PMID- 9396441
OWN - NLM
STAT- MEDLINE
DCOM- 19980109
LR  - 20220309
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 96
IP  - 10
DP  - 1997 Nov 18
TI  - Arterial baroreflex modulation of heart rate in chronic heart failure: clinical 
      and hemodynamic correlates and prognostic implications.
PG  - 3450-8
AB  - BACKGROUND: In chronic heart failure (CHF), arterial baroreflex regulation of 
      cardiac function is impaired, leading to a reduction in the tonic restraining 
      influence on the sympathetic nervous system. Because baroreflex sensitivity 
      (BRS), as assessed by the phenylephrine technique, significantly contributes to 
      postinfarction risk stratification, the aim of the present study was to evaluate 
      whether in CHF patients a depressed BRS is associated with a worse clinical 
      hemodynamic status and unfavorable outcome. METHODS AND RESULTS: BRS was assessed 
      in 282 CHF patients in sinus rhythm receiving stable medical therapy (age, 52+/-9 
      years; New York Heart Association [NYHA] class, 2.4+/-0.6; left ventricular 
      ejection fraction [LVEF], 23+/-6%). The BRS of the entire population averaged 
      3.9+/-4.0 ms/mm Hg (mean+/-SD) and was significantly related to LVEF and 
      hemodynamic parameters (LVEF, P<.005; cardiac index and pulmonary wedge pressure, 
      P<.001 by regression analysis). Patients in NYHA classes III or IV and those with 
      severe mitral regurgitation had markedly depressed vagal reflexes. The 
      association of BRS with survival was described after its categorization in three 
      groups: below the lowest quartile (<1.3 ms/mm Hg), between the lowest quartile 
      and the median (1.3 to 3 ms/mm Hg), and above the median (>3 ms/mm Hg). During a 
      mean follow-up of 15+/-12 months, 78 primary events (cardiac death, nonfatal 
      cardiac arrest, and status 1 priority transplantation) occurred (27.6%). BRS was 
      significantly related to outcome (log rank, 9.1; P<.01), with a relative risk of 
      2.7 (95% confidence interval, 1.6 to 4.7) for patients with the major derangement 
      in BRS (<1.3 ms/mm Hg). At multivariate analysis, BRS was an independent 
      predictor of death after adjustment for noninvasive known risk factors but not 
      when hemodynamic indexes were also considered. In CHF patients with severe mitral 
      regurgitation, however, BRS remained a strong prognostic marker independent of 
      hemodynamic function. CONCLUSIONS: In moderate to severe CHF, a depressed 
      sensitivity of vagal reflexes parallels the deterioration of clinical and 
      hemodynamic status and is significantly associated with poor survival. 
      Particularly in patients with severe mitral regurgitation the baroreceptor 
      modulation of heart rate provides prognostic information of incremental value to 
      hemodynamic parameters.
FAU - Mortara, A
AU  - Mortara A
AD  - Division of Cardiology, Centro Medico di Montescano, S Maugeri Foundation, IRCCS, 
      Pavia, Italy.
FAU - La Rovere, M T
AU  - La Rovere MT
FAU - Pinna, G D
AU  - Pinna GD
FAU - Prpa, A
AU  - Prpa A
FAU - Maestri, R
AU  - Maestri R
FAU - Febo, O
AU  - Febo O
FAU - Pozzoli, M
AU  - Pozzoli M
FAU - Opasich, C
AU  - Opasich C
FAU - Tavazzi, L
AU  - Tavazzi L
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
MH  - Adult
MH  - Arteries/*physiopathology
MH  - Baroreflex/*physiology
MH  - Cardiac Output, Low/mortality/*physiopathology
MH  - Chronic Disease
MH  - Heart Rate/*physiology
MH  - Hemodynamics/physiology
MH  - Humans
MH  - Middle Aged
MH  - Prognosis
MH  - Survival Analysis
EDAT- 1997/12/13 00:00
MHDA- 1997/12/13 00:01
CRDT- 1997/12/13 00:00
PHST- 1997/12/13 00:00 [pubmed]
PHST- 1997/12/13 00:01 [medline]
PHST- 1997/12/13 00:00 [entrez]
AID - 10.1161/01.cir.96.10.3450 [doi]
PST - ppublish
SO  - Circulation. 1997 Nov 18;96(10):3450-8. doi: 10.1161/01.cir.96.10.3450.