Determinants of Transvenous Phrenic Nerve Stimulation-Induced Improvements in LV Function in Central Sleep Apnea and Heart Failure.

IF 5.6 2区医学 Q1 Medicine

Sleep Pub Date : 2025-03-28 DOI:10.1093/sleep/zsaf085

Ali Azarbarzin, Neda Esmaeili, Daniel Vena, Ludovico Messineo, Susan Redline, Scott McKane, Andrew Wellman, Shahrokh Javaheri, Scott A Sands

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引用次数: 0

Abstract

Study objectives: Central sleep apnea (CSA) is common in heart failure (HF) patients but its treatment's impact on cardiac function is unclear. Transvenous phrenic nerve stimulation (TPNS) is an emerging CSA therapy that may improve long-term left ventricular systolic function (LVEF) in HF. Given the cardiovascular risk of sleep apnea appears contingent on respiratory-event-related heart rate surges ("high ∆HR"), we hypothesized that TPNS treatment may preferentially improve LVEF in CSA patients with high ∆HR.

Methods: In the remedē® System pivotal trial, ∆HR was calculated from baseline polysomnography in patients with HF. Primary analysis quantified whether treatment-related change in left ventricular ejection fraction (∆LVEF; echocardiography, biplane method) vs. control was greater in "high ∆HR" (>14.6 beats/min, i.e.,fourth quartile) vs. "low ∆HR (≤4.2 beats/min, i.e., first quartile)" at 6 months (treatment-by-"high ∆HR" interaction). Longitudinal analysis quantified whether favorable LVEF changes from baseline were maintained longer term (6-12 months).

Results: In primary analysis (N=79, M:F=74:5, LVEF=34±12% [mean±SD]), TPNS vs. control was associated with a markedly greater improvement in LVEF in patients with high ∆HR vs. low ∆HR (estimate [95%CI]: +7.8[0.37,15.2]%, P-interaction=0.04). In longitudinal analysis, LVEF increased in patients with high ∆HR at 6, 9, and 12 months (+2.5[-0.1,5.1]%, +3.9[1.2,6.5]%, +3.7[1.0,6.4]% from baseline, respectively) but not among low ∆HR (-0.1[-2.8, 2.6]%; -0.3[-3.1, 2.4]%; -0.8[-3.7, 2.1]%).

Conclusions: Compared to low ∆HR, patients with high ∆HR showed greater LVEF improvement with TPNS for CSA. High ∆HR, a potential reflection of CSA-related sympathetic overactivity, may identify those who benefit most from CSA treatment.

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来源期刊

Sleep Medicine-Neurology (clinical)

CiteScore

8.70

自引率

10.70%

发文量

期刊介绍： SLEEP® publishes findings from studies conducted at any level of analysis, including: Genes Molecules Cells Physiology Neural systems and circuits Behavior and cognition Self-report SLEEP® publishes articles that use a wide variety of scientific approaches and address a broad range of topics. These may include, but are not limited to: Basic and neuroscience studies of sleep and circadian mechanisms In vitro and animal models of sleep, circadian rhythms, and human disorders Pre-clinical human investigations, including the measurement and manipulation of sleep and circadian rhythms Studies in clinical or population samples. These may address factors influencing sleep and circadian rhythms (e.g., development and aging, and social and environmental influences) and relationships between sleep, circadian rhythms, health, and disease Clinical trials, epidemiology studies, implementation, and dissemination research.