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Original Research |

Acute Effects of Nasal CPAP in Patients with Hypertrophic Cardiomyopathy

Flávia B. Nerbass, PT, PhD; Vera M.C. Salemi, MD, PhD; Rodrigo P. Pedrosa, MD, PhD; Natanael de P. Portilho, MD; Julio C.A. Ferreira-Filho, MD, PhD; Henrique T. Moriya, PhD; Murillo O. Antunes, MD; Edmundo Arteaga-Fernández, MD, PhD; Luciano F. Drager, MD, PhD; Geraldo Lorenzi-Filho, MD, PhD
Author and Funding Information

Conflict of interest: All authors declare no conflicts of interest regarding this study.

Prior abstract publication/presentation: The results of this study “Safety of acute nasal CPAP therapy in patients with hypertrophic cardiomyopathy” were presented at the American Thoracic Society International Conference, 2015, Denver, Colorado.

This study is registered at: www.clinicaltrials.gov (NCT01631006)

1Sleep Laboratory, Pulmonary Division, University of São Paulo Medical School, São Paulo, Brazil

2Cardiomyopathy Unit of the Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil

3Hospital Dom Hélder Câmara – IMIP Hospitalar, Recife, Brazil

4Biomedical Engineering Laboratory, University of São Paulo, Brazil

5Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil

Corresponding Author: Geraldo Lorenzi-Filho, Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Av. Enéas Carvalho de Aguiar, 44, São Paulo, Brazil ZIP.


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.05.004
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Abstract

Background  Hypertrophic cardiomyopathy (HCM) is a common genetic disease that may cause left ventricular outflow tract (LVOT) obstruction, heart failure, and sudden death. Recent studies have shown a high prevalence of obstructive sleep apnea among patients with HCM. Because the hemodynamics of patients with LVOT obstruction are unstable and depend on load conditions to the heart, we evaluated the acute effects of CPAP on hemodynamics and cardiac performance in patients with HCM.

Methods  We studied 26 stable patients with HCM divided into nonobstructive-HCM (n=12) and obstructive-HCM (n=14) groups (LVOT gradient pressure lower or higher than 30 mm Hg, respectively). Patients in the supine position while awake were continuously monitored by beat-to-beat blood pressure and electrocardiography. A 2-dimensional echocardiography was performed at rest (Baseline) and after 20 minutes of nasal CPAP at 1.5 cmH2O and 10 cmH2O, which was applied in a random order interposed by 10 minutes without CPAP.

Results  Blood pressure, cardiac output, stroke volume, heart rate, left ventricular ejection fraction and LVOT gradient did not change during the study period in either group. CPAP at 10 cmH2O decreased right atrial size and right ventricular relaxation in all patients. CPAP at 10 cmH2O decreased left atrial volume significantly and decreased right ventricular outflow acceleration time, suggesting an increase in pulmonary artery pressure in obstructive patients.

Conclusions  The acute application of CPAP is apparently safe in patients with HCM because CPAP does not lead to hemodynamic compromise. Long-term studies in HCM patients with sleep apnea and nocturnal CPAP are warranted.


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