Obstructive sleep apnea and right ventricular function: A meta‐analysis of speckle tracking echocardiographic studies

Tadić, Marijana; Gherbesi, Elisa; Faggiano, Andrea; Sala, Carla; Carugo, Stefano; Cuspidi, Cesare

doi:10.1111/jch.14550

Cited by 6 publications

(6 citation statements)

References 37 publications

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“…In a study with 42 conscious healthy dogs, global longitudinal strain and strain rate showed a correlation with breed and weight ( 55 ). In humans, the estimation of right ventricular mechanics remains challenging due to the complex right ventricular shape and retrosternal location in the mediastinum, which complicates echocardiographic assessment of the right ventricular ( 56 , 57 ). Similarly, in veterinary echocardiography, this is further complicated by various thoracic shapes present in different breeds.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic analysis of dogs before and after surgical treatment of brachycephalic obstructive airway syndrome

et al. 2023

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Brachycephalic dogs with brachycephalic obstructive airway syndrome (BOAS) are a valuable animal model for obstructive sleep apnea (OSA) in humans. Clinical signs of upper airway obstruction improve after surgical treatment of BOAS, but the impact of surgery on morphology and function of the heart has not been studied. Therefore, we aimed to compare the echocardiographic variables of dogs before and after surgical treatment of BOAS. We included 18 client-owned dogs with BOAS (7 French Bulldogs, 6 Boston Terriers, and 5 Pugs) scheduled for surgical correction. We performed a complete echocardiographic examination before and 6 to 12 (median 9) months after surgery. Seven non-brachycephalic dogs were included in the control group. After surgery, BOAS patients had a significantly (p < 0.05) larger left atrium to aortic ratio (LA/Ao), left atrium in the long axis index, and thickness of the left ventricular posterior wall in diastole index. They also had a higher late diastolic annular velocity of the interventricular septum (Am) and increased global right ventricular strain and left ventricular global strain in the apical 4-chamber view, as well as a higher caudal vena cava collapsibility index (CVCCI). Before surgery, BOAS patients had a significantly lower CVCCI, Am, peak systolic annular velocity of the interventricular septum (Si), and early diastolic annular velocity of the interventricular septum (Ei) compared to non-brachycephalic dogs. After surgery, BOAS patients had a smaller right ventricular internal diameter at base index, right ventricular area in systole index, mitral annular plane systolic excursion index, and tricuspid annular plane systolic excursion index, as well as lower values of Am, Si, Ei, and late diastolic annular velocity of the interventricular septum, and a larger LA/Ao compared to non-brachycephalic dogs. Significant differences between BOAS patients and non-brachycephalic dogs indicate higher right heart pressures and decreased systolic and diastolic ventricular function in BOAS dogs, which is in accordance with the results of studies in OSA patients. In parallel with the marked clinical improvement, right heart pressures decreased, and right ventricular systolic and diastolic function improved after surgery.

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Section: Discussionmentioning

confidence: 99%

Echocardiographic analysis of dogs before and after surgical treatment of brachycephalic obstructive airway syndrome

et al. 2023

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“…RV global and free-wall longitudinal strains represent parameters of RV systolic function and mechanics, which provide more information than conventional parameters (TAPSE, FAC, s’, and myocardial performance index) due to their higher sensitivity, specificity, reproducibility, and predictive value in a large spectrum of cardiovascular conditions [ 7 , 8 , 9 ]. Table 2 summarizes data about RV GLS and free-wall RVLS at baseline and strain values, as well as RV systolic parameters after CPAP therapy.…”

Section: Mechanisms Of Rv Remodeling In Osamentioning

confidence: 99%

“…Our meta-analysis that included almost all aforementioned studies showed significantly lower RV GLS and free-wall RVLS in OSA patients compared with controls, as well as in patients with severe OSA in comparison to those with mild OSA [ 8 ]. The meta-regression analysis showed a significant association between AHI and RV GLS in all included OSA patients [ 8 ]. It should be also noted that TAPSE was reduced in OSA patients included in this meta-analysis, but it was not able to differentiate mild from moderate or severe OSA.…”

Section: Mechanisms Of Rv Remodeling In Osamentioning

confidence: 99%

“…It should be also noted that TAPSE was reduced in OSA patients included in this meta-analysis, but it was not able to differentiate mild from moderate or severe OSA. This was also the case with RV GLS, but not with the free-wall RVLS that was able to distinguish mild from moderate or severe OSA [ 8 ]. These findings are encouraging the evaluation of RV longitudinal strain, particularly free-wall RVLS, in all OSA patients at any stage of disease, as it was proven to be a sensitive parameter of subclinical RV damage ( Table 2 ).…”

Section: Mechanisms Of Rv Remodeling In Osamentioning

confidence: 99%

“…The remodeling is reflected in RV hypertrophy and RV systolic dysfunction, but the latest studies revealed that the RV longitudinal strain represents a better early imaging marker for RV remodeling than other conventional echocardiographic parameters that have been routinely used for the evaluation of RV structure and systolic function. It seems that RV longitudinal strain is more sensitive to subclinical changes in RV function than other tricuspid annular plane systolic excursion (TAPSE), s’ (systolic flow velocity of the lateral tricuspid annulus measured by tissue Doppler), and fractional area change (FAC) [ 7 , 8 ]. This makes it more appropriate for easy and prompt detection of subclinical RV damage, as well as for the monitoring of RV functional improvement during CPAP therapy, which was proven to be very effective in these patients [ 4 , 5 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Obstructive Sleep Apnea and Right Ventricular Remodeling: Do We Have All the Answers?

Tadić

Cuspidi

2023

JCM

Self Cite

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Obstructive sleep apnea (OSA) syndrome is a very important sleep-related breathing disorder related to increased cardiovascular and overall morbidity and mortality. It is associated with multisystemic target organ damage due to micro- and macrovascular changes, resulting in carotid and coronary atherosclerosis, increased arterial stiffness, retinal damage, microalbuminuria, and cardiac remodeling. The latter consists of left ventricular (LV) hypertrophy, as well as diastolic and systolic dysfunction. The increasing burden of evidence shows that OSA also induces right ventricular (RV) remodeling that is more difficult to diagnose, but may also contribute to cardiovascular morbidity and mortality in these patients. Conventional echocardiographic parameters for assessment of RV systolic and diastolic functions are often not sensitive enough to detect subclinical and subtle changes in the RV function. Data published over last decade showed that the RV function, particularly systolic, is impaired in OSA patients and related with its severity. However, the introduction of speckle tracking echocardiography and the particularly longitudinal strain enabled the earlier detection of functional and mechanical changes even when conventional echocardiographic parameters of RV systolic function remained unchanged. The 3D echocardiography provided the possibility to evaluate the entire RV, with its unique shape, and determine 3D RV ejection fraction, which is comparable with results obtained by cardiac magnetic resonance. The use of this modality also provided a new insight into RV systolic (dys)function in OSA patients. In addition to weight loss, which has been proven very helpful in OSA patients, the only approved therapeutic approach is continuous positive airway pressure (CPAP) therapy. It is very important to assess if this therapy induces any improvement in cardiac structure and function. Limited data on this topic show that RV longitudinal strain is a more sensitive parameter rather than other conventional RV indexes in the detection of improvement in RV systolic function and mechanics. The aim of this review article is to summarize the current understanding of RV structural, functional, and mechanical changes in patients with OSA. Furthermore, we sought to provide the current knowledge regarding the effect of CPAP therapy on RV reverse remodeling in OSA patients.

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Predicting heart failure symptoms from the apnoea–hypopnoea index determined by full‐ night polysomnography

Ikeda,

Kubota,

Inami

et al. 2024

ESC Heart Failure

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AimsSleep‐disordered breathing (SDB) is closely related to cardiovascular diseases. The higher the apnoea–hypopnoea index (AHI), the higher the prevalence of cardiovascular diseases. Despite these findings suggesting a close link between SDB and heart failure, the relationship between the severity of SDB and the onset of heart failure symptoms in individuals without apparent heart failure symptoms (Heart Failure Stage A + B) remains poorly understood.Methods and resultsBetween December 2010 and June 2017, we conducted full‐night polysomnography (PSG) at the Nippon Medical School Chiba Hokusoh Hospital, extracting patients who were at risk of heart failure (Stage A or B in the Heart Failure Guidelines). Using a median cut‐off of AHI ≥ 41.6 events/hour, we divided the patients into two groups and examined the composite endpoint of all‐cause mortality plus hospitalization due to heart failure as the primary endpoint. We included 230 patients (mean age 63.0 ± 12.5 years, 78.3% males) meeting the selection criteria. When comparing the two groups, those with AHI < 41.6 events/hour (L group, n = 115) and those with AHI ≥ 41.6 events/hour (H group, n = 115), the H group had higher body mass index and higher serum triglyceride, and lower the frequency of acute coronary syndrome and lower estimated glomerular filtration rate than did the L group, but no other patient characteristics differed significantly. The H group had a significantly higher incidence of the composite endpoint than did the L group (10.6% vs. 2.6%, P = 0.027). Factors associated with the composite endpoint were identified through multivariate analyses, with AHI, haemoglobin, and left atrial dimension emerging as significant factors (hazard ratio [HR] = 1.02, 95% confidence interval [CI] = 1.00–1.04, P = 0.024; HR = 0.71, 95% CI = 0.54–0.94, P = 0.017; and HR = 1.10, 95% CI = 1.03–1.18, P = 0.006, respectively). Conversely, the minimum SpO2 during PSG (<80%) was not associated with the composite endpoint.ConclusionsIn patients with SDB who are at risk of heart failure, severe SDB is associated with a high risk of all‐cause mortality and the development of heart failure. Additionally, combining cardiac echocardiography and PSG data may improve risk stratification, offering potential assistance for early intervention. Further examination with a validation cohort is necessary.

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Obstructive sleep apnea and right ventricular function: A meta‐analysis of speckle tracking echocardiographic studies

Cited by 6 publications

References 37 publications

Echocardiographic analysis of dogs before and after surgical treatment of brachycephalic obstructive airway syndrome

Echocardiographic analysis of dogs before and after surgical treatment of brachycephalic obstructive airway syndrome

Obstructive Sleep Apnea and Right Ventricular Remodeling: Do We Have All the Answers?

Predicting heart failure symptoms from the apnoea–hypopnoea index determined by full‐ night polysomnography

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