PMID- 19130988
OWN - NLM
STAT- MEDLINE
DCOM- 20090202
LR  - 20220409
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 53
IP  - 2
DP  - 2009 Jan 13
TI  - Prognostic implications of baroreflex sensitivity in heart failure patients in 
      the beta-blocking era.
PG  - 193-9
LID - 10.1016/j.jacc.2008.09.034 [doi]
AB  - OBJECTIVES: This study investigated the clinical correlates and prognostic value 
      of depressed baroreceptor-heart rate reflex sensitivity (BRS) among patients with 
      heart failure (HF), with and without beta-blockade. BACKGROUND: Abnormalities in 
      autonomic reflexes play an important role in the development and progression of 
      HF. Few studies have assessed the effects of beta-blockers on BRS in HF. METHODS: 
      The study population consisted of 103 stable HF patients, age (median 
      [interquartile range]) 54 years (48 to 57 years), with New York Heart Association 
      (NYHA) functional class > or =III in 22, and with a left ventricular ejection 
      fraction (LVEF) of 30% (24% to 36%), treated with beta-blockers; and 144 
      untreated patients, age 55 years (48 to 60 years), with NYHA functional class > 
      or =III in 47%, and an LVEF of 26% (21% to 30%). They underwent BRS testing 
      (phenylephrine technique). RESULTS: In both treated and untreated patients, a 
      lower BRS was associated with a higher (> or =III) NYHA functional class (p = 
      0.0002 and p < 0.0001, respectively); a more severe (> or =2) mitral 
      regurgitation (p = 0.007 and p = 0.0002), respectively; a lower LVEF (p = 0.0004 
      and p = 0.001, respectively), baseline RR interval (p = 0.0004 and p = 0.0002, 
      respectively), and SDNN (p < 0.0001, p = 0.002, respectively); and a higher blood 
      urea nitrogen (p = 0.004, p < 0.0001, respectively). Clinical variables explained 
      only 43% of BRS variability among treated and 36% among untreated patients. 
      During a median follow-up of 29 months, 17 of 103 patients and 55 of 144 
      patients, respectively, experienced a cardiac event. A depressed BRS (<3.0 ms/mm 
      Hg) was significantly associated with the outcome, independently of known risk 
      predictors and beta-blocker treatment (adjusted hazard ratio: 3.0 [95% confidence 
      interval: 1.5 to 5.9], p = 0.001). CONCLUSIONS: Baroreceptor-heart rate reflex 
      sensitivity does not simply mirror the pathophysiological substrate of HF. A 
      depressed BRS conveys independent prognostic information that is not affected by 
      the modification of autonomic dysfunction brought about by beta-blockade.
FAU - La Rovere, Maria Teresa
AU  - La Rovere MT
AD  - Divisione di Cardiologia, e Bioingegneria, Fondazione Salvatore Maugeri, IRCCS 
      Istituto Scientifico di Montescano, Montescano, Italy. 
      mariateresa.larovere@fsm.it
FAU - Pinna, Gian Domenico
AU  - Pinna GD
FAU - Maestri, Roberto
AU  - Maestri R
FAU - Robbi, Elena
AU  - Robbi E
FAU - Caporotondi, Angelo
AU  - Caporotondi A
FAU - Guazzotti, Gianpaolo
AU  - Guazzotti G
FAU - Sleight, Peter
AU  - Sleight P
FAU - Febo, Oreste
AU  - Febo O
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Adrenergic beta-Antagonists)
SB  - IM
MH  - Adrenergic beta-Antagonists/*pharmacology/*therapeutic use
MH  - Aged
MH  - Baroreflex/*drug effects
MH  - Heart Failure/*drug therapy/*physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Retrospective Studies
MH  - Severity of Illness Index
EDAT- 2009/01/10 09:00
MHDA- 2009/02/03 09:00
CRDT- 2009/01/10 09:00
PHST- 2008/07/11 00:00 [received]
PHST- 2008/08/28 00:00 [revised]
PHST- 2008/09/01 00:00 [accepted]
PHST- 2009/01/10 09:00 [entrez]
PHST- 2009/01/10 09:00 [pubmed]
PHST- 2009/02/03 09:00 [medline]
AID - S0735-1097(08)03375-5 [pii]
AID - 10.1016/j.jacc.2008.09.034 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2009 Jan 13;53(2):193-9. doi: 10.1016/j.jacc.2008.09.034.