title: Prognostic value of baroreflex sensitivity assessed by phase IV of Valsalva manoeuvre in patients with mild-to-moderate heart failure.
abstract: BACKGROUND
  In patients with heart failure, impairment of baroreflex function occurs early and contributes to sympathetic activation, however, at present its prognostic role has not been definitively established.
  
  
  OBJECTIVE
  To evaluate the prognostic significance of baroceptor impairment in patients with different degrees of heart failure.
  
  
  METHODS
  We enrolled 52 consecutive patients with heart failure, referred to our institution for functional evaluation. Twenty-eight suffered from ischemic cardiomyopathy and 26 from dilated cardiomyopathy. Thirteen patients were in NYHA class I, 20 in NYHA class II and 19 in class III. All patients underwent baroreflex assessment by phase IV Valsalva manoeuvre using Finapres finger monitoring of arterial blood pressure, echocardiography [with evaluation of left ventricular ejection fraction (LVEF), fractional shortening (LVFS), left ventricular end diastolic diameter (LVEDD) and mean pulmonary artery pressure] and functional evaluation by cardiopulmonary exercise test and 6-min walk corridor test within 2 days of hospital admission.
  
  
  RESULTS
  Mean duration of follow-up was 26 months (range 6-35 months). At baseline, evaluation in 13 patients BRS was normal (>5 ms/mmHg), in 17 moderately impaired (1.5-5 ms/mmHg) and in 22 severely depressed (<1.5 ms/mmHg). Baroreflex function was relatively preserved in patients in NYHA class I (5.1+/-2.5) in comparison to patients in NYHA class II and III (2.1+/-2.3 and 2.08+/-1.9 ms/mmHg, respectively). Of the 52 patients who entered the study at the end of follow-up 15 died of cardiac cause and 5 underwent heart transplantation. Survival free from heart transplantation was 62% in patients with normal baroreflex function, 62% in patients with moderate impairment of baroreflex and 66% in patients with major derangement. NYHA class, LVEF, LVFS and LVEDD were significantly associated with event free survival while baroreflex function was not.
  
  
  CONCLUSIONS
  Our results suggest that evaluation of BRS impairment by phase IV Valsalva manoeuvre has limited prognostic value in patients with heart failure.
authors.affiliation: Istituto di Clinica Medica e Cardiologia, Università' di Firenze, Viale GB Morgagni 85, 50134, Firenze, Italy. g.gensini@dfc.unifi.it
authors.forename: C
authors.initials: C
authors.lastname: Rostagno
authors.forename: G
authors.initials: G
authors.lastname: Galanti
authors.forename: M
authors.initials: M
authors.lastname: Felici
authors.forename: M
authors.initials: M
authors.lastname: Maccherini
authors.forename: G
authors.initials: G
authors.lastname: Sani
authors.forename: S
authors.initials: S
authors.lastname: Caciolli
authors.forename: G F
authors.initials: GF
authors.lastname: Gensini
mesh_terms: D000328:Adult; D000368:Aged; D017704:Baroreflex; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology*; D005080:Exercise Test; D006333:Heart Failure / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies; D014636:Valsalva Maneuver; D016277:Ventricular Function, Left