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Subclinical impairment of dynamic left ventricular systolic and diastolic function in patients with obstructive sleep apnea and preserved left ventricular ejection fraction

BMC Pulmonary Medicine. 2020;20(1):1-9 DOI 10.1186/s12890-020-1099-9

 

Journal Homepage

Journal Title: BMC Pulmonary Medicine

ISSN: 1471-2466 (Online)

Publisher: BMC

LCC Subject Category: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the respiratory system

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML

 

AUTHORS


Antonello D’Andrea (Unit of Cardiology and Intensive Care, Umberto I Hospital)

Angelo Canora (Department of Clinical Medicine and Surgery, Respiratory Medicine Section, Federico II University (at Monaldi Hospital))

Simona Sperlongano (Unit of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital)

Domenico Galati (Haematology-Oncology and Stem Cell Transplantation Unit, Department of Haematology and Innovative Therapies, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale)

Serena Zanotta (Haematology-Oncology and Stem Cell Transplantation Unit, Department of Haematology and Innovative Therapies, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale)

Giorgio Emanuele Polistina (Department of Clinical Medicine and Surgery, Respiratory Medicine Section, Federico II University (at Monaldi Hospital))

Carmine Nicoletta (Department of Clinical Medicine and Surgery, Respiratory Medicine Section, Federico II University (at Monaldi Hospital))

Giacomo Ghinassi (Department of Clinical Medicine and Surgery, Respiratory Medicine Section, Federico II University (at Monaldi Hospital))

Maurizio Galderisi (Department of Advanced Biomedical Sciences, Federico II University Hospital Via S. Pansini 5)

Alessandro Sanduzzi Zamparelli (Department of Clinical Medicine and Surgery, Respiratory Medicine Section, Federico II University (at Monaldi Hospital))

Patrizio Lancellotti (CHU de Liége, Service de Cardiologie)

Marialuisa Bocchino (Department of Clinical Medicine and Surgery, Respiratory Medicine Section, Federico II University (at Monaldi Hospital))

EDITORIAL INFORMATION

Open peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 23 weeks

 

Abstract | Full Text

Abstract Background Hypoxia affects myocardial oxygen supply resulting in subclinical cardiac dysfunction in obstructive sleep apnea (OSA) patients, with cardiovascular complications being associated with increased oxidative burst (OB). The aims of our study were to assess left ventricular (LV) dynamic myocardial deformation and diastolic reserve at rest and upon exercise, along with OB determination in this patients subset. Methods Conventional echocardiography, Doppler myocardial imaging and LV 2D speckle tracking echocardiography were performed in 55 OSA patients with preserved LV ejection fraction (EF) and 35 age and sex-comparable healthy controls. Peripheral OB levels were evaluated by flow cytometry. Results Despite comparable LVEF, LV global longitudinal strain (GLS) was significantly reduced in OSA at rest (− 13.4 ± 3.8 vs − 18.4 ± 3.3 in controls, P <  0.001) and at peak exercise (− 15.8 ± 2.6 vs − 23.4 ± 4.3, P <  0.001). Systolic pulmonary artery pressure (sPAP) and E/E′ ratios increase during effort were higher in OSA than in controls (ΔsPAP 44.3% ± 6.4 vs 32.3% ± 5.5, P <  0.0001, and ΔE/E’ 87.5% ± 3.5 vs 25.4% ± 3.3, P <  0.0001, respectively). The best correlate of E/E′ at peak stress was peak exertion capacity (r = − 0.50, P <  0.001). OB was also increased in OSA patients (P = 0.001) but, unlike OSA severity, was not associated with LV diastolic dysfunction. Conclusions Evaluation of diastolic function and myocardial deformation during exercise is feasible through stress echocardiography. OSA patients with preserved LVEF show subclinical LV systolic dysfunction, impaired LV systolic and diastolic reserve, reduced exercise tolerance, and increased peripheral levels of OB. Therapy aimed at increasing LV diastolic function reserve might improve the quality of life and exercise tolerability in OSA patients.