title: Long-term chronic baroreflex activation: persistent efficacy in patients with heart failure and reduced ejection fraction.
abstract: OBJECTIVE
  Baroreflex activation therapy (BAT) has recently been shown to reduce muscle sympathetic nerve activity and hospitalization rate while improving clinical variables through 6 months of therapy in patients with heart failure and reduced ejection fraction (HFrEF). The objective of the present study is to extend the information on this patient cohort over a long-term follow-up.
  
  
  RESULTS
  Eleven patients were enrolled in the study and presented with optimized, stable medical therapy, New York Heart Association Class III HFrEF with left ventricular ejection fraction 40% or less, impaired functional capacity and no active cardiac resynchronization therapy. For the present report, muscle sympathetic nerve activity, baroreflex sensitivity data and hospitalization rate together with standard clinical data were collected at 12 and 21.5 ± 4.2 months following BAT activation. Two patients died during long-term follow-up. The remaining nine patients maintained the improvements observed at 6 months, including reduced sympathetic activity and rates of hospitalization.
  
  
  CONCLUSIONS
  BAT provides long-term chronic reductions in sympathetic activity and utilization of hospital resources in patients with HFrEF. General clinical presentation, quality of life and functional capacity are likewise improved and maintained. The temporal association of BAT with sympathetic drive diminution and improvement in objective clinical measures suggests a cause-and-effect relationship that will be verified in future randomized controlled trials of outcome.
authors.affiliation: aCardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni bIstituto Scientifico IRCCS Auxologico cClinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milan, Italy dCVRx, Inc., Minneapolis, Minnesota, USA eUniversità Milano-Bicocca, Milan fDepartment of Molecular Medicine, University of Pavia, Pavia, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Gronda
authors.forename: Gino
authors.initials: G
authors.lastname: Seravalle
authors.forename: Fosca Quarti
authors.initials: FQ
authors.lastname: Trevano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costantino
authors.forename: Andrea
authors.initials: A
authors.lastname: Casini
authors.forename: Ali
authors.initials: A
authors.lastname: Alsheraei
authors.forename: Eric G
authors.initials: EG
authors.lastname: Lovett
authors.forename: Emilio
authors.initials: E
authors.lastname: Vanoli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Guido
authors.initials: G
authors.lastname: Grassi
mesh_terms: D000368:Aged; D017704:Baroreflex / Q000502:physiology*; D004599:Electric Stimulation Therapy; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*