Abstract 10459: Acute Hemodynamic Effects of Adaptive Servoventilation in Patients With Pre-Capillary and Post-Capillary Pulmonary Hypertension

Abstract

Introduction: Since recent data suggest an increased cardiovascular mortality associated with adaptive servoventilation therapy (ASV) in patients with heart failure with reduced ejection fraction and central sleep apnea there is major concern of whether to use this therapy in other diseases such as heart failure with preserved ejection fraction (HFpEF) or precapillary pulmonary Hypertension (PH). Hypothesis: This study therefore aimed to clarify acute hemodynamic effects of ASV in patients with HFpEF or PH. Methods: A series of clinically stable patients with pre- or post-capillary PH underwent ASV therapy (maximum pressure support 25 mmHg, minimum pressure support 15 mmHg) during right heart catheterization. Hemodynamics were measured at rest, at the end of a 15-minute episode of ASV therapy, and 15 minutes after ASV completion. Hemodynamic variables included heart rate, systemic blood pressure, right atrial pressure (RAP), mean pulmonary artery pressure (PAPm), pulmonary arterial wedge pressure (PAWP), cardiac output measured by thermodilution, and pulmonary vascular resistance (PVR). Results: The study enrolled 33 patients; 12 patients with post-capillary PH due to HFpEF, and 21 patients with pre-capillary PH due to pulmonary arterial hypertension (n=8) or chronic thromboembolic pulmonary hypertension (n=13). ASV was well tolerated by all patients and resulted in reductions in blood pressure, heart rate, PAPm (-5 mmHg, p <0.001) and PVR (-10%, p=0.01). Right and left filling pressure increased, while the cardiac output decreased (-0.4 L/min; p<0.001). The hemodynamic effects of ASV were almost identical in both patient populations. Conclusions: ASV has moderate hemodynamic effects in patients with HFpEF or PH of various origins, most importantly a consistent decline in PAPm and cardiac output. ASV was safe and well tolerated during this short-term study, but the observed drop in cardiac output may be of concern if this treatment is applied in patients with advanced HFpEF or PH with severely impaired right ventricular function.