Longitudinal ventricular systolic dysfunction in patients with very severe obstructive sleep apnea: A case control study using speckle tracking imaging

Varghese, Mithun J.; Sharma, Gautam; Shukla, Geeta; Seth, Sandeep; Mishra, Sundeep; Gupta, Anupama; Bahl, Vinay K.

doi:10.1016/j.ihj.2016.12.011

Cited by 29 publications

(28 citation statements)

References 30 publications

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“…The assessment of the left ventricular systolic function, which was normal in all patients except one with a mild dysfunction, was supported with measurement of the left ventricular global longitudinal strain (GLS) [ 31 , 32 ]. Its new parameter in echocardiography, which detects subclinical cardiac involvement in different systemic diseases while systolic function is assessed by EF, is normal [ 33 – 35 ]. Up-to-date echocardiography experts established that the limit of normal value for this parameter is −20% [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Heart in Acromegaly: The Echocardiographic Characteristics of Patients Diagnosed with Acromegaly in Various Stages of the Disease

Popielarz-Grygalewicz

Gąsior

Konwicka

et al. 2018

International Journal of Endocrinology

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To determine whether the echocardiographic presentation allows for diagnosis of acromegalic cardiomyopathy. 140 patients with acromegaly underwent echocardiography as part of routine diagnostics. The results were compared with the control group comprising of 52 age- and sex-matched healthy volunteers. Patients with acromegaly presented with higher BMI, prevalence of arterial hypertension, and glucose metabolism disorders (i.e., diabetes and/or prediabetes). In patients with acromegaly, the following findings were detected: increased left atrial volume index, increased interventricular septum thickness, increased posterior wall thickness, and increased left ventricular mass index, accompanied by reduced diastolic function measured by the following parameters: E'med., E/E', and E/A. Additionally, they presented with abnormal right ventricular systolic pressure. All patients had normal systolic function measured by ejection fraction. However, the values of global longitudinal strain were slightly lower in patients than in the control group; the difference was statistically significant. There were no statistically significant differences in the size of the right and left ventricle, thickness of the right ventricular free wall, and indexed diameter of the ascending aorta between patients with acromegaly and healthy volunteers. None of 140 patients presented systolic dysfunction, which is the last phase of the so-called acromegalic cardiomyopathy. Some abnormal echocardiographic parameters found in acromegalic patients may be caused by concomitant diseases and not elevated levels of GH or IGF-1 alone. The potential role of demographic parameters like age, sex, and/or BMI requires further research.

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Section: Discussionmentioning

confidence: 99%

Heart in Acromegaly: The Echocardiographic Characteristics of Patients Diagnosed with Acromegaly in Various Stages of the Disease

Popielarz-Grygalewicz

Gąsior

Konwicka

et al. 2018

International Journal of Endocrinology

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“…The reduction in LV circumferential and radial strain was revealed in moderate and severe OSA patients, but not in those with mild OSA. 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 patients with OSA. 6 The correlation between AHI and LV longitudinal strain and strain rates was significantly stronger than between AHI and parameters of LV diastolic function.…”

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confidence: 99%

“…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 patients with OSA. The authors did not find significant difference in LV structure (LV wall thickness and LV mass index) between obese and OSA patients, but they found significantly worse LV diastolic function in patients with OSA than in the obese and control groups.…”

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confidence: 99%

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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“…Regarding echocardiographic findings, many studies have found similar results. Indeed, Varghese et al [22] investigated the LV function using several parameters then compared them between patients with very severe OSA (AHI ≥ 40) and patients without OSA (control group). They found that there was no significant difference between the two groups regarding the conventional parameters of LV systolic function, including Simpson biplane LV ejection fraction and MPI.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Biventricular Function in Patients with Obstructive Sleep Apnea and Atrial Fibrillation: A Cross-sectional Study Using Two-dimensional Speckle Tracking Imaging

Fathia

Boudiche

Sammoud

et al. 2019

JAMMR

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Background: Obstructive sleep apnea syndrome (OSA) is a common but often under diagnosed condition. According to literature, OSA prevalence in atrial fibrillation (AF) patients varies from 21 to 85%. OSA is increasingly recognized as a risk factor for biventricular dysfunction. The present study aimed to compare left and right ventricular functions, assessed by conventional echocardiographic parameters and speckle tracking imaging, in non-valvular atrial fibrillation (NVAF) patients with and without severe OSA. Methods: A cross-sectional analytic study was conducted. Forty successive patients with NVAF were included. All of them had a clinical screening for symptoms suggestive of OSA and underwent polysomnographic study. Patients were divided into two groups (group 1: without severe OSA with an apnea-hypopnea index (AHI) < 30 events per hour (e/h), and group 2: having severe OSA with an AHI ≥ 30 e/h). Echocardiography was performed in all patients. Left and right ventricular function parameters were measured including global longitudinal strain (GLS) and myocardial performance index (MPI). Results: OSA was diagnosed in 90% of NVAF patients. The average AHI was 22.1 ± 13 e/h. Eleven patients (27.5%) had mild OSA, 9 patients (22.5%) had moderate OSA, and 16 patients (40%) had severe OSA. General clinical characteristics were comparable between groups. A statistically significant association was demonstrated between severe OSA and impairment of left ventricular GLS (-17.3 ± 4.5 vs. -14.9 ± 3%, in group 1 and 2 respectively, p = 0.02) and left ventricular MPI (0.37 ± 0.09 vs. 0.49 ± 0.13, in group 1 and 2 respectively, p = 0.01). Right ventricular lateral wall strain was non significantly lower in group 1 compared to group 2 (-22.5 ± 8.4 vs. -18.4 ± 5.8%, in group 1 and 2 respectively, p = 0.15). On multivariate logistic regression analysis, left ventricular GLS impairment (> -18%) and MPI > 0.37 were independent predictors of severe OSA. Conclusion: Severe OSA was diagnosed in 40% of NVAF patients. Impairment of left ventricular GLS and left MPI were statistically associated with severe OSA.

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Longitudinal ventricular systolic dysfunction in patients with very severe obstructive sleep apnea: A case control study using speckle tracking imaging

Abstract: Very severe OSA is associated with significant diastolic dysfunction as well as early systolic abnormalities as evidenced by abnormal global longitudinal strain. Sleep apnea severity as measured by AHI was the only significant predictor of abnormal longitudinal strain in these patients.

Cited by 29 publications

References 30 publications

Heart in Acromegaly: The Echocardiographic Characteristics of Patients Diagnosed with Acromegaly in Various Stages of the Disease

Heart in Acromegaly: The Echocardiographic Characteristics of Patients Diagnosed with Acromegaly in Various Stages of the Disease

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

Assessment of Biventricular Function in Patients with Obstructive Sleep Apnea and Atrial Fibrillation: A Cross-sectional Study Using Two-dimensional Speckle Tracking Imaging

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