Sleep-Disordered Breathing Is Associated With Reduced Left Atrial Strain Measured by Cardiac Magnetic Resonance Imaging in Patients After Acute Myocardial Infarction

Abstract

AimsSleep disordered breathing (SDB) is known to cause left atrial (LA) remodeling. However, the relationship between SDB severity and LA dysfunction is insufficiently understood and may be elucidated by detailed feature tracking (FT) strain analysis of cardiac magnetic resonance images (CMR). After myocardial infarction (MI), both the left ventricle and atrium are subjected to increased stress which may be substantially worsened by concomitant SDB that could impair consequential healing. We therefore analyzed atrial strain in patients at the time of acute MI and 3 months after.Methods and Results40 patients with acute MI underwent CMR and polysomnography (PSG) within 3–5 days after MI. Follow-up was performed 3 months after acute MI. CMR cine data were analyzed using a dedicated FT software. Atrial strain (ε) and strain rate (SR) for atrial reservoir ([εs]; [SRs]), conduit ([εe]; [SRe]) and booster function ([εa]; [SRa]) were measured in two long-axis views. SDB was defined by an apnea-hypopnea-index (AHI) ≥15/h. Interestingly, LA εs and εe were significantly reduced in patients with SDB and correlated negative with AHI as a measure of SDB severity at both baseline and follow-up. Intriguingly, patients that exhibited a reduced AHI at follow-up were more likely to have developed improved atrial reservoir and conduit strain (linear regression, p=0.08 for εs and εe). Patients with improved SDB (ΔAHI < −5/h) exhibited a mean improvement of LA reservoir strain of +7.2 ± 8.4% whereas patients with SDB deterioration (ΔAHI> + 5/h) showed a mean decrease of −5.3 ± 11.0% (p = 0.0131). Similarly, the difference for LA conduit function was +4.8 ± 5.9% (ΔAHI < −5/h) vs −3.6 ± 8.8% (ΔAHI> +5/h). Importantly, conventional volumetric parameters for atrial function (LA area, LA volume index) did not correlate with AHI at baseline or follow-up.ConclusionOur results show that LA function measured by CMR strain but not by volumetry is impaired in patients with SDB during acute cardiac injury. Consistent with a mechanistic association, improvement of SBD at follow-up resulted in improved LA strain. LA strain measurement might thus provide insight into atrial function in patients with SDB.

The Significance of Sleep Disorders in Post-myocardial Infarction Depression

“…SBD is a known cause of left atrial (LA) remodeling. Post-MI stress can substantially worsen healing process with concomitant SDB [ 31 ]. SBD is highly prevalent in patients with HF.…”

“…SBD is highly prevalent in patients with HF. SBD and OSA have multiple closely interconnected mechanisms [ 31 ]. SBD and OSA in combination with hypoxia increase sympathetic activity, BP, and myocardial oxygen demand predisposing to arrhythmias [ 31 ].…”

“…SBD and OSA have multiple closely interconnected mechanisms [ 31 ]. SBD and OSA in combination with hypoxia increase sympathetic activity, BP, and myocardial oxygen demand predisposing to arrhythmias [ 31 ]. Hypoxia stimulates myocardial fibrosis in both acute and chronic HF [ 31 ].…”

“…SBD and OSA in combination with hypoxia increase sympathetic activity, BP, and myocardial oxygen demand predisposing to arrhythmias [ 31 ]. Hypoxia stimulates myocardial fibrosis in both acute and chronic HF [ 31 ]. SBD is a predictor of worse outcomes in CVD and impairs myocardial salvage in acute MI leading to adverse cardiac remodeling [ 31 ].…”

“…Hypoxia stimulates myocardial fibrosis in both acute and chronic HF [ 31 ]. SBD is a predictor of worse outcomes in CVD and impairs myocardial salvage in acute MI leading to adverse cardiac remodeling [ 31 ]. Atria are more susceptible to effects of SDB than ventricles due to thinner musculature [ 31 ].…”