Abstract 12327: Non-Invasive Positive Airway Pressure Improves Mortality in Heart Failure Patients With Preserved Left Ventricular Ejection Fraction and Sleep-Disordered Breathing
Background: It has been recognized that the prevalence of patients with preserved left ventricular ejection fraction (LVEF) is relatively high in heart failure. Clinical characteristics are different between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). However, post-discharge mortality risk in HFpEF is similarly high with HFrEF, and effective pharmaco-therapy for HFpEF is still unclear. Management of comorbidities such as sleep disordered breathing (SDB) may have an overall significant prognostic impact on HFpEF. However, it still remains unclear whether the use of positive airway pressure (PAP) device including continuous positive airway pressure (CPAP) and adaptive servo ventilation (ASV) improve long-term prognosis of patients with HFpEF and SDB.
Methods: One hundred and nine patients with HFpEF (LVEF of > 50%) and moderate-severe SDB (apnea hypopnea index (AHI) > 15 /h) were enrolled. Study subjects (mean LVEF 59.5%, mean AHI 28.1 /h, median BNP 308.1 pg/ml) were divided into two groups: 30 patients treated with conventional medications for HF and PAP (PAP group: CPAP, n=13 and ASV, n=17), and 79 patients with medications alone (Non-PAP group). Patients were followed to register cardiac and all-cause death after enrollment (average follow up period 826 days).
Results: Mean age, blood pressure, pulse rate, LVEF, renal function, and plasma BNP levels were not different between PAP and Non-PAP groups at baseline. In Kaplan-Meier analysis, event free rate from all cause death was significantly higher in PAP group than in Non-PAP group (0% vs. 17.7%, logrank P<0.05). Event free rate from cardiac death tended to be higher in PAP group than in Non-PAP group (0% vs. 11.1%, logrank P=0.08)
Conclusions: PAP could improve long-term all cause mortality in HFpEF and SDB.
Author Disclosures: S. Suzuki: None. A. Yoshihisa: None. S. Miura: None. M. Takiguchi: None. T. Shimizu: None. S. Abe: None. K. Sugimoto: None. T. Yamaki: None. H. Kunii: None. K. Nakazato: None. H. Suzuki: None. S. Saitoh: None. Y. Takeishi: None.
- © 2014 by American Heart Association, Inc.