TY - JOUR
T1 - Estimation of baroreflex sensitivity by the bivariate phase rectified signal averaging method
T2 - a comparison with the phenylephrine method
AU - Maestri, Roberto
AU - La Rovere, Maria Teresa
AU - Raczak, Grzegorz
AU - Danilowicz-Szymanowicz, Ludmiła
AU - Pinna, Gian Domenico
PY - 2017/9/26
Y1 - 2017/9/26
N2 - OBJECTIVES: A novel technique to assess spontaneous baroreflex sensitivity (BRS) by bivariate phase-rectified signal averaging (PRSA-BRS) has been recently proposed and its independent prognostic power demonstrated. This method, however, has never been compared with the phenyleprine test (Phe-BRS), commonly regarded as the reference method in clinical and research applications.APPROACH: In 192 heart failure (HF) and 41 post-myocardial infarction (post-MI) patients we compared PRSA-BRS with Phe-BRS, assessing both association and agreement.MAIN RESULTS: Phe-BRS and PRSA-BRS were (mean ± SD) 4.8 ± 5.0 (range: -3.8,25.0) and 1.2 ± 1.5 (-2.1,6.9) ms mmHg(-1) in HF (p < 0.0001), and 5.0 ± 3.8 (-1.2,12.5) and 0.8 ± 1.7 (-2.0,6.9) ms mmHg(-1) in post-MI patients (p = 0.001). Moderate association was observed (r = 0.53, p < 0.0001 and r = 0.43, p = 0.004 in HF and post-MI, respectively). The vast majority (86% in HF and 90% in post-MI) of PRSA-BRS measurements were smaller than corresponding Phe-BRS values. The difference between PRSA-BRS and Phe-BRS was strongly dependent on the magnitude of BRS, with a trend towards more negative differences as BRS increased. Negative PRSA-BRS values were observed in 15% of HF and in 37% of post-MI patients, whereas negative Phe-BRS values were observed in 8% of HF and 5% of post-MI patients.SIGNIFICANCE: Although the association with Phe-BRS suggests that PRSA-BRS contains relevant information about cardiac autonomic control and reflects the strength of the baroreceptor-heart rate reflex, the marked disagreement between the two measurements indicates that PRSA-BRS measurements cannot be taken as estimates of BRS. Many factors may account for the observed lack of agreement: the different physiological conditions under which Phe-BRS and PRSA-BRS are measured, the inclusion of non-baroreflex mediated components of RR-intervals in PRSA-BRS and some computational aspects related to the normalization of PRSA-BRS values.
AB - OBJECTIVES: A novel technique to assess spontaneous baroreflex sensitivity (BRS) by bivariate phase-rectified signal averaging (PRSA-BRS) has been recently proposed and its independent prognostic power demonstrated. This method, however, has never been compared with the phenyleprine test (Phe-BRS), commonly regarded as the reference method in clinical and research applications.APPROACH: In 192 heart failure (HF) and 41 post-myocardial infarction (post-MI) patients we compared PRSA-BRS with Phe-BRS, assessing both association and agreement.MAIN RESULTS: Phe-BRS and PRSA-BRS were (mean ± SD) 4.8 ± 5.0 (range: -3.8,25.0) and 1.2 ± 1.5 (-2.1,6.9) ms mmHg(-1) in HF (p < 0.0001), and 5.0 ± 3.8 (-1.2,12.5) and 0.8 ± 1.7 (-2.0,6.9) ms mmHg(-1) in post-MI patients (p = 0.001). Moderate association was observed (r = 0.53, p < 0.0001 and r = 0.43, p = 0.004 in HF and post-MI, respectively). The vast majority (86% in HF and 90% in post-MI) of PRSA-BRS measurements were smaller than corresponding Phe-BRS values. The difference between PRSA-BRS and Phe-BRS was strongly dependent on the magnitude of BRS, with a trend towards more negative differences as BRS increased. Negative PRSA-BRS values were observed in 15% of HF and in 37% of post-MI patients, whereas negative Phe-BRS values were observed in 8% of HF and 5% of post-MI patients.SIGNIFICANCE: Although the association with Phe-BRS suggests that PRSA-BRS contains relevant information about cardiac autonomic control and reflects the strength of the baroreceptor-heart rate reflex, the marked disagreement between the two measurements indicates that PRSA-BRS measurements cannot be taken as estimates of BRS. Many factors may account for the observed lack of agreement: the different physiological conditions under which Phe-BRS and PRSA-BRS are measured, the inclusion of non-baroreflex mediated components of RR-intervals in PRSA-BRS and some computational aspects related to the normalization of PRSA-BRS values.
KW - Journal Article
U2 - 10.1088/1361-6579/aa8b5a
DO - 10.1088/1361-6579/aa8b5a
M3 - Article
C2 - 28885986
SN - 0967-3334
VL - 38
SP - 1874
EP - 1884
JO - Physiological Measurement
JF - Physiological Measurement
IS - 10
ER -