Key result
ASV fails to reduce sympathetic nerve activity vs medical therapy, with lower MSNA predicting worse prognosis.
Why the study?
Does adaptive servo-ventilation (ASV) alter peripheral nervous sympathetic activity (MSNA) compared to medical treatment in heart failure patients with central sleep apnoea?
Does adaptive servo-ventilation (ASV) alter peripheral nervous sympathetic activity (MSNA) compared to medical treatment in heart failure patients with central sleep apnoea?
In heart failure patients with central sleep apnoea, ASV does not significantly change sympathetic nerve activity over 12 weeks, but reduced sympathetic activity is paradoxically associated with worse prognosis in those receiving ASV.
Answers are grounded in this paper and cite their sources.
No support for MSNA as ASV mechanism in HF; leaves open treatment-specific prognostic value of sympathetic activity.
Heart failure (HF) due to left ventricular systolic dysfunction is characterised by numerous neuro-hormonal alterations, a prominent feature of which is activation of the sympathetic nervous system. The pathogenesis of sympatho-excitation in HF, albeit yet to be fully elucidated, is multifactorial, including blunted cardiopulmonary inhibition, arterial baroreceptor desensitisation, exacerbated muscle mechanoreceptor control, chemoreflex dysfunction, augmented cardiac reflex sympatho-excitation, and the influences of abnormal humoral and metabolic products within the central nervous system [1]. This sub-study of the SERVE-HF study found unchanged peripheral nervous sympathetic activity (MSNA) in heart failure patients on medical treatment or on ASV after 12 weeks. Reduced MSNA was associated with worse prognosis only in the ASV group. http://bit.ly/3i5WRRb
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Bonsignore et al. (2023) conducted an editorial in Heart failure with left ventricular systolic dysfunction and central sleep apnoea. Adaptive servo-ventilation (ASV) vs. Medical treatment was evaluated on Peripheral muscle sympathetic nerve activity (MSNA) and prognosis. Adaptive servo-ventilation (ASV) resulted in unchanged peripheral sympathetic activity (MSNA) at 12 weeks vs medical therapy, while reduced MSNA predicted worse prognosis only in the ASV group.
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