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• W2529609502 abstract "BackgroundObstructive sleep apnea (OSA) is common in patients with congestive heart failure (CHF) and can contribute to disease progression. Continuous positive airway pressure (CPAP) is used to treat OSA and has been shown to improve left ventricular function in CHF patients. However, the effects of CPAP therapy on right ventricular (RV) function, an independent predictor of outcome in CHF patients, are not known.MethodsIn this randomized controlled trial, 45 patients with OSA (apnea/hypopnea index >10 events/hour by nocturnal polysomnography) and stable CHF (left ventricular ejection fraction ≤45% and at least NYHA Class II symptoms) were randomized to receive CPAP (n=22) or no CPAP (n=23) therapy. Echocardiography was used to measure RV systolic and diastolic function parameters at baseline and after 6-8 weeks.ResultsIn the CPAP treatment group, RV fractional area change (FAC) improved from baseline to follow-up study (38.2 ± 10.9% to 41.4 ± 11.5%, p=0.04). In contrast, there was no change in RV FAC in the no CPAP group (43.9 ± 7.2% to 44.4 ± 7.8%, p=0.60). Tricuspid annular systolic excursion velocity, RV myocardial performance index, and tricuspid E/A and E/e’ ratios did not change in either cohort. On subgroup analysis, patients with impaired RV systolic function at baseline demonstrated an improvement in RV FAC with CPAP therapy compared to those who did not receive CPAP therapy (+5.0 ± 4.5% vs. -0.5 ± 5.2%, p=0.04). No improvement in RV FAC was observed in patients with normal RV systolic function at baseline (+1.7 ± 6.4% vs. +1.4 ± 2.0%, p=0.87).ConclusionIn patients with CHF and OSA, short-term CPAP therapy improved RV FAC but had no effect on other measures of RV systolic and diastolic function. The improvement in RV FAC with CPAP was limited to those patients with abnormal baseline RV systolic function. Further studies are required to elucidate the potential longer-term effects of CPAP therapy on RV function in CHF patients with OSA. BackgroundObstructive sleep apnea (OSA) is common in patients with congestive heart failure (CHF) and can contribute to disease progression. Continuous positive airway pressure (CPAP) is used to treat OSA and has been shown to improve left ventricular function in CHF patients. However, the effects of CPAP therapy on right ventricular (RV) function, an independent predictor of outcome in CHF patients, are not known. Obstructive sleep apnea (OSA) is common in patients with congestive heart failure (CHF) and can contribute to disease progression. Continuous positive airway pressure (CPAP) is used to treat OSA and has been shown to improve left ventricular function in CHF patients. However, the effects of CPAP therapy on right ventricular (RV) function, an independent predictor of outcome in CHF patients, are not known. MethodsIn this randomized controlled trial, 45 patients with OSA (apnea/hypopnea index >10 events/hour by nocturnal polysomnography) and stable CHF (left ventricular ejection fraction ≤45% and at least NYHA Class II symptoms) were randomized to receive CPAP (n=22) or no CPAP (n=23) therapy. Echocardiography was used to measure RV systolic and diastolic function parameters at baseline and after 6-8 weeks. In this randomized controlled trial, 45 patients with OSA (apnea/hypopnea index >10 events/hour by nocturnal polysomnography) and stable CHF (left ventricular ejection fraction ≤45% and at least NYHA Class II symptoms) were randomized to receive CPAP (n=22) or no CPAP (n=23) therapy. Echocardiography was used to measure RV systolic and diastolic function parameters at baseline and after 6-8 weeks. ResultsIn the CPAP treatment group, RV fractional area change (FAC) improved from baseline to follow-up study (38.2 ± 10.9% to 41.4 ± 11.5%, p=0.04). In contrast, there was no change in RV FAC in the no CPAP group (43.9 ± 7.2% to 44.4 ± 7.8%, p=0.60). Tricuspid annular systolic excursion velocity, RV myocardial performance index, and tricuspid E/A and E/e’ ratios did not change in either cohort. On subgroup analysis, patients with impaired RV systolic function at baseline demonstrated an improvement in RV FAC with CPAP therapy compared to those who did not receive CPAP therapy (+5.0 ± 4.5% vs. -0.5 ± 5.2%, p=0.04). No improvement in RV FAC was observed in patients with normal RV systolic function at baseline (+1.7 ± 6.4% vs. +1.4 ± 2.0%, p=0.87). In the CPAP treatment group, RV fractional area change (FAC) improved from baseline to follow-up study (38.2 ± 10.9% to 41.4 ± 11.5%, p=0.04). In contrast, there was no change in RV FAC in the no CPAP group (43.9 ± 7.2% to 44.4 ± 7.8%, p=0.60). Tricuspid annular systolic excursion velocity, RV myocardial performance index, and tricuspid E/A and E/e’ ratios did not change in either cohort. On subgroup analysis, patients with impaired RV systolic function at baseline demonstrated an improvement in RV FAC with CPAP therapy compared to those who did not receive CPAP therapy (+5.0 ± 4.5% vs. -0.5 ± 5.2%, p=0.04). No improvement in RV FAC was observed in patients with normal RV systolic function at baseline (+1.7 ± 6.4% vs. +1.4 ± 2.0%, p=0.87). ConclusionIn patients with CHF and OSA, short-term CPAP therapy improved RV FAC but had no effect on other measures of RV systolic and diastolic function. The improvement in RV FAC with CPAP was limited to those patients with abnormal baseline RV systolic function. Further studies are required to elucidate the potential longer-term effects of CPAP therapy on RV function in CHF patients with OSA. In patients with CHF and OSA, short-term CPAP therapy improved RV FAC but had no effect on other measures of RV systolic and diastolic function. The improvement in RV FAC with CPAP was limited to those patients with abnormal baseline RV systolic function. Further studies are required to elucidate the potential longer-term effects of CPAP therapy on RV function in CHF patients with OSA." @default.
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• W2529609502 date "2015-10-01" @default.
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• W2529609502 title "THE EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE ON RV FUNCTION IN PATIENTS WITH CHF AND OSA: A RANDOMIZED CONTROL TRIAL" @default.
• W2529609502 doi "https://doi.org/10.1016/j.cjca.2015.07.429" @default.
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