Meta-Analysis of Pulmonary Artery Denervation for Treatment of Pulmonary Hypertension

ABSTRACT Introduction: Pulmonary artery denervation (PADN) can reduce the sympathetic nervous system (SNS) activity, reduce pulmonary artery pressure (PAP), and improve the quality of life in patients with pulmonary hypertension (PH). We conducted a systematic meta-analysis of the effectiveness of PADN in the treatment of PH patients. Methods: This is a comprehensive literature search including all public clinical trials investigating the effects of PADN on PH. Outcomes were mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), cardiac output (CO), right ventricular (RV) Tei index, 6-minute walk distance (6MWD), and New York Heart Association (NYHA) cardiac function grading. Results: A total of eight clinical studies with 213 PH patients who underwent PADN were included. Meta-analysis showed that after PADN, mPAP (mean difference [MD] -12.51, 95% confidence interval [CI] -17.74 to -7.27, P<0.00001) (mmHg) and PVR (MD -5.17, 95% CI -7.70 to -2.65, P<0.0001) (Wood unit) decreased significantly, CO (MD 0.59, 95% CI 0.32 to 0.86, P<0.0001) (L/min) and 6MWD (MD 107.75, 95% CI 65.64 to 149.86, P<0.00001) (meter) increased significantly, and RV Tei index (MD -0.05, 95% CI -0.28 to 0.17, P=0.63) did not change significantly. Also after PADN, the proportion of NYHA cardiac function grading (risk ratio 0.23, 95% CI 0.14 to 0.37, P<0.00001) III and IV decreased significantly. Conclusion: This meta-analysis supports PADN as a potential new treatment for PH. Further high-quality randomized controlled studies are needed.

摘要
引言：肺动脉去神经术（Pulmonary artery denervation, PADN）可降低交感神经系统（Sympathetic nervous system, SNS）活性、降低肺动脉压（Pulmonary artery pressure, PAP），并改善肺动脉高压（Pulmonary hypertension, PH）患者的生活质量。本研究针对PADN治疗肺动脉高压患者的有效性开展了系统性荟萃分析。
方法：本研究全面检索了所有公开的、探讨PADN对肺动脉高压影响的临床试验。结局指标包括平均肺动脉压（mean pulmonary artery pressure, mPAP）、肺血管阻力（pulmonary vascular resistance, PVR）、心输出量（cardiac output, CO）、右心室（right ventricular, RV）Tei指数、6分钟步行距离（6-minute walk distance, 6MWD）以及纽约心脏协会（New York Heart Association, NYHA）心功能分级。
结果：本研究共纳入8项临床研究，涉及213例接受PADN治疗的肺动脉高压患者。荟萃分析结果显示，PADN术后患者的平均肺动脉压（均差[MD] -12.51，95%置信区间[CI] -17.74至-7.27，P<0.00001，单位：mmHg）与肺血管阻力（均差[MD] -5.17，95%置信区间[CI] -7.70至-2.65，P<0.0001，单位：Wood单位）显著降低；心输出量（均差[MD] 0.59，95%置信区间[CI] 0.32至0.86，P<0.0001，单位：L/min）与6分钟步行距离（均差[MD] 107.75，95%置信区间[CI] 65.64至149.86，P<0.00001，单位：米）显著升高；而右心室Tei指数（均差[MD] -0.05，95%置信区间[CI] -0.28至0.17，P=0.63）无显著变化。此外，PADN术后纽约心脏协会心功能分级为Ⅲ、Ⅳ级的患者占比显著降低（风险比[RR] 0.23，95%置信区间[CI] 0.14至0.37，P<0.00001）。
结论：本项荟萃分析支持PADN作为肺动脉高压的潜在新型治疗手段，未来仍需开展高质量的随机对照研究以进一步验证其临床价值。