Abstract
Adaptive servo-ventilation (ASV) therapy using an innovative ventilator—originally developed to treat sleep-disordered breathing (SDB)—is a novel modality of noninvasive positive pressure ventilation and is gaining acceptance among Japanese cardiologists in expectation of its applicability to treat patients with chronic heart failure (CHF) based on its acute beneficial hemodynamic effects. We conducted a multicenter, retrospective, real-world observational study in 115 Japanese patients with CHF, who had undergone home ASV therapy for the first time from January through December 2009, to examine their profile and the effects on their symptoms and hemodynamics. Medical records were used to investigate New York Heart Association (NYHA) class, echocardiographic parameters including left ventricular ejection fraction (LVEF), cardiothoracic ratio (CTR), brain natriuretic peptide (BNP), and other variables. Most of the patients were categorized to NYHA classes II (44.4 %) and III (40.7 %). SDB severity was not determined in 44 patients, and SDB was not detected or was mild in 27 patients. In at least 71 patients (61.7 %), therefore, ASV therapy was not applied for the treatment of SDB. CHF was more severe, i.e., greater NYHA class, lower LVEF, and higher CTR, in 87 ASV-continued patients (75.7 %) than in 28 ASV-discontinued patients (24.3 %). However, SDB severity was not related to continuity of ASV. The combined proportion of NYHA classes III and IV (P = 0.012) and LVEF (P = 0.009) improved significantly after ASV therapy. CTR and BNP did not improve significantly after ASV therapy but showed significant beneficial changes in their time-course analysis (P < 0.05, respectively). Improvements in LVEF and NYHA class after ASV therapy were not influenced by SDB severity at onset. The present study suggests that ASV therapy would improve the symptoms and hemodynamics of CHF patients, regardless of SDB severity. A randomized clinical study to verify these effects is warranted.
Highlights
Chronic heart failure (CHF) is the end-stage pathology of all heart diseases [1], and pharmacotherapy is the first-lineHeart Vessels (2015) 30:805–817 therapy for patients with chronic heart failure (CHF)
The ventilator used for adaptive servo-ventilation (ASV), a form of Noninvasive positive pressure ventilation (NPPV), offers superior tolerability and simple operability based on the provision of support pressure; the device was originally developed to treat sleep-disordered breathing (SDB) [16] and is synchronized to the respiration patterns of individual patients through its original algorithm and potentially allows for the application of home Adaptive servo-ventilation (ASV) therapy to the treatment of CHF patients
The proportions of patients were 40.9 % (47/115) to 73.9 % (85/115), who were analyzed for seven investigation items: vital signs [body weight, pulse rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP)], echocardiography, brain natriuretic peptide (BNP), renal function test, symptoms of CHF, chest X-ray, and hematology
Summary
Chronic heart failure (CHF) is the end-stage pathology of all heart diseases [1], and pharmacotherapy is the first-lineHeart Vessels (2015) 30:805–817 therapy for patients with CHF. Noninvasive positive pressure ventilation (NPPV) has been shown to improve pulmonary congestion of patients with acute heart failure (AHF) and in the acute exacerbation of CHF through the following hemodynamic actions: re-opening of collapsed alveoli, prevention of small airway obstruction, enlargement of lung volume, improvements in oxygenation and lung compliance [9,10,11,12,13,14,15], amelioration of left ventricular afterload through a reduction in transmural pressure induced by positive intrathoracic pressure [13, 14], and relief of left ventricular preload through a reduction in venous return [10, 15] Based on these acute beneficial effects of NPPV, cardiologists had been aware of the potential applicability of NPPV to the treatment of CHF patients. B coefficient for the logistic regression equation to predict the dependent variable from the independent variable, SE standard error around the coefficient, df degree of freedom for Wald v2 test, Exp(B) exponentiation of the B coefficient, an odds ratio, LVEF left ventricular ejection fraction, AHI apnea–hypopnea index, CI confidence interval, CKD chronic kidney disease a Wald v2 statistic b A value of P \ 0.05 was considered statistically significant df
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