Causal linear parametric model for baroreflex gain assessment in patients with recent myocardial infarction

Abstract

Spectral and cross-spectral analysis of R-R interval and systolic arterial pressure (SAP) spontaneous fluctuations have been proposed for noninvasive evaluation of baroreflex sensitivity (BRS). However, results are not in good agreement with clinical measurements. In this study, a bivariate parametric autoregressive model with exogenous input (ARXAR model), able to divide the R-R variability into SAP-related and -unrelated parts, was used to quantify the gain (αARXAR) of the baroreflex regulatory mechanism. For performance assessing, two traditional noninvasive methods based on frequency domain analysis [spectral, baroreflex gain by autogressive model (αAR); cross-spectral, baroreflex gain by bivariate autoregressive model (α2AR)] and one based on the time domain [baroreflex gain by sequence analysis (αSEQ)] were considered and compared with the baroreflex gain by phenylephrine test (αPHE). The BRS evaluation was performed on 30 patients (61 ± 10 yr) with recent (10 ± 3 days) myocardial infarction. The ARXAR model allowed dividing the R-R variability (950 ± 1,099 ms2) into SAP-related (256 ± 418 ms2) and SAP-unrelated (694 ± 728 ms2) parts. αAR (12.2 ± 6.1 ms/mmHg) and α2AR (8.9 ± 5.6 ms/mmHg) as well as αSEQ (12.6 ± 7.1 ms/mmHg) overestimated BRS assessed by αPHE (6.4 ± 4.7 ms/mmHg), whereas the ARXAR index gave a comparable value (αARXAR = 5.4 ± 3.3 ms/mmHg). All noninvasive methods were significantly correlated to αPHE (αARXAR and αSEQ were more correlated than the other indexes). Thus the baroreflex gain obtained describing the causal dependence of R-R interval on SAP showed a good agreement with αPHE and may provide additional information regarding the gain estimation in the frequency domain.