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Randomized Controlled Trial
. 2018 Mar;20(3):536-544.
doi: 10.1002/ejhf.1048. Epub 2017 Nov 30.

Adaptive servo-ventilation for central sleep apnoea in systolic heart failure: results of the major substudy of SERVE-HF

Martin R Cowie  1 , Holger Woehrle  2   3 , Karl Wegscheider  4 , Eik Vettorazzi  4 , Susanne Lezius  4 , Wolfgang Koenig  5   6   7 , Frank Weidemann  8   9 , Gillian Smith  10 , Christiane Angermann  11 , Marie-Pia d'Ortho  12 , Erland Erdmann  13 , Patrick Levy  14 , Anita K Simonds  10 , Virend K Somers  15 , Faiez Zannad  16 , Helmut Teschler  17
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Free article
Randomized Controlled Trial

Adaptive servo-ventilation for central sleep apnoea in systolic heart failure: results of the major substudy of SERVE-HF

Martin R Cowie et al. Eur J Heart Fail. 2018 Mar.
Free article

Abstract

Aims: The SERVE-HF trial investigated the impact of treating central sleep apnoea (CSA) with adaptive servo-ventilation (ASV) in patients with systolic heart failure. A preplanned substudy was conducted to provide insight into mechanistic changes underlying the observed effects of ASV, including assessment of changes in left ventricular function, ventricular remodelling, and cardiac, renal and inflammatory biomarkers.

Methods and results: In a subset of the 1325 randomised patients, echocardiography, cardiac magnetic resonance imaging (cMRI) and biomarker analysis were performed at baseline, and 3 and 12 months. In secondary analyses, data for patients with baseline and 12-month values were evaluated; 312 patients participated in the substudy. The primary endpoint, change in echocardiographically determined left ventricular ejection fraction from baseline to 12 months, did not differ significantly between the ASV and the control groups. There were also no significant between-group differences for changes in left ventricular dimensions, wall thickness, diastolic function or right ventricular dimensions and ejection fraction (echocardiography), and on cMRI (in small patient numbers). Plasma N-terminal pro B-type natriuretic peptide concentration decreased in both groups, and values were similar at 12 months. There were no significant between-group differences in changes in cardiac, renal and systemic inflammation biomarkers.

Conclusion: In patients with systolic heart failure and CSA, addition of ASV to guideline-based medical management had no statistically significant effect on cardiac structure and function, or on cardiac biomarkers, renal function and systemic inflammation over 12 months. The increased cardiovascular mortality reported in SERVE-HF may not be related to adverse remodelling or worsening heart failure.

Keywords: Adaptive servo-ventilation; Biomarkers; Cardiac function; Central sleep apnoea; Heart failure.

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