Cardiology Letters 2013, 22(3):228-233

Significance of baroreflex sensitivity in advanced heart failure

Huňavý M¹, Gášpár P¹, Adamčik Š¹, Gonsorčík J¹, Račeková-Dobrovičová A²

¹ Klinika kardiológie UPJŠ LF a VÚSCH a.s., Košice, Slovenská republika

² Department of Cardiology, Duisburg, Germany

Baroreflex sensitivity as an indirect marker of sympatho-parasympathetic interaction provides information about the level of autonomic nervous system dysfunction, which significantly contributes to development and progression of heart failure.

Aim: Our objective was to evaluate the clinical significance of spontaneous baroreflex sensitivity (BRS) in patients with chronic heart failure of ischaemic and nonischaemic etiology, and to evaluate BRS in patients with heart failure and other associated comorbidities (diabetes mellitus, chronic kidney disease).

Methods: We examined 40 patients (13 women and 27 men) with diagnosis of chronic heart failure and sinus rhythm during examination. Average age of the group was 60 ± 11.4 years. For the recording of continuous changes of blood pressure and heart rate we used COLIN CBM-7000, the noninvasive monitor. Examination consisted of two measurements, each of them lasted 5 minutes. The resulting value of baroreflex sensitivity was obtained by averaging these two measurements.

Results: Average value of BRS in the whole group was 6.8 ± 2.7 ms/mmHg, without gender significance (men vs women 6.7 ± 2.7 vs. 7.0 ± 2.8 ms/mmHg). By linear regressive analysis we found positive correlation between BRS and left ventricular ejection fraction (LVEF) (r2 = 0.426). BRS values were significantly lower in patients with LVEF < 30% in comparison to patients with LVEF ≥ 30% (5.5 ± 2.5 vs 7.9 ± 2.3 ms/mmHg; p < 0.05). We found no significant difference between patients with ischaemic and nonischaemic origin of heart failure (6.6 ± 2.8 vs 7.0 ± 2.6 ms/mmHg). Diabetics had significantly lower BRS when compared to nondiabetic patients (4.7 ± 2.0 vs 7.6 ± 2.5 ms/mmHg; p < 0.01). BRS in comparison with symptoms of heart failure had a decreasing tendency with the highest values in class NYHA II up to the lowest values in class NYHA IV (7.7 ± 2.7 vs 4.8 ± 0.2 ms/mmHg; p < 0.01). In the group of patients with chronic kidney disease (CKD) the value of BRS was significantly lower than in patients without CKD (3.2 ± 0.9 ms/mmHg vs 7.3 ± 2.5 ms/mmHg; p < 0.01). We found no influence of cardiovascular drugs on BRS values.

Conclusion: In our study of patients with advanced heart failure (candidates for cardiac resynchronization therapy or heart transplant) we found lower values of BRS in patients with lower LVEF regardless of its etio­ logy: in higher NYHA class, in diabetics and patients with CKD.

Keywords: baroreflex sensitivity; etiology; chronic heart failure

Published: March 1, 2013  Show citation