Work

Splanchnic Nerve Block with Botulinum Toxin for Therapy of Chronic Heart Failure – Mechanism of Action (SPONGE-HF)

Year: 2023

Type: article

Abstract: 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][3][4][5] These interventions also improved the functional capacity of patients with HF. [2][3][4][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.

Source: European Journal of Heart Failure