Impact of non-invasive positive pressure ventilation on pulmonary artery diastolic pressure: a longitudinal physiologic analysis
M Chedid, S Kaplan, L Kinney-Kruse, R Germany, M BennettAbstract
Background
Non-invasive positive pressure ventilation (NIPPV) is frequently used in heart failure patients with sleep-disordered breathing, yet its direct hemodynamic impact on pulmonary pressures remains incompletely characterized in real-world longitudinal data.
Purpose
To evaluate the association between NIPPV use and pulmonary artery diastolic (PAD) pressure across defined periods of use and non-use.
Methods
Serial Implantable pulmonary artery pressure monitoring system derived PAD measurements were analyzed retrospectively across predefined periods of documented NIPPV use and non-use in a single patient with chronic heart failure and obstructive sleep apnea. PAD values were grouped by NIPPV exposure and compared using a Welch two-sample t-test. Figure 1 demonstrates longitudinal PAD trends relative to NIPPV status.
Results
A total of 57 PAD measurements were analyzed (21 during NIPPV use, 36 during non-use). Mean PAD during NIPPV use was significantly lower compared with non-use (21.0 ± 4.8 vs 29.7 ± 5.7 mmHg; p < 0.001). This corresponded to an absolute mean reduction of approximately 8.7 mmHg during periods of NIPPV exposure. Visual inspection of longitudinal data demonstrated consistently lower PAD pressures during NIPPV use, with higher and more variable pressures during non-use (Figure 1). During periods of NIPPV use, the patient remained on a stable maintenance diuretic regimen without additional or escalated diuretic dosing.
Conclusion
In this longitudinal physiologic analysis, NIPPV use was associated with significantly lower PAD pressures compared with non-use. These findings suggest a potential hemodynamic benefit of NIPPV in selected heart failure patients and support further investigation in larger cohorts to define the role of sleep-disordered breathing therapy in pulmonary pressure modulation and congestion management.For image description, please refer to the figure legend and surrounding text.