Beneficial effects of adaptive servo-ventilation on natriuretic peptides and diastolic function in acute heart failure patients with preserved ejection fraction and sleep-disordered breathing

PurposeAdaptive servo-ventilation (ASV) is a ventilator algorithm able to correct breathing through anticyclic support of breathing in patients with central sleep apnea (CSA). So far, very few data exist regarding the role of ASV on acute heart failure with preserved ejection fraction (HFpEF).MethodsWe performed a single-center prospective, randomized, case-control study in consecutive acute HFpEF (left ventricle ejection fraction, LVEF 45%) patients with sleep-disordered breathing (SDB, apnea-hypopnea index, AHI >15/h) and prevalence of CSA.ResultsWe included ten consecutive patients randomized for ASV on top of standard therapy for acute heart failure (group 1) versus standard care alone (group 2). ASV therapy significantly reduced AHI and CSA. An improvement in cardiac diastolic function was seen in group 1 compared to group 2 (E/E' 17.5 to 9.6, p<0.02 vs 18.5 to 14.5, p=0.4). Brain natriuretic peptide (BNP) markedly decreased in cases, but not in controls (298 to 84pg/ml, p<0.02 vs 280 to 120pg/ml, p=0.06). Right ventricle (RV) function significantly improved in group 1, differently from group 2.ConclusionsAn acute use of ASV seems effective in reducing BNP and improving diastolic and RV function in acute HFpEF patients with SDB and CSA, compared to standard treatment.