Spontaneous baroreflex sensitivity indexes computed in the low-frequency band and bivariate phase-rectified signal averaging significantly predicted cardiac events in heart failure patients (P<0.01).
Cohort (n=228)
Which estimation methods of spontaneous baroreflex sensitivity best predict cardiac events in patients with heart failure?
Different spontaneous baroreflex sensitivity indexes have varying predictive values for cardiac events in heart failure patients, with prognostic information linked to low-frequency band oscillations.
p-value: p=<0.01
OBJECTIVE: Several methods have been developed so far to estimate cardiac baroreflex sensitivity (BRS) through the analysis of spontaneous fluctuations of systolic arterial pressure (SAP) and R-R interval. Their relative performance in predicting cardiac mortality in heart failure patients is not known. The aim of this study was to compare the prognostic value of a set of representative indexes of spontaneous BRS in these patients. METHODS: We studied 228 stable, moderate-to-severe heart failure patients with reduced ejection fraction, in sinus rhythm, who underwent an 8-min supine recording of ECG, arterial blood pressure and respiration during paced breathing (15 breaths/min). BRS was estimated according to the following methods: sequence (BRSSeq) ; nonparametric transfer function in the low-frequency band (BRSTFNP-LF) ; parametric spectral computed in the low-frequency and high-frequency bands (BRSPS-LF and BRSPS-HF) ; parametric transfer function computed in the low-frequency and high-frequency bands (BRSTFP-LF and BRSTFP-HF) ; model-based closed loop (BRSCL) ; and bivariate phase-rectified signal averaging (BRSPRSA). RESULTS: During a median follow-up of 36 months, 45 patients experienced a cardiac event. Only BRSTFNP-LF, BRSPS-LF, BRSTFP-LF and BRSPRSA were significantly associated with the outcome (P < 0. 01), and statistical significance remained (P ≤ 0. 03) after adjusting for clinical covariates. BRSTFNP-LF and BRSPRSA also significantly improved the risk classification. CONCLUSION: This study shows that different spontaneous BRS indexes have different predictive value in patients with heart failure. It also shows that the prognostic information of BRS estimates is linked to SAP and RR oscillations in the low-frequency band.
Pinna et al. (Tue,) conducted a cohort in heart failure with reduced ejection fraction (n=228). Spontaneous baroreflex sensitivity (BRS) estimation methods was evaluated on cardiac event (p=<0.01). Spontaneous baroreflex sensitivity indexes computed in the low-frequency band and bivariate phase-rectified signal averaging significantly predicted cardiac events in heart failure patients (P<0.01).