Acute hemodynamic effects of adaptive servoventilation in patients with pre-capillary and post-capillary pulmonary hypertension

Karen M. Olsson, Anika Frank, Jan Fuge, Tobias Welte, Marius M. Hoeper, Thomas Bitter

The hemodynamic effects of adaptive servoventilation (ASV) in patients with pulmonary hypertension (PH) are unknown. A series of clinically stable patients with pre- or post-capillary PH underwent ASV therapy (endexpiratory positive airway pressure support 12-14 cm H2O, pressure support 4-10 cm H2O) during right heart catheterization. Hemodynamics were measured at rest, at the end of a 15-min episode of ASV therapy, and 15 min after ASV completion. Hemodynamic variables included heart rate, blood pressure, right atrial pressure (RAP), mean pulmonary artery pressure (PAPm), pulmonary arterial wedge pressure (PAWP), cardiac output and pulmonary vascular resistance (PVR). The study enrolled 33 patients; 12 patients with post-capillary PH due to heart failure with preserved ejection fraction, and 21 patients with pre-capillary PH due to pulmonary arterial hypertension (n = 8) or chronic thromboembolic pulmonary hypertension (n = 13). ASV was well tolerated by all patients and resulted in reductions in systolic blood pressure (-8 mmHg, p = 0.01), PAPm (-5 mmHg, p <0.001) and PVR (-10 %, p = 0.01). Right and left filling pressure increased, while the cardiac output decreased (-0.4 L/min; p < 0.001). The hemodynamic effects of ASV were similar in both patient populations. ASV had moderate hemodynamic effects in patients with PH of various origins, most importantly a decline in systolic blood pressure, PAPm and cardiac output. ASV was safe and well tolerated during this short-term study, but the observed drop in blood pressure and cardiac output may be of concern if ASV is applied in patients with advanced PH and severely impaired right ventricular function.