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Fukumoto Y, Tada T, Suzuki H, Nishimoto Y, Moriuchi K, Arikawa T, Adachi H, Momomura SI, Seino Y, Yasumura Y, Yokoyama H, Hiasa G, Hidaka T, Nohara S, Okayama H, Tsutsui H, Kasai T, Takata Y, Enomoto M, Saigusa Y, Yamamoto K, Kinugawa K, Kihara Y. Chronic Effects of Adaptive Servo-Ventilation Therapy on Mortality and the Urgent Rehospitalization Rate in Patients Experiencing Recurrent Admissions for Heart Failure - A Multicenter Prospective Observational Study (SAVIOR-L). Circ J 2024; 88:692-702. [PMID: 38569914 DOI: 10.1253/circj.cj-23-0827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND This study investigated whether the chronic use of adaptive servo-ventilation (ASV) reduces all-cause mortality and the rate of urgent rehospitalization in patients with heart failure (HF).Methods and Results: This multicenter prospective observational study enrolled patients hospitalized for HF in Japan between 2019 and 2020 who were treated either with or without ASV therapy. Of 845 patients, 110 (13%) received chronic ASV at hospital discharge. The primary outcome was a composite of all-cause death and urgent rehospitalization for HF, and was observed in 272 patients over a 1-year follow-up. Following 1:3 sequential propensity score matching, 384 patients were included in the subsequent analysis. The median time to the primary outcome was significantly shorter in the ASV than in non-ASV group (19.7 vs. 34.4 weeks; P=0.013). In contrast, there was no significant difference in the all-cause mortality event-free rate between the 2 groups. CONCLUSIONS Chronic use of ASV did not impact all-cause mortality in patients experiencing recurrent admissions for HF.
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Affiliation(s)
- Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Takeshi Tada
- Cardiovascular Medicine, Kurashiki Central Hospital
| | - Hideaki Suzuki
- Department of Cardiovascular Medicine, Tohoku University Hospital
- Department of Brain Sciences, Imperial College London
| | - Yuji Nishimoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Kenji Moriuchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takuo Arikawa
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
| | - Hitoshi Adachi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | | | | | | | | | - Go Hiasa
- Department of Cardiology, Ehime Prefectural Central Hospital
| | - Takayuki Hidaka
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
- Department of Cardiology, Hiroshima Prefectural Hospital
| | - Shoichiro Nohara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Hideki Okayama
- Department of Cardiology, Ehime Prefectural Central Hospital
| | - Hiroyuki Tsutsui
- School of Medicine and Graduate School, International University of Health and Welfare
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine and Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine
| | | | - Mika Enomoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine
| | - Kouji Yamamoto
- Department of Biostatistics, Yokohama City University School of Medicine
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, Faculty of Medicine, University of Toyama
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
- Kobe City Medical Center General Hospital
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Nomoto Y, Imamura T, Kinugawa K. Systemic Congestion as a Determinant of Efficacy in Adaptive Servo-Ventilation Therapy: A Retrospective Observational Study. J Clin Med 2024; 13:674. [PMID: 38337368 PMCID: PMC10856717 DOI: 10.3390/jcm13030674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The optimal criteria for patient selection in the context of adaptive servo-ventilation (ASV) therapy remain a subject of ongoing investigation. We postulate that baseline plasma volume, assessable through several straightforward clinical parameters, might be correlated with a more pronounced reduction in plasma B-type natriuretic peptide (BNP) levels following mid-term ASV therapy. METHODS We included patients diagnosed with congestive heart failure who had received continuous ASV therapy for a minimum of three months. The primary outcome of interest was the extent of decline in logarithmically transformed plasma BNP levels, defined as a decrease of more than 0.10 during the 3-month ASV treatment period. RESULTS A total of 66 patients were included in the study. The median age of the cohort was 66 years, with 53 patients (80%) being male. The median plasma volume status at baseline was -16.9%, and patients were categorized into two groups based on this median value. Patients with elevated baseline plasma volume status experienced a statistically significant reduction in plasma BNP levels (p = 0.016), whereas those with lower plasma volume exhibited no significant change in BNP levels (p = 0.23). A higher baseline plasma volume status was independently associated with a significant reduction in plasma BNP levels, with an adjusted odds ratio of 1.036 (95% confidence interval: 1.01-1.07, p = 0.032). CONCLUSIONS The presence of systemic congestion at baseline, quantified by the estimated plasma volume status, may serve as a crucial determinant of the efficacy of ASV therapy, leading to improvements in plasma BNP levels among patients suffering from congestive heart failure.
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Beres E, Babes K, Beres ZL, Botea M, Davidescu L. Effect of home non-invasive ventilation on left ventricular function and quality of life in patients with heart failure and central sleep apnea syndrome. BALNEO AND PRM RESEARCH JOURNAL 2022. [DOI: 10.12680/balneo.2022.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Central Sleep Apnea Syndrome (CSAS) and Cheyne-Stokes breathing are prevalent in patients with heart failure with reduced ejection fraction (HFrEF). Positive respiratory pressure therapy (PAP) associated with drug therapy for heart failure can improve quality of life, although tolerance to PAP therapy can be difficult to achieve.
Materials and method: Patients for this prospective, mono-center, cohort study were selected from patients with chronic heart failure who present at the Sleep Laboratory of the Medical Clinic of Pneumology, Oradea who underwent polysomnography. 38 HFrEF and CSAS patients were included between January 2019 to December 2021 in the study, with an apnea-hypopnea index (AHI) >=15/hour of sleep. Echocardiographic hemodynamic parameters (left ventricular ejection fraction-LVEF, mitral regurgitation score), PAP compliance, and quality of life using the severe respiratory failure questionnaire (SRI) at the initiation of PAP and after 3 months were included.
Results: After 3 months of PAP therapy LVEF increased significantly (from 31.4% ±12.2to 38.0%±10.9, p=0.0181), AHI decreased (from 40.1±18.7 to 6.8±6.1 events/h, p<0.0001) and all the categories of SRI showed improvement with significant general score increase (from 57.0±15.1 to 66.6±16.9, p<0.0001).
Conclusion: The association of PAP therapy with drug therapy in patients with HFrEF and CSAS improves hemodynamic parameters and quality of life.
Keywords: Chronic heart failure, positive airway pressure therapy, central sleep apnea syndrome
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Affiliation(s)
| | | | | | - Mihai Botea
- University of Oradea, Emergency Medicine Department;
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4
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Hori M, Imamura T, Narang N, Kinugawa K. Pressure Ramp Testing for Optimization of End-Expiratory Pressure Settings in Adaptive Servo-Ventilation Therapy. Circ Rep 2022; 4:17-24. [PMID: 35083384 PMCID: PMC8710634 DOI: 10.1253/circrep.cr-21-0132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Masakazu Hori
- Second Department of Internal Medicine, Toyama University
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5
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Silva AMVD, Nard ATD, Righi GDA, Nascimento JR, Lima RM, Signori LU. Bilevel positive airway pressure improves the autonomic balance in the postoperative period following cardiac surgery: a randomized trial. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/19023129012022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The use of bilevel positive airway pressure (BiPAP) has repercussions on cardiorespiratory outcomes. However, the literature still lacks analyses of the postoperative influence of BiPAP on the modulation of the autonomic nervous system after cardiac surgery. This study aimed to evaluate the effects of BiPAP on peripheral oxygen saturation, vital signs, and autonomic balance during hospitalization after cardiac surgery. This randomized controlled trial evaluated 36 patients before and after surgery. The BiPAP group was treated in two 20-minute daily sessions of routine physical therapy since 18 hours after surgery until discharge. The control group received routine physical therapy during the same period. Our primary outcome was peripheral oxygen saturation. Secondary outcomes were vital signs and autonomic balance evaluated by heart rate variability. We observed that peripheral oxygen saturation and blood pressure were unaffected at hospital discharge. Both groups showed a similar increase in heart and respiratory rates. The BiPAP group showed a reduction of the low sympathetic frequency component in −27.1 n.u. (95% CI: −39 to −15.2), increase of high parasympathetic frequency in 27.1 n.u. (95% CI: 15.2 to 39), and an improvement to the LF/HF ratio in −2.5 (95% CI: −3.8 to −1.2), when compared to the control group. BiPAP attenuated sympathetic activity and improved vagal modulation and autonomic balance at hospital discharge. These findings evidence that BiPAP enables more efficient autonomic mechanisms during hospitalization after cardiac surgery.
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Hu WH, Khoo MCK. Treatment of Cheyne-Stokes Respiration in Heart Failure with Adaptive Servo-Ventilation: An Integrative Model. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:79-103. [PMID: 36217080 DOI: 10.1007/978-3-031-06413-5_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The SERVE-HF (Treatment of Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients with Heart Failure) multicenter trial found a small but significant increase in all-cause and cardiovascular mortality in patients assigned to adaptive servo-ventilation (ASV) versus guideline-based medical treatment. To better understand the physiological underpinnings of this clinical outcome, we employ an integrative computer model to simulate congestive heart failure with Cheyne-Stokes respiration (CHF-CSR) in subjects with a broad spectrum of underlying pathogenetic mechanisms, as well as to determine the in silico changes in cardiopulmonary and autonomic physiology resulting from ASV. Our simulation results demonstrate that while the elimination of CSR through ASV can partially restore cardiorespiratory and autonomic physiology toward normality in the vast majority of CHF phenotypes, the degree of restoration can be highly variable, depending on the combination of CHF mechanisms in play. The group with the lowest left ventricular ejection fraction (LVEF) appears to be most vulnerable to the potentially adverse effects of ASV, but the level of pulmonary capillary wedge pressure (PCWP) plays an important role in determining the nature of these effects.
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7
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Noninvasive Positive Pressure Ventilation for Acute Decompensated Heart Failure. Heart Fail Clin 2020; 16:271-282. [PMID: 32503751 DOI: 10.1016/j.hfc.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Noninvasive positive pressure ventilation (NIPPV), which can be applied without endotracheal airway or tracheostomy, has been used as the first-line device for patients with acute decompensated heart failure (ADHF) and cardiogenic pulmonary edema. Positive airway pressure (PAP) devices include continuous PAP, bilevel PAP, and adaptive servoventilation. NIPPV can provide favorable physiologic benefits, including improving oxygenation, respiratory mechanics, and pulmonary and systemic hemodynamics. It can also reduce the intubation rate and improve clinical symptoms, resulting in good quality of life and mortality.
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8
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Hiasa G, Okayama H, Kazatani Y. Assessment of pulmonary congestion is of prime importance. Heart Vessels 2019; 34:1897. [DOI: 10.1007/s00380-019-01407-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/05/2019] [Indexed: 11/28/2022]
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Ventricular remodeling in preterm infants: computational cardiac magnetic resonance atlasing shows significant early remodeling of the left ventricle. Pediatr Res 2019; 85:807-815. [PMID: 30758323 DOI: 10.1038/s41390-018-0171-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/01/2018] [Accepted: 08/27/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Premature birth is associated with ventricular remodeling, early heart failure, and altered left ventricular (LV) response to physiological stress. Using computational cardiac magnetic resonance (CMR) imaging, we aimed to quantify preterm ventricular remodeling in the neonatal period, and explore contributory clinical factors. METHODS Seventy-three CMR scans (34 preterm infants, 10 term controls) were performed to assess in-utero development and preterm ex-utero growth. End-diastolic computational atlases were created for both cardiac ventricles; t statistics, linear regression modeling, and principal component analysis (PCA) were used to describe the impact of prematurity and perinatal factors on ventricular volumetrics, ventricular geometry, myocardial mass, and wall thickness. RESULTS All preterm neonates demonstrated greater weight-indexed LV mass and higher weight-indexed end-diastolic volume at term-corrected age (P < 0.05 for all preterm gestations). Independent associations of increased term-corrected age LV myocardial wall thickness were (false discovery rate <0.05): degree of prematurity, antenatal glucocorticoid administration, and requirement for >48 h postnatal respiratory support. PCA of LV geometry showed statistical differences between all preterm infants at term-corrected age and term controls. CONCLUSIONS Computational CMR demonstrates that significant LV remodeling occurs soon after preterm delivery and is associated with definable clinical situations. This suggests that neonatal interventions could reduce long-term cardiac dysfunction.
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Abstract
Clinical advantages in the adaptive servo-ventilation (ASV) therapy have been reported in selected heart failure patients with/without sleep-disorder breathing, whereas multicenter randomized control trials could not demonstrate such advantages. Considering this discrepancy, optimal patient selection and device setting may be a key for the successful ASV therapy. Hemodynamic and echocardiographic parameters indicating pulmonary congestion such as elevated pulmonary capillary wedge pressure were reported as predictors of good response to ASV therapy. Recently, parameters indicating right ventricular dysfunction also have been reported as good predictors. Optimal device setting with appropriate pressure setting during appropriate time may also be a key. Large-scale prospective trial with optimal patient selection and optimal device setting is warranted.
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11
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Hiasa G, Okayama H, Hosokawa S, Kosaki T, Kawamura G, Shigematsu T, Takahashi T, Kawada Y, Yamada T, Matsuoka H, Saito M, Sumimoto T, Kazatani Y. Beneficial effects of adaptive servo-ventilation therapy on readmission and medical costs in patients with chronic heart failure. Heart Vessels 2018; 33:859-865. [PMID: 29357095 DOI: 10.1007/s00380-018-1124-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/19/2018] [Indexed: 11/24/2022]
Abstract
Adaptive servo-ventilation (ASV) therapy is a novel modality of noninvasive positive pressure ventilation and is now widely utilized to treat patients with chronic heart failure (CHF). However, there has been no clinical study of the effect of ASV therapy on readmission and cost-effectiveness for the treatment of CHF. The present study was conducted to evaluate the clinical efficacy and cost-effectiveness of home ASV therapy in 45 patients with a history of two or more admissions a year for worsening CHF. Seven patients refused to undergo chronic ASV therapy and three died. Thus, 35 patients were eventually enrolled in the present study. New York Heart Association class (2.8 ± 0.4 versus 2.3 ± 0.5, p < 0.001), log plasma B-type natriuretic peptide level (2.53 ± 0.44 versus 2.29 ± 0.40 pg/mL, p < 0.0001), left atrial dimension (47.5 ± 7.0 versus 44.9 ± 7.6 mm, p = 0.014), and mitral regurgitation area ratio (20.3 ± 12.1 versus 16.9 ± 8.9%, p = 0.007) decreased significantly after 12 months of ASV therapy. The frequency of hospitalization after ASV was significantly lower than before ASV (1.0 ± 1.0 versus 2.3 ± 0.5 times/year/patient, p < 0.0001). ASV also decreased the duration of hospitalization from 64.4 ± 46.5 to 22.8 ± 27.5 days/year/patient (p < 0.0001). Consequently, the total medical costs were reduced by 37% after ASV (1.95 ± 1.37 versus 3.11 ± 1.75 million yen/patient, p = 0.003). ASV therapy reduced readmissions and medical costs in patients with CHF.
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Affiliation(s)
- Go Hiasa
- Department of Cardiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Hideki Okayama
- Department of Cardiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan.
| | - Saki Hosokawa
- Department of Cardiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Tetsuya Kosaki
- Department of Cardiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Go Kawamura
- Department of Cardiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Tatsuya Shigematsu
- Department of Cardiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Tatsunori Takahashi
- Department of Cardiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Yoshitaka Kawada
- Department of Cardiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Tadakatsu Yamada
- Department of Cardiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Hiroshi Matsuoka
- Department of Cardiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Makoto Saito
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan
| | | | - Yukio Kazatani
- Department of Cardiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
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Kato T, Kasai T, Yatsu S, Murata A, Matsumoto H, Suda S, Hiki M, Shiroshita N, Kato M, Kawana F, Miyazaki S, Daida H. Acute Effects of Positive Airway Pressure on Functional Mitral Regurgitation in Patients with Systolic Heart Failure. Front Physiol 2017; 8:921. [PMID: 29218014 PMCID: PMC5703848 DOI: 10.3389/fphys.2017.00921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/31/2017] [Indexed: 01/19/2023] Open
Abstract
Background: Acute effects of positive airway pressure (PAP) [including continuous PAP (CPAP) and adaptive servo-ventilation, an advanced form of bi-level PAP] on functional mitral regurgitation (fMR) in patients with heart failure (HF) with left ventricular (LV) systolic dysfunction remain unclear. Thus, whether PAP therapy reduces fMR in such patients with HF was investigated. Methods and Results: Twenty patients with HF and LV systolic dysfunction defined as LV ejection fraction (LVEF) <50% (14 men; mean LVEF, 35.0 ± 11.5%) with fMR underwent echocardiography during 10-min CPAP (4 and 8 cm H2O) and adaptive servo-ventilation. For fMR assessment, MR jet area fraction, defined as the ratio of MR jet on color Doppler to the left atrial area, was measured. The forward stroke volume (SV) index (fSVI) was calculated from the time-velocity integral, cross-sectional area of the aortic annulus, and body surface area. fMR significantly reduced on CPAP at 8 cm H2O (0.30 ± 0.12) and adaptive servo-ventilation (0.29 ± 0.12), compared with the baseline phase (0.37 ± 0.12) and CPAP at 4 cm H2O (0.34 ± 0.12) (P < 0.001). The fSVI did not change in any of the PAP sessions (P = 0.888). However, significant differences in fSVI responses to PAP were found between sexes (P for interaction, 0.006), with a significant reduction in fSVI in women (P = 0.041) and between patients with baseline fSVI ≥ and < the median value (27.8 ml/m2, P for interaction, 0.018), with a significant fSVI reduction in patients with high baseline fSVI (P = 0.028). In addition, significant differences were found in fSVI responses to PAP between patients with LV end-systolic volume (LVESV) index ≥ and < the median value (62.0 ml/m2, P for interaction, 0.034), with a significant fSVI increase in patients with a high LVESV index (P = 0.023). Conclusion: In patients with HF, LV systolic dysfunction, and fMR, PAP can alleviate fMR without any overall changes in forward SV. However, MR alleviation due to PAP might be associated with a decrease in forward SV in women with high baseline SV, whereas MR alleviation due to PAP might be accompanied by increased forward SV in patients with a dilated LV.
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Affiliation(s)
- Takao Kato
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shoichiro Yatsu
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Azusa Murata
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroki Matsumoto
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shoko Suda
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masaru Hiki
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Nanako Shiroshita
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mitsue Kato
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fusae Kawana
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Sakiko Miyazaki
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
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Imamura T, Kinugawa K. Right Ventricular End-Diastolic Pressure Is a Key to the Changes in Cardiac Output During Adaptive Servo-Ventilation Support in Patients With Heart Failure. Int Heart J 2017; 58:536-543. [DOI: 10.1536/ihj.16-489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Teruhiko Imamura
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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14
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Iwasaku T, Ando T, Eguchi A, Okuhara Y, Naito Y, Mano T, Masuyama T, Hirotani S. Adaptive Servo-Ventilation Treatment Increases Stroke Volume in Stable Systolic Heart Failure Patients With Low Tricuspid Annular Plane Systolic Excursion. Int Heart J 2017; 58:393-399. [DOI: 10.1536/ihj.16-327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Toshihiro Iwasaku
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
| | - Tomotaka Ando
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
| | - Akiyo Eguchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
| | - Yoshitaka Okuhara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
| | - Yoshiro Naito
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
| | - Toshiaki Mano
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
| | - Tohru Masuyama
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
| | - Shinichi Hirotani
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
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15
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Beneficial effects of rapid introduction of adaptive servo-ventilation in the emergency room in patients with acute cardiogenic pulmonary edema. J Cardiol 2017; 69:308-313. [DOI: 10.1016/j.jjcc.2016.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/09/2016] [Accepted: 05/25/2016] [Indexed: 01/08/2023]
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16
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Iwasaku T, Okuhara Y, Eguchi A, Ando T, Naito Y, Masuyama T, Hirotani S. Right Ventricular Enlargement and Renal Function Are Associated With Smooth Introduction of Adaptive Servo-Ventilation Therapy in Chronic Heart Failure Patients. Int Heart J 2017; 58:232-237. [DOI: 10.1536/ihj.16-173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Toshihiro Iwasaku
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
| | - Yoshitaka Okuhara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
| | - Akiyo Eguchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
| | - Tomotaka Ando
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
| | - Yoshiro Naito
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
| | - Tohru Masuyama
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
| | - Shinichi Hirotani
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine
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Abstract
Central sleep apnea (CSA) and obstructive sleep apnea (OSA) are prevalent in heart failure (HF) and associated with a worse prognosis. Nocturnal oxygen therapy may decrease CSA events, sympathetic tone, and improve left ventricular ejection fraction, although mortality benefit is unknown. Although treatment of OSA in patients with HF is recommended, therapy for CSA remains controversial. Continuous positive airway pressure use in HF-CSA may improve respiratory events, hemodynamics, and exercise capacity, but not mortality. Adaptive servo ventilation is contraindicated in patients with symptomatic HF with predominant central sleep-disordered events. The role of phrenic nerve stimulation in CSA therapy is promising.
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Affiliation(s)
- Bernardo J Selim
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Center for Sleep Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Center for Sleep Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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Randerath W, Verbraecken J, Andreas S, Arzt M, Bloch KE, Brack T, Buyse B, De Backer W, Eckert DJ, Grote L, Hagmeyer L, Hedner J, Jennum P, La Rovere MT, Miltz C, McNicholas WT, Montserrat J, Naughton M, Pepin JL, Pevernagie D, Sanner B, Testelmans D, Tonia T, Vrijsen B, Wijkstra P, Levy P. Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Respir J 2016; 49:13993003.00959-2016. [DOI: 10.1183/13993003.00959-2016] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/25/2016] [Indexed: 02/07/2023]
Abstract
The complexity of central breathing disturbances during sleep has become increasingly obvious. They present as central sleep apnoeas (CSAs) and hypopnoeas, periodic breathing with apnoeas, or irregular breathing in patients with cardiovascular, other internal or neurological disorders, and can emerge under positive airway pressure treatment or opioid use, or at high altitude. As yet, there is insufficient knowledge on the clinical features, pathophysiological background and consecutive algorithms for stepped-care treatment. Most recently, it has been discussed intensively if CSA in heart failure is a “marker” of disease severity or a “mediator” of disease progression, and if and which type of positive airway pressure therapy is indicated. In addition, disturbances of respiratory drive or the translation of central impulses may result in hypoventilation, associated with cerebral or neuromuscular diseases, or severe diseases of lung or thorax. These statements report the results of an European Respiratory Society Task Force addressing actual diagnostic and therapeutic standards. The statements are based on a systematic review of the literature and a systematic two-step decision process. Although the Task Force does not make recommendations, it describes its current practice of treatment of CSA in heart failure and hypoventilation.
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Sleep Apnea and Left Atrial Phasic Function in Heart Failure With Reduced Ejection Fraction. Can J Cardiol 2016; 32:1402-1410. [DOI: 10.1016/j.cjca.2016.02.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 01/07/2023] Open
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Noninvasive Positive Pressure Ventilation in Chronic Heart Failure. Can Respir J 2016; 2016:3915237. [PMID: 27891061 PMCID: PMC5116333 DOI: 10.1155/2016/3915237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/22/2016] [Accepted: 10/04/2016] [Indexed: 12/23/2022] Open
Abstract
Instruction and Objectives. Noninvasive positive pressure ventilation (NPPV) alleviates sleep-disordered breathing (SDB) and it may improve cardiac function in SDB patients. Because large randomized controlled trials directly evaluating the impact of NPPV on cardiac function are lacking, we conducted a meta-analysis of published data on effectiveness of NPPV in improving cardiac function in patients with chronic heart failure regardless of SDB presence. Methods. Controlled trials were identified in PubMed, OVID, and EMBASE databases. Both fixed and randomized models were used in meta-analysis with primary outcomes of left ventricular ejection fraction (LVEF). Results. Nineteen studies were included with a total of 843 patients. Compared to standard medical treatment (SMT) plus sham-NPPV or SMT only, NPPV plus SMT was associated with improvement in LVEF (weighted mean difference 5.34, 95% CI, [3.85,6.82]; P < 0.00001) and plasma brain natriuretic peptide (BNP) level (weighted mean difference -117.37, 95% CI, [-227.22, -7.52]; P = 0.04) and no influence on overall mortality (RR 1.00, 95% CI, [0.96,1.04]; P = 0.95). Conclusions. In the present meta-analysis, use of NPPV plus SMT improved LVEF and reduced plasma BNP level but did not improve overall mortality in patients with chronic heart failure.
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S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen – Kapitel „Schlafbezogene Atmungsstörungen“. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0093-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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22
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Bronicki RA. Cardiopulmonary Interactions in Children with Heart Failure. Curr Cardiol Rev 2016; 12:104-6. [PMID: 26585038 PMCID: PMC4861937 DOI: 10.2174/1573403x12666151119164802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/15/2015] [Indexed: 11/22/2022] Open
Abstract
Cardiopulmonary interactions are present but inconsequential in humans with normal cardiac and respiratory function; however, in the presence of significant impairment in either system, the importance of the interplay between cardiovascular and pulmonary systems cannot be overstated. This review will discuss the physiologic underpinnings and consequences of these interactions in patients with heart failure.
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Affiliation(s)
- Ronald A Bronicki
- Baylor College of Medicine, Department of Pediatrics, Section of Critical Care Medicine, Texas Children's Hospital, 6621 Fannin st. W6006, Houston, Texas, 77030, USA.
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Selim B, Ramar K. Advanced positive airway pressure modes: adaptive servo ventilation and volume assured pressure support. Expert Rev Med Devices 2016; 13:839-51. [PMID: 27478974 DOI: 10.1080/17434440.2016.1218759] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Volume assured pressure support (VAPS) and adaptive servo ventilation (ASV) are non-invasive positive airway pressure (PAP) modes with sophisticated negative feedback control systems (servomechanism), having the capability to self-adjust in real time its respiratory controlled variables to patient's respiratory fluctuations. However, the widespread use of VAPS and ASV is limited by scant clinical experience, high costs, and the incomplete understanding of propriety algorithmic differences in devices' response to patient's respiratory changes. Hence, we will review and highlight similarities and differences in technical aspects, control algorithms, and settings of each mode, focusing on the literature search published in this area. AREAS COVERED One hundred twenty relevant articles were identified by Scopus, PubMed, and Embase databases from January 2010 to 2016, using a combination of MeSH terms and keywords. Articles were further supplemented by pearling. Recommendations were based on the literature review and the authors' expertise in this area. Expert commentary: ASV and VAPS differ in their respiratory targets and response to a respiratory fluctuation. The VAPS mode targets a more consistent minute ventilation, being recommended in the treatment of sleep related hypoventilation disorders, while ASV mode attempts to provide a more steady breathing airflow pattern, treating successfully most central sleep apnea syndromes.
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Affiliation(s)
- Bernardo Selim
- a Division of Pulmonary and Critical Care Medicine , Mayo Clinic , Rochester , MN , USA
| | - Kannan Ramar
- a Division of Pulmonary and Critical Care Medicine , Mayo Clinic , Rochester , MN , USA
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Abstract
OBJECTIVES The objectives of this review are to discuss the mechanisms by which respiration impacts cardiovascular function and vice versa, with an emphasis on the impact of these interactions in pediatric cardiac critical care. DATA SOURCE A search of MEDLINE was conducted using PubMed. CONCLUSIONS In the presence of underlying cardiac and respiratory disease, the interplay between these two systems is significant and plays a pivotal role in the pathophysiology of acute and chronic phases of a wide spectrum of diseases. An understanding of these relationships is essential to optimizing the care of critically ill patients.
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Abstract
Congestive heart failure (CHF) is among the most common causes of admission to hospitals in the United States, especially in those over age 65. Few data exist regarding the prevalence CHF of Cheyne-Stokes respiration (CSR) owing to congestive heart failure in the intensive care unit (ICU). Nevertheless, CSR is expected to be highly prevalent among those with CHF. Treatment should focus on the underlying mechanisms by which CHF increases loop gain and promotes unstable breathing. Few data are available to determine prevalence of CSR in the ICU, or how CSR might affect clinical management and weaning from mechanical ventilation.
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Affiliation(s)
- Scott A Sands
- Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA; Department of Allergy, Immunology and Respiratory Medicine and Central Clinical School, Alfred Hospital and Monash University, 55 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Robert L Owens
- Division of Pulmonary and Critical Care Medicine, University of California San Diego, 9300 Campus Point Drive, #7381, La Jolla, CA 92037, USA.
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Yang H, Sawyer AM. The effect of adaptive servo ventilation (ASV) on objective and subjective outcomes in Cheyne-Stokes respiration (CSR) with central sleep apnea (CSA) in heart failure (HF): A systematic review. Heart Lung 2016; 45:199-211. [DOI: 10.1016/j.hrtlng.2016.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 01/26/2023]
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Murase K, Ono K, Yoneda T, Iguchi M, Yokomatsu T, Mizoguchi T, Izumi T, Akao M, Miki S, Nohara R, Ueshima K, Mishima M, Kimura T, White DP, Chin K. Adaptive servoventilation versus oxygen therapy for sleep disordered breathing in patients with heart failure: a randomised trial. Open Heart 2016; 3:e000366. [PMID: 27099761 PMCID: PMC4823544 DOI: 10.1136/openhrt-2015-000366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/24/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Both adaptive servoventilation (ASV) and nocturnal oxygen therapy improve sleep disordered breathing (SDB), but their effects on cardiac parameters have not been compared systematically. METHODS AND RESULTS 43 patients with chronic heart failure (CHF; left ventricular ejection fraction (LVEF) ≤50%) with SDB were randomly assigned to undergo ASV (n=19, apnoea hypopnoea index (AHI)=34.2±12.1/h) or oxygen therapy (n=24, 36.9±9.9/h) for 3 months. More than 70% of SDB events in both groups were central apnoeas or hypopnoeas. Although nightly adherence was less for the ASV group than for the oxygen group (4.4±2.0 vs 6.2±1.8 h/day, p<0.01), the improvement in AHI was larger in the ASV group than in the oxygen group (-27.0±11.5 vs -16.5±10.2/h, p<0.01). The N-terminal pro-brain natriuretic peptide (NT-proBNP) level in the ASV group improved significantly after titration (1535±2224 to 1251±2003 pg/mL, p=0.01), but increased slightly at follow-up and this improvement was not sustained (1311±1592 pg/mL, p=0.08). Meanwhile, the level of plasma NT-proBNP in the oxygen group did not show a significant change throughout the study (baseline 1071±1887, titration 980±1913, follow-up 1101±1888 pg/mL, p=0.19). The significant difference in the changes in the NT-proBNP level throughout the study between the 2 groups was not found (p=0.30). Neither group showed significant changes in echocardiographic parameters. CONCLUSIONS Although ASV produced better resolution of SDB in patients with CHF as compared with oxygen therapy, neither treatment produced a significant improvement in cardiac function in the short term. Although we could not draw a definite conclusion because of the small number of participants, our data do not seem to support the routine use of ASV or oxygen therapy to improve cardiac function in patients with CHF with SDB. TRIAL REGISTRATION NUMBER NCT01187823 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Kimihiko Murase
- Department of Respiratory Medicine , Graduate School of Medicine, Kyoto University , Kyoto , Japan
| | - Koh Ono
- Department of Cardiovascular Medicine , Graduate School of Medicine, Kyoto University , Kyoto , Japan
| | - Tomoya Yoneda
- Clinical Laboratory Medicine , Kyoto University Hospital , Kyoto , Japan
| | - Moritake Iguchi
- Department of Cardiovascular Medicine , Kyoto Medical Centre , Kyoto , Japan
| | - Takafumi Yokomatsu
- Department of Cardiovascular Medicine , Kyoto Mitsubishi Hospital , Kyoto , Japan
| | - Tetsu Mizoguchi
- Department of Cardiovascular Medicine , Kyoto Mitsubishi Hospital , Kyoto , Japan
| | - Toshiaki Izumi
- Department of Cardiovascular Medicine , Kitano Hospital , Osaka , Japan
| | - Masaharu Akao
- Department of Cardiovascular Medicine , Kyoto Medical Centre , Kyoto , Japan
| | - Shinji Miki
- Department of Cardiovascular Medicine , Kyoto Mitsubishi Hospital , Kyoto , Japan
| | - Ryuji Nohara
- Department of Cardiovascular Medicine , Kitano Hospital , Osaka , Japan
| | - Kenji Ueshima
- Department of EBM Research , Institute for Advancement of Clinical and Translational Research, Kyoto University Hospital , Kyoto , Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine , Graduate School of Medicine, Kyoto University , Kyoto , Japan
| | - Takeshi Kimura
- Clinical Laboratory Medicine , Kyoto University Hospital , Kyoto , Japan
| | - David P White
- Division of Sleep Medicine , Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts , USA
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine , Graduate School of Medicine, Kyoto University , Kyoto , Japan
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Rabec C, Emeriaud G, Amadeo A, Fauroux B, Georges M. New modes in non-invasive ventilation. Paediatr Respir Rev 2016; 18:73-84. [PMID: 26688194 DOI: 10.1016/j.prrv.2015.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023]
Abstract
Non-invasive ventilation is useful to treat some forms of respiratory failure. Hence, the number of patients receiving this treatment is steadily increasing. Considerable conceptual and technical progress has been made in the last years by manufacturers concerning this technique. This includes new features committed to improve its effectiveness as well as patient-ventilator interactions. The goal of this review is to deal with latest advances in ventilatory modes and features available for non-invasive ventilation. We present a comprehensive analysis of new modes of ventilator assistance committed to treat respiratory failure (hybrid modes) and central and complex sleep apnea (adaptive servo ventilation), and of new modes of triggering and cycling (neurally adjusted ventilatory assist). Technical aspects, modes of operation and settings of these new features as well as an exhaustive review of published data, their benefits and limits, and the potential place of these devices in clinical practice, are discussed.
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Affiliation(s)
- Claudio Rabec
- Pulmonary Departement and Respiratory Critical Care Unit, University Hospital Dijon, France; Inserm U 866, University of Burgundy, School of Medicine, Dijon, France.
| | - Guillaume Emeriaud
- Pediatric Intensive Care Unit, Saint Justine Hospital, Université de Montréal, Montreal, Canada
| | - Alessandro Amadeo
- AP-HP, Hôpital Necker, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France; Paris Descartes University, France; Inserm U 955, Team 13, Créteil, France
| | - Brigitte Fauroux
- AP-HP, Hôpital Necker, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France; Paris Descartes University, France; Inserm U 955, Team 13, Créteil, France
| | - Marjolaine Georges
- Pulmonary Departement and Respiratory Critical Care Unit, University Hospital Dijon, France; Inserm U 866, University of Burgundy, School of Medicine, Dijon, France
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Lacerda D, Costa D, Reis M, Gomes ELDFD, Costa IP, Borghi-Silva A, Marsico A, Stirbulov R, Arena R, Sampaio LMM. Influence of bilevel positive airway pressure on autonomic tone in hospitalized patients with decompensated heart failure. J Phys Ther Sci 2016; 28:1-6. [PMID: 26957719 PMCID: PMC4755965 DOI: 10.1589/jpts.28.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/05/2015] [Indexed: 01/01/2023] Open
Abstract
[Purpose] This study evaluated the effect of Bilevel Positive Airway (BiPAP) on the autonomic control of heart rate, assessed by heart rate variability (HRV), in patients hospitalized with decompensated heart failure. [Subjects and Methods] This prospective cross-sectional study included 20 subjects (age: 69±8 years, 12 male, left ventricular ejection fraction: 36 ±8%) diagnosed with heart failure who were admitted to a semi-intensive care unit with acute decompensation. Date was collected for HRV analysis during: 10 minutes spontaneous breathing in the resting supine position; 30 minutes breathing with BiPAP application (inspiratory pressure = 20 cmH2O and expiratory pressure = 10 cmH2O); and 10 minutes immediately after removal of BiPAP, during the return to spontaneous breathing. [Results] Significantly higher values for indices representative of increased parasympathetic activity were found in the time and frequency domains as well as in nonlinear Poincaré analysis during and after BiPAP in comparison to baseline. Linear HRV analysis: standard deviation of the average of all R-R intervals in milliseconds = 30.99±4.4 pre, 40.3±6.2 during, and 53.3±12.5 post BiPAP. Non-linear HRV analysis: standard deviations parallel in milliseconds = 8.31±4.3 pre, 12.9±5.8 during, and 22.8 ±6.3 post BiPAP. [Conclusion] The present findings demonstrate that BiPAP enhances vagal tone in patients with heart failure, which is beneficial for patients suffering from acute decompensation.
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Affiliation(s)
- Diego Lacerda
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho, Brazil
| | - Dirceu Costa
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho, Brazil
| | - Michel Reis
- Physical Therapy Department, School of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Brazil
| | | | - Ivan Peres Costa
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), Brazil
| | - Aline Marsico
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho, Brazil
| | | | - Ross Arena
- Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois Chicago, USA
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Momomura SI, Seino Y, Kihara Y, Adachi H, Yasumura Y, Yokoyama H, Wada H, Ise T, Tanaka K. Adaptive servo-ventilation therapy for patients with chronic heart failure in a confirmatory, multicenter, randomized, controlled study. Circ J 2016; 79:981-90. [PMID: 25912560 DOI: 10.1253/circj.cj-15-0221] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adaptive servo-ventilation (ASV) therapy is expected to be novel nonpharmacotherapy with hemodynamic effects on patients with chronic heart failure (CHF), but sufficient evidence has not been obtained. METHODS AND RESULTS A 24-week, open-label, randomized, controlled study was performed to confirm the cardiac function-improving effect of ASV therapy on CHF patients. At 39 institutions, 213 outpatients with CHF, whose left ventricular ejection fraction (LVEF) was <40% and who had mild to severe symptoms [New York Heart Association (NYHA) class: ≥II], were enrolled. After excluding 8 patients, 102 and 103 underwent ASV plus guideline-directed medical therapy (GDMT) [ASV group] and GDMT only [control group], respectively. The primary endpoint was LVEF, and the secondary endpoints were HF deterioration, B-type natriuretic peptide (BNP), and clinical composite response (CCR: NYHA class+HF deterioration). LVEF and BNP improved significantly at completion against the baseline values in the 2 groups. However, no significant difference was found between these groups. HF deterioration tended to be suppressed. The ASV group showed a significant improvement in CCR corroborated by significant improvements in NYHA class and ADL against the control group. CONCLUSIONS Under the present study's conditions, ASV therapy was not superior to GDMT in the cardiac function-improving effect but showed a clinical status-improving effect, thus indicating a given level of clinical benefit.
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Affiliation(s)
- Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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Affiliation(s)
- Takashi Koyama
- Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine
| | - Hiroyuki Watanabe
- Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine
| | - Hiroshi Ito
- Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine
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Imamura T, Kinugawa K, Nitta D, Komuro I. Long-Term Adaptive Servo-Ventilator Treatment Prevents Cardiac Death and Improves Clinical Outcome. Int Heart J 2016; 57:47-52. [DOI: 10.1536/ihj.15-229] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Teruhiko Imamura
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Koichiro Kinugawa
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Daisuke Nitta
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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Imamura T, Kinugawa K, Nitta D, Komuro I. Shorter Heart Failure Duration Is a Predictor of Left Ventricular Reverse Remodeling During Adaptive Servo-Ventilator Treatment in Patients With Advanced Heart Failure. Int Heart J 2016; 57:198-203. [DOI: 10.1536/ihj.15-332] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Teruhiko Imamura
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Koichiro Kinugawa
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Daisuke Nitta
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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Acute hemodynamic effects of adaptive servoventilation in patients with pre-capillary and post-capillary pulmonary hypertension. Respir Res 2015; 16:137. [PMID: 26538143 PMCID: PMC4634794 DOI: 10.1186/s12931-015-0298-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 10/29/2015] [Indexed: 01/11/2023] Open
Abstract
RATIONALE The hemodynamic effects of adaptive servoventilation (ASV) in patients with pulmonary hypertension (PH) are unknown. METHODS A series of clinically stable patients with pre- or post-capillary PH underwent ASV therapy (endexpiratory positive airway pressure support 12-14 cm H2O, pressure support 4-10 cm H2O) during right heart catheterization. Hemodynamics were measured at rest, at the end of a 15-min episode of ASV therapy, and 15 min after ASV completion. Hemodynamic variables included heart rate, blood pressure, right atrial pressure (RAP), mean pulmonary artery pressure (PAPm), pulmonary arterial wedge pressure (PAWP), cardiac output and pulmonary vascular resistance (PVR). RESULTS The study enrolled 33 patients; 12 patients with post-capillary PH due to heart failure with preserved ejection fraction, and 21 patients with pre-capillary PH due to pulmonary arterial hypertension (n = 8) or chronic thromboembolic pulmonary hypertension (n = 13). ASV was well tolerated by all patients and resulted in reductions in systolic blood pressure (-8 mmHg, p = 0.01), PAPm (-5 mmHg, p <0.001) and PVR (-10%, p = 0.01). Right and left filling pressure increased, while the cardiac output decreased (-0.4 L/min; p < 0.001). The hemodynamic effects of ASV were similar in both patient populations. CONCLUSIONS ASV had moderate hemodynamic effects in patients with PH of various origins, most importantly a decline in systolic blood pressure, PAPm and cardiac output. ASV was safe and well tolerated during this short-term study, but the observed drop in blood pressure and cardiac output may be of concern if ASV is applied in patients with advanced PH and severely impaired right ventricular function.
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Wu X, Fu C, Zhang S, Liu Z, Li S, Jiang L. Adaptive servoventilation improves cardiac dysfunction and prognosis in heart failure patients with sleep-disordered breathing: a meta-analysis. CLINICAL RESPIRATORY JOURNAL 2015; 11:547-557. [PMID: 26403758 DOI: 10.1111/crj.12390] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/24/2015] [Accepted: 09/24/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Adaptive servoventilation (ASV) is a new therapeutic modality to treat sleep-disordered breathing (SDB) especially for central sleep apnoea associated with Cheyne-Stokes respiration, whereas the role of ASV in SDB patients with heart failure (HF) is controversial. The purpose of this study was to evaluate the effects of ASV on these patients through a meta-analysis of published data. METHODS A comprehensive literature search was performed to identify studies focused on ASV through databases, including PubMed, Medline, Embase, Cochrane Library and Web of science from 1950 to 2014. Parallel randomised controlled trials which compared ASV to other controls in HF and SDB patients with extractable data were meet our inclusion criteria. Random effects meta-analysis models were applied using RevMan 5.2. RESULTS Seven studies involving 301 patients were recruited in the meta-analysis. The weighted mean difference in apnoea hyponea index (-17.73 events/h, 95% CI, -21.85 to -2.94) and left ventricular ejection fraction (MD: 4.68, 95% CI, 2.74-6.63) both favored ASV compared to control conditions. The urinary noradrenaline level (MD: -32.18, 95%CI: -44.07 to -20.09) was decreased, while the exercise capacity measured by 6-min walk distance (MD: 41.26, 95% CI, 17.06-65.45) was improved after ASV treatment. Whereas neither left ventricular end-diastolic diameter (LVEDD) nor Epworth sleepiness-scale score (ESS) significantly changed after ASV therapy. CONCLUSIONS ASV is superior to other therapy, as it can result in good consequences for patients with SDB and improve their prognosis in cardiac function. Further studies will still be needed to assess the benefit of it.
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Affiliation(s)
- Xu Wu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cuiping Fu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuqi Zhang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zilong Liu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shanqun Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liyan Jiang
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
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Asakawa N, Sakakibara M, Noguchi K, Kamiya K, Yamada S, Yoshitani T, Ono K, Oba K, Tsutsui H. Adaptive Servo-Ventilation Has More Favorable Acute Effects on Hemodynamics Than Continuous Positive Airway Pressure in Patients With Heart Failure. Int Heart J 2015; 56:527-32. [PMID: 26370373 DOI: 10.1536/ihj.15-110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.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.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/m(2), P = 0.048), but was not changed by ASV (2.3 ± 0.4 to 2.0 ± 0.3 L/ minute/m(2), 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.ASV had more beneficial effects on acute hemodynamics and acceptance than CPAP in HF patients.
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Affiliation(s)
- Naoya Asakawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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Spießhöfer J, Fox H, Lehmann R, Efken C, Heinrich J, Bitter T, Körber B, Horstkotte D, Oldenburg O. Heterogenous haemodynamic effects of adaptive servoventilation therapy in sleeping patients with heart failure and Cheyne-Stokes respiration compared to healthy volunteers. Heart Vessels 2015; 31:1117-30. [PMID: 26296413 DOI: 10.1007/s00380-015-0717-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
Abstract
This study investigated the haemodynamic effects of adaptive servoventilation (ASV) in heart failure (HF) patients with Cheyne-Stokes respiration (CSR) versus healthy controls. Twenty-seven HF patients with CSR and 15 volunteers were ventilated for 1 h using a new ASV device (PaceWave™). Haemodynamics were continuously and non-invasively recorded at baseline, during ASV and after ventilation. Prior to the actual study, a small validation study was performed to validate non-invasive measurement of Stroke volume index (SVI). Non-invasive measurement of SVI showed a marginal overall difference of -0.03 ± 0.41 L/min/m(2) compared to the current gold standard (Thermodilution-based measurement). Stroke volume index (SVI) increased during ASV in HF patients (29.7 ± 5 to 30.4 ± 6 to 28.7 ± 5 mL/m(2), p < 0.05) and decreased slightly in volunteers (50.7 ± 12 to 48.6 ± 11 to 47.9 ± 12 mL/m(2)). Simultaneously, 1 h of ASV was associated with a trend towards an increase in parasympathetic nervous activity (PNA) in HF patients and a trend towards an increase in sympathetic nervous activity (SNA) in healthy volunteers. Blood pressure (BP) and total peripheral resistance response increased significantly in both groups, despite marked inter-individual variation. Effects were independent of vigilance. Predictors of increased SVI during ASV in HF patients included preserved right ventricular function, normal resting BP, non-ischaemic HF aetiology, mitral regurgitation and increased left ventricular filling pressures. This study confirms favourable haemodynamic effects of ASV in HF patients with CSR presenting with mitral regurgitation and/or increased left ventricular filling pressures, but also identified a number of new predictors. This might be mediated by a shift towards more parasympathetic nervous activity in those patients.
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Affiliation(s)
- Jens Spießhöfer
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Henrik Fox
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Roman Lehmann
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Christina Efken
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Jessica Heinrich
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Thomas Bitter
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Britta Körber
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
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Tomita Y, Kasai T. Effectiveness of adaptive servo-ventilation. World J Respirol 2015; 5:112-125. [DOI: 10.5320/wjr.v5.i2.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 04/16/2015] [Accepted: 06/11/2015] [Indexed: 02/06/2023] Open
Abstract
Adaptive servo-ventilation (ASV) has been developed as a specific treatment for sleep-disordered breathing, in particular Cheyne-Stokes respiration with central sleep apnea (CSA). Heart failure patients often have sleep-disordered breathing, which consists of either obstructive sleep apnea (OSA) or CSA. Other medical conditions, such as stroke, acromegaly, renal failure, and opioid use may be associated with CSA. Continuous positive airway pressure (CPAP) therapy is widely used for patients with OSA, but some of these patients develop CSA on CPAP, which is called treatment-emergent CSA. CPAP can be useful as a treatment for these various forms of CSA, but it is insufficient to eliminate respiratory events in approximately half of patients with CSA. As compared to CPAP, ASV may be a better option to treat CSA, with sufficient alleviation of respiratory events as well as improvement of cardiac function in heart failure patients. In patients without heart failure, ASV can also alleviate CSA and relieve their symptom. Recently, ASV has been widely used for patients with various forms of CSA. ASV may be also used in the setting without CSA, but it should be assessed more carefully. Clinicians should have a better understanding of the indications for ASV in each setting.
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Wang Y, Cao J, Feng J, Chen BY. Cheyne-Stokes respiration during sleep: mechanisms and potential interventions. Br J Hosp Med (Lond) 2015; 76:390-6. [PMID: 26140557 DOI: 10.12968/hmed.2015.76.7.390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cheyne-Stokes respiration is characterized by a typical waxing and waning pattern in breathing amplitude, interspersed with central apnoeas or hypopnoeas. This article reviews current knowledge regarding Cheyne-Stokes respiration with a particular emphasis on the mechanisms and latest methods of intervention.
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Affiliation(s)
| | | | | | - Bao-Yuan Chen
- Chief Physician in the Department of Respiratory Diseases, Tianjin Medical University General Hospital, Tianjin, 300052, China
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Abstract
Congestive heart failure (CHF) is among the most common causes of admission to hospitals in the United States, especially in those over age 65. Few data exist regarding the prevalence CHF of Cheyne-Stokes respiration (CSR) owing to congestive heart failure in the intensive care unit (ICU). Nevertheless, CSR is expected to be highly prevalent among those with CHF. Treatment should focus on the underlying mechanisms by which CHF increases loop gain and promotes unstable breathing. Few data are available to determine prevalence of CSR in the ICU, or how CSR might affect clinical management and weaning from mechanical ventilation.
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Affiliation(s)
- Scott A Sands
- Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA; Department of Allergy, Immunology and Respiratory Medicine and Central Clinical School, Alfred Hospital and Monash University, 55 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Robert L Owens
- Division of Pulmonary and Critical Care Medicine, University of California San Diego, 9300 Campus Point Drive, #7381, La Jolla, CA 92037, USA.
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Tamura Y, Koyama T, Watanabe H, Hosoya T, Ito H. Beneficial effects of adaptive servo-ventilation therapy on albuminuria in patients with heart failure. J Cardiol 2015; 65:412-7. [DOI: 10.1016/j.jjcc.2014.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/26/2014] [Accepted: 07/09/2014] [Indexed: 11/25/2022]
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Cowie MR, Woehrle H, Oldenburg O, Damy T, van der Meer P, Erdman E, Metra M, Zannad F, Trochu JN, Gullestad L, Fu M, Böhm M, Auricchio A, Levy P. Sleep-disordered Breathing in Heart Failure - Current State of the Art. Card Fail Rev 2015; 1:16-24. [PMID: 28785426 PMCID: PMC5491026 DOI: 10.15420/cfr.2015.01.01.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/07/2015] [Indexed: 11/04/2022] Open
Abstract
Sleep-disordered breathing (SDB), either obstructive sleep apnoea (OSA) or central sleep apnoea (CSA)/Cheyne-Stokes respiration (CSR) and often a combination of the two, is highly prevalent in patients with heart failure (HF), is associated with reduced functional capacity and quality of life, and has a negative prognostic impact. European HF guidelines identify that sleep apnoea is of concern in patients with HF. Continuous positive airway pressure is the treatment of choice for OSA, and adaptive servoventilation (ASV) appears to be the most consistently effective therapy for CSA/CSR while also being able to treat concomitant obstructive events. There is a growing body of evidence that treating SDB in patients with HF, particularly using ASV for CSA/CSR, improves functional outcomes such as HF symptoms, cardiac function, cardiac disease markers, exercise tolerance and quality of life. However, conflicting results have been reported on 'hard' outcomes such as mortality and healthcare utilisation, and the influence of effectively treating SDB, including CSA/CSR, remains to be determined in randomised clinical trials. Two such trials (SERVE-HF and ADVENT-HF) in chronic stable HF and another in post-acute decompensated HF (CAT-HF) are currently underway.
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Affiliation(s)
| | - Holger Woehrle
- Imperial College London, London, UK;
- ResMed Science Centre, ResMed Europe, Munich, Germany;
| | - Olaf Oldenburg
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany;
| | | | - Peter van der Meer
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
| | | | | | | | | | | | - Michael Fu
- Sahlgrenska University Hospital/östra Hospital, Göteborg, Sweden;
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Hieda M, Seguchi O, Mutara Y, Sunami H, Sato T, Yanase M, Hiroki H, Fujita T, Nakatani T. Acute response test to adaptive servo-ventilation, a possible modality to assessing the reversibility of pulmonary vascular resistance. J Artif Organs 2015; 18:280-3. [PMID: 25809453 DOI: 10.1007/s10047-015-0833-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/16/2015] [Indexed: 11/25/2022]
Abstract
Since pulmonary hypertension (PH) due to left-sided heart failure (HF) with elevated pulmonary vascular resistance (PVR) is contraindication for heart transplantation (HTx), correct evaluation of reversibility in PVR is essential for adequate therapeutic decision-making. However, guidelines or recommended protocols for pharmacological testing to evaluate the reversibility of PVR have not been established yet. In this report, we presented a 34-year-old male with advanced HF complicated by severe PH with high PVR [5.93 Wood units (WU)] who was deemed eligible for HTx. To evaluate his HTx candidacy, oxygen inhalation test was applied during right heart catheterization (RHC) and PVR was drastically decreased to 2.29 WU. At that time, acute response test to adaptive servo-ventilation (ASV) was also applied and use of ASV temporarily but substantially decreased PVR to 2.15 WU. From the results of both oxygen inhalation test and acute response test to ASV, reversibility of PVR in this patient was confirmed, and the patient was approved as HTx candidate and received left ventricular assist device (LVAD) implantation for bridge to transplant. After LVAD implantation, PVR substantially and persistently decreased to 2.4 WU. These findings indicate that acute response test to ASV during RHC may be a possible modality to evaluate the reversibility of PVR in HF patients with PH complicated by elevated PVR.
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Affiliation(s)
- Michinari Hieda
- Department of Transplantation, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan,
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Tashiro N, Takahashi S, Takasaki T, Katayama K, Taguchi T, Watanabe M, Kurosaki T, Imai K, Kimura H, Sueda T. Efficacy of cardiopulmonary rehabilitation with adaptive servo-ventilation in patients undergoing off-pump coronary artery bypass grafting. Circ J 2015; 79:1290-8. [PMID: 25766513 DOI: 10.1253/circj.cj-14-1078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Postoperative complications after cardiac surgery increase mortality. This study aimed to evaluate the efficacy of cardiopulmonary rehabilitation with adaptive servo-ventilation (ASV) in patients undergoing off-pump coronary artery bypass grafting (OPCAB). METHODS AND RESULTS A total of 66 patients undergoing OPCAB were enrolled and divided into 2 groups according to the use of ASV (ASV group, 30 patients; non-ASV group, 36 patients). During the perioperative period, all patients undertook cardiopulmonary rehabilitation. ASV was used from postoperative day (POD) 1 to POD5. Hemodynamics showed a different pattern in the 2 groups. Blood pressure (BP) on POD6 in the ASV group was significantly lower than that in the non-ASV group (systolic BP, 112.9±12.6 vs. 126.2±15.8 mmHg, P=0.0006; diastolic BP, 62.3±9.1 vs. 67.6±9.3 mmHg, P=0.0277). The incidence of postoperative atrial fibrillation (POAF) was lower in the ASV group than in the non-ASV group (10% vs. 33%, P=0.0377). The duration of oxygen inhalation in the ASV group was significantly shorter than that in the non-ASV group (5.1±2.2 vs. 7.6±6.0 days, P=0.0238). The duration of postoperative hospitalization was significantly shorter in the ASV group than in the non-ASV group (23.5±6.6 vs. 29.0±13.1 days, P=0.0392). CONCLUSIONS Cardiopulmonary rehabilitation with ASV after OPCAB reduces both POAF occurrence and the duration of hospitalization.
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Oldenburg O, Arzt M, Bitter T, Bonnemeier H, Edelmann F, Fietze I, Podszus T, Schäfer T, Schöbel C, Skobel E, Skowasch D, Penzel T, Nienaber C. Positionspapier „Schlafmedizin in der Kardiologie“. KARDIOLOGE 2015. [DOI: 10.1007/s12181-015-0654-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Seino Y, Momomura SI, Kihara Y, Adachi H, Yasumura Y, Yokoyama H. Effects of adaptive servo-ventilation therapy on cardiac function and remodeling in patients with chronic heart failure (SAVIOR-C): study protocol for a randomized controlled trial. Trials 2015; 16:14. [PMID: 25928620 PMCID: PMC4331142 DOI: 10.1186/s13063-014-0530-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/19/2014] [Indexed: 01/06/2023] Open
Abstract
Background Adaptive servo-ventilation (ASV) therapy, which is a form of noninvasive positive pressure ventilation therapy and uses an innovative ventilator that has simple operability and provides good patient adherence, potentially has therapeutic benefits—suppression of the deterioration and progression of chronic heart failure (CHF) and a reduction in the number of repeated hospitalizations. Therefore, ASV therapy draws attention as a novel, noninvasive nonpharmacotherapy for patients with CHF owing to its hemodynamics-improving effect, and it is currently being accepted in real-world clinical settings in Japan. However, clinical evidence sufficient for treatment recommendation is lacking because a multicenter, randomized, controlled study of ASV therapy has never been conducted. Methods/Design The present study is a confirmatory, prospective, multicenter, collaborative, open-label, blinded-endpoint, parallel-group, randomized, controlled study. At 40 medical institutions in Japan, 200 Japanese outpatients with mild to severe CHF (age: ≥ 20 years; New York Heart Association classification: greater than or equal to class II) will be randomly assigned to either of the following two study groups: the ASV group, in which 100 outpatients undergo guideline-directed medical therapy and ASV therapy for 24 weeks; and the control group, in which 100 outpatients undergo only guideline-directed medical therapy for 24 weeks. The objective of the present study is to confirm whether the ASV group is superior to the control group concerning the improvement of left ventricular contractility and remodeling, both assessed by two-dimensional echocardiography. Furthermore, the present study will also secondarily examine the effects of ASV therapy on the prognosis and quality of life of patients with CHF. Discussion ASV therapy using the device has the potential to provide therapeutic benefits based on its simple operability and good patient adherence and possesses the potential to improve left ventricular contractility and remodeling. Therefore, the present study is expected to afford more solid scientific evidence regarding ASV therapy as a novel, noninvasive, nonpharmacological, in-home, long-term ventilation therapy for patients with mild to severe CHF. Trial registration UMIN identifier: UMIN000006549, registered on 17 October, 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13063-014-0530-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yoshihiko Seino
- Department of Cardiology, Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan.
| | - Hitoshi Adachi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kamiizumi-machi, Maebashi, Gunma, 371-0004, Japan.
| | - Yoshio Yasumura
- Cardiovascular Division, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan.
| | - Hiroyuki Yokoyama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan.
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Kato T, Suda S, Kasai T. Positive airway pressure therapy for heart failure. World J Cardiol 2014; 6:1175-91. [PMID: 25429330 PMCID: PMC4244615 DOI: 10.4330/wjc.v6.i11.1175] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/16/2014] [Accepted: 09/18/2014] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a life-threatening disease and is a growing public health concern. Despite recent advances in pharmacological management for HF, the morbidity and mortality from HF remain high. Therefore, non-pharmacological approaches for HF are being developed. However, most non-pharmacological approaches are invasive, have limited indication and are considered only for advanced HF. Accordingly, the development of less invasive, non-pharmacological approaches that improve outcomes for patients with HF is important. One such approach may include positive airway pressure (PAP) therapy. In this review, the role of PAP therapy applied through mask interfaces in the wide spectrum of HF care is discussed.
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Affiliation(s)
- Takao Kato
- Takao Kato, Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Shoko Suda
- Takao Kato, Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Takatoshi Kasai
- Takao Kato, Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
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Performance of conventional and enhanced adaptive servoventilation (ASV) in heart failure patients with central sleep apnea who have adapted to conventional ASV. Sleep Breath 2014; 19:795-800. [PMID: 25413958 DOI: 10.1007/s11325-014-1083-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 09/08/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Adaptive servo-ventilation (ASV) is a positive pressure ventilator support system to normalize ventilation in patients with Cheyne-Stokes respiration (CSR). The latest generation enhanced ASV device (PaceWave; ResMed) has a new feature--auto-adjustment of EPAP. This study tested the hypothesis that enhanced ASV with auto-adjustment of EPAP (PaceWave) is non-inferior to conventional ASV (AutoSetCS). METHODS This prospective, randomized, crossover, single-center study enrolled adult patients with stable heart failure (HF) and moderate-to-severe sleep-disordered breathing (SDB) who had been receiving conventional ASV therapy for at least 4 weeks. Patients received conventional ASV for one night and enhanced ASV on another night. Support settings for the two ASV devices were similar, with fixed expiratory positive airway pressure (EPAP) set to between 4 and 10 cm H2O and variable EPAP set to between 4 and 15 cm H2O. Full polysomnography was performed during ASV therapy on both nights. Endpoints were the number of nocturnal respiratory events and oxygen desaturations, and changes in blood pressure (BP). RESULTS Levels of EPAP were comparable during the use of enhanced and conventional ASV, but minimum and maximum inspiratory pressure support values were significantly higher with the PaceWave device. All measures of apnea and hypopnea, and oxygen saturation, were significantly improved during ASV therapy with either device. There were no significant changes in BP or heart rate. CONCLUSIONS Enhanced ASV is non-inferior to ASV with fixed EPAP in patients with chronic HF and CSR, with a trend towards better control of respiratory events.
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Nakano S, Kasai T, Tanno J, Sugi K, Sekine Y, Muramatsu T, Senbonmatsu T, Nishimura S. The effect of adaptive servo-ventilation on dyspnoea, haemodynamic parameters and plasma catecholamine concentrations in acute cardiogenic pulmonary oedema. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 4:305-15. [PMID: 25178690 DOI: 10.1177/2048872614549103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 08/07/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adaptive servo-ventilation has a potential sympathoinhibitory effect in acute cardiogenic pulmonary oedema (ACPO). AIMS To evaluate the acute effects of adaptive servo-ventilation in patients with ACPO. METHODS Fifty-eight consecutive patients with ACPO were divided into those who underwent adaptive servo-ventilation and those who received oxygen therapy alone as part of their immediate care. Visual analogue scale, vital signs, blood gas data and plasma catecholamine concentrations at baseline and 1 h during emergency care, and subsequent clinical events (death within 30 days, intubation within seven days or between seven and 30 days, and length of hospital stay) were assessed. Pre-matched and post-propensity score (PS)-matched datasets were analysed. RESULTS During the first hour of adaptive servo-ventilation, plasma catecholamine concentrations fell significantly (baseline versus 1 h: epinephrine p = 0.003, norepinephrine p < 0.001, dopamine p < 0.001), with falls in blood pressure, heart rate, respiratory rate and pCO2, and rise in HCO3 and pH. In the PS-matched model, visual analogue scale (p = 0.036), systolic blood pressure (from 153.8 ± 30.7 to 133.1 ± 16.3 mmHg; p = 0.025) and plasma dopamine concentration (p = 0.034) fell significantly in the adaptive servo-ventilation group compared with the oxygen therapy alone group. The clinical outcomes between the groups were comparable. CONCLUSION In patients with ACPO, emergency care using adaptive servo-ventilation attenuated plasma catecholamine concentrations and led to the improvement of dyspnoea, vital signs and acid-base balance, without adversely influencing clinical outcomes. Using adaptive servo-ventilation, rather than standard oxygen alone, may relieve dyspnoea and improve haemodynamic status, possibly by modulating sympathetic nerve activity.
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Affiliation(s)
- Shintaro Nakano
- Department of Cardiology, International Medical Centre, Saitama Medical University, Japan
| | - Takatoshi Kasai
- Cardio-Respiratory Sleep Medicine, Department of Cardiology, Juntendo University, Tokyo, Japan
| | - Jun Tanno
- Department of Cardiology, International Medical Centre, Saitama Medical University, Japan
| | - Keiki Sugi
- Department of Cardiology, International Medical Centre, Saitama Medical University, Japan
| | - Yasumasa Sekine
- Department of Emergency and Acute Medicine, International Medical Centre, Saitama Medical University, Japan
| | - Toshihiro Muramatsu
- Department of Cardiology, International Medical Centre, Saitama Medical University, Japan
| | - Takaaki Senbonmatsu
- Department of Cardiology, International Medical Centre, Saitama Medical University, Japan
| | - Shigeyuki Nishimura
- Department of Cardiology, International Medical Centre, Saitama Medical University, Japan
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Javaheri S, Brown LK, Randerath WJ. Clinical Applications of Adaptive Servoventilation Devices. Chest 2014; 146:858-868. [DOI: 10.1378/chest.13-1778] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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