Adaptive Servo-Ventilation Treatment Increases Stroke Volume in Stable Systolic Heart Failure Patients With Low Tricuspid Annular Plane Systolic Excursion

Abstract

SummaryWe hypothesized that the effects of adaptive servo-ventilation (ASV) therapy were influenced by right-sided heart performance. This study aimed to clarify the interaction between the effects of ASV and right-sided heart performance in patients with stable heart failure (HF) with reduced ejection fraction (HFrEF).Twenty-six stable HF inpatients (left ventricular ejection fraction < 0.45, without moderate to severe mitral regurgitation (MR) were analyzed. Echocardiography was performed before and after 30 minutes of ASV. ASV increased stroke volume index (SVI) in 14 patients (30.0 ± 11.9 to 41.1 ± 16.1 mL/m 2 ) and reduced SVI in 12 patients (36.0 ± 10.1 to 31.9 ± 12.2 mL/m 2 ). Multivariate linear regression analysis revealed that tricuspid annular plane systolic excursion (TAPSE) before ASV was an independent association factor for (SV during ASV -SV before ASV)/LVEDV × 100 (%) (%ΔSV/LVEDV). ROC analysis of TAPSE for %ΔSV/LVEDV > 0 showed that the cut-off point was 16.5 mm. All patients were divided into 2 groups according to the TAPSE value. Although no significant differences were found in the baseline characteristics and blood tests, there were significant differences in tricuspid lateral annular systolic velocity, TAPSE, right atrial area, and right ventricular (RV) area before ASV between patients with TAPSE ≤ 16.5 mm and those with TAPSE > 16.5 mm. Interestingly, ASV reduced RV area and increased TAPSE in patients with TAPSE ≤ 16.5 mm, while it reduced TAPSE in those > 16.5 mm.ASV therapy has the potential to increase SVI in stable HFrEF patients with low TAPSE. (Int Heart J 2017; 58: 393-399)

Right Heart is a Key to Response to Adaptive Servo-Ventilation Therapy

“…3) As a functional index, reduced tricuspid annular plane systolic excursion was associated with an increase in systolic volume during ASV support. 4) The authors hypothesized that improvement in RV function due to the unloading of preload on the RV also improved left ventricular diastolic performance via a rightleft heart morphological interaction. As a pressure index, our team reported that an elevated baseline RV enddiastolic pressure was a key to increase CO during ASV support.…”

What is the Optimal Strategy for Adaptive Servo-Ventilation Therapy?

“…12) These acute effects are observed during 10-30 minute ASV support. [12][13][14][15] Such effect reduces volume and pressure loads in the left ventricular (LV) cavity, which facilitates LV reverse remodeling, accompanied by decrease in plasma level of B-type natriuretic peptide (BNP) and E/e', recovery of the degree of mitral regurgitation, improvement in LV ejection fraction (LVEF), and reduction in LV volume after several months of ASV support. 13,[16][17][18][19][20] Not only the hemodynamic stabilization but also the stabilization of respiratory pattern results in the suppression of sympathetic nerve activity.…”

“…37) The lower tricuspid annular plane systolic excursion and enlarged RV cavity were reported as predictors of improvement in CO during ASV support. 15,36) Both parameters indicate RV dysfunction, which was improved following an increase in CO during ASV support. The authors speculated the mechanism as follows: the recovery of RV dysfunction during ASV support also improves LV diastolic dysfunction and increases CO via a geometric shift in the interventricular septum.…”