Arterial baroreflex modulation of heart rate in chronic heart failure: clinical and hemodynamic correlates and prognostic implications.
Arterial baroreflex modulation of heart rate in chronic heart failure: clinical and hemodynamic correlates and prognostic implications.
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DOI：
10.1161/01.cir.96.10.3450
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发表时间：
1997-11
期刊：
影响因子：
37.8
通讯作者：
A. Mortara;M. T. L. Rovere;G. Pinna;A. Prpa;R. Maestri;O. Febo;Massimo Pozzoli;C. Opasich;Luigi Tavazzi
中科院分区：
文献类型：
--
作者：
A. Mortara;M. T. L. Rovere;G. Pinna;A. Prpa;R. Maestri;O. Febo;Massimo Pozzoli;C. Opasich;Luigi Tavazzi
背景在慢性心力衰竭（CHF）中，心脏功能的动脉压力反射调节受损，导致对交感神经系统的紧张性抑制影响减少。由于压力感受性反射敏感性（BRS），如苯肾上腺素技术评估，显着有助于梗死后危险分层，本研究的目的是评估是否在CHF患者中，一个抑郁的BRS与更糟糕的临床血流动力学状态和不利的结果。方法和结果：对282例接受稳定药物治疗的窦性心律CHF患者（年龄52+/-9岁;纽约心脏协会[NYHA]分级2.4+/-0.6;左心室射血分数[LVEF] 23+/-6%）进行BRS评估。整个人群的BRS平均值为3.9+/-4.0 ms/mm Hg（平均值+/-SD），与LVEF和血流动力学参数（LVEF，P3 ms/mm Hg）显著相关。在平均15+/-12个月的随访中，发生了78起主要事件（心源性死亡、非致死性心脏骤停和1级优先移植）（27.6%）。BRS与预后显著相关（log rank，9.1; P<.01），BRS严重紊乱（<1.3 ms/mm Hg）患者的相对危险度为2.7（95%置信区间，1.6 ~ 4.7）。在多变量分析中，BRS是校正非侵入性已知危险因素后死亡的独立预测因子，但当血流动力学指标也被考虑时则不是。然而，在伴有严重二尖瓣返流的CHF患者中，BRS仍然是一个独立于血流动力学功能的强有力的预后标志物。结论：在中度至重度CHF患者中，迷走神经反射敏感性降低与临床和血流动力学状态恶化平行，并与生存率低显著相关。特别是在重度二尖瓣返流患者中，心率的压力感受器调制为血流动力学参数提供了增量价值的预后信息。
BACKGROUND In chronic heart failure (CHF), arterial baroreflex regulation of cardiac function is impaired, leading to a reduction in the tonic restraining influence on the sympathetic nervous system. Because baroreflex sensitivity (BRS), as assessed by the phenylephrine technique, significantly contributes to postinfarction risk stratification, the aim of the present study was to evaluate whether in CHF patients a depressed BRS is associated with a worse clinical hemodynamic status and unfavorable outcome. METHODS AND RESULTS BRS was assessed in 282 CHF patients in sinus rhythm receiving stable medical therapy (age, 52+/-9 years; New York Heart Association [NYHA] class, 2.4+/-0.6; left ventricular ejection fraction [LVEF], 23+/-6%). The BRS of the entire population averaged 3.9+/-4.0 ms/mm Hg (mean+/-SD) and was significantly related to LVEF and hemodynamic parameters (LVEF, P3 ms/mm Hg). During a mean follow-up of 15+/-12 months, 78 primary events (cardiac death, nonfatal cardiac arrest, and status 1 priority transplantation) occurred (27.6%). BRS was significantly related to outcome (log rank, 9.1; P<.01), with a relative risk of 2.7 (95% confidence interval, 1.6 to 4.7) for patients with the major derangement in BRS (<1.3 ms/mm Hg). At multivariate analysis, BRS was an independent predictor of death after adjustment for noninvasive known risk factors but not when hemodynamic indexes were also considered. In CHF patients with severe mitral regurgitation, however, BRS remained a strong prognostic marker independent of hemodynamic function. CONCLUSIONS In moderate to severe CHF, a depressed sensitivity of vagal reflexes parallels the deterioration of clinical and hemodynamic status and is significantly associated with poor survival. Particularly in patients with severe mitral regurgitation the baroreceptor modulation of heart rate provides prognostic information of incremental value to hemodynamic parameters.