The arterial baroreflex effectiveness index in risk stratification of chronic heart failure patients who are candidates for cardiac resynchronization therapy

详细信息    查看全文

• 作者：Joã ; o Fernandes Serô ; dio^a ; ^{jserodio@campus.ul.pt" class="auth_mail" title="E-mail the corresponding author} ; Má ; rio Martins Oliveira^a ; ^b ; Sé ; rgio Matoso Laranjo^a ; Cristiano Tavares^a ; Pedro Silva Cunha^b ; Ana Abreu^b ; Luí ; sa Branco^b ; Sandra Alves^b ; Isabel Rocha^a ; Rui Cruz Ferreira^b
• 关键词：Heart failure ; Cardiac resynchronization therapy ; Arterial baroreflex
• 刊名：Revista Portuguesa de Cardiologia
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：35
• 期：6
• 页码：343-350
• 全文大小：875 K

文摘

Baroreflex function is an independent marker of prognosis in heart failure (HF). However, little is known about its relation to response to cardiac resynchronization therapy (CRT). The aim of this study is to assess arterial baroreflex function in HF patients who are candidates for CRT.

Methods

The study population consisted of 25 patients with indication for CRT, aged 65±10 years, NYHA functional class ≥III in 52%, QRS width 159±15 ms, left ventricular ejection fraction (LVEF) 29±5%, left ventricular end-systolic volume (LVESV) 150±48 ml, B-type natriuretic peptide (BNP) 357±270 pg/ml, and peak oxygen consumption (peak VO₂) 18.4±5.0 ml/kg/min. An orthostatic tilt test was performed to assess the baroreflex effectiveness index (BEI) by the sequence method. This group was compared with 15 age-matched healthy individuals.

Results

HF patients showed a significantly depressed BEI during tilt (31±12% vs. 49±18%, p=0.001). A lower BEI was associated with higher BNP (p=0.038), lower peak VO₂ (p=0.048), and higher LVESV (p=0.031). By applying a cut-off value of 25% for BEI, two clusters of patients were identified: lower risk cluster (BEI >25%) QRS 153 ms, LVESV 129 ml, BNP 146 pg/ml, peak VO₂ 19.0 ml/kg/min; and higher risk cluster (IEB ≤25%) QRS 167 ms, LVESV 189 ml, BNP 590 pg/ml, peak VO₂ 16.2 ml/kg/min.

Conclusions

Candidates for CRT show depressed arterial baroreflex function. Lower BEI was observed in high-risk HF patients. Baroreflex function correlated closely with other clinical HF parameters. Therefore, BEI may improve risk stratification in HF patients undergoing CRT.