Purpose of review: To summarize and discuss the available studies on the effects of long-term noninvasive ventilation (NIV) on cardiac function in patients with chronic hypercapnic respiratory failure. Recent findings: A total of nine studies investigated the acute and long-term effects of NIV on cardiac performance in patients with chronic hypercapnic respiratory failure. Summary: Both the application of expiratory airway pressure and (higher) inspiratory pressures may acutely decrease cardiac output during the initiation of NIV. However, the meaning of this effect in the long term is not clear. Apparently, natriuretic peptides decrease after a certain period of NIV use and heart rate variability seems to improve. Probably, a decreased cardiac output might not be disadvantageous and ref...