Effects of chronic carotid baroreceptor activation on arterial stiffness in severe heart failure.
BACKGROUND
Heart failure with reduced ejection fraction (HFrEF) is characterized by activation of the sympathetic nervous system and increased arterial stiffness, leading to an impaired ventricular-vascular coupling. Baroreflex activation therapy (BAT) has been shown to reduce muscle sympathetic nerve activity (MSNA) and improve clinical status of patients with HFrEF. The purpose of this investigation was to determine the effects of BAT on arterial stiffness in HFrEF.


RESULTS
MSNA, clinical variables, and parameters of central blood pressure (BP) and arterial stiffness were collected in 18 NYHA Class III HFrEF patients, nine receiving BAT and nine continuing with optimal medical management alone. Patients were followed for 3 months, with measurements at that time compared to baseline evaluation. Baseline characteristics of the groups were well matched. At 3 months, BAT did not improve central BP and arterial stiffness despite a significant amelioration of MSNA, NYHA class, Minnesota living with heart failure questionnaire score, number of heart failure medications and six-minute walking distance. The control group exhibited no significant changes in all the measured variables.


CONCLUSIONS
Despite significant reductions in MSNA and clinical improvement, BAT does not appear to chronically modify arterial stiffness within this HFrEF cohort. Additional study is required to determine if this result applies to the HFrEF population as a whole.
Cardiovascular Department, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
Edoardo
E
Gronda
Clinica Medica, University of Milano-Bicocca, Via Pergolesi 33, 20090, Monza, Italy.
GianMaria
G
Brambilla
Istituto Auxologico, Milan, Italy.
Gino
G
Seravalle
Clinica Medica, University of Milano-Bicocca, Via Pergolesi 33, 20090, Monza, Italy.
Alessandro
A
Maloberti
Clinica Medica, University of Milano-Bicocca, Via Pergolesi 33, 20090, Monza, Italy.
Matteo
M
Cairo
Cardiovascular Department, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
Giuseppe
G
Costantino
CVRx Inc., Minneapolis, MN, USA.
Eric
E
Lovett
Cardiovascular Department, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
Emilio
E
Vanoli
Istituto Auxologico, Milan, Italy.
Giuseppe
G
Mancia
Cardiovascular Department, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy. guido.grassi@unimib.it.|Clinica Medica, University of Milano-Bicocca, Via Pergolesi 33, 20090, Monza, Italy. guido.grassi@unimib.it.
Guido
G
Grassi
D000368:Aged; D017704:Baroreflex; D001794:Blood Pressure; D002346:Carotid Sinus / Q000294:innervation*; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D058542:Implantable Neurostimulators; D007558:Italy; D008297:Male; D008875:Middle Aged; D011311:Pressoreceptors / Q000378:metabolism*; D063177:Pulse Wave Analysis; D012720:Severity of Illness Index; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D013997:Time Factors; D016896:Treatment Outcome; D059289:Vascular Stiffness; D016277:Ventricular Function, Left
Arterial stiffness; Baroreflex activation therapy; Central blood pressure; Congestive heart failure; Pulse wave velocity