Edoardo Gronda1, GianMaria Brambilla2, Gino Seravalle3, Alessandro Maloberti2, Matteo Cairo2, Giuseppe Costantino1, Eric Lovett4, Emilio Vanoli1, Giuseppe Mancia3, Guido Grassi5,6. 1. Cardiovascular Department, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy. 2. Clinica Medica, University of Milano-Bicocca, Via Pergolesi 33, 20090, Monza, Italy. 3. Istituto Auxologico, Milan, Italy. 4. CVRx Inc., Minneapolis, MN, USA. 5. Cardiovascular Department, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy. guido.grassi@unimib.it. 6. Clinica Medica, University of Milano-Bicocca, Via Pergolesi 33, 20090, Monza, Italy. guido.grassi@unimib.it.
Abstract
BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) is characterized by activation of the sympathetic nervous system and increased arterial stiffness, leading to an impaired ventricular-vascular coupling. Baroreflex activation therapy (BAT) has been shown to reduce muscle sympathetic nerve activity (MSNA) and improve clinical status of patients with HFrEF. The purpose of this investigation was to determine the effects of BAT on arterial stiffness in HFrEF. METHODS AND RESULTS: MSNA, clinical variables, and parameters of central blood pressure (BP) and arterial stiffness were collected in 18 NYHA Class III HFrEF patients, nine receiving BAT and nine continuing with optimal medical management alone. Patients were followed for 3 months, with measurements at that time compared to baseline evaluation. Baseline characteristics of the groups were well matched. At 3 months, BAT did not improve central BP and arterial stiffness despite a significant amelioration of MSNA, NYHA class, Minnesota living with heart failure questionnaire score, number of heart failure medications and six-minute walking distance. The control group exhibited no significant changes in all the measured variables. CONCLUSIONS: Despite significant reductions in MSNA and clinical improvement, BAT does not appear to chronically modify arterial stiffness within this HFrEF cohort. Additional study is required to determine if this result applies to the HFrEF population as a whole.
RCT Entities:
BACKGROUND:Heart failure with reduced ejection fraction (HFrEF) is characterized by activation of the sympathetic nervous system and increased arterial stiffness, leading to an impaired ventricular-vascular coupling. Baroreflex activation therapy (BAT) has been shown to reduce muscle sympathetic nerve activity (MSNA) and improve clinical status of patients with HFrEF. The purpose of this investigation was to determine the effects of BAT on arterial stiffness in HFrEF. METHODS AND RESULTS: MSNA, clinical variables, and parameters of central blood pressure (BP) and arterial stiffness were collected in 18 NYHA Class III HFrEF patients, nine receiving BAT and nine continuing with optimal medical management alone. Patients were followed for 3 months, with measurements at that time compared to baseline evaluation. Baseline characteristics of the groups were well matched. At 3 months, BAT did not improve central BP and arterial stiffness despite a significant amelioration of MSNA, NYHA class, Minnesota living with heart failure questionnaire score, number of heart failure medications and six-minute walking distance. The control group exhibited no significant changes in all the measured variables. CONCLUSIONS: Despite significant reductions in MSNA and clinical improvement, BAT does not appear to chronically modify arterial stiffness within this HFrEF cohort. Additional study is required to determine if this result applies to the HFrEF population as a whole.
Authors: Kerstin Wustmann; Jan P Kucera; Ingrid Scheffers; Markus Mohaupt; Abraham A Kroon; Peter W de Leeuw; Jürg Schmidli; Yves Allemann; Etienne Delacrétaz Journal: Hypertension Date: 2009-07-20 Impact factor: 10.190
Authors: Peter Dolliner; Lindsay Brammen; Senta Graf; Martin Huelsmann; Leopold Stiebellehner; Andreas Gleiss; Philipp Ubl; Guenter Steurer Journal: Clin Res Cardiol Date: 2013-04-12 Impact factor: 5.460
Authors: Edoardo Gronda; Gino Seravalle; Gianmaria Brambilla; Giuseppe Costantino; Andrea Casini; Ali Alsheraei; Eric G Lovett; Giuseppe Mancia; Guido Grassi Journal: Eur J Heart Fail Date: 2014-07-28 Impact factor: 15.534
Authors: Jacobus F Benson; Johan P Schoeman; Frans J Venter; James A Ker; Gareth E Zeiler; Lynette Bester; Janet van Niekerk; Gregory R Tintinger Journal: Front Cardiovasc Med Date: 2019-01-15