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Gentile F, Passino C, Emdin M, Giannoni A. Baroreflex Activation Therapy In Heart Failure: Targeting the Right Patient. Eur J Heart Fail 2022; 24:1674-1676. [DOI: 10.1002/ejhf.2627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Francesco Gentile
- Cardiology Division Pisa University Hospital Pisa Italy
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Claudio Passino
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio Pisa Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna Pisa Italy
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio Pisa Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna Pisa Italy
| | - Alberto Giannoni
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio Pisa Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna Pisa Italy
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A Novel and Simple Exercise Test Parameter to Assess Responsiveness to Cardiac Resynchronization Therapy. Diagnostics (Basel) 2020; 10:diagnostics10110920. [PMID: 33182381 PMCID: PMC7695287 DOI: 10.3390/diagnostics10110920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022] Open
Abstract
This study assessed the value of heart rate recovery index (HRRI), a new parameter of an exercise test, as the predictor of response to cardiac resynchronization therapy (CRT). Methods: Consecutive patients receiving a CRT device were followed up after implantation and every 6 months. An effort test (ET) was quantified by minimum heart rate/maximum heart rate, as well as acceleration and deceleration times. HRRI was calculated as the ratio between acceleration and deceleration time (AT/DT) and compared to outcome. We used logistic regression to assess the predictive value of HRRI for responders and non-responders to CRT. The area under the curve (AUC) was computed to distinguish between positive and negative outcomes. Results: A total of 109 patients (74 men, mean age 63.3 ± 9.8 years) were analyzed; permanent long-term fusion CRT pacing was possible in 65 patients. Patients were assigned to two groups: responders and non-responders (98/11 patients). During a mean follow-up of 36 months, 545 ETs were performed. HRRI was significantly higher in responders versus non-responders (3.16 ± 2 vs. 1.4 ± 0.5, p < 0.001). The optimal cutoff value for HRRI as a predictor of CRT response was 1.51 (area under the receiver operating characteristic (ROC) curve = 0.844). Responders had significant left-ventricular (LV) reverse remodeling (LV end-diastolic volume = 240 ± 90 mL vs. 217 ± 89 mL, p < 0.001) and higher LV ejection fraction (26 ± 5.8% vs. 35 ± 8.7%, p < 0.001). Conclusions: HRRI computation during routine ET is useful for the evaluation of responsiveness to CRT.
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Parati G, Ochoa JE. Prognostic value of baroreflex sensitivity in heart failure. A 2018 reappraisal. Eur J Heart Fail 2018; 21:59-62. [PMID: 30468274 DOI: 10.1002/ejhf.1334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/12/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
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Paleczny B, Olesińska-Mader M, Siennicka A, Niewiński P, Nowak K, Buldańczyk A, Jankowska EA, Banasiak W, von Haehling S, Ponikowska B, Anker SD, Ponikowski P. Assessment of baroreflex sensitivity has no prognostic value in contemporary, optimally managed patients with mild-to-moderate heart failure with reduced ejection fraction: a retrospective analysis of 5-year survival. Eur J Heart Fail 2018; 21:50-58. [DOI: 10.1002/ejhf.1306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 07/23/2018] [Accepted: 07/27/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Bartłomiej Paleczny
- Department of Physiology; Wroclaw Medical University; Wroclaw Poland
- Department of Cardiology, Centre for Heart Diseases; 4th Military Hospital; Wroclaw Poland
| | | | - Agnieszka Siennicka
- Department of Physiology; Wroclaw Medical University; Wroclaw Poland
- Department of Cardiology, Centre for Heart Diseases; 4th Military Hospital; Wroclaw Poland
| | - Piotr Niewiński
- Department of Cardiology, Centre for Heart Diseases; 4th Military Hospital; Wroclaw Poland
- Department of Heart Diseases; Wroclaw Medical University; Wroclaw Poland
| | - Krzysztof Nowak
- Department of Cardiology, Centre for Heart Diseases; 4th Military Hospital; Wroclaw Poland
- Department of Heart Diseases; Wroclaw Medical University; Wroclaw Poland
| | | | - Ewa A. Jankowska
- Department of Cardiology, Centre for Heart Diseases; 4th Military Hospital; Wroclaw Poland
- Department of Heart Diseases; Wroclaw Medical University; Wroclaw Poland
| | - Waldemar Banasiak
- Department of Cardiology, Centre for Heart Diseases; 4th Military Hospital; Wroclaw Poland
| | - Stephan von Haehling
- Department of Cardiology and Pneumology; University of Göttingen Medical Center; Göttingen Germany
| | - Beata Ponikowska
- Department of Physiology; Wroclaw Medical University; Wroclaw Poland
| | - Stefan D. Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK; and Berlin-Brandenburg Centre for Regenerative Therapies (BCRT); Berlin Germany
- German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin; Germany
| | - Piotr Ponikowski
- Department of Cardiology, Centre for Heart Diseases; 4th Military Hospital; Wroclaw Poland
- Department of Heart Diseases; Wroclaw Medical University; Wroclaw Poland
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Fernandes Serôdio J, Martins Oliveira M, Matoso Laranjo S, Tavares C, Silva Cunha P, Abreu A, Branco L, Alves S, Rocha I, Cruz Ferreira R. The arterial baroreflex effectiveness index in risk stratification of chronic heart failure patients who are candidates for cardiac resynchronization therapy. Rev Port Cardiol 2016; 35:343-50. [PMID: 27255174 DOI: 10.1016/j.repc.2015.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/22/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Baroreflex function is an independent marker of prognosis in heart failure (HF). However, little is known about its relation to response to cardiac resynchronization therapy (CRT). The aim of this study is to assess arterial baroreflex function in HF patients who are candidates for CRT. METHODS The study population consisted of 25 patients with indication for CRT, aged 65±10 years, NYHA functional class ≥III in 52%, QRS width 159±15 ms, left ventricular ejection fraction (LVEF) 29±5%, left ventricular end-systolic volume (LVESV) 150±48 ml, B-type natriuretic peptide (BNP) 357±270 pg/ml, and peak oxygen consumption (peak VO2) 18.4±5.0 ml/kg/min. An orthostatic tilt test was performed to assess the baroreflex effectiveness index (BEI) by the sequence method. This group was compared with 15 age-matched healthy individuals. RESULTS HF patients showed a significantly depressed BEI during tilt (31±12% vs. 49±18%, p=0.001). A lower BEI was associated with higher BNP (p=0.038), lower peak VO2 (p=0.048), and higher LVESV (p=0.031). By applying a cut-off value of 25% for BEI, two clusters of patients were identified: lower risk cluster (BEI >25%) QRS 153 ms, LVESV 129 ml, BNP 146 pg/ml, peak VO2 19.0 ml/kg/min; and higher risk cluster (IEB ≤25%) QRS 167 ms, LVESV 189 ml, BNP 590 pg/ml, peak VO2 16.2 ml/kg/min. CONCLUSIONS Candidates for CRT show depressed arterial baroreflex function. Lower BEI was observed in high-risk HF patients. Baroreflex function correlated closely with other clinical HF parameters. Therefore, BEI may improve risk stratification in HF patients undergoing CRT.
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Affiliation(s)
| | - Mário Martins Oliveira
- Institute of Physiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal; Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal
| | - Sérgio Matoso Laranjo
- Institute of Physiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Cristiano Tavares
- Institute of Physiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | | | - Ana Abreu
- Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal
| | - Luísa Branco
- Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal
| | - Sandra Alves
- Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal
| | - Isabel Rocha
- Institute of Physiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Fernandes Serôdio J, Martins Oliveira M, Matoso Laranjo S, Tavares C, Silva Cunha P, Abreu A, Branco L, Alves S, Rocha I, Cruz Ferreira R. The arterial baroreflex effectiveness index in risk stratification of chronic heart failure patients who are candidates for cardiac resynchronization therapy. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
The arterial baroreflex is an important determinant of the neural regulation of the cardiovascular system. It has been recognised that baroreflex-mediated sympathoexcitation contributes to the development and progression of many cardiovascular disorders. Accordingly, the quantitative estimation of the arterial baroreceptor-heart rate reflex (baroreflex sensitivity, BRS), has been regarded as a synthetic index of neural regulation at the sinus atrial node. The evaluation of BRS has been shown to provide clinical and prognostic information in a variety of cardiovascular diseases, including myocardial infarction and heart failure that are reviewed in the present article.
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Okutucu S, Karakulak UN, Aytemir K, Oto A. Heart rate recovery: a practical clinical indicator of abnormal cardiac autonomic function. Expert Rev Cardiovasc Ther 2012; 9:1417-30. [PMID: 22059791 DOI: 10.1586/erc.11.149] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The autonomic nervous system (ANS) and cardiovascular function are intricately and closely related. One of the most frequently used diagnostic and prognostic tools for evaluating cardiovascular function is the exercise stress test. Exercise is associated with increased sympathetic and decreased parasympathetic activity and the period of recovery after maximum exercise is characterized by a combination of sympathetic withdrawal and parasympathetic reactivation, which are the two main arms of the ANS. Heart rate recovery after graded exercise is one of the commonly used techniques that reflects autonomic activity and predicts cardiovascular events and mortality, not only in cardiovascular system disorders, but also in various systemic disorders. In this article, the definition, applications and protocols of heart rate recovery and its value in various diseases, in addition to exercise physiology, the ANS and their relationship, will be discussed.
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Affiliation(s)
- Sercan Okutucu
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
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SHINOHARA TETSUJI, TAKAHASHI NAOHIKO, SAITO SYOTARO, OKADA NORIHIRO, WAKISAKA OSAMU, YUFU KUNIO, HARA MASAHIDE, NAKAGAWA MIKIKO, SAIKAWA TETSUNORI, YOSHIMATSU HIRONOBU. Effect of Cardiac Resynchronization Therapy on Cardiac Sympathetic Nervous Dysfunction and Serum C-reactive Protein Level. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:1225-30. [DOI: 10.1111/j.1540-8159.2011.03156.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Okutucu S, Aytemir K, Evranos B, Aksoy H, Sabanov C, Karakulak UN, Kaya EB, Kabakci G, Tokgozoglu L, Ozkutlu H, Oto A. Cardiac resynchronization therapy improves exercise heart rate recovery in patients with heart failure. Europace 2010; 13:526-32. [PMID: 21076146 DOI: 10.1093/europace/euq410] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
AIMS Heart rate (HR) recovery (HRR), defined as the rate of decline in the HR immediately following the cessation of exercise, is influenced by autonomic function. Heart rate recovery in heart failure (HF) has been shown to correlate with severity of HF. Cardiac resynchronization therapy (CRT) improves cardiac autonomic functions in HF. We aimed to evaluate the effects of CRT on cardiac autonomic function assessed by HRR. METHODS AND RESULTS Forty-eight patients [62.3 ± 10.7 years; 37 men; left ventricular (LV) ejection fraction 24.8 ± 4.1%] with HF were enrolled. A treadmill exercise testing was conducted in all patients by using a modified Naughton protocol before and 6 months after CRT. Heart rate recovery indices were calculated by subtracting first, second, and third minute HR from the maximal HR and designated as HRR1, HRR2, and HRR3, respectively. Standard echocardiography was performed before and 6 months after CRT. Left ventricular reverse remodelling (LVRM) was quantified as the percentage of decline in the LV end-systolic volume after CRT. Mean HRR1 (13.0 ± 5.9 vs. 17.9 ± 8.9 b.p.m., P = 0.001), HRR2 (20.5 ± 9.3 vs. 23.8 ± 11.3 b.p.m., P = 0.001), and HRR3 (25.7 ± 11.1 vs. 29.2 ± 12.0 b.p.m., P = 0.001) values improved 6 months after CRT. Pearson's analyses revealed a good positive correlation between LVRM and ΔHRR1 (r = 0.642, P = 0.001) and a moderate correlation between reduction LVRM and ΔHRR2 (r = 0.591, P = 0.033) and ΔHRR3 (r = 0.436, P = 0.001). CONCLUSION Cardiac resynchronization therapy favourably alters the cardiac autonomic functions. Heart rate recovery indices improved after CRT and the degree of improvement in HRR indices correlated with LVRM.
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Affiliation(s)
- Sercan Okutucu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye/Ankara, Ankara 06100, Turkey.
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