title: Acute improvement of pulmonary hemodynamics does not alleviate Cheyne-Stokes respiration in chronic heart failure-a randomized, controlled, double-blind, crossover trial.
abstract: OBJECTIVE
  This randomized, controlled trial aimed to investigate whether acute improvement of pulmonary congestion would reduce the severity of Cheyne-Stokes respiration (CSR) in patients with chronic heart failure (CHF).
  
  
  METHODS
  Twenty-one consecutive patients with CHF and CSR (apnea-hypopnea index [AHI] ≥15/h) underwent right heart catheterization with titration of intravenous (IV) glyceryltrinitrate (GTN) to a maximum tolerable dosage and inhalation of iloprost 10 μg/mL after a washout phase. Maximum tolerable dosages of GTN and iloprost were randomly applied during full cardiorespiratory polysomnography within two split-night procedures and compared with IV or inhaled sodium chloride (NaCl) 0.9 %, respectively.
  
  
  RESULTS
  GTN (6.2 ± 1.5 mg/h) and iloprost significantly lowered \mean pulmonary artery pressure (20.1 ± 9.0 to 11.6 ± 4.2 mmHg, p < 0.001 and 16.9 ± 7.9 to 14.2 ± 6.4 mmHg, p < 0.01, respectively). Pulmonary capillary wedge pressure was only reduced by GTN (14.0 ± 5.6 to 7.2 ± 3.9 mmHg, p < 0.001), and there was no significant change in the cardiac index. Sleep studies revealed no significant improvement in markers of CSR severity, including AHI, central apnea index, and CSR cycle length following GTN or iloprost treatment. Significant decreases in blood pressure, mean oxygen saturation, and S3 sleep were documented during GTN infusion.
  
  
  CONCLUSIONS
  Acute improvement of pulmonary congestion by GTN had no immediate impact on CSR severity. Future investigations must therefore include longer treatment periods and treatment regimens that have positive, rather than negative, additional effects on peripheral and central chemoreceptors and sleep structure.
  
  
  BACKGROUND
  German Clinical Trial Registry-ID:DRKS00000467 ( www.germanctr.de ).
authors.affiliation: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany. bitter.thomas@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bitter
authors.affiliation: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
authors.forename: Henrik
authors.initials: H
authors.lastname: Fox
authors.affiliation: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
authors.forename: Heidi
authors.initials: H
authors.lastname: Schmalgemeier
authors.affiliation: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Wellmann
authors.affiliation: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Zwenke
authors.affiliation: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Spiesshöfer
authors.affiliation: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
authors.forename: Zisis
authors.initials: Z
authors.lastname: Dimitriadis
authors.affiliation: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Horstkotte
authors.affiliation: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Oldenburg
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D006328:Cardiac Catheterization; D002302:Cardiac Output / Q000187:drug effects*; D002639:Cheyne-Stokes Respiration / Q000188:drug therapy*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D016285:Iloprost / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008168:Lung / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use*; D017286:Polysomnography / Q000187:drug effects*; D011669:Pulmonary Wedge Pressure / Q000187:drug effects*
chemical_list: D005996:Nitroglycerin; D016285:Iloprost
keywords: Cheyne-Stokes respiration; Heart failure; Pulmonary circulation; Sleep apnea syndrome