Chronic Baroreflex Activation: A Potential Therapeutic Approach to Heart Failure With Preserved Ejection Fraction

Abstract Heart failure with preserved ejection fraction (HFpEF) is a substantial public health issue, equal in magnitude to heart failure with reduced ejection fraction. Clinical outcomes of HFpEF patients are generally poor, related annual accrual of health care expenses amount to billions of dolla...

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Bibliographic Details
Published in:Journal of cardiac failure 2011-02, Vol.17 (2), p.167-178
Main Authors: Georgakopoulos, Dimitrios, PhD, Little, William C., MD, Abraham, William T., MD, Weaver, Fred A., MD, Zile, Michael R., MD
Format: Article
Language:English
Subjects:
Autonomic Nervous System
Baroreceptors
Baroreflex - physiology
Cardiac Pacing, Artificial
Cardiovascular
Carotid Sinus - innervation
Chronic Disease
Electric Stimulation
electrical stimulation
Heart Failure - therapy
Humans
hypertrophy
Hypertrophy, Left Ventricular - prevention & control
Renin-Angiotensin System
Stroke Volume
Time Factors
Ventricular Function, Left
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Summary:Abstract Heart failure with preserved ejection fraction (HFpEF) is a substantial public health issue, equal in magnitude to heart failure with reduced ejection fraction. Clinical outcomes of HFpEF patients are generally poor, related annual accrual of health care expenses amount to billions of dollars, and no therapy has been shown to be effective in randomized clinical trials. Baroreflex activation therapy (BAT) produced by stimulating the carotid sinuses using an implanted device (Rheos) is being studied for the treatment of hypertension, the primary comorbidity of HFpEF. Other potential benefits include regression of left ventricular hypertrophy, normalization of the sympathovagal balance, inhibition of the renin-angiotensin-aldosterone system, arterio- and venodilation, and preservation of renal function. This paper reviews the evidence suggesting that BAT may be a promising therapy for HFpEF and introduces the HOPE4HF trial (ClinicalTrials.gov Identifier: NCT00957073), a randomized outcomes trial designed to evaluate the clinical safety and efficacy of BAT in the HFpEF population.
ISSN:1071-9164
1532-8414
DOI:10.1016/j.cardfail.2010.09.004