scholarly journals Central sleep apnoea and periodic breathing in heart failure: prognostic significance and treatment options

2019 ◽  
Vol 28 (153) ◽  
pp. 190084 ◽  
Author(s):  
Winfried Randerath ◽  
Oana Deleanu ◽  
Sofia Schiza ◽  
Jean-Louis Pepin
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Failure ◽  
Treatment Options ◽  
Randomised Trial ◽  
Prognostic Significance ◽  
Periodic Breathing ◽  
Sleep Apnoea ◽  
Reduced Ejection Fraction ◽  
Central Sleep Apnoea

Central sleep apnoea (CSA) including periodic breathing is prevalent in more than one-third of patients with heart failure and is highly and independently associated with poor outcomes. Optimal treatment is still debated and well-conducted studies regarding efficacy and impact on outcomes of available treatment options are limited, particularly in cardiac failure with preserved ejection fraction. While continuous positive airway pressure and oxygen reduce breathing disturbances by 50%, adaptive servoventilation (ASV) normalises breathing disturbances by to controlling the underlying mechanism of CSA. Results are contradictory regarding impact of ASV on hard outcomes. Cohorts and registry studies show survival improvement under ASV, while secondary analyses of the large SERVE-HF randomised trial showed an excess mortality in cardiac failure with reduced ejection fraction. The current priority is to understand which phenotypes of cardiac failure patients may benefit from treatment guiding individualised and personalised management.

scholarly journals Ventricular arrhythmia in heart failure patients with reduced ejection fraction and central sleep apnoea

2021 ◽  
pp. 00147-2021
Author(s):  
Christoph Fisser ◽  
Jannis Bureck ◽  
Lara Gall ◽  
Victoria Vaas ◽  
Jörg Priefert ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Ventricular Arrhythmia ◽  
Sleep Stage ◽  
Multivariate Logistic Regression Analysis ◽  
Sleep Apnoea ◽  
Temporal Association ◽  
Recording Time ◽  
Reduced Ejection Fraction ◽  
Central Sleep Apnoea

Cheyne-Stokes respiration (CSR) may trigger ventricular arrhythmia in patients with heart failure with reduced ejection fraction (HFrEF) and central sleep apnoea (CSA). This study determined the prevalence and predictors of a high nocturnal ventricular arrhythmia burden in patients with HFrEF and CSA (with and without CSR) and to evaluate the temporal association between CSR and the ventricular arrhythmia burden.This cross-sectional ancillary analysis included 239 participants from the SERVE-HF major sub-study who had HFrEF and CSA, and nocturnal ECG from polysomnography. CSR was stratified in ≥20% and <20% of total recording time (TRT). High burden of ventricular arrhythmia was defined as >30 premature ventricular complexes (PVCs) per hour of TRT. A sub-analysis was performed to evaluate the temporal association between CSR and ventricular arrhythmias in sleep stage N2.High ventricular arrhythmia burden was observed in 44% of patients. In multivariate logistic regression analysis, male sex, lower systolic blood pressure, non-use of antiarrhythmic medication and CSR ≥20% were significantly associated with PVC >30/h (odds ratio [95% confidence interval]: 5.49 [1.51–19.91], p=0.010; 0.98 [0.97–1.00], p=0.017; 5.02 [1.51–19.91], p=0.001; and 2.22 [1.22–4.05]; p=0.009; respectively). PVCs occurred more frequently during sleep phases with versus without CSR (median [interquartile range]: 64.6 [24.8–145.7] versus 34.6 [4.8–75.2]/h N2 sleep; p=0.006).Further mechanistic studies and arrhythmia analysis of major randomised trials evaluating the effect treating CSR on ventricular arrhythmia burden and arrhythmia-related outcomes are warranted to understand how these data match with the results of the parent SERVE-HF study.

scholarly journals The Molecular and Cellular Mechanisms Associated with a Microvascular Inflammation in the Pathogenesis of Heart Failure with Preserved Ejection Fraction

Acta Naturae ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 40-51
Author(s):  
A. G. Ovchinnikov ◽  
T. I. Arefieva ◽  
A. V. Potekhina ◽  
A. Yu. Filatova ◽  
F. T. Ageev ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Severe Disease ◽  
Treatment Options ◽  
Cellular Mechanisms ◽  
Reduced Ejection Fraction ◽  
Hypertrophied Myocardium ◽  
Microvascular Inflammation ◽  
Novel Strategy ◽  
Current Paradigm

Heart failure withpreserved ejection fraction (HFpEF) is a severe disease with an often unfavorable outcome. The prevalence of HFpEF continues to increase, while effective treatment options remain elusive. All the medical strategies used toimprove the outcome in a heart failure with reduced ejection fraction proved ineffective in HFpEF, which was probably due to the different mechanisms ofdevelopment of these two types of heart failure and the diversity of the HFpEF phenotypes. According to the current paradigm of HFpEF development, a chronic mild pro-inflammatory statecauses a coronary microvascular endothelial inflammation, with further myocardial fibrosis and diastolic dysfunction progression. This inflammatory paradigm of HFpEF has been confirmed with someevidence, and suppressing the inflammation may become a novel strategy for treating and managing HFpEF. This review summarizes current concepts about a microvascular inflammation in hypertrophied myocardium and provides a translational perspective of the anti-inflammatory and immunomodulatory approaches in HFpEF.

scholarly journals Daytime periodic breathing during short-term laboratory recordings in heart failure patients: the iceberg tip of central sleep apnoea?

2017 ◽  
Vol 20 (5) ◽  
pp. 934-936 ◽  
Author(s):  
Maria Teresa La Rovere ◽  
Roberto Maestri ◽  
Elena Robbi ◽  
Angelo Caporotondi ◽  
Giampaolo Guazzotti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Periodic Breathing ◽  
Sleep Apnoea ◽  
Short Term ◽  
Heart Failure Patients ◽  
Central Sleep Apnoea

Nocturnal Hypertension and Heart Failure: Mechanisms, Evidence, and New Treatments

Hypertension ◽  
2021 ◽  
Author(s):  
Kazuomi Kario ◽  
Bryan Williams
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiovascular Events ◽  
Treatment Options ◽  
Left Ventricular ◽  
Nocturnal Hypertension ◽  
Reduced Ejection Fraction ◽  
Nighttime Blood Pressure ◽  
Evidence Based Treatments ◽  
New Treatments

Heart failure (HF) is a common condition with an increasing prevalence. Despite a variety of evidence-based treatments for patients with HF with reduced ejection fraction, morbidity and mortality rates remain high. Furthermore, there are currently no treatments that have yet been shown to reduce complication and death rates in patients who have HF with preserved ejection fraction. Hypertension is a common comorbidity in patients with HF, contributing to disease development and prognosis. For example, hypertension is closely associated with the development of left ventricular hypertrophy, which an important precursor of HF. In particular, nighttime blood pressure (BP) appears to be an important, modifiable risk factor. Both nighttime BP and an abnormal circadian pattern of nighttime BP dipping have been shown to predict development of HF and the occurrence of cardiovascular events, independent of office BP. Key mechanisms for this association include sodium handling/salt sensitivity and increased sympathetic activation. These pathogenic mechanisms are targeted by several new treatment options, including sodium-glucose cotransporter 2 inhibitors, angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor antagonists, and renal denervation. All of these could form part of antihypertensive strategies designed to control nighttime BP and contribute to the goal of achieving perfect 24-hour BP management. Nevertheless, additional research is needed to determine the effects of reducing nighttime BP and improving the circadian BP profile on the rate of HF, other cardiovascular events, and mortality.

Sleep apnoea: treatment options and sleep/cardiovascular outcome

ESC CardioMed ◽  
2018 ◽  
pp. 1065-1069
Author(s):  
Holger Woehrle ◽  
Michael Arzt
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Invasive Ventilation ◽  
Adaptive Servo Ventilation ◽  
Central Sleep Apnoea ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
New Treatment

In addition to lifestyle interventions, treatments for obstructive sleep apnoea focus on maintaining upper airway patency. Continuous positive airway pressure (CPAP) is recommended as first-line therapy. Beneficial cardiovascular effects of CPAP include increased intrathoracic pressure, reduced left ventricular preload and afterload, and reduced transmural cardiac pressure gradients. CPAP also reduces nocturnal ischaemia and blood pressure, and decreases the risk of post-treatment atrial fibrillation recurrence. However, secondary prevention with CPAP did not significantly reduce the rate of major cardio- and cerebrovascular events in the SAVE study. Mandibular advancement devices, surgery, and upper airway stimulation are options for patients unwilling to use or tolerate CPAP. Central sleep apnoea and Cheyne–Stokes respiration are common in patients with heart disease, especially heart failure. Adaptive servo-ventilation is the most effective therapy for alleviating central sleep apnoea with Cheyne–Stokes respiration. However, it is now contraindicated in heart failure patients with an ejection fraction of 45% or lower and predominant central sleep apnoea because of an increased risk of cardiovascular death, based on SERVE-HF study results. However, adaptive servo-ventilation may still have a role in other settings, including heart failure with preserved ejection fraction. Phrenic nerve stimulation is a new treatment modality that has shown promising results in a feasibility study. Hypoventilation is another breathing disorder that needs effective management. Data in cardiovascular disease are lacking, but CPAP and non-invasive ventilation have been shown to be effective in patients with obesity hypoventilation syndrome. Furthermore, effective reduction of chronic hypercapnia during home non-invasive ventilation treatment in patients with chronic obstructive pulmonary disease has been shown to significantly improve survival.

New Novel Treatment Approaches for Heart Failure With Reduced Ejection Fraction

2016 ◽  
Vol 30 (5) ◽  
pp. 541-548
Author(s):  
Shreya Patel ◽  
Keith Veltri
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Hospital Readmission ◽  
Treatment Options ◽  
Poor Quality ◽  
Pharmacological Agents ◽  
Reduced Ejection Fraction ◽  
New Novel ◽  
Novel Treatment

Despite availability of standardized drug therapies with proven beneficial outcomes, heart failure is associated with poor quality of life, increased hospital readmission, and high mortality rate. In the recent years, comprehensive understanding of the pathophysiological mechanisms of heart failure has led to the development and approval of 2 new pharmacological agents, sacubitril–valsartan and ivabradine. These agents are currently approved for use in heart failure with reduced ejection fraction (HFrEF) and present as novel approaches to further improve prognosis and outcomes in patients with HF. They offer alternative treatment options for patients who are intolerant or continue to be symptomatic despite utilization of standard HF drug therapies at optimally tolerated dosages. A review of these 2 novel agents in HFrEF, including information on pivotal trials that led to its approval and its place in therapy for HFrEF, is presented.

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