The Prevalence of Asymptomatic Reduction of Left Ventricular Apical Wall Motion in Patients With Long-term Right Ventricular Apical Pacing

Abstract

Background and purpose: Emerging clinical data has shown that adaptive servo ventilation (ASV) can improve cardiac function in patients with chronic heart failure (CHF) accompanied by sleep disordered breathing (SDB). However, the underlying mechanisms remain unknown. CHF with SDB is thought of as a state of chronic inflammation caused by repetitive hypoxic stress. This study is designed to test the hypothesis that ASV attenuates inflammatory response and improves cardiac functions and clinical states. Methods and Results: Thirty hospital inpatients with NYHA II or III underwent polysomnography. Positive correlation was shown between apnea hypopnea index and hs-CRP levels (r 50.539, p 5 0.025). Inpatients were divided into two groups as ASV- (n 520) and Non-ASV-group (n 5 10), and hs-CRP and CHF parameters were measured before-and-after ASV treatment. Improvement of NYHA class was observed all in ASV-group but none in Non-ASV-group. In contrast to Non-ASV-group, B-type natriuretic peptide in ASV-group was significantly decreased from 212.3 6181.3 to 77.4 6 54.1 pg/ml, (p 50.04). Ejection fraction was improved in ASV-group from 43.4 6 6.4 to 53.3 6 6.0% (p 50.002), but not in Non-ASV-group. A decrease in hs-CRP was evident in ASV-group (0.85 60.59 to 0.21 6 0.18 mg/d, p 5 0.008) but not in Non-ASV-group. The increase in ejection fraction correlated with a decrease in CRP levels (r 5-0.725, p 50.001). Conclusion: ASV improves cardiac functions and clinical states in CHF patients with SDB through anti-inflammatory action.