Iwasaku Toshihiro, Ando Tomotaka, Eguchi Akiyo, Okuhara Yoshitaka, Naito Yoshiro, Mano Toshiaki, Masuyama Tohru, Hirotani Shinichi
Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo College of Medicine.
Int Heart J. 2017 May 31;58(3):393-399. doi: 10.1536/ihj.16-327. Epub 2017 May 8.
We hypothesized that the effects of adaptive servo-ventilation (ASV) therapy were influenced by right-sided heart performance. This study aimed to clarify the interaction between the effects of ASV and right-sided heart performance in patients with stable heart failure (HF) with reduced ejection fraction (HFrEF).Twenty-six stable HF inpatients (left ventricular ejection fraction < 0.45, without moderate to severe mitral regurgitation (MR) were analyzed. Echocardiography was performed before and after 30 minutes of ASV. ASV increased stroke volume index (SVI) in 14 patients (30.0 ± 11.9 to 41.1 ± 16.1 mL/m) and reduced SVI in 12 patients (36.0 ± 10.1 to 31.9 ± 12.2 mL/m). Multivariate linear regression analysis revealed that tricuspid annular plane systolic excursion (TAPSE) before ASV was an independent association factor for (SV during ASV - SV before ASV)/LVEDV × 100 (%) (%ΔSV/LVEDV). ROC analysis of TAPSE for %ΔSV/LVEDV > 0 showed that the cut-off point was 16.5 mm. All patients were divided into 2 groups according to the TAPSE value. Although no significant differences were found in the baseline characteristics and blood tests, there were significant differences in tricuspid lateral annular systolic velocity, TAPSE, right atrial area, and right ventricular (RV) area before ASV between patients with TAPSE ≤ 16.5 mm and those with TAPSE > 16.5 mm. Interestingly, ASV reduced RV area and increased TAPSE in patients with TAPSE ≤ 16.5 mm, while it reduced TAPSE in those > 16.5 mm.ASV therapy has the potential to increase SVI in stable HFrEF patients with low TAPSE.
我们假设适应性伺服通气（ASV）治疗的效果受右心功能影响。本研究旨在阐明射血分数降低的稳定型心力衰竭（HF）患者中ASV效果与右心功能之间的相互作用。分析了26例稳定型HF住院患者（左心室射血分数<0.45，无中度至重度二尖瓣反流（MR））。在ASV治疗30分钟前后进行了超声心动图检查。ASV使14例患者的每搏量指数（SVI）增加（从30.0±11.9增至41.1±16.1 mL/m），而使12例患者的SVI降低（从36.0±10.1降至31.9±12.2 mL/m）。多变量线性回归分析显示，ASV治疗前的三尖瓣环平面收缩期位移（TAPSE）是（ASV期间的SV - ASV治疗前的SV）/左心室舒张末期容积×100%（%ΔSV/LVEDV）的独立关联因素。对%ΔSV/LVEDV>0的TAPSE进行ROC分析表明，截断点为16.5 mm。根据TAPSE值将所有患者分为两组。虽然在基线特征和血液检查方面未发现显著差异，但TAPSE≤16.5 mm的患者与TAPSE>16.5 mm的患者在ASV治疗前的三尖瓣外侧环收缩速度、TAPSE、右心房面积和右心室（RV）面积方面存在显著差异。有趣的是，ASV使TAPSE≤16.5 mm的患者的RV面积减小且TAPSE增加，而使TAPSE>16.5 mm的患者的TAPSE降低。ASV治疗有可能增加TAPSE较低的稳定型HFrEF患者的SVI。
