Comparison of acute and chronic impact of adaptive servo‐ventilation on left chamber geometry and function in patients with chronic heart failure

Abstract

AimsThe aim of this study was to determine differences in the acute and chronic impact of adaptive servo-ventilation (ASV) on left chamber geometry and function in patients with chronic heart failure (CHF). Methods and resultsAn acute ASV study was performed to measure echocardiographic parameters before and 30 min after the initiation of ASV therapy in 30 CHF patients (mean age: 69 years, 23 male). The chronic effects of ASV therapy were also evaluated in 26 of these 30 patients over a mean follow-up period of 24 weeks. Patients were divided into two groups according to the status of ASV therapy [ASV group (n ¼ 15) and withdrawal group (n ¼ 11)]. In the acute study, heart rate and blood pressure were significantly decreased 30 min after the ASV therapy compared with baseline. Stroke volume and cardiac output were significantly increased in conjunction with a reduction in systemic vascular resistance. Multivariate regression analysis revealed baseline E/e ′ to be an independent predictor for absolute increase in cardiac output. In the chronic study, a significant reduction of left ventricular (LV)/left atrial (LA) volumes and the severity of mitral regurgitation (MR), and improved LV diastolic function parameters were noted in the ASV group. These beneficial effects were not observed in the withdrawal group. ConclusionThe acute beneficial impact of ASV is mainly associated with the reduction of afterload resulting in an increase in stroke volume and cardiac output. In contrast, chronic ASV therapy produces LV and LA reverse remodelling resulting in an improvement in LV function and the severity of MR in patients with CHF.--

Adaptive Servo-Ventilation Therapy Improves Long-Term Prognosis in Heart Failure Patients With Anemia and Sleep-Disordered Breathing

“…These effects lead to alleviation of pulmonary congestion and mitral regurgitation. 29,30) Moreover, ASV prevents CSA and unstable breathing, which might help reduce enhanced sympathetic nervous activity. 31) In our previous reports, even single night use of ASV showed improvements in cardiac function and the suppression of sympathetic nervous activity, 20) and in addition, the short-term use of ASV decreased plasma cystatin C and increased eGFR cystatin C levels, demonstrating the possibility that cardio-renal function was improved by ASV in CHF patients with SDB.…”

Right Ventricular Enlargement and Renal Function Are Associated With Smooth Introduction of Adaptive Servo-Ventilation Therapy in Chronic Heart Failure Patients

“…5,13) Major causes that worsen adherence to ASV therapy are considered to be the discomfort from the mask itself, or the discomfort due to PAP, especially during the phase of expiration. It has recently been shown that not SDB status such as AHI, obstructive sleep apnea index, and central sleep apnea index, but "impatience" followed by "economic reasons" are related to the discontinuation of ASV treatment.…”

“…It has been reported that ASV treatment improves cardiac function in CHF patients. [5][6][7][8][9] Although ASV therapy has beneficial effects on CHF, the intervention is frequently rejected by CHF patients because of unpleasant feelings from the mask or positive airway pressure (PAP). It remains unknown which patient characteristics influence the smooth introduction of ASV therapy.…”

Effective Treatment of Congestive Heart Failure Using Adaptive Servo-ventilation in an End-stage Renal Disease Patient on Hemodialysis

“…An increase in cardiac output when the PCWP is high in patients with HF is considered to be a favorable effect (2)(3)(4). Furthermore, it has been suggested that the positive intrathoracic pressure produced by ASV mechanically increases the output of a failing heart as follows: 1) ASV decreases excess preload by blocking venous return, 2) ASV decreases LV afterload by outwardly pressurizing the LV and 3) ASV decreases MR (5).…”