Pulmonary artery denervation improves left ventricular diastolic function in patients with isolated post-capillary pulmonary hypertension secondary to heart failure with preserved ejection fraction: a safety and proof-of-principle cohort study.

Background The benefits of pulmonary artery denervation (PADN) for patients with isolated post-capillary pulmonary hypertension (IpcPH) secondary to left heart failure with preserved ejection fraction (HFpEF) remain unknown.

Aims This study aimed to evaluate the safety and feasibility of PADN in patients with HFpEF-induced IpcPH.

Methods This was a single-centre, proof-of-principle cohort study conducted in China. Patients with chronic HFpEF (>=6 months), receiving guideline-directed medical therapy for >=3 months, and meeting criteria for stage C heart failure and IpcPH were included. Eligible patients had New York Heart Association Class III or ambulatory Class IV symptoms and a plasma N-terminal prohormone B-type natriuretic peptide level >300 pg/mL. Right heart catheterisation was performed to assess haemodynamics, and the rate of change of left ventricular pressure (dP/dt) was monitored for 10 minutes following the PADN procedure.

Results At 10 minutes post-procedure, PADN resulted in a 16.9% reduction in mean pulmonary arterial pressure (PAP) and a 22.9% reduction in pulmonary artery wedge pressure (PAWP), with no significant changes in cardiac output, right atrial pressure, or pulmonary vascular resistance. Additionally, the minimum left ventricular dP/dt (dP/dtmin) significantly decreased from -1,698.9±322.9 mmHg/s at baseline to -2,048.0±442.3 mmHg/s (a 20.5% reduction; p=0.012), indicating improved left ventricular relaxation. However, the maximum dP/dt and left ventricular end-systolic pressure remained unchanged.

Conclusions PADN is associated with significant reductions in PAP and PAWP, likely driven by improved left ventricular relaxation, as reflected by dP/dtmin, in patients with HFpEF-induced IpcPH. ClinicalTrials.gov: NCT06323512.