Acute effects of adaptive servo-ventilation on hemodynamics in advanced chronic heart failure patients

Abstract

Background: Advanced chronic heart failure (ACHF) is related to high mortality and poor prognosis. In ACHF patients, systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) are often elevated. Adaptive servo-ventilation (ASV) was initially developed to treat patients with sleep-disordered breathing. However, recent studies have speculated its therapeutic effect for patients with heart failure. Methods: We measured hemodynamic parameters using right cardiac catheter ization before and 20 minutes after initiation of ASV therapy (EEP, 5 cmH2O; in-spiratory pressure support, 3-10 cmH2O) in 10 ACHF patients (DCM n=8, dHCM n=2; mean age 42.1 years). All met the European Society of Cardiology Criteria(Table presented) for Advanced Chronic Heart Failure and received optimal medical therapy for at least 1 month, with catecholamine given as necessary. Results: See Table 1. Conclusion: Our findings suggest that respiratory patterns in the present ACHF patients were stabilized by ASV. The continuous positive airway pressure obtained led to an increase in intra-thoracic pressure, which reduces left ventricular afterload and unloads the inspiratory muscles. These changes may provide hemodynamic advantages to ACHF patients by decreasing SVR and PVR from decremented sympathetic nerve activity.