Pulmonary Denervation for Heart Failure-Related Pulmonary Hypertension
In brief
Adding pulmonary artery denervation halves 2-year clinical worsening in heart failure-related pulmonary hypertension
In a Chinese randomized trial of 264 patients, adding pulmonary artery denervation to medical therapy was associated with an estimated 2-year clinical-worsening rate of 26%, compared with 52% on medical therapy alone. The composite included death, heart failure events, transplant, or reduced walking distance; median follow-up was 338 days, so longer-term results remain uncertain.
- Journal
- The New England journal of medicine (Q1)
- Published
- 30 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Hang Zhang, Qiguang Wang, Ming Liang, Xiang Chen, Wei Zhuang, Biao Cheng, et al.
- PMID
- 42670986
- DOI
- 10.1056/NEJMoa2609056
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (top studies of the week, 11 October 2026): Pulmonary denervation trial for HF‑PH
- Picked for Pulmonary and Respiratory Medicine (top studies of the week, 6 September 2026): Pulmonary artery denervation trial for HF‑related PH
Abstract
BACKGROUND: Pulmonary hypertension that is caused by left heart disease and is associated with heart failure may be driven by sympathetic overactivation leading to increased pulmonary vascular resistance, right ventricular dysfunction, and poor outcomes. Pulmonary-artery denervation may reduce sympathetic activity, although its clinical effects on left heart disease-associated pulmonary hypertension are unknown. METHODS: We conducted a multicenter, randomized trial in China involving patients with pulmonary hypertension associated with left heart disease and heart failure. Patients were randomly assigned in a 1:1 ratio to receive pulmonary-artery denervation plus guideline-directed medical therapy or to receive medical therapy alone. The primary outcome was clinical worsening - a composite of death, heart or lung transplantation, hospitalization for heart failure, outpatient worsening of heart failure, or a decline in the 6-minute walk distance - through the latest follow-up. RESULTS: A total of 264 patients underwent randomization: 134 to receive pulmonary-artery denervation plus medical therapy and 130 to receive medical therapy alone. During a median follow-up of 338 days, the Kaplan-Meier estimated 2-year incidence of clinical worsening was 25.7% in the pulmonary-artery denervation group and 51.5% in the medical-therapy group (hazard ratio, 0.49; 95% confidence interval, 0.30 to 0.82; P = 0.006). Access-site hematomas occurred in two patients in the pulmonary-artery denervation group and in one patient in the medical-therapy group; there were no other procedural complications. Adverse events during follow-up occurred with similar frequency in the two groups. CONCLUSIONS: Among patients with pulmonary hypertension associated with left heart disease and heart failure receiving guideline-directed medical therapy, pulmonary-artery denervation resulted in fewer events of clinical worsening than medical therapy. (Funded by Pulnovo Medical and others; PADN-HF-PH ClinicalTrials.gov number, NCT05824923.).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.