Die Cheyne-Stokes Atmung: Freund oder Feind der Herzinsuffizienz?

Diese Arbeit zeigt, dass Hyperventilationen bei Patienten mit Herzinsuffizienz und eingeschränkter Ejektionsfraktion zu einem gewünschten Anstieg des Herz-Zeit Volumens führen können. Gleichzeitig wird aufgezeigt, dass die Therapie der CSR mittels adaptiver Servoventilation in großen Gruppen von Patienten mit Herzinsuffizienz und eingeschränkter Ejektionsfraktion nicht zu einem gewünschten Anstieg des Herz-Zeit Volumens führt. Auch bezogen auf die respiratorischen Effekte einer Therapie mittels adaptiver Servoventilation bei Patienten mit Herzinsuffizienz und eingeschränkter Ejektionsfraktion konnte gezeigt werden, dass die ASV Therapie trotz einer Wirksamkeit im Sinne einer auch möglichen Stabilisierung der Atmung gerade bei wachen Patienten eine Veränderung des Säure-Basen Haushaltes hin zur Alkalose bewirken kann

The prognostic significance of serum sodium in a population undergoing cardiac resynchronisation therapy

Purpose: To determine the prognostic implications of changes towards hyponatremia at varying time-points in the treatment of patients undergoing cardiac resynchronisation therapy (CRT). Methods: A retrospective series of 249 patients was studied from 2002 to 2013. The population was categorized on the basis of serum sodium profile at baseline, at 1 month and at 6 month follow up visits following successful CRT implantation. The composite endpoint was all-cause mortality and heart failure hospitalisation (defined by the need for intravenous diuretic therapy) following CRT implantation. Results: A total of 249 patients (67.8 ± 12.5 years; NYHA class III/IV 75; LVEF 27.2 ± 8.8%) were followed up for a median of 5.5 years. Hyponatremia at baseline, 1 month or 6 months follow up did not predict the composite endpoint. 26% of patients showed hyponatremia at baseline prior to CRT implantation, while it was present in 19.9% of patients 1 month (p = 0.003) and in 16% (p  7.0 mmol/l) (HR 1.61 [1.05–2.46], p = 0.03) at baseline were associated with an increased risk of unplanned heart failure hospitalisation and all-cause mortality after CRT implantation. Conclusions: A change towards hyponatremia when observed 6 months after CRT implantation may predict a worse clinical outcome. Additionally, renal impairment and higher diuretic doses are associated with an increased risk of mortality in the population analysed

Sleep duration and quality in heart failure patients

Sleep-disordered breathing (SDB) is highly prevalent in patients with heart failure and reduced left ventricular ejection fraction (HF-REF). SDB is classified as predominant obstructive (OSA) or central (CSA) and may alter sleep duration, sleep quality, and quality of life. This study describes sleep quality and duration in well-characterized cohorts of these patients. Two hundred fifty consecutive patients with HF-REF (NYHA class ≥II, ejection fraction ≤45%) underwent cardiac and pulmonary examination, plus full attended in-hospital overnight polysomnography (PSG). PSG recordings were performed according to current recommendations and underwent independent, blinded analysis at a core laboratory. Patients with HF-REF and CSA were older and had more impaired cardiac function compared to those with OSA. With respect to sleep parameters, patients with CSA spent more time in bed than those with OSA (468 ± 52 vs 454 ± 46 min, p = 0.021) while sleep efficiency was lower (67 ± 14 vs 72 ± 13% of total sleep time (TST), p = 0.008). In addition, CSA patients spent more time awake after sleep onset (101 ± 61 vs 71 ± 46 min, p = 0.001) and had more stage N1 (light) sleep (33 ± 19 vs 28 ± 16% of TST, p = 0.017). Overall, the proportion of sleep spent in N3 (slow-wave/deep) sleep in HF-REF patients with SDB was low (4.1 ± 6.3% of TST) compared with healthy adults. HF-REF patients with CSA compared to OSA have worse sleep efficiency and quality. This could result in less restorative sleep, changes in sympathovagal balance, and impaired resetting of important reflexes, which might contribute to worse cardiovascular outcomes in HF-REF patients with SDB

Impact of SERVE-HF on management of sleep disordered breathing in heart failure: a call for further studies

Sleep disordered breathing (SDB) (obstructive sleep apnea, central sleep apnea/Cheyne-Stokes respiration or the combination of both) is highly prevalent in patients with a wide variety of cardiovascular diseases including hypertension, arrhythmia, coronary artery disease, myocardial infarction and stroke (reviewed previously in the September issue of this journal). Its close association with outcomes in chronic heart failure with reduced ejection fraction (HF-REF) suggests that it may be a potential treatment target. Herein, we provide an update on SDB and its treatment in HF-REF

Autonomic and respiratory consequences of altered chemoreflex function: clinical and therapeutic implications in cardiovascular diseases

: The importance of chemoreflex function for cardiovascular health is increasingly recognized in clinical practice. The physiological function of the chemoreflex is to constantly adjust ventilation and circulatory control to match respiratory gases to metabolism. This is achieved in a highly integrated fashion with the baroreflex and the ergoreflex. The functionality of chemoreceptors is altered in cardiovascular diseases, causing unstable ventilation and apnoeas and promoting sympathovagal imbalance, and it is associated with arrhythmias and fatal cardiorespiratory events. In the last few years, opportunities to desensitize hyperactive chemoreceptors have emerged as potential options for treatment of hypertension and heart failure. This review summarizes up to date evidence of chemoreflex physiology/pathophysiology, highlighting the clinical significance of chemoreflex dysfunction, and lists the latest proof of concept studies based on modulation of the chemoreflex as a novel target in cardiovascular diseases

Respiratory effects of adaptive servoventilation therapy in patients with heart failure and Cheyne-Stokes respiration compared to healthy volunteers

$\textbf {Background:}$ Nocturnal adaptive servoventilation (ASV) therapy is now frequently used to treat Cheyne-Stokes respiration (CSR), which is highly prevalent in patients with moderate-to-severe heart failure (HF) and characterized by periodical breathing (hyperventilation). $\textbf {Objectives:}$ This study analyzed and compared the acute effects of a novel ASV device on carbon dioxide pressure $(pCO_{2})$ and oxygen saturation $(SaO_{2})$ in HF patients with CSR and healthy volunteers. The influence of being asleep or awake on the ASV algorithm was also determined. $\textbf {Methods:}$ All subjects underwent ASV ($PaceWave^{TM}$, ResMed) for 1 h. Transcutaneous $pCO_{2}$ $(PtcCO_{2})$ and $SaO_{2}$ were assessed transcutaneously, while wakefulness was analyzed using EEG recordings. Assessments were made 30 min before and after ASV, and during 1 h of ASV. $\textbf {Results:}$ Twenty HF patients (19 male; age 79 $\pm$ 12 years) and 15 volunteers (13 male, age 25 $\pm$ 4 years) were included. When awake, ASV was associated with a trend towards a decrease in $PtcCO_{2}$ and an increase in $SaO_{2}$ versus baseline in HF patients (34.4 $\pm$ 3.2 to 33.7 $\pm$ 3.8 mm Hg and 93.8 $\pm$ 2.6 to 94.9 $\pm$ 2.6%, respectively) and volunteers (39.5 $\pm$ 3.0 to 38.2 $\pm$ 3.8 mm Hg and 96.9 $\pm$ 1.3 to 97.8 $\pm$ 0.9%). While asleep during ASV, $PtcCO_{2}$ increased to 36.3 $\pm$ 3.8 mm Hg and $SaO_{2}$ decreased to 93.8 $\pm$ 2.6% in HF patients, with similar changes in volunteers ($PtcCO_{2}$ 41.7 $\pm$ 3.0 mm Hg, $SaO_{2}$ 97.1 $\pm$ 1.2). All comparisons were statistically significant (p $\leq$ 0.05, except the PtcCO2 decrease in both groups when awake). $\textbf {Conclusions:}$ ASV therapy might result in hyperventilation when subjects are awake, but while asleep, $PtcCO_{2}$ increased to mid-normal values, effects that would be favorable in HF patients with CSR