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Updated: May 9, 2025
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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
6.3K
LV Structure and Function in HFrEF With and Without Peak-Flow-Triggered Adaptive Servo-Ventilation-Treated
Shoichiro Yatsu1, Anna Woo2, Christian M Horvath1
1Sleep Research Laboratories of the University Health Network, Toronto Rehabilitation Institute (KITE) and Toronto General Hospital and University of Toronto, Toronto, Canada; Department of Medicine, University Health Network and Sinai Health and University of Toronto, Toronto, Canada.
JACC. Heart Failure
|May 1, 2025
Summary
Sleep-disordered breathing, particularly central sleep apnea, is linked to worse heart function in heart failure patients. However, adaptive servo-ventilation did not improve heart structure or function in this study.
Area of Science:
- Cardiology
- Sleep Medicine
- Pulmonology
Background:
- Sleep-disordered breathing (SDB), encompassing obstructive sleep apnea (OSA) and central sleep apnea (CSA), is implicated in promoting left ventricular (LV) remodeling and systolic dysfunction.
- The ADVENT-HF trial investigated the association between SDB and reversible impairments in LV structure and function in patients with heart failure with reduced ejection fraction.
Purpose of the Study:
- To test the hypothesis that SDB is associated with reversible impairment of LV structure and function in patients with heart failure with reduced ejection fraction.
- To evaluate the effect of adaptive servo-ventilation (ASV) on LV structure and function in patients with SDB and heart failure.
Main Methods:
- Participants with ejection fraction ≤45% underwent echocardiography and polysomnography.
- Patients were categorized into no-SDB (apnea-hypopnea index [AHI] <15/h), OSA (AHI ≥15/h with ≥50% obstructive events), or CSA (AHI ≥15 with >50% central events).
- SDB patients were randomized to a control group or to ASVPF, with repeat echocardiography after 6 months.
Main Results:
- Patients with OSA showed similar LV structure and function compared to those without SDB.
- Patients with CSA exhibited greater LV mass index and lower LV ejection fraction than OSA and no-SDB groups.
- ASVPF effectively abolished SDB but did not significantly alter LV structure or function at 6 months in the overall cohort or subgroups.
Conclusions:
- In heart failure with reduced ejection fraction, OSA is not associated with distinct LV structure or function compared to no-SDB.
- CSA is associated with more significant LV remodeling and systolic dysfunction than OSA or no-SDB.
- Six months of ASVPF treatment for SDB did not impact LV structure or function in this patient population.
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