Abstract 14184: Brain Natriuretic Peptide and Integrated Area of Desaturation Index are Pretherapeutic Factors to Predict the Efficacy of Adaptive Servo Ventilation Therapy in Patients With Heart Failure
Introduction: Previously, we reported that brain natriuretic peptide (BNP) and integrated area of desaturation (IAD) index, which is new measurement for assessing the severity of sleep apnea, which is obtained by integrating nocturnal desaturation area are major predictor of fatal cardiovascular events in patients with heart failure (HF) after adaptive servo ventilation (ASV) therapy. Our aim is to predict the prognosis for patients with HF according to 4 subsets classification using BNP and IAD index before ASV therapy.
Method: After medical therapy was optimized, a total of 89 consecutive HF patients (70 ± 11years; 62 male patients) were initiated ASV therapy for HF treatment, and classified into 4 subsets based on BNP (cut-off value: 500 pg/ml) and IAD index (cut-off value: 50 %sec/min) before ASV therapy. A group of patients showing BNP <500 pg/ml and IAD index ≧50 %sec/min was designated as subset I, showing BNP ≧500 pg/ml and IAD index ≧50 %sec/min was designated as subset II, showing BNP <500 pg/ml and IAD index <50 %sec/min was designated as subset III, and showing BNP ≧500 pg/ml and IAD index <50 %sec/min was designated as subset IV.
Results: Twenty-seven patients (30.3%) were classified into subset II (BNP ≧500 pg/ml and IAD index ≧50 %sec/min). Compared with other subsets, there were no significant differences between the 4 groups respect to age and gender, but left ventricular ejection fraction showed significant difference (subset I; 50.8 ± 14.5%, subset II; 32.1 ± 13.0%, subset III; 46.6 ± 20.4%, subset IV;40.3 ± 17.2%, p = 0.0005). After two-year follow up, fatal cardiovascular events including death from progressive of HF, cardioembolic stroke, and fatal cardiac arrhythmias showed significantly higher in subset II (subset I; 11.1% subset II; 47.1%, subset III; 6.5%, subset IV; 42.9%, p = 0.001) (Figure).
Conclusions: Our results suggest that BNP and IAD index are pretherapeutic factors how much patients suffer from fatal cardiovascular events before ASV therapy.
- © 2013 by American Heart Association, Inc.