Comparison between invasive and non-invasive measurements of baroreflex sensitivity. Implications for studies on risk stratification after a myocardial infarction

Aims The ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) study has proved the independent prognostic value of baroreflex sensitivity. A limitation of the traditional method of estimating baroreflex sensitivity by phenylephrine, is the need to monitor intra-arterial blood pressure. O...

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Published in:European heart journal 2000-09, Vol.21 (18), p.1522-1529
Main Authors: Pinna, G.D, La Rovere, M.T, Maestri, R, Mortara, A, Bigger, J.T, Schwartz, P.J
Format: Article
Language:English
Subjects:
Autonomic Nervous System - physiopathology
Baroreflex - physiology
Baroreflex sensitivity
Biological and medical sciences
Cardiology. Vascular system
Coronary heart disease
Data Interpretation, Statistical
Female
Finapres
Heart
Humans
Male
Medical sciences
Middle Aged
myocardial infarction
Myocardial Infarction - physiopathology
Phenylephrine - administration & dosage
Predictive Value of Tests
Prognosis
Reproducibility of Results
risk stratification
Sensitivity and Specificity
Signal Processing, Computer-Assisted
Vasoconstrictor Agents - administration & dosage
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container_end_page 1529
container_issue 18
container_start_page 1522
container_title European heart journal
container_volume 21
creator Pinna, G.D
La Rovere, M.T
Maestri, R
Mortara, A
Bigger, J.T
Schwartz, P.J
description Aims The ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) study has proved the independent prognostic value of baroreflex sensitivity. A limitation of the traditional method of estimating baroreflex sensitivity by phenylephrine, is the need to monitor intra-arterial blood pressure. Our objective was to establish whether this invasive method of monitoring could be superseded by non-invasive methods, such as the Finapres device. Methods and Results Patients with three repeated invasive and non-invasive baroreflex sensitivity measurements were selected from the ATRAMI database (n=454). The mean of these measurements was taken as the baroreflex sensitivity estimate. The repeatability of both methods (standard deviation of the three measurements) decreased with increasing baroreflex sensitivity. There was no constant bias between invasive and non-invasive measurements (0·22±2·2ms.mmHg−1, P=0·42). The linear correlation was very high (r=0·91, P
doi_str_mv 10.1053/euhj.1999.1948
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Implications for studies on risk stratification after a myocardial infarction</title><source>Oxford Journals Online</source><creator>Pinna, G.D ; La Rovere, M.T ; Maestri, R ; Mortara, A ; Bigger, J.T ; Schwartz, P.J</creator><creatorcontrib>Pinna, G.D ; La Rovere, M.T ; Maestri, R ; Mortara, A ; Bigger, J.T ; Schwartz, P.J</creatorcontrib><description>Aims The ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) study has proved the independent prognostic value of baroreflex sensitivity. A limitation of the traditional method of estimating baroreflex sensitivity by phenylephrine, is the need to monitor intra-arterial blood pressure. Our objective was to establish whether this invasive method of monitoring could be superseded by non-invasive methods, such as the Finapres device. Methods and Results Patients with three repeated invasive and non-invasive baroreflex sensitivity measurements were selected from the ATRAMI database (n=454). The mean of these measurements was taken as the baroreflex sensitivity estimate. The repeatability of both methods (standard deviation of the three measurements) decreased with increasing baroreflex sensitivity. There was no constant bias between invasive and non-invasive measurements (0·22±2·2ms.mmHg−1, P=0·42). The linear correlation was very high (r=0·91, P&lt;0·01). The normalized 95% limits of agreement were −0·5 and 0·52. On survival analysis, invasive and non-invasive baroreflex sensitivity gave similar prognostic information (likelihood ratio: 155·6 (P=0·007) and 155·0 (P=0·006); risk ratio: 0·79 and 0·81, respectively). According to the ATRAMI cut-off points, 85% of patients were classified concordantly by the two methods. None of the patients at high (low) risk with the invasive method were classified as low (high) risk class by the non-invasive method. Conclusion Despite wide limits of agreement, invasive and non-invasive baroreflex sensitivity measurements are highly correlated and provide equivalent prognostic information.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1053/euhj.1999.1948</identifier><identifier>PMID: 10973766</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Autonomic Nervous System - physiopathology ; Baroreflex - physiology ; Baroreflex sensitivity ; Biological and medical sciences ; Cardiology. Vascular system ; Coronary heart disease ; Data Interpretation, Statistical ; Female ; Finapres ; Heart ; Humans ; Male ; Medical sciences ; Middle Aged ; myocardial infarction ; Myocardial Infarction - physiopathology ; Phenylephrine - administration &amp; dosage ; Predictive Value of Tests ; Prognosis ; Reproducibility of Results ; risk stratification ; Sensitivity and Specificity ; Signal Processing, Computer-Assisted ; Vasoconstrictor Agents - administration &amp; dosage</subject><ispartof>European heart journal, 2000-09, Vol.21 (18), p.1522-1529</ispartof><rights>2000 INIST-CNRS</rights><rights>Copyright 2000 The European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c398t-9e97e046102a85fc88174698c367e607403e73bb55d101bff9672ea1607a00a53</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=1470576$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10973766$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pinna, G.D</creatorcontrib><creatorcontrib>La Rovere, M.T</creatorcontrib><creatorcontrib>Maestri, R</creatorcontrib><creatorcontrib>Mortara, A</creatorcontrib><creatorcontrib>Bigger, J.T</creatorcontrib><creatorcontrib>Schwartz, P.J</creatorcontrib><title>Comparison between invasive and non-invasive measurements of baroreflex sensitivity. Implications for studies on risk stratification after a myocardial infarction</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Aims The ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) study has proved the independent prognostic value of baroreflex sensitivity. A limitation of the traditional method of estimating baroreflex sensitivity by phenylephrine, is the need to monitor intra-arterial blood pressure. Our objective was to establish whether this invasive method of monitoring could be superseded by non-invasive methods, such as the Finapres device. Methods and Results Patients with three repeated invasive and non-invasive baroreflex sensitivity measurements were selected from the ATRAMI database (n=454). The mean of these measurements was taken as the baroreflex sensitivity estimate. The repeatability of both methods (standard deviation of the three measurements) decreased with increasing baroreflex sensitivity. There was no constant bias between invasive and non-invasive measurements (0·22±2·2ms.mmHg−1, P=0·42). The linear correlation was very high (r=0·91, P&lt;0·01). The normalized 95% limits of agreement were −0·5 and 0·52. On survival analysis, invasive and non-invasive baroreflex sensitivity gave similar prognostic information (likelihood ratio: 155·6 (P=0·007) and 155·0 (P=0·006); risk ratio: 0·79 and 0·81, respectively). According to the ATRAMI cut-off points, 85% of patients were classified concordantly by the two methods. None of the patients at high (low) risk with the invasive method were classified as low (high) risk class by the non-invasive method. Conclusion Despite wide limits of agreement, invasive and non-invasive baroreflex sensitivity measurements are highly correlated and provide equivalent prognostic information.</description><subject>Autonomic Nervous System - physiopathology</subject><subject>Baroreflex - physiology</subject><subject>Baroreflex sensitivity</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Coronary heart disease</subject><subject>Data Interpretation, Statistical</subject><subject>Female</subject><subject>Finapres</subject><subject>Heart</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>myocardial infarction</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Phenylephrine - administration &amp; dosage</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Reproducibility of Results</subject><subject>risk stratification</subject><subject>Sensitivity and Specificity</subject><subject>Signal Processing, Computer-Assisted</subject><subject>Vasoconstrictor Agents - administration &amp; dosage</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><recordid>eNpNkUFvFCEUx4nR2LV69Wg4GG-zwswAw9Fsqm1SY2I0abyQN-wj0s7ACjNr9-v0k5bJbqoXCPx_7z3Ij5C3nK05E81HnH_frrnWuixt94ysuKjrSstWPCcrxrWopOxuzsirnG8ZY53k8iU540yrRkm5Ig-bOO4g-RwD7XH6ixioD3vIfo8UwpaGGKqnixEhzwlHDFOm0dEeUkzoBrynGUP2k9_76bCmV-Nu8BYmH0OmLiaap3nrsdQEWmbdlXMqqTsxFNyEiQIdD9FC2noYyiMcJLukr8kLB0PGN6f9nPz8fPFjc1ldf_tytfl0XdlGd1OlUStkreSshk4423VctVJ3tpEKJVMta1A1fS_EljPeO6elqhF4iYAxEM05-XDsu0vxz4x5MqPPFocBAsY5G1XXLRO6LeD6CNoUcy7_N7vkR0gHw5lZrJjFilmsmMVKKXh36jz3I27_w48aCvD-BEC2MLgEwfr8j2sVE2rBqiPm84T3TzGkOyNLI2Eub36ZrzVXm-LffG8eAZCJqOM</recordid><startdate>20000901</startdate><enddate>20000901</enddate><creator>Pinna, G.D</creator><creator>La Rovere, M.T</creator><creator>Maestri, R</creator><creator>Mortara, A</creator><creator>Bigger, J.T</creator><creator>Schwartz, P.J</creator><general>Oxford University Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20000901</creationdate><title>Comparison between invasive and non-invasive measurements of baroreflex sensitivity. Implications for studies on risk stratification after a myocardial infarction</title><author>Pinna, G.D ; La Rovere, M.T ; Maestri, R ; Mortara, A ; Bigger, J.T ; Schwartz, P.J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c398t-9e97e046102a85fc88174698c367e607403e73bb55d101bff9672ea1607a00a53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Autonomic Nervous System - physiopathology</topic><topic>Baroreflex - physiology</topic><topic>Baroreflex sensitivity</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Coronary heart disease</topic><topic>Data Interpretation, Statistical</topic><topic>Female</topic><topic>Finapres</topic><topic>Heart</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>myocardial infarction</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Phenylephrine - administration &amp; dosage</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Reproducibility of Results</topic><topic>risk stratification</topic><topic>Sensitivity and Specificity</topic><topic>Signal Processing, Computer-Assisted</topic><topic>Vasoconstrictor Agents - administration &amp; dosage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pinna, G.D</creatorcontrib><creatorcontrib>La Rovere, M.T</creatorcontrib><creatorcontrib>Maestri, R</creatorcontrib><creatorcontrib>Mortara, A</creatorcontrib><creatorcontrib>Bigger, J.T</creatorcontrib><creatorcontrib>Schwartz, P.J</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pinna, G.D</au><au>La Rovere, M.T</au><au>Maestri, R</au><au>Mortara, A</au><au>Bigger, J.T</au><au>Schwartz, P.J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison between invasive and non-invasive measurements of baroreflex sensitivity. Implications for studies on risk stratification after a myocardial infarction</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2000-09-01</date><risdate>2000</risdate><volume>21</volume><issue>18</issue><spage>1522</spage><epage>1529</epage><pages>1522-1529</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Aims The ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) study has proved the independent prognostic value of baroreflex sensitivity. A limitation of the traditional method of estimating baroreflex sensitivity by phenylephrine, is the need to monitor intra-arterial blood pressure. Our objective was to establish whether this invasive method of monitoring could be superseded by non-invasive methods, such as the Finapres device. Methods and Results Patients with three repeated invasive and non-invasive baroreflex sensitivity measurements were selected from the ATRAMI database (n=454). The mean of these measurements was taken as the baroreflex sensitivity estimate. The repeatability of both methods (standard deviation of the three measurements) decreased with increasing baroreflex sensitivity. There was no constant bias between invasive and non-invasive measurements (0·22±2·2ms.mmHg−1, P=0·42). The linear correlation was very high (r=0·91, P&lt;0·01). The normalized 95% limits of agreement were −0·5 and 0·52. On survival analysis, invasive and non-invasive baroreflex sensitivity gave similar prognostic information (likelihood ratio: 155·6 (P=0·007) and 155·0 (P=0·006); risk ratio: 0·79 and 0·81, respectively). According to the ATRAMI cut-off points, 85% of patients were classified concordantly by the two methods. None of the patients at high (low) risk with the invasive method were classified as low (high) risk class by the non-invasive method. Conclusion Despite wide limits of agreement, invasive and non-invasive baroreflex sensitivity measurements are highly correlated and provide equivalent prognostic information.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>10973766</pmid><doi>10.1053/euhj.1999.1948</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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ispartof European heart journal, 2000-09, Vol.21 (18), p.1522-1529
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1522-9645
language eng
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source Oxford Journals Online
subjects Autonomic Nervous System - physiopathology
Baroreflex - physiology
Baroreflex sensitivity
Biological and medical sciences
Cardiology. Vascular system
Coronary heart disease
Data Interpretation, Statistical
Female
Finapres
Heart
Humans
Male
Medical sciences
Middle Aged
myocardial infarction
Myocardial Infarction - physiopathology
Phenylephrine - administration & dosage
Predictive Value of Tests
Prognosis
Reproducibility of Results
risk stratification
Sensitivity and Specificity
Signal Processing, Computer-Assisted
Vasoconstrictor Agents - administration & dosage
title Comparison between invasive and non-invasive measurements of baroreflex sensitivity. Implications for studies on risk stratification after a myocardial infarction
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