Adaptive servo ventilation reduces central sleep apnea in chronic heart failure patients: beneficial effects on autonomic modulation of heart rate.

Aim Adaptive servo ventilation (ASV) is a method of ventilator support aimed to treat central sleep apnea (CSA). We investigated the effects of an acute use of ASV in chronic heart failure (CHF) patients with CSA and the potential influence on sympathetic nerve activity. Methods Patients were studied with ambulatory cardiorespiratory 24 Holter (Somte) recording of air flow, ECG and oxygen saturation. Comparison before and after ASV treatment was made for apnea index (AI), apnea-hypopnea index (AHI), pulse oxygen saturation, desaturation related to apnea, heart rate (HR) and heart rate variability (HRV). Results Seventeen patients were enrolled. At baseline, apnea index and apnea-hypopnea index were, respectively, 16.92 +/- 7.8 and 41.37 +/- 17.5. During ASV, they significantly decreased to 0.06 +/- 0.0 (P<0.001) and 2.84 +/- 1.1 (P<0.001). The mean and minimal oxygen saturation (%) increased from 94 +/- 1 and 86.5 +/- 4 to 95 +/- 2 (P=0.04) and 91 +/- 2 (P=0.008). Mean HR decreased from 68 +/- 10 to 62 +/- 7 beats/min (P<0.003). In 11 out of 17 patients, HRV was calculated, documenting a significant improvement of the standard deviation of the average of NN - normal sinus to normal sinus (SDANN), standard deviation of NN intervals (SDNN) and SDNN index (respectively, 71.5 +/- 31.1 vs. 80.4 +/- 36.1, P=0.008; 99.7 +/- 31.3 vs. 112.7 +/- 37.5, P=0.003; 57.8 +/- 20.7 vs. 69.3 +/- 30.8, P=0.03). Conclusion The acute use of ASV is effective on CSA by increasing oxygen saturation and reducing HR. Moreover, the significant improvement of HRV highlights ASV's benefit in moderating the sympathetic adrenergic ton

Regular Wine Consumption in Chronic Heart Failure: Impact on Outcomes, Quality of Life, and Circulating Biomarkers

Background-Moderate, regular alcohol consumption is generally associated with a lower risk of cardiovascular events but data in patients with chronic heart failure are scarce. We evaluated the relations between wine consumption, health status, circulating biomarkers, and clinical outcomes in a large Italian population of patients with chronic heart failure enrolled in a multicenter clinical trial. Methods and Results-A brief questionnaire on dietary habits was administered at baseline to 6973 patients enrolled in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure (GISSI-HF) trial. The relations between wine consumption, fatal and nonfatal clinical end points, quality of life, symptoms of depression, and circulating biomarkers of cardiac function and inflammation (in subsets of patients) were evaluated with simple and multivariable-adjusted statistical models. Almost 56% of the patients reported drinking at least 1 glass of wine per day. After adjustment, clinical outcomes were not significantly different in the predefined 4 groups of wine consumption. However, patients with more frequent wine consumption had a significantly better perception of health status (Kansas City Cardiomyopathy Questionnaire score, adjusted P&lt;0.0001), less frequent symptoms of depression (Geriatric Depression Scale, adjusted P=0.01), and lower plasma levels of biomarkers of vascular inflammation (osteoprotegerin and C-terminal proendothelin-1, adjusted P&lt;0.0001, and pentraxin-3, P=0.01) after adjusting for possible confounders. Conclusions-We show for the first time in a large cohort of patients with chronic heart failure that moderate wine consumption is associated with a better perceived and objective health status, lower prevalence of depression, and less vascular inflammation, but does not translate into more favorable clinical 4-year outcomes. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT0033633