Acute effects of non-invasive ventilatory support on functional mitral regurgitation in patients with exacerbation of congestive heart failure

Objective: The purpose of this study was to evaluate the acute effects of continuous positive airway pressure (CPAP) and bi-level airway pressure (BiPAP) on functional mitral regurgitation (MR) in patients with acute exacerbation of severe chronic congestive heart failure (CHF). Design: A cross-over study. Setting: A cardiopulmonary intensive care unit. Patients and interventions: Ten male patients affected by an acute exacerbation of congestive heart failure and hemodynamically significant MR were submitted to an echocardiograph color Doppler ultrasound evaluation during CPAP and BiPAP non-invasive ventilation. We analyzed left ventricle ejection fraction, area of MR and deceleration time (Dec-t). Outcome measures: The primary end point was to evaluate whether CPAP and BiPAP were effective in reducing functional MR. Results: After 30 min, the area of MR decreased from 10.0 +/- 2.7 to 8.0 +/- 2.9 cm(2) with CPAP and from 9.9 +/- 2.6 to 8.6 +/- 2.6 cm(2) with BiPAP (p < 0.01): Dec-t increased from 120.9 +/- 12.7 to 136.0 +/- 8.7 ms after CPAP and from 120.5 +/- 11.4 to 134.2 +/- 13.6 ms after BiPAP (p < 0.01). Conclusion: In patients with exacerbation of severe CHF and functional MR, both modalities of non-invasive ventilation (CPAP and BiPAP) significantly improved ejection fraction and were equally effective in reducing MR.