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. 2013 Feb;10(1):4-10.
doi: 10.3109/15412555.2012.719050. Epub 2012 Dec 28.

Evaluation of right ventricular remodeling using cardiac magnetic resonance imaging in co-existent chronic obstructive pulmonary disease and obstructive sleep apnea

Bhavneesh Sharma  1 , Tomas G Neilan, Raymond Y Kwong, Damien Mandry, Robert L Owens, David McSharry, Jessie P Bakker, Atul Malhotra
Affiliations

Evaluation of right ventricular remodeling using cardiac magnetic resonance imaging in co-existent chronic obstructive pulmonary disease and obstructive sleep apnea

Bhavneesh Sharma et al. COPD. 2013 Feb.

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 (R(2) = 0.65, p = 0.03). Our pilot results suggest that untreated overlap syndrome may cause more extensive RV remodeling than COPD alone.

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Figures

Figure 1
Figure 1
Cardiac MRI images showing manually traced right and left ventricular endocardial (inner) and epicardial (outer) borders at end systole and end diastole. LV: left ventricular; RV: right ventricular.
Figure 2
Figure 2
Patient inclusion diagram. AHI: apnea-hypopnea index; COPD: chronic obstructive pulmonary disease; PSG: polysomnography.
Figure 3
Figure 3
Comparison of right ventricular mass index between untreated overlap syndrome and COPD-only subjects (p = 0.02).
Figure 4
Figure 4
Comparison of right ventricular (RV) remodeling index (ratio of RV mass index to RV end-diastolic volume index) between untreated overlap syndrome and COPD-only subjects (p = 0.02).
Figure 5
Figure 5
Correlation between right ventricular mass index and oxygen desaturation index during sleep in untreated overlap syndrome subjects (p = 0.03).
See this image and copyright information in PMC

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