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Splanchnic Nerve Modulation Effects on Surrogate Measures of Venous Capacitance.

Publication ,  Journal Article
Kittipibul, V; Ganesh, A; Coburn, A; Coyne, BJ; Gray, JM; Molinger, J; Ray, N; Podgoreanu, M; McCartney, SL; Mamoun, N; Fitzhugh, RC; Lurz, P ...
Published in: J Am Heart Assoc
July 18, 2023

Background Splanchnic nerve modulation (SNM) is an emerging procedure to reduce cardiac filling pressures in heart failure. Although the main contributor to reduction in cardiac preload is thought to be increased venous capacitance in the splanchnic circulation, supporting evidence is limited. We examined changes in venous capacitance surrogates pre- and post-SNM. Methods and Results This is a prespecified analysis of a prospective, open-label, single-arm interventional study evaluating the effects of percutaneous SNM with ropivacaine in chronic heart failure with elevated filling pressures at rest and with exercise. Patients underwent cardiopulmonary exercise testing with invasive hemodynamic assessment pre- and post-SNM. Blood pressure changes with modified Valsalva maneuver and hemoconcentration, pre- and post-SNM were compared using a repeated measures model. Inferior vena cava diameter and collapsibility (>50% decrease in size with inspiration), and presence of bendopnea pre- and post-SNM were also compared. Fifteen patients undergoing SNM (age 58 years, 47% women, 93% with left ventricular ejection fraction ≤35%) were included. After SNM, changes in systolic blood pressure during Valsalva (peak-to-trough) were greater (41 versus 48 mm Hg, P=0.025). Exercise-induced hemoconcentration was unchanged (0.63 versus 0.43 g/dL, P=0.115). Inferior vena cava diameter was reduced (1.59 versus 1.30 cm, P=0.034) with higher collapsibility (33% versus 73%, P=0.014). Bendopnea was less (47% versus 13%, P=0.025). Conclusions SNM resulted in increased venous capacitance, associated decreased cardiac preload, and decreased bendopnea. Minimally invasive measures of venous capacitance could serve as markers of successful SNM. Long-term effects of SNM on venous capacitance warrant further investigation for heart failure management. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03453151.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

July 18, 2023

Volume

12

Issue

14

Start / End Page

e028780

Location

England

Related Subject Headings

  • Ventricular Function, Left
  • Stroke Volume
  • Splanchnic Nerves
  • Prospective Studies
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
  • Female
  • 3201 Cardiovascular medicine and haematology
 

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Kittipibul, V., Ganesh, A., Coburn, A., Coyne, B. J., Gray, J. M., Molinger, J., … Fudim, M. (2023). Splanchnic Nerve Modulation Effects on Surrogate Measures of Venous Capacitance. J Am Heart Assoc, 12(14), e028780. https://doi.org/10.1161/JAHA.122.028780
Kittipibul, Veraprapas, Arun Ganesh, Aubrie Coburn, Brian J. Coyne, James Matthew Gray, Jeroen Molinger, Neil Ray, et al. “Splanchnic Nerve Modulation Effects on Surrogate Measures of Venous Capacitance.J Am Heart Assoc 12, no. 14 (July 18, 2023): e028780. https://doi.org/10.1161/JAHA.122.028780.
Kittipibul V, Ganesh A, Coburn A, Coyne BJ, Gray JM, Molinger J, et al. Splanchnic Nerve Modulation Effects on Surrogate Measures of Venous Capacitance. J Am Heart Assoc. 2023 Jul 18;12(14):e028780.
Kittipibul, Veraprapas, et al. “Splanchnic Nerve Modulation Effects on Surrogate Measures of Venous Capacitance.J Am Heart Assoc, vol. 12, no. 14, July 2023, p. e028780. Pubmed, doi:10.1161/JAHA.122.028780.
Kittipibul V, Ganesh A, Coburn A, Coyne BJ, Gray JM, Molinger J, Ray N, Podgoreanu M, McCartney SL, Mamoun N, Fitzhugh RC, Lurz P, Green CL, Hernandez AF, Patel MR, Fudim M. Splanchnic Nerve Modulation Effects on Surrogate Measures of Venous Capacitance. J Am Heart Assoc. 2023 Jul 18;12(14):e028780.
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

July 18, 2023

Volume

12

Issue

14

Start / End Page

e028780

Location

England

Related Subject Headings

  • Ventricular Function, Left
  • Stroke Volume
  • Splanchnic Nerves
  • Prospective Studies
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
  • Female
  • 3201 Cardiovascular medicine and haematology