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 in 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 and 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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Shah, Monica R
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Cleveland Clinic Lerner
Internal Medicine/Medicine
Schools of Medicine
United States
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Kiernan, Michael S; Stevens, Susanna R; Tang, W H Wilson et al. (2018) Determinants of Diuretic Responsiveness and Associated Outcomes During Acute Heart Failure Hospitalization: An Analysis From the NHLBI Heart Failure Network Clinical Trials. J Card Fail 24:428-438
Borlaug, Barry A; Anstrom, Kevin J; Lewis, Gregory D et al. (2018) Effect of Inorganic Nitrite vs Placebo on Exercise Capacity Among Patients With Heart Failure With Preserved Ejection Fraction: The INDIE-HFpEF Randomized Clinical Trial. JAMA 320:1764-1773
Napier, Rebecca; McNulty, Steven E; Eton, David T et al. (2018) Comparing Measures to Assess Health-Related Quality of Life in Heart Failure With Preserved Ejection Fraction. JACC Heart Fail 6:552-560
Butler, Javed; Kalogeropoulos, Andreas P; Anstrom, Kevin J et al. (2018) Diastolic Dysfunction in Individuals With Human Immunodeficiency Virus Infection: Literature Review, Rationale and Design of the Characterizing Heart Function on Antiretroviral Therapy (CHART) Study. J Card Fail 24:255-265
Tang, W H Wilson; Dunlap, Mark E (2017) Reconsidering Renal Sympathetic Denervation for Heart Failure. JACC Basic Transl Sci 2:282-284
Butler, Javed; Anstrom, Kevin J; Felker, G Michael et al. (2017) Efficacy and Safety of Spironolactone in Acute Heart Failure: The ATHENA-HF Randomized Clinical Trial. JAMA Cardiol 2:950-958
Grodin, Justin L; Sun, Jie-Lena; Anstrom, Kevin J et al. (2017) Implications of Serum Chloride Homeostasis in Acute Heart Failure (from ROSE-AHF). Am J Cardiol 119:78-83
Lewis, Gregory D; Malhotra, Rajeev; Hernandez, Adrian F et al. (2017) Effect of Oral Iron Repletion on Exercise Capacity in Patients With Heart Failure With Reduced Ejection Fraction and Iron Deficiency: The IRONOUT HF Randomized Clinical Trial. JAMA 317:1958-1966
Grodin, Justin L; Gallup, Dianne; Anstrom, Kevin J et al. (2017) Implications of Alternative Hepatorenal Prognostic Scoring Systems in Acute Heart Failure (from DOSE-AHF and ROSE-AHF). Am J Cardiol 119:2003-2009
Grodin, Justin L; Lala, Anuradha; Stevens, Susanna R et al. (2016) Clinical Implications of Serum Albumin Levels in Acute Heart Failure: Insights From DOSE-AHF and ROSE-AHF. J Card Fail 22:884-890

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