Adaptive servo-ventilation has more favorable acute effects on hemodynamics than continuous positive airway pressure in patients with Heart Failure

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/m², P = 0.048), but was not changed by ASV (2.3 ± 0.4 to 2.0 ± 0.3 L/ minute/m², P = 0.299). There was a significant positive correlation between baseline PCWP and % of baseline SVI by CPAP 10 cmH₂O (r = 0.705, P < 0.001) and ASV (r = 0.750, P < 0.001). ASV and CPAP 10 cmH₂O had significantly greater slopes of this correlation than CPAP 5 cmH₂O, suggesting that patients with higher PCWP had a greater increase in SVI by ASV and CPAP 10 cmH₂O. The relationship between baseline PCWP and % of baseline SVI by ASV was shifted upwards compared to CPAP 10 cmH₂O. Furthermore, based on the results of a questionnaire, patients accepted CPAP 5 cmH₂O and ASV more favorably compared to CPAP 10 cmH₂O. ASV had more beneficial effects on acute hemodynamics and acceptance than CPAP in HF patients.