1D)and had an increase in average 6-min walk distance of 8.7± 51.6 m(range -115 to 71 m) from before to after the procedure (P=0.606)and 24.7± 31.2 m (range -28 to 71 m) 24 h after the procedure (P= 0.045).