Nomoto Yu, Imamura Teruhiko, Kinugawa Koichiro
Second Department of Internal Medicine, Toyama University, 2630 Sugitani, Toyama 930-0194, Japan.
J Clin Med. 2024 Jan 24;13(3):674. doi: 10.3390/jcm13030674.
The optimal criteria for patient selection in the context of adaptive servo-ventilation (ASV) therapy remain a subject of ongoing investigation. We postulate that baseline plasma volume, assessable through several straightforward clinical parameters, might be correlated with a more pronounced reduction in plasma B-type natriuretic peptide (BNP) levels following mid-term ASV therapy.
We included patients diagnosed with congestive heart failure who had received continuous ASV therapy for a minimum of three months. The primary outcome of interest was the extent of decline in logarithmically transformed plasma BNP levels, defined as a decrease of more than 0.10 during the 3-month ASV treatment period.
A total of 66 patients were included in the study. The median age of the cohort was 66 years, with 53 patients (80%) being male. The median plasma volume status at baseline was -16.9%, and patients were categorized into two groups based on this median value. Patients with elevated baseline plasma volume status experienced a statistically significant reduction in plasma BNP levels ( = 0.016), whereas those with lower plasma volume exhibited no significant change in BNP levels ( = 0.23). A higher baseline plasma volume status was independently associated with a significant reduction in plasma BNP levels, with an adjusted odds ratio of 1.036 (95% confidence interval: 1.01-1.07, = 0.032).
The presence of systemic congestion at baseline, quantified by the estimated plasma volume status, may serve as a crucial determinant of the efficacy of ASV therapy, leading to improvements in plasma BNP levels among patients suffering from congestive heart failure.
在适应性伺服通气（ASV）治疗中，患者选择的最佳标准仍是一个正在研究的课题。我们推测，通过几个简单的临床参数可评估的基线血浆容量，可能与中期ASV治疗后血浆B型利钠肽（BNP）水平更显著的降低相关。
我们纳入了被诊断为充血性心力衰竭且接受持续ASV治疗至少三个月的患者。感兴趣的主要结局是对数转换后的血浆BNP水平下降程度，定义为在3个月的ASV治疗期间下降超过0.10。
共有66例患者纳入研究。该队列的中位年龄为66岁，其中53例患者（80%）为男性。基线时血浆容量状态的中位数为-16.9%，并根据该中位数将患者分为两组。基线血浆容量状态升高的患者血浆BNP水平有统计学显著降低（P = 0.016），而血浆容量较低的患者BNP水平无显著变化（P = 0.23）。较高的基线血浆容量状态与血浆BNP水平的显著降低独立相关，调整后的优势比为1.036（95%置信区间：1.01 - 1.07，P = 0.032）。
通过估计的血浆容量状态量化的基线全身性充血的存在，可能是ASV治疗疗效的关键决定因素，可使充血性心力衰竭患者的血浆BNP水平得到改善。
