Abstract 17996: Treatment of Sleep-Disordered Breathing and Cardiac Remodeling in Heart Failure With Reduced Ejection Fraction: Insights From the CAT-HF Trial

• Published in: Circulation (New York, N.Y.) N.Y.), 2016-11, Vol.134 (Suppl_1 Suppl 1), p.A17996-A17996
• Main Authors: Daubert, Melissa, Oldenberg, Olaf, Whellan, David, Tasissa, Gudaye, Woehrle, Holger, Punjabi, Naresh, Anstrom, Kevin, Blase, Amy, Benjafield, Adam, Lindenfeld, JoAnn, Fiuzat, Mona, O’Connor, Christopher
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539

IntroductionSleep-disordered breathing (SDB) is a marker of poor prognosis in heart failure and may worsen cardiac dysfunction over time.HypothesisAdaptive servo-ventilation (ASV) treatment of SDB will reverse pathologic cardiac remodeling in heart failure with reduced ejection fraction (HFrEF).MethodsThe Cardiovascular Improvements with Minute Ventilation-targeted Adaptive Servo-Ventilation Therapy in Heart Failure (CAT-HF) trial randomized patients with acute decompensated heart failure and confirmed SDB to either optimal medical therapy (OMT) or treatment with ASV plus OMT. Echocardiograms, performed at baseline and 6 months, evaluated indexed left ventricular (LV) volumes, ejection fraction (EF), E/e’, right ventricular systolic pressure (RVSP) and RV function (TAPSE). Differences between treatment groups were assessed using Wilcoxon rank sum tests.ResultsThe CAT-HF trial was stopped early in response to results of the SERVE-HF trial, which found an increased mortality in patients with chronic HFrEF and predominant central sleep apnea who were treated with ASV. Of the 126 patients that were randomized in CAT-HF prior to trial cessation, 102 patients (52 OMT + ASV; 50 OMT alone) had HFrEF. Baseline echocardiographic characteristics were similar between treatment groups. Both treatment groups demonstrated a decrease in LV end-systolic volume index (LVESVI), -10ml in the ASV group and -9ml in OMT alone. Similarly, both groups had an increase in EF+4% and +5%, respectively. However, there was no difference in LVESVI or EF between treatment groups at 6 months (p=0.39 and p=0.71, respectively) (Figure). There was also a reduction in E/e’ but this did not significantly differ between treatment groups (p=0.49). There was no significant change in RVSP or RV function in either treatment group.ConclusionsAmong HFrEF patients with SDB, there was evidence of reverse LV remodeling regardless of whether patients received OMT with ASV or OMT alone.