Impact of adaptive servo‐ventilation on cardiovascular function and prognosis in heart failure patients with preserved left ventricular ejection fraction and sleep‐disordered breathing

Abstract

AimsEffective 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 longterm prognosis of patients with HFpEF and SDB. Methods and resultsThirty-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 flowmediated 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). ConclusionASV 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.--

Association between sleep‐disordered breathing and arterial stiffness in heart failure patients with reduced or preserved ejection fraction

“…Additionally, meta‐analysis has demonstrated that continuous positive airway pressure improves aortic stiffness in patients with OSA 40. We previously reported that the reduction of all‐cause mortality in HFpEF patients with SDB after positive airway pressure treatment might be partly due to improvement of aortic stiffness 41, 42. Thus, it is possible to speculate that SDB management using positive airway pressure improves the prognosis of HFpEF patients via a decrease in arterial stiffness, which is one of the important mechanisms underlying HFpEF, as we reported in our previous study.…”

A Long-Term Prognosis of Adaptive Servo Ventilation Therapy for Patients with Heart Failure -Consideration in Severity of Sleep-Disordered Breathing-

“…18 Furthermore, Yoshihisa et al reported that ASV therapy improved the long-term prognosis of patients with chronic HF and CSR for about 3 years, and that of patients with HF, preserved LVEF, and SDB for about 4 years. 10,19 Similar research also suggested that ASV therapy could improve the prognosis of patients with HF and comorbid chronic kidney disease and SDB. 20 However, the present report differs from those reports 10,[18][19][20] in that we evaluated the relationship between longterm prognosis and SDB severity.…”

“…10,19 Similar research also suggested that ASV therapy could improve the prognosis of patients with HF and comorbid chronic kidney disease and SDB. 20 However, the present report differs from those reports 10,[18][19][20] in that we evaluated the relationship between longterm prognosis and SDB severity. Indeed, we found improved long-term prognosis regardless of SDB severity in a larger cohort (n = 61) than previously reported.…”

“…Furthermore, many reports showed that the ASV therapy for the patients with HF was effective. 5,7,9,10,11,[18][19][20][21][22] Although it is well known that the prognosis of patients is negatively correlated with the severity of SDB, 12 little has been reported on the long-term prognosis in patients with HF after initiating ASV therapy. Earlier, we showed that ASV therapy was effective for patients with HF and that it improved their prognosis after one year.…”

Heart failure and sleep disordered breathing

“…Several studies suggest that ASV is more effective than CPAP, bi -level pressure support ventilation, or increased dead space in alleviating CSA 36 -39) . We demonstrated that ASV improves not only left ventricular systolic 40 -42) and diastolic function 43) , but also pulmonary function 27) , renal function 44) , vascular function 43) , as well as prognosis in HF patients with reduced or preserved EF 27,40 -44) . Recent meta -analyses on ASV in HF patients with CSA suggested an overall improvement in CSA, as well as improvements in LVEF, diastolic dimensions and function, 6 -min walk test distance, plasma natriuretic peptide concentration, and sympathetic activity 2,45) .…”