Acute hemodynamic effects of adaptive servo-ventilation in patients with heart failure.
BACKGROUND
Adaptive servo-ventilation (ASV) improves cardiac function in patients with heart failure (HF). We compared the hemodynamics of control and HF patients, and identified the predictors for acute effects of ASV in HF.


RESULTS
We performed baseline echocardiographic measurements and hemodynamic measurements at baseline and after 15 min of ASV during cardiac catheterization in 11 control and 34 HF patients. Heart rate and blood pressure did not change after ASV in either the control or HF group. Stroke volume index (SVI) decreased from 49.3±7.6 to 41.3±7.6 ml/m2 in controls (P<0.0001) but did not change in the HF patients (from 34.8±11.5 to 32.8±8.9 ml/m2, P=0.148). In the univariate analysis, pulmonary capillary wedge pressure (PCWP), mitral regurgitation (MR)/left atrial (LA) area, E/A, E/e', and the sphericity index defined by the ratio between the short-axis and long-axis dimensions of the left ventricle significantly correlated with % change of SVI from baseline during ASV. PCWP and MR/LA area were independent predictors by multivariate analysis. Moreover, responders (15 of 34 HF patients; 44%) categorized by an increase in SVI showed significantly higher PCWP, MR, and sphericity index.


CONCLUSIONS
Left ventricular structure and MR, as well as PCWP, could predict acute favorable effects on hemodynamics by ASV therapy in HF patients.
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, and Translational Research and Clinical Trial Center, Hokkaido University Hospital, Sapporo, Japan.
Shiro
S
Yamada
Mamoru
M
Sakakibara
Takashi
T
Yokota
Kiwamu
K
Kamiya
Naoya
N
Asakawa
Hiroyuki
H
Iwano
Satoshi
S
Yamada
Koji
K
Oba
Hiroyuki
H
Tsutsui
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D016022:Case-Control Studies; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D059725:Interactive Ventilatory Support; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000628:therapy; D015999:Multivariate Analysis; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left