A recent randomized trial from China has highlighted that incorporating pulmonary-artery denervation with guideline-directed medical therapy (GDMT) significantly reduced clinical worsening in patients suffering from pulmonary hypertension associated with left heart disease and heart failure.
Important Results
The 2-year probability of clinical worsening, which encompasses death, heart or lung transplantation, hospitalizations for heart failure, outpatient deterioration necessitating intravenous diuretics, or a decrease in the 6-minute walk distance, was remarkably lower at 25.7% in the denervation plus GDMT group, compared to 51.5% in the GDMT-only group (HR 0.49, 95% CI 0.30-0.82, P=0.006).
Secondary analyses confirmed similar outcomes even when excluding the 6-minute walk test metric from the composite endpoint, as reported by Dr. Shao-Liang Chen from Nanjing Medical University during the European Society of Cardiology Congress in Munich. These findings have also been published simultaneously in the New England Journal of Medicine.
Study Limitations
Dr. Chen acknowledged several limitations in the PADN-HF-PH trial, which included its open-label design, a relatively short follow-up period of approximately one year, and that it was conducted exclusively in China.
He mentioned that assessments regarding generalizability and the implications of blinding are underway in the continuing international sham-controlled PULSE-LHD trial.
Pathophysiology Insights
Pulmonary hypertension arising from left heart disease, coupled with heart failure, may result from sympathetic overactivation, contributing to increased pulmonary vascular resistance, right ventricular dysfunction, and adverse outcomes. The process of pulmonary-artery denervation disrupts the sympathetic nerves that supply the pulmonary artery, potentially diminishing sympathetic activity and subsequently improving patient outcomes.
Dr. Felix Mahfoud from University Hospital Basel in Switzerland described the findings of PADN-HF-PH as
Fuente: https://www.medpagetoday.com/meetingcoverage/esc/122861
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