<International Circulation>: You have just made a presentation on the potential usage of RDN (renal sympathetic denervation) in the treatment of heart failure. Can you give us a brief summary of the mechanism of RDN for heart failure?

　　Dr. Bohm: Heart failure is associated with sympathetic activation and beyond the activity of the sympathetic nervous system (which can be judged by circulating norepinephrine concentrations)， it is known that norepinephrine released from the kidney is more important and more associated with death rates from heart failure. So it is an easy way to directly reduce that by renal denervation and that has been shown by several investigators.

　　《国际循环》：您刚展示了一项关于肾脏去神经术（RDN）用于心力衰竭治疗的研究，您能简要总结RDN用于心力衰竭的机制吗？

　　Bohm教授：心力衰竭与交感神经激活有关，可通过循环中去甲肾上腺素浓度来衡量。现在已知从肾脏释放的去甲肾上腺素与心力衰竭死亡率相关性更大。因此，通过RDN直接降低其水平是一种简单的方法，而且已经被数位研究者证实。

　　<International Circulation>: What are the potential benefits of RDN in heart failure?

　　Dr. Bohm:  In heart failure populations， the procedure causes a reduction in sympathetic activity. We still need trials， but we have good evidence to believe that renal denervation will reduce hypertrophy which is also related to poor outcomes. It reduces blood pressure if it is high and it reduces heart rate which is another important mechanism for outcomes in heart failure. Also it is preventative for arrhythmia. There is data that it might reduce the prevalence and incidence of atrial fibrillation and furthermore， there are patients reported from Germany and also the United States where renal denervation was able to block electrical storms which is a life-threatening complication in heart failure.

　　《国际循环》：RDN用于心衰的潜在获益有哪些？

　　Bohm教授：在心力衰竭患者中，RDN可引起交感活性减低。我们仍需进行更多试验，但是我们有好的证据证实RDN将降低心肌肥厚，其也与预后差有关。能够降低增高的血压，也能降低心率，这是对心力衰竭预后十分重要的另一机制。另外，RDN也可预防心律失常。有数据表明其能减少房颤的患病率和发病率。而且，有德国及美国的研究报道，RDN能阻断电风暴，它是一种威胁生命的心力衰竭并发症。

　　<International Circulation>: Which types of heart failure patients will benefit most from RDN therapy?

　　Dr. Bohm: There are small trials ongoing and in the majority of these trials， it is heart failure with reduced ejection fraction. There is one trial in the Netherlands that is working on heart failure with preserved ejection fraction (diastolic heart failure).

　　《国际循环》：哪些患者能从RDN治疗中获益最多？

　　Bohm教授：现在有一些小型研究正在进行，其中绝大多数研究中纳入的是射血分数降低的心力衰竭患者。荷兰有一项正在进行的研究是关于射血分数保留的心力衰竭（收缩性心衰）。

　　<International Circulation>: Can you talk about the current states of this research?

　　Dr. Bohm: It has not been published yet so is still under embargo so we have to wait until that is finished. There is one previous report on exercise tolerance in patients with heart failure and the walking distance on a six-minute walking test was markedly improved which is reassuring that the procedure is effective. Also there was no significant drop in blood pressure， which indicates that it might be safe as well.

　　《国际循环》：该项研究目前的进展如何？

　　Bohm教授：这项研究目前还没有发表，只有在其发表后才能获悉最新进展。之前有报告关于心衰患者运动耐量，检测到6分钟步行距离试验显著改善，提示RDN治疗是有效的。当然，并没有显著的血压降低，也提示该操作可能是安全的。

　　<International Circulation>: Why do you think there is no significant blood pressure drop in these heart failure patients?

　　Dr. Bohm: The procedure only reduces blood pressure when blood pressure is high. When blood pressure is lower， there is no significant change in blood pressure. This has also been investigated in the SYMPLICITY HTN-3 registry with 10000 patients which was just presented at the ACC. Patients with low blood pressure have low response and patients with high blood pressure have a big response.

　　《国际循环》：你为什么说那些心衰患者的血压没有明显降低？

　　Bohm教授：RDN仅降低血压增高患者的血压。当血压较低时，RDN对血压没有明显改变。这也在今年召开的ACC上公布的SYMPLICITY HTN-3试验所纳入的10000例患者中证实。血压较低的患者对RDN的反应性低，而血压高者反应明显。

　　<International Circulation>: What do we need to do now to learn more about the usefulness of RDN in heart failure patients?

　　Dr. Bohm: We need the trials and the studies and hopefully industry will sponsor those trials in heart failure and hypertension. We have a trial ongoing with sham procedure. We need to achieve effective denervation and good proctoring. It cannot be done in beginner centers but in centers with a lot of experience.

　　《国际循环》：为更加了解RDN用于心力衰竭的有效性，我们应如何做？

　　Bohm教授：我们需要开展更多试验和研究，并希望厂家能够赞助这些心力衰竭和高血压相关试验。我们现在有一项采用假手术的试验正在进行中。我们需要达到有效的去神经和较好的监督。这项研究不能在初学者中心完成而是需要在有许多经验的中心进行。

　　<International Circulation>: Do those trials need to be large?

　　Dr. Bohm: It should first start with small trials where we will look at exercise tolerance and biomarkers， which is what is ongoing. At the end of the day， to recommend RDN for the general population of patients， there should be an outcomes trial.

　　《国际循环》：那些试验需要规模很大吗？

　　Bohm教授：试验刚开始仅小规模即可，我们将会观察运动耐量和标志物，这是正在进行中的。研究终末，将推荐RDN用于一般的患者群体，将会是一项观察预后试验。