Pulmonary artery denervation improved 6MWD by 92m, reduced mPAP by 11.84mmHg, PVR by 4.88mmHg, and lowered clinical worsening (OR 0.30) in pulmonary hypertension.
Does pulmonary artery denervation improve functional and echocardiographic parameters and reduce clinical worsening in patients with pulmonary hypertension?
Pulmonary artery denervation significantly improves functional status, hemodynamics, and reduces clinical worsening in patients with pulmonary hypertension.
Absolute Event Rate: 0% vs 0%
Abstract Background This study aims to assess the feasibility of pulmonary artery denervation (PADN) and its impact on echocardiographic and functional improvements and mortality rates in patients with pulmonary hypertension (PH). Methods We systematically searched for the studies evaluating the findings of pulmonary artery denervation for PH. The efficacy and safety outcomes in functional and echocardiographic parameters, including 6-min walking distance (6MWD); Mean pulmonary artery pressure (mPAP); Pulmonary vascular resistance (PVR); Cardiac output (CO); Tricuspid annular plane systolic excursion (TAPSE); and right ventricular fractional area change (RV FAC), and NT-ProBNP. The secondary outcomes were overall mortality and clinical worsening. Results Nine studies with 454 patients were included. The mean age was 47.8 years (95% CI: 42.2 to 53.5 years), 57% (43% to 71%) was female, and 79% (95% CI: 61% to 90%) were in NYHA functional class III or IV. Regarding the change of 6MWD for pH patients comparing the control group (Std diff in means = 2.62, 95%CI (0.57 to 4.66), P = .012), the difference was statistically significant (MD = 92.03m; 95% CI: 46.37 to 137.68, P 0.001) in subgroup indicating that PADN therapy can improve the 6-minute walking distance of pH patients. Echocardiographic findings after PADN indicated noticeable reductions in mPAP (MD = −11.84; 95% CI: −16.46 to −7.23 mmHg; P 0.001), PVR (MD = −4.88; 95% CI: −6.81 to −2.95 mmHg; P 0.001), RV Tei-index (MD = −0.15; 95% CI: −0.21 to −0.10 mmHg; P 0.001). There was significant improvement detected in CO (MD = 0.55; 95% CI: 0.30 to 0.81 %; P 0.001), TAPSE (MD = 0.23mm; 95% CI: -0.02 to 4.90 %; P = 0.07) and RV FAC (MD = 4.69; 95% CI: 0.96 to 8.42 %; P = 0.014) after PADN treatment. Pooled analyses demonstrated negligible differences between PADN and control group in terms all-cause death (OR = 0.53; 95% CI: 0.24 to 1.18; P = .12) and transplantation (OR = 0.20; 95% CI: 0.009 to 4.27; P = .30), while clinical worsening (OR = 0.30; 95% CI: 0.15 to 0.60; P= .001) and rehospitalisation (OR = 0.07; 95% CI: 0.019 to 0.28; P 0.001) were noticeably lower in the PADN group. Conclusions This meta-analysis demonstrates that PADN significantly improves functional status and haemodynamic parameters in patients with PH, reducing clinical worsening and rehospitalisation rates. PADN shows promise as a therapeutic option for PH patients who remain symptomatic despite medical therapy.
Cekirdekci et al. (Sat,) reported a other. Pulmonary artery denervation improved 6MWD by 92m, reduced mPAP by 11.84mmHg, PVR by 4.88mmHg, and lowered clinical worsening (OR 0.30) in pulmonary hypertension.