Background and study objectives: Noninvasive positive
airway pressure may play a significant role in treating patients with
congestive heart failure (CHF). We tested our hypothesis that
noninvasive bilevel positive airway pressure improves left ventricular
performance in patients with chronic CHF secondary to severe systolic
Objectives: To determine the
cardiac performance of patients using bilevel positive airway pressure,
and to describe the hemodynamic effects of bilevel positive airway
pressure and its use as a therapeutic adjunct in these patients.
Design: Prospective, cohort, nonrandomized study.
Setting: Outpatient medicine clinic.
Patients: Fourteen patients (9 men and 5 women) with stable
chronic CHF with left ventricular ejection fraction ≤ 35%; mean age
was 60.6 years (range, 43 to 87 years).
Bilevel positive airway pressure via nasal mask at an inspiratory
pressure of 5 cm H2O and an expiratory pressure of 3 cm
H2O on spontaneous mode at room air for 1 h.
Measurements and results: Myocardial performance and
changes were measured using clinical and echocardiographic parameters.
Baseline clinical and echocardiographic parameters were compared with
the same parameters after 1 h of bilevel positive airway pressure.
Statistically significant (p < 0.05, Wilcoxon matched pair
signed-rank test) decreases were noted in these mean values: systolic
BP from 136.21 to 124.14 mm Hg (p = 0.008), heart rate from 85.07 to
74.71 beats/min (p = 0.002), respiratory rate from 23.07 to 15.43
breaths/min (p = 0.001), and systemic vascular resistance from
1671.46 to 1236.27 dyne · s · cm3 (p = 0.001).
Statistically significant increases were noted in these mean values:
cardiac output from 5.09 to 6.37 L/min (p = 0.004), ejection fraction
from 28.71% to 34.36% (p = 0.001), and end-diastolic volume from
224.36 to 246.21 mL (p = 0.045).
positive airway pressure has excellent potential for improving left
ventricular performance of patients with chronic CHF secondary to
severe systolic dysfunction.