Altered Baroreflex-Mediated Cardiovascular Responses to Acute Hypotension in Heart Failure Patients Compared to Healthy Adults

Patients with heart failure (HF) exhibit baroreflex dysfunction, which is associated with increased morbidity and mortality. Orthostatic hypotension, a decrease in blood pressure (BP) upon standing, is a condition that often occurs in HF, and may be linked with altered baroreflex responsiveness in this population. However, data on baroreflex-mediated cardiovascular responses to acute hypotension in HF patients are limited. Therefore, 8 HF patients (7 men; mean±SEM 65±3y; ejection fraction 30.5±3.1%) and 7 healthy control (CON) adults (6 men; 65±2y) underwent 7.5 minutes of unilateral lower-limb ischemia via inflation of a thigh cuff on one leg to non-pharmacologically induce acute hypotension upon cuff deflation. Beat-to-beat systolic BP, diastolic BP, and mean arterial BP (MAP; photoplethysmographic finger cuff) and heart rate (HR; electrocardiogram) were recorded continuously before, during, and after cuff inflation. Statistical analysis involved independent-samples t-tests. Baseline values were not different between groups (systolic BP: 128±8 vs. 128±4mmHg; diastolic BP: 73±3 vs. 82±5mmHg; MAP: 90±3 vs. 97±4mmHg; HR: 62±2 vs. 56±2b.min-1 for HF and CON, respectively; P\u3e0.05). The magnitude of the induced decrease in MAP was similar in both groups (HF -11±1 vs. CON -12±2mmHg; P\u3e0.05). However, the time-to-peak MAP decrease was significantly longer in HF compared to CON (HF 11±2 vs. CON 6±1s; PP\u3e0.05). However, the time-to-peak HR increase was longer in HF compared to CON (HF 9±1 vs. CON 6±1s; PP\u3e0.05). However, the time-to-peak HR increase was longer in HF compared to CON (HF 9±1 vs. CON 6±1s;

Cardiac resynchronization therapy: evaluation of ventricular dysynchrony and patient selection

Cardiac resynchronization therapy (CRT) is an established treatment modality for systolic heart failure. Aimed to produce simultaneous biventricular stimulation and correct the lack of ventricular synchrony in selected patients with congestive heart failure, CRT has shown to improve mortality and reduce hospital admissions when compared to medical treatment. At present, the indication criteria for the implantation of a CRT device include an ejection fraction of less than 35%, heart failure symptoms consistent with NYHA functional class III-IV and a QRS complex duration equal or longer than 120 milliseconds. It has been reported that 30% of patients who meet those criteria still may not derive clinical benefit from CRT. Due to the existing diversity of imaging modalities and resources for their process and analysis, a great expectation in terms of more accurate diagnosis of ventricular dyssynchrony has been raised. Reliable identification of dyssynchrony could allow us to better predict the favorable response of an individual patient to CRT and therefore offer this procedure to those individuals most likely to benefit. We review the available techniques for the study of ventricular dyssynchrony for CRT patient selection and the results of its application in clinical trials. Despite tremendous progress in the imaging technology available for the assessment and diagnosis of ventricular dyssynchrony, an ideal method has not been identified and the duration of the QRS complex in the surface ECG remains the accepted criteria of dyssynchrony in the selection of patients for CRT