Different estimation methods of spontaneous baroreflex sensitivity have different predictive value in heart failure patients

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: Several methods have been developed so far to estimate cardiac baroreflex sensitivity (BRS) through the analysis of spontaneous fluctuations of systolic arterial pressure (SAP) and R-R interval. Their relative performance in predicting cardiac mortality in heart failure patients is not known. The aim of this study was to compare the prognostic value of a set of representative indexes of spontaneous BRS in these patients. Methods: We studied 228 stable, moderate-to-severe heart failure patients with reduced ejection fraction, in sinus rhythm, who underwent an 8-min supine recording of ECG, arterial blood pressure and respiration during paced breathing (15 breaths/min). BRS was estimated according to the following methods: Sequence (BRSSeq); nonparametric transfer function in the low-frequency band (BRSTF-NP-LF); parametric spectral computed in the low-frequency and high-frequency bands (BRSPS-LF and BRSPS-HF); parametric transfer function computed in the low-frequency and high-frequency bands (BRSTF-P-LF and BRSTF-P-HF); model-based closed loop (BRSCL); and bivariate phase-rectified signal averaging (BRSPRSA). Results: During a median follow-up of 36 months, 45 patients experienced a cardiac event. Only BRSTF-NP-LF, BRSPS-LF, BRSTF-P-LF and BRS PRSA were significantly associated with the outcome (P < 0.01), and statistical significance remained (P ≤ 0.03) after adjusting for clinical covariates. BRSTF-NP-LF and BRSPRSA also significantly improved the risk classification. Conclusion: This study shows that different spontaneous BRS indexes have different predictive value in patients with heart failure. It also shows that the prognostic information of BRS estimates is linked to SAP and RR oscillations in the low-frequency band. © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Original languageEnglish
Pages (from-to)1666-1675
Number of pages10
JournalJournal of Hypertension
Volume35
Issue number8
DOIs
Publication statusPublished - 2017

Fingerprint

Baroreflex
Heart Failure
Arterial Pressure
Respiration
Blood Pressure
Electrocardiography
Mortality
Health

Keywords

  • baroreceptors
  • noninvasive
  • prognosis
  • risk stratification
  • adult
  • arterial pressure
  • Article
  • disease severity
  • electrocardiogram
  • female
  • follow up
  • heart failure
  • heart failure with reduced ejection fraction
  • human
  • major clinical study
  • male
  • middle aged
  • predictive value
  • pressoreceptor reflex
  • priority journal
  • reference value

Cite this

@article{cab1c63f9ba642ff85be55cf80f412b2,
title = "Different estimation methods of spontaneous baroreflex sensitivity have different predictive value in heart failure patients",
abstract = "Objective: Several methods have been developed so far to estimate cardiac baroreflex sensitivity (BRS) through the analysis of spontaneous fluctuations of systolic arterial pressure (SAP) and R-R interval. Their relative performance in predicting cardiac mortality in heart failure patients is not known. The aim of this study was to compare the prognostic value of a set of representative indexes of spontaneous BRS in these patients. Methods: We studied 228 stable, moderate-to-severe heart failure patients with reduced ejection fraction, in sinus rhythm, who underwent an 8-min supine recording of ECG, arterial blood pressure and respiration during paced breathing (15 breaths/min). BRS was estimated according to the following methods: Sequence (BRSSeq); nonparametric transfer function in the low-frequency band (BRSTF-NP-LF); parametric spectral computed in the low-frequency and high-frequency bands (BRSPS-LF and BRSPS-HF); parametric transfer function computed in the low-frequency and high-frequency bands (BRSTF-P-LF and BRSTF-P-HF); model-based closed loop (BRSCL); and bivariate phase-rectified signal averaging (BRSPRSA). Results: During a median follow-up of 36 months, 45 patients experienced a cardiac event. Only BRSTF-NP-LF, BRSPS-LF, BRSTF-P-LF and BRS PRSA were significantly associated with the outcome (P < 0.01), and statistical significance remained (P ≤ 0.03) after adjusting for clinical covariates. BRSTF-NP-LF and BRSPRSA also significantly improved the risk classification. Conclusion: This study shows that different spontaneous BRS indexes have different predictive value in patients with heart failure. It also shows that the prognostic information of BRS estimates is linked to SAP and RR oscillations in the low-frequency band. {\circledC} 2017 Wolters Kluwer Health, Inc. All rights reserved.",
keywords = "baroreceptors, noninvasive, prognosis, risk stratification, adult, arterial pressure, Article, disease severity, electrocardiogram, female, follow up, heart failure, heart failure with reduced ejection fraction, human, major clinical study, male, middle aged, predictive value, pressoreceptor reflex, priority journal, reference value",
author = "G.D. Pinna and A. Porta and R. Maestri and {De Maria}, B. and {Dalla Vecchia}, L.A. and {La Rovere}, M.T.",
note = "Cited By :2 Export Date: 2 March 2018 CODEN: JOHYD Correspondence Address: Pinna, G.D.; Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri SpA SB, Istituto di Montescano-IRCCS, Via per Montescano 35, Italy; email: giandomenico.pinna@icsmaugeri.it References: Smyth, H.S., Sleight, P., Pickering, G.W., Reflex regulation of arterial pressure during sleep in man. A quantitative method of assessing baroreflex sensitivity (1969) Circ Res, 24, pp. 109-121; La Rovere, M.T., Bigger, J.T., Jr., Marcus, F.I., Mortara, A., Schwartz, P.J., Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes after Myocardial Infarction) Investigators (1998) Lancet, 351, pp. 478-484; Pinna, G.D., Maestri, R., La Rovere, M.T., Assessment of baroreflex sensitivity from spontaneous oscillations of blood pressure and heart rate: Proven clinical value (2015) Physiol Meas, 36, pp. 741-753; Pinna, G.D., Maestri, R., Capomolla, S., Febo, O., Robbi, E., Cobelli, F., La Rovere, M.T., Applicability and clinical relevance of the transfer function method in the assessment of baroreflex sensitivity in heart failure patients (2005) J Am Coll Cardiol, 46, pp. 1314-1321; Porta, A., Baselli, G., Rimoldi, O., Malliani, A., Pagani, M., Assessing baroreflex gain from spontaneous variability in conscious dogs: Role of causality and respiration (2000) Am J Physiol, 279, pp. H2558-H2567; Laude, D., Elghozi, J.L., Girard, A., Bellard, E., Bouhaddi, M., Castiglioni, P., Comparison of various techniques used to estimate spontaneous baroreflex sensitivity (the EuroBaVar study) (2004) Am J Physiol, 286, pp. R226-R231; Vallais, F., Baselli, G., Lucini, D., Pagani, M., Porta, A., Spontaneous baroreflex sensitivity estimates during graded bicycle exercise: A comparative study (2009) Physiol Meas, 30, pp. 201-213; Porta, A., Bari, V., Bassani, T., Marchi, A., Pistuddi, V., Ranucci, M., Modelbased causal closed loop approach to the estimate of baroreflex sensitivity during propofol anesthesia in patients undergoing coronary artery bypass graft (2013) J App Physiol, 115, pp. 1032-1042; Pinna, G.D., Maestri, R., Reliability of transfer function estimates in cardiovascular variability analysis (2001) Med Biol Eng Comput, 39, pp. 338-347; Parati, G., Di Rienzo, M., Bertinieri, G., Pomidossi, G., Casadei, R., Groppelli, A., Evaluation of the baroreceptor-heart rate reflex by 24-h intraarterial blood pressure monitoring in humans (1988) Hypertension, 12, pp. 214-222; Pinna, G.D., Maestri, R., Raczak, G., La Rovere, M.T., Measuring baroreflex sensitivity from the gain function between arterial pressure and heart period (2002) Clin Sci (Lond), 103, pp. 81-88; Pagani, M., Somers, V.K., Furlan, R., Dell'Orto, S., Conway, J., Baselli, G., Changes in autonomic regulation induced by physical training in mild hypertension (1988) Hypertension, 12, pp. 600-610; Baselli, G., Porta, A., Rimoldi, O., Pagani, M., Cerutti, S., Spectral decomposition in multichannel recordings based on multivariate parametric identification (1997) IEEE Trans Biomed Eng, 44, pp. 1092-1101; Baselli, G., Cerutti, S., Badilini, F., Biancardi, L., Porta, A., Pagani, M., Model for the assessment of heart period and arterial pressure variability interactions and of respiration influences (1994) Med Biol Eng Comput, 32, pp. 143-152; Bauer, A., Morley-Davies, A., Barthel, P., Muller, A., Ulm, K., Malik, M., Schmidt, G., Bivariate phase-rectified signal averaging for assessment of spontaneous baroreflex sensitivity: Pilot study of the technology (2010) J Electrocardiol, 43, pp. 649-653; Muller, A., Morley-Davies, A., Barthel, P., Hnatkova, K., Bauer, A., Ulm, K., Bivariate phase-rectified signal averaging for assessment of spontaneous baroreflex sensitivity: Normalization of the results (2012) J Electrocardiol, 45, pp. 77-81; Mortara, A., Sleight, P., Pinna, G.D., Maestri, R., Prpa, A., La Rovere, M.T., Abnormal awake respiratory patterns are common in chronic heart failure and may prevent evaluation of autonomic tone by measures of heart rate variability (1997) Circulation, 96, pp. 246-252; Pinna, G.D., Maestri, R., La Rovere, M.T., Gobbi, E., Fanfulla, F., Effect of paced breathing on ventilatory and cardiovascular variability parameters during short-term investigations of autonomic function (2006) Am J Physiol Heart Circ Physiol, 290, pp. H424-H433; Maestri, R., Raczak, G., Torunski, A., Sukiennik, A., Kozowski, D., La Rovere, M.T., Pinna, G.D., Day-by-day variability of spontaneous baroreflex sensitivity measurements: Implications for their reliability in clinical and research applications (2009) J Hypertens, 27, pp. 806-812; La Rovere, M.T., Maestri, R., Robbi, E., Caporotondi, A., Guazzotti, G., Febo, O., Pinna, G.D., Comparison of the prognostic values of invasive and noninvasive assessments of baroreflex sensitivity in heart failure (2011) J Hypertens, 29, pp. 1546-1552; Gouveia, S., Scotto, M.G., Pinna, G.D., Maestri, R., La Rovere, M.T., Ferreira, P.J., Spontaneous baroreceptor reflex sensitivity for risk stratification of heart failure patients: Optimal cut-off and age effects (2015) Clin Sci (Lond), 129, pp. 1163-1172; Mazumdar, M., Glassman, J.R., Categorizing a prognostic variable: Review of methods, code for easy implementation and applications to decision-making about cancer treatments (2000) Stat Med, 19, pp. 113-132; Harrell, F.E., (2001) Regression Modeling Strategies, with Applications to Linear Models, Logistic Regression and Survival Analysis, p. 2061. , New York, New York: Springer-Verlag; Hlatky, M.A., Greenland, P., Arnett, D.K., Ballantyne, C.M., Criqui, M.H., Elkind, M.S., Criteria for evaluation of novel markers of cardiovascular risk: A scientific statement from the American Heart Association (2009) Circulation, 119, pp. 2408-2416. , American Heart Association Expert Panel on Subclinical Atherosclerotic Diseases and Emerging Risk Factors and the Stroke Council; Altman, D.G., Andersen, P.K., Bootstrap investigation of the stability of a Cox regression model (1989) Stat Med, 8, pp. 771-783; Radaelli, A., Mancia, G., Balestri, G., Rovati, A., Anzuini, A., Di Rienzo, M., Cardiovascular variability is similarly altered in coronary patients with normal left ventricular function and in heart failure patients (2014) J Hypertens, 32, pp. 2261-2266; La Rovere, M.T., Pinna, G.D., Maestri, R., Mortara, A., Capomolla, S., Febo, O., Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients (2003) Circulation, 107, pp. 565-570; Pomeranz, B., MacAulay, R.J., Caudill, M.A., Kutz, I., Adam, D., Gordon, D., Assessment of autonomic function in humans by heart rate spectral analysis (1985) Am J Physiol, 248 (1), pp. H151-H153; Porta, A., Bassani, T., Bari, V., Pinna, G.D., Maestri, R., Guzzetti, S., Accounting for respiration is necessary to reliably infer Granger causality from cardiovascular variability series (2012) IEEE Trans Biomed Eng, 59, pp. 832-841; Eckberg, D.L., The human respiratory gate (2003) J Physiol, 548, pp. 339-352; Taylor, J.A., Eckberg, D.L., Fundamental relations between short-term RR interval and arterial pressure oscillations in humans' (1996) Circulation, 93, pp. 1527-1532; Cevese, A., Gulli, G., Polati, E., Gottin, L., Grasso, R., Baroreflex and oscillation of heart period at 0.1 Hz studied by alpha-blockade and cross-spectral analysis in healthy humans (2001) J Physiol, 531, pp. 235-244; Van De Vooren, H., Gademan, M.G., Swenne, C.A., TenVoorde, B.J., Schalij, M.J., Van Der Wall, E.E., Baroreflex sensitivity, blood pressure buffering, resonance: What are the links Computer simulation of healthy subjects and heart failure patients (2007) J Appl Physiol, 102, pp. 1348-1356; Kay, S.M., (1988) Modern Spectral Estimation: Theory and Applications, pp. 195-198. , Englewood Cliffs New Jersey: Prentice Hall; Badilini, F., Maison-Blanche, P., Coumel, P., Heart rate variability in passive tilt test: Comparative evaluation of autoregressive and FFT spectral analyses (1998) PACE-Pacing Clin. Electrophysiol, 21, pp. 1122-1132; Parlow, J., Viale, J.P., Annat, G., Hughson, R., Quintin, L., Spontaneous cardiac baroreflex in humans. Comparison with drug-induced responses (1995) Hypertension, 25, pp. 1058-1068; Maestri, R., Raczak, G., Torunski, A., Sukiennik, A., Kozlowski, D., La Rovere, M.T., Pinna, G.D., Day-by-day variability of spontaneous baroreflex sensitivity measurements: Implications for their reliability in clinical and research applications (2009) J Hypertens, 27, pp. 806-812; Floras, J.S., Jones, J.V., Hassan, M.O., Sleight, P., Effects of acute and chronic beta-adrenoreceptor blockade on baroreflex sensitivity in humans (1988) J Auton Nerv Syst, 25, pp. 87-94; La Rovere, M.T., Pinna, G.D., Maestri, R., Robbi, E., Caporotondi, A., Guazzotti, G., Prognostic implications of baroreflex sensitivity in heart failure patients in the beta-blocking era (2009) J Am Coll Cardiol, 53, pp. 193-199; Sarzi Braga, S., La Rovere, M.T., Pedretti, R.F., Baroreflex sensitivity normalization after cardiac resynchronization therapy (2006) Int J Cardiol, 109, pp. 118-120; La Rovere, M.T., Bersano, C., Gnemmi, M., Specchia, G., Schwartz, P.J., Exercise-induced increase in baroreflex sensitivity predicts improved prognosis after myocardial infarction (2002) Circulation, 106, pp. 945-949; Schwartz, P.J., La Rovere, M.T., De Ferrari, G.M., Mann, D.L., Autonomic modulation for the management of patients with chronic heart failure (2015) Circ Heart Fail, 8, pp. 619-628; Mann, M.C., Exner, D.V., Hemmelgarn, B.R., Hanley, D.A., Turin, T.C., MacRae, J.M., The VITAH Trial-Vitamin D supplementation and cardiac autonomic tone in patients with end-stage kidney disease on hemodialysis: A blinded, randomized controlled trial (2016) Nutrients, 28, p. E608; Mortara, A., Vanoli, E., Baroreceptor activation therapy: The importance of targeting the right patient: Who needs to be treated (2015) Eur J Heart Fail, 17, pp. 1000-1002; Barthel, P., Bauer, A., Muller, A., Huster, K.M., Kanters, J.K., Paruchuri, V., Spontaneous baroreflex sensitivity: Prospective validation trial of a novel technique in survivors of acute myocardial infarction (2012) Heart Rhythm, 9, pp. 1288-1294",
year = "2017",
doi = "10.1097/HJH.0000000000001377",
language = "English",
volume = "35",
pages = "1666--1675",
journal = "Journal of Hypertension",
issn = "0263-6352",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Different estimation methods of spontaneous baroreflex sensitivity have different predictive value in heart failure patients

AU - Pinna, G.D.

AU - Porta, A.

AU - Maestri, R.

AU - De Maria, B.

AU - Dalla Vecchia, L.A.

AU - La Rovere, M.T.

N1 - Cited By :2 Export Date: 2 March 2018 CODEN: JOHYD Correspondence Address: Pinna, G.D.; Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri SpA SB, Istituto di Montescano-IRCCS, Via per Montescano 35, Italy; email: giandomenico.pinna@icsmaugeri.it References: Smyth, H.S., Sleight, P., Pickering, G.W., Reflex regulation of arterial pressure during sleep in man. A quantitative method of assessing baroreflex sensitivity (1969) Circ Res, 24, pp. 109-121; La Rovere, M.T., Bigger, J.T., Jr., Marcus, F.I., Mortara, A., Schwartz, P.J., Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes after Myocardial Infarction) Investigators (1998) Lancet, 351, pp. 478-484; Pinna, G.D., Maestri, R., La Rovere, M.T., Assessment of baroreflex sensitivity from spontaneous oscillations of blood pressure and heart rate: Proven clinical value (2015) Physiol Meas, 36, pp. 741-753; Pinna, G.D., Maestri, R., Capomolla, S., Febo, O., Robbi, E., Cobelli, F., La Rovere, M.T., Applicability and clinical relevance of the transfer function method in the assessment of baroreflex sensitivity in heart failure patients (2005) J Am Coll Cardiol, 46, pp. 1314-1321; Porta, A., Baselli, G., Rimoldi, O., Malliani, A., Pagani, M., Assessing baroreflex gain from spontaneous variability in conscious dogs: Role of causality and respiration (2000) Am J Physiol, 279, pp. H2558-H2567; Laude, D., Elghozi, J.L., Girard, A., Bellard, E., Bouhaddi, M., Castiglioni, P., Comparison of various techniques used to estimate spontaneous baroreflex sensitivity (the EuroBaVar study) (2004) Am J Physiol, 286, pp. R226-R231; Vallais, F., Baselli, G., Lucini, D., Pagani, M., Porta, A., Spontaneous baroreflex sensitivity estimates during graded bicycle exercise: A comparative study (2009) Physiol Meas, 30, pp. 201-213; Porta, A., Bari, V., Bassani, T., Marchi, A., Pistuddi, V., Ranucci, M., Modelbased causal closed loop approach to the estimate of baroreflex sensitivity during propofol anesthesia in patients undergoing coronary artery bypass graft (2013) J App Physiol, 115, pp. 1032-1042; Pinna, G.D., Maestri, R., Reliability of transfer function estimates in cardiovascular variability analysis (2001) Med Biol Eng Comput, 39, pp. 338-347; Parati, G., Di Rienzo, M., Bertinieri, G., Pomidossi, G., Casadei, R., Groppelli, A., Evaluation of the baroreceptor-heart rate reflex by 24-h intraarterial blood pressure monitoring in humans (1988) Hypertension, 12, pp. 214-222; Pinna, G.D., Maestri, R., Raczak, G., La Rovere, M.T., Measuring baroreflex sensitivity from the gain function between arterial pressure and heart period (2002) Clin Sci (Lond), 103, pp. 81-88; Pagani, M., Somers, V.K., Furlan, R., Dell'Orto, S., Conway, J., Baselli, G., Changes in autonomic regulation induced by physical training in mild hypertension (1988) Hypertension, 12, pp. 600-610; Baselli, G., Porta, A., Rimoldi, O., Pagani, M., Cerutti, S., Spectral decomposition in multichannel recordings based on multivariate parametric identification (1997) IEEE Trans Biomed Eng, 44, pp. 1092-1101; Baselli, G., Cerutti, S., Badilini, F., Biancardi, L., Porta, A., Pagani, M., Model for the assessment of heart period and arterial pressure variability interactions and of respiration influences (1994) Med Biol Eng Comput, 32, pp. 143-152; Bauer, A., Morley-Davies, A., Barthel, P., Muller, A., Ulm, K., Malik, M., Schmidt, G., Bivariate phase-rectified signal averaging for assessment of spontaneous baroreflex sensitivity: Pilot study of the technology (2010) J Electrocardiol, 43, pp. 649-653; Muller, A., Morley-Davies, A., Barthel, P., Hnatkova, K., Bauer, A., Ulm, K., Bivariate phase-rectified signal averaging for assessment of spontaneous baroreflex sensitivity: Normalization of the results (2012) J Electrocardiol, 45, pp. 77-81; Mortara, A., Sleight, P., Pinna, G.D., Maestri, R., Prpa, A., La Rovere, M.T., Abnormal awake respiratory patterns are common in chronic heart failure and may prevent evaluation of autonomic tone by measures of heart rate variability (1997) Circulation, 96, pp. 246-252; Pinna, G.D., Maestri, R., La Rovere, M.T., Gobbi, E., Fanfulla, F., Effect of paced breathing on ventilatory and cardiovascular variability parameters during short-term investigations of autonomic function (2006) Am J Physiol Heart Circ Physiol, 290, pp. H424-H433; Maestri, R., Raczak, G., Torunski, A., Sukiennik, A., Kozowski, D., La Rovere, M.T., Pinna, G.D., Day-by-day variability of spontaneous baroreflex sensitivity measurements: Implications for their reliability in clinical and research applications (2009) J Hypertens, 27, pp. 806-812; La Rovere, M.T., Maestri, R., Robbi, E., Caporotondi, A., Guazzotti, G., Febo, O., Pinna, G.D., Comparison of the prognostic values of invasive and noninvasive assessments of baroreflex sensitivity in heart failure (2011) J Hypertens, 29, pp. 1546-1552; Gouveia, S., Scotto, M.G., Pinna, G.D., Maestri, R., La Rovere, M.T., Ferreira, P.J., Spontaneous baroreceptor reflex sensitivity for risk stratification of heart failure patients: Optimal cut-off and age effects (2015) Clin Sci (Lond), 129, pp. 1163-1172; Mazumdar, M., Glassman, J.R., Categorizing a prognostic variable: Review of methods, code for easy implementation and applications to decision-making about cancer treatments (2000) Stat Med, 19, pp. 113-132; Harrell, F.E., (2001) Regression Modeling Strategies, with Applications to Linear Models, Logistic Regression and Survival Analysis, p. 2061. , New York, New York: Springer-Verlag; Hlatky, M.A., Greenland, P., Arnett, D.K., Ballantyne, C.M., Criqui, M.H., Elkind, M.S., Criteria for evaluation of novel markers of cardiovascular risk: A scientific statement from the American Heart Association (2009) Circulation, 119, pp. 2408-2416. , American Heart Association Expert Panel on Subclinical Atherosclerotic Diseases and Emerging Risk Factors and the Stroke Council; Altman, D.G., Andersen, P.K., Bootstrap investigation of the stability of a Cox regression model (1989) Stat Med, 8, pp. 771-783; Radaelli, A., Mancia, G., Balestri, G., Rovati, A., Anzuini, A., Di Rienzo, M., Cardiovascular variability is similarly altered in coronary patients with normal left ventricular function and in heart failure patients (2014) J Hypertens, 32, pp. 2261-2266; La Rovere, M.T., Pinna, G.D., Maestri, R., Mortara, A., Capomolla, S., Febo, O., Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients (2003) Circulation, 107, pp. 565-570; Pomeranz, B., MacAulay, R.J., Caudill, M.A., Kutz, I., Adam, D., Gordon, D., Assessment of autonomic function in humans by heart rate spectral analysis (1985) Am J Physiol, 248 (1), pp. H151-H153; Porta, A., Bassani, T., Bari, V., Pinna, G.D., Maestri, R., Guzzetti, S., Accounting for respiration is necessary to reliably infer Granger causality from cardiovascular variability series (2012) IEEE Trans Biomed Eng, 59, pp. 832-841; Eckberg, D.L., The human respiratory gate (2003) J Physiol, 548, pp. 339-352; Taylor, J.A., Eckberg, D.L., Fundamental relations between short-term RR interval and arterial pressure oscillations in humans' (1996) Circulation, 93, pp. 1527-1532; Cevese, A., Gulli, G., Polati, E., Gottin, L., Grasso, R., Baroreflex and oscillation of heart period at 0.1 Hz studied by alpha-blockade and cross-spectral analysis in healthy humans (2001) J Physiol, 531, pp. 235-244; Van De Vooren, H., Gademan, M.G., Swenne, C.A., TenVoorde, B.J., Schalij, M.J., Van Der Wall, E.E., Baroreflex sensitivity, blood pressure buffering, resonance: What are the links Computer simulation of healthy subjects and heart failure patients (2007) J Appl Physiol, 102, pp. 1348-1356; Kay, S.M., (1988) Modern Spectral Estimation: Theory and Applications, pp. 195-198. , Englewood Cliffs New Jersey: Prentice Hall; Badilini, F., Maison-Blanche, P., Coumel, P., Heart rate variability in passive tilt test: Comparative evaluation of autoregressive and FFT spectral analyses (1998) PACE-Pacing Clin. Electrophysiol, 21, pp. 1122-1132; Parlow, J., Viale, J.P., Annat, G., Hughson, R., Quintin, L., Spontaneous cardiac baroreflex in humans. Comparison with drug-induced responses (1995) Hypertension, 25, pp. 1058-1068; Maestri, R., Raczak, G., Torunski, A., Sukiennik, A., Kozlowski, D., La Rovere, M.T., Pinna, G.D., Day-by-day variability of spontaneous baroreflex sensitivity measurements: Implications for their reliability in clinical and research applications (2009) J Hypertens, 27, pp. 806-812; Floras, J.S., Jones, J.V., Hassan, M.O., Sleight, P., Effects of acute and chronic beta-adrenoreceptor blockade on baroreflex sensitivity in humans (1988) J Auton Nerv Syst, 25, pp. 87-94; La Rovere, M.T., Pinna, G.D., Maestri, R., Robbi, E., Caporotondi, A., Guazzotti, G., Prognostic implications of baroreflex sensitivity in heart failure patients in the beta-blocking era (2009) J Am Coll Cardiol, 53, pp. 193-199; Sarzi Braga, S., La Rovere, M.T., Pedretti, R.F., Baroreflex sensitivity normalization after cardiac resynchronization therapy (2006) Int J Cardiol, 109, pp. 118-120; La Rovere, M.T., Bersano, C., Gnemmi, M., Specchia, G., Schwartz, P.J., Exercise-induced increase in baroreflex sensitivity predicts improved prognosis after myocardial infarction (2002) Circulation, 106, pp. 945-949; Schwartz, P.J., La Rovere, M.T., De Ferrari, G.M., Mann, D.L., Autonomic modulation for the management of patients with chronic heart failure (2015) Circ Heart Fail, 8, pp. 619-628; Mann, M.C., Exner, D.V., Hemmelgarn, B.R., Hanley, D.A., Turin, T.C., MacRae, J.M., The VITAH Trial-Vitamin D supplementation and cardiac autonomic tone in patients with end-stage kidney disease on hemodialysis: A blinded, randomized controlled trial (2016) Nutrients, 28, p. E608; Mortara, A., Vanoli, E., Baroreceptor activation therapy: The importance of targeting the right patient: Who needs to be treated (2015) Eur J Heart Fail, 17, pp. 1000-1002; Barthel, P., Bauer, A., Muller, A., Huster, K.M., Kanters, J.K., Paruchuri, V., Spontaneous baroreflex sensitivity: Prospective validation trial of a novel technique in survivors of acute myocardial infarction (2012) Heart Rhythm, 9, pp. 1288-1294

PY - 2017

Y1 - 2017

N2 - Objective: Several methods have been developed so far to estimate cardiac baroreflex sensitivity (BRS) through the analysis of spontaneous fluctuations of systolic arterial pressure (SAP) and R-R interval. Their relative performance in predicting cardiac mortality in heart failure patients is not known. The aim of this study was to compare the prognostic value of a set of representative indexes of spontaneous BRS in these patients. Methods: We studied 228 stable, moderate-to-severe heart failure patients with reduced ejection fraction, in sinus rhythm, who underwent an 8-min supine recording of ECG, arterial blood pressure and respiration during paced breathing (15 breaths/min). BRS was estimated according to the following methods: Sequence (BRSSeq); nonparametric transfer function in the low-frequency band (BRSTF-NP-LF); parametric spectral computed in the low-frequency and high-frequency bands (BRSPS-LF and BRSPS-HF); parametric transfer function computed in the low-frequency and high-frequency bands (BRSTF-P-LF and BRSTF-P-HF); model-based closed loop (BRSCL); and bivariate phase-rectified signal averaging (BRSPRSA). Results: During a median follow-up of 36 months, 45 patients experienced a cardiac event. Only BRSTF-NP-LF, BRSPS-LF, BRSTF-P-LF and BRS PRSA were significantly associated with the outcome (P < 0.01), and statistical significance remained (P ≤ 0.03) after adjusting for clinical covariates. BRSTF-NP-LF and BRSPRSA also significantly improved the risk classification. Conclusion: This study shows that different spontaneous BRS indexes have different predictive value in patients with heart failure. It also shows that the prognostic information of BRS estimates is linked to SAP and RR oscillations in the low-frequency band. © 2017 Wolters Kluwer Health, Inc. All rights reserved.

AB - Objective: Several methods have been developed so far to estimate cardiac baroreflex sensitivity (BRS) through the analysis of spontaneous fluctuations of systolic arterial pressure (SAP) and R-R interval. Their relative performance in predicting cardiac mortality in heart failure patients is not known. The aim of this study was to compare the prognostic value of a set of representative indexes of spontaneous BRS in these patients. Methods: We studied 228 stable, moderate-to-severe heart failure patients with reduced ejection fraction, in sinus rhythm, who underwent an 8-min supine recording of ECG, arterial blood pressure and respiration during paced breathing (15 breaths/min). BRS was estimated according to the following methods: Sequence (BRSSeq); nonparametric transfer function in the low-frequency band (BRSTF-NP-LF); parametric spectral computed in the low-frequency and high-frequency bands (BRSPS-LF and BRSPS-HF); parametric transfer function computed in the low-frequency and high-frequency bands (BRSTF-P-LF and BRSTF-P-HF); model-based closed loop (BRSCL); and bivariate phase-rectified signal averaging (BRSPRSA). Results: During a median follow-up of 36 months, 45 patients experienced a cardiac event. Only BRSTF-NP-LF, BRSPS-LF, BRSTF-P-LF and BRS PRSA were significantly associated with the outcome (P < 0.01), and statistical significance remained (P ≤ 0.03) after adjusting for clinical covariates. BRSTF-NP-LF and BRSPRSA also significantly improved the risk classification. Conclusion: This study shows that different spontaneous BRS indexes have different predictive value in patients with heart failure. It also shows that the prognostic information of BRS estimates is linked to SAP and RR oscillations in the low-frequency band. © 2017 Wolters Kluwer Health, Inc. All rights reserved.

KW - baroreceptors

KW - noninvasive

KW - prognosis

KW - risk stratification

KW - adult

KW - arterial pressure

KW - Article

KW - disease severity

KW - electrocardiogram

KW - female

KW - follow up

KW - heart failure

KW - heart failure with reduced ejection fraction

KW - human

KW - major clinical study

KW - male

KW - middle aged

KW - predictive value

KW - pressoreceptor reflex

KW - priority journal

KW - reference value

U2 - 10.1097/HJH.0000000000001377

DO - 10.1097/HJH.0000000000001377

M3 - Article

VL - 35

SP - 1666

EP - 1675

JO - Journal of Hypertension

JF - Journal of Hypertension

SN - 0263-6352

IS - 8

ER -