Prognostic value of baroreflex sensitivity assessed by phase IV of Valsalva manoeuvre in patients with mild-to-moderate heart failure

Carlo Rostagno, Giorgio Galanti, Massimo Felici, Massimo Maccherini, Guido Sani, Sabina Caciolli, Gian Franco Gensini

Research output: Contribution to journalArticlepeer-review


Background: In patients with heart failure, impairment of baroreflex function occurs early and contributes to sympathetic activation, however, at present its prognostic role has not been definitively established. Aims: To evaluate the prognostic significance of baroceptor impairment in patients with different degrees of heart failure. Methods: We enrolled 52 consecutive patients with heart failure, referred to our institution for functional evaluation. Twenty-eight suffered from ischemic cardiomyopathy and 26 from dilated cardiomyopathy. Thirteen patients were in NYHA class I, 20 in NYHA class II and 19 in class III. All patients underwent baroreflex assessment by phase IV Valsalva manoeuvre using Finapres finger monitoring of arterial blood pressure, echocardiography [with evaluation of left ventricular ejection fraction (LVEF), fractional shortening (LVFS), left ventricular end diastolic diameter (LVEDD) and mean pulmonary artery pressure] and functional evaluation by cardiopulmonary exercise test and 6-min walk corridor test within 2 days of hospital admission. Results: Mean duration of follow-up was 26 months (range 6-35 months). At baseline, evaluation in 13 patients BRS was normal (> 5 ms/mmHg), in 17 moderately impaired (1.5-5 ms/mmHg) and in 22 severely depressed (<1.5 ms/mmHg). Baroreflex function was relatively preserved in patients in NYHA class I (5.1 ± 2.5) in comparison to patients in NYHA class II and III (2.1 ± 2.3 and 2.08 ± 1.9 ms/mmHg, respectively). Of the 52 patients who entered the study at the end of follow-up 15 died of cardiac cause and 5 underwent heart transplantation. Survival free from heart transplantation was 62% in patients with normal baroreflex function. 62% in patients with moderate impairment of baroreflex and 66% in patients with major derangement. NYHA class, LVEF, LVFS and LVEDD were significantly associated with event free survival while baroreflex function was not. Conclusions: Our results suggest that evaluation of BRS impairment by phase IV Valsalva manoeuvre has limited prognostic value in patients with heart failure. (C) 2000 European Society of Cardiology.

Original languageEnglish
Pages (from-to)41-45
Number of pages5
JournalEuropean Journal of Heart Failure
Issue number1
Publication statusPublished - Mar 1 2000


  • Baroreceptors
  • Heart failure
  • Risk stratification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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