Evaluation of Right Ventricular Remodeling Using Cardiac Magnetic Resonance Imaging in Co-Existent Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea

Abstract

Untreated chronic obstructive pulmonary disease (COPD) co-existing with obstructive sleep apnea (OSA), also known as overlap syndrome, has higher cardiovascular mortality than COPD alone but its underlying mechanism remains unclear. We hypothesize that the presence of overlap syndrome is associated with more extensive right ventricular (RV) remodeling compared to patients with COPD alone. Adult COPD patients (GOLD stage 2 or higher) with at least 10 pack-years of smoking history were included. Overnight laboratory-based polysomnography was performed to test for OSA. Subjects with an apnea-hypopnea index (AHI) >10/h were classified as having overlap syndrome (n = 7), else classified as having COPD-only (n = 11). A cardiac MRI was performed to assess right and left cardiac chambers sizes, ventricular masses, and cine function. RV mass index (RVMI) was markedly higher in the overlap group than the COPD-only group (19 ± 6 versus 11 ± 6; p = 0.02). Overlap syndrome subjects had a reduced RV remodeling index (defined as the ratio between RVMI and RV end-diastolic volume index) compared to the COPD-only group (0.27 ± 0.06 versus 0.18 ± 0.08; p = 0.02). In the overlap syndrome subjects, the extent of RV remodeling was associated with severity of oxygen desaturation (R2 = 0.65, p = 0.03). Our pilot results suggest that untreated overlap syndrome may cause more extensive RV remodeling than COPD alone.

T1 Measurements for Detection of Expansion of the Myocardial Extracellular Volume in Chronic Obstructive Pulmonary Disease

“…These patients were included in a prior published study detailing cardiovascular structure among patients with the overlap syndrome. 17 All COPD study participants also completed the Epworth Sleepiness Scale to assess daytime sleepiness 18 and the Modified Medical Research Council (MMRC) score to assess dyspnea before the polysomnography. 18 We recruited healthy volunteer controls by open enrolment using an IRB approved research website (http://clinicaltrials.partners.org/).…”

Pulmonary Artery Enlargement Is Associated With Right Ventricular Dysfunction and Loss of Blood Volume in Small Pulmonary Vessels in Chronic Obstructive Pulmonary Disease

“…Cardiac magnetic resonance imaging (cMRI) is the gold standard for the assessment of both the morphological and functional characteristics of the RV particularly in patients with COPD in whom echocardiographic assessment is often not possible 11-14 . Furthermore, cMRI has been used to demonstrate a relationship between progressive airflow obstruction and computed tomography (CT)-detected emphysema and impaired left ventricular (LV) filling, stroke volume (SV), and RV hypertrophy 15-20 .…”

Sleep-related disorders in chronic obstructive pulmonary disease

“…This complex relationship led Sharma et al to hypothesize that right ventricular volumes and function may be worse in overlap syndrome than the individual conditions due to increased hypoxemia and/or hypercapnia, particularly during sleep. In a pilot study of 18 patients, they reported that the overlap syndrome is associated with increased RV mass and RV remodeling compared with COPD alone, and that the extent of the adverse RV remodeling correlated with the degree of nocturnal oxygen desaturation [67].…”