OBJECTIVES: No studies have compared the prognostic values of invasive (phenylephrine, Phe) and noninvasive (transfer function) assessments of baroreflex sensitivity (BRS). METHODS: Three hundred and one heart failure patients [age: 53 ± 8 years, New York Heart Association class II-III: 88%, left-ventricular ejection fraction (LVEF): 28 ± 8%] underwent an 8 min ECG and arterial pressure recording, followed by Phe administration. RESULTS: Phe-BRS and transfer function BRS (TF-BRS) could be measured in 89 and 72% of cases, respectively. The correlation and the 5-95th percentiles of the difference between the two methods were 0.61 (P < 0.0001), and -7.6, +7.5 ms/mmHg, respectively. During a median of 36 months, 23% of the patients experienced a cardiac event. In the common dataset of 202 patients, both BRS measurements (<3 ms/mmHg) were significantly associated with the outcome (both P < 0.001), but Phe-BRS had a better discriminatory power (area under the curve (AUC): 0.74 vs. 0.66, P = 0.03). Patients with a missing BRS (due to high grade ectopic activity) had a higher event rate (Phe-BRS: 38 vs. 24%, P = 0.23; TF-BRS: 37 vs. 19%, P = 0.002). Using this information, a prognostic index was derived for each BRS method, increasing measurability to 94 and 98%, respectively. Both indexes significantly predicted the outcome after adjustment for clinical covariates [hazard ratio (95% CI): 1.9 (1.1-3.3), P = 0.03 for Phe index and 2.0 (1.1-3.7), P = 0.02 for transfer function index]. CONCLUSION: Although the measurability of TF-BRS in heart failure patients is impaired, prognostic information can be extended to almost all patients, with a predictive power similar to that of Phe-BRS. The two measurements, however, convey a certain amount of independent prognostic information. Hence, TF-BRS can be integrated with but not replace Phe-BRS.
OBJECTIVES: No studies have compared the prognostic values of invasive (phenylephrine, Phe) and noninvasive (transfer function) assessments of baroreflex sensitivity (BRS). METHODS: Three hundred and one heart failurepatients [age: 53 ± 8 years, New York Heart Association class II-III: 88%, left-ventricular ejection fraction (LVEF): 28 ± 8%] underwent an 8 min ECG and arterial pressure recording, followed by Phe administration. RESULTS:Phe-BRS and transfer function BRS (TF-BRS) could be measured in 89 and 72% of cases, respectively. The correlation and the 5-95th percentiles of the difference between the two methods were 0.61 (P < 0.0001), and -7.6, +7.5 ms/mmHg, respectively. During a median of 36 months, 23% of the patients experienced a cardiac event. In the common dataset of 202 patients, both BRS measurements (<3 ms/mmHg) were significantly associated with the outcome (both P < 0.001), but Phe-BRS had a better discriminatory power (area under the curve (AUC): 0.74 vs. 0.66, P = 0.03). Patients with a missing BRS (due to high grade ectopic activity) had a higher event rate (Phe-BRS: 38 vs. 24%, P = 0.23; TF-BRS: 37 vs. 19%, P = 0.002). Using this information, a prognostic index was derived for each BRS method, increasing measurability to 94 and 98%, respectively. Both indexes significantly predicted the outcome after adjustment for clinical covariates [hazard ratio (95% CI): 1.9 (1.1-3.3), P = 0.03 for Phe index and 2.0 (1.1-3.7), P = 0.02 for transfer function index]. CONCLUSION: Although the measurability of TF-BRS in heart failurepatients is impaired, prognostic information can be extended to almost all patients, with a predictive power similar to that of Phe-BRS. The two measurements, however, convey a certain amount of independent prognostic information. Hence, TF-BRS can be integrated with but not replace Phe-BRS.
Authors: Edgar Toschi-Dias; Ivani C Trombetta; Valdo J D Silva; Cristiane Maki-Nunes; Felipe X Cepeda; Maria Janieire N N Alves; Glauce L Carvalho; Luciano F Drager; Geraldo Lorenzi-Filho; Carlos E Negrão; Maria Urbana P B Rondon Journal: Sleep Breath Date: 2018-06-11 Impact factor: 2.816
Authors: Raphaela V Groehs; Edgar Toschi-Dias; Ligia M Antunes-Correa; Patrícia F Trevizan; Maria Urbana P B Rondon; Patrícia Oliveira; Maria J N N Alves; Dirceu R Almeida; Holly R Middlekauff; Carlos E Negrão Journal: Am J Physiol Heart Circ Physiol Date: 2015-03-06 Impact factor: 4.733
Authors: Henry Blomster; Tomi P Laitinen; Juha Ek Hartikainen; Tiina M Laitinen; Esko Vanninen; Helena Gylling; Johanna Sahlman; Jouko Kokkarinen; Jukka Randell; Juha Seppä; Henri Tuomilehto Journal: Nat Sci Sleep Date: 2015-06-25
Authors: Alberto Porta; Paolo Castiglioni; Marco Di Rienzo; Vlasta Bari; Tito Bassani; Andrea Marchi; Maddalena Alesssandra Wu; Andrei Cividjian; Luc Quintin Journal: Auton Neurosci Date: 2013-03-27 Impact factor: 3.145