Restrictive left ventricular filling pattern as a strong predictor of depressed baroreflex sensitivity in heart failure.
BACKGROUND
The aim of this study was to test the hypothesis that a restrictive left ventricular diastolic filling pattern, as an index of elevated pulmonary wedge pressure, would predict a depressed baroreflex sensitivity (BRS) in patients with chronic heart failure.


METHODS
A total of 189 consecutive patients with an ejection fraction < or = 40% at echocardiography, in sinus rhythm and clinically stable for at least 1 month in oral therapy, underwent clinical examination, echo-Doppler study and the phenylephrine test.


RESULTS
The correlations between the NYHA functional class, echo-Doppler variables and BRS were weak, although significant (r ranging from -0.15 to 0.40). However, patients with a deceleration time < 140 ms as an expression of restrictive filling, compared to those with a deceleration time > or = 140 ms, had a lower BRS (3 +/- 4 vs 6 +/- 4 ms/mmHg, p < 0.00001), a lower ejection fraction (20 +/- 6 vs 28 +/- 7%, p < 0.00001), greater left ventricular (end-diastolic volume index 137 +/- 43 vs 113 +/- 45 ml/m2, p < 0.00001) and left atrial dimensions (25 +/- 6 vs 20 +/- 5 cm2, p < 0.00001), more severe mitral regurgitation (3 +/- 1 vs 2.3 +/- 1, p < 0.00001) and were in a higher NYHA class (2.3 +/- 0.6 vs 1.8 +/- 0.5, p < 0.00001). Medications at the time of the study were similar in the two groups. At stepwise regression analysis, the deceleration time emerged as the most powerful independent predictor of a depressed BRS (< 3 ms/mmHg), followed by mitral regurgitation, age, and NYHA class (all data p = 0.0001).


CONCLUSIONS
In patients with chronic heart failure, the presence of a restrictive left ventricular filling pattern is highly predictive of autonomic derangement as expressed by low values of BRS.
Eleuteri
E
E
Cardiology Division, Salvatore Maugeri Foundation, IRCCS, Medical Center of Rehabilitation, Veruno (NO), Italy. cdl@intercom.it
Lanfranchi
P
P
Scapellato
F
F
Temporelli
P L
PL
Giannuzzi
P
P
D000367:Age Factors; D000368:Aged; D017704:Baroreflex / Q000502:physiology*; D002313:Cardiomyopathy, Restrictive / Q000150:complications; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*