Depressed arterial baroreflex sensitivity and not reduced heart rate variability identifies patients with chronic heart failure and nonsustained ventricular tachycardia

The effect of high ventricular filling pressure

A. Mortara, M. T. La Rovere, G. D. Pinna, P. Parziale, R. Maestri, S. Capomolla, C. Opasich, F. Cobelli, L. Tavazzi

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

In chronic heart failure (CHF) the contributing role of increased sympathetic activity and hemodynamic dysfunction in the genesis of ventricular arrhythmias has not been well established. To assess the relation between severe ventricular arrhythmias, hemodynamic impairment, and autonomic nervous system derangement, 142 patients with CHF in sinus rhythm underwent 24-hour electrocardiographic recording, right-sided heart catheterization, and evaluation of sympathovagal balance by heart rate variability (HRV) and baroreflex sensitivity (BRS). Patients were grouped according to the absence (without nonsustained ventricular tachycardia [NSVT]; n = 87) or presence (with NSVT; n = 55) of NSVT. Patients with NSVT had higher pulmonary artery and capillary pressures and more pronounced signs of sympathetic activation and parasympathetic withdrawal compared with those without NSVT. However, logistic regression analysis revealed that depressed BRS but not reduced HRV was significantly associated with the presence of NSVT, at both univariate analysis and after adjustment for clinical and hemodynamic variables. Moreover, it was found that when depressed BRS was associated with high pulmonary capillary pressure, the odds ratio for having NSVT rose markedly from 3.8 to 6.5. In conclusion, this study indicates that in stable CHF the assessment of arterial baroreflex function, but not HRV analysis, allows identification of patients at high risk of NSVT. It is suggested that the effect of depressed BRS is strengthened by the simultaneous presence of increased myocardial wall stress. These data support the hypothesis of a contributory role of autonomic nervous system dysfunction as expressed by the inability to activate effective vagal reflexes and an indirect index of ventricular stretch in the genesis of life-threatening arrhythmias.

Original languageEnglish
Pages (from-to)879-888
Number of pages10
JournalAmerican Heart Journal
Volume134
Issue number5 I
Publication statusPublished - 1997

Fingerprint

Baroreflex
Ventricular Pressure
Ventricular Tachycardia
Heart Failure
Heart Rate
Cardiac Arrhythmias
Hemodynamics
Autonomic Nervous System
Pressure
Cardiac Catheterization
Pulmonary Artery
Reflex
Logistic Models
Odds Ratio
Regression Analysis
Lung

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{28905a683d7847118f2174a56926a4ad,
title = "Depressed arterial baroreflex sensitivity and not reduced heart rate variability identifies patients with chronic heart failure and nonsustained ventricular tachycardia: The effect of high ventricular filling pressure",
abstract = "In chronic heart failure (CHF) the contributing role of increased sympathetic activity and hemodynamic dysfunction in the genesis of ventricular arrhythmias has not been well established. To assess the relation between severe ventricular arrhythmias, hemodynamic impairment, and autonomic nervous system derangement, 142 patients with CHF in sinus rhythm underwent 24-hour electrocardiographic recording, right-sided heart catheterization, and evaluation of sympathovagal balance by heart rate variability (HRV) and baroreflex sensitivity (BRS). Patients were grouped according to the absence (without nonsustained ventricular tachycardia [NSVT]; n = 87) or presence (with NSVT; n = 55) of NSVT. Patients with NSVT had higher pulmonary artery and capillary pressures and more pronounced signs of sympathetic activation and parasympathetic withdrawal compared with those without NSVT. However, logistic regression analysis revealed that depressed BRS but not reduced HRV was significantly associated with the presence of NSVT, at both univariate analysis and after adjustment for clinical and hemodynamic variables. Moreover, it was found that when depressed BRS was associated with high pulmonary capillary pressure, the odds ratio for having NSVT rose markedly from 3.8 to 6.5. In conclusion, this study indicates that in stable CHF the assessment of arterial baroreflex function, but not HRV analysis, allows identification of patients at high risk of NSVT. It is suggested that the effect of depressed BRS is strengthened by the simultaneous presence of increased myocardial wall stress. These data support the hypothesis of a contributory role of autonomic nervous system dysfunction as expressed by the inability to activate effective vagal reflexes and an indirect index of ventricular stretch in the genesis of life-threatening arrhythmias.",
author = "A. Mortara and {La Rovere}, {M. T.} and Pinna, {G. D.} and P. Parziale and R. Maestri and S. Capomolla and C. Opasich and F. Cobelli and L. Tavazzi",
year = "1997",
language = "English",
volume = "134",
pages = "879--888",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "5 I",

}

TY - JOUR

T1 - Depressed arterial baroreflex sensitivity and not reduced heart rate variability identifies patients with chronic heart failure and nonsustained ventricular tachycardia

T2 - The effect of high ventricular filling pressure

AU - Mortara, A.

AU - La Rovere, M. T.

AU - Pinna, G. D.

AU - Parziale, P.

AU - Maestri, R.

AU - Capomolla, S.

AU - Opasich, C.

AU - Cobelli, F.

AU - Tavazzi, L.

PY - 1997

Y1 - 1997

N2 - In chronic heart failure (CHF) the contributing role of increased sympathetic activity and hemodynamic dysfunction in the genesis of ventricular arrhythmias has not been well established. To assess the relation between severe ventricular arrhythmias, hemodynamic impairment, and autonomic nervous system derangement, 142 patients with CHF in sinus rhythm underwent 24-hour electrocardiographic recording, right-sided heart catheterization, and evaluation of sympathovagal balance by heart rate variability (HRV) and baroreflex sensitivity (BRS). Patients were grouped according to the absence (without nonsustained ventricular tachycardia [NSVT]; n = 87) or presence (with NSVT; n = 55) of NSVT. Patients with NSVT had higher pulmonary artery and capillary pressures and more pronounced signs of sympathetic activation and parasympathetic withdrawal compared with those without NSVT. However, logistic regression analysis revealed that depressed BRS but not reduced HRV was significantly associated with the presence of NSVT, at both univariate analysis and after adjustment for clinical and hemodynamic variables. Moreover, it was found that when depressed BRS was associated with high pulmonary capillary pressure, the odds ratio for having NSVT rose markedly from 3.8 to 6.5. In conclusion, this study indicates that in stable CHF the assessment of arterial baroreflex function, but not HRV analysis, allows identification of patients at high risk of NSVT. It is suggested that the effect of depressed BRS is strengthened by the simultaneous presence of increased myocardial wall stress. These data support the hypothesis of a contributory role of autonomic nervous system dysfunction as expressed by the inability to activate effective vagal reflexes and an indirect index of ventricular stretch in the genesis of life-threatening arrhythmias.

AB - In chronic heart failure (CHF) the contributing role of increased sympathetic activity and hemodynamic dysfunction in the genesis of ventricular arrhythmias has not been well established. To assess the relation between severe ventricular arrhythmias, hemodynamic impairment, and autonomic nervous system derangement, 142 patients with CHF in sinus rhythm underwent 24-hour electrocardiographic recording, right-sided heart catheterization, and evaluation of sympathovagal balance by heart rate variability (HRV) and baroreflex sensitivity (BRS). Patients were grouped according to the absence (without nonsustained ventricular tachycardia [NSVT]; n = 87) or presence (with NSVT; n = 55) of NSVT. Patients with NSVT had higher pulmonary artery and capillary pressures and more pronounced signs of sympathetic activation and parasympathetic withdrawal compared with those without NSVT. However, logistic regression analysis revealed that depressed BRS but not reduced HRV was significantly associated with the presence of NSVT, at both univariate analysis and after adjustment for clinical and hemodynamic variables. Moreover, it was found that when depressed BRS was associated with high pulmonary capillary pressure, the odds ratio for having NSVT rose markedly from 3.8 to 6.5. In conclusion, this study indicates that in stable CHF the assessment of arterial baroreflex function, but not HRV analysis, allows identification of patients at high risk of NSVT. It is suggested that the effect of depressed BRS is strengthened by the simultaneous presence of increased myocardial wall stress. These data support the hypothesis of a contributory role of autonomic nervous system dysfunction as expressed by the inability to activate effective vagal reflexes and an indirect index of ventricular stretch in the genesis of life-threatening arrhythmias.

UR - http://www.scopus.com/inward/record.url?scp=0030815420&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030815420&partnerID=8YFLogxK

M3 - Article

VL - 134

SP - 879

EP - 888

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 5 I

ER -