Left Ventricular Response to Continuous Positive Airway Pressure: Role of Left Ventricular Geometry

Abstract

Background: Continuous positive airway pressure (CPAP) may be a useful adjunct in patients with congestive heart failure. Objectives: To evaluate the relationship between left ventricular geometry and hemodynamic response to CPAP. Methods: Right heart catheter studies were performed in 26 patients before, during and after application of CPAP (8 cm H₂O) over 15 min. Response to therapy was defined as an increase in stroke volume using CPAP. Results: Cardiac output decreased from 6.9 ± 1.9 to 6.2 ± 1.4 liters/min (p = 0.01) with a slight increase after cessation of CPAP (not significant). There was no significant change in stroke volume (92 ± 34 vs. 90 ± 31 ml, p = 0.584) or pulmonary capillary wedge pressure (14.7 ± 7.0 vs. 14.2 ± 6.5 mm Hg, p = 0.26). There was a correlation between hemodynamic effects of CPAP therapy and left ventricular end-diastolic volume (r = 0.515, p = 0.01), mass-volume ratio (r = –0.41, p = 0.04) and pulmonary capillary wedge pressure (r = 0.654, p = 0.001) at baseline. Half the patients (n = 13) were categorized as responders with an average increase in stroke volume of 11.5 ± 2.1%. Responders showed significantly higher left ventricular end-diastolic volume, pulmonary capillary wedge pressure and lower mass-volume ratio. Conclusion: Patients with high pulmonary capillary wedge pressure, elevated end-diastolic volumes and a low left ventricular mass-volume ratio might profit from CPAP therapy.

Effects of Auto-Servo Ventilation on Patients with Sleep-Disordered Breathing, Stable Systolic Heart Failure and Concomitant Diastolic Dysfunction: Subanalysis of a Randomized Controlled Trial

“…On the one hand, this is congruent with previous findings, which also did not reveal a significant effect of an SDB-specific therapy on LVEF in HF patients [17,39] but, on the other hand, it contrasts with studies reporting a positive effect on systolic function [16,36,38,40,41,42,43]. For instance, Bradley et al [40] described a rather moderate but significant gain of systolic function (LVEF 2.2 ± 5.4 vs. 0.4 ± 5.3%, p = 0.02) in their study evaluating CPAP versus no CPAP in 258 HF patients with central sleep apnea.…”

Acute haemodynamic effects of continuous positive airway pressure in awake patients with heart failure

“…In addition, there are conflicting results of CPAP on the acute effects on CO in awake CHF patients. In CHF patients with increased pulmonary capillary wedge pressures, both an increase and a decrease in CO by CPAP application were observed . In CHF patients with normal pulmonary wedge pressure, application of CPAP consistently causes a drop of CO .…”

“…In CHF patients with increased pulmonary capillary wedge pressures, both an increase and a decrease in CO by CPAP application were observed . In CHF patients with normal pulmonary wedge pressure, application of CPAP consistently causes a drop of CO . In a study of 61 CHF patients with SDB, a significant drop in blood pressure (BP) without change of heart rate (HR) was observed when fixed PAP (CPAP, bi‐level PAP or adaptive servoventilation) was applied during the daytime .…”

Acute and Chronic Effects of Noninvasive Ventilation on Left and Right Myocardial Function in Patients with Obstructive Sleep Apnea Syndrome: A Speckle Tracking Echocardiographic Study

“…12 Tricuspid annular plane systolic excursion (TAPSE) was used as an index of RV longitudinal systolic function by placing an M-mode cursor through the tricuspid annulus and measuring the amount of longitudinal motion of the annulus at peak systole (in mm) in the standard apical four-chamber view. 13 Right atrial (RA) measurements were assessed in the apical four-chamber view. Maximum RA diameter was defined from the mid-level of the RA free wall to the interatrial septum.…”