A novel optimized adaptive servo-ventilation setting for a patient with severe heart failure based on the echocardiogram: A case report

Background Adaptive servo-ventilation is a non-invasive positive-pressure ventilation therapy considered beneficial for treating heart failure in patients with central sleep apnea. However, to the best of our knowledge, there is no evidence indicating that this therapy increases the mortality in heart failure patients. We hypothesized that adaptive servo-ventilation settings are important for heart failure patients with reduced ejection fraction. Therefore, to determine the suitable adaptive servo-ventilation setting for such patients, we optimized these settings to improve the left ventricular output during the therapy. Case Summary We present a case of heart failure caused by dilated cardiomyopathy in a 45-year-old man. He was hospitalized due to heart failure; his left ventricular ejection fraction was approximately 20%, and hemodynamics analysis revealed his heart failure grade was Forrester subset IV. During hospitalization, he was diagnosed with sleep apnea; therefore, we induced adaptive servo-ventilation with our optimized setting using an echocardiogram evaluating stroke volume. Using this method, we could determine the appropriate setting that increased his stroke volume and improved his apnea-hypopnea index. At the fifth-year follow-up, he had no dyspnoea on effort (New York Heart Association Functional Classification I). He continued using the adaptive servo-ventilation with good adherence, and no hospitalization for ventricular arrhythmia and heart failure was reported. Discussion Our adaptive servo-ventilation optimized setting showed beneficial effects in a heart failure patient with reduced ejection fraction. This method improved the patient's stroke volume and apnea-hypopnea index, indicating that this novel method should be considered for heart failure patients with reduced ejection fraction.

Automated summary

Optimized adaptive servo-ventilation settings showed beneficial effects in a heart failure patient with reduced ejection fraction, improving stroke volume and apnea-hypopnea index.