Adjunctive Use of Noninvasive Ventilation During Exercise in Patients With Decompensated Heart Failure

Moraes, Igor Gutierrez; Kimoto, Karen; Fernandes, Marcos; Grams, Samantha Torres; Yamaguti, Wellington Pereira

doi:10.1016/j.amjcard.2016.10.025

Cited by 4 publications

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“…The increase in intrathoracic pressure with mechanical ventilation has a positive effect on LV function, [ 5 , 6 ] related to a decrease in LV afterload [ 7 , 8 ] and studies have reported positive effects of mechanical ventilation on heart in acute decompensated situation. [ 7 – 9 ] We found a positive relationship between HMV and LV systolic function, which is consistent with previous reports in patients with acute heart failure treated with mechanical ventilation. [ 12 , 17 ]…”

Section: Discussionsupporting

confidence: 91%

“…[ 5 , 6 ] In acute decompensated heart failure, applying of noninvasive ventilation relieves symptoms and improves heart performance. [ 7 – 9 ] Little is known about the evolution of cardiac function in patients requiring mechanical ventilation because of chronic respiratory failure in neuromuscular disorders. We aimed to analyze the natural history of cardiac function in patients with DMD and BMD (dystrophinopathies) on HMV.…”

Section: Introductionmentioning

confidence: 99%

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Natural history of cardiac function in Duchenne and Becker muscular dystrophies on home mechanical ventilation

et al. 2018

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Heart impairment is classical in dystrophinopathies and its management relies on medical drugs. Mechanical ventilation is used to treat respiratory failure, but can affect cardiac function. We aimed to investigate the natural history of cardiac function in patients with Duchenne (DMD) and Becker (BMD) muscular dystrophies on home mechanical ventilation (HMV).We reviewed the chart of DMD and BMD patients, followed in our institution, to obtain ventilation setting at HMV initiation and echocardiographic data at baseline and end follow up, as well as onset cardiac events and thoracic mechanical complication. We analyzed cumulative incidence of cardiac events as well as echocardiographic parameters evolution and its association with ventilation settings.We included 111 patients (101 DMD and 10 BMD). Median age was 21 years [18–26], median pulmonary vital capacity (VC) 15% of predicted [10–24]. All patients were on HMV and 46% ventilated using tracheostomy. After a median follow up of 6.3 years, we found a slight decrease of the left ventricular ejection fraction (LVEF) (45% at end follow up vs 50% at baseline P = .019) and a stabilization of the LV end diastolic diameter indexed (LVEDD indexed 29.4 mm/m2 vs 30.7 mm/m2 at end follow up, P = .17). Tidal volume (VT) level was inversely associated with the annual rate of the LVEF decline (r = −0.29, P = .025). Left atrium (LA) diameter decreased with mechanical ventilation (24 mm vs 20 mm, P = .039) and we found a reduction of systolic pulmonary pressure (35 mm Hg vs 25 mm Hg, P = .011). The cumulative incidence of cardiac events was 12.6%. Pneumothorax occurred in 4% of patients. Hypoxic arrest secondary to the presence of tracheal plugin occurred in 4% of patients with invasive ventilation.HMV is not harmful, decreases pulmonary pressure and may protect heart in dystrophinopathies, in addition with cardioprotective drugs. In patients with DMD and BMD on HMV, cumulative incidence of cardiac events remains moderate and incidence of pneumothorax is rare.

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