Abstract 10932: Adaptive Servo Ventilation Improves Long-term Prognosis in Heart Failure Patients With Preserved Left Ventricular Ejection Fraction and Sleep Disordered Breathing
Background: Effective pharmaco-therapy for heart failure (HF) with preserved left ventricular ejection fraction (LVEF) is still unclear. Sleep disordered breathing (SDB) may cause cardiac diastolic dysfunction. A high prevalence of SDB has been documented in HF patients with preserved LVEF. Adaptive servo ventilation (ASV) improves SDB including Cheyne-Stokes respiration. However, it still remains unclear whether ASV improves cardiac function and long-term prognosis of HF patients with preserved LVEF and SDB.
Methods: Thirty eight HF patients with preserved LVEF (defined as LVEF of > 45%) and moderate-severe SDB (defined as apnea hypopnea index > 15 /h) were enrolled. Study subjects (mean LVEF 55.2 ± 8.0%, mean apnea hypopnea index 38.7 ± 13.7 /h) were divided into two groups: 14 patients treated with conventional medications for HF and ASV (ASV group) and 24 patients treated with conventional medications alone (Non-ASV group). BNP, LVEF, right ventricular systolic pressure (RVPs), ratio of early transmitral flow velocity to mitral annular velocity (E/E'), and systolic blood pressure (SBP) were determined before and 6 months after treatments. Patients were followed to register cardiac events after discharge (average follow up period 576 days).
Results: Although LVEF did not improve in both groups, BNP, RVPs, E/E', and SBP significantly reduced in ASV group (BNP: 208.7 ± 106.3 to 106.0 ± 53.5 pg/ml, RVPs: 56.5 ± 35.6 to 36.3 ± 14.4 mmHg, E/E': 11.5 ± 6.7 to 8.0 ± 2.8, SBP: 120.3 ± 13.6 to 111.6 ± 18.7 mmHg, P<0.05, respectively), but not in Non-ASV group. Eight events (death 4, re-hospitalization 5) ocurred in this follow up period. Importantly, event free rate was significantly higher in ASV group than in Non-ASV group (92.9% vs. 66.7%, logrank P<0.05).
Conclusions: ASV decreased cardiac overload and improved long-term prognosis in HF patients with preserved LVEF and SDB. ASV might be a promissing useful tool for HF patients with preserved LVEF and SDB. .
- © 2012 by American Heart Association, Inc.