演題

OJ25-5

Optimized Settings for Adaptive Servo Ventilation in Patients with Severe Heart Failure Based on the Echocardiogram

[演者] 谷野 紗恵:1
[共同演者] 関口 治樹:1, 田中 友佳子:2, 芹澤 直紀:1, 萩原 誠久:1
1:東京女子医科大学 循環器内科, 2:東京女子医科大学 卒後臨床研修センター

Background:Adaptive Servo Ventilation(ASV) is reportedly beneficial for the treatment of heart failure(HF) in patients with central sleep apnea syndrome. However,the recent SERVE-HF trial reported that ASV treatment increased mortality in these patients. One cause of the negative result was thought to be the low output induced by high expiratory positive airway pressure(EPAP). Therefore, we hypothesized that optimized ASV settings could be determined by evaluating outflow on the echocardiogram,thereby ensuring benefits for severe HF patients.Methods:We optimized ASV settings using hemodynamic parameters on the echocardiogram in hospitalized patients with severe HF,who were treated with catecholamine. We calculated stroke volume(SV),and compared the response to ASV with EPAP settings of 2,4,6,or 8mmHg. We determined the optimal setting at which the SV reached the maximum value and compared this with the settings at baseline and discharge. We also evaluated the apnea-hypopnea index(AHI) with polysomnography.Result:We analyzed 20 patients(mean EF 32%). ASV treatment improved the SV(mean SV 53.4ml increased to 58.8ml,P<0.05) when optimal settings were used. However,the SV decreased when ASV was performed with a higher than optimal EPAP setting. Moreover,at discharge,the EPAP setting was lower than at baseline(mean EPAP 4.75cmH2O decreased to 3.71cmH2O,P<0.05).Conclusion:In patients with severe HF, high EPAP decreased SV, and optimal settings were different at baseline and after treatment. It is necessary to investigate whether optimal ASV settings reduce mortality in these patients.

[Keywords] sleep apnea / heart failure
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