title: Adaptive servo-ventilation therapy using an innovative ventilator for patients with chronic heart failure: a real-world, multicenter, retrospective, observational study (SAVIOR-R).
abstract: Adaptive servo-ventilation (ASV) therapy using an innovative ventilator-originally developed to treat sleep-disordered breathing (SDB)-is a novel modality of noninvasive positive pressure ventilation and is gaining acceptance among Japanese cardiologists in expectation of its applicability to treat patients with chronic heart failure (CHF) based on its acute beneficial hemodynamic effects. We conducted a multicenter, retrospective, real-world observational study in 115 Japanese patients with CHF, who had undergone home ASV therapy for the first time from January through December 2009, to examine their profile and the effects on their symptoms and hemodynamics. Medical records were used to investigate New York Heart Association (NYHA) class, echocardiographic parameters including left ventricular ejection fraction (LVEF), cardiothoracic ratio (CTR), brain natriuretic peptide (BNP), and other variables. Most of the patients were categorized to NYHA classes II (44.4 %) and III (40.7 %). SDB severity was not determined in 44 patients, and SDB was not detected or was mild in 27 patients. In at least 71 patients (61.7 %), therefore, ASV therapy was not applied for the treatment of SDB. CHF was more severe, i.e., greater NYHA class, lower LVEF, and higher CTR, in 87 ASV-continued patients (75.7 %) than in 28 ASV-discontinued patients (24.3 %). However, SDB severity was not related to continuity of ASV. The combined proportion of NYHA classes III and IV (P = 0.012) and LVEF (P = 0.009) improved significantly after ASV therapy. CTR and BNP did not improve significantly after ASV therapy but showed significant beneficial changes in their time-course analysis (P < 0.05, respectively). Improvements in LVEF and NYHA class after ASV therapy were not influenced by SDB severity at onset. The present study suggests that ASV therapy would improve the symptoms and hemodynamics of CHF patients, regardless of SDB severity. A randomized clinical study to verify these effects is warranted.
authors.affiliation: Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan. momochan-tky@umin.ac.jp.
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Momomura
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Seino
authors.affiliation: Department of Cardiovascular Medicine, Hiroshima University, Hiroshima, Japan.
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Kihara
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Adachi
authors.affiliation: Cardiovascular Division, Osaka National Hospital, Osaka, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Yasumura
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yokoyama
mesh_terms: D000368:Aged; D001835:Body Weight; D002908:Chronic Disease; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006439:Hemodynamics; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000628:therapy*; D016896:Treatment Outcome; D012122:Ventilators, Mechanical; D016277:Ventricular Function, Left
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Adaptive servo-ventilation; Cardiac function; Chronic heart failure; Noninvasive positive pressure ventilation; Sleep-disordered breathing
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