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.