Improved Cardiac Structure and Ventricular-Arterial Coupling After Baroreflex Activation Therapy

Baroreflex activation therapy (BAT) improves functional status, quality of life, and exercise capacity in patients with heart failure with reduced ejection fraction; however, its direct effects on reversing adverse cardiac remodeling as assessed by improvements in cardiac structure, function, and coupling with the arterial system remain unclear. We present 2 cases of patients who initially presented with decompensated heart failure, and despite initial medical therapy and continued outpatient follow-up, were unable to tolerate full escalation of guideline-directed medical therapy. The patients remained symptomatic, with high biomarker levels, poor functional capacity, severe heart failure symptoms, and objectively had decreased stroke volume, low left ventricular ejection fraction, and high left ventricular mass. However, soon after implantation of BAT, not only did their heart failure symptoms and hemodynamics improve, but they were able to tolerate further escalation of medical therapy. After BAT, there was evidence of reverse cardiac remodeling, with improvement in biomarkers, left ventricular ejection fraction, contractility, and ventricular-arterial coupling.