AimsSleep disordered breathing (SDB) may contribute to disease progression in patients with chronic heart failure (CHF). The objective of this observational study was to evaluate whether SDB is a risk factor for mortality in CHF patients and whether this risk can be attenuated by treatment with positive airway pressure (PAP). ) and (ii) evaluated the impact of PAP treatment on mortality in those with severe SDB. After accounting for significant confounding factors (age, NYHA class, cause of CHF, diabetes, and PAP treatment), patients with severe SDB (n ¼ 176) had a 2.0-fold increased hazard ratio for death compared with those without severe SDB [95% confidence interval (CI) 1.1 -3.5, P ¼ 0.023]. In an adjusted on-treatment analysis of the group with severe SDB, mortality was significantly less in patients using PAP (18%) compared with those with untreated SDB (52%; hazard ratio 0.4, 95% CI 0.2-0.6, P ¼ 0.001). Mortality in the PAP-treated group was lower compared with the untreated group at any time-point of the follow-up period. Methods and results We ConclusionThe presence of severe SDB in CHF patients constitutes a significantly increased risk for death, independent of established risk factors. In CHF patients with SDB, use of PAP therapy was associated with a decreased mortality rate at any time point of the follow-up, suggesting that PAP can be safely used in such patients.--

AimsPulmonary hypertension is a clinical syndrome characterized by a progressive increase in pulmonary vascular resistance leading to right ventricular failure and death. Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are key subgroups of this disorder with comparable clinical and pathological findings. Resting pulmonary haemodynamics correlate only moderately with functional parameters and do not predict prognosis in these patients sufficiently accurately. We therefore correlated exercise haemodynamics with peak oxygen uptake (peakVO 2 ) and determined their prognostic significance. Methods and resultsThirty-six consecutive patients (21 female, 54 + 15 years) with PAH (n ¼ 21) or inoperable CTEPH were studied. The mean follow-up period was 1709 + 837 days. All patients underwent right heart catheterization at rest and during exercise, and cardiopulmonary exercise testing. Patients had severe pulmonary hypertension at rest (mean pulmonary artery pressure 46 + 11 mmHg, cardiac index 2.2 + 0.6 L/min/m 2 , pulmonary vascular resistance 861 + 330 dynes/s/cm 5 ). Exercise cardiac index correlated with peakVO 2 (r ¼ 0.59, P , 0.001) and was the only independent predictor of peakVO 2 on multivariate stepwise linear regression analyses (P , 0.001). PeakVO 2 was the strongest predictor of survival (x 2 ¼ 14.5, P ¼ 0.003). Among haemodynamic variables, only exercise cardiac index (x 2 ¼ 5.6, P ¼ 0.018) and the slope of the pressure/flow relationship (x 2 ¼ 4.1, P ¼ 0.04) were significant prognostic indicators. ConclusionThe ability of the right ventricle to increase the cardiac index during exercise is an important determinant of exercise capacity in patients with pulmonary hypertension. It also predicts prognosis and might therefore be useful in the clinical assessment of these patients.--

No abstract

In patients with severe chronic hypercapnic COPD receiving NIV at high inspiratory pressure levels and showing high adherence to this therapy, long-term survival was significantly higher than in non-ventilated patients. Patients displaying more severe disease according to known risk factors seemed to benefit most from long-term NIV.

No abstract