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. 2023 May;112(5):594-604.
doi: 10.1007/s00392-022-02139-3. Epub 2022 Dec 12.

Impact of transcatheter edge-to-edge mitral valve repair on central sleep apnoea

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Impact of transcatheter edge-to-edge mitral valve repair on central sleep apnoea

Michael G Paulus et al. Clin Res Cardiol. 2023 May.

Abstract

Aims: Sleep-disordered breathing (SDB) and its subtype central sleep apnoea (CSA) are highly prevalent in patients with heart failure and associated with worse prognosis. Whereas pharmacological therapy of heart failure has been shown to ameliorate CSA, results from previous studies on the effect of mitral regurgitation therapy on SDB are contradicting. The aim of this study was to assess the impact of transcatheter edge-to-edge mitral valve repair (TEER) on prevalence and severity of CSA.

Methods and results: We enrolled 47 patients undergoing TEER for symptomatic mitral regurgitation in a prospective study. Secondary mitral regurgitation and left ventricular ejection fraction < 50% were present in 79% and 68% of patients, respectively. Respiratory polygraphy was performed before TEER in a compensated condition and four weeks after the procedure. 34 patients completed the follow-up. At baseline, 19 (56%) patients showed moderate-to-severe SDB, of whom 13 (68%) were classified as CSA. Both apnoea-hypopnoea index and percentage of recorded time spent in Cheyne-Stokes respiration strongly decreased from baseline to follow-up (median [IQR] 16 [7-30] vs. 7 [4-15] /h, p = 0.007; 6 [0-34] vs. 0 [0-8] %, p = 0.008). Median relative reduction of central apnoea index was 75% (p = 0.023), while obstructive apnoea index did not change significantly. Increase in stroke volume after TEER and high systolic pulmonary artery pressure at baseline predicted a > 50% reduction of both Apnoea-hypopnoea index and Cheyne-Stokes respiration.

Conclusion: TEER is associated with a significant short-term reduction of CSA and Cheyne-Stokes respiration in high-risk patients, strengthening its value as an effective treatment option for advanced heart failure.

Keywords: Cheyne–Stokes respiration; Edge-to-edge mitral valve repair; Mitral regurgitation; Sleep apnoea; Sleep-disordered breathing; Transcatheter mitral valve repair.

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Conflict of interest statement

Kurt Debl, Christine Meindl and Bernhard Unsöld received travel support from Abbott Vascular. The other authors declare they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Study flow chart. SDB, sleep-disordered breathing; TEER, transcatheter edge-to-edge mitral valve repair
Fig. 2
Fig. 2
Prevalence of moderate-to-severe SDB (A), Apnoea-Hypopnoea index (B) and proportion of Cheyne-Stokes respiration (C) at baseline and four weeks after TEER. B Data are shown as tukey-style box plots. C Data are shown as mean ± SEM. AHI, Apnoea-Hypopnoea index; CSA, central sleep apnoea; CSR, Cheyne-Stokes respiration; OSA, obstructive sleep apnoea; SDB, sleep-disordered breathing
Fig. 3
Fig. 3
Correlation between AHI reduction four weeks after TEER and baseline systolic pulmonary artery pressure (A) or stroke volume increase (B) in patients with at least mild SDB (AHI ≥ 5/h, n = 28). Data are shown as scatter plots with linear regression lines. AHI, Apnoea-Hypopnoea index; sPAP, systolic pulmonary artery pressure

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