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Implantation of Combined Telemetric ECG and Blood Pressure Transmitters to Determine Spontaneous Baroreflex Sensitivity in Conscious Mice
Published on: February 14, 2021
Baroreflex sensitivity predicts long-term cardiovascular mortality after myocardial infarction even in patients with
Gaetano M De Ferrari1, Antonio Sanzo, Alessandra Bertoletti
1Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Insights
Depressed baroreflex sensitivity (BRS) predicts long-term cardiovascular mortality in post-myocardial infarction (MI) patients with preserved left ventricular function, even in low-risk groups. This autonomic marker identifies high-risk individuals for targeted preventive strategies.
Area of Science:
- Cardiology
- Autonomic Nervous System Function
- Cardiovascular Risk Stratification
Background:
- Risk stratification post-myocardial infarction (MI) typically relies on left ventricular ejection fraction (LVEF).
- Autonomic markers, such as baroreflex sensitivity (BRS), may refine risk assessment.
- Previous studies indicated BRS had limited predictive power in specific post-MI subgroups.
Purpose of the Study:
- To evaluate the long-term predictive value of depressed baroreflex sensitivity (BRS) in post-myocardial infarction (MI) patients.
- To determine if BRS predicts cardiovascular mortality in patients with preserved left ventricular function.
- To assess BRS's independent predictive power irrespective of age and LVEF.
Main Methods:
- Enrolled 244 consecutive post-MI patients with preserved LVEF (>35%).
- Assessed baroreflex sensitivity (BRS) 4 weeks post-MI.
- Followed patients for a mean of 5 years to track cardiovascular mortality.
Main Results:
- Cardiovascular mortality occurred in 5.7% of patients over 5 years.
- Multivariate analysis identified depressed BRS as a significant predictor of cardiovascular mortality (p=0.0001).
- Depressed BRS conferred a significantly higher relative risk of death, particularly in younger patients.
Conclusions:
- Depressed baroreflex sensitivity (BRS) identifies a high-risk subgroup among post-MI patients with preserved left ventricular function.
- BRS is an independent predictor of long-term cardiovascular mortality, regardless of age.
- These findings suggest a need for more aggressive preventive strategies in identified high-risk patients.
Objectives:
This study sought to assess the long-term predictive power of depressed baroreflex sensitivity (BRS) among post-myocardial infarction (MI) patients with preserved left ventricular function.
Background:
Risk stratification after MI is primarily performed by identifying patients with depressed left ventricular ejection fraction (LVEF) because of their greater mortality. Autonomic markers can help refining risk stratification. Depressed BRS (<3 ms/mm Hg) correlated with cardiovascular mortality in 1,284 post-MI patients during a 21-month follow-up in the multicenter ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) study, but had no significant predictive power in patients with LVEF >35% or above age 65 years.
Methods:
Two hundred forty-four consecutive post-MI patients (age 59 +/- 10 years) with LVEF >35% (average 54 +/- 8%) were enrolled. They underwent a complete assessment, including BRS 4 weeks after MI.
Results:
During a 5-year mean follow-up, 14 (5.7%) patients died of cardiovascular causes. Multivariate analysis identified BRS (p = 0.0001), but not LVEF and age, as predictive of cardiovascular mortality. The relative risk (95% confidence interval [CI]) for depressed BRS was 11.4 (95% CI 3.3 to 39.0) for the overall population, 19.6 (95% CI 4.1 to 94.8) for patients
Conclusions:
Even among the large number of low-risk post-MI patients with preserved left ventricular function, depressed BRS identifies, independently of age, a subgroup at long-term high risk for cardiovascular mortality in which more aggressive preventive strategies should be considered.
