non-ASV Group Research Articles

Chronic Effects of Adaptive Servo-Ventilation Therapy on Mortality and the Urgent Rehospitalization Rate in Patients Experiencing Recurrent Admissions for Heart Failure - A Multicenter Prospective Observational Study (SAVIOR-L).

This study investigated whether the chronic use of adaptive servo-ventilation (ASV) reduces all-cause mortality and the rate of urgent rehospitalization in patients with heart failure (HF). This multicenter prospective observational study enrolled patients hospitalized for HF in Japan between 2019 and 2020 who were treated either with or without ASV therapy. Of 845 patients, 110 (13%) received chronic ASV at hospital discharge. The primary outcome was a composite of all-cause death and urgent rehospitalization for HF, and was observed in 272 patients over a 1-year follow-up. Following 1:3 sequential propensity score matching, 384 patients were included in the subsequent analysis. The median time to the primary outcome was significantly shorter in the ASV than in non-ASV group (19.7 vs. 34.4 weeks; P=0.013). In contrast, there was no significant difference in the all-cause mortality event-free rate between the 2 groups. Chronic use of ASV did not impact all-cause mortality in patients experiencing recurrent admissions for HF.

Adaptive servo ventilation for sleep apnoea in heart failure: the FACE study 3-month data

RationaleAdaptive servo ventilation (ASV) is contraindicated in patients with systolic heart failure (HF) who have a left ventricular ejection fraction (LVEF) below 45% and predominant central sleep apnoea (CSA). However,...

Adaptive Servo-ventilation Therapy Results in the Prevention of Arrhythmias in Patients with Heart Failure Due to Ischemic Heart Disease.

Objective Whether or not adaptive servo-ventilation (ASV) is effective in preventing arrhythmias in patients with heart failure (HF) due to ischemic heart disease (IHD) is unclear. This study estimated the effects of ASV therapy on arrhythmias in patients with HF due to IHD. Methods One hundred and forty-one consecutive hospitalized patients with HF due to IHD (mean age: 74.9±11.9 years old) were retrospectively assessed in this study. Of the 141 patients, 75 were treated with ASV (ASV group), and 66 were treated without ASV (Non-ASV group). We estimated the incidence of arrhythmias, including paroxysmal atrial fibrillation (PAF) and ventricular tachycardia (VT), during one-year follow-up in both groups using multivariable logistic regression models. Results Men accounted for 55.3% of the study population. There were no significant differences in the baseline clinical characteristic data between the ASV and Non-ASV groups with respect to age, sex, heart rate, risk factors, oral medication, or laboratory data, including the estimated glomerular filtration rate (eGFR), brain natriuretic peptide, and left ventricular ejection fraction. ASV therapy was associated with a reduced incidence of arrhythmia after adjusting for demographic and cardiovascular disease risk factors (odds ratio, 0.27; 95% confidence interval, 0.11 to 0.63; p<0.01; compared to the Non-ASV group). In addition, at the 1-year follow-up, an improvement (increase) in the eGFR was found in the ASV group but not in the Non-ASV group. Conclusion ASV therapy was able to prevent arrhythmias, including PAF and VT, with short-term improvements in the renal function in patients with HF due to IHD.

Adaptive servo-ventilation therapy improves cardiac sympathetic nerve activity, cardiac function, exercise capacity, and symptom in patients with chronic heart failure and Cheyne-Stokes respiration

PurposeAdaptive servo-ventilation (ASV) therapy has been reported to be effective for improving central sleep apnea (CSA) and chronic heart failure (CHF). The purpose of this study was to clarify whether ASV is effective for CSA, cardiac sympathetic nerve activity (CSNA), cardiac symptoms/function, and exercise capacity in CHF patients with CSA and Cheyne-Stokes respiration (CSR-CSA). MethodsIn this study, 31 CHF patients with CSR-CSA and a left ventricular ejection fraction (LVEF) ≤ 40% were randomized into an ASV group and a conservative therapy (non-ASV) group for 6 month. Nuclear imagings with 123I-Metaiodobenzylguanidine (MIBG) and 99mTc-Sestamibi were performed. Exercise capacity using a specific activity scale (SAS) and the New York Heart Association (NYHA) class were evaluated. CSNA was evaluated by 123I-MIBG imaging, with the delayed heart/mediastinum activity ratio (H/M), delayed total defect score (TDS), and washout rate (WR). ResultsThe ASV group had significantly better (P < .05) results than the non-ASV group with respect to the changes of AHI (−20.8 ± 14.6 vs −0.5 ± 8.1), TDS (−7.9 ± 4.3 vs 1.4 ± 6.0), and H/M(0.16 ± 0.16 vs −0.04 ± 0.10) on 123I-MIBG imaging, as well as the changes of LVEF (5.3 ± 3.9% vs 0.7 ± 32.6%), SAS (1.6 ± 1.4 vs 0.3 ± 0.7), and NYHA class (2.2 ± 0.4 vs 2.7 ± 0.5) after 6-month therapy. ConclusionsPerforming ASV for 6 months achieved improvement of CSR-CSA, CSNA, cardiac symptoms/function, and exercise capacity in CHF patients with CSR-CSA.

Adaptive servo-ventilation suppresses elevation of C-reactive protein and sympathetic activity in acute uncomplicated type B aortic dissection.

The aim of this prospective, randomized study was to investigate the effects of adaptive servo-ventilation (ASV), based on haemodynamic parameters, sympathetic status and respiratory conditions in patients with acute uncomplicated type B aortic dissection. We enrolled 28 patients with acute uncomplicated type B aortic dissection requiring antihypertensive therapies, who had been admitted within 24 h from onset. Study subjects were randomly assigned either to the ASV group (n = 14) or to the non-ASV group (n = 14). Antihypertensive therapy at an acute phase led to significant reduction in blood pressure in both groups. Heart rate significantly dropped in the ASV group. In the non-ASV group, noradrenaline (746 ± 343 to 912 ± 402 pg/ml, P = 0.033) and dopamine (30 ± 21 to 42 ± 28 pg/ml, P = 0.015) significantly increased at 1 h after admission. Low frequency/high frequency ratios significantly decreased in the ASV group (2.1 ± 1.6 to 1.7 ± 1.1, P = 0.045). During follow-up at the subacute period, pleural effusion significantly increased in the non-ASV group (649 ± 611 vs 190 ± 292%, P = 0.033). Peak C-reactive protein (CRP) had a significant positive correlation with pleural effusion volume (P = 0.039) and was significantly greater in the non-ASV group (15.5 ± 6.3 vs 8.5 ± 6.1 mg/dl, P= 0.009). In acute type B aortic dissection, ASV was considered to have suppressed the development of sympathetic nervous activity, pleural effusion and elevation of peak CRP.

Beneficial Effects of Short-Duration ASV Therapy on Albuminuria in Heart Failure Patients

BackgroundDaytime adaptive servo-ventilation (ASV) therapy can be effective for heart failure (HF) patients. Albuminuria is recognized as a prognostic marker for HF. We investigated whether short-duration daytime ASV therapy reduced albuminuria in HF patients.Methods and ResultsTwenty-one consecutive HF patients were divided into two groups: those who tolerated ASV therapy (ASV group, n = 14) and those who did not (non-ASV group, n = 7). ASV therapy was administered to enrolled patients for 1 week for 2 h per day (1 h in the morning and 1 h in the afternoon). The urinary albumin to creatinine ratio (UACR), urinary 24 h norepinephrine (NE) excretion, high-sensitivity C-reactive protein (hs-CRP), and plasma brain natriuretic peptide (BNP) levels were measured before and 1 week after ASV therapy. In the ASV group, but not the non-ASV group, the UACR significantly decreased, together with the decrease in urinary NE and hs-CRP levels. There were significant correlations between the changes in UACR and hs-CRP and between the changes in urinary NE and hs-CRP. Multiple linear regression analyses indicated that ASV use was the strongest predictor of decreased UACR.ConclusionAlbuminuria, urinary NE and hs-CRP levels reduced in HF patients who could receive short-duration and short-term ASV therapy. Anti-inflammatory effects of ASV therapy may partly mediate the reduction of albuminuria. BackgroundDaytime adaptive servo-ventilation (ASV) therapy can be effective for heart failure (HF) patients. Albuminuria is recognized as a prognostic marker for HF. We investigated whether short-duration daytime ASV therapy reduced albuminuria in HF patients. Daytime adaptive servo-ventilation (ASV) therapy can be effective for heart failure (HF) patients. Albuminuria is recognized as a prognostic marker for HF. We investigated whether short-duration daytime ASV therapy reduced albuminuria in HF patients. Methods and ResultsTwenty-one consecutive HF patients were divided into two groups: those who tolerated ASV therapy (ASV group, n = 14) and those who did not (non-ASV group, n = 7). ASV therapy was administered to enrolled patients for 1 week for 2 h per day (1 h in the morning and 1 h in the afternoon). The urinary albumin to creatinine ratio (UACR), urinary 24 h norepinephrine (NE) excretion, high-sensitivity C-reactive protein (hs-CRP), and plasma brain natriuretic peptide (BNP) levels were measured before and 1 week after ASV therapy. In the ASV group, but not the non-ASV group, the UACR significantly decreased, together with the decrease in urinary NE and hs-CRP levels. There were significant correlations between the changes in UACR and hs-CRP and between the changes in urinary NE and hs-CRP. Multiple linear regression analyses indicated that ASV use was the strongest predictor of decreased UACR. Twenty-one consecutive HF patients were divided into two groups: those who tolerated ASV therapy (ASV group, n = 14) and those who did not (non-ASV group, n = 7). ASV therapy was administered to enrolled patients for 1 week for 2 h per day (1 h in the morning and 1 h in the afternoon). The urinary albumin to creatinine ratio (UACR), urinary 24 h norepinephrine (NE) excretion, high-sensitivity C-reactive protein (hs-CRP), and plasma brain natriuretic peptide (BNP) levels were measured before and 1 week after ASV therapy. In the ASV group, but not the non-ASV group, the UACR significantly decreased, together with the decrease in urinary NE and hs-CRP levels. There were significant correlations between the changes in UACR and hs-CRP and between the changes in urinary NE and hs-CRP. Multiple linear regression analyses indicated that ASV use was the strongest predictor of decreased UACR. ConclusionAlbuminuria, urinary NE and hs-CRP levels reduced in HF patients who could receive short-duration and short-term ASV therapy. Anti-inflammatory effects of ASV therapy may partly mediate the reduction of albuminuria. Albuminuria, urinary NE and hs-CRP levels reduced in HF patients who could receive short-duration and short-term ASV therapy. Anti-inflammatory effects of ASV therapy may partly mediate the reduction of albuminuria.

Efficacy of cardiopulmonary rehabilitation with adaptive servo-ventilation in patients undergoing off-pump coronary artery bypass grafting.

Postoperative complications after cardiac surgery increase mortality. This study aimed to evaluate the efficacy of cardiopulmonary rehabilitation with adaptive servo-ventilation (ASV) in patients undergoing off-pump coronary artery bypass grafting (OPCAB). A total of 66 patients undergoing OPCAB were enrolled and divided into 2 groups according to the use of ASV (ASV group, 30 patients; non-ASV group, 36 patients). During the perioperative period, all patients undertook cardiopulmonary rehabilitation. ASV was used from postoperative day (POD) 1 to POD5. Hemodynamics showed a different pattern in the 2 groups. Blood pressure (BP) on POD6 in the ASV group was significantly lower than that in the non-ASV group (systolic BP, 112.9±12.6 vs. 126.2±15.8 mmHg, P=0.0006; diastolic BP, 62.3±9.1 vs. 67.6±9.3 mmHg, P=0.0277). The incidence of postoperative atrial fibrillation (POAF) was lower in the ASV group than in the non-ASV group (10% vs. 33%, P=0.0377). The duration of oxygen inhalation in the ASV group was significantly shorter than that in the non-ASV group (5.1±2.2 vs. 7.6±6.0 days, P=0.0238). The duration of postoperative hospitalization was significantly shorter in the ASV group than in the non-ASV group (23.5±6.6 vs. 29.0±13.1 days, P=0.0392). Cardiopulmonary rehabilitation with ASV after OPCAB reduces both POAF occurrence and the duration of hospitalization.

Impact of Adaptive Servo-ventilation on Cardiovascular Function and Prognosis in Patients with HFpEF and Sleep-disordered Breathing

Effective pharmacotherapy for HFpEF is still unclear. Sleep-disordered breathing (SDB) causes cardiovascular dysfunction causing factors of HFpEF. However, it remains unclear whether adaptive servo-ventilation (ASV) improves cardiovascular function and prognosis of patients with HFpEF and SDB. Thirty-six patients with HFpEF and moderate-severe SDB (LVEF 56.0%, apnea hypopnea index 36.5/h) were assigned to two groups: 18 patients treated with medications and ASV (ASV group) and 18 patients treated without ASV (Non-ASV group).

Beneficial effects of adaptive servo-ventilation therapy on albuminuria in patients with heart failure

BackgroundShort-duration adaptive servo-ventilation (ASV) therapy can be effective for heart failure (HF) patients. Albuminuria is recognized as a prognostic marker for HF. We investigated whether short-duration and short-term ASV therapy reduced albuminuria in HF patients. Methods and resultsTwenty-one consecutive HF patients were divided into two groups: those who tolerated ASV therapy (ASV group, n=14) and those who did not (non-ASV group, n=7). ASV therapy was administered to enrolled patients for 1 week for 2h per day (1h in the morning and 1h in the afternoon). The urinary albumin to creatinine ratio (UACR), urinary 24h norepinephrine (NE) excretion, high-sensitivity C-reactive protein (hs-CRP), and plasma brain natriuretic peptide (BNP) levels were measured before and 1 week after ASV therapy. In the ASV group, but not the non-ASV group, the UACR significantly decreased, together with a decrease in urinary NE and hs-CRP levels. There were significant correlations between the changes in UACR and hs-CRP and between the changes in urinary NE and hs-CRP. Multiple linear regression analyses indicated that ASV use was the strongest predictor of decreased UACR. ConclusionAlbuminuria, urinary NE, and hs-CRP levels reduced in HF patients who could receive short-duration and short-term ASV therapy. Anti-inflammatory effects of ASV therapy may partly mediate the reduction of albuminuria.

Adaptive servo-ventilation improves exercise oscillatory ventilation and ventilatory inefficiency in patients with heart failure and central sleep apnea

BackgroundAdaptive servo-ventilation (ASV) can improve ventilatory inefficiency and exercise oscillatory ventilation (EOV) in patients with heart failure (HF) and central sleep apnea (CSA). Although these improvements might originate from both increase in cardiac function and decrease in sympathetic nerve activity, mechanisms underlying the interrelationship remain unknown. MethodsWe compared cardiopulmonary exercise test, muscle sympathetic nerve activity (MSNA) and echocardiography findings at baseline and 3.5±0.8months (mean±SD) of follow-up in 28 patients with both HF (New York Heart Association functional class II and III; left ventricular ejection fraction (LVEF)<45%) and CSA (apnea–hypopnea index (AHI)≥15/h). Of these, 17 patients consented (ASV group) and 11 patients declined (non-ASV group) to undergo ASV treatment. Compliance with ASV and changes in AHI were determined from data collected by integral counters. ResultsVE/VCO2-slope and EOV amplitude at baseline were positively correlated with MSNA, but not with LVEF. ASV therapy reduced VE/VCO2-slope and EOV amplitude (both p<0.01) in association with decrease in MSNA (p<0.01) and increase in LVEF (p<0.001). In non-ASV group, however, these parameters remained unchanged. Change in VE/VCO2-slope was correlated with both change in AHI and average use of ASV. By contrast, change in EOV amplitude was correlated with change in AHI. Changes in VE/VCO2-slope and EOV amplitude were correlated with changes of MSNA (p<0.05), but not with those in LVEF. ConclusionsASV improves ventilatory inefficiency and EOV probably via suppression of CSA and its sympathoinhibitory effect.

Adaptive servo‐ventilation therapy improves cardiac sympathetic nerve activity in patients with heart failure

This study investigated whether abnormal cardiac sympathetic nerve activity (SNA) is associated with the severity of central sleep apnoea (CSA) and whether adaptive servo-ventilation (ASV) therapy can improve cardiac SNA in heart failure (HF) patients with predominant CSA. Overnight polysomnography was conducted to diagnose CSA. Cardiac SNA was analysed by [123I]metaiodobenzylguanidine scintigraphy in 26 consecutive HF patients with predominant CSA. Of the 26 patients, 10 agreed to ASV therapy. Cardiac SNA was analysed 6 months after initiating ASV based on a non-randomized protocol. The apnoea-hypopnoea index and central apnoea index were significantly correlated with the washout rate (WR) and a delayed heart to mediastinal (H/M) ratio, suggesting that SNA is associated with abnormal breathing patterns. The WR, H/M ratio, plasma BNP level, and LVEF were significantly improved (WR, 40.0 ± 11.6% vs. 34.6 ± 11.4%, P = 0.046; H/M ratio, 1.5 ± 0.1 vs.1.8 ± 0.3, P = 0.013; ln BNP, 5.4 ± 1.0 vs. 4.6 ± 1.2, P = 0.007; and LVEF, 43.8 ± 10.4% vs. 47.0 ± 10.6%, P < 0.001) in the ASV group patients, but not in the non-ASV group patients. Multiple linear regression analyses showed that a decreased WR was strongly associated with an increased LVEF (coefficient = -0.454, P = 0.013). Abnormal cardiac SNA could be significantly correlated with the severity of CSA in HF patients. ASV therapy might improve cardiac function in these patients by partially mediating cardiac SNA regulation.

Impact of adaptive servo‐ventilation on cardiovascular function and prognosis in heart failure patients with preserved left ventricular ejection fraction and sleep‐disordered breathing

Effective pharmacotherapy for heart failure with preserved left ventricular ejection fraction (HFpEF) is still unclear. Sleep-disordered breathing (SDB) causes cardiovascular dysfunction, giving rise to factors involved in HFpEF. However, it remains unclear whether adaptive servo-ventilation (ASV) improves cardiovascular function and long-term prognosis of patients with HFpEF and SDB. Thirty-six patients with HFpEF (LVEF >50%) and moderate to severe SDB (apnoea-hypopnoea index >15/h) were enrolled. Study subjects (LVEF 56.0%, apnoea-hypopnoea index 36.5/h) were randomly assigned to two groups: 18 patients treated with medications and ASV (ASV group) and 18 patients not treated with ASV (non-ASV group). NYHA class, cardiac function including LVEF, left atrial volume index (LAVI), E/E', vascular function including flow-mediated dilatation (FMD) and cardio-ankle vascular index (CAVI), and levels of BNP and troponin T were determined at baseline and 6 months later. Patients were followed to register cardiac events after enrolment (follow-up 543 days). ASV therapy improved cardiac diastolic function and decreased CAVI and BNP (NYHA class, 2.3 to 1.5; LAVI, 48.6 to 42.6 mL/m(2); E/E', 12.8 to 7.1; CAVI, 9.0 to 7.7; BNP, 121.5 to 58.1 pg/mL, P < 0.0125, respectively). LVEF, FMD, and troponin T did not change significantly in either group. Importantly, the event-free rate was significantly higher in the ASV group than in the non-ASV group (94.4% vs. 61.1%, log-rank P < 0.05). ASV may improve the prognosis of HFpEF patients with SDB, with favourable effects such as improvement of symptoms, cardiac diastolic function, and arterial stiffness. ASV may be a useful therapeutic tool for HFpEF patients with SDB.

Adaptive Servoventilation Improves Cardiorenal Function and Prognosis in Heart Failure Patients With Chronic Kidney Disease and Sleep-Disordered Breathing

BackgroundChronic kidney disease (CKD) and sleep-disordered breathing (SDB) play critical roles in the progression of chronic heart failure (CHF). However, it still remains unclear whether adaptive servoventilation (ASV) improves cardiorenal function and the prognosis of CHF patients with CKD and SDB. Methods and ResultsEighty CHF patients with CKD (estimated glomerular filtration rate of <60 mL min−1 1.73 cm−2) and SDB (apnea-hypopnea index >15/h) were enrolled and divided into 2 groups: 36 patients were treated with usual care plus ASV (ASV group) and 44 patients were treated with usual care alone (Non-ASV group). Levels of B-type natriuretic peptide, glomerular filtration rate, cystatin C, C-reactive protein, noradrenaline, and left ventricular ejection fraction were measured before treatment and 6 months after treatment. Patients were followed to register cardiac events occurring after enrollment. Six months of ASV therapy reduced levels of B-type natriuretic peptide, cystatin C, C-reactive protein, and noradrenaline and improved the glomerular filtration rate and ejection fraction (all P < .05). However, none of these parameters changed in the Non-ASV group. Thirty-two events (14 deaths and 18 rehospitalizations) occurred during the follow-up period (mean 513 days). Importantly, the event-free rate was significantly higher in the ASV group than in the Non-ASV group (77.8% vs 45.5%; log rank P < .01). ConclusionsASV improves the prognosis of CHF patients with CKD and SDB, with favorable effects such as the improvement of cardiorenal function and attenuation of inflammation and sympathetic nervous activity.

Effect of Adaptive Servoventilation on Muscle Sympathetic Nerve Activity in Patients With Chronic Heart Failure and Central Sleep Apnea

BackgroundAdaptive servoventilation (ASV) improves cardiac function and sympathetic nerve activity in patients with heart failure (HF). However, the mechanisms underlying these improvements remain obscure. Methods and ResultsWe compared muscle sympathetic nerve activity (MSNA) and cardiorespiratory polygraphy and echocardiography findings at baseline and at 3.5 ± 0.8 months’ follow-up in 32 patients with HF (New York Heart Association functional class II or III; ejection fraction <45%) and central sleep apnea (CSA; apnea-hypopnea index [AHI] ≥15/h) who consented (n = 20; ASV group) or declined (n = 12; non-ASV group) to undergo ASV treatment. Compliance with ASV and changes in AHI were determined from data collected by integral counters in devices and from cardiorespiratory polygraphic findings, respectively. Ejection fraction and MSNA significantly changed in the ASV (both P < .001) but not the non-ASV group. Although changes in AHI and MSNA correlated, the average use of ASV did not. In contrast, changes in AHI and the average use of ASV were independent predictors of changes in ejection fraction (both P < .01). ConclusionsASV decreases MSNA and improves cardiac function in association with suppression of CSA in patients with HF.

Adaptive servo ventilation improves Cheyne-Stokes respiration, cardiac function, and prognosis in chronic heart failure patients with cardiac resynchronization therapy

Cheyne-Stokes respiration (CSR-CSA) is often observed in patients with chronic heart failure (CHF). Although cardiac resynchronization therapy (CRT) is effective for CHF patients with left ventricular dyssynchrony, it is still unclear whether adaptive servo ventilation (ASV) improves cardiac function and prognosis of CHF patients with CSR-CSA after CRT. Twenty two patients with CHF and CSR-CSA after CRT defibrillator (CRTD) implantation were enrolled in the present study and randomly assigned into two groups: 11 patients treated with ASV (ASV group) and 11 patients treated without ASV (non-ASV group). Measurement of plasma B-type natriuretic peptide (BNP) levels (before 3, and 6 months later) and echocardiography (before and 6 months) were performed in each group. Patients were followed up to register cardiac events (cardiac death and re-hospitalization) after discharge. In the ASV group, indices for apnea-hypopnea, central apnea, and oxyhemoglobin saturation were improved on ASV. BNP levels, cardiac systolic and diastolic function were improved with ASV treatment for 6 months. Importantly, the event-free rate was significantly higher in the ASV group than in the non-ASV group. ASV improves CSR-CSA, cardiac function, and prognosis in CHF patients with CRTD. Patients with CSR-CSA and post CRTD implantation would get benefits by treatment with ASV.

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

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&lt;0.05) and E/E' (16.5±6.5 vs. 9.2±4.1, P&lt;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&lt;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.

Impact of Adaptive Servo-Ventilation on Functional Mitral Regurgitation in Patients with Heart Failure

Background: Although adaptive servo-ventilation (ASV) produces chronic improvement of left ventricular ejection fraction (LVEF) in patients with heart failure (HF), its impact on functional mitral regurgitation (FMR) has not been clarified. Methods: To investigate the effects of ASV on FMR, we measured left ventricle (LV)/atrial (LA) volumes, sphericity index (SI), and vena contracta width (VCW) in 20 HF patients at baseline and 3 months after ASV therapy. Patients were divided into two groups [continuous ASV therapy group (n=12) and withdrawal group (n=8, non-ASV group)].

Effects of Implementing Adaptive Support Ventilation in a Medical Intensive Care Unit

Adaptive support ventilation (ASV) facilitates ventilator liberation in postoperative patients in surgical intensive care units (ICU). Whether ASV has similar benefits in patients with acute respiratory failure is unclear. We conducted a pilot study in a medical ICU that manages approximately 600 mechanically ventilated patients a year. The ICU has one respiratory therapist who manages ventilators twice during the day shift (8:00 am to 5:00 pm). No on-site respiratory therapist was present at night. We prospectively enrolled 79 patients mechanically ventilated for ≥ 24 hours on pressure support of ≥ 15 cm H(2)O, with or without synchronized intermittent mandatory ventilation, F(IO(2)) ≤ 50%, and PEEP ≤ 8 cm H(2)O. We switched the ventilation mode to ASV starting at a "%MinVol" setting of 80-100%. We defined spontaneous breathing trial (SBT) readiness as a frequency/tidal-volume ratio of < 105 (breaths/min)/L on pressure support of ≤ 8 cm H(2)O and PEEP of ≤ 5 cm H(2)O for at least 2 h, and all spontaneous breaths. The T-piece SBT was considered successful if the frequency/tidal-volume ratio remained below 105 (breaths/min)/L for 30 min, and we extubated after successful SBT. The control group consisted of 70 patients managed with conventional ventilation modes and a ventilator protocol during a 6-month period immediately before the ASV study period. Extubation was attempted in 73% of the patients in the ASV group, and 80% of the patients in the non-ASV group. The re-intubation rates in the ASV and non-ASV groups were 5% and 7%, respectively. In the ASV group, 20% of the patients achieved extubation readiness within 1 day, compared to 4% in the non-ASV group (P = <.001). The median time from the enrollment to extubation readiness was 1 day for the ASV group and 3 days for the non-ASV group (P = .055). Patients switched to ASV were more likely to be liberated from mechanical ventilation at 3 weeks (P = .04). Multiple logistic regression analysis showed that, of the independent factors in the model, only ASV was associated with shorter time to extubation readiness (P = .048 via likelihood ratio test). Extubation readiness may not be recognized in a timely manner in at least 15% of patients recovering from respiratory failure. ASV helps to identify these patients and may improve their weaning outcomes.

Adaptive Servo Ventilation Improves Cardiac Dysfunction and Prognosis in Chronic Heart Failure Patients With Cheyne-Stokes Respiration

Cheyne-Stokes respiration (CSR) is often observed in patients with chronic heart failure (CHF). Although adaptive servo ventilation (ASV) is effective for CSR, it remains unclear whether ASV improves the cardiac function and prognosis of patients with CHF and CSR.Sixty patients with CHF and CSR (mean left ventricular ejection fraction 38.7%, mean apnea hypopnea index 36.8 times/hour, mean central apnea index 19.1 times/hour) were enrolled in this study. Patients were divided into two groups: 23 patients treated with ASV (ASV group) and 37 patients treated without ASV (Non-ASV group). Measurement of plasma B-type natriuretic peptide (BNP) levels and echocardiography were performed before, 3 and 6 months after treatments in each group. Patients were followed-up for cardiac events (cardiac death and re-hospitalization) after discharge. In the ASV group, NYHA functional class, BNP levels, cardiac systolic and diastolic function were significantly improved with ASV treatment for 6 months. In contrast, none of these parameters changed in the Non-ASV group. Importantly, Kaplan-Meier analysis clearly demonstrated that the event-free rate was significantly higher in the ASV group than in the Non-ASV group.Adaptive servo ventilation improves cardiac function and prognosis in patients with chronic heart failure and Cheyne-Stokes respiration.

Adaptive Servo Ventilation Improves Cardiac Function and Prognosis in Heart Failure Patients With Cheyne-Stokes Respiration

Background: It still remains unclear whether adaptive servo ventilation (ASV) improves cardiac function and prognosis of patients with heart failure (HF) and Cheyne-Stokes respiration (CSR). Methods: Sixty patients with HF and CSR (LVEF 38.7%, apnea hypopnea index 36.8 times/hr) were enrolled in this study: 23 patients treated with conventional medications for HF and ASV (ASV group) and 37 patients treated without ASV (Non-ASV group). BNP and LVEF were measured before and 6 months after treatment. Patients were followed for cardiac events after discharge. Results: In ASV group, BNP (P<0.01) and LVEF (P<0.01) significantly improved after 6 months. In contrast, these parameters did not change in Non-ASV group. Event free rate was significantly higher in ASV group (P<0.01). Conclusions: ASV improved cardiac function and prognosis in patients with HF and CSR.