LV Structure and Function in HFrEF With and Without Peak-Flow-Triggered Adaptive Servo-Ventilation-Treated Sleep-Disordered Breathing

Shoichiro Yatsu¹, Anna Woo², Christian M Horvath¹, Tomoyuki Tobushi³, Alexander G Logan⁴, John S Floras⁵, George Tomlinson⁶, T Douglas Bradley⁷; ADVENT-HF Investigators

Collaborators, Affiliations

Collaborators

ADVENT-HF Investigators:
G Lorenzi-Filho, L Drager, L R Bittencourt, C Amodeo, Adriana Bertolami, R P Pedrosa, T D Bradley, J S Floras, A G Logan, C M Ryan, D H Delgado, S Mak, G Tomlinson, R S Leung, D Morrison, M Fitzpatrick, P Mayer, R J Kimoff, L Mielniczuk, R Beanlands, F Series, J A Fleetham, C Demers, C Rinne, E Giannouli, F deRoquefeuil, F Goutorbe, S Redolfi, V Puel, R Tamisier, M Arzt, W Randerath, M T La Rovere, G Parati, C Tantucci, L Taranto Montemurro, D Raccagni, T Kasai, Y Takata, Y Tomita, K Narui, S Ando, T Kadokami, T Hirai, K Chin, M Mayos Pérez, P Lloberes Canadell, J F Masa Jimenez, F Barbé, N P González Mangado, F Del Campo, J Durán Cantolla, J M Marin, M González Martinez, A Williams, A Dal Nogare, M Dunlap, D Kapoor, S Parthasarathy

Affiliations

¹ Sleep Research Laboratories of the University Health Network, Toronto Rehabilitation Institute (KITE) and Toronto General Hospital and University of Toronto, Toronto, Canada; Department of Medicine, University Health Network and Sinai Health and University of Toronto, Toronto, Canada.
² Department of Medicine, University Health Network and Sinai Health and University of Toronto, Toronto, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
³ Department of Medicine, University Health Network and Sinai Health and University of Toronto, Toronto, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, Toronto, Ontario, Canada.
⁴ Department of Medicine, University Health Network and Sinai Health and University of Toronto, Toronto, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada.
⁵ Department of Medicine, University Health Network and Sinai Health and University of Toronto, Toronto, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada.
⁶ Toronto General Hospital Research Institute, Toronto, Ontario, Canada.
⁷ Sleep Research Laboratories of the University Health Network, Toronto Rehabilitation Institute (KITE) and Toronto General Hospital and University of Toronto, Toronto, Canada; Department of Medicine, University Health Network and Sinai Health and University of Toronto, Toronto, Canada. Electronic address: douglas.bradley@utoronto.ca.

PMID: 40310326
DOI: 10.1016/j.jchf.2025.02.016

LV Structure and Function in HFrEF With and Without Peak-Flow-Triggered Adaptive Servo-Ventilation-Treated Sleep-Disordered Breathing

Shoichiro Yatsu et al. JACC Heart Fail. 2025.

. 2025 Apr 30:102434.

doi: 10.1016/j.jchf.2025.02.016. Online ahead of print.

Authors

Shoichiro Yatsu¹, Anna Woo², Christian M Horvath¹, Tomoyuki Tobushi³, Alexander G Logan⁴, John S Floras⁵, George Tomlinson⁶, T Douglas Bradley⁷; ADVENT-HF Investigators

Collaborators

ADVENT-HF Investigators:
G Lorenzi-Filho, L Drager, L R Bittencourt, C Amodeo, Adriana Bertolami, R P Pedrosa, T D Bradley, J S Floras, A G Logan, C M Ryan, D H Delgado, S Mak, G Tomlinson, R S Leung, D Morrison, M Fitzpatrick, P Mayer, R J Kimoff, L Mielniczuk, R Beanlands, F Series, J A Fleetham, C Demers, C Rinne, E Giannouli, F deRoquefeuil, F Goutorbe, S Redolfi, V Puel, R Tamisier, M Arzt, W Randerath, M T La Rovere, G Parati, C Tantucci, L Taranto Montemurro, D Raccagni, T Kasai, Y Takata, Y Tomita, K Narui, S Ando, T Kadokami, T Hirai, K Chin, M Mayos Pérez, P Lloberes Canadell, J F Masa Jimenez, F Barbé, N P González Mangado, F Del Campo, J Durán Cantolla, J M Marin, M González Martinez, A Williams, A Dal Nogare, M Dunlap, D Kapoor, S Parthasarathy

Affiliations

¹ Sleep Research Laboratories of the University Health Network, Toronto Rehabilitation Institute (KITE) and Toronto General Hospital and University of Toronto, Toronto, Canada; Department of Medicine, University Health Network and Sinai Health and University of Toronto, Toronto, Canada.
² Department of Medicine, University Health Network and Sinai Health and University of Toronto, Toronto, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
³ Department of Medicine, University Health Network and Sinai Health and University of Toronto, Toronto, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, Toronto, Ontario, Canada.
⁴ Department of Medicine, University Health Network and Sinai Health and University of Toronto, Toronto, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada.
⁵ Department of Medicine, University Health Network and Sinai Health and University of Toronto, Toronto, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada.
⁶ Toronto General Hospital Research Institute, Toronto, Ontario, Canada.
⁷ Sleep Research Laboratories of the University Health Network, Toronto Rehabilitation Institute (KITE) and Toronto General Hospital and University of Toronto, Toronto, Canada; Department of Medicine, University Health Network and Sinai Health and University of Toronto, Toronto, Canada. Electronic address: douglas.bradley@utoronto.ca.

PMID: 40310326
DOI: 10.1016/j.jchf.2025.02.016

Abstract

Background: Sleep-disordered breathing (SDB), comprising obstructive sleep apnea (OSA) and central sleep apnea (CSA), could promote left ventricular (LV) remodeling and systolic dysfunction.

Objectives: The authors tested the hypothesis, in the ADVENT-HF (Adaptive Servo-ventilation for Sleep-disordered Breathing in Patients with Heart Failure with Reduced Ejection Fraction) trial, that SDB is associated with reversible impairment of LV structure and function.

Methods: Participants underwent echocardiography (ejection fraction ≤45%) and polysomnography. They were classified as no-SDB (apnea-hypopnea index [AHI] <15/h); OSA (AHI ≥15/h with ≥50% of events obstructive), or CSA (AHI ≥15 with >50% of events central). Those with SDB were randomized to a control group or to peak-flow-triggered adaptive servo-ventilation (ASV_PF) to treat SDB and, in them, echocardiography was repeated 6 months later.

Results: Subjects with OSA (n = 543) had similar LV structure and function to those without SDB (n = 56). Subjects with CSA (n = 201) had greater LV mass index and lower LV ejection fraction than the other groups. LV volumes were higher in the CSA than in the OSA group (P < 0.05 for all). ASV_PF abolished SDB, but had no significant effect, whether evaluated by allocation or adherence, 6 months post-randomization on LV structure or function for the entire cohort (n = 549), or either subgroup.

Conclusions: Among patients with heart failure with reduced ejection fraction, those with OSA had similar LV structure and function to those without SDB. Patients with CSA had greater LV remodeling and systolic dysfunction than those with OSA or without SDB. Six months of SDB suppression of OSA and CSA by ASV_PF had no impact on LV structure or function. (Adaptive Servo-ventilation for Sleep-disordered Breathing in Patients with Heart Failure with Reduced Ejection Fraction [ADVENT-HF]).

Keywords: central sleep apnea; echocardiography; left ventricular remodeling; obstructive sleep apnea; randomized controlled clinical trial.

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Conflict of interest statement

Funding Support and Author Disclosures Partial funding for this trial and the peak-flow-triggered adaptive servo-ventilation devices were provided by Philips RS North America LLC. These resources supported the work of all co-authors and trial sites. The trial was jointly funded by the Canadian Institutes of Health Research (operating grant IS2-95225) and, in accordance with its University-Industry Partnership Program, by Philips RS North America LLC, which also provided ASV(PF) devices. Neither funding source participated in the design or conduct of the trial, the collection, analysis, or interpretation of data, the writing of the manuscript, or the decision to submit its findings for publication. Dr Horvath was supported by the Continuing Medical Education Fellowship in Respiratory Medicine from the Division of Respirology of the University of Toronto. Dr Tobushi was supported by the Sinai Health Foundation. Dr Bradley was supported by the Godfrey S. Pettit Chair in Respiratory Medicine. Dr Floras was supported by the Tier I Canada Research Chair in Integrative Cardiovascular Biology. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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LV Structure and Function in HFrEF With and Without Peak-Flow-Triggered Adaptive Servo-Ventilation-Treated Sleep-Disordered Breathing

Collaborators

Affiliations

LV Structure and Function in HFrEF With and Without Peak-Flow-Triggered Adaptive Servo-Ventilation-Treated Sleep-Disordered Breathing

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

LinkOut - more resources

Full Text Sources

Research Materials

Miscellaneous