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THE EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE ON RV FUNCTION IN PATIENTS WITH CHF AND OSA: A RANDOMIZED CONTROL TRIAL
Abstracts
May 2008 and March 2015. All perioperative and follow-up data on LVAD recipients was collected in a prospective manner. We reviewed the patient characteristics and clinical outcomes between the two groups. RESULTS: During the study period, 32 HMII and 76 HVAD were implanted. Baseline characteristics for the HMII and HVAD were: age 49.5 yrs. vs. 48.4 yrs. (p¼0.77), male sex 65.6% vs. 65.8% (p¼0.98), ischemic cardiomyopathy 28.1% vs. 40.8% (p¼0.005). The treatment strategy at time of LVAD implantation was 15.6% BTC and 81.3% BTT for HMII and 39.5% BTC and 57.9% BTT for HVAD (p¼ 0.05). The mean duration of support was 377.3 days for HMII and 264.4 days for HVAD. Seven (21.9%) HMII’s and 5 (6.6%) HVAD’s were explanted, respectively (p¼0.005). The 1-year survival was 86% for HMII and 83% HVAD (p>0.05). Table 1 shows the number of events per patient year (EPY) for LVAD related complications. There were no significant differences between the two groups related to gastrointestinal or cerebral bleeding, thromboembolic events, or driveline infections. Patients with HVAD devices had significantly more strokes than HMII (0.38 EPY vs. 0.09 EPY, respectively, p¼0.04). CONCLUSION: Although one-year survival was similar in HMII and HVAD patients, the incidence of stroke was significantly higher in HVAD patients, a finding that is consistent with those reported in previous studies. Larger comparative analyses are necessary to support our findings and further elucidate clinically relevant difference between the two devices.
Canadian Cardiovascular Society (CCS) Oral LEST WE FORGET: THE RIGHT HEART Sunday, October 25, 2015
S203 BACKGROUND: Obstructive sleep apnea (OSA) is common in patients with congestive heart failure (CHF) and can contribute to disease progression. Continuous positive airway pressure (CPAP) is used to treat OSA and has been shown to improve left ventricular function in CHF patients. However, the effects of CPAP therapy on right ventricular (RV) function, an independent predictor of outcome in CHF patients, are not known. METHODS: In this randomized controlled trial, 45 patients with OSA (apnea/hypopnea index >10 events/hour by nocturnal polysomnography) and stable CHF (left ventricular ejection fraction 45% and at least NYHA Class II symptoms) were randomized to receive CPAP (n¼22) or no CPAP (n¼23) therapy. Echocardiography was used to measure RV systolic and diastolic function parameters at baseline and after 6-8 weeks. RESULTS: In the CPAP treatment group, RV fractional area change (FAC) improved from baseline to follow-up study (38.2 10.9% to 41.4 11.5%, p¼0.04). In contrast, there was no change in RV FAC in the no CPAP group (43.9 7.2% to 44.4 7.8%, p¼0.60). Tricuspid annular systolic excursion velocity, RV myocardial performance index, and tricuspid E/A and E/e’ ratios did not change in either cohort. On subgroup analysis, patients with impaired RV systolic function at baseline demonstrated an improvement in RV FAC with CPAP therapy compared to those who did not receive CPAP therapy (+5.0 4.5% vs. -0.5 5.2%, p¼0.04). No improvement in RV FAC was observed in patients with normal RV systolic function at baseline (+1.7 6.4% vs. +1.4 2.0%, p¼0.87). CONCLUSION: In patients with CHF and OSA, short-term CPAP therapy improved RV FAC but had no effect on other measures of RV systolic and diastolic function. The improvement in RV FAC with CPAP was limited to those patients with abnormal baseline RV systolic function. Further studies are required to elucidate the potential longer-term effects of CPAP therapy on RV function in CHF patients with OSA.
384 THE UTILITY OF BEDSIDE CLINICAL ASSESSMENT OF INTRAVASCULAR VOLUME STATUS WITH HAND CARRIED ULTRASOUND DEVICES IN HEMODIALYSIS CLINICS H Bews, Y Zhang, C Rigatto, M Sood, N Tangri, A Eng, P Komenda, DS Jassal Winnipeg, Manitoba
383 THE EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE ON RV FUNCTION IN PATIENTS WITH CHF AND OSA: A RANDOMIZED CONTROL TRIAL S Promislow, IG Burwash, J Leech, L Mielniczuk, A Guo, K Chan, L Beauchesne, R deKemp, H Haddad, O Walter, L Garrard, J Floras, R Beanlands, G Dwivedi Ottawa, Ontario
BACKGROUND:
In Canada, the majority of end stage renal disease (ESRD) patients undergo conventional facility based hemodialysis. Despite technological advancements, conventional hemodialysis is associated with significant patient morbidity and mortality related to fluid imbalances. Inaccurate hemodialysis prescriptions calculated from clinical estimates of intravascular volume status (IVS) may serve as a major contributor to patient morbidity. Previous studies have
May 2008 and March 2015. All perioperative and follow-up data on LVAD recipients was collected in a prospective manner. We reviewed the patient characteristics and clinical outcomes between the two groups. RESULTS: During the study period, 32 HMII and 76 HVAD were implanted. Baseline characteristics for the HMII and HVAD were: age 49.5 yrs. vs. 48.4 yrs. (p¼0.77), male sex 65.6% vs. 65.8% (p¼0.98), ischemic cardiomyopathy 28.1% vs. 40.8% (p¼0.005). The treatment strategy at time of LVAD implantation was 15.6% BTC and 81.3% BTT for HMII and 39.5% BTC and 57.9% BTT for HVAD (p¼ 0.05). The mean duration of support was 377.3 days for HMII and 264.4 days for HVAD. Seven (21.9%) HMII’s and 5 (6.6%) HVAD’s were explanted, respectively (p¼0.005). The 1-year survival was 86% for HMII and 83% HVAD (p>0.05). Table 1 shows the number of events per patient year (EPY) for LVAD related complications. There were no significant differences between the two groups related to gastrointestinal or cerebral bleeding, thromboembolic events, or driveline infections. Patients with HVAD devices had significantly more strokes than HMII (0.38 EPY vs. 0.09 EPY, respectively, p¼0.04). CONCLUSION: Although one-year survival was similar in HMII and HVAD patients, the incidence of stroke was significantly higher in HVAD patients, a finding that is consistent with those reported in previous studies. Larger comparative analyses are necessary to support our findings and further elucidate clinically relevant difference between the two devices.
Canadian Cardiovascular Society (CCS) Oral LEST WE FORGET: THE RIGHT HEART Sunday, October 25, 2015
S203 BACKGROUND: Obstructive sleep apnea (OSA) is common in patients with congestive heart failure (CHF) and can contribute to disease progression. Continuous positive airway pressure (CPAP) is used to treat OSA and has been shown to improve left ventricular function in CHF patients. However, the effects of CPAP therapy on right ventricular (RV) function, an independent predictor of outcome in CHF patients, are not known. METHODS: In this randomized controlled trial, 45 patients with OSA (apnea/hypopnea index >10 events/hour by nocturnal polysomnography) and stable CHF (left ventricular ejection fraction 45% and at least NYHA Class II symptoms) were randomized to receive CPAP (n¼22) or no CPAP (n¼23) therapy. Echocardiography was used to measure RV systolic and diastolic function parameters at baseline and after 6-8 weeks. RESULTS: In the CPAP treatment group, RV fractional area change (FAC) improved from baseline to follow-up study (38.2 10.9% to 41.4 11.5%, p¼0.04). In contrast, there was no change in RV FAC in the no CPAP group (43.9 7.2% to 44.4 7.8%, p¼0.60). Tricuspid annular systolic excursion velocity, RV myocardial performance index, and tricuspid E/A and E/e’ ratios did not change in either cohort. On subgroup analysis, patients with impaired RV systolic function at baseline demonstrated an improvement in RV FAC with CPAP therapy compared to those who did not receive CPAP therapy (+5.0 4.5% vs. -0.5 5.2%, p¼0.04). No improvement in RV FAC was observed in patients with normal RV systolic function at baseline (+1.7 6.4% vs. +1.4 2.0%, p¼0.87). CONCLUSION: In patients with CHF and OSA, short-term CPAP therapy improved RV FAC but had no effect on other measures of RV systolic and diastolic function. The improvement in RV FAC with CPAP was limited to those patients with abnormal baseline RV systolic function. Further studies are required to elucidate the potential longer-term effects of CPAP therapy on RV function in CHF patients with OSA.
384 THE UTILITY OF BEDSIDE CLINICAL ASSESSMENT OF INTRAVASCULAR VOLUME STATUS WITH HAND CARRIED ULTRASOUND DEVICES IN HEMODIALYSIS CLINICS H Bews, Y Zhang, C Rigatto, M Sood, N Tangri, A Eng, P Komenda, DS Jassal Winnipeg, Manitoba
383 THE EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE ON RV FUNCTION IN PATIENTS WITH CHF AND OSA: A RANDOMIZED CONTROL TRIAL S Promislow, IG Burwash, J Leech, L Mielniczuk, A Guo, K Chan, L Beauchesne, R deKemp, H Haddad, O Walter, L Garrard, J Floras, R Beanlands, G Dwivedi Ottawa, Ontario
BACKGROUND:
In Canada, the majority of end stage renal disease (ESRD) patients undergo conventional facility based hemodialysis. Despite technological advancements, conventional hemodialysis is associated with significant patient morbidity and mortality related to fluid imbalances. Inaccurate hemodialysis prescriptions calculated from clinical estimates of intravascular volume status (IVS) may serve as a major contributor to patient morbidity. Previous studies have