Acute Effects of Continuous Positive Air way Pressure on Pulse Pressure
in Chronic Heart Failure |
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Authors: | M?nica Quint?o Sérgio Chermont Luana Marchese Lúcia Brand?o Sabrina Pereira Bernardez Evandro Tinoco Mesquita Nazareth de Novaes Rocha Ant?nio Claudio L Nóbrega |
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Institution: | 1. Programa de Pós-graduação em Ciências Cardiovasculares/Universidade Federal Fluminense, Teresópolis, RJ - Brazil ;2. Clínica de Insuficiência Cardíaca (CLIC)/Centro Universitário Serra dos Órgãos, Teresópolis, RJ - Brazil |
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Abstract: | Background Patients with heart failure (HF) have left ventricular dysfunction and reduced
mean arterial pressure (MAP). Increased adrenergic drive causes vasoconstriction
and vessel resistance maintaining MAP, while increasing peripheral vascular
resistance and conduit vessel stiffness. Increased pulse pressure (PP) reflects a
complex interaction of the heart with the arterial and venous systems. Increased
PP is an important risk marker in patients with chronic HF (CHF). Non-invasive
ventilation (NIV) has been used for acute decompensated HF, to improve congestion
and ventilation through both respiratory and hemodynamic effects. However, none of
these studies have reported the effect of NIV on PP. ObjectiveThe objective of this study was to determine the acute effects of NIV with CPAP on
PP in outpatients with CHF. MethodsFollowing a double-blind, randomized, cross-over, and placebo-controlled protocol,
twenty three patients with CHF (17 males; 60 ± 11 years; BMI 29 ± 5
kg/cm2, NYHA class II, III) underwent CPAP via nasal mask for 30 min
in a recumbent position. Mask pressure was 6 cmH2O, whereas placebo was
fixed at 0-1 cmH2O. PP and other non invasive hemodynamics variables
were assessed before, during and after placebo and CPAP mode. ResultsCPAP decreased resting heart rate (Pre: 72 ± 9; vs. Post 5 min: 67 ± 10 bpm; p
< 0.01) and MAP (CPAP: 87 ± 11; vs. control 96 ± 11 mmHg; p < 0.05 post 5
min). CPAP decreased PP (CPAP: 47 ± 20 pre to 38 ± 19 mmHg post; vs. control: 42 ±
12 mmHg, pre to 41 ± 18 post p < 0.05 post 5 min). Conclusion NIV with CPAP decreased pulse pressure in patients with stable CHF. Future
clinical trials should investigate whether this effect is associated with improved
clinical outcome. |
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Keywords: | Heart Failure Pulse Pressure CPAP |
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