Adaptive Servo-Ventilation Has More Favorable Acute Effects on Hemodynamics Than Continuous Positive Airway Pressure in Patients With Heart Failure
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- Asakawa Naoya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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- Sakakibara Mamoru
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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- Noguchi Keiji
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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- Kamiya Kiwamu
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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- Yamada Shiro
- Department of Cardiovascular Medicine, Otaru-Kyokai Hospital
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- Yoshitani Takashi
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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- Ono Kota
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital
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- Oba Koji
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo
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- Tsutsui Hiroyuki
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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抄録
Adaptive servo-ventilation (ASV) has been attracting attention as a novel respiratory support therapy for heart failure (HF). However, the acute hemodynamic effects have not been compared between ASV and continuous positive airway pressure (CPAP) in HF patients.<br>We studied 12 consecutive patients with stable chronic HF. Hemodynamic measurement was performed by right heart catheterization before and after CPAP 5 cmH2O, CPAP 10 cmH2O, and ASV for 15 minutes each.<br>Heart rate, blood pressure, pulmonary capillary wedge pressure (PCWP), and stroke volume index (SVI) were not changed by any intervention. Right atrial pressure significantly increased after CPAP 10 cmH2O (3.6 ± 3.3 to 6.7 ± 1.6 mmHg, P = 0.005) and ASV (4.1 ± 2.6 to 6.8 ± 1.5 mmHg, P = 0.026). Cardiac index was significantly decreased by CPAP 10 cmH2O (2.3 ± 0.4 to 1.9 ± 0.3 L/minute/m2, P = 0.048), but was not changed by ASV (2.3 ± 0.4 to 2.0 ± 0.3 L/ minute/m2, P = 0.299). There was a significant positive correlation between baseline PCWP and % of baseline SVI by CPAP 10 cmH2O (r = 0.705, P < 0.001) and ASV (r = 0.750, P < 0.001). ASV and CPAP 10 cmH2O had significantly greater slopes of this correlation than CPAP 5 cmH2O, suggesting that patients with higher PCWP had a greater increase in SVI by ASV and CPAP 10 cmH2O. The relationship between baseline PCWP and % of baseline SVI by ASV was shifted upwards compared to CPAP 10 cmH2O. Furthermore, based on the results of a questionnaire, patients accepted CPAP 5 cmH2O and ASV more favorably compared to CPAP 10 cmH2O.<br>ASV had more beneficial effects on acute hemodynamics and acceptance than CPAP in HF patients.
収録刊行物
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- International Heart Journal
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International Heart Journal 56 (5), 527-532, 2015
一般社団法人 インターナショナル・ハート・ジャーナル刊行会