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768
Correspondences
While we are uncertain about the clinical significance of changes of echocardiographic parameters of diastolic function in the acute setting, we entirely agree that evaluation of long-term effects of positive airway pressure therapy on diastolic dysfunction is a valuable approach in this patient population since (i) in approximately 50% patients with heart failure ejection fraction is preserved (heart failure with preserved ejection fraction);3 and (ii) heart failure with reduced ejection fraction (HFREF) is often accompanied by diastolic dysfunction.4,5 Regardless of the presence of systolic dysfunction, diastolic dysfunction represents an independent prognostic factor for a worse outcome.3,4 Therefore, we evaluated in a recent randomized controlled pilot study5 the effects of adaptive-servo ventilation (ASV) treatment for 12 weeks on echocardiographic parameters of diastolic function in patients with stable HFREF and concomitant diastolic dysfunction. ASV efficiently abolished sleep-disordered breathing, and was associated with a statistically non-significant improvement in measures of diastolic dysfunction (e.g. deceleration time, ASV vs no treatment of sleep-disordered breathing: −43.9 ± 88.8 vs 12.4 ± 68.8, P > 0.05).5 The proportion of patients whose diastolic dysfunction improved was non-significantly higher in the ASV than in the control group, respectively (37% vs 15%, P > 0.05).5 These data provide estimates of effect size and justify the evaluation of the effects of positive airway pressure therapy on diastolic function in larger randomized controlled trials. However, we did not assess the acute effects of positive airway pressure therapy on diastolic function, which might have complemented the presented data on blood pressure, heart rate and non-invasively assessed cardiac output.1,2
Reply 2 Dear Editor: We agree with Gerhardy et al. that it is important to consider the haemodynamic effects of CPAP in pure diastolic heart failure as well as heart failure with impaired ejection fraction. We congratulate the authors on their collection of pilot data assessing echocardiographic parameters in five diastolic heart failure patients. It is reassuring to see that no adverse haemodynamic effects were demonstrated. We believe that the data presented here, in addition to those of Schroll et al.,1 are reassuring, but also justify a larger study in heart failure populations (both systolic and diastolic) assessing the detailed cardiovascular and haemodynamic effects of CPAP therapy. Ultimately, it would be highly desirable to ascertain which Conflict of Interest Statement GSH has received research funding and equipment for research from Resmed, Philips and Compumedics.
Respirology (2014) 19, 767–770
Stephan Schroll, MD, Christoph Birner, MD and Michael Arzt, MD Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany Correspondence: Stephan Schroll, Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg 93053, Germany. Email: [email protected]
REFERENCES 1 Schroll S, Series F, Lewis K, Benjamin A, Escourrou P, Luigart R, Pfeifer M, Arzt M. Acute haemodynamic effects of continuous positive airway pressure in awake patients with heart failure. Respirology 2014; 19: 47–52. 2 Fortin J, Habenbacher W, Heller A, Hacker A, Grullenberger R, Innerhofer J, Passath H, Wagner C, Haitchi G, Flotzinger D et al. Non-invasive beat-to-beat cardiac output monitoring by an improved method of transthoracic bioimpedance measurement. Comput. Biol. Med. 2006; 36: 1185–203. 3 Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003; 289: 194–202. 4 Hansen A, Haass M, Zugck C, Krueger C, Unnebrink K, Zimmermann R, Kuebler W, Kuecherer H. Prognostic value of Doppler echocardiographic mitral inflow patterns: implications for risk stratification in patients with chronic congestive heart failure. J. Am. Coll. Cardiol. 2001; 37: 1049–55. 5 Birner C, Series F, Lewis K, Benjamin A, Wunderlich S, Escourrou P, Zeman F, Luigart R, Pfeifer M, Arzt M. Effects of auto-servo ventilation on patients with sleep-disordered breathing, stable systolic heart failure and concomitant diastolic dysfunction: subanalysis of a randomized controlled trial. Respiration 2014; 87: 54–62.
patients with heart failure will benefit most from the CPAP treatment of sleep-disordered breathing. Garun S. Hamilton MBBS, FRACP, PhD1,2,3, Bradley A. Edwards, PhD3 and Scott A. Sands, PhD2,3 1 Monash Lung and Sleep, Monash Health, 2Monash University, Clayton, Victoria, Australia, and 3Division of Sleep Medicine, Brigham andWomen’s Hospital and Harvard Medical School, Boston, Massachusetts, USA Correspondence: Garun S. Hamilton, Monash Lung and Sleep, Monash Health, Monash University, Clayton, Vic. 3800, Australia. Email: [email protected]
REFERENCE 1 Schroll S, Series F, Lewis K, Benjamin A, Escourrou P, Luigart R, Pfeifer M, Arzt M. Acute haemodynamic effects of continuous positive airway pressure in awake patients with heart failure. Respir. 2014; 19: 47–52.
© 2014 Asian Pacific Society of Respirology
768
Correspondences
While we are uncertain about the clinical significance of changes of echocardiographic parameters of diastolic function in the acute setting, we entirely agree that evaluation of long-term effects of positive airway pressure therapy on diastolic dysfunction is a valuable approach in this patient population since (i) in approximately 50% patients with heart failure ejection fraction is preserved (heart failure with preserved ejection fraction);3 and (ii) heart failure with reduced ejection fraction (HFREF) is often accompanied by diastolic dysfunction.4,5 Regardless of the presence of systolic dysfunction, diastolic dysfunction represents an independent prognostic factor for a worse outcome.3,4 Therefore, we evaluated in a recent randomized controlled pilot study5 the effects of adaptive-servo ventilation (ASV) treatment for 12 weeks on echocardiographic parameters of diastolic function in patients with stable HFREF and concomitant diastolic dysfunction. ASV efficiently abolished sleep-disordered breathing, and was associated with a statistically non-significant improvement in measures of diastolic dysfunction (e.g. deceleration time, ASV vs no treatment of sleep-disordered breathing: −43.9 ± 88.8 vs 12.4 ± 68.8, P > 0.05).5 The proportion of patients whose diastolic dysfunction improved was non-significantly higher in the ASV than in the control group, respectively (37% vs 15%, P > 0.05).5 These data provide estimates of effect size and justify the evaluation of the effects of positive airway pressure therapy on diastolic function in larger randomized controlled trials. However, we did not assess the acute effects of positive airway pressure therapy on diastolic function, which might have complemented the presented data on blood pressure, heart rate and non-invasively assessed cardiac output.1,2
Reply 2 Dear Editor: We agree with Gerhardy et al. that it is important to consider the haemodynamic effects of CPAP in pure diastolic heart failure as well as heart failure with impaired ejection fraction. We congratulate the authors on their collection of pilot data assessing echocardiographic parameters in five diastolic heart failure patients. It is reassuring to see that no adverse haemodynamic effects were demonstrated. We believe that the data presented here, in addition to those of Schroll et al.,1 are reassuring, but also justify a larger study in heart failure populations (both systolic and diastolic) assessing the detailed cardiovascular and haemodynamic effects of CPAP therapy. Ultimately, it would be highly desirable to ascertain which Conflict of Interest Statement GSH has received research funding and equipment for research from Resmed, Philips and Compumedics.
Respirology (2014) 19, 767–770
Stephan Schroll, MD, Christoph Birner, MD and Michael Arzt, MD Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany Correspondence: Stephan Schroll, Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg 93053, Germany. Email: [email protected]
REFERENCES 1 Schroll S, Series F, Lewis K, Benjamin A, Escourrou P, Luigart R, Pfeifer M, Arzt M. Acute haemodynamic effects of continuous positive airway pressure in awake patients with heart failure. Respirology 2014; 19: 47–52. 2 Fortin J, Habenbacher W, Heller A, Hacker A, Grullenberger R, Innerhofer J, Passath H, Wagner C, Haitchi G, Flotzinger D et al. Non-invasive beat-to-beat cardiac output monitoring by an improved method of transthoracic bioimpedance measurement. Comput. Biol. Med. 2006; 36: 1185–203. 3 Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003; 289: 194–202. 4 Hansen A, Haass M, Zugck C, Krueger C, Unnebrink K, Zimmermann R, Kuebler W, Kuecherer H. Prognostic value of Doppler echocardiographic mitral inflow patterns: implications for risk stratification in patients with chronic congestive heart failure. J. Am. Coll. Cardiol. 2001; 37: 1049–55. 5 Birner C, Series F, Lewis K, Benjamin A, Wunderlich S, Escourrou P, Zeman F, Luigart R, Pfeifer M, Arzt M. Effects of auto-servo ventilation on patients with sleep-disordered breathing, stable systolic heart failure and concomitant diastolic dysfunction: subanalysis of a randomized controlled trial. Respiration 2014; 87: 54–62.
patients with heart failure will benefit most from the CPAP treatment of sleep-disordered breathing. Garun S. Hamilton MBBS, FRACP, PhD1,2,3, Bradley A. Edwards, PhD3 and Scott A. Sands, PhD2,3 1 Monash Lung and Sleep, Monash Health, 2Monash University, Clayton, Victoria, Australia, and 3Division of Sleep Medicine, Brigham andWomen’s Hospital and Harvard Medical School, Boston, Massachusetts, USA Correspondence: Garun S. Hamilton, Monash Lung and Sleep, Monash Health, Monash University, Clayton, Vic. 3800, Australia. Email: [email protected]
REFERENCE 1 Schroll S, Series F, Lewis K, Benjamin A, Escourrou P, Luigart R, Pfeifer M, Arzt M. Acute haemodynamic effects of continuous positive airway pressure in awake patients with heart failure. Respir. 2014; 19: 47–52.
© 2014 Asian Pacific Society of Respirology
