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Long-term chronic baroreflex activation: persistent efficacy in patients with heart failure and reduced ejection fraction.
J Hypertens. 2015 Aug; 33(8):1704-8.JH

Abstract

AIMS

Baroreflex activation therapy (BAT) has recently been shown to reduce muscle sympathetic nerve activity and hospitalization rate while improving clinical variables through 6 months of therapy in patients with heart failure and reduced ejection fraction (HFrEF). The objective of the present study is to extend the information on this patient cohort over a long-term follow-up.

METHODS AND RESULTS

Eleven patients were enrolled in the study and presented with optimized, stable medical therapy, New York Heart Association Class III HFrEF with left ventricular ejection fraction 40% or less, impaired functional capacity and no active cardiac resynchronization therapy. For the present report, muscle sympathetic nerve activity, baroreflex sensitivity data and hospitalization rate together with standard clinical data were collected at 12 and 21.5 ± 4.2 months following BAT activation. Two patients died during long-term follow-up. The remaining nine patients maintained the improvements observed at 6 months, including reduced sympathetic activity and rates of hospitalization.

CONCLUSION

BAT provides long-term chronic reductions in sympathetic activity and utilization of hospital resources in patients with HFrEF. General clinical presentation, quality of life and functional capacity are likewise improved and maintained. The temporal association of BAT with sympathetic drive diminution and improvement in objective clinical measures suggests a cause-and-effect relationship that will be verified in future randomized controlled trials of outcome.

Authors+Show Affiliations

aCardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni bIstituto Scientifico IRCCS Auxologico cClinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milan, Italy dCVRx, Inc., Minneapolis, Minnesota, USA eUniversità Milano-Bicocca, Milan fDepartment of Molecular Medicine, University of Pavia, Pavia, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26132760

Citation

Gronda, Edoardo, et al. "Long-term Chronic Baroreflex Activation: Persistent Efficacy in Patients With Heart Failure and Reduced Ejection Fraction." Journal of Hypertension, vol. 33, no. 8, 2015, pp. 1704-8.
Gronda E, Seravalle G, Trevano FQ, et al. Long-term chronic baroreflex activation: persistent efficacy in patients with heart failure and reduced ejection fraction. J Hypertens. 2015;33(8):1704-8.
Gronda, E., Seravalle, G., Trevano, F. Q., Costantino, G., Casini, A., Alsheraei, A., Lovett, E. G., Vanoli, E., Mancia, G., & Grassi, G. (2015). Long-term chronic baroreflex activation: persistent efficacy in patients with heart failure and reduced ejection fraction. Journal of Hypertension, 33(8), 1704-8. https://doi.org/10.1097/HJH.0000000000000603
Gronda E, et al. Long-term Chronic Baroreflex Activation: Persistent Efficacy in Patients With Heart Failure and Reduced Ejection Fraction. J Hypertens. 2015;33(8):1704-8. PubMed PMID: 26132760.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term chronic baroreflex activation: persistent efficacy in patients with heart failure and reduced ejection fraction. AU - Gronda,Edoardo, AU - Seravalle,Gino, AU - Trevano,Fosca Quarti, AU - Costantino,Giuseppe, AU - Casini,Andrea, AU - Alsheraei,Ali, AU - Lovett,Eric G, AU - Vanoli,Emilio, AU - Mancia,Giuseppe, AU - Grassi,Guido, PY - 2015/7/2/entrez PY - 2015/7/2/pubmed PY - 2016/4/9/medline SP - 1704 EP - 8 JF - Journal of hypertension JO - J. Hypertens. VL - 33 IS - 8 N2 - AIMS: Baroreflex activation therapy (BAT) has recently been shown to reduce muscle sympathetic nerve activity and hospitalization rate while improving clinical variables through 6 months of therapy in patients with heart failure and reduced ejection fraction (HFrEF). The objective of the present study is to extend the information on this patient cohort over a long-term follow-up. METHODS AND RESULTS: Eleven patients were enrolled in the study and presented with optimized, stable medical therapy, New York Heart Association Class III HFrEF with left ventricular ejection fraction 40% or less, impaired functional capacity and no active cardiac resynchronization therapy. For the present report, muscle sympathetic nerve activity, baroreflex sensitivity data and hospitalization rate together with standard clinical data were collected at 12 and 21.5 ± 4.2 months following BAT activation. Two patients died during long-term follow-up. The remaining nine patients maintained the improvements observed at 6 months, including reduced sympathetic activity and rates of hospitalization. CONCLUSION: BAT provides long-term chronic reductions in sympathetic activity and utilization of hospital resources in patients with HFrEF. General clinical presentation, quality of life and functional capacity are likewise improved and maintained. The temporal association of BAT with sympathetic drive diminution and improvement in objective clinical measures suggests a cause-and-effect relationship that will be verified in future randomized controlled trials of outcome. SN - 1473-5598 UR - https://www.unboundmedicine.com/medline/citation/26132760/Long_term_chronic_baroreflex_activation:_persistent_efficacy_in_patients_with_heart_failure_and_reduced_ejection_fraction_ L2 - http://dx.doi.org/10.1097/HJH.0000000000000603 DB - PRIME DP - Unbound Medicine ER -