Right ventricular diastolic dysfunction in patients with obstructive sleep apnea syndrome

Abstract

Background and Objectives This study aimed to assess right ventricular (RV) diastolic dysfunction in patients with obstructive sleep apnea syndrome (OSAS) using velocity vector imaging (VVI) and to evaluate the application of VVI technology. Methods According to the apnea–hypopnea index (AHI), 69 patients with OSAS were divided into three groups: mild, moderate, and severe. A total of 35 cases of healthy subjects were enrolled as the control group. Digital images of apex four‐chamber views were acquired to measure the peak early diastolic strain rate (RV‐SRe), late diastolic strain rate(RV‐SRa), and RV‐SRe/RV‐SRa using VVI. Results RV‐SRe, RV‐Sra, and RV‐SRe/RV‐SRa were decreasing along with the disease severity. RV‐SRe, RV‐SRe/RV‐SRa in moderate and severe OSAS group showed lower than control and mild OSAS groups. RV‐SRa in severe OSAS group showed lower than control group. RV‐SRe had the best correlation with AHI than other parameters. Conclusions Right ventricular diastolic dysfunction starts before the development of heart failure and pulmonary hypertension in patients with OSAS. RV‐SRe was the parameter that may reflect subclinical myocardial dysfunction and can better reflect RV diastolic dysfunction.

Right ventricular diastolic dysfunction might correlate with body mass index as well as with AHI in patients with obstructive sleep apnea syndrome

“…Li and co-workers also showed that this ventricular dysfunction positively correlated with the degree of OSAS, expressed in terms of apnea hypopnea index (AHI). 1 In other words, increased levels of AHI significantly correlated with an impairment of right ventricular dysfunction. 1 These observations are very clear and in part confirm our previous data, which demonstrated that systolic pulmonary artery pressure (PAP) in obese patients with OSA was significantly higher than in obese patients without OSAS (P < .0001), whereas patients with OSAS alone without obesity did not have a statistical significant increase in systolic PAP.…”

“…1 In other words, increased levels of AHI significantly correlated with an impairment of right ventricular dysfunction. 1 These observations are very clear and in part confirm our previous data, which demonstrated that systolic pulmonary artery pressure (PAP) in obese patients with OSA was significantly higher than in obese patients without OSAS (P < .0001), whereas patients with OSAS alone without obesity did not have a statistical significant increase in systolic PAP. 2 In our opinion, obesity, which often appears earlier than OSAS, starts promoting endothelial pulmonary dysfunction, while the coexistence with OSAS might accelerate the evolution toward pulmonary hypertension.…”

“…We read with great interest the article entitled: "Right ventricular diastolic dysfunction in patients with obstructive sleep apnea syndrome" by the authors Li and colleagues, published in "Echocardiography" on February 20, 2020. 1 In the manuscript, authors clearly demonstrate that right ventricular dysfunction is an early phenomenon, which begins before the development of heart failure and pulmonary hypertension, in patients with obstructive sleep apnea (OSAS). Li and co-workers also showed that this ventricular dysfunction positively correlated with the degree of OSAS, expressed in terms of apnea hypopnea index (AHI).…”

“…3 However, the authors of the recent article did not establish the possible correlation between body mass index (BMI) and right ventricular dysfunction, which seems to be existent, looking at the tendency toward the Increased BMI of some subjects, who contextually show an inverse right ventricular function. 1 Taken these data all together, there is an urgent need to detect…”

Correlation between AHI and right ventricular diastolic function in patients with obstructive sleep apnea syndrome, a reply to Pierluigi Carratù

“…1 Therefore, the purpose of our study is to assess the influence of obstructive sleep apnea syndrome (OSAS) on right ventricular (RV) diastolic dysfunction. 2 At the beginning of the study, we have noticed the influence of obesity on pulmonary hypertension.…”