Abstract 8506: Adaptive Servo Ventilation Improves Cardiac Function and Prognosis in Chronic Heart Failure Patients with Cheyne-stokes Respiration After Cardiac Resynchronization Therapy

Abstract

Backgrounds: Cheyne-Stokes respiration (CSR) is frequently observed in chronic heart failure (CHF) patients and is associated with adverse prognosis. Although it has been reported that cardiac resynchronization therapy (CRT) partly improves CSR, CSR often persists after CRT implantation. Therefore, we examined whether adaptive servo ventilation (ASV) improves cardiac function and prognosis of CHF patients with CSR after CRT. Methods: Polysomnography was performed at 12 months after CRT defibrillator (CRTD) implantation. Twenty two patients with CSR post CRTD implantation (mean age 62.0 years, AHI 36.3±19.2 /h) were enrolled in this study and randomly assigned into 2 groups: 11 patients treated with ASV (ASV group) and 11 patients without ASV (Non-ASV group). Plasma B-type natriuretic peptide (BNP) levels, estimated right ventricular systolic pressure (RVPs), and the ratio of early transmitral flow velocity to mitral annular velocity (E/E') were determined before and 6 months later in each group. Patients were followed up to register cardiac events (cardiac deaths and rehospitalization due to worsening heart failure). Results: In ASV group, indices for apnea-hypopnea, central apnea, and oxyhemoglobin saturation were improved on ASV. Levels of plasma BNP (Figure A), RVPs (38.1±16.8 vs. 27.4±18.4 mmHg, P<0.05) and E/E' (16.5±6.5 vs. 9.2±4.1, P<0.01) were improved with ASV treatment for 6 months, but not in Non-ASV group. Importantly, event free rate was significantly higher in ASV group than in Non-ASV group (91% vs. 45%, P<0.05) as shown in Figure B. Conclusions: ASV improved CSR, cardiac overload, diastolic function, and prognoisis of CHF patients with CRTD. CHF patients with CSR and post CRTD implantation would get benefits by treatment with ASV.