Abstract 10597: Acute Hemodynamic Effects of Adaptive Servo-Ventilation in Patients with Chronic Left Heart Failure
Background: Adaptive servo-ventilation (ASV) involves monitoring of respiratory rate and airflow with each breath, thereby providing appropriately timed ventilation support. The acute hemodynamic effects of ASV in patients with chronic left heart failure have not been well investigated. Therefore, we investigated these effects by using right heart catheterization (RHC).
Methods: We performed RHC for 20 patients with chronic left heart failure (mean age: 64 ± 17 years; men, 12; women, 8). Fourteen patients had reduced ejection fraction (HFrEF) and 6 had preserved ejection fraction (HFpEF). After the patients were stabilized in a supine position for 20 min under room air conditions, their baseline hemodynamic measurements were determined. Subsequently, they received ASV therapy for 20 min. The ASV system (AutoSet CS; ResMed, Sydney, Australia) was used with a default setting and a facemask. We evaluated the RHC data before and after ASV.
Results: The visual analog scale (VAS) score and heart rate significantly decreased (p < 0.05 for both) after ASV therapy. ASV therapy significantly decreased mean pulmonary artery pressure (PAP) (p < 0.001) and pulmonary capillary wedge pressure (PCWP) (p < 0.01) without changing the pulmonary vascular resistance index in patients with HFrEF and those with HFpEF. Patients with pulmonary hypertension showed significantly greater improvement in VAS, PAP, and PCWP after ASV therapy than those without pulmonary hypertension (p < 0.05 for all). ASV therapy decreased aortic blood pressure (p < 0.05) without changing the systemic vascular resistance index. Furthermore, it decreased cardiac output but did not change mixed venous oxygen saturation, suggesting decreased oxygen demand in peripheral tissue.
Conclusion: ASV therapy improves symptoms and hemodynamics by decreasing oxygen demand and preload by physiological support and positive airway support, respectively, in patients with chronic heart failure, regardless of HFrEF and HFpEF.
- © 2012 by American Heart Association, Inc.