Despite the major progress in the treatment of heart failure, the burden of heart failure is steadily increasing in the Western world. Heart failure is characterized by increased sympathetic activity, and chronic sympathetic activation is involved in the maintenance of the pathological state. Recent studies have shown that catheter-based renal denervation (RDN) presents a safe and minimally invasive treatment option for uncontrolled hypertension, a condition that is driven by increased sympathetic activity. Although randomized controlled trials (RCTs) have examined the effect of RDN in heart failure patients, results are inconsistent due partly to limited power with small sample sizes. We aimed to conduct a meta-analysis of RCTs on the effect of RDN in heart failure patients with reduced left ventricular (LV) ejection fraction (EF). Electronic search identified 5 RCTs including 177 patients. In the pooled analysis, RDN increased LVEF (weighted mean difference (WMD) [95% CI] = 6.289 [1.883, 10.695]%) and 6-min walk distance (61.063 [24.313, 97.813] m) and decreased B-type natriuretic peptide levels (standardized mean difference [95% CI] = - 1.139 [- 1.824, - 0.454]) compared with control. In contrast, RDN did not significantly change estimated glomerular filtration rate (WMD [95% CI] = 5.969 [- 2.595, 14.533] ml/min/1.73 m2) and systolic (- 1.991 [- 15.639, 11.655] mmHg) or diastolic (- 0.003 [- 10.325, 10.320] mmHg) blood pressure compared with control. Our meta-analysis suggests that RDN may improve LV function and exercise capacity in heart failure patients with reduced EF, providing the rationale to conduct large-scale multicenter trials to confirm the observed potential benefits of RDN.

中文翻译：

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基于导管的肾去神经支配对射血分数降低的心力衰竭的影响：随机对照试验的荟萃分析。

尽管心力衰竭的治疗取得了重大进展，但西方世界的心力衰竭负担正在稳步增加。心力衰竭的特征是交感神经活动增加，慢性交感神经激活参与病理状态的维持。最近的研究表明，基于导管的肾去神经支配 (RDN) 为不受控制的高血压提供了一种安全且微创的治疗选择，这种情况是由交感神经活动增加驱动的。尽管随机对照试验 (RCT) 已经检查了 RDN 对心力衰竭患者的影响，但结果不一致，部分原因是样本量小，功效有限。我们旨在对 RDN 对左心室 (LV) 射血分数 (EF) 降低的心力衰竭患者的影响进行一项荟萃分析。电子搜索确定了 5 项 RCT，包括 177 名患者。在汇总分析中，RDN 增加了 LVEF（加权平均差 (WMD) [95% CI] = 6.289 [1.883, 10.695]%）和 6 分钟步行距离（61.063 [24.313, 97.813] m）并降低了 B 型利尿钠肽水平（标准化平均差 [95% CI] = - 1.139 [- 1.824, - 0.454]）与对照相比。相比之下，RDN 没有显着改变估计的肾小球滤过率（WMD [95% CI] = 5.969 [- 2.595, 14.533] ml/min/1.73 m2）和收缩压（- 1.991 [- 15.639, 11.655] mmHg）或舒张压（ - 0.003 [- 10.325, 10.320] mmHg) 血压与对照相比。我们的荟萃分析表明，RDN 可以改善 EF 降低的心力衰竭患者的左室功能和运动能力，