Autonomic Predictors of Hospitalization Due to Heart Failure Decompensation in Patients with Left Ventricular Systolic Dysfunction

Abstract

IntroductionAutonomic nervous system balance can be significantly deteriorated during heart failure exacerbation. However, it is still unknown whether these changes are only the consequence of heart failure decompensation or can also predict development thereof. Objectives were to verify if simple, non-invasive autonomic parameters, such as baroreflex sensitivity and short-term heart rate variability can provide independent of other well-known clinical parameters information on the risk of heart failure decompensation in patients with left ventricular systolic dysfunction.MethodsIn 142 stable patients with left ventricular ejection fraction ≤ 40%, baroreflex sensitivity and short-term heart rate variability, as well as other well-known clinical parameters, were analyzed. During 23 ± 9 months of follow-up 19 patients were hospitalized due to the heart failure decompensation (EVENT).ResultsPre-specified cut-off values of baroreflex sensitivity (≤2.4 ms/mmHg) and low frequency power index of heart rate variability (≤19 ms2) were significantly associated with the EVENTs (hazard ratio 4.43, 95% confidence interval [CI] 1.35–14.54 and 5.41, 95% CI 1.87–15.65 respectively). EVENTs were also associated with other parameters, such as left ventricular ejection fraction, NYHA class, diuretic use, renal function, brain natriuretic peptide and hemoglobin level, left atrial size, left and right ventricular heart failure signs. After adjusting baroreflex sensitivity and low frequency power index for each of the abovementioned parameters, autonomic parameters were still significant predictors of hospitalization due to the heart failure decompensation.ConclusionSimple, noninvasive autonomic indices can be helpful in identifying individuals with increased risk of hospitalization due to the heart failure decompensation among clinically stable patients with left ventricular systolic dysfunction, even when adjusted for other well-known clinical parameters.

Global longitudinal strain can predict heart failure exacerbation in stable outpatients with ischemic left ventricular systolic dysfunction

“…In the group of laboratory parameters, increased levels of natriuretic peptides, troponins, catecholamine’s, urea, creatinine and low sodium levels have high prognostic value. In addition, one should not forget about other sociodemographic factors such as: age, marital status, compliance with dietary and therapeutic recommendations [5–9]. Many prior publications emphasize the usefulness ​​of left ventricular (LV) ejection fraction (LVEF) assessment, which was considered one of the most important risk factors for morbidity and mortality.…”

Heart rate variability in pulmonary hypertension with and without sleep apnea

“…While autonomic nervous dysfunction has been extensively described among those with left heart failure (Danilowicz-Szymanowicz et al., 2016), less is known about autonomic modulation, in those with RV dysfunction (e.g. PH).…”

“…Heart rate variability (HRV), the fluctuation in time intervals between consecutive heartbeats, is regulated by both the sympathetic and parasympathetic divisions of the autonomic nervous system at the sino-atrial node and provides an assessment of autonomic nervous system modulation (Pagani et al., 1986; Task Force of ESC/NASPE, 1996). Decreased HRV portends a worse prognosis in the general population (Hillebrand et al., 2013; Maheshwari et al., 2016) and in particular in those with heart failure (Danilowicz-Szymanowicz et al., 2016). Moreover, the clinical importance of low HRV has been recognized for risk stratification for sudden arrhythmic death in the general population (Maheshwari et al., 2016).…”

Efeitos do treinamento muscular inspiratório no controle autonômico: revisão sistemática

“…The findings pointing out improvement in the autonomic control are specially significant, since there is evidence showing that, besides the participation of autonomic disfunction in the physiopathology of many diseases, as arterial hypertension 3 , autonomic unbalance confers a worse prognosis to individuals [31][32][33][34] . It is known that SNA has a toxic effect to the heart, causing cardiomyocyte programed death and increase in the myocardium work 35 , while the parasympathetic activity confers a cardioprotective effect 36 .…”

“…It is known that SNA has a toxic effect to the heart, causing cardiomyocyte programed death and increase in the myocardium work 35 , while the parasympathetic activity confers a cardioprotective effect 36 . Thus, individuals with autonomic disfunction have higher risks of cardiac decompensation 33 and sudden death 34 , and interventions that may enable improvements in this scenario are specially beneficial to these patients' health, representing a relevant implication for clinical practice. In this sense, the most recent guidelines for treating cardiovascular diseases point out IMT as an alternative for the process of cardiovascular rehabilitation 37 .…”