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Restoration of normal sympathetic neural function in heart failure following baroreflex activation therapy: final 43-month study report.
J Hypertens. 2017 12; 35(12):2532-2536.JH

Abstract

BACKGROUND

Baroreflex activation therapy (BAT) exerts in severe heart failure sympathoinhibitory effects, improving clinical variables and reducing hospitalization rate. The current follow-up study was aimed at determining the long-term effects of BAT, assessing whether BAT in heart failure allows to restore physiological levels of sympathetic function.

METHODS

Seven patients out of the 11 heart failure patients aged 66.5 ± 3 years (mean ± SEM) in New York Heart Association Class III with left ventricular ejection fraction 40% or less and impaired functional capacity recruited in the study survived at the final follow-up (43.5 ± 2.1 months). Measurements included muscle sympathetic nerve activity (MSNA, microneurography) and spontaneous baroreflex-MSNA sensitivity together with hospitalization rate, echocardiography, Minnesota score, New York Heart Association class and standard clinical data. Measurements were collected before and at 6, 21 and 43 months following BAT. Data were compared with those collected in 17 age-matched healthy controls. All assessments were made with the heart failure patient on optimal active therapy.

RESULTS

In the seven patients, BAT maintained its beneficial effects over 43.5 ± 2.1 months of follow-up. MSNA values underwent a progressive significant reduction from baseline to 21 and 43 months follow-up following BAT (from 46.2 ± 2.4 to 31.3 ± 3.0 e 26.6 ± 2.0 bursts/min, P < 0.05 at least), becoming almost superimposable to the ones seen in healthy controls (25.5 ± 0.8 bursts/min). Baroreflex-MSNA sensitivity improved, without achieving, however, a full normalization. Blood pressure and heart rate did not change. Left ventricular ejection fraction improved significantly from 32.3 ± 2 to 36.7 ± 3% (P < 0.05). Hospitalization rate decreased substantially when measured as days/year/patients it decreased from 10.3 ± 2.5 preimplant to 1.01 ± 1.4 at the 43.5th month follow-up (P < 0.02). No side effects were reported in the long-term period.

CONCLUSION

The current study provides evidence that BAT in heart failure with reduced ejection fraction allows not only to improve hemodynamic and clinical profile but also to exert profound sympathoinhibitory effects, allowing an almost complete restoration of physiological levels of the sympathetic neural function.

Authors+Show Affiliations

aClinica Medica, Department of Medicine and Surgery, University Milano-Bicocca bIRCCS Multimedica, Sesto San Giovanni cIRCCS Istituto Auxologico Italiano, Milan dDepartment 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)

Journal Article

Language

eng

PubMed ID

28816745

Citation

Dell'Oro, Raffaella, et al. "Restoration of Normal Sympathetic Neural Function in Heart Failure Following Baroreflex Activation Therapy: Final 43-month Study Report." Journal of Hypertension, vol. 35, no. 12, 2017, pp. 2532-2536.
Dell'Oro R, Gronda E, Seravalle G, et al. Restoration of normal sympathetic neural function in heart failure following baroreflex activation therapy: final 43-month study report. J Hypertens. 2017;35(12):2532-2536.
Dell'Oro, R., Gronda, E., Seravalle, G., Costantino, G., Alberti, L., Baronio, B., Staine, T., Vanoli, E., Mancia, G., & Grassi, G. (2017). Restoration of normal sympathetic neural function in heart failure following baroreflex activation therapy: final 43-month study report. Journal of Hypertension, 35(12), 2532-2536. https://doi.org/10.1097/HJH.0000000000001498
Dell'Oro R, et al. Restoration of Normal Sympathetic Neural Function in Heart Failure Following Baroreflex Activation Therapy: Final 43-month Study Report. J Hypertens. 2017;35(12):2532-2536. PubMed PMID: 28816745.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Restoration of normal sympathetic neural function in heart failure following baroreflex activation therapy: final 43-month study report. AU - Dell'Oro,Raffaella, AU - Gronda,Edoardo, AU - Seravalle,Gino, AU - Costantino,Giuseppe, AU - Alberti,Luca, AU - Baronio,Barbara, AU - Staine,Tiziana, AU - Vanoli,Emilio, AU - Mancia,Giuseppe, AU - Grassi,Guido, PY - 2017/8/18/pubmed PY - 2018/5/24/medline PY - 2017/8/18/entrez SP - 2532 EP - 2536 JF - Journal of hypertension JO - J. Hypertens. VL - 35 IS - 12 N2 - BACKGROUND: Baroreflex activation therapy (BAT) exerts in severe heart failure sympathoinhibitory effects, improving clinical variables and reducing hospitalization rate. The current follow-up study was aimed at determining the long-term effects of BAT, assessing whether BAT in heart failure allows to restore physiological levels of sympathetic function. METHODS: Seven patients out of the 11 heart failure patients aged 66.5 ± 3 years (mean ± SEM) in New York Heart Association Class III with left ventricular ejection fraction 40% or less and impaired functional capacity recruited in the study survived at the final follow-up (43.5 ± 2.1 months). Measurements included muscle sympathetic nerve activity (MSNA, microneurography) and spontaneous baroreflex-MSNA sensitivity together with hospitalization rate, echocardiography, Minnesota score, New York Heart Association class and standard clinical data. Measurements were collected before and at 6, 21 and 43 months following BAT. Data were compared with those collected in 17 age-matched healthy controls. All assessments were made with the heart failure patient on optimal active therapy. RESULTS: In the seven patients, BAT maintained its beneficial effects over 43.5 ± 2.1 months of follow-up. MSNA values underwent a progressive significant reduction from baseline to 21 and 43 months follow-up following BAT (from 46.2 ± 2.4 to 31.3 ± 3.0 e 26.6 ± 2.0 bursts/min, P < 0.05 at least), becoming almost superimposable to the ones seen in healthy controls (25.5 ± 0.8 bursts/min). Baroreflex-MSNA sensitivity improved, without achieving, however, a full normalization. Blood pressure and heart rate did not change. Left ventricular ejection fraction improved significantly from 32.3 ± 2 to 36.7 ± 3% (P < 0.05). Hospitalization rate decreased substantially when measured as days/year/patients it decreased from 10.3 ± 2.5 preimplant to 1.01 ± 1.4 at the 43.5th month follow-up (P < 0.02). No side effects were reported in the long-term period. CONCLUSION: The current study provides evidence that BAT in heart failure with reduced ejection fraction allows not only to improve hemodynamic and clinical profile but also to exert profound sympathoinhibitory effects, allowing an almost complete restoration of physiological levels of the sympathetic neural function. SN - 1473-5598 UR - https://www.unboundmedicine.com/medline/citation/28816745/Restoration_of_normal_sympathetic_neural_function_in_heart_failure_following_baroreflex_activation_therapy:_final_43_month_study_report_ L2 - http://dx.doi.org/10.1097/HJH.0000000000001498 DB - PRIME DP - Unbound Medicine ER -