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Titolo:
ARTERIAL BAROREFLEX MODULATION OF HEART-RATE IN CHRONIC HEART-FAILURE- CLINICAL AND HEMODYNAMIC CORRELATES AND PROGNOSTIC IMPLICATIONS
Autore:
MORTARA A; LAROVERE MT; PINNA GD; PRPA A; MAESTRI R; FEBO O; POZZOLI M; OPASICH C; TAVAZZI L;
Indirizzi:
IRCCS,S MAUGERI FDN,CTR MED MONTESCANO,DIV CARDIOL PAVIA ITALY
Titolo Testata:
Circulation
fascicolo: 10, volume: 96, anno: 1997,
pagine: 3450 - 3458
SICI:
0009-7322(1997)96:10<3450:ABMOHI>2.0.ZU;2-9
Fonte:
ISI
Lingua:
ENG
Soggetto:
SYMPATHETIC-NERVE ACTIVITY; MYOCARDIAL-INFARCTION; AUTONOMIC PATHOPHYSIOLOGY; BARORECEPTOR SENSITIVITY; CARDIOVASCULAR MORTALITY; REFLEXES; DOGS; ABNORMALITIES; REVERSAL; FLOW;
Keywords:
HEART FAILURE; BARORECEPTORS; NERVOUS SYSTEM, AUTONOMIC; PROGNOSIS; HEMODYNAMICS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
34
Recensione:
Indirizzi per estratti:
Citazione:
A. Mortara et al., "ARTERIAL BAROREFLEX MODULATION OF HEART-RATE IN CHRONIC HEART-FAILURE- CLINICAL AND HEMODYNAMIC CORRELATES AND PROGNOSTIC IMPLICATIONS", Circulation, 96(10), 1997, pp. 3450-3458

Abstract

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 CHFpatients 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 ill NYHA classes III or IV and those with severe mitral regurgitation had markedly depressed vagal reflexes, The associationof BRS with survival was described after its categorization in three groups: below the lowest quartile (< 1.3 ms/mm Hg), between the lowestquartile 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 independentpredictor 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.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 07/07/20 alle ore 05:02:36