Evaluation of subclinical left ventricular systolic dysfunction in patients with obstructive sleep apnea by automated function imaging method; an observational study

Abstract

Objective: We aimed to evaluate the subclinical left ventricular (LV) systolic dysfunction with the automated function imaging method (AFI) based on speckle tracking echocardiography (STE) in obstructive sleep apnea patients (OSA) with normal left ventricular ejection fraction (LVEF) and without any confounding disease that can cause myocardial dysfunction. Methods: Twenty-one healthy individuals and 58 OSA patients were included in this observational cross-sectional study. According to the severity of disease, OSA patients were examined in three groups; mild, moderate and severe OSA. Apical 2-, 3-and 4-chamber images were obtained for AFI evaluation. The global systolic longitudinal strain (GL S ) values were determined for each view, and averages of these were used in comparison of the patient groups. One-way ANOVA, Kruskal-Wallis, Pearson correlation tests and linear regression analysis were used for statistical analysis. Results: The GL S values of the OSA patients were lower than of the healthy individuals and these values were decreased along with the OSA severity (Healthy:-25.58±-2.16%, Mild:-23.93±-3.96%, Moderate:-21.27±-2.60%, Severe:-16.94±-2.66%, respectively). The difference was significant between moderate OSA patients and healthy individuals, and significant between severe OSA patients and all other groups (p<0.03). The apnea-hypopnea index was found to be correlated with the GL S (β=-0.659, 95% CI: 0.09-0.17, p<0.001). Conclusion: Longitudinal LV mechanics in OSA patients with normal LVEF are deteriorated in the subclinical stage being associated with the severity of disease. AFI can be used as an effective and safe method in the determination of subclinical myocardial dysfunction in OSA patients, because it is semi-automated and easy to use with a short analysis time.(Anadolu Kardiyol Derg 2012; 12: 320-30) Key words: Obstructive sleep apnea, speckle tracking echocardiography, myocardial strain, regression analysis 320 ÖZET Amaç: Sol ventrikül ejeksiyon fraksiyonu normal ve miyokart fonksiyonlarını etkileyecek ek hastalığı bulunmayan, obstrüktif uyku apneli (OUA) hastalarda, subklinik sol ventrikül sistolik disfonksiyonunu, iki boyutlu benek izleme ekokardiyografi tekniğine dayanan, otomatik fonksiyonel görün-tüleme yöntemi (OFG) ile değerlendirmeyi amaçladık. Yöntemler: Gözlemsel enine-kesitli çalışmamıza 21'i sağlıklı, 58'i OUA hastası olan toplam 79 kişi alındı. OUA'lı hastalar hastalığın ciddiyetine göre hafif, orta ve ağır olarak 3 gruba ayrıldı. OFG değerlendirmesi için sol ventrikülün apikal 2-, 3-, 4-boşluk görüntüleri kullanıldı. İlgili boşluk-lara ait sistolik longitüdinal deformasyon değerlerinin aritmetik ortalaması olan, global longitüdinal deformasyon değerleri gruplar arasında karşılaştırıldı. İstatistiksel analiz için tek -yönlü ANOVA, Kruskal-Wallis, Pearson korelasyon testleri ve doğrusal regresyon analizi kullanıldı. Bulgular: Sağlıklı gruba göre hafif OUA grubundan itibaren hastalığın ciddiyeti ile global longitüdinal deformasyon değerleri azalmaktaydı (Sağlıklı: -%25...

A Novel Method for Sensitive Determination of Subclinical Left-Ventricular Systolic Dysfunction in Subjects With Obstructive Sleep Apnea

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“…In most cases, LV systolic and diastolic dysfunction induced by OSA are temporary and functional, which could result in recovery when the hypoxia is improved or treated with CPAP therapy. 19 There are only a few published studies 19,21,22 that have used speckle-tracking echocardiography in the assessment of longitudinal and circumferential systolic myocardial functions in OSA subjects. In this study, we found that both longitudinal and circumferential strain in 3 myocardial layers were homogeneously decreased and correlated with the degree of OSA.…”

The association of neutrophil to lymphocyte ratio with presence and severity of obstructive sleep apnea

“…Infl ammation plays an important role in the pathogenesis of atherosclerosis (20). Hypoxia and systemic infl ammation may lead to progressive atherosclerosis and contribute to increased risk of CVD in patients with OSA (21)(22)(23). Increased levels of infl ammatory markers are associated with increased cardiovascular risk (24).…”

The effect of incremental endurance exercise training on left ventricular mechanics: a prospective observational deformation imaging study

“…It has been shown in numerous studies that strain measurements by speckle tracking echocardiography is useful in subclinical detection of cardiac involvement in many systemic diseases (22,24,25). Recently, Baggish et al (6) demonstrated, in a longitudinal study, that a 90 day period of endurance exercise training increased the LV strain without changing the LV-EF.…”