Restoration of normal sympathetic neural function in heart failure following baroreflex activation therapy: Final 43-month study report

Raffaella Dell'Oro, Edoardo Gronda, Gino Seravalle, Giuseppe Costantino, Luca Alberti, Barbara Baronio, Tiziana Staine, Emilio Vanoli, Giuseppe Mancia, Guido Grassi

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Baroreflex activation therapy (BAT) exerts in severe heart failure sympathoinhibitory effects, improving clinical variables and reducing hospitalization rate. The current follow-up study was aimed at determining the long-term effects of BAT, assessing whether BAT in heart failure allows to restore physiological levels of sympathetic function. Methods: Seven patients out of the 11 heart failure patients aged 66.5±3 years (mean±SEM) in New York Heart Association Class III with left ventricular ejection fraction 40% or less and impaired functional capacity recruited in the study survived at the final follow-up (43.5±2.1 months). Measurements included muscle sympathetic nerve activity (MSNA, microneurography) and spontaneous baroreflex-MSNA sensitivity together with hospitalization rate, echocardiography, Minnesota score, New York Heart Association class and standard clinical data. Measurements were collected before and at 6, 21 and 43 months following BAT. Data were compared with those collected in 17 age-matched healthy controls. All assessments were made with the heart failure patient on optimal active therapy. Results: In the seven patients, BAT maintained its beneficial effects over 43.5±2.1 months of follow-up. MSNA values underwent a progressive significant reduction from baseline to 21 and 43 months follow-up following BAT (from 46.2±2.4 to 31.3±3.0 e 26.6±2.0bursts/min, P<0.05 at least), becoming almost superimposable to the ones seen in healthy controls (25.5±0.8bursts/min). Baroreflex-MSNA sensitivity improved, without achieving, however, a full normalization. Blood pressure and heart rate did not change. Left ventricular ejection fraction improved significantly from 32.3±2 to 36.7±3% (P<0.05). Hospitalization rate decreased substantially when measured as days/year/patients it decreased from 10.3±2.5 preimplant to 1.01±1.4 at the 43.5th month follow-up (P<0.02). No side effects were reported in the long-term period. Conclusion: The current study provides evidence that BAT in heart failure with reduced ejection fraction allows not only to improve hemodynamic and clinical profile but also to exert profound sympathoinhibitory effects, allowing an almost complete restoration of physiological levels of the sympathetic neural function.

Original languageEnglish
Pages (from-to)2532-2536
Number of pages5
JournalJournal of Hypertension
Volume35
Issue number12
DOIs
Publication statusPublished - Dec 1 2017

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Baroreflex
Heart Failure
Hospitalization
Therapeutics
Stroke Volume
Echocardiography
Heart Rate
Hemodynamics
Blood Pressure
Muscles

Keywords

  • baroreceptor activation therapy
  • baroreflex
  • congestive heart failure
  • sympathetic activity

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Restoration of normal sympathetic neural function in heart failure following baroreflex activation therapy : Final 43-month study report. / Dell'Oro, Raffaella; Gronda, Edoardo; Seravalle, Gino; Costantino, Giuseppe; Alberti, Luca; Baronio, Barbara; Staine, Tiziana; Vanoli, Emilio; Mancia, Giuseppe; Grassi, Guido.

In: Journal of Hypertension, Vol. 35, No. 12, 01.12.2017, p. 2532-2536.

Research output: Contribution to journalArticle

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abstract = "Background: Baroreflex activation therapy (BAT) exerts in severe heart failure sympathoinhibitory effects, improving clinical variables and reducing hospitalization rate. The current follow-up study was aimed at determining the long-term effects of BAT, assessing whether BAT in heart failure allows to restore physiological levels of sympathetic function. Methods: Seven patients out of the 11 heart failure patients aged 66.5±3 years (mean±SEM) in New York Heart Association Class III with left ventricular ejection fraction 40{\%} or less and impaired functional capacity recruited in the study survived at the final follow-up (43.5±2.1 months). Measurements included muscle sympathetic nerve activity (MSNA, microneurography) and spontaneous baroreflex-MSNA sensitivity together with hospitalization rate, echocardiography, Minnesota score, New York Heart Association class and standard clinical data. Measurements were collected before and at 6, 21 and 43 months following BAT. Data were compared with those collected in 17 age-matched healthy controls. All assessments were made with the heart failure patient on optimal active therapy. Results: In the seven patients, BAT maintained its beneficial effects over 43.5±2.1 months of follow-up. MSNA values underwent a progressive significant reduction from baseline to 21 and 43 months follow-up following BAT (from 46.2±2.4 to 31.3±3.0 e 26.6±2.0bursts/min, P<0.05 at least), becoming almost superimposable to the ones seen in healthy controls (25.5±0.8bursts/min). Baroreflex-MSNA sensitivity improved, without achieving, however, a full normalization. Blood pressure and heart rate did not change. Left ventricular ejection fraction improved significantly from 32.3±2 to 36.7±3{\%} (P<0.05). Hospitalization rate decreased substantially when measured as days/year/patients it decreased from 10.3±2.5 preimplant to 1.01±1.4 at the 43.5th month follow-up (P<0.02). No side effects were reported in the long-term period. Conclusion: The current study provides evidence that BAT in heart failure with reduced ejection fraction allows not only to improve hemodynamic and clinical profile but also to exert profound sympathoinhibitory effects, allowing an almost complete restoration of physiological levels of the sympathetic neural function.",
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T1 - Restoration of normal sympathetic neural function in heart failure following baroreflex activation therapy

T2 - Final 43-month study report

AU - Dell'Oro, Raffaella

AU - Gronda, Edoardo

AU - Seravalle, Gino

AU - Costantino, Giuseppe

AU - Alberti, Luca

AU - Baronio, Barbara

AU - Staine, Tiziana

AU - Vanoli, Emilio

AU - Mancia, Giuseppe

AU - Grassi, Guido

PY - 2017/12/1

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N2 - Background: Baroreflex activation therapy (BAT) exerts in severe heart failure sympathoinhibitory effects, improving clinical variables and reducing hospitalization rate. The current follow-up study was aimed at determining the long-term effects of BAT, assessing whether BAT in heart failure allows to restore physiological levels of sympathetic function. Methods: Seven patients out of the 11 heart failure patients aged 66.5±3 years (mean±SEM) in New York Heart Association Class III with left ventricular ejection fraction 40% or less and impaired functional capacity recruited in the study survived at the final follow-up (43.5±2.1 months). Measurements included muscle sympathetic nerve activity (MSNA, microneurography) and spontaneous baroreflex-MSNA sensitivity together with hospitalization rate, echocardiography, Minnesota score, New York Heart Association class and standard clinical data. Measurements were collected before and at 6, 21 and 43 months following BAT. Data were compared with those collected in 17 age-matched healthy controls. All assessments were made with the heart failure patient on optimal active therapy. Results: In the seven patients, BAT maintained its beneficial effects over 43.5±2.1 months of follow-up. MSNA values underwent a progressive significant reduction from baseline to 21 and 43 months follow-up following BAT (from 46.2±2.4 to 31.3±3.0 e 26.6±2.0bursts/min, P<0.05 at least), becoming almost superimposable to the ones seen in healthy controls (25.5±0.8bursts/min). Baroreflex-MSNA sensitivity improved, without achieving, however, a full normalization. Blood pressure and heart rate did not change. Left ventricular ejection fraction improved significantly from 32.3±2 to 36.7±3% (P<0.05). Hospitalization rate decreased substantially when measured as days/year/patients it decreased from 10.3±2.5 preimplant to 1.01±1.4 at the 43.5th month follow-up (P<0.02). No side effects were reported in the long-term period. Conclusion: The current study provides evidence that BAT in heart failure with reduced ejection fraction allows not only to improve hemodynamic and clinical profile but also to exert profound sympathoinhibitory effects, allowing an almost complete restoration of physiological levels of the sympathetic neural function.

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KW - baroreceptor activation therapy

KW - baroreflex

KW - congestive heart failure

KW - sympathetic activity

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