Decreased Baroreflex Sensitivity Assessed from Phase IV of Valsalva Maneuver in Mild Congestive Heart Failure

Abstract

Decreased sensitivity of cardiopulmonary and arterial baroreceptors has been hypothesized to sustain sympathetic activation in patients with heart failure. In the present investigation the relationship between the impairment of baroreflex sensitivity and clinical severity of congestive heart failure was investigated. The authors studied 58 patients with heart failure (14 in NYHA class I, 22 in NYHA class II, and 22 in NYHA class III), 38 women and 20 men, age range 28-65 years. Thirty-two patients suffered from idiopathic dilated cardiomyopathy and 26 from coronary heart disease. As control group they examined 21 age-matched subjects. Baroreceptor sensitivity was studied by using the Valsalva maneuver as stimulus. Arterial pressure and heart rate were measured noninvasively by Finapres instrument (Ohmeda) and signals were recorded and elaborated with a personal computer. A decrease of baroreflex sensitivity was already demonstrable in NYHA class I patients (4.72 +/- 3.31 vs 9.25 +/- 5.05 msec/mm Hg in control group) (p < 0.005). A further impairment of baroreceptor response was found in patients in NYHA class II (1.94 +/- 2.88 msec/mm Hg, p < 0.001) and class III (1.78 +/- 1.52 msec/mm Hg, p < 0.001). Baroreceptor response showed a significant correlation with functional NYHA class (r = 0.61, p < 0.001) and anaerobic threshold (r = 0.57, p < 0.001) while the correlation was less tight with left ventricular end-diastolic diameter, fractional shortening, left ventricular ejection fraction, pulmonary mean arterial blood pressure, cardiac index, distance at 6 minutes walk corridor test, and maximal oxygen consumption (VO2max). These results suggest that baroreceptor function may be impaired early in the clinical course of heart failure and may contribute to sympathetic activation.

Short- and Long-Term Joint Symbolic Dynamics of Heart Rate and Blood Pressure in Dilated Cardiomyopathy

“…Furthermore, the number of frequent or seldom word types was less in DCM than in CON. This also points at a loss of HRV mediated by an impaired blood pressure regulation in DCM that has been described by other authors [21].…”

Cardiovascular autonomic dysfunction in dementia with Lewy bodies and Parkinson's disease

“…In patients with PD, Lewy bodies are found mainly in the brain stem; autonomic symptoms frequently coexist with core motor impairments, such as tremor, extremity rigidity, bradykinesia, and postural instability. For instance, OH affects from 20% to 50% of patients with PD [5][6][7][8][9][10]. However, autonomic function in DLB has received little attention and has not been studied systematically [11][12][13].…”

Relationship Between Cardiac Sympathetic Function and Baroreceptor Sensitivity After Acute Myocardial Infarction

“…11 Previous studies have demonstrated the high reproducibility and close relation between the Valsalva method and the phenylephrine method. 10,18 Rostangno et al reported that the BRS obtained by the Valsalva method could predict worsening outcome in patients with ventricular dysfunction 19 and the BRS value obtained in the present study is similar to theirs, which suggests that BRS is reduced in patients who have experienced an AMI.…”