Details

Autor(en) / Beteiligte

• Forde, I
• Mansukhani, MP
• Kolla, B
• Olson, LJ
• Morgenthaler, TI

Titel

1050 UTILITY OF NT-PROBNP TO SCREEN FOR HEART FAILURE WITH REDUCED EJECTION FRACTION IN CENTRAL SLEEP APNEA CONSIDERED FOR ADAPTIVE SERVOVENTILATION

Ist Teil von

• Sleep (New York, N.Y.), 2017-04, Vol.40 (suppl_1), p.A390-A391

Ort / Verlag

US: Oxford University Press

Erscheinungsjahr

2017

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• Abstract Introduction: Adaptive servoventilation (ASV) has been demonstrated to better control disordered breathing events in patients with central sleep apnea (CSA). However, in the recent SERVE-HF trial, increased all-cause and cardiovascular mortality was observed in patients with symptomatic heart failure (HF) with left ventricular ejection fraction (LVEF) ≤45% and CSA treated with ASV. Wait times for echocardiography can vary between 2 to 6 weeks. The aim of this study was to determine whether there is an NT-proBNP level that corresponds to LVEF <45% in candidates for ASV treatment. Methods: A retrospective chart review of patients with CSA commenced on ASV was performed on a Rochester Epidemiology Project cohort from Olmsted County, MN (n=315). LVEF reported on echocardiography performed closest to date of diagnostic polysomnography and NT-proBNP level obtained within 1 year of echocardiography, were recorded. Results: A total of 117 subjects (mean age 73.5 ± 12.3 years, 82.1% male, 98.3% white, mean BMI 30.84 ± 6.25 kg/m2) had NT-proBNP level performed within 1 year of polysomnography. Median EF was 45% (Q1:30, Q3: 60%) and median NT-proBNP 1472 pg/mL (Q1:700, Q3: 3210pg/mL). Forty-eight % of patients had LVEF<45%. NT-proBNP negatively correlated with LVEF (Pearson’s correlation coefficient -0.17, p=0.001). The receiver operating characteristic (ROC) curve generated by examining different BNP thresholds for predicting EF< 45, had an area under the curve of 0.63 (SE 0.05, 95% CI 0.53–0.71, p=0.016). NT-proBNP level >453pg/mL corresponded to LVEF<45% with sensitivity of 91% and specificity of 23% (95% CI 13.4–36.0) whereas NT-proBNP >4134pg/mL (LVEF <45%) had a specificity of 90.0% and sensitivity of 30.3% (95% CI 79.5–96.2). Conclusion: NT-proBNP level >453pg/mL in conjunction with clinical history in patients with CSA, who are candidates for ASV treatment, may help identify those that need further testing with echocardiography to estimate LVEF. NT-proBNP value >4134pg/mL could conceivably eliminate need for routine echocardiography in this group of patients. Addition of other clinical variables might further refine predictive capabilities. Support (If Any):