Obesity and sleep apnea are independently associated with adverse left ventricular remodeling and clinical outcome in patients with atrial fibrillation and preserved ventricular function

Shah, Ravi; Abbasi, Siddique; Heydari, Bobak; Farhad, Hoshang; Dodson, John A.; Bakker, Jessie P.; John, Roy M.; Veves, Aristidis; Malhotra, Atul; Blankstein, Ron; Jerosch‐Herold, Michael; Kwong, Raymond Y.; Neilan, Tomas G.

doi:10.1016/j.ahj.2014.01.002

Cited by 30 publications

(17 citation statements)

References 27 publications

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“…The prevalence of CSA in HFpEF is less defined. Estimates vary from 18% to 30% depending on body weight, the cut-off levels used and the different diagnostic criteria of HFpEF [57,[64][65][66]. Prevalence of CSA increases with increasing impairment of diastolic function [57].…”

Section: )mentioning

confidence: 99%

Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep

et al. 2016

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The complexity of central breathing disturbances during sleep has become increasingly obvious. They present as central sleep apnoeas (CSAs) and hypopnoeas, periodic breathing with apnoeas, or irregular breathing in patients with cardiovascular, other internal or neurological disorders, and can emerge under positive airway pressure treatment or opioid use, or at high altitude. As yet, there is insufficient knowledge on the clinical features, pathophysiological background and consecutive algorithms for stepped-care treatment. Most recently, it has been discussed intensively if CSA in heart failure is a "marker" of disease severity or a "mediator" of disease progression, and if and which type of positive airway pressure therapy is indicated. In addition, disturbances of respiratory drive or the translation of central impulses may result in hypoventilation, associated with cerebral or neuromuscular diseases, or severe diseases of lung or thorax. These statements report the results of an European Respiratory Society Task Force addressing actual diagnostic and therapeutic standards. The statements are based on a systematic review of the literature and a systematic two-step decision process. Although the Task Force does not make recommendations, it describes its current practice of treatment of CSA in heart failure and hypoventilation.

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Section: )mentioning

confidence: 99%

Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep

et al. 2016

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“… 142 A recent study among patients with AF and mainly preserved LVEF undergoing cardiac magnetic resonance imaging prior to catheter ablation revealed that sleep apnea (probably OSA in most cases) was an independent predictor of death and hospitalization for HF. 143 However, prospective mechanistic studies evaluating the impact of OSA and disease severity in HFpEF, the impact of CPAP on surrogate markers, and the clinical effects of treating OSA in HFpEF are lacking.…”

Section: Cardiac Diseases and Osamentioning

confidence: 99%

A clinical approach to obstructive sleep apnea as a risk factor for cardiovascular disease

Maeder¹,

Schoch²,

Rickli³

2016

VHRM

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Obstructive sleep apnea (OSA) is associated with cardiovascular risk factors, cardiovascular diseases, and increased mortality. Epidemiological studies have established these associations, and there are now numerous experimental and clinical studies which have provided information on the possible underlying mechanisms. Mechanistic proof-of-concept studies with surrogate endpoints have been performed to demonstrate that treatment of OSA by continuous positive airway pressure (CPAP) has the potential to reverse or at least to attenuate not only OSA but also the adverse cardiovascular effects associated with OSA. However, no randomized studies have been performed to demonstrate that treatment of OSA by CPAP improves clinical outcomes in patients with cardiovascular risk factors and/or established cardiovascular disease and concomitant OSA. In the present review, we summarize the current knowledge on the role of OSA as a potential cardiovascular risk factor, the impact of OSA on cardiac function, the role of OSA as a modifier of the course of cardiovascular diseases such as coronary artery disease, atrial fibrillation, and heart failure, and the insights from studies evaluating the impact of CPAP therapy on the cardiovascular features associated with OSA.

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“…Obesity contributes to the development of several risk factors that are associated with cardiac arrhythmias, including metabolic syndrome, ischemic heart disease [ 1 , 2 ], atrial enlargement, left ventricular hypertrophy [ 3 ], systolic and diastolic heart failure [ 4 , 5 ] and sleep apnea [ 6 ]. The cardiac structural abnormalities that are associated with obesity may potentially increase the risk for ventricular arrhythmogenesis including myocyte hypertrophy, fibrosis, focal myocardial disarray, fatty infiltration and increased epicardial fat [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of obesity on the effectiveness of cardiac resynchronization to reduce the risk of first and recurrent ventricular tachyarrhythmia events

Szepietowska

Polonsky

Sherazi

et al. 2016

Cardiovasc Diabetol

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BackgroundObesity is associated with multiple adverse cardiovascular conditions and may increase the risk of ventricular tachyarrhythmias (VT/VF). There is limited data on the association between obesity and risk of VT/VF requiring appropriate implantable cardioverter-defibrillator (ICD) therapies and the effectiveness of cardiac resynchronization therapy (CRT) to reduce risk for VT/VF. The multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy (MADIT-CRT) was design to investigate effectiveness of CRT therapy to reduce cardiovascular outcome for patients with heart failure (HF) and reduced ejection fraction.Methods and resultsWe identified patients enrolled in the MADIT CRT trial as obese (n = 433) and non-obese (n = 845) and analyzed their risk for appropriate device therapy for VT/VF, repeated VT/VF events, fast VT/VF, as well as events after first VT/VF episodes. Obesity was defined as body mass index (BMI) ≥30 kg/m2. Among ICD patients, the risk of first appropriate ICD therapy for VT/VF at 3 years was similar between obese and non-obese patients (23 vs. 21 %, p = 0.76). CRT-D treatment reduced the risk of first appropriate ICD therapy both in non-obese ([HR]; 0.58 [CI]: 0.42–0.79; p < 0.001) and obese patients (HR 0.75, 95 % CI 0.5–1.38; p = 0.179) (interaction p value 0.323). Similarly, a significant reduction in the risk of fast VT/VF was observed in non-obese patients ([HR]; 0.49 [CI]: 0.33–0.73; p < 0.001) and obese ([HR]; 0.49 [CI]: 0.29–0.81; p < 0.01), (interaction p value 0.984).ConclusionObese and non-obese patients with mild heart failure have a similar risk of ventricular tachyarrhythmias. Obesity in mild heart failure did not diminish the clinical benefit of cardiac resynchronization therapy to reduce risk for appropriate ICD therapy.Clinical trial registrationhttp://clinicaltrials.gov/ct2/show/NCT00180271Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-016-0401-x) contains supplementary material, which is available to authorized users.

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Obesity and sleep apnea are independently associated with adverse left ventricular remodeling and clinical outcome in patients with atrial fibrillation and preserved ventricular function

Cited by 30 publications

References 27 publications

Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep

Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep

A clinical approach to obstructive sleep apnea as a risk factor for cardiovascular disease

Effect of obesity on the effectiveness of cardiac resynchronization to reduce the risk of first and recurrent ventricular tachyarrhythmia events

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