This proposal represents a joint effort combining the vast infrastructure, extensive clinical and research experience, as well as large patient volumes in heart failure at the Cleveland Clinic, together with the clinical trial expertise and diverse patient populations at University Hospitals and MetroHealth Medical Center to establish the Cleveland Regional Clinical Center (RCC). Led by Drs. W. H. Wilson Tang and Randall C. Starting and joined by Drs. James Fang and Mark Dunlap as co-investigators, and taking advantage of the Cleveland Clinical and Translational Sciences Collaborative (CTSC) that recently integrated the research infrastructure our three institutions, our goal is to participate n the Heart Failure Clinical Research Network to test new hypotheses and therapies to advance the management of heart failure. In particular, we hope to expand our longstanding academic interest in developing strategies to alleviate cardio-renal compromise in congestive heart failure. Our proposed project serves as a mechanistic study to discern the possible role of renal sympathetic nerves in mediating cardiac and/or renal complications of the cardio-renal syndrome. Utilizing a novel, catheter-based renal sympathetic denervation (RSD) technique currently under investigation for treatment of refractory hypertension (Symplicity Catheter System), we test the hypothesis that in patients with hypertensive heart failure recently admitted for congestive heart failure that RSD may provide incremental improvement in neurohormonal profile, improve cardio-renal function, and facilitate symptomatic relief over usual care. Our consortium provides a unique opportunity to contribute to the overall Network with clinical trials expertise and leadership in heart failure to fulfill the scientific requirements, and the diverse ad broad regional patient populations across a wide range of practice settings with proven abilities to recruit and fulfill the performance requirements, and to test a novel treatment approach to tackle one of the most challenging aspects of contemporary heart failure.

Public Health Relevance

The incidence of heart failure continues to increase in large due to the expansion of the aging population and therapeutic advances in the management of acute cardiovascular diseases. The presence of cardio-renal dysfunction constitutes a major impediment to adequate management of heart failure, and further understanding and novel strategies to relieve cardio-renal compromise is a priority to improve outcomes.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Cooperative Clinical Research--Cooperative Agreements (U10)
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Special Emphasis Panel (ZHL1-CSR-K (O2))
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Mascette, Alice
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Cleveland Clinic Lerner
Internal Medicine/Medicine
Schools of Medicine
United States
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Margulies, Kenneth B; Anstrom, Kevin J; Hernandez, Adrian F et al. (2014) GLP-1 agonist therapy for advanced heart failure with reduced ejection fraction: design and rationale for the functional impact of GLP-1 for heart failure treatment study. Circ Heart Fail 7:673-9
Chen, Horng H; Anstrom, Kevin J; Givertz, Michael M et al. (2013) Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: the ROSE acute heart failure randomized trial. JAMA 310:2533-43
Hawwa, Nael; Schreiber Jr, Martin J; Tang, W H Wilson (2013) Pharmacologic management of chronic reno-cardiac syndrome. Curr Heart Fail Rep 10:54-62
Chen, Horng H; AbouEzzeddine, Omar F; Anstrom, Kevin J et al. (2013) Targeting the kidney in acute heart failure: can old drugs provide new benefit? Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE AHF) trial. Circ Heart Fail 6:1087-94