Splanchnic Nerve Modulation Effects on Surrogate Measures of Venous Capacitance

Abstract

BACKGROUND: Splanchnic nerve modulation (SNM) is an emerging procedure to reduce cardiac filling pressures in heart failure. Although the main contributor to reduction in cardiac preload is thought to be increased venous capacitance in the splanch-nic circulation, supporting evidence is limited. We examined changes in venous capacitance surrogates pre-and post-SNM. METHODS AND RESULTS: This is a prespecified analysis of a prospective, open-label, single-arm interventional study evaluat-ing the effects of percutaneous SNM with ropivacaine in chronic heart failure with elevated filling pressures at rest and with exercise. Patients underwent cardiopulmonary exercise testing with invasive hemodynamic assessment pre-and post-SNM. Blood pressure changes with modified Valsalva maneuver and hemoconcentration, pre-and post-SNM were compared using a repeated measures model. Inferior vena cava diameter and collapsibility (>50% decrease in size with inspiration), and pres-ence of bendopnea pre-and post-SNM were also compared. Fifteen patients undergoing SNM (age 58 years, 47% women, 93% with left ventricular ejection fraction ≤35%) were included. After SNM, changes in systolic blood pressure during Valsalva (peak-to-trough) were greater (41 versus 48 mm Hg, P=0.025). Exercise-induced hemoconcentration was unchanged (0.63 versus 0.43 g/dL, P=0.115). Inferior vena cava diameter was reduced (1.59 versus 1.30 cm, P=0.034) with higher collapsibility (33% versus 73%, P=0.014). Bendopnea was less (47% versus 13%, P=0.025). CONCLUSIONS: SNM resulted in increased venous capacitance, associated decreased cardiac preload, and decreased bendo-pnea. Minimally invasive measures of venous capacitance could serve as markers of successful SNM. Long-term effects of SNM on venous capacitance warrant further investigation for heart failure management.