Lung artery nerve procedure halves worsening in heart failure

A catheter procedure that quietens overactive nerves around the main lung artery halved the rate of clinical worsening in people with heart failure and raised lung pressure, according to a Chinese trial presented at the European Society of Cardiology (ESC) Congress on 30 August 2026.

The trial is called PADN-HF-PH. It compared pulmonary artery denervation (PADN) added to standard heart failure medicines against the medicines alone in 264 patients. The results were published the same day in the New England Journal of Medicine.

It's an early result. But it targets a group of patients who currently have no treatment aimed at their lung pressure at all.

Why lung pressure matters in heart failure

When the left side of the heart is weak or stiff, blood backs up into the lungs. Over time, the pressure in the blood vessels of the lungs rises. Doctors call this pulmonary hypertension due to left heart disease. In the World Health Organization's classification it is group 2 pulmonary hypertension, and it is the most common type.

Raised lung pressure puts strain on the right side of the heart, which has to push blood through those stiffened vessels. The trial authors were blunt about the stakes. In the summary published by the American College of Cardiology, Hang Zhang and colleagues said that pulmonary hypertension "remains one of the strongest predictors of hospitalization, right ventricular failure, and death in patients with left heart disease and heart failure."

Treatment today focuses on the left heart problem underneath. Guideline-directed medical therapy, the standard set of heart failure drugs, helps overall. However, as the device maker Pulnovo Medical points out in its announcement of the results, there are no approved therapies aimed at the pulmonary hypertension itself in this group.

What pulmonary artery denervation involves

The pulmonary artery carries blood from the right side of the heart to the lungs. Around its trunk and main branches sit sympathetic nerves, part of the body's fight or flight system. In pulmonary hypertension these nerves are thought to be overactive, which tightens and remodels the lung blood vessels.

PADN uses a catheter threaded through a vein into the pulmonary artery. Energy delivered from the catheter tip damages those nerves to calm the signal. It is done in a catheter laboratory, much like other heart procedures that go in through a vein, so there is no open surgery and no cut into the chest. The idea is similar in spirit to renal denervation for high blood pressure, which targets nerves around the kidney arteries.

Pulnovo says its PADN system is approved in 12 countries or regions, with roughly 1,500 procedures done so far in WHO group 1 pulmonary hypertension (pulmonary arterial hypertension). The 2022 ESC and European Respiratory Society guidelines on pulmonary hypertension mention PADN as an investigational treatment. This trial was a step into group 2, the much larger population with left heart disease.

How the trial was run

PADN-HF-PH was a randomised controlled trial run at several hospitals in China. It was led by Yaling Han of the General Hospital of Northern Theater Command. The NEJM paper lists Shao-Liang Chen of Nanjing First Hospital, Yaling Han and Gregg Stone of Mount Sinai in New York as co-corresponding authors. Chen presented the findings in the Hot Line 6 session on heart failure at the ESC Congress.

Patients had pulmonary hypertension linked to left heart disease and heart failure. They were randomly assigned to:

• PADN plus guideline-directed medical therapy
• guideline-directed medical therapy alone

The conference and press summaries don't describe a sham procedure for the comparison group. That matters when reading some of the softer outcomes, such as walking distance and questionnaire scores, because patients who know they've had a procedure can feel and perform differently. Our guide to open-label and blinded trials explains why. Check the full NEJM paper for the exact blinding arrangements.

The main outcome was clinical worsening. That was a composite of death, heart or lung transplant, hospital admission for heart failure, worsening heart failure treated with intravenous diuretics as an outpatient, or a significant fall in six-minute walk distance. Median follow-up was 338 days, a little under a year.

The main results

The hazard ratio of 0.49 means patients who had the procedure were about half as likely to have a worsening event at any given time. The p value was 0.006.

The repeat event result is worth noticing. Many heart failure patients don't have one bad episode. They cycle in and out of hospital. Counting every event, the procedure group had about 20 fewer per 100 patient-years.

Pulnovo's release lists the other findings:

• At 12 months, six-minute walk distance improved by a net 24.8 metres in the PADN group compared with medicines alone.
• The risk of a fall of 10% or more in walk distance was lower with PADN (hazard ratio 0.37, 95% CI 0.15 to 0.92).
• Scores on the Kansas City Cardiomyopathy Questionnaire, which measures symptoms and daily life, improved.
• NT-proBNP, a blood marker of heart strain, fell further from baseline at six months in the PADN group.

Safety

The safety numbers were reassuring in this sample. Access-site haematomas, bruising or bleeding where the catheter goes in, occurred in two patients in the PADN group and one in the medicines group. There were no other procedural complications. The ACC summary adds that adverse events overall were not significantly different between groups.

Two hundred and sixty-four patients is a small trial for safety, though. Rare harms, such as damage to the artery wall, might only show up when thousands of people have been treated.

How much weight to put on this

There are good reasons to take it seriously. The effect on the main outcome was large, it was published in a top journal, and an experienced US trialist was among the senior authors.

There are also reasons for caution, and the authors flagged some of them themselves. "Additional long-term follow-up will be important to determine whether the observed mid-term improvements translate into sustained reductions in mortality and hospitalization for HF," Zhang and colleagues wrote.

Several points stand out:

1. The two-year figures are Kaplan-Meier estimates projected from a median follow-up of under a year.
2. The composite outcome mixes hard events like death with a fall in walking distance. It isn't clear from the summaries how much of the gap each part explains.
3. All patients were treated in China. Heart failure care, drug use and patient profiles vary between countries, so a confirmation trial elsewhere would help.
4. Without a reported sham control, the walking and questionnaire results are more open to expectation effects than the hospital and death numbers.

None of these undo the result. They mean the next trials will be watched closely, especially for effects on death and hospital admission.

Putting the numbers in plain terms

Imagine 100 people like those in the trial, all on standard heart failure medicines. Based on the estimates, about 52 would be expected to have a worsening event within two years. Add PADN and that drops to about 26.

That's roughly 26 fewer people with a worsening event for every 100 treated. Remember these are projections from a short follow-up and include walking test declines as well as admissions and deaths. Our explainer on reading trial results with absolute risk covers why this kind of framing matters.

How it fits with other heart procedures

Cardiology has had a run of catheter procedures moving into heart failure care. We have also covered TRIC-I-HF, which tested repairing a leaking tricuspid valve, and AIR-STEMI on functional angiography after heart attack. PADN is different because it treats nerves around a blood vessel, not a valve or a blockage.

Can patients get PADN?

Not routinely for this use in Europe, the UK or the US. Pulnovo says it is expanding its research into group 2 pulmonary hypertension and its approvals so far rest largely on experience in group 1 disease. Before a health service could adopt PADN for heart failure patients, regulators would need to review the evidence and, in the UK, NICE would usually assess it.

If you have heart failure and have been told your lung pressures are raised, ask your cardiologist whether any trials of PADN or similar procedures are recruiting nearby. Our guide on finding and joining a clinical trial explains where to look.

This article summarises published research for general information. It is not medical advice, so please speak to your own care team before making any changes.