Daubert MA, et al. - Whether treatment of sleep-disordered breathing (SDB) with adaptive servo-ventilation (ASV) can reverse pathologic cardiac remodeling in heart failure (HF) patients, was investigated this trial. Treating heart failure with reduced ejection fraction (HFrEF) patients with SDB resulted in significant reverse left ventricle (LV) remodeling regardless of treatment allocation. ASV treatment may also improve diastolic function, as indicated by the observed substantial reductions in left atrium (LA) volume among HFrEF and preserved EF (HFpEF) patients receiving ASV.

Methods

• In the Cardiovascular Improvements with Minute Ventilation-targeted Adaptive Servo-Ventilation Therapy in Heart Failure (CAT-HF) trial, patients with acute decompensated HF and confirmed SDB were randomized to either optimal medical therapy (OMT) or treatment with ASV and OMT.
• This trial included patients with reduced ejection fraction (HFrEF) or preserved EF (HFpEF).
• Cardiac size and function as well as cardiac remodeling over time were assessed using echocardiograms, performed at baseline and 6 months.
• The CAT-HF trial was stopped early after the SERVE-HF trial found increased mortality among HFrEF patients with central sleep apnea treated with ASV.

Results

• Both baseline and 6-month echocardiograms (77 HFrEF and 18 HfpEF) were available for 95 of 126 patients enrolled before trial termination.
• Researchers noted that, among HFrEF patients, both treatment arms showed a significant increase in EF: +4.3% in the ASV group (0.0004) and+ 4.6% in OMT alone (P=.007) and a significant decrease in LV end-systolic volume index: -9.4 ml/m² in the ASV group (P=.01) and -8.6 ml/m² in OMT alone (P=.003).
• In the ASV arm, greater reductions were noted in left atrial (LA) volume and E/e’, while more improvement in right ventricular function was observed in patients receiving OMT alone.
• A decrease in LA size was noted in HFpEF patients treated with ASV; this decrease was greater than those receiving OMT alone.
• No significant intergroup differences were noted at 6 months despite the presence of significant intragroup changes within the ASV + OMT and OMT alone groups.