Potential for Use of Non Invasive Lung Ventilation in Patients With Decompensated Chronic Heart Failure

Abstract

This open controlled single centre study was designed to evaluate efficacy of non invasive lung ventilation (NIV) in patients with decompensated chronic heart failure (DCHF). Inclusion criteria were inpatient DCHF complicating ischaemic heart disease (IHD) or dilated cardiomyopathy (DCM); the ejection fraction of the left ventricle (EFLV) < 35 %, NYHA functional classes III-IV, age > 40 years, increase in dyspnea during pre vious 7 days. The study involved 33 patients (22 males and 11 females, mean age, 58.94 ± 9.76 years; EFLV, 28.84 ± 5.47 %). The patients were randomized into 2 groups: the 1 st group (n = 22) was treated with the conventional therapy (inhibitors of angiotensin converting enzyme, nitrates, digoxin, diuretics, statins) and NIV (BiPAP or CPAP, 6-8 h / day). The 2 nd group (n = 11) received medications only. The 1 st group patients demonstrated more remarkable improvements in dyspnea, heart beat rate, breathing rate and lung function compared to the 2 nd group patients (p < 0.01). Treatment with HIV increased EFLV, reduced the LV size, decreased blood levels of BNP (p = 0.015), IL 6 (p = 0.015) and CRP (p = 0.006). In the control group, there were no significant changes in central haemodynamics, lung function, BNP concentration or systemic inflammation markers to the 10-14 th days of therapy. NIV was well tolerated; no serious adverse event was recorded during the study. Therefore, NIV could greatly improve dyspnea, central haemodynamics, lung function, and LV dysfunction and reduce systemic inflammation in patients with DCHF.