Plenary Session 11

3月27日［土］17:20-18:50

 
  Renal denervation Up-to-Date: Basic and clinical evidence
  
 
   
  循環器疾患の発症と重症化抑制を目指し、循環調節システムを修飾する新規イノベーション治療である腎デナベーションに注目が集まっている。腎臓は循環体液量の主要調節臓器で、高血圧や心不全の病態に直結するが、本治療は脳と腎臓の臓器連関経路である腎交感神経を部分的に遮断する。デナベーション手技としては、主に高周波アブレーション、超音波アブレーション、アルコールを用いたケミカルアブレーションがあり、いずれも腎動脈内腔より経カテーテルで除神経する。近年発表されたシャム手技群を設けた無作為比較試験（SPYRAL HTN-OFF MED/ON MED試験、RADIANCE-HTN試験）では、腎デナベーションにより夜間・早朝を含めた24時間にわたる明確な降圧効果が示され、コントロール不良の高血圧管理、さらにその先にある不整脈や心不全などの発症や重症化予防に期待が高まっている。一方、基礎研究として中枢神経を含む正確な降圧機序や循環血液量、代謝、さらに炎症免疫系への多面的効果、臨床的研究としてはレスポンダーの同定、治療効果の評価、除神経手技の技術革新新、SGLT2阻害やARNIなど新規循環器系薬剤を含めた薬剤との相互作用など、まだまだ未解決な課題が山積している。これらの解決のためには、基礎と臨床のトランスレーショナルリサーチが重要となる。　本プレナリーセッションでは、臨床導入が真近に迫った腎デナベーションをめぐる基礎と臨床の最新エビデンスを総括し、今後の展望を図りたい。
Renal denervation, a novel innovative therapy that modify the circulation regulatory system to reduce the onset and severity of cardiovascular disease are drawing attention. Kidneys regulate fluid volume in the circulation, and its condition is directly related to the pathogenesis of hypertension and heart failure. The renal denervation partially blocks the renal sympathetic nervous system, which is an organ-related pathway between the brain and the kidney. Radiofrequency ablation, ultrasonic ablation, and chemical ablation with alcohol are the most common techniques. Denervation is performed through the lumen of the renal artery using a catheter. A recently published randomized controlled trial with a sham group (SPYRAL HTN-OFF MED/ ON MED study and RADIANCE-HTN study) clearly showed an blood pressure effect of renal denervation throughout 24 hours including nighttime and morning hours. This technique may help to manage poorly controlled hypertension and prevent arrhythmias and heart failure. Future investigation will focus on the antihypertensive mechanism of renal denervation, including the central nervous system, and its multifaceted effects on circulating blood volume and metabolisms, as well as on the inflammatory immune system. In addition, the identification of responders, evaluation of efficacy, innovations in denervation techniques, and interactions with drugs, including novel cardiovascular agents such as SGLT2 inhibitors or ARNI, need to be clarified. Translational research between basic and clinical research is important to resolve these issues. In this plenary session, we will discuss the basic and clinical aspects of renal denervation, which is about to be introduced into the clinical practice. We would like to summarize the latest evidence and plan for the near future.
 
 
   
 
 
Kazuomi Kario   Kazuomi Kario
Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke
   Felix Mahfoud   Felix Mahfoud
Innere Medizin III, Saarland University Medical Center, Hamburg, Germany
 
 
 
 
   
 
 
Felix Mahfoud   Felix Mahfoud
Innere Medizin III, Saarland University Medical Center, Hamburg, Germany
   Keisuke Shinohara   Keisuke Shinohara
Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka
 
 
 
Kenichi Katsurada   Kenichi Katsurada
Department of Cardiology, Jichi Medical University, Shimotsuke
   Jiro Aoki   Jiro Aoki
Division of Cardiology, Mitsui Memorial Hospital, Tokyo
 
 
 
Shinsuke Nanto   Shinsuke Nanto
Department of Cardiology, Nishinomiya Municipal Central Hospital, Nishinomiya