Abstract 17996: Treatment of Sleep-Disordered Breathing and Cardiac Remodeling in Heart Failure With Reduced Ejection Fraction: Insights From the CAT-HF Trial
Introduction: Sleep-disordered breathing (SDB) is a marker of poor prognosis in heart failure and may worsen cardiac dysfunction over time.
Hypothesis: Adaptive servo-ventilation (ASV) treatment of SDB will reverse pathologic cardiac remodeling in heart failure with reduced ejection fraction (HFrEF).
Methods: The Cardiovascular Improvements with Minute Ventilation-targeted Adaptive Servo-Ventilation Therapy in Heart Failure (CAT-HF) trial randomized patients with acute decompensated heart failure and confirmed SDB to either optimal medical therapy (OMT) or treatment with ASV plus OMT. Echocardiograms, performed at baseline and 6 months, evaluated indexed left ventricular (LV) volumes, ejection fraction (EF), E/e’, right ventricular systolic pressure (RVSP) and RV function (TAPSE). Differences between treatment groups were assessed using Wilcoxon rank sum tests.
Results: The CAT-HF trial was stopped early in response to results of the SERVE-HF trial, which found an increased mortality in patients with chronic HFrEF and predominant central sleep apnea who were treated with ASV. Of the 126 patients that were randomized in CAT-HF prior to trial cessation, 102 patients (52 OMT + ASV; 50 OMT alone) had HFrEF. Baseline echocardiographic characteristics were similar between treatment groups. Both treatment groups demonstrated a decrease in LV end-systolic volume index (LVESVI), -10ml in the ASV group and -9ml in OMT alone. Similarly, both groups had an increase in EF: +4% and +5%, respectively. However, there was no difference in LVESVI or EF between treatment groups at 6 months (p=0.39 and p=0.71, respectively) (Figure). There was also a reduction in E/e’ but this did not significantly differ between treatment groups (p=0.49). There was no significant change in RVSP or RV function in either treatment group.
Conclusions: Among HFrEF patients with SDB, there was evidence of reverse LV remodeling regardless of whether patients received OMT with ASV or OMT alone.
Author Disclosures: M. Daubert: Other Research Support; Modest; ResMed Corp. O. Oldenberg: Other Research Support; Modest; ResMed Corp. Consultant/Advisory Board; Modest; ResMed Corp. D. Whellan: Research Grant; Significant; New Haven Pharmaceuticals. Other Research Support; Significant; ResMed Corp. Consultant/Advisory Board; Modest; ResMed Corp. G. Tasissa: None. H. Woehrle: Employment; Significant; ResMed Corp, Trial Sponsor. N. Punjabi: Consultant/Advisory Board; Modest; ResMed Corp. K. Anstrom: Research Grant; Significant; National Institute of Health, Merck, Bayer, AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Company, Boehringer Ingelheim, Pulmonary Fibrosis Foundation, Medtronic. Consultant/Advisory Board; Modest; Abbott Vascular, AstraZeneca, Bristol-Meyers Squibb, Gilead, Janssen, Pfizer, GlaxoSmithKline. Other; Modest; Data monitoring committee for National Institute of Health, Data monitoring committee for Forest, Data monitoring committee for Pfizer, Data monitoring committee for GlaxoSmithKline. A. Blase: Employment; Significant; ResMed Corp, Trial Sponsor. A. Benjafield: Employment; Significant; ResMed Corp, Trial Sponsor. J. Lindenfeld: Consultant/Advisory Board; Modest; ResMed Corp. M. Fiuzat: Other Research Support; Modest; ResMed Corp. C. O’Connor: Other Research Support; Modest; ResMed Corp.
- © 2016 by American Heart Association, Inc.