Effects of sympathomodulation on pulse wave properties in heart failure with preserved ejection fraction

One important contributor to the pathogenesis and perpetuation of HFpEF is unfavorable pulse wave reflection, frequently caused by increased arterial stiffness, due to aging and longstanding hypertension. One possible path to address pathological wave reflections is reducing sympathetic overactivity via renal denervation (RDN) with the aim to enhance arterial compliance. We sought to non-invasively quantify pulse wave reflections changes in patients undergoing RDN.

Patients who underwent RDN for resistant hypertension were classified as patients with HFpEF and patients without heart failure, the latter of which served as the control group. Pulse wave analysis (PWA) was assessed using a piezoelectric device, and reflection magnitude was quantified by the augmentation index (AIx), and timing by backward transit time (BTT) before and 3 months after RDN. Ambulatory blood pressure was assessed at baseline and after 3 months to adjust for blood pressure changes.

Of 51 patients, 22 had HFpEF, and 29 served as controls. While baseline values in AIx and BTT were not different between HFpEF and control patients, RDN was associated with a significant decrease in AIx by 5.6% (p = 0.04) and a significant prolongation of BTT by 17.8 ms (p = 0.007) in patients with HFpEF. Conversely, no significant changes were observed in control patients for AIx (p = 0.13) and BTT (p = 0.56).

The study observed a beneficial change in the timing and magnitude of central wave reflections in HFpEF after RDN. This implies a dynamic component of arterial stiffness in HFpEF patients and renders large artery stiffness a potential therapeutic target.