title: Impact of adaptive servo-ventilation on cardiovascular function and prognosis in heart failure patients with preserved left ventricular ejection fraction and sleep-disordered breathing.
abstract: OBJECTIVE
  Effective pharmacotherapy for heart failure with preserved left ventricular ejection fraction (HFpEF) is still unclear. Sleep-disordered breathing (SDB) causes cardiovascular dysfunction, giving rise to factors involved in HFpEF. However, it remains unclear whether adaptive servo-ventilation (ASV) improves cardiovascular function and long-term prognosis of patients with HFpEF and SDB.
  
  
  RESULTS
  Thirty-six patients with HFpEF (LVEF >50%) and moderate to severe SDB (apnoea-hypopnoea index >15/h) were enrolled. Study subjects (LVEF 56.0%, apnoea-hypopnoea index 36.5/h) were randomly assigned to two groups: 18 patients treated with medications and ASV (ASV group) and 18 patients not treated with ASV (non-ASV group). NYHA class, cardiac function including LVEF, left atrial volume index (LAVI), E/E', vascular function including flow-mediated dilatation (FMD) and cardio-ankle vascular index (CAVI), and levels of BNP and troponin T were determined at baseline and 6 months later. Patients were followed to register cardiac events after enrolment (follow-up 543 days). ASV therapy improved cardiac diastolic function and decreased CAVI and BNP (NYHA class, 2.3 to 1.5; LAVI, 48.6 to 42.6 mL/m(2); E/E', 12.8 to 7.1; CAVI, 9.0 to 7.7; BNP, 121.5 to 58.1 pg/mL, P < 0.0125, respectively). LVEF, FMD, and troponin T did not change significantly in either group. Importantly, the event-free rate was significantly higher in the ASV group than in the non-ASV group (94.4% vs. 61.1%, log-rank P < 0.05).
  
  
  CONCLUSIONS
  ASV may improve the prognosis of HFpEF patients with SDB, with favourable effects such as improvement of symptoms, cardiac diastolic function, and arterial stiffness. ASV may be a useful therapeutic tool for HFpEF patients with SDB.
authors.affiliation: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan. yoshihis@fmu.ac.jp
authors.forename: Akiomi
authors.initials: A
authors.lastname: Yoshihisa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Yamaki
authors.forename: Koichi
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kunii
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakazato
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Suzuki
authors.forename: Shu-ichi
authors.initials: S
authors.lastname: Saitoh
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Takeishi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D017286:Polysomnography / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012891:Sleep Apnea Syndromes / Q000503:physiopathology* / Q000628:therapy; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
chemical_list: D020107:Troponin T; D020097:Natriuretic Peptide, Brain