In:
European Journal of Heart Failure, Wiley, Vol. 17, No. 10 ( 2015-10), p. 1066-1074
Abstract:
Increased sympathetic and decreased parasympathetic activity contribute to heart failure ( HF ) symptoms and disease progression. Carotid baroreceptor stimulation (baroreflex activation therapy, BAT ) results in centrally mediated reduction of sympathetic and increase in parasympathetic activity. Because patients treated with cardiac resynchronization therapy ( CRT ) may have less sympathetic/parasympathetic imbalance, we hypothesized that there would be differences in the response to BAT in patients with CRT vs. those without CRT . Methods and results New York Heart Association ( NYHA ) Class III patients with an ejection fraction ( EF ) ≤35% were randomized (1 : 1) to ongoing guideline‐directed medical and device therapy ( GDMT , control) or ongoing GDMT plus BAT . Safety endpoint was system‐/procedure‐related major adverse neurological and cardiovascular events ( MANCE ). Efficacy endpoints were Minnesota Living with Heart Failure Quality of Life ( QoL ), 6‐min hall walk distance ( 6MHWD ), N ‐terminal pro‐brain natriuretic peptide ( NT‐proBNP ), left ventricular ejection fraction ( LVEF ), and HF hospitalization rate. In this sample, 146 patients were randomized (70 control; 76 BAT ) and were 140 activated (45 with CRT and 95 without CRT ). MANCE ‐free rate at 6 months was 100% in CRT and 96% in no‐ CRT group. At 6 months, in the no‐ CRT group, QoL score, 6MHWD , LVEF , NT‐proBNP and HF hospitalizations were significantly improved in BAT patients compared with controls. Changes in efficacy endpoints in the CRT group favoured BAT ; however, the improvements were less than in the no‐ CRT group and were not statistically different from control. Conclusions BAT is safe and significantly improved QoL , exercise capacity, NTpro‐BNP , EF , and rate of HF hospitalizations in GDMT ‐treated NYHA Class III HF patients. These effects were most pronounced in patients not treated with CRT .
Type of Medium:
Online Resource
ISSN:
1388-9842
,
1879-0844
DOI:
10.1002/ejhf.2015.17.issue-10
Language:
English
Publisher:
Wiley
Publication Date:
2015
detail.hit.zdb_id:
1500332-2
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