Splanchnic Nerve Block Mediated Changes in Stressed Blood Volume in Heart Failure

METHODS We analyzed data from 2 prospective, single-arm clinical studies in decompensated HFrEF (splanchnic HF-1; resting hemodynamics) and ambulatory heart failure (splanchnic HF-2; exercise hemodynamics). Patients underwent invasive hemodynamics and short-term SNB with local anesthetics. SBV was simulated using heart rate, cardiac output, central venous pressure, pulmonary capillary wedge pressure, systolic and diastolic systemic arterial and pulmonary artery pressures, and left ventricular ejection fraction. SBV is presented as ml/70 kg body weight. OBJECTIVES The authors estimated changes of stressed blood volume (SBV) induced by splanchnic nerve block (SNB) in patients with either decompensated or ambulatory heart failure with reduced ejection fraction (HFrEF). BACKGROUND The splanchnic vascular capacity is a major determinant of the SBV, which in turn determines cardiac filling pressures and may be modifiable through SNB. METHODS We analyzed data from 2 prospective, single-arm clinical studies in decompensated HFrEF (splanchnic HF-1; resting hemodynamics) and ambulatory heart failure (splanchnic HF-2; exercise hemodynamics). Patients underwent invasive hemodynamics and short-term SNB with local anesthetics. SBV was simulated using heart rate, cardiac output, central venous pressure, pulmonary capillary wedge pressure, systolic and diastolic systemic arterial and pulmonary artery pressures, and left ventricular ejection fraction. SBV is presented as ml/70 kg body weight. RESULTS Mean left ventricular ejection fraction was 21 +/- 11%. In patients with decompensated HFrEF (n = 11), the mean estimated SBV was 3,073 +/- 251 ml/70 kg. At 30 min post-SNB, the estimated SBV decreased by 10% to 2,754 +/- 386 ml/70 kg (p = 0.003). In ambulatory HFrEF (n = 14) patients, the mean estimated SBV was 2,664 +/- 488 ml/70 kg and increased to 3,243 +/- 444 ml/70 kg (p < 0.001) at peak exercise. The resting estimated SBV was lower in ambulatory patients with HFrEF than in decompensated HFrEF (p = 0.019). In ambulatory patients with HFrEF, post-SNB, the resting estimated SBV decreased by 532 +/- 264 ml/70 kg (p < 0.001). Post-SNB, with exercise, there was no decrease of estimated SBV out of proportion to baseline effects (p = 0.661). CONCLUSIONS The estimated SBV is higher in decompensated than in ambulatory heart failure. SNB reduced the estimated SBV in decompensated and ambulatory heart failure. The reduction in estimated SBV was maintained throughout exercise. (Splanchnic Nerve Anesthesia in Heart Failure, NCT02669407; Abdominal Nerve Blockade in Chronic Heart Failure, NCT03453151) (J Am Coll Cardiol HF 2021;9:293-300) (c) 2021 by the American College of Cardiology Foundation. RESULTS Mean left ventricular ejection fraction was 21 ? 11%. In patients with decompensated HFrEF (n = 11), the mean estimated SBV was 3,073 ? 251 ml/70 kg. At 30 min post-SNB, the estimated SBV decreased by 10% to 2,754 ? 386 ml/70 kg (p = 0.003). In ambulatory HFrEF (n = 14) patients, the mean estimated SBV was 2,664 ? 488 ml/70 kg and increased to 3,243 ? 444 ml/70 kg (p < 0.001) at peak exercise. The resting estimated SBV was lower in ambulatory patients with HFrEF than in decompensated HFrEF (p = 0.019). In ambulatory patients with HFrEF, post-SNB, the resting estimated SBV decreased by 532 ? 264 ml/70 kg (p < 0.001). Post-SNB, with exercise, there was no decrease of esti

Automated summary

The study analyzed data from two prospective clinical studies on decompensated HFrEF and ambulatory heart failure patients. The results showed that splanchnic nerve block decreased the estimated stressed blood volume in decompensated HFrEF patients, while it increased in ambulatory HFrEF patients.