The utility of magnetic resonance imaging in a trial to assess the effect of renal denervation in heart failure with preserved ejection fraction

Background Heart failure with preserved ejection fraction (HF-PEF) is common and has a poor prognosis with a 3 year mortality rate of 23%. There are currently no effective therapies for this condition. HF-PEF is characterized by symptoms of heart failure, normal or a mildly impaired ejection fraction and evidence of adverse cardiac and vascular remodelling. A feature of all heart failure is a heightened sympathetic nervous system (SNS), which can now be abrogated using renal denervation (RD). Methods We are conducting a study of patients with HF-PEF who will be randomised (2:1) to receive RD or open control. As a phase II mechanistic study we are primarily investigating the effect of RD on patient symptoms (questionnaire), cardio-pulmonary exercise function, B-type natriuretic peptide levels, left ventricular filling pressures, left ventricular mass and left atrial volume. We are also assessing macrovascular function using aorta imaging to calculate aorta distensibility, pulse wave velocity and aortic flow. Finally,