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Wester M, Pec J, Lebek S, Fisser C, Debl K, Hamer O, Poschenrieder F, Buchner S, Maier LS, Arzt M, Wagner S. Sleep-Disordered Breathing Is Associated With Reduced Left Atrial Strain Measured by Cardiac Magnetic Resonance Imaging in Patients After Acute Myocardial Infarction. Front Med (Lausanne) 2022; 9:759361. [PMID: 35252229 PMCID: PMC8888827 DOI: 10.3389/fmed.2022.759361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/17/2022] [Indexed: 11/24/2022] Open
Abstract
Aims Sleep 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 Results 40 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. Conclusion Our 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.
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Affiliation(s)
- Michael Wester
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Jan Pec
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Simon Lebek
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Fisser
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Kurt Debl
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Okka Hamer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Stefan Buchner
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
- Department of Internal Medicine, Cham Hospital, Cham, Germany
| | - Lars S. Maier
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Michael Arzt
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Wagner
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
- *Correspondence: Stefan Wagner
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Speckle tracking echocardiography in heart failure development and progression in patients with apneas. Heart Fail Rev 2021; 27:1869-1881. [PMID: 34853962 DOI: 10.1007/s10741-021-10197-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
Obstructive (OA) and central apneas (CA) are highly prevalent breathing disorders that have a negative impact on cardiac structure and function; while OA promote the development of progressive cardiac alterations that can eventually lead to heart failure (HF), CA are more prevalent once HF ensues. Therefore, the early identification of the deleterious effects of apneas on cardiac function, and the possibility to detect an initial cardiac dysfunction in patients with apneas become relevant. Speckle tracking echocardiography (STE) imaging has become increasingly recognized as a method for the early detection of diastolic and systolic dysfunction, by the evaluation of left atrial and left and right ventricular global longitudinal strain, respectively. A growing body of evidence is available on the alterations of STE in OA, while very little is known with regard to CA. In this review, we discuss the current knowledge and gap of evidence concerning apnea-related STE alterations in the development and progression of HF.
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Zhang Y, Shui W, Tian Y, Zhang Z, Li J, Wang J. The impact of left ventricular geometry on left atrium phasic function in obstructive sleep apnea syndrome: a multimodal echocardiography investigation. BMC Cardiovasc Disord 2021; 21:209. [PMID: 33894755 PMCID: PMC8070276 DOI: 10.1186/s12872-021-02018-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/13/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Left ventricular geometry and left atrium (LA) enlargement are risk factors for cardiovascular disease. However, reports on the relationship between left ventricular geometry and LA volume yielded contradictory findings, and LA phasic function remains unclear. Hence, this study aimed to investigate the influence of left ventricular geometry on LA volume and phasic function in patients with obstructive sleep apnea syndrome (OSAS) via a multimodal echocardiographic approach. METHODS In this cross-sectional study, 221 patients with OSAS (age 20-68 years, mean age 45.27 ± 12.50 years) underwent clinical evaluation, polysomnography, and multimodal echocardiographic examination with two-dimensional echocardiography (2DE), two-dimensional speckle-tracking echocardiography (2D-STE) and three-dimensional echocardiography (3DE). Based on conventional classification of left ventricular geometry, patients with OSAS were divided into four groups: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). RESULTS Based on 2DE and 3DE, the LA volumes and indices gradually increased from NG to CH. Additionally, 2DE and 3DE LA maximum volume index (LAVImax) were higher in patients with CH and EH than in patients with NG and CR (P < 0.05). The reservoir function, estimated by LA total emptying fraction (LA TotEF) was lower in patients with CH than in patients with NG in 2DE and 3DE (both, P < 0.05). Also, LA conduit function, evaluated by LA passive emptying fraction (LA PassEF) was lower in patients with CH than in patients with NG and CR, and in patients with EH than in those with NG in 2DE and 3DE (all, P < 0.05). The LA booster pump function, evaluated by LA active emptying fraction (LA ActEF) showed no statistically significant difference in 2DE; however, it was greater in patients with CH than in those with NG in 3DE. Similar results were obtained by 2D-STE, and CH was significantly associated with LA strain during systole (LAS-S, β = - 0.546, 95%CI: - 6.371-(- 3.444); P < 0.001), early diastole (LAS-E, β = - 0.636, 95%CI: - 9.532-(- 5.710); P < 0.001), and late diastole (LAS-A, β = - 0.450, 95%CI: 1.518-3.909; P < 0.001) in multiple linear regression. CONCLUSIONS The LA phasic function changed with left ventricular geometry via multimodal echocardiography. CH had the most notable negative effect on the maximum volume and phasic function of the LA.
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Affiliation(s)
- Yong Zhang
- Medical imaging department of Shanxi Medical University; Department of Ultrasound, First Hospital of Shanxi Medical University, 85 Jiefang Nan Road, Taiyuan, 030001, Shanxi, China
| | - Wen Shui
- Medical imaging department of Shanxi Medical University; Department of Ultrasound, First Hospital of Shanxi Medical University, 85 Jiefang Nan Road, Taiyuan, 030001, Shanxi, China
| | - Yun Tian
- Medical imaging department of Shanxi Medical University; Department of Ultrasound, First Hospital of Shanxi Medical University, 85 Jiefang Nan Road, Taiyuan, 030001, Shanxi, China
| | - Zhenxia Zhang
- Department of Respiratory, First Hospital of Shanxi Medical University, 85 Jiefang Nan Road, Taiyuan, 030001, Shanxi, China
| | - Juan Li
- Medical imaging department of Shanxi Medical University; Department of Ultrasound, First Hospital of Shanxi Medical University, 85 Jiefang Nan Road, Taiyuan, 030001, Shanxi, China
| | - Jian Wang
- Medical imaging department of Shanxi Medical University; Department of Ultrasound, First Hospital of Shanxi Medical University, 85 Jiefang Nan Road, Taiyuan, 030001, Shanxi, China.
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Abnormal atrial function in hypertensive patients with obstructive sleep apnea assessed by speckle tracking echocardiography. Hypertens Res 2020; 43:841-844. [DOI: 10.1038/s41440-020-0415-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 12/15/2022]
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Evaluation of the left atrial function by two-dimensional speckle-tracking echocardiography in diabetic patients with obesity. Int J Cardiovasc Imaging 2020; 36:643-652. [PMID: 31927663 DOI: 10.1007/s10554-020-01768-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/03/2020] [Indexed: 12/13/2022]
Abstract
Obesity and diabetes are risk factors for atrial cardiomyopathy and are, thus, deemed public health concerns. However, the effects of obesity on the left atrial (LA) function in patients with diabetes have not been determined yet. We sought to evaluate the effects of obesity on the LA function in patients with type 2 diabetes. Ninety-six consecutive patients with type 2 diabetes without significant coronary artery stenosis in selective coronary angiography were included in this cross-sectional study. Two-dimensional speckle-tracking echocardiography (2DSTE)-derived longitudinal LA myocardial deformation markers were compared between 42 obese and 54 nonobese patients. The longitudinal strain and the longitudinal strain rate of the LA myocardium during the reservoir phase and the contraction phase were reduced in the obese patients with diabetes compared with the nonobese patients with diabetes in the unadjusted analysis. In the adjusted analysis, longitudinal strain and the longitudinal strain rate during the contraction phase and the longitudinal strain rate during the reservoir phase were decreased in the obese patients with diabetes. The reservoir and contraction functions of the LA as evaluated by 2DSTE were decreased in our obese patients with diabetes compared with our nonobese patients with diabetes.
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Left atrial strain improves estimation of filling pressures in heart failure: a simultaneous echocardiographic and invasive haemodynamic study. Clin Res Cardiol 2018; 108:703-715. [PMID: 30536044 PMCID: PMC6529379 DOI: 10.1007/s00392-018-1399-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 11/28/2018] [Indexed: 12/31/2022]
Abstract
Aims Left ventricular diastolic pressure estimation is essential for characterization of heart failure (HF). Patients with normal resting left atrial (LA) pressures (LAP), but steep LAP elevation on exertion, pose a particular diagnostic challenge. Current recommendations on echocardiographic LAP estimation have limited accuracy. Our aim was to investigate whether LA mechanical alterations assessed by LA strain (LA-GS) can contribute to non-invasive LAP diagnostics. Methods and results Simultaneous echocardiographic and right heart catheterization (RHC) data at rest and during exercise was analyzed in 164 prospectively enrolled patients, referred for RHC due to HF symptoms. 56% had preserved ejection fraction (pEF). At rest, 97 patients displayed elevated mean pulmonary arterial wedge pressure (PAWPM); further 32 patients had normal resting, but elevated PAWPM during exercise. LA-GS demonstrated a stronger relationship with resting PAWPM (r = − 0.61, p < 0.001) than any of the indices (E/e′, LAVi, TRVmax) incorporated in the currently recommended diagnostic algorithm. The diagnostic ability of LA-GS for detecting elevated resting PAWPM (AUC: 0.80, p < 0.001) outperformed that of the recommended algorithm (AUC: 0.69). Importantly, resting LA-GS performed even better in identifying patients with pathological PAWPM either at rest or during stress (AUC: 0.90, p < 0.001), whereas the diagnostic potential of the current algorithm was modest and limited to pEF patients (AUC = 0.72). Finally, among the non-invasive indices, LA-GS entailed the strongest prognostic value for death or heart transplantation (OR: 2.7; p < 0.05). Conclusion LA-GS comprises a robust method for PAWPM assessment at rest. More importantly, it reliably discerns pathological PAWPM rise on exertion despite normal resting pressures. Electronic supplementary material The online version of this article (10.1007/s00392-018-1399-8) contains supplementary material, which is available to authorized users.
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Assessment of left atrial function using speckle tracking echocardiography in ankylosing spondylitis: a case-control study. Int J Cardiovasc Imaging 2018; 34:1863-1868. [PMID: 30014361 DOI: 10.1007/s10554-018-1411-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
The aim of this study is to assess the left atrium (LA) deformation parameters by using 2D speckle tracking echocardiography (2D-STE) in ankylosing spondylitis (AS) patients and to evaluate the relationship between these parameters and AS clinical indexes. 30 patients with AS (22 males, 8 females) and 30 healthy individuals (19 males, 11 females) were enrolled in this study. Transthoracic echocardiography was performed to both groups. Besides the conventional echocardiographic parameters, the LA strain parameters; including systolic-reservoir (LA S-S), early diastolic-conduit (LA S-E), late diastolic-contraction (LA S-A) were measured. No significant difference was found between two groups in terms of conventional echocardiographic parameters except mean deceleration time (DT). Mean DT was prolonged in the AS patients compare with the control group (173.5 ± 22.5 vs. 155.3 ± 36.7, p = 0.025). In the AS patients, LA S-S (48.3 ± 9.4 vs. 56.9 ± 10.1, p = 0.001), LA S-E (26.4 ± 6.4 vs. 31.6 ± 7.3, p = 0.005) and LA S-A (21.9 ± 4.7 vs. 25.4 ± 5.7, p = 0.013) values were statistically lower than the control group. Also a negative correlation was observed between the Bath Ankylosing Spondylitis Metrology Index (BASMI) and LA S-S (r = - 0.509, p = 0.004), LA S-E (r = - 0.501, p = 0.005). Our study demonstrated that 2D-STE is a useful method to determine the left atrial involvement in AS patients without the clinical evident of cardiovascular disease.
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Fox H, Bitter T, Horstkotte D, Oldenburg O. Sleep-Disordered Breathing and Arrhythmia in Heart Failure Patients. Sleep Med Clin 2017; 12:229-241. [PMID: 28477777 DOI: 10.1016/j.jsmc.2017.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) treatment remains complex and challenging, with current recommendations aiming at consideration and treatment of comorbidities in patients with HF. Sleep-disordered breathing (SDB) and arrhythmia come into play, as both are associated with quality of life deterioration, and morbidity and mortality increase in patients with HF. Interactions of these diseases are versatile and may appear intransparent in daily practice. Nevertheless, because of their importance for patients' condition and prognosis, SDB and arrhythmia individually, but also through interaction on one another, necessitate attention, following the fact that treatment is requested and desired considering latest research findings and outcomes.
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Affiliation(s)
- Henrik Fox
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany.
| | - Thomas Bitter
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
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9
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Xu R, Luo R, Tan B, Gan T, Li G. Early changes of left atrial function in chronic asymptomatic alcoholics by two-dimensional speckle-tracking echocardiography. Acta Cardiol 2017; 72:28-35. [PMID: 28597735 DOI: 10.1080/00015385.2017.1281548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Chronic excessive alcohol intake has been reported as a possible cause of dilated cardiomyopathy. Two-dimensional speckle-tracking echocardiography (2D-STE) is a novel method for the angle-independent and objective quantification of myocardial deformation. This study sought to assess left atrial function changes among alcoholics related to the duration of heavy drinking by 2D-STE. Methods We classified 92 asymptomatic alcoholics into mild, moderate and severe groups. Thirty age-matched controls were also recruited. We measured left atrial (LA) phasic volumes (max, min and pre-atrial contraction volume) using Simpson's method in apical four-chamber view. Passive emptying (LAPEF) and active emptying (LAAEF) indices were calculated. Global longitudinal strain rate (SRs) during left ventricular (LV) ejection, early diastolic strain rate (SRe) during LV early diastole and peak negative strain rate (SRa) after the P-wave were also obtained by averaging all atrial segments. Results The alcoholics had larger LA volumes (max, min and pre-atrial contraction volume) since moderate stage (P < 0.01). LAPEF, SRs SRe, and E/A ratio showed progressive decrease according to the grades of alcoholism. The differences between the groups were significant, beginning from the moderate group (P < 0.01). During LAAEF, SRa values increased with the disease severity up to moderate alcoholics and then deteriorated significantly in severe alcoholics (P < 0.01). Conclusions These data suggest that 2D-STE may be considered a promising tool for the early detection of impairment of LA function in alcoholics.
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Affiliation(s)
- Rui Xu
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, China
| | - Runlan Luo
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, China
| | - Bijun Tan
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, China
| | - Tian Gan
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, China
| | - Guangsen Li
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, China
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Wang Y, Zhang Y, Ma C, Guan Z, Liu S, Zhang W, Li Y, Yang J. Evaluation of Left and Right Atrial Function in Patients with Coronary Slow-Flow Phenomenon Using Two-Dimensional Speckle Tracking Echocardiography. Echocardiography 2016; 33:871-80. [PMID: 26857684 DOI: 10.1111/echo.13197] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Coronary slow-flow phenomenon (CSFP) is an angiographic diagnosis characterized by delayed coronary opacification in the absence of obstructive coronary artery disease. Currently, several investigators are focusing on ventricular function assessment in patients with CSFP; however, there is a paucity of data on their atrial function. This study was performed to evaluate left atrial (LA) and right atrial (RA) function in patients with CSFP. MATERIALS AND METHODS Eighty-two patients with CSFP and 55 controls without CSFP were enrolled in the study. Diagnosis of CSFP was made by thrombolysis in myocardial infarction frame count (TFC). The LA and RA global longitudinal strain and strain rate during systole (Ss, SRs), during early diastole (Se, SRe), and during late diastole (Sa, SRa) were measured using two-dimensional speckle tracking echocardiography. RESULTS In the CSFP group, LA Se and SRe decreased, while LA Sa and SRa increased, compared with the control group. RA Se and SRe were lower in patients with CSFP than in the controls. CONCLUSIONS LA conduit function decreased in patients with CSFP, while contractile function increased. RA conduit function also decreased in patients with CSFP.
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Affiliation(s)
- Yonghuai Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yan Zhang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China.,Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhengyu Guan
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shuang Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Weixin Zhang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yuling Li
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Nappo R, Degiovanni A, Bolzani V, Sartori C, Di Giovine G, Cerini P, Fossaceca R, Kovács SJ, Marino PN. Quantitative assessment of atrial conduit function: a new index of diastolic dysfunction. Clin Res Cardiol 2015; 105:17-28. [PMID: 26123829 PMCID: PMC4712233 DOI: 10.1007/s00392-015-0882-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/09/2015] [Indexed: 11/27/2022]
Abstract
Background Heart failure (HF) epidemic has increased need for accurate diastolic dysfunction (DD) quantitation. Cardiac MRI can elucidate left atrial (LA) phasic function, and accurately quantify its conduit contribution to left ventricular (LV) filling, but has limited availability. We hypothesized that the percentage of LV stroke volume due to atrial conduit volume (LACV), as assessed using 3D-echocardiography, can differentiate among progressive degrees of DD in HF patients. Methods and results Sixty-three subjects (66 ± 12 years) with DD and ejection fraction (EF) ranging 14–62 % underwent full-volume 3D-echocardiography. Simultaneous LA and LV volume curves as function of time (t) were calculated, with LACV as \documentclass[12pt]{minimal}
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\begin{document}$${\text{LACV}}\left( t \right) \, = \, \left[ {{\text{LV}}\left( t \right){-}{\text{LV minimum}}} \right] \, - \, \left[ {{\text{LA maximum }} - {\text{ LA}}\left( t \right)} \right]$$\end{document}LACVt=LVt-LV minimum-LA maximum-LAt, expressed as % of stroke volume. Patients were assigned to four (0–3, from none to severe) DD grades, according to classical Doppler parameters. In this population DD is linked to LACV, with progressively higher percentages of conduit contribution to stroke volume associated with higher degrees of DD (p = 0.0007). Patients were then dichotomized into no-mild (n = 26) or severe (n = 37) DD groups. Apart from atrial volume, larger (p < 0.02) in severe DD group, no differences between groups were found for LV diastolic and stroke volume, EF, mass and flow propagation velocity. However, a significant difference was found for LACV expressed as % of LV stroke volume (29 ± 15 vs. 43 ± 23 %, p = 0.016). Conclusions Our study confirms that LACV contribution to stroke volume increases along with worsening DD, as assessed in the context of (near) constant-volume four-chamber heart physiology. Thus, LACV can serve as new parameter for DD grading severity in HF patients.
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Affiliation(s)
- Rosaria Nappo
- Clinical Cardiology, Department of Translational Medicine, Azienda Ospedaliero Universitaria "Maggiore della Carità", Università del Piemonte Orientale, Corso Mazzini 18, 28100, Novara, Italy
| | - Anna Degiovanni
- Clinical Cardiology, Department of Translational Medicine, Azienda Ospedaliero Universitaria "Maggiore della Carità", Università del Piemonte Orientale, Corso Mazzini 18, 28100, Novara, Italy
| | - Virginia Bolzani
- Clinical Cardiology, Department of Translational Medicine, Azienda Ospedaliero Universitaria "Maggiore della Carità", Università del Piemonte Orientale, Corso Mazzini 18, 28100, Novara, Italy
| | - Chiara Sartori
- Clinical Cardiology, Department of Translational Medicine, Azienda Ospedaliero Universitaria "Maggiore della Carità", Università del Piemonte Orientale, Corso Mazzini 18, 28100, Novara, Italy
| | - Gabriella Di Giovine
- Clinical Cardiology, Department of Translational Medicine, Azienda Ospedaliero Universitaria "Maggiore della Carità", Università del Piemonte Orientale, Corso Mazzini 18, 28100, Novara, Italy
| | - Paolo Cerini
- Radiology, Department of Translational Medicine, Azienda Ospedaliero Universitaria "Maggiore della Carità", Università del Piemonte Orientale, Corso Mazzini 18, 28100, Novara, Italy
| | - Rita Fossaceca
- Radiology, Department of Translational Medicine, Azienda Ospedaliero Universitaria "Maggiore della Carità", Università del Piemonte Orientale, Corso Mazzini 18, 28100, Novara, Italy
| | - Sándor J Kovács
- Cardiovascular Biophysics Laboratory, Washington University Medical Center, 660 South Euclid Avenue, St Louis, MO, 63110, USA
| | - Paolo N Marino
- Clinical Cardiology, Department of Translational Medicine, Azienda Ospedaliero Universitaria "Maggiore della Carità", Università del Piemonte Orientale, Corso Mazzini 18, 28100, Novara, Italy.
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Miśkowiec D, Karolina K, Michalski BW, Uznańska-Loch B, Kurpesa M, Kasprzak JD, Lipiec P. Left Atrial Dysfunction Assessed by Two-Dimensional Speckle Tracking Echocardiography in Patients with Impaired Left Ventricular Ejection Fraction and Sleep-Disordered Breathing. Echocardiography 2015; 33:38-45. [DOI: 10.1111/echo.12987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Dawid Miśkowiec
- Department of Cardiology; Medical University of Lodz; Lodz Poland
| | | | | | | | | | | | - Piotr Lipiec
- Department of Cardiology; Medical University of Lodz; Lodz Poland
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13
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Bitter T, Fox H, Gaddam S, Horstkotte D, Oldenburg O. Sleep-Disordered Breathing and Cardiac Arrhythmias. Can J Cardiol 2015; 31:928-34. [PMID: 26037822 DOI: 10.1016/j.cjca.2015.04.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 02/07/2023] Open
Abstract
Over the past few years sleep-disordered breathing has been identified as an important factor in arrhythmogenesis and a potential target of therapy to prevent cardiac arrhythmias in selected patients. In this review we highlight the role of obstructive sleep apnea and Cheyne-Stokes respiration in the pathophysiology of arrhythmias, address their clinical effect in supraventricular and ventricular tachyarrhythmias, and in conduction disturbances, and address the role of current treatment options for sleep-disordered breathing in the primary and secondary prevention of arrhythmic events.
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Affiliation(s)
- Thomas Bitter
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
| | - Henrik Fox
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - SaiPrassad Gaddam
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
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Schaefer CA, Adam L, Weisser-Thomas J, Pingel S, Vogel G, Klarmann-Schulz U, Nickenig G, Pizarro C, Skowasch D. High prevalence of peripheral arterial disease in patients with obstructive sleep apnoea. Clin Res Cardiol 2015; 104:719-26. [PMID: 25725776 DOI: 10.1007/s00392-015-0834-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) merits increasing attention as cardiovascular risk factor. Whereas carotid and coronary artery disease have been associated with OSA, occurrence of peripheral arterial disease (PAD) in OSA remains undefined. METHODS We screened 100 patients with suspected OSA for PAD. After polysomnography, each patient underwent standardized angiological testing including ankle-brachial index (ABI), central pulse wave velocity, pulse wave index and duplex sonography. RESULTS Among total study population, PAD prevalence accounted for 88%, of those 68% had asymptomatic plaques and 20% were symptomatic Fontaine ≥ IIa. In confirmed OSA, prevalence raised up to 98%. Except for smoking habits, distribution of established risk factors did not differ between OSA groups (patients without, mild, intermediate and severe OSA). Presence of plaque, Fontaine PAD stages and intermittent claudication exhibited significant gain with increasing AHI. A logistic regression model revealed that age (OR = 1.199, 95% CI [1.066; 1.348]) and the logarithmically transformed AHI (OR = 5.426, 95% CI [1.068; 27.567]) had the strongest influence on plaque presence. Central pulse wave velocity as marker of arterial stiffness was positively correlated with AHI. CONCLUSION OSA is associated with a high prevalence of PAD. This implies substantial diseasés under-recognition and a presumable atherogenic role of OSA in the pathogenesis of PAD. However, vasoprotective impact of OSA treatment remains to be determined.
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Affiliation(s)
- C A Schaefer
- Department of Internal Medicine II, Cardiology, Pneumology and Angiology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany,
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Laporta R, Anandam A, El-Solh AA. Screening for obstructive sleep apnea in veterans with ischemic heart disease using a computer-based clinical decision-support system. Clin Res Cardiol 2012; 101:737-44. [PMID: 22476823 DOI: 10.1007/s00392-012-0453-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 03/22/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the validity of a handheld clinical decision-support system (CDSS) in detecting obstructive sleep apnea (OSA) in veterans with ischemic heart disease against polysomnography (PSG) and to compare the diagnostic accuracy of the CDSS versus the Berlin questionnaire. METHODS We enrolled prospectively 143 patients with underlying ischemic heart disease. Veterans with history of neurologic disease, systolic congestive heart failure, or receiving opiates were excluded from participation. Participants were asked to complete the Berlin Questionnaire and to answer all eight questions of CDSS-software. At the end of the interview, veterans were scheduled for an in-laboratory polysomnogram. RESULTS Ninety one patients completed the study. The prevalence of OSA (AHI ≥5/h) was 74.7 % with a median AHI of 11.5/h (range 0-90). When compared to PSG, the CDSS and the Berlin questionnaire achieved a sensitivity of 98.5 % [95 % confidence interval (CI) 92.1-100] and 80.9 % (95 % CI 69.5-89.4) and a specificity of 86.9 % (95 % CI 66.4-97.2) and 39.1 % (95 % CI 19.7-61.5) at a threshold value of AHI ≥5 with a corresponding area under the curve of 0.93 (95 % CI 0.85-0.97) and 0.60 (95 % CI 0.49-0.70); respectively. CONCLUSIONS CDSS is a superior screening tool for identifying cardiac veterans with undiagnosed OSA than the BQ.
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Affiliation(s)
- Rachel Laporta
- Medical Research, VA Western New York Healthcare System, Buffalo, NY, 14215-1199, USA
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