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Different estimation methods of spontaneous baroreflex sensitivity have different predictive value in heart failure
Gian Domenico Pinna1, Alberto Porta, Roberto Maestri
1aDepartment of Biomedical Engineering, Istituti Clinici Scientifici Maugeri SpA SB, Istituto di Montescano - IRCCS, Montescano (PV) bDepartment of Biomedical Sciences for Health, University of Milan, Milan cDepartment of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan dDepartment of Cardiology, Istituti Clinici Scientifici Maugeri SpA SB, Istituto di Milano - IRCCS, Milan, Italy eDepartment of Cardiology, Istituti Clinici Scientifici Maugeri SpA SB, Istituto di Montescano - IRCCS, Montescano (PV), Italy.
Different methods for estimating cardiac baroreflex sensitivity (BRS) show varying predictive power for heart failure mortality. The most effective BRS indexes are linked to systolic arterial pressure and R-R interval oscillations in the low-frequency band.
Area of Science:
- Cardiology
- Physiology
- Biomedical Engineering
Background:
- Cardiac baroreflex sensitivity (BRS) is crucial for cardiovascular regulation.
- Estimating BRS using spontaneous fluctuations in systolic arterial pressure (SAP) and R-R intervals is common.
- The prognostic value of different BRS estimation methods in heart failure is not well-established.
Purpose of the Study:
- To compare the prognostic value of various spontaneous BRS indexes in heart failure patients.
- To identify which BRS estimation methods best predict cardiac mortality in this population.
Main Methods:
- Studied 228 stable heart failure patients with reduced ejection fraction.
- Recorded ECG, arterial blood pressure, and respiration during paced breathing.
- Estimated BRS using sequence, transfer function (nonparametric and parametric), spectral analysis, model-based closed loop, and phase-rectified signal averaging methods.
Main Results:
- During 36 months follow-up, 45 cardiac events occurred.
- Nonparametric transfer function in the low-frequency band (BRSTF_NP-LF), parametric spectral analysis in the low-frequency band (BRSPS-LF), parametric transfer function in the low-frequency band (BRSTF_P-LF), and phase-rectified signal averaging (BRSPRSA) were significantly associated with cardiac events.
- BRSTF_NP-LF and BRSPRSA improved risk classification.
Conclusions:
- Different spontaneous BRS indexes possess varying predictive capabilities in heart failure.
- Prognostic information from BRS estimates is primarily associated with SAP and R-R interval oscillations within the low-frequency band.