Ravi V Shah1, Siddique A Abbasi2, Bobak Heydari2, Hoshang Farhad2, John A Dodson3, Jessie P Bakker4, Roy M John2, Aristidis Veves5, Atul Malhotra6, Ron Blankstein2, Michael Jerosch-Herold7, Raymond Y Kwong2, Tomas G Neilan8. 1. Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA. 2. Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA. 3. Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA. 4. Division of Sleep Medicine, Brigham and Women's Hospital, Boston, MA. 5. Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA. 6. Pulmonary and Critical Care Division, University of California San Diego, La Jolla, CA. 7. Department of Radiology, Brigham and Women's Hospital, Boston, MA. 8. Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, MA. Electronic address: tneilan@partners.org.
Abstract
AIMS: Obesity is associated with the development of atrial fibrillation (AF), and both obesity and AF are independently associated with the development of heart failure with preserved ejection fraction. We tested the hypothesis that sleep apnea (SA) would have a body mass index (BMI) independent association with adverse left ventricular (LV) remodeling and clinical outcomes in patients with AF and preserved LV function. METHODS AND RESULTS: From 720 consecutive patients with AF, 403 patients without myocardial disease (preserved LV function) were identified and followed up for 3.3 ± 1.5 years. The primary outcome was a combination of all-cause mortality/heart failure hospitalization. Left ventricular mass and LV mass-to-volume ratio were higher in patients with SA and obesity (P < .0001 for all). Body mass index (β per log = .47; P < .0001) and SA (β = .05; P = .045) were independently associated with LV mass index. Patients with treated SA had a lower LV mass index (but not LV mass-to-volume ratio) compared with untreated (P = .002). In a best overall multivariable model, SA therapy (β = -.129; P = .001) and BMI (β per log = .373; P = .0007) had opposing associations with LV mass index. Sleep apnea (hazard ratio [HR] = 2.94; P = .0004) and BMI (HR per 1 kg/m(2) = 1.08; P = .004) were associated with clinical outcome in unadjusted analysis. Only SA was associated with clinical outcome in a best overall multivariable model (HR = 2.14; P = .02). CONCLUSION: Sleep apnea and obesity are independently associated with adverse LV remodeling and clinical outcomes in patients with preserved LV function, whereas continuous positive airway pressure therapy is associated with a beneficial effect on LV remodeling. Research investigating SA therapies in patients at high risk for LV remodeling and heart failure is warranted.
AIMS: Obesity is associated with the development of atrial fibrillation (AF), and both obesity and AF are independently associated with the development of heart failure with preserved ejection fraction. We tested the hypothesis that sleep apnea (SA) would have a body mass index (BMI) independent association with adverse left ventricular (LV) remodeling and clinical outcomes in patients with AF and preserved LV function. METHODS AND RESULTS: From 720 consecutive patients with AF, 403 patients without myocardial disease (preserved LV function) were identified and followed up for 3.3 ± 1.5 years. The primary outcome was a combination of all-cause mortality/heart failure hospitalization. Left ventricular mass and LV mass-to-volume ratio were higher in patients with SA and obesity (P < .0001 for all). Body mass index (β per log = .47; P < .0001) and SA (β = .05; P = .045) were independently associated with LV mass index. Patients with treated SA had a lower LV mass index (but not LV mass-to-volume ratio) compared with untreated (P = .002). In a best overall multivariable model, SA therapy (β = -.129; P = .001) and BMI (β per log = .373; P = .0007) had opposing associations with LV mass index. Sleep apnea (hazard ratio [HR] = 2.94; P = .0004) and BMI (HR per 1 kg/m(2) = 1.08; P = .004) were associated with clinical outcome in unadjusted analysis. Only SA was associated with clinical outcome in a best overall multivariable model (HR = 2.14; P = .02). CONCLUSION:Sleep apnea and obesity are independently associated with adverse LV remodeling and clinical outcomes in patients with preserved LV function, whereas continuous positive airway pressure therapy is associated with a beneficial effect on LV remodeling. Research investigating SA therapies in patients at high risk for LV remodeling and heart failure is warranted.
Authors: Jane Colish; Jonathan R Walker; Nader Elmayergi; Saleh Almutairi; Fawaz Alharbi; Matthew Lytwyn; Andrew Francis; Sheena Bohonis; Matthew Zeglinski; Iain D C Kirkpatrick; Sat Sharma; Davinder S Jassal Journal: Chest Date: 2011-08-11 Impact factor: 9.410
Authors: Otavio R Coelho-Filho; Luciana F Seabra; François-Pierre Mongeon; Shuaib M Abdullah; Sanjeev A Francis; Ron Blankstein; Marcelo F Di Carli; Michael Jerosch-Herold; Raymond Y Kwong Journal: JACC Cardiovasc Imaging Date: 2011-08
Authors: Dimpi Patel; Prasant Mohanty; Luigi Di Biase; Mazen Shaheen; William R Lewis; Kara Quan; Jennifer E Cummings; Paul Wang; Amin Al-Ahmad; Preeti Venkatraman; Eyad Nashawati; Dhanunjaya Lakkireddy; Robert Schweikert; Rodney Horton; Javier Sanchez; Joseph Gallinghouse; Steven Hao; Salwa Beheiry; Deb S Cardinal; Jason Zagrodzky; Robert Canby; Shane Bailey; J David Burkhardt; Andrea Natale Journal: Circ Arrhythm Electrophysiol Date: 2010-08-05
Authors: Evrim B Turkbey; Robyn L McClelland; Richard A Kronmal; Gregory L Burke; Diane E Bild; Russell P Tracy; Andrew E Arai; João A C Lima; David A Bluemke Journal: JACC Cardiovasc Imaging Date: 2010-03
Authors: Giovanni Cioffi; Tiziano Edoardo Russo; Carlo Stefenelli; Alessandro Selmi; Francesco Furlanello; Dana Cramariuc; Eva Gerdts; Giovanni de Simone Journal: J Hypertens Date: 2010-05 Impact factor: 4.844
Authors: Chee Yuan Ng; Tong Liu; Michael Shehata; Steven Stevens; Sumeet S Chugh; Xunzhang Wang Journal: Am J Cardiol Date: 2011-04-29 Impact factor: 2.778
Authors: Luciano F Drager; Luiz A Bortolotto; Adelaide C Figueiredo; Bruno Caldin Silva; Eduardo M Krieger; Geraldo Lorenzi-Filho Journal: Chest Date: 2007-05 Impact factor: 9.410
Authors: Karuna Chilukuri; Darshan Dalal; Shrirang Gadrey; Joseph E Marine; Edwin Macpherson; Charles A Henrikson; Alan Cheng; Saman Nazarian; Sunil Sinha; David Spragg; Ronald Berger; Hugh Calkins Journal: J Cardiovasc Electrophysiol Date: 2009-11-17
Authors: Eric S Kerns; Esther D Kim; Lucy A Meoni; Stephen M Sozio; Bernard G Jaar; Michelle M Estrella; Rulan S Parekh; Ghada Bourjeily Journal: Am J Nephrol Date: 2018-08-15 Impact factor: 3.754
Authors: Tetz C Lee; Zhezhen Jin; Shunichi Homma; Koki Nakanishi; Mitchell S V Elkind; Tatjana Rundek; Aylin Tugcu; Kenji Matsumoto; Ralph L Sacco; Marco R Di Tullio Journal: J Am Soc Echocardiogr Date: 2019-07-13 Impact factor: 5.251
Authors: Kevin P Cohoon; Robert D McBane; Naser Ammash; Joshua P Slusser; Diane E Grill; Waldemar E Wysokinski Journal: J Thromb Thrombolysis Date: 2016-05 Impact factor: 2.300
Authors: Claudia E Korcarz; Paul E Peppard; Terry B Young; Carrie B Chapman; K Mae Hla; Jodi H Barnet; Erika Hagen; James H Stein Journal: Sleep Date: 2016-06-01 Impact factor: 5.849
Authors: Jessie P Bakker; Dimitrios Baltzis; Francesco Tecilazich; Raymond H Chan; Warren J Manning; Tomas G Neilan; Meredith L Wallace; Margo Hudson; Atul Malhotra; Sanjay R Patel; Aristidis Veves Journal: Ann Am Thorac Soc Date: 2020-04