Key result
Cardiac baroreflex sensitivity assessment was not associated with the composite of all-cause death and ICD discharge in optimally treated patients with HFrEF (P≥0.15 for low vs. preserved BRS).
Why the study?
Does cardiac baroreflex sensitivity (BRS) assessment provide prognostic value for survival in optimally managed patients with mild-to-moderate HFrEF?
Cohort (n=97)
Does cardiac baroreflex sensitivity (BRS) assessment provide prognostic value for survival in optimally managed patients with mild-to-moderate HFrEF?
p-value: p=≥0.15
Assessment of cardiac baroreflex sensitivity provides no prognostic information in contemporary, optimally managed patients with mild-to-moderate HFrEF.
BRS assessment adds no prognostic value in optimally managed mild-to-moderate HFrEF; leaves open relevance in less-treated or higher-risk populations.
Objectives We evaluated the prognostic value of cardiac baroreflex sensitivity (BRS) in contemporary, optimally treated patients with mild-to-moderate heart failure with reduced ejection fraction (HFrEF). Methods and results Data from 97 patients with HFrEF (left ventricular ejection fraction 32 ± 6%, all receiving angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and beta-blocker, 85% receiving aldosterone antagonist) were analysed retrospectively. All patients underwent standard clinical assessment, cardiopulmonary exercise testing and BRS evaluation with three methods: the phenylephrine (BRS-Phe), the sequence (BRS-Seq) and the controlled breathing (BRS-CtrBr) method. Data on 5-year all-cause mortality and appropriate and documented implantable cardioverter-defibrillator (ICD) discharges were collected. During a mean follow-up of 53 ± 15 months, the composite endpoint of all-cause death and appropriate and documented ICD discharge occurred in 31 (32%) patients. BRS measures assessed using all three methods were not related to survival in univariate Cox proportional hazards analyses (all P >0.25). There were also no differences in survival between low vs. preserved BRS groups, irrespective of the method used for BRS assessment (all P ≥0.15). BRS-Phe correlated with several clinically important variables (including left ventricular ejection fraction: rS = 0.27, and peak oxygen consumption: rS = 0.32, both P < 0.05), while clinical associations of BRS-Seq and BRS-CtrBr were sparse. Conclusions Assessment of cardiac BRS provides no prognostic information in the contemporary mild-to-moderate HFrEF population receiving optimal management.
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Paleczny et al. (2018) conducted a cohort in Mild-to-moderate heart failure with reduced ejection fraction (HFrEF) (n=97). Low cardiac baroreflex sensitivity (BRS) vs. Preserved BRS was evaluated on Composite of all-cause death and appropriate and documented ICD discharge (p=≥0.15). Cardiac baroreflex sensitivity assessment was not associated with the composite of all-cause death and ICD discharge in optimally treated patients with HFrEF (P≥0.15 for low vs. preserved BRS).
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