Objective. To study the prognostic value of echocardiographic parameters of early cardiac remodeling in patients with hypertension (HTN) and obstructive sleep apnea (OSA). Design and methods. The study included 59 men with HTN and OSA (with an apnea/hypopnea index > 15 per hour). At baseline, all patients underwent polysomnography and echocardiography with an additional assessment of the global longitudinal strain (GLS). At baseline and at 12-month follow-up, a 6-minute walk test was performed. After 12 months, the clinical course of the disease was assessed. The criteria for an unfavorable course were episodes of hospitalization, the development of acute coronary syndrome, cerebral stroke, paroxysmal atrial fibrillation, worsening of chronic heart failure with a transition to a higher NYHA functional class. Results. In groups with favorable and unfavorable clinical course, some baseline echocardiographic parameters differed significantly: interventricular septal thickness (p = 0,037), left ventricular myocardial mass index (LVMI) (p = 0,003), tricuspid annular plane systolic excursion (TAPSE) (p < 0.001), GLS (p = 0,019), peak tricuspid regurgitation (p = 0,027), left atrial volume index (p = 0,048). Regression analysis showed that baseline TAPSE and LVMI had predictive value for an unfavorable clinical course. Conclusions. Our results confirm that certain echocardiographic parameters, in particular, LVMI and TAPSE, are predictors of the development and progression of cardiovascular complications in OSA patients.
Aim To study the role of soluble ST2 (sST2), N-terminal pro-brain natriuretic peptide (NT-proBNP), and С-reactive protein (CRP) in patients with chronic heart failure and preserved left ventricular ejection fraction (CHF with pLVEF) and syndrome of obstructive sleep apnea (SOSA) in stratification of the risk for development of cardiovascular complications (CVC) during one month of a prospective observation.Material and methods The study included 71 men with SOSA with an apnea/hypopnea index (AHI) >15 per hour, abdominal obesity, and arterial hypertension. Polysomnographic study and echocardiography according to a standard protocol with additional evaluation of left ventricular myocardial fractional changes and work index were performed for all patients at baseline and after 12 months of observation. Serum concentrations of sST2 , NT-proBNP, and CRP were measured at baseline by enzyme-linked immunoassay (ELISA).Results The ROC analysis showed that the cutoff point characterizing the development of CVC were sST2 concentrations ≥29.67 ng/l (area under the curve, AUC, 0.773, sensitivity 65.71 %, specificity 86.11 %; p<0.0001) while concentrations of NT-proBNP (AUC 0.619; p=0.081) and CRP (AUC 0.511; р=0.869) were not prognostic markers for the risk of CVC. According to data of the ROC analysis, all patients were divided into 2 groups based on the sST2 cutoff point: group 1 included 29 patients with ST2 ≥29.67 ng/l and group 2 included 42 patients with ST2 <29.67 ng/l. The Kaplan-Meyer analysis showed that the incidence of CVC was higher in group 1 than in group 2 (79.3 and 28.6 %, respectively, p<0.001). The regression analysis showed that adding values of AHI and left ventricular myocardial mass index (LVMMI) to sST2 in the model increased the analysis predictive significance.Conclusion Measuring sST2 concentration may be used as a noninvasive marker for assessment of the risk of CVC development in patients with CHF with pLVEF and SOSA within 12 months of observation. Adding AHI and LVMMI values to the model increases the predictive significance of the analysis.
Адрес для корреспонденции: Кирьяков Кирилл Сергеевич-врач-анестезиолог-реаниматолог отделения анестезиологии, реанимации и интенсивной терапии для детей Перинатального центра Национального медицинского исследовательского центра им. В.А. Алмазова, ORCID: 0000-0002-5636-1775 Хатагова Регина Борисовна-врач-анестезиолог-реаниматолог отделения анестезиологии, реанимации и интенсивной терапии для детей Перинатального центра Национального медицинского исследовательского центра им. В.А. Алмазова, ORCID: 0000-0002-6685-3060 Тризна Евгений Владимирович-врач-анестезиолог-реаниматолог отделения анестезиологии, реанимации и интенсивной терапии для детей Перинатального центра Национального медицинского исследовательского центра им. В.А. Алмазова, ORCID: 0000-0001-6908-8045 Зеленина Зоя Александровна-врач-анестезиолог-реаниматолог отделения анестезиологии, реанимации и интенсивной терапии для детей Перинатального центра Национального медицинского исследовательского центра им. В.А. Алмазова, ORCID: 0000-0002-1067-811X Яковлев Алексей Владимирович (Yakovlev A.V.)-зав. отделением анестезиологии, реанимации и интенсивной терапии для детей Перинатального центра Национального медицинского исследовательского центра им. В.А. Алмазова, ORCID: 0000-0002-5537-8559 Петрова Наталья Александровна-к.м.н., зав. НИЛ физиологии и патологии новорожденных, доцент кафедры детских болезней Национального медицинского исследовательского центра им. В.А. Алмазова,
Aim. To examine the relationship between obstructive sleep apnea syndrome and metabolic dysfunction in obese patients.Methods. The study included 66 male patients aged 53±5.11 years with previously diagnosed obstructive sleep apnea syndrome and obesity (body mass index ≥30 kg/m2). Cardiorespiratory monitoring, 24-hour blood pressure monitoring was performed in all patients; low density lipoprotein, triglycerides, high density lipoprotein, total cholesterol and glucose blood levels, as well as adiponectin and leptin blood concentrations were measured in all patients.Results. Blood pressure level and leptin blood concentration were significantly higher in patients with severe form of obstructive sleep apnea syndrome. There was no statistically significant relationship found between the lipid profile parameters and other adipokines and the severity of obstructive sleep apnea syndrome. The data analysis also revealed association between the elevated levels of leptin and the classic cardiovascular risk factors - arterial hypertension and low density lipoprotein level.Conclusion. The revealed associations may indicate the additional role of leptin as the biochemical marker of early development of obstructive breathing sleep disorders in patients with abdominal obesity, as well as the early manifestation of other components of metabolic syndrome - arterial hypertension and dyslipidemia with concomitant significant increase in cardiovascular risk.
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