Renal Sympathetic Denervation in Congestive Heart Failure

描述(由申请者提供)：该提案是将克利夫兰诊所庞大的基础设施、丰富的临床和研究经验以及大量心力衰竭患者，以及大学医院和MetroHealth医疗中心的临床试验专业知识和多样化的患者群体相结合，建立克利夫兰地区临床中心(RCC)。我们的目标是参与心力衰竭临床研究网络，由W.H.Wilson Tang博士和Randall C.领导，James Fang博士和Mark Dunlap博士作为联合研究员，并利用克利夫兰临床和翻译科学合作中心(CTSC)最近整合了我们三个机构的研究基础设施。特别是，我们希望扩大我们长期的学术兴趣，开发策略来缓解充血性心力衰竭的心肾损害。 我们建议的项目作为一项机制研究，以辨别肾交感神经在介导心肾综合征心脏和/或肾脏并发症中的可能作用。利用目前正在研究的一种新的、基于导管的肾交感神经去神经化(RSD)技术来治疗顽固性高血压(Symplicity导管系统)，我们测试了一种假设，即在最近因充血性心力衰竭而入院的高血压心力衰竭患者中，RSD可能提供神经激素谱的递增改善，改善心肾功能，并比常规治疗更容易缓解症状。我们的联盟提供了一个独特的机会，可以为整个网络做出贡献，该网络拥有心力衰竭方面的临床试验专业知识和领导力，以满足科学要求，以及广泛的地区患者群体，他们在广泛的执业环境中具有被证明有能力招募和满足绩效要求的人，并测试一种新的治疗方法，以应对当代心力衰竭最具挑战性的方面之一。 相关性(见说明)：由于老龄化人口的扩大和急性心血管疾病管理方面的治疗进展，心力衰竭的发病率总体上继续增加。心肾功能障碍的存在是心力衰竭充分治疗的主要障碍，进一步了解和采取新的策略来缓解心肾功能损害是改善预后的优先事项。

DESCRIPTION (provided by applicant): This proposal represents a joint effort combining the vast infrastructure, extensive clinical and research experience, as well as large patient volumes in heart failure at the Cleveland Clinic, together with the clinical trial expertise and diverse patient populations at University Hospitals and MetroHealth Medical Center to establish the Cleveland Regional Clinical Center (RCC). Led by Drs. W. H. Wilson Tang and Randall C. Starting and joined by Drs. James Fang and Mark Dunlap as co-investigators, and taking advantage of the Cleveland Clinical and Translational Sciences Collaborative (CTSC) that recently integrated the research infrastructure our three institutions, our goal is to participate n the Heart Failure Clinical Research Network to test new hypotheses and therapies to advance the management of heart failure. In particular, we hope to expand our longstanding academic interest in developing strategies to alleviate cardio-renal compromise in congestive heart failure. Our proposed project serves as a mechanistic study to discern the possible role of renal sympathetic nerves in mediating cardiac and/or renal complications of the cardio-renal syndrome. Utilizing a novel, catheter-based renal sympathetic denervation (RSD) technique currently under investigation for treatment of refractory hypertension (Symplicity Catheter System), we test the hypothesis that in patients with hypertensive heart failure recently admitted for congestive heart failure that RSD may provide incremental improvement in neurohormonal profile, improve cardio-renal function, and facilitate symptomatic relief over usual care. Our consortium provides a unique opportunity to contribute to the overall Network with clinical trials expertise and leadership in heart failure to fulfill the scientific requirements, and the diverse ad broad regional patient populations across a wide range of practice settings with proven abilities to recruit and fulfill the performance requirements, and to test a novel treatment approach to tackle one of the most challenging aspects of contemporary heart failure. RELEVANCE (See instructions): The incidence of heart failure continues to increase in large due to the expansion of the aging population and therapeutic advances in the management of acute cardiovascular diseases. The presence of cardio-renal dysfunction constitutes a major impediment to adequate management of heart failure, and further understanding and novel strategies to relieve cardio-renal compromise is a priority to improve outcomes.