Impact of Adaptive Servo-Ventilation on Cardiovascular Function and Prognosis in Heart Failure Patients With Preserved Left Ventricular Ejection Fraction and Sleep-Disordered Breathing

Eur J Heart Fail. 2013 May;15(5):543-50. doi: 10.1093/eurjhf/hfs197. Epub 2012 Dec 18.

Abstract

Aims: Effective pharmacotherapy for heart failure with preserved left ventricular ejection fraction (HFpEF) is still unclear. Sleep-disordered breathing (SDB) causes cardiovascular dysfunction, giving rise to factors involved in HFpEF. However, it remains unclear whether adaptive servo-ventilation (ASV) improves cardiovascular function and long-term prognosis of patients with HFpEF and SDB.

Methods and results: Thirty-six patients with HFpEF (LVEF >50%) and moderate to severe SDB (apnoea-hypopnoea index >15/h) were enrolled. Study subjects (LVEF 56.0%, apnoea-hypopnoea index 36.5/h) were randomly assigned to two groups: 18 patients treated with medications and ASV (ASV group) and 18 patients not treated with ASV (non-ASV group). NYHA class, cardiac function including LVEF, left atrial volume index (LAVI), E/E', vascular function including flow-mediated dilatation (FMD) and cardio-ankle vascular index (CAVI), and levels of BNP and troponin T were determined at baseline and 6 months later. Patients were followed to register cardiac events after enrolment (follow-up 543 days). ASV therapy improved cardiac diastolic function and decreased CAVI and BNP (NYHA class, 2.3 to 1.5; LAVI, 48.6 to 42.6 mL/m(2); E/E', 12.8 to 7.1; CAVI, 9.0 to 7.7; BNP, 121.5 to 58.1 pg/mL, P < 0.0125, respectively). LVEF, FMD, and troponin T did not change significantly in either group. Importantly, the event-free rate was significantly higher in the ASV group than in the non-ASV group (94.4% vs. 61.1%, log-rank P < 0.05).

Conclusion: ASV may improve the prognosis of HFpEF patients with SDB, with favourable effects such as improvement of symptoms, cardiac diastolic function, and arterial stiffness. ASV may be a useful therapeutic tool for HFpEF patients with SDB.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Heart Failure / physiopathology*
  • Heart Failure / therapy
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Polysomnography / statistics & numerical data
  • Prognosis
  • Prospective Studies
  • Respiration, Artificial / methods*
  • Sleep Apnea Syndromes / physiopathology*
  • Sleep Apnea Syndromes / therapy
  • Stroke Volume / physiology*
  • Treatment Outcome
  • Troponin T / blood

Substances

  • Troponin T
  • Natriuretic Peptide, Brain