Key result
Lower baseline baroreflex sensitivity is linked to death or heart transplantation in moderate-to-severe HF.
Cohort (n=35)
p-value: p=<0.05
In patients with moderate-to-severe heart failure, lower baroreflex sensitivity (indicating reduced vagal tone) is associated with higher plasma renin activity and predicts a poorer prognosis including death or heart transplantation.
Lower baroreflex sensitivity was associated with adverse outcomes in heart failure; hypothesis-generating and should not yet change risk stratification.
The increase of sympathetic activity in heart failure is accompanied by reduced parasympathetic tone. The renin-angiotensin system (RAS) is often activated in heart failure. It not only has multiple interactions with the sympathetic nervous system but also may influence vagal tone directly via angiotensin II. Animal studies show a reduction of parasympathetic tone by a direct action of angiotensin II in the area postrema, where the blood-brain barrier is absent. It is possible that in addition to the sympathetic and renin-angiotensin systems the parasympathetic nervous system may also influence prognosis in heart failure. Therefore, baroreflex sensitivity (BS) as an index of vagal tone was examined in 35 patients with moderate-to-severe heart failure (NYHA II-III). Independent of the severity of heart failure, BS was lower the higher the plasma renin activity. At 56 months after initial examination, a comparison of the surviving patients (group 1, n = 20) with the patients who died or underwent heart transplantation (group 2, n = 15) did not reveal significant differences in the initial hemodynamic data. However, group 2 patients showed a tendency to higher initial plasma renin activity and a significantly lower BS (1.3 +/- 0.2 versus 2.2 +/- 0.3 ms/mm Hg; p < 0.05). It is concluded that in patients with heart failure a relation between the RAS and the parasympathetic nervous system is likely, as there is a significant negative relationship between BS and plasma renin activity. Among patients with similar degrees of heart failure, low vagal tone identifies patients with a poor prognosis.
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Osterziel et al. (1994) conducted a cohort in moderate-to-severe heart failure (NYHA II-III) (n=35). Baroreflex sensitivity was evaluated on Death or heart transplantation (p=<0.05). In patients with moderate-to-severe heart failure, those who died or required transplantation at 56 months had significantly lower baseline baroreflex sensitivity (1.3 vs 2.2 ms/mm Hg; p<0.05).
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