Pulmonary Denervation Reduces Worsening in Heart Failure Patients

Adding pulmonary-artery denervation to guideline-directed medical therapy (GDMT) has demonstrated a significant reduction in clinical worsening among patients suffering from pulmonary hypertension linked to left heart disease and heart failure. These findings stem from a Chinese randomized trial, the results of which were presented at the American College of Cardiology (ACC) 2024 Scientific Session. The study focused on a specific patient population where pulmonary hypertension is a complication of underlying left ventricular dysfunction, a common scenario in advanced heart failure.

The trial enrolled 100 patients diagnosed with pulmonary hypertension associated with left heart disease and heart failure. These participants were randomly assigned to either receive GDMT alone or GDMT combined with pulmonary-artery denervation. Pulmonary-artery denervation is a procedure that targets the nerves surrounding the pulmonary arteries, aiming to reduce sympathetic nervous system activity that can contribute to vasoconstriction and elevated pulmonary pressures. The procedure involves catheter-based ablation of these nerves.

Over a median follow-up period of 18 months, the primary endpoint of clinical worsening was observed in a substantially lower proportion of patients in the denervation group compared to the control group. Clinical worsening was defined by a composite of events including death, hospitalization for heart failure, or a significant decline in functional status. Specifically, the denervation group experienced a 35% reduction in the risk of clinical worsening. This suggests that modulating the neural input to the pulmonary vasculature may offer a novel therapeutic avenue for this challenging patient subgroup.

While the study did not meet its secondary endpoints, such as significant improvements in pulmonary artery pressure or exercise capacity, the reduction in clinical worsening is considered a clinically meaningful outcome. The researchers highlighted that pulmonary hypertension in the context of left heart failure is notoriously difficult to treat, and current therapies primarily focus on managing the underlying cardiac dysfunction and its systemic consequences. Pulmonary-artery denervation represents a potential adjunctive therapy that targets a different pathophysiological mechanism. Further research, including larger, multi-center trials, is warranted to confirm these findings and to better understand the long-term efficacy and safety of this intervention. The study was conducted at a single center in China, and the patient population may not be fully representative of global demographics, underscoring the need for broader validation.