Splanchnic nerve block with botulinum toxin for therapy of chronic heart failure - mechanism of action (SPONGE-HF).
Splanchnic nerve block with botulinum toxin for therapy of chronic heart failure - mechanism of action (SPONGE-HF).
复制标题
用肉毒杆菌毒素进行内脏神经阻滞治疗慢性心力衰竭 - 作用机制 (SPONGE-HF)。
DOI：
10.1002/ejhf.2829
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发表时间：
2023
影响因子：
18.2
通讯作者：
Patel,Manesh
中科院分区：
文献类型：
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作者：
Fudim,Marat;Parikh,Kishan;Ganesh,Arun;Molinger,Jeroen;Ray,Neil;Coburn,Aubrie;Coyne,BrianJ;Swavely,AshleyG;Andrews,Jennifer;Gray,JamesMatthew;Rao,VishalN;Felker,GMichael;Borges-Neto,Salvador;Hernandez,AdrianF;Patel,Manesh
慢性心力衰竭（HF）的特点是运动能力有限，部分原因是心脏充盈压力过高。1麻醉短期阻断植神经，手术切除或导管消融长期阻断已被证明对降低心衰患者运动性血压升高是安全有效的。这些干预措施也改善了心衰患者的功能能力。2-5我们的目的是研究所提出的作用机制，包括通过减少从腹部到胸腔的血容量来改变血管容量，以及通过改善心肾功能来减少血管充血。我们使用一种新型的、微创的肉毒杆菌毒素长期内脏神经阻滞（SNB）来测试这些作用机制。本研究是一项针对慢性心衰患者的前瞻性、开放标签、单臂介入研究。符合条件的患者在运动时基线肺毛细血管楔压(PCWP)≥25 mmHg。患者接受有创血流动力学评估的心肺运动试验，随后经皮单侧含肉毒杆菌毒素SNB（100单位，不超过1.5单位/kg）。随后，患者在2周、4周和8周接受了重复仰卧心肺运动试验（CPET）的系列测试。仅在4周的检查中重复有创血流动力学和运动。在每次检查中，我们重复了全身和肺含水量的无创指标。需要放射性示踪剂的措施，如血容量分析和放射性体积描记术，仅在4周检查时重复。
Chronic heart failure (HF) is characterized by limited exercise capacity driven in part by an excessive elevation of cardiac filling pressures. 1 The short-term blockade of splanchnic nerves with anesthetics and long-term blockade with surgical resection or catheter-based ablation has proven to be safe and effective in reducing exercise-induced pressure elevation in patients with HF. 2–5 These interventions also improved the functional capacity of patients with HF. 2–5 We aimed to investigate the proposed mechanisms-of-action, including changes in vascular capacity with reduced blood volume shifts from the abdomen to the thorax, and vascular decongestion through an improved cardiorenal function. 6 We tested these mechanisms-of-action using a novel, minimally-invasive long-term splanchnic nerve block (SNB) with botulinum toxin.The present study was a prospective, open-label, single-arm interventional study in patients with chronic HF. Eligible patients had a baseline pulmonary capillary wedge pressure (PCWP)≥ 25 mmHg with exercise. Patients underwent cardiopulmonary exercise testing with invasive hemodynamic assessment, followed by percutaneous unilateral SNB with botulinum toxin (100 Units, not more than 1.5 Units/kg). Subsequently, patients underwent serial testing at 2, 4 and 8 weeks with repeat supine cardiopulmonary exercise testing (CPET). Invasive hemodynamics with exercise were repeated at the 4-week exam only. At each exam we repeated non-invasive metrics of whole body and lung water content. Measures requiring radiotracers such as blood volume analysis and radioplethysmography were repeated at the 4-week exam only.