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Updated: Aug 30, 2025

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Chemoreflex and Baroreflex Sensitivity Hold a Strong Prognostic Value in Chronic Heart Failure.

Alberto Giannoni1, Francesco Gentile2, Francesco Buoncristiani3

  • 1Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana G. Monasterio, CNR-Regione Toscana, Pisa, Italy.

JACC. Heart Failure
|September 1, 2022
PubMed
Summary

Abnormal baroreflex sensitivity (BRS) and chemoreflex sensitivity (CRS) are common in heart failure (HF) patients on modern treatment. Both BRS and CRS predict adverse outcomes, highlighting their role in autonomic imbalance and risk stratification.

Keywords:
autonomic nervous systembaroreflexchemoreflexheart failurehospitalizationmortality

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Area of Science:

  • Cardiology
  • Autonomic Nervous System Research
  • Heart Failure Management

Background:

  • Novel heart failure (HF) treatments often target baroreflex sensitivity (BRS) and chemoreflex sensitivity (CRS).
  • Previous prognostic studies on BRS and CRS in HF were limited and partly predate modern therapies like beta-blockers.

Purpose of the Study:

  • To evaluate the clinical and prognostic significance of BRS and CRS in a large cohort of contemporary chronic heart failure patients.
  • To determine if BRS and CRS measurements can improve risk stratification in HF management.

Main Methods:

  • Assessed BRS (SD method) and CRS (hypoxia/hypercapnia rebreathing) in 425 outpatients with chronic HF (LVEF ≤49%).
  • Followed patients for a composite endpoint including cardiac death, ICD shock, or HF hospitalization.
  • Patients were on modern HF treatments, with 94% receiving beta-blockers.

Main Results:

  • Decreased BRS (36%) was linked to lower exercise tolerance and heart rate variability.
  • Increased CRS (20%) correlated with higher norepinephrine and central apneas.
  • Both reduced BRS and increased CRS independently predicted adverse outcomes, with combined abnormalities showing the worst prognosis.

Conclusions:

  • Abnormal BRS and CRS are prevalent in patients with chronic HF receiving contemporary treatment.
  • These autonomic dysfunctions contribute to exercise limitation, ventilation instability, and predict poor outcomes in HF.
  • BRS and CRS assessment offers valuable risk stratification for HF patients on modern therapies.