To assess relations between Valsalva- and phenylephrine test-derived measures and outcome in reduced ejection fraction heart failure (HFrEF) patients receiving comprehensive neurohormonal blockade pharmacotherapy.
Data from 56 HFrEF patients (LVEF: 32±6%; mean±SD) subjected to Valsalva and phenylephrine tests were analyzed retrospectively. Baroreflex-related (Valsalva-ratio [cBRS] and BP-RRI slope from phase IV [cBRS]) and non-baroreflex-related measures (systolic BP rise in phase IV [ΔSBP], and pulse-amplitude-ratio [PAR]) were calculated from Valsalva. Short-term outcome (HF-related hospitalization, ICD shock or all-cause death within 24-months from examination) and long-term outcome (ICD shock or all-cause death within 60-months) were analyzed.
The endpoint occurred in 16 and 18 patients, for short- and long-term outcome, respectively. Low ΔSBP identified patients at risk in long-term perspective, as evidenced by low- vs. high ΔSBP comparison (square-wave response patients assigned to low ΔSBP group, P=0.002), and Cox model (HR: 0.91, CI: 0.86-0.96, P<0.001), and tended to identify patients at risk in short-term outcome (HR: 0.95, CI: 0.91-1.00, P=0.055). There was a tendency towards higher event-free survival in low-PAR group (low vs. high PAR; HR: 0.44, CI: 0.17-1.18, P=0.104).
Non-baroreflex-related measures obtained from Valsalva: ΔSBP and PAR, might carry prognostic value in HFrEF patients receiving neurohormonal blockade pharmacotherapy.

Copyright © 2021. Published by Elsevier Inc.