Prognostic value of baroreflex sensitivity assessed by phase IV of Valsalva manoeuvre in patients with mild-to-moderate heart failure

Background: In patients with heart failure, impairment of baroreflex functi on occurs early and contributes to sympathetic activation, however, at pres ent its prognostic role has not been definitively established. Aims: To eva luate the prognostic significance of baroceptor impairment in patients with different degrees of heart failure. Methods: We enrolled 52 consecutive pa tients with heart failure, referred to our institution for functional evalu ation. Twenty-eight suffered from ischemic cardiomyopathy and 26 from dilat ed cardiomyopathy. Thirteen patients were in NYHA class I, 20 in NYHA class II and 19 in class III. All patients underwent baroreflex assessment by ph ase IV Valsalva manoeuvre using Finapres finger monitoring of arterial bloo d pressure, echocardiography [with evaluation of left ventricular ejection fraction (LVEF), fractional shortening (LVFS), left ventricular end diastol ic diameter (LVEDD) and mean pulmonary artery pressure] and functional eval uation by cardiopulmonary exercise test and 6-min walk corridor test within 2 days of hospital admission. Results: Mean duration of follow-up was 26 m onths (range 6-35 months). At baseline, evaluation in 13 patients BRS was n ormal (> 5 ms/mmHg), in 17 moderately impaired (1.5-5 ms/mmHg) and in 22 se verely depressed(< 1.5 ms/mmHg). Baroreflex function was relatively preserv ed in patients in NYHA class I (5.1 +/- 2.5) in comparison to patients in N YHA 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 he art transplantation was 62% in patients with normal baroreflex function, 62 % in patients with moderate impairment of baroreflex and 66% in patients wi th major derangement. NYHA class, LVEF, LVFS and LVEDD were significantly a ssociated with event free survival while baroreflex function was not. Concl usions: Our results suggest that evaluation of BRS impairment by phase IV V alsalva manoeuvre has limited prognostic value in patients with heart failu re. (C) 2000 European Society of Cardiology. All rights reserved.