BMC Pulmonary Medicine (Mar 2020)

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

  • Antonello D’Andrea,
  • Angelo Canora,
  • Simona Sperlongano,
  • Domenico Galati,
  • Serena Zanotta,
  • Giorgio Emanuele Polistina,
  • Carmine Nicoletta,
  • Giacomo Ghinassi,
  • Maurizio Galderisi,
  • Alessandro Sanduzzi Zamparelli,
  • Patrizio Lancellotti,
  • Marialuisa Bocchino

DOI
https://doi.org/10.1186/s12890-020-1099-9
Journal volume & issue
Vol. 20, no. 1
pp. 1 – 9

Abstract

Read online

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.

Keywords