セキグチ　ハルキ   SEKIGUCHI Haruki   関口　治樹    所属   医学部 医学科（東京女子医科大学病院）    職種   准教授
言語種別	日本語
発表タイトル	Optimized Settings for Adaptive Servo-ventilation in Patients with Severe Heart Failure Diagnosed Using Echocardiography
会議名	第83回日本循環器学会学術集会
主催者	日本循環器学会
学会区分	全国規模の学会
発表形式	ポスター掲示
講演区分	一般
発表者・共同発表者	◎田中友佳子, 谷野紗恵, 関口治樹, 芹澤直紀, 新井光太郎, 鈴木真由美, 志賀剛, 萩原誠久
発表年月日	2019/03/31
開催地 （都市, 国名）	横浜市
概要	*Poster Session (Japanese)98 Heart Failure Non Pharmacology 4 Background: Adaptive servo-ventilation (ASV) is reportedly beneficial for the treatment of heart failure in patients with central sleep apnea syndrome. However, SERVE-HF trial reported that ASV treatment increased mortality. One cause of the negative result was considered to be the low output induced by high expiratory positive airway pressure (EPAP) against the background of low left ventricular ejection fraction (LVEF).Hypothesis: We hypothesized that optimized ASV settings can be determined by evaluating outflow by using echocardiography, thereby ensuring benefits for patients with severe heart failure(HF).Methods: Between July 2016 and March 2017, we optimized ASV settings by using hemodynamic parameters on echocardiography in hospitalized patients with severe HF. We calculated stroke volume (SV) by using the time-velocity integral in the LV outflow tract and compared the response to ASV with EPAP settings of 2, 4, 6, or 8 mmHg. We determined the optimal setting at which the SV reached the maximum value. We compared re-hospitalization between the patients who used ASV with titration (n=22) and without titration (n=28).Result: We evaluated 50 patients with severe HF (mean EF, 32%). ASV treatment improved the SV (from 53.4 to 58.8 ml, P<0.05) when optimal settings were used. During the 1 year follow-up, significantly fewer number of hospitalization patients observed in the patients without ASV titration than in those with ASV titration (23.7% vs 57.1%, respectively; p <0.05).Conclusion: The result indicated that the optimal setting for ASV may be beneficial for preventing re-hospitalization in patients with severe HF. Whether optimal ASV settings reduce mortality in these patients must be investigated.