Long-Term Adaptive Servo-Ventilator Treatment Prevents Cardiac Death and Improves Clinical Outcome

Abstract

SummaryAdaptive servo-ventilation (ASV) is a recently developed, noninvasive therapeutic tool for the treatment of heart failure (HF). However, the efficacy of ASV therapy in patients with advanced HF remains uncertain, especially as regards its contribution to freedom from cardiac replacement therapy. A total of 85 patients with advanced HF (New York Heart Association [NYHA] class IV 71%, inotrope infusion-dependent 34%) refractory to guideline-directed medical therapy, received ASV therapy, irrespective of sleep-disordered breathing, at our institute between 2008 and 2014. Among these 85 patients, 46 continued ASV therapy for > 1 month (continued group), whereas 39 discontinued the therapy after < 1 month because of intolerance (discontinued group). There were no significant differences in baseline variables between the two groups. Heart rate indicating sympathetic activity, left ventricular (LV) reverse remodeling assessed by LV diastolic diameter, LV ejection fraction, and the grades of mitral and tricuspid regurgitations, HF severity assessed by NYHA class and plasma level of B-type natriuretic peptide, and end-organ dysfunction, improved significantly at 6 months following the initiation of ASV therapy (P < 0.05 for all). All-cause mortality and cardiac death rate were significantly lower during 2-year follow up in the continued group (P < 0.05 for both). In conclusion, ASV is a novel therapeutic tool prior to cardiac replacement therapy in patients with advanced HF and may prolong the period until cardiac replacement therapy becomes necessary. (Int Heart J 2016; 57: 47-52)

Shorter Heart Failure Duration Is a Predictor of Left Ventricular Reverse Remodeling During Adaptive Servo-Ventilator Treatment in Patients With Advanced Heart Failure

“…We previously demonstrated higher cardiac deathfree survival during ASV therapy compared with the control group. 19) Continuous ASV therapy improves survival in patients with advanced HF irrespective of responsiveness to ASV therapy, and may ameliorate patient quality of life, especially in the responders to ASV therapy.…”

“…[5][6][7][8][9][10][11][12][13] We recently reported that ASV therapy improved the clinical course compared with the discontinued group in patients with advanced HF. 19) However, there are few reports discussing the responsiveness to ASV therapy. 7) In this study, 26% were responders, whose LVEF improved > 5% at 6 months.…”

“…19) These favorable effects remain and avoid the worsening of congestive HF as well as readmission due to cardiovascular events.…”

Impact of Compound Hypertonic Saline Solution on Decompensated Heart Failure

“…Our study showed that heart failure patients will not only develop chest tightness, shortness of breath, palpitations, fatigue, and other symptoms, but may also experience poor appetite, poor sleep, and bad moods. [21][22][23] Past research has demonstrated that a long-term low salt diet can help patients with heart failure to recover. 9,24,25) However, we found that a normal salt intake was more beneficial than a low salt diet for patients with heart failure.…”

Optimization of pressure settings during adaptive servo-ventilation support using real-time heart rate variability assessment: initial case report

“…This therapy could decrease preload and afterload, ameliorate impaired sympathetic nerve activity and increase cardiac output, eventually facilitating left ventricular reverse remodeling and improving prognosis during short- or mid-term study periods [2–8]. ASV therapy was originally developed for treating sleep-disordered breathing (SDB) but is currently being adopted for treating decompensated heart failure, irrespective of the existence of SDB [9].…”