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. 2020 Mar 29;20(1):76.
doi: 10.1186/s12890-020-1099-9.

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  1 , Angelo Canora  2 , Simona Sperlongano  3 , Domenico Galati  4 , Serena Zanotta  4 , Giorgio Emanuele Polistina  2 , Carmine Nicoletta  2 , Giacomo Ghinassi  2 , Maurizio Galderisi  5 , Alessandro Sanduzzi Zamparelli  2 , Patrizio Lancellotti  6 , Marialuisa Bocchino  7
Affiliations

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 et al. BMC Pulm Med. .

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: 2D speckle tracking echocardiography; Diastolic function; Exercise echocardiography; Obstructive sleep apnea; Oxidative burst.

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Conflict of interest statement

Prof. M. Bocchino and Prof A. Sanduzzi are associate editors of BMC Pulm Med. The remaining Authors have no conflicting interests for this study.

Figures

Fig. 1
Fig. 1
Levels of oxidative burst in OSA patients and healthy controls. a Distribution of oxidative burst (OB), calculated as mean fluorescence intensity (MFI), in OSA patients with respect to healthy volunteers; b Boxplot showing that peripheral levels of OB (MFI) are significantly increased in OSA patients as compared to healthy volunteers; c Boxplot showing the distribution of OB (MFI) in OSA patients according to t90%. As reported, OB levels are significantly increased in patients with t90 > 30%
Fig. 2
Fig. 2
Left ventricular systolic and diastolic dysfunction in OSA patients. Two-dimensional echocardiography (a: apical four chamber view) showing mild impairment of resting LV regional and global strain (mainly in the septal region, see arrow) (b) and significant diastolic dysfunction assessed by transmitral flow pattern (c) and both lateral (d) and septal (e) pulsed Doppler tissue imaging
See this image and copyright information in PMC

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