Left ventricular torsion in patients with obstructive sleep apnoea before and after continuous positive airway pressure therapy: assessment by two-dimensional speckle tracking echocardiography

Vural, Mutlu; Çetin, Süha; Keser, Nurgül; Fırat, Hikmet; Akdemir, Ramazan; Gündüz, Hüseyin

doi:10.1080/00015385.2017.1315257

Cited by 14 publications

(28 citation statements)

References 35 publications

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“…LV longitudinal strain was also lower in patients with severe OSA, whereas LV circumferential and radial strains were not different between controls and OSA patients. 12 Vural et al 13 reported gradual deterioration of LV longitudinal strain from mild to severe OSA group, but circumferential and radial strains were lower only in moderate and severe OSA patients. Apical rotation and torsion were lower only in severe OSA comparing with controls, but there was no difference between controls and mild or moderate OSA.…”

Section: Vitarelli Et Al 12 Investigated LV Mechanics In Patients Witmentioning

confidence: 97%

“…Apical rotation and torsion were lower only in severe OSA comparing with controls, but there was no difference between controls and mild or moderate OSA. 13 The effect of therapy which includes continuous positive airway pressure (CPAP) on LV remodeling in patients with OSA is still matter of debate. Kim et al 14 compared the effect of CPAP and sham treatment on LV remodeling in patients with OSA and reported that CPAP treatment significantly improved LV global longitudinal strain compared with the sham treatment after 3 months of therapy, even though the differences in LV dimension or ejection fraction was not noticed.…”

Section: Vitarelli Et Al 12 Investigated LV Mechanics In Patients Witmentioning

confidence: 99%

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Obstructive sleep apnea and left ventricular strain: Useful tool or fancy gadget?

Cuspidi

Tadić

2019

J of Clinical Hypertension

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Obstructive sleep apnea (OSA) syndrome is the most common sleep-breathing disorder, which is characterized with snoring, interruptions in breading during sleeping, or daytime sleepiness, and choking or gasping during sleep. Polysomnography defined OSA as 5 or more episodes of obstructive apneas/hypopneas per hour during sleep. 1,2 There are many risk factors for OSA, but the most important is obesity, and therefore, many studies are devoted to the assessment of the influence of weight reduction in OSA. 3 It is also known that OSA increases risk of resistant arterial hypertension, coronary artery disease, heart failure, pulmonary hypertension, and various cardiovascular conditions. 4 Moreover, investigations demonstrated the association between OSA and cardiac remodeling. However, these studies were usually concentrated on left ventricular (LV) structure and function, which mainly included basic echocardiographic parameters such as LV hypertrophy, LV ejection fraction, and several basic parameters of LV diastolic (dys)function. 5 Investigations regarding LV mechanics in patients with OSA are scarce.Altekin et al 6 included 58 OSA patients with different severity of OSA. Patients were classified as mild OSA when the apnea-hypopnea index (AHI) was between 5 and 15, moderate OSA was diagnosed in patients with AHI between 15 and 30 and severe OSA was defined as AHI higher than 30. 6 The authors reported that main parameters of LV diastolic function (E/A, E/e′, mitral deceleration time, left atrial volume index) deteriorated gradually from mild to severe OSA. 6 More interestingly, the authors found gradual reduction in LV longitudinal strain from mild, across moderate, to severe OSA. The reduction in LV circumferential and radial strain was revealed in moderate and severe OSA patients, but not in those with mild OSA. However, strain rates referring to LV mechanics during early and late diastole also gradually deteriorated from mild to severe OSA in all three directions-longitudinal, circumferential, and radial. 6 The correlation between AHI and LV longitudinal strain and strain rates was significantly stronger than between AHI and parameters of LV diastolic function. 6 On the other hand, there was no correlation between AHI and LV ejection fraction and only weak correlation with LV mass index. 6 One should underline that there was no significant difference in body mass index (BMI) between three observed groups. However, the authors did not perform multivariate regression analysis including BMI in the model in order to exclude potential effect of obesity on the final results. Varghese et al 7 also reported significantly lower LV longitudinal strain in patients with severe OSA, but without significant difference in LV circumferential strain. LV longitudinal strain, but not circumferential strain, was found to correlate significantly with AHI. 7 Cho et al 8 included 25 patients with OSA and compared LV remodeling in these patients with healthy controls and obese patients, as well as the impact of bariatric surgery in pati...

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Section: Vitarelli Et Al 12 Investigated LV Mechanics In Patients Witmentioning

confidence: 97%

Section: Vitarelli Et Al 12 Investigated LV Mechanics In Patients Witmentioning

confidence: 99%

Obstructive sleep apnea and left ventricular strain: Useful tool or fancy gadget?

Cuspidi

Tadić

2019

J of Clinical Hypertension

View full text Add to dashboard Cite

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“…An increased AHI was associated with decreased mitral E wave [9] and increased mitral A wave velocities [9, 17] (Table 4). Although Varghese et al did not find a significant difference regarding mitral E/A ratio in patients with severe OSA (1.1 ± 0.2) versus controls (1.2 ± 0.2; p =0.09) [10], several other studies reported that mitral E/A ratio decreases with OSA severity [9, 13, 17]. Surprisingly, Altekin et al found significantly lower E/A ratio only in patients with mild OSA ( p =0.0009) but not in subjects with moderate or severe OSA [11].…”

Section: Introductionmentioning

confidence: 99%

“…E/e` mean ratio, an estimate of LV end-diastolic pressures, is higher in subjects with moderate-to-severe OSA than in controls [10, 11, 16, 25, 27] and is positively correlated to AHI ( r =0.202; p =0.014) [17]. Since E/E` is known to be linked to myocardial fibrosis, Altekin et al suggest that fibrosis, along with increased LV filling pressures, promotes subclinical LV systolic dysfunction in OSA subjects [11].…”

Section: Introductionmentioning

confidence: 99%

“…In such cases, longitudinal myocardial fibers, mainly located in the subendocardium, are very vulnerable to fibrosis, resulting in decreased longitudinal shortening and a compensatory elevation of circumferential shortening and torsion [42]. LV torsion is the twist of the ventricle around its long axis, given by the antagonistic rotation of the basal and apical segments [17], and increased LV torsion is an early indicator of left ventricular dysfunction in patients with normal LV-EF. Reports show contradictory results regarding LV torsion in OSA patients: while Vural et al found that LV torsion is decreased in subjects with AHI>30 and in controls compared to patients with mild or moderate sleep apnea [17], Vitarelli et al reported a significant increase in LV torsion in severe sleep apnea versus controls [24].…”

Section: Introductionmentioning

confidence: 99%

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Review of Echocardiographic Findings in Patients with Obstructive Sleep Apnea

Sascău

Zota

Stătescu

et al. 2018

Canadian Respiratory Journal

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Obstructive sleep apnea (OSA) causes recurrent apneas due to upper respiratory tract collapse, leading to sympathetic nervous system hyperactivation and increased cardiovascular risk. Moderate and severe forms of obstructive sleep apnea are associated with increased atrial volumes and affect left ventricular diastolic and then systolic function. Right ventricular ejection fraction can be accurately assessed via three-dimensional echocardiography, while bidimensional imaging can only provide a set of surrogate parameters to characterize systolic function (tricuspid annulus plane systolic excursion, right ventricular fractional area change, and lateral S'). Tissue Doppler imaging is a more sensitive tool in detecting functional ventricular impairment, but its use is limited by angle dependence and the unwanted influence of tethering forces. Two-dimensional speckle tracking echocardiography is considered more suitable for the assessment of ventricular function, as it is able to distinguish between active and passive wall motion. Abnormal strain values, a marker of subclinical myocardial dysfunction, can be detected even in patients with normal ejection fraction and chamber volumes. The left ventricular longitudinal strain is more affected by the presence of obstructive sleep apnea than circumferential strain values. Although the observed OSA-induced changes are subtle, the benefit of a detailed echocardiographic screening for subclinical heart failure in OSA patients on therapy adherence and outcome should be addressed by further studies.

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Obstructive sleep apnea and cardiac mechanics: how strain could help us?

2020

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Left ventricular torsion in patients with obstructive sleep apnoea before and after continuous positive airway pressure therapy: assessment by two-dimensional speckle tracking echocardiography

Abstract: LV torsion was altered in OSA patients with varying degrees according to the disease severity. Furthermore, there was no significant change of torsion after 24 weeks of CPAP therapy.

Cited by 14 publications

References 35 publications

Obstructive sleep apnea and left ventricular strain: Useful tool or fancy gadget?

Obstructive sleep apnea and left ventricular strain: Useful tool or fancy gadget?

Review of Echocardiographic Findings in Patients with Obstructive Sleep Apnea

Obstructive sleep apnea and cardiac mechanics: how strain could help us?

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