The role of renal denervation in the treatment of heart failure

Paul A. Sobotka, Henry Krum, Michael Böhm, Darrel P. Francis, Markus P. Schlaich

Research output: Contribution to journalReview article

67 Citations (Scopus)

Abstract

The heart and kidney interact in terms of hemodynamics and neurohumoral regulatory mechanisms, and this helps to maintain circulatory homeostasis under normal conditions. However, the normal regulatory mechanisms become inappropriate in the setting of congestive heart failure (CHF), and significant renal dysfunction often develops in CHF patients. Activation of renal sympathetic efferent nerves causes renin release, sodium and water retention, and reduced renal blood flow, all hallmarks of the renal manifestations of CHF. An increase in plasma levels of angiotensin II that is mediated in part by renal sympathetic activation has an effect on the central nervous system to further increase global sympathetic tone. Renal sympathetic activity can be assessed clinically by renal norepinephrine spillover, and an increase in renal norepinephrine spillover in CHF predicts reduced survival. In addition to efferent sympathetic activation, activation of renal sensory nerves in CHF may cause a reflex increase in sympathetic tone that contributes to elevated peripheral vascular resistance and vascular remodeling as well as left ventricular remodeling and dysfunction. In animal models of heart failure, surgical renal denervation has been shown to improve both renal and ventricular function. Although surgical renal denervation has long been known to lower blood pressure and improve survival in patients with hypertension, the invasive nature of this approach and its associated complications has limited its appeal. However, a novel catheter-based device has recently been introduced that specifically interrupts both efferent and afferent renal nerves, and there is significant interest in the use of this device to treat both hypertension and CHF. Several ongoing clinical trials are investigating the safety and efficacy of renal denervation in patients with CHF.

Original languageEnglish
Pages (from-to)285-292
Number of pages8
JournalCurrent Cardiology Reports
Volume14
Issue number3
DOIs
Publication statusPublished - 1 Jun 2012
Externally publishedYes

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Denervation
Treatment Failure
Heart Failure
Kidney
Vascular Resistance
Norepinephrine
Hypertension
Equipment and Supplies
Ventricular Remodeling
Survival
Ventricular Function
Renal Circulation
Left Ventricular Dysfunction
Renin
Angiotensin II
Reflex
Homeostasis
Catheters
Central Nervous System
Animal Models

Cite this

Sobotka, Paul A. ; Krum, Henry ; Böhm, Michael ; Francis, Darrel P. ; Schlaich, Markus P. / The role of renal denervation in the treatment of heart failure. In: Current Cardiology Reports. 2012 ; Vol. 14, No. 3. pp. 285-292.
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The role of renal denervation in the treatment of heart failure. / Sobotka, Paul A.; Krum, Henry; Böhm, Michael; Francis, Darrel P.; Schlaich, Markus P.

In: Current Cardiology Reports, Vol. 14, No. 3, 01.06.2012, p. 285-292.

Research output: Contribution to journalReview article

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T1 - The role of renal denervation in the treatment of heart failure

AU - Sobotka, Paul A.

AU - Krum, Henry

AU - Böhm, Michael

AU - Francis, Darrel P.

AU - Schlaich, Markus P.

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N2 - The heart and kidney interact in terms of hemodynamics and neurohumoral regulatory mechanisms, and this helps to maintain circulatory homeostasis under normal conditions. However, the normal regulatory mechanisms become inappropriate in the setting of congestive heart failure (CHF), and significant renal dysfunction often develops in CHF patients. Activation of renal sympathetic efferent nerves causes renin release, sodium and water retention, and reduced renal blood flow, all hallmarks of the renal manifestations of CHF. An increase in plasma levels of angiotensin II that is mediated in part by renal sympathetic activation has an effect on the central nervous system to further increase global sympathetic tone. Renal sympathetic activity can be assessed clinically by renal norepinephrine spillover, and an increase in renal norepinephrine spillover in CHF predicts reduced survival. In addition to efferent sympathetic activation, activation of renal sensory nerves in CHF may cause a reflex increase in sympathetic tone that contributes to elevated peripheral vascular resistance and vascular remodeling as well as left ventricular remodeling and dysfunction. In animal models of heart failure, surgical renal denervation has been shown to improve both renal and ventricular function. Although surgical renal denervation has long been known to lower blood pressure and improve survival in patients with hypertension, the invasive nature of this approach and its associated complications has limited its appeal. However, a novel catheter-based device has recently been introduced that specifically interrupts both efferent and afferent renal nerves, and there is significant interest in the use of this device to treat both hypertension and CHF. Several ongoing clinical trials are investigating the safety and efficacy of renal denervation in patients with CHF.

AB - The heart and kidney interact in terms of hemodynamics and neurohumoral regulatory mechanisms, and this helps to maintain circulatory homeostasis under normal conditions. However, the normal regulatory mechanisms become inappropriate in the setting of congestive heart failure (CHF), and significant renal dysfunction often develops in CHF patients. Activation of renal sympathetic efferent nerves causes renin release, sodium and water retention, and reduced renal blood flow, all hallmarks of the renal manifestations of CHF. An increase in plasma levels of angiotensin II that is mediated in part by renal sympathetic activation has an effect on the central nervous system to further increase global sympathetic tone. Renal sympathetic activity can be assessed clinically by renal norepinephrine spillover, and an increase in renal norepinephrine spillover in CHF predicts reduced survival. In addition to efferent sympathetic activation, activation of renal sensory nerves in CHF may cause a reflex increase in sympathetic tone that contributes to elevated peripheral vascular resistance and vascular remodeling as well as left ventricular remodeling and dysfunction. In animal models of heart failure, surgical renal denervation has been shown to improve both renal and ventricular function. Although surgical renal denervation has long been known to lower blood pressure and improve survival in patients with hypertension, the invasive nature of this approach and its associated complications has limited its appeal. However, a novel catheter-based device has recently been introduced that specifically interrupts both efferent and afferent renal nerves, and there is significant interest in the use of this device to treat both hypertension and CHF. Several ongoing clinical trials are investigating the safety and efficacy of renal denervation in patients with CHF.

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KW - Kidney

KW - Norepinephrine

KW - Renal blood flow

KW - Renal denervation

KW - Sympathetic

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SP - 285

EP - 292

JO - Current Cardiology Reports

JF - Current Cardiology Reports

SN - 1523-3782

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ER -