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Echocardiographic changes with non-invasive ventilation and CPAP in obesity hypoventilation syndrome

Abstract: Rationale: Despite a significant association between obesity hypoventilation syndrome (OHS) and cardiac dysfunction, no randomised trials have assessed the impact of non-invasive ventilation (NIV) or CPAP on cardiac structure and function assessed by echocardiography. Objectives: We performed a secondary analysis of the data from the largest multicentre randomised controlled trial of OHS (Pickwick project, n=221) to determine the comparative efficacy of 2 months of NIV (n=71), CPAP (n=80) and lifestyle modification (control group, n=70) on structural and functional echocardiographic changes. Methods: Conventional transthoracic two-dimensional and Doppler echocardiograms were obtained at baseline and after 2 months. Echocardiographers at each site were blinded to the treatment arms. Statistical analysis was performed using intention-to-treat analysis. Results: At baseline, 55% of patients had pulmonary hypertension and 51% had evidence of left ventricular hypertrophy. Treatment with NIV, but not CPAP, lowered systolic pulmonary artery pressure (-3.4 mm Hg, 95% CI -5.3 to -1.5; adjusted P=0.025 vs control and P=0.033 vs CPAP). The degree of improvement in systolic pulmonary artery pressure was greater in patients treated with NIV who had pulmonary hypertension at baseline (-6.4 mm Hg, 95% CI -9 to -3.8). Only NIV therapy decreased left ventricular hypertrophy with a significant reduction in left ventricular mass index (-5.7 g/m2; 95% CI -11.0 to -4.4). After adjusted analysis, NIV was superior to control group in improving left ventricular mass index (P=0.015). Only treatment with NIV led to a significant improvement in 6 min walk distance (32 m; 95% CI 19 to 46). Conclusion: In patients with OHS, medium-term treatment with NIV is more effective than CPAP and lifestyle modification in improving pulmonary hypertension, left ventricular hypertrophy and functional outcomes. Long-term studies are needed to confirm these results.

 Fuente: Thorax . 2018 Apr;73(4):361-368

Editorial: BMJ Publishing Group

 Año de publicación: 2018

Nº de páginas: 8

Tipo de publicación: Artículo de Revista

 DOI: 10.1136/thoraxjnl-2017-210642

ISSN: 0040-6376,1468-3296

Url de la publicación: https://doi.org/10.1136/thoraxjnl-2017-210642

Autores/as

CORRAL, JAIME

MOGOLLON, MARIA VICTORIA

SÁNCHEZ-QUIROGA, M. ÁNGELES

GÓMEZ DE TERREROS, JAVIER

ROMERO, AUXILIADORA

CABALLERO, CANDELA

TERAN SANTOS, JOAQUIN

ALONSO ÁLVAREZ, MARÍA L.

GÓMEZ GARCÍA, TERESA

LÓPEZ MARTÍNEZ, SOLEDAD

DE LUCAS, PILAR

MARIN, JOSÉ M.

ROMERO, ODILE

DÍAZ CAMBRILES, TRINIDAD

CHINER, EUSEBI

EGEA, CARLOS

LANG, ROBERTO M.

MOKHLESI, BABAK

MASA, JUAN F.