Acute Effects of Nasal CPAP in Patients With Hypertrophic Cardiomyopathy
Flávia B Nerbass1, Vera M C Salemi2, Rodrigo P Pedrosa3
1Sleep Laboratory, Pulmonary Division, Heart Institute (InCor) University of São Paulo Medical School, São Paulo, Brazil.
Insights
Continuous positive airway pressure (CPAP) appears safe for hypertrophic cardiomyopathy (HCM) patients, showing no immediate negative effects on hemodynamics. Further research is needed for long-term impacts in HCM patients with sleep apnea.
Area of Science:
- Cardiology
- Sleep Medicine
- Medical Devices
Background:
- Hypertrophic cardiomyopathy (HCM) is a genetic heart condition.
- HCM can lead to left ventricular outflow tract (LVOT) obstruction, heart failure, and sudden death.
- Obstructive sleep apnea (OSA) is common in HCM patients.
Purpose of the Study:
- To assess the acute effects of CPAP on hemodynamics and cardiac function in HCM patients.
- To compare effects in obstructive versus non-obstructive HCM.
- To determine CPAP safety in this population.
Main Methods:
- 26 stable HCM patients (12 non-obstructive, 14 obstructive) were studied.
- Beat-to-beat BP and ECG monitored awake, supine patients.
- Echocardiography assessed effects of CPAP (1.5 and 10 cm H2O) vs. no CPAP.
Main Results:
- No significant changes in BP, cardiac output, stroke volume, heart rate, or ejection fraction.
- CPAP (10 cm H2O) reduced right atrial size and RV relaxation.
- CPAP decreased left atrial volume and suggested increased pulmonary artery pressure in obstructive HCM.
Conclusions:
- Acute CPAP application is safe in HCM patients, with no hemodynamic compromise.
- Long-term studies are needed for HCM patients with sleep apnea using nocturnal CPAP.
Background:
Hypertrophic cardiomyopathy (HCM) is a common genetic disease that may cause left ventricular outflow tract (LVOT) obstruction, heart failure, and sudden death. Recent studies have shown a high prevalence of OSA among patients with HCM. Because the hemodynamics in patients with LVOT obstruction are unstable and depend on the loading conditions of the heart, we evaluated the acute effects of CPAP on hemodynamics and cardiac performance in patients with HCM.
Methods:
We studied 26 stable patients with HCM divided into nonobstructive HCM (n = 12) and obstructive HCM (n = 14) groups (LVOT gradient pressure lower or higher than 30 mm Hg, respectively). Patients in the supine position while awake were continuously monitored with beat-to-beat BP measurements and electrocardiography. Two-dimensional echocardiography was performed at rest (baseline) and after 20 min of nasal CPAP at 1.5 cm H2O and 10 cm H2O, which was applied in a random order interposed by 10 min without CPAP.
Results:
BP, cardiac output, stroke volume, heart rate, left ventricular ejection fraction, and LVOT gradient did not change during the study period in either group. CPAP at 10 cm H2O decreased right atrial size and right ventricular relaxation in all patients. It also decreased left atrial volume significantly and decreased right ventricular outflow acceleration time, suggesting an increase in pulmonary artery pressure in patients with obstructive HCM.
Conclusions:
The acute application of CPAP is apparently safe in patients with HCM, because CPAP does not lead to hemodynamic compromise. Long-term studies in patients with HCM and sleep apnea and nocturnal CPAP are warranted.
Trial Registry:
ClinicalTrials.gov; No. NCT01631006; URL: www.clinicaltrials.gov.
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