Restrictive left ventricular filling pattern as a strong predictor of depressed baroreflex sensitivity in heart failure

E. Eleuteri, P. Lanfranchi, F. Scapellato, P. L. Temporelli, P. Giannuzzi

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background. The aim of this study was to test the hypothesis that a restrictive left ventricular diastolic filling pattern, as an index of elevated pulmonary wedge pressure, would predict a depressed baroreflex sensitivity (BRS) in patients with chronic heart failure. Methods. A total of 189 consecutive patients with an ejection fraction ≤ 40% at echocardiography, in sinus rhythm and clinically stable for at least 1 month in oral therapy, underwent clinical examination, echo-Doppler study and the phenylephrine test. Results. The correlations between the NYHA functional class, echo-Doppler variables and BRS were weak, although significant (r ranging from -0.15 to 0.40). However, patients with a deceleration time <140 ms as an expression of restrictive filling, compared to those with a deceleration time ≥ 140 ms, had a lower BRS (3 ± 4 vs 6 ± 4 ms/mmHg, p <0.00001), a lower ejection fraction (20 ± 6 vs 28 ± 7%, p <0.00001), greater left ventricular (end-diastolic volume index 137 ± 43 vs 113 ± 45 ml/m2, p <0.00001) and left atrial dimensions (25 ± 6 vs 20 ± 5 cm2, p <0.00001), more severe mitral regurgitation (3 ± 1 vs 2.3 ± 1, p <0.00001) and were in a higher NYHA class (2.3 ± 0.6 vs 1.8 ± 0.5, p <0.00001). Medications at the time of the study were similar in the two groups. At stepwise regression analysis, the deceleration time emerged as the most powerful independent predictor of a depressed BRS (<3 ms/mmHg), followed by mitral regurgitation, age, and NYHA class (all data p = 0.0001). Conclusions. In patients with chronic heart failure, the presence of a restrictive left ventricular filling pattern is highly predictive of autonomic derangement as expressed by low values of BRS.

Original languageEnglish
Pages (from-to)344-348
Number of pages5
JournalItalian Heart Journal
Volume2
Issue number5
Publication statusPublished - 2001

Fingerprint

Baroreflex
Heart Failure
Deceleration
Mitral Valve Insufficiency
Pulmonary Wedge Pressure
Time and Motion Studies
Phenylephrine
Stroke Volume
Echocardiography
Regression Analysis

Keywords

  • Baroreflex sensitivity
  • Diastolic dysfunction
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Restrictive left ventricular filling pattern as a strong predictor of depressed baroreflex sensitivity in heart failure. / Eleuteri, E.; Lanfranchi, P.; Scapellato, F.; Temporelli, P. L.; Giannuzzi, P.

In: Italian Heart Journal, Vol. 2, No. 5, 2001, p. 344-348.

Research output: Contribution to journalArticle

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abstract = "Background. The aim of this study was to test the hypothesis that a restrictive left ventricular diastolic filling pattern, as an index of elevated pulmonary wedge pressure, would predict a depressed baroreflex sensitivity (BRS) in patients with chronic heart failure. Methods. A total of 189 consecutive patients with an ejection fraction ≤ 40{\%} at echocardiography, in sinus rhythm and clinically stable for at least 1 month in oral therapy, underwent clinical examination, echo-Doppler study and the phenylephrine test. Results. The correlations between the NYHA functional class, echo-Doppler variables and BRS were weak, although significant (r ranging from -0.15 to 0.40). However, patients with a deceleration time <140 ms as an expression of restrictive filling, compared to those with a deceleration time ≥ 140 ms, had a lower BRS (3 ± 4 vs 6 ± 4 ms/mmHg, p <0.00001), a lower ejection fraction (20 ± 6 vs 28 ± 7{\%}, p <0.00001), greater left ventricular (end-diastolic volume index 137 ± 43 vs 113 ± 45 ml/m2, p <0.00001) and left atrial dimensions (25 ± 6 vs 20 ± 5 cm2, p <0.00001), more severe mitral regurgitation (3 ± 1 vs 2.3 ± 1, p <0.00001) and were in a higher NYHA class (2.3 ± 0.6 vs 1.8 ± 0.5, p <0.00001). Medications at the time of the study were similar in the two groups. At stepwise regression analysis, the deceleration time emerged as the most powerful independent predictor of a depressed BRS (<3 ms/mmHg), followed by mitral regurgitation, age, and NYHA class (all data p = 0.0001). Conclusions. In patients with chronic heart failure, the presence of a restrictive left ventricular filling pattern is highly predictive of autonomic derangement as expressed by low values of BRS.",
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AU - Scapellato, F.

AU - Temporelli, P. L.

AU - Giannuzzi, P.

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N2 - Background. The aim of this study was to test the hypothesis that a restrictive left ventricular diastolic filling pattern, as an index of elevated pulmonary wedge pressure, would predict a depressed baroreflex sensitivity (BRS) in patients with chronic heart failure. Methods. A total of 189 consecutive patients with an ejection fraction ≤ 40% at echocardiography, in sinus rhythm and clinically stable for at least 1 month in oral therapy, underwent clinical examination, echo-Doppler study and the phenylephrine test. Results. The correlations between the NYHA functional class, echo-Doppler variables and BRS were weak, although significant (r ranging from -0.15 to 0.40). However, patients with a deceleration time <140 ms as an expression of restrictive filling, compared to those with a deceleration time ≥ 140 ms, had a lower BRS (3 ± 4 vs 6 ± 4 ms/mmHg, p <0.00001), a lower ejection fraction (20 ± 6 vs 28 ± 7%, p <0.00001), greater left ventricular (end-diastolic volume index 137 ± 43 vs 113 ± 45 ml/m2, p <0.00001) and left atrial dimensions (25 ± 6 vs 20 ± 5 cm2, p <0.00001), more severe mitral regurgitation (3 ± 1 vs 2.3 ± 1, p <0.00001) and were in a higher NYHA class (2.3 ± 0.6 vs 1.8 ± 0.5, p <0.00001). Medications at the time of the study were similar in the two groups. At stepwise regression analysis, the deceleration time emerged as the most powerful independent predictor of a depressed BRS (<3 ms/mmHg), followed by mitral regurgitation, age, and NYHA class (all data p = 0.0001). Conclusions. In patients with chronic heart failure, the presence of a restrictive left ventricular filling pattern is highly predictive of autonomic derangement as expressed by low values of BRS.

AB - Background. The aim of this study was to test the hypothesis that a restrictive left ventricular diastolic filling pattern, as an index of elevated pulmonary wedge pressure, would predict a depressed baroreflex sensitivity (BRS) in patients with chronic heart failure. Methods. A total of 189 consecutive patients with an ejection fraction ≤ 40% at echocardiography, in sinus rhythm and clinically stable for at least 1 month in oral therapy, underwent clinical examination, echo-Doppler study and the phenylephrine test. Results. The correlations between the NYHA functional class, echo-Doppler variables and BRS were weak, although significant (r ranging from -0.15 to 0.40). However, patients with a deceleration time <140 ms as an expression of restrictive filling, compared to those with a deceleration time ≥ 140 ms, had a lower BRS (3 ± 4 vs 6 ± 4 ms/mmHg, p <0.00001), a lower ejection fraction (20 ± 6 vs 28 ± 7%, p <0.00001), greater left ventricular (end-diastolic volume index 137 ± 43 vs 113 ± 45 ml/m2, p <0.00001) and left atrial dimensions (25 ± 6 vs 20 ± 5 cm2, p <0.00001), more severe mitral regurgitation (3 ± 1 vs 2.3 ± 1, p <0.00001) and were in a higher NYHA class (2.3 ± 0.6 vs 1.8 ± 0.5, p <0.00001). Medications at the time of the study were similar in the two groups. At stepwise regression analysis, the deceleration time emerged as the most powerful independent predictor of a depressed BRS (<3 ms/mmHg), followed by mitral regurgitation, age, and NYHA class (all data p = 0.0001). Conclusions. In patients with chronic heart failure, the presence of a restrictive left ventricular filling pattern is highly predictive of autonomic derangement as expressed by low values of BRS.

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