Dian Wang1, Gen Shan Ma1, Xiao Yan Wang2, Qiang Qiang Lu3, Yu Wang1, Nai Feng Liu4. 1. Department of Cardiology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China. 2. Department of Geriatric Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 3. Department of Pneumology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China. 4. Department of Cardiology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China. liunaifengseu@126.com.
Abstract
BACKGROUND: Previous studies have demonstrated that patients with obstructive sleep apnea (OSA) may develop left ventricular (LV) diastolic dysfunction. We aimed to study whether OSA patients have LV regional systolic dysfunction with myocardial deformation changes, despite a normal LV ejection fraction, using real-time 3D speckle-tracking echocardiography (Rt3D-STE). METHODS: Seventy-eight patients with OSA and no comorbidities were studied. They were divided into the following three groups according to the apnea-hypopnea index (AHI): 5~15/h as group I (mild OSA, 26 cases), 15~30/h as group II (moderate OSA, 29 cases), and ≥30/h as group III (severe OSA, 23 cases). Thirty gender-age-matched normal subjects were included as controls. The parameters of LV diastolic function were acquired with traditional echocardiography. The LV myocardial deformation parameters were obtained, including the longitudinal (LS), circumferential (CS), radial (RS), and area (AS) strains, with Rt3D-STE. RESULTS: LV global systolic function was normal in all patients, but diastolic function was impaired in groups II and III (E/E' was 9.6 ± 2.8 and 10.4 ± 2.5, respectively, p < 0.0001). The global LS and AS were significantly reduced in groups II and III compared with the controls and group I (LS 15.9 ± 1.4 % and 14.8 ± 1.5 % vs 18.2 ± 1.7 % and 17.8 ± 1.5 %; AS 27.4 ± 1.8 % and 24.9 ± 2.3 % vs 33.4 ± 2.2 % and 32.7 ± 2.9 %, respectively, p < 0.0001), but the global CS and RS were significantly reduced only in group III (17.3 ± 1.4 % and 43.1 ± 6.5 % vs 19.6 ± 1.6 % and 55.4 ± 4.0 %, respectively, <0.0001). The severity of OSA was significantly associated with the LV global AS value (r = -0.80, p < 0.0001), LS (r = -0.64, p < 0.0001), CS (r = -0.51, p < 0.0001), and RS (r = -0.62, p < 0.0001). CONCLUSIONS: Patients with moderate and severe OSA tended to have both LV diastolic dysfunction and abnormalities in regional systolic function with myocardial deformation changes, in spite of the normal LV ejection fraction. Myocardial strains of the LV were negatively correlated with the AHI. Rt-3DST had important clinical significance in the early evaluation of cardiac dysfunction in OSA patients.
BACKGROUND: Previous studies have demonstrated that patients with obstructive sleep apnea (OSA) may develop left ventricular (LV) diastolic dysfunction. We aimed to study whether OSA patients have LV regional systolic dysfunction with myocardial deformation changes, despite a normal LV ejection fraction, using real-time 3D speckle-tracking echocardiography (Rt3D-STE). METHODS: Seventy-eight patients with OSA and no comorbidities were studied. They were divided into the following three groups according to the apnea-hypopnea index (AHI): 5~15/h as group I (mild OSA, 26 cases), 15~30/h as group II (moderate OSA, 29 cases), and ≥30/h as group III (severe OSA, 23 cases). Thirty gender-age-matched normal subjects were included as controls. The parameters of LV diastolic function were acquired with traditional echocardiography. The LV myocardial deformation parameters were obtained, including the longitudinal (LS), circumferential (CS), radial (RS), and area (AS) strains, with Rt3D-STE. RESULTS: LV global systolic function was normal in all patients, but diastolic function was impaired in groups II and III (E/E' was 9.6 ± 2.8 and 10.4 ± 2.5, respectively, p < 0.0001). The global LS and AS were significantly reduced in groups II and III compared with the controls and group I (LS 15.9 ± 1.4 % and 14.8 ± 1.5 % vs 18.2 ± 1.7 % and 17.8 ± 1.5 %; AS 27.4 ± 1.8 % and 24.9 ± 2.3 % vs 33.4 ± 2.2 % and 32.7 ± 2.9 %, respectively, p < 0.0001), but the global CS and RS were significantly reduced only in group III (17.3 ± 1.4 % and 43.1 ± 6.5 % vs 19.6 ± 1.6 % and 55.4 ± 4.0 %, respectively, <0.0001). The severity of OSA was significantly associated with the LV global AS value (r = -0.80, p < 0.0001), LS (r = -0.64, p < 0.0001), CS (r = -0.51, p < 0.0001), and RS (r = -0.62, p < 0.0001). CONCLUSIONS:Patients with moderate and severe OSA tended to have both LV diastolic dysfunction and abnormalities in regional systolic function with myocardial deformation changes, in spite of the normal LV ejection fraction. Myocardial strains of the LV were negatively correlated with the AHI. Rt-3DST had important clinical significance in the early evaluation of cardiac dysfunction in OSA patients.
Entities:
Keywords:
Left ventricular dysfunction; Myocardial deformation; Obstructive sleep apnea; Real-time 3D speckle-tracking echocardiography
Authors: F Torrent-Guasp; M Ballester; G D Buckberg; F Carreras; A Flotats; I Carrió; A Ferreira; L E Samuels; J Narula Journal: J Thorac Cardiovasc Surg Date: 2001-08 Impact factor: 5.209
Authors: Khawaja Afzal Ammar; Timothy E Paterick; Bijoy K Khandheria; M Fuad Jan; Christopher Kramer; Matt M Umland; Alix J Tercius; Lisa Baratta; A Jamil Tajik Journal: Echocardiography Date: 2012-05-17 Impact factor: 1.724
Authors: Girardin Jean-Louis; Ferdinand Zizi; Luther T Clark; Clinton D Brown; Samy I McFarlane Journal: J Clin Sleep Med Date: 2008-06-15 Impact factor: 4.062
Authors: Jing Ping Sun; Jianli Niu; David Chou; Hsuan-Hung Chuang; Kai Wang; Jeanne Drinko; Allen Borowski; William J Stewart; James D Thomas Journal: J Am Soc Echocardiogr Date: 2007-05 Impact factor: 5.251
Authors: Maurice Dematteis; Cécile Julien; Christiane Guillermet; Nathalie Sturm; Sylvie Lantuejoul; Michel Mallaret; Patrick Lévy; Evelyne Gozal Journal: Am J Respir Crit Care Med Date: 2007-10-25 Impact factor: 21.405
Authors: Khin Mae Hla; Terry Young; Laurel A Finn; Paul E Peppard; Timothy J Kinsey; David Ende Journal: Sleep Breath Date: 2008-02-05 Impact factor: 2.816