Eficácia da denervação simpática renal como tratamento para a insuficiência cardíaca
DOI:
https://doi.org/10.11606/issn.1679-9836.v102i5e-187827Palavras-chave:
Simpatectomia, Denervação, Insuficiência CardíacaResumo
A insuficiência cardíaca (IC) tem se tornado cada vez mais frequente na população e, dada a importância dessa doença a nível mundial, diversos estudos avaliam novas formas para tratá-la, como a denervação simpática renal (DSR), com o intuito de inibir a ativação cardíaca estimulada pelos rins. O objetivo desse estudo é compreender se a DSR é um tratamento factível para a insuficiência cardíaca e quais são suas vantagens. Foi realizado uma revisão integrativa da literatura com busca nas bases de dados PubMed e Scielo, utilizando os descritores “Sympathectomy”, “Denervation” e “Heart failure”, encontrados no DeCS. Buscou-se por artigos publicados nos últimos 10 anos, em inglês, espanhol e português, disponíveis na íntegra, excluindo estudos com modelos experimentais. Foram encontrados 188 artigos e destes 23 foram selecionados. A DSR consiste em inativar o nervo renal, suprimindo a atividade simpática e do sistema renina-angiotensina-aldosterona. Apesar de ser uma técnica delicada, a DSR é segura, apresentando complicações inerentes a procedimentos invasivos, porém de baixa a moderada gravidade, e poucos efeitos adversos. Dessa forma, a DSR demonstrou ser um promissor tratamento para a IC, promovendo a remissão de sintomas importantes, como controle de arritmias e remissão de edemas periféricos, contudo não representou a cura para essa doença.
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Ponikowski P, Voors A, Anker S, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37(27):2129-2200. doi: https://doi.org/10.1093/eurheartj/ehw128
Ziaeian B, Fonarow G. Epidemiology and aetiology of heart failure. Nature Rev Cardiol. 2016;13(6):368-378. doi: https://doi.org/10.1038/nrcardio.2016.25
Kiuchi M, Nolde J, Villacorta H, et al. New Approaches in the Management of Sudden Cardiac Death in Patients with Heart Failure—Targeting the Sympathetic Nervous System. Int J Molr Sci. 2019;20(10):2430. doi: https://doi.org/10.3390/ijms20102430
Borovac J, D'Amario D, Bozic J, Glavas D. Sympathetic nervous system activation and heart failure: Current state of evidence and the pathophysiology in the light of novel biomarkers. World J Cardiol. 2020;12(8):373-408. doi: https://doi.org/10.4330/wjc.v12.i8.373
Parati G, Esler M. The human sympathetic nervous system: its relevance in hypertension and heart failure. Eur Heart J. 2012;33(9):1058-1066. doi: https://doi.org/10.1093/eurheartj/ehs041
Rexel T, Bertog S, Vaskelyte L, Sievert H. Renal denervation. Anadolu Kardiyoloji Dergisi/The Anatolian. J. cardiol. 2014;14(2):186-191. doi: https://doi.org/10.5152/akd.2014.5294
Hoogerwaard A, Elvan A. Is renal denervation still a treatment option in cardiovascular disease?. Trends cardiovasc. med. 2020;30(4):189-195. doi: https://doi.org/10.1016/j.tcm.2019.05.006
Staico, R., Armaganijan, L., Moreira, D. et al. Denervação simpática renal: um novo cateter em um novo cenário. Rev. bras. cardiol. invasiva. 2012;21(4):396-400. doi: https://doi.org/10.1590/S2179-83972013000400016
Geng, J., Chen, C., Zhou, X., Qian, W. and Shan, Q. Influence of Renal Sympathetic Denervation in Patients with Early-Stage Heart Failure Versus Late-Stage Heart Failure. Int. heart j. 2018;59(1):99-104. doi: https://doi.org/10.1536/ihj.16-413
Singh, J., Kandala, J. and John Camm, A. Non-pharmacological modulation of the autonomic tone to treat heart failure. Eur Heart J. 2013;35(2):77-85. doi: https://doi.org/10.1093/eurheartj/eht436
Floras, J. Arterial Baroreceptor and Cardiopulmonary Reflex Control of Sympathetic Outflow in Human Heart Failure. Ann. N. Y. Acad. sci. 2006;940(1):500-513. doi: https://doi.org/10.1111/j.1749-6632.2001.tb03701.x
Chatterjee, N. and Singh, J. Novel Interventional Therapies to Modulate the Autonomic Tone in Heart Failure. JACC: Heart Failure. 2015;3(10):786-802. doi: https://doi.org/10.1016/j.jchf.2015.05.008
Kishi, T. Deep and future insights into neuromodulation therapies for heart failure. J. cardiol. 2016;68(5):368-372. doi: https://doi.org/10.1016/j.jjcc.2016.05.010
Kishi, T. Heart Failure as a Disruption of Dynamic Circulatory Homeostasis Mediated by the Brain. Int. heart j. 2016;57(2):145-149. doi: https://doi.org/10.1536/ihj.15-517
Hasking, G., Esler, M., Jennings, G., Burton, D., Johns, J. and Korner, P. Norepinephrine spillover to plasma in patients with congestive heart failure: evidence of increased overall and cardiorenal sympathetic nervous activity. Circulation. 1986;73(4):615-621. doi: https://doi.org/10.1161/01.cir.73.4.615
Petersson, M., Friberg, P., Eisenhofer, G., Lambert, G. and Rundqvist, B. Long-term outcome in relation to renal sympathetic activity in patients with chronic heart failure. Eur Heart J. 2005;26(9):906-913. doi: https://doi.org/10.1093/eurheartj/ehi184
Pascual-Figal, D. Neprilysin and Heart Failure. J. Am. Coll. Cardiol. 2017;70(17):2154-2156. doi: https://doi.org/10.1016/j.jacc.2017.09.003
McArdle, M., deGoma, E., Cohen, D., Townsend, R., Wilensky, R. and Giri, J. Beyond Blood Pressure: Percutaneous Renal Denervation for the Management of Sympathetic Hyperactivity and Associated Disease States. J. Am. Heart Assoc. 2015;4(3):e001415. doi: https://doi.org/10.1161/JAHA.114.001415
Böhm, M., Ewen, S., Kindermann, I., Linz, D., Ukena, C. and Mahfoud, F. Renal denervation and heart failure. Eur. j. heart fail. 2014;16(6):608-613. doi: https://doi.org/10.1002/ejhf.83
Böhm, M., Ewen, S., Linz, D., et al. Therapeutic potential of renal sympathetic denervation in patients with chronic heart failure. EuroIntervention. 2013;9:122-126. doi: https://doi.org/10.4244/EIJV9SRA21
Sobotka, P., Mahfoud, F., Schlaich, M., Hoppe, U., Böhm, M. and Krum, H. Sympatho-renal axis in chronic disease. Clin. res. Cardiol. 2011;100(12):1049-1057. doi: https://doi.org/10.1007/s00392-011-0335-y
Gao, J., Yang, W. and Liu, Z. Percutaneous renal artery denervation in patients with chronic systolic heart failure: A randomized controlled trial. Cardiol j. 2019;26(5):503-510. doi: https://doi.org/10.5603/CJ.a2018.0028
Patel, H., Rosen, S., Hayward, C. et al. Renal denervation in heart failure with preserved ejection fraction (RDT-PEF): a randomized controlled trial. Eur. j. heart fail. 2016;18(6):703-712. doi: https://doi.org/10.1002/ejhf.502
Shen, M. and Zipes, D. Interventional and Device-Based Autonomic Modulation in Heart Failure. Heart fail. clin. 2015;11(2):337-348. doi: https://doi.org/10.1016/j.hfc.2014.12.010
Gao, J., Xie, Y., Yang, W., Zheng, J. and Liu, Z. Effects of percutaneous renal sympathetic denervation on cardiac function and exercise tolerance in patients with chronic heart failure. Rev. port. cardiol. 2017;36(1):45-51. doi: https://doi.org/10.1016/j.repc.2016.07.007
Bhat, A., Kuang, Y., Gan, G., Burgess, D. and Denniss, A. An Update on Renal Artery Denervation and Its Clinical Impact on Hypertensive Disease. BioMed res. int. 2015;2015:1-9. doi: https://doi.org/10.1155/2015/607079
Hoogerwaard, A. and Elvan, A. Is renal denervation still a treatment option in cardiovascular disease?. Trends cardiovasc. med. 2020;30(4):189-195. doi: https://doi.org/10.1016/j.tcm.2019.05.006
Verloop W, Beeftink M, Nap A et al. Renal denervation in heart failure with normal left ventricular ejection fraction. Rationale and design of the DIASTOLE (DenervatIon of the renal Sympathetic nerves in heart failure with normal Lv Ejection fraction) trial. Eur. j. heart fail. 2013;15(12):1429-1437. doi: https://doi.org/10.1093/eurjhf/hft119
Schwartz, P., La Rovere, M., De Ferrari, G. and Mann, D. Autonomic Modulation for the Management of Patients with Chronic Heart Failure. Circ. Heart fail. 2015;8(3):619-628. doi: https://doi.org/10.1161/CIRCHEARTFAILURE.114.001964
Kanai, T. and Krum, H. New Treatment for Old Disease: Management of Resistant Hypertension by Percutaneous Renal Sympathetic Denervation. Rev. esp. de cardiol. (Internet. Engl. ed.). 2013;66(9):734-740. doi: https://doi.org/10.1016/j.rec.2013.06.001
Froeschl, M., Hadziomerovic, A. and Ruzicka, M. Percutaneous Renal Sympathetic Denervation: 2013 and Beyond. Can. j. cardiol. 2014;30(1):64-74. doi: https://doi.org/10.1016/j.cjca.2013.11.003
Berukstis, A., Vajauskas, D., Gargalskaite, U. et al. Impact of renal sympathetic denervation on cardiac sympathetic nerve activity evaluated by cardiac MIBG imaging. EuroIntervention. 2016;11(9):1070-1076. doi: https://doi.org/10.4244/EIJV11I9A215
Yang, J., Choi, S. and Gwon, H. Percutaneous Renal Sympathetic Denervation for the Treatment of Resistant Hypertension with Heart Failure: First Experience in Korea. J. Korean Med. Sci. 2013;28(6):951. doi: https://doi.org/10.3346/jkms.2013.28.6.951
Schlaich M. Renal Sympathetic Denervation: A Viable Option for Treating Resistant Hypertension. Am. j. hypertens. 2017;30(9):847-856. doi: https://doi.org/10.1093/ajh/hpx033
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Copyright (c) 2023 Elany Maria Ferreira Portela, Jeanne Beatriz Nunes da Silva, Laís Emanuelle Lamounier, Lara Kaiulani Lamounier , Talitha Araújo Velôso Faria
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