Sympathomodulation in Heart Failure with High vs. Normal Ejection Fraction.

Background: Despite recent advances in the treatment of heart failure with preserved ejection fraction (HFpEF), the overall outcome is poor and evidence-based therapeutic options are scarce. So far, the only evidence-based therapy in HFpEF, sodium glucose linked transporter 2 inhibitors, has only insignificant effects in patients with a high EF (EF > 60%, HEF) when compared to a normal EF (EF 50%-60%, NEF). This could be explained by different biomechanical and cellular phenotypes of HFpEF across the range of EFs rather than a uniform pathophysiology. We aimed to investigate the concept of different phenotypes in the HEF and NEF using noninvasive single-beat estimations and to observe alterations in pressure-volume relations in both groups following sympathomodulation using renal denervation (RDN). Methods: Patients from a previous study on RDN in HFpEF were stratified by having HFpEF with an HEF or NEF. Single-beat estimations were used to derive arterial elastance (Ea), end-systolic elastance (Ees), and diastolic capacitance (VPED Results: Overall, 63 patients were classified as having an HEF, and 36 patients were classified as having an NEF. Ea did not differ between the groups and was reduced at follow-up in both groups ( Conclusions: Beneficial effects of RDN were observed in the NEF and HEF, supporting the further investigation of sympathomodulating treatments for HFpEF in future trials.