Author:
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,González Mónica,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
Abstract
RationaleDespite 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.ObjectivesWe 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.MethodsConventional 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.ResultsAt 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).ConclusionIn 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.Trial registration numberPre-results, NCT01405976 (https://clinicaltrials.gov/).
Funder
AIR LIQUIDE SPAIN
Instituto de Salud Carlos III
SPANISH RESPIRATORY FOUNDATION 2005. FEPAR
Subject
Pulmonary and Respiratory Medicine
Cited by
55 articles.
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