PMID- 16198850
OWN - NLM
STAT- MEDLINE
DCOM- 20051222
LR  - 20071115
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 46
IP  - 7
DP  - 2005 Oct 4
TI  - Applicability and clinical relevance of the transfer function method in the 
      assessment of baroreflex sensitivity in heart failure patients.
PG  - 1314-21
AB  - OBJECTIVES: We sought to assess applicability, clinical correlates, and 
      prognostic value of the transfer function method for measuring baroreflex 
      sensitivity (TF-BRS). BACKGROUND: Abnormalities in autonomic reflexes play an 
      important role in the development and progression of chronic heart failure (CHF). 
      Simple and non-invasive techniques for clinical measurement of such reflexes are 
      desirable. METHODS: In 317 stable CHF patients in sinus rhythm (median age 
      [interquartile range]: 54 years [48 to 59 years], New York Heart Association 
      [NYHA] functional class II to III: 88%, left ventricular ejection fraction 
      [LVEF]: 27% [22% to 33%]) we recorded electrocardiograms and non-invasive 
      arterial pressure during paced breathing to measure TF-BRS. RESULTS: Owing to a 
      high number of ectopic beats, TF-BRS could be computed in 72% of the patients; 
      TF-BRS was lower in NYHA functional class III to IV and mitral regurgitation 2 to 
      3 (p < 0.0005 for both). Correlation with LVEF and standard deviation of all 
      normal-to-normal intervals was 0.18 and 0.31 (p < 0.001 for both). During a mean 
      follow-up of 26 months, 23% of the patients experienced a cardiac event. A 
      depressed TF-BRS (< or =3.1 ms/mm Hg) was significantly associated with the 
      outcome (hazard ratio 3.2, 95% confidence interval [CI] 1.7 to 6.0, p = 0.0003). 
      Patients with a missing TF-BRS had a high event rate (36%). Combining this 
      information with available TF-BRS measurements, a new prognostic index could be 
      computed in 97% of the patients that significantly predicted the outcome after 
      adjustment for clinical and functional variables (hazard ratio 2.5, 95% CI 1.3 to 
      4.6 p = 0.004). CONCLUSIONS: In CHF patients in sinus rhythm, TF-BRS conveys 
      relevant clinical and prognostic information, but its measurability is markedly 
      affected by ectopic activity. Nevertheless, a TF-BRS-based risk index carrying 
      significant and independent prognostic information can be computed in almost all 
      patients.
FAU - Pinna, Gian Domenico
AU  - Pinna GD
AD  - Department of Cardiology and Biomedical Engineering, Salvatore Maugeri 
      Foundation, IRCCS, Scientific Institute of Montescano, Montescano, PV, Italy. 
      gdpinna@fsm.it
FAU - Maestri, Roberto
AU  - Maestri R
FAU - Capomolla, Soccorso
AU  - Capomolla S
FAU - Febo, Oreste
AU  - Febo O
FAU - Robbi, Elena
AU  - Robbi E
FAU - Cobelli, Franco
AU  - Cobelli F
FAU - La Rovere, Maria Teresa
AU  - La Rovere MT
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
MH  - Baroreflex/*physiology
MH  - Diagnostic Techniques, Neurological
MH  - Female
MH  - Heart Failure/*physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Risk Assessment
EDAT- 2005/10/04 09:00
MHDA- 2005/12/24 09:00
CRDT- 2005/10/04 09:00
PHST- 2004/12/13 00:00 [received]
PHST- 2005/06/16 00:00 [revised]
PHST- 2005/06/21 00:00 [accepted]
PHST- 2005/10/04 09:00 [pubmed]
PHST- 2005/12/24 09:00 [medline]
PHST- 2005/10/04 09:00 [entrez]
AID - S0735-1097(05)01658-X [pii]
AID - 10.1016/j.jacc.2005.06.062 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2005 Oct 4;46(7):1314-21. doi: 10.1016/j.jacc.2005.06.062.