Ablating the renal nerves to treat heart failure with reduced ejection fraction: another treatment option in a crowded s
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EDITORIAL
Ablating the renal nerves to treat heart failure with reduced ejection fraction: another treatment option in a crowded space? Murray Esler1 Received: 29 October 2020 / Accepted: 30 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Keywords Renal denervation · Sympathetic nervous system · Heart failure · Renal sympathetic nerves Howard Levin and Mark Gelfand first showed the feasibility of catheter-based renal denervation for cardiovascular diseases almost 20 years ago [US provisional patents 60/370 190 (April 2002), 60/415 575 (October 2002) and 60/442 970 (January 2003)]. Sympathetic nerves pass to the human kidneys via the outer wall and peri-adventitial region of the renal arteries, within reach of ablative energy delivered from the artery lumen. The renal sympathetic outflow is activated in hypertension, heart failure, obesity and hepatic cirrhosis [1], so that the renal sympathetic nerves came to be seen as a logical, potential target in these disorders. Levin and Gelfand initially envisioned an application of catheter-based renal denervation in heart failure. The patents for renal denervation were acquired by The Foundry, an innovative venture capital group, which initiated a program of renal denervation in severe, drug-resistant hypertension. This was conducted by the start-up company, Ardian, whose engineers developed and tested renal denervation catheters delivering radiofrequency energy. The first two trials of catheter-based renal denervation for drugresistant hypertension commenced in Melbourne in 2007 and 2009, with subsequent publication of the trial outcomes in the Lancet in 2009 and 2010 [2, 3]. Renal denervation is now an approved device for the treatment of hypertension in more than 20 countries, in spite of which it remains experimental in US. In this issue of Clinical Autonomic Research, a meta-analysis by Lian and colleagues [4] takes renal denervation back full circle to its origins, the planned therapeutic application of this technology in heart failure. The meta-analysis is timely. A previous review of renal denervation in heart failure suggested benefit, but was based * Murray Esler [email protected] 1
Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC 3004, Australia
on too few studies to be definitive [5]. The addition of six original studies published in the past 3 years now allows the authors of this meta-analysis to conclude that the treatment is both safe and beneficial. The meta-analysis conformed to the features expected for validity. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed [6]. Strict and appropriate trial inclusion and exclusion criteria were applied. The Newcastle–Ottawa Scale was used to assess the quality of the trials (https://www.ohri.ca/clinical_epidemiology/oxfor d.asp). The contribution of each trial to the pooled estimates of effects was assessed in a sensitivity analysis. Publication bias was tested for with Begg’s funnel plot and Egger’s t
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