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

Abstract

Background: Advanced chronic heart failure (ACHF), the final stage of cardiovascular disease, 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) is a non-invasive method for positive pressure ventilation that automatically adjusts inspiratory pressure support for each breath and set at the low level of end-expiratory pressure. ASV was initially developed to treat patients with sleep-disordered breathing (SDB). Recently, several studies have indicated its therapeutic effect for patients with heart failure. We investigated the acute hemodynamic effects of ASV in ACHF patients. Methods: We measured hemodynamic parameters using right cardiac catheterization before, and 20 minutes after initiation of ASV therapy in 13 ACHF patients (dilated cardiomyopathy n=10, dilated hypertrophic cardiomyopathy n=3 ; mean age 41.2 years; 10 males; NYHA functional class III n=2 or IV n=11). All met the European Society of Cardiology Criteria for Advanced Chronic Heart Failure and received optimal medical therapy for at least 1 month, with catecholamine given as necessary before ASV therapy. ASV was applied using a full-face mask at default pressure settings (EEP, 5 cmH2O; inspiratory pressure support, 3-10 cmH2O). Results and Discussion: The acute effect of ASV was shown in Table. Following initiation of ASV, heart rate and respiratory rate were significantly decreased, and SpO2 and SvO2 were significantly increased. And also, pulmonary artery pressure, pulmonary capillary wedge pressure (PCWP), SVR, and PVR were significantly decreased. These results indicate that ASV leads to stabilize respiratory patterns in patients with ACHF, and this stability of respiratory patterns might cause the decrement of the sympathetic nerve activity and provide hemodynamic changes including the decreasing of PCWP, SVR and PVR. Conclusion: Our findings suggest that ASV may provide beneficial effects on hemodynamics in patients with ACHF. (Table presented) .