Pulmonary-Artery Denervation Reduces Clinical Worsening in Heart Failure Patients with Pulmonary Hypertension
Pulmonary-artery denervation combined with guideline-directed medical therapy significantly reduces clinical worsening events in patients suffering from pulmonary hypertension associated with left heart disease and heart failure, according to findings presented at the ESC Congress 2026 and simultaneously published ahead of print in the New England Journal of Medicine.
Key Clinical Takeaways:
- The multicenter trial evaluated 264 patients in China, randomizing them to receive either catheter-based pulmonary-artery denervation alongside standard medical therapy or medical therapy alone.
- At a median follow-up of 338 days, the Kaplan-Meier estimated two-year incidence of clinical worsening reached nearly 26% in the denervation group, compared with nearly 52% in the control group receiving medication alone.
- Procedural safety data showed minimal complications, limited to two access-site hematomas in the denervation cohort and one in the medical therapy group, with no significant differences in overall adverse events.
Clinical Trial Design and Primary Endpoints
Led by investigators Hang Zhang, MD, and Qiguang Wang, MD, the multicenter study sought to address a persistent clinical gap in cardiovascular care. Despite major advances in pharmacologic and device-based interventions, pulmonary hypertension remains one of the strongest predictors of hospitalization, right ventricular failure, and death in patients with left heart disease and heart failure. To measure the efficacy of catheter ablation on this high-risk population, researchers tracked a composite primary endpoint of clinical worsening.
This composite primary endpoint encompassed death, heart or lung transplantation, hospitalization for heart failure, outpatient worsening of heart failure, or a confirmed decline in the six-minute walk distance over the study timeline. The trial's design directly confronts the complex pathogenesis of heart failure-related pulmonary hypertension, targeting autonomic remodeling within the pulmonary vasculature to alter disease trajectory.
Efficacy and Safety Findings at ESC Congress 2026
By halving the estimated two-year incidence of clinical worsening from nearly 52% down to 26%, pulmonary-artery denervation offers a viable therapeutic avenue where pharmacotherapy alone frequently hits a plateau.
Safety analyses confirmed that the catheter-based procedure did not introduce excessive procedural hazards. Investigators reported no significant differences in the overall frequency of adverse events across the study arms. Procedural complications remained rare, restricted entirely to access-site hematomas.
Future Directions and Long-Term Research Trajectory
While the mid-term outcomes from the PADN-HF-PH trial establish a strong clinical rationale for pulmonary-artery denervation, investigators emphasize the necessity of extended observation. Additional long-term follow-up remains essential to determine whether these observed mid-term improvements translate into sustained reductions in overall mortality and recurrent hospitalizations for heart failure.
*Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.*