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Reduction of sleep-disordered breathing following effective percutaneous mitral valve repair with the MitraClip system

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Abstract

Purpose

This study tested the hypothesis that a reduction of pulmonary congestion achieved by a reduction of mitral regurgitation (MR) severity in heart failure (HF) patients is associated with reduced event lengths of sleep-disordered breathing (SDB).

Methods

We prospectively enrolled 20 consecutive HF patients who underwent MitraClip implantation. Patients underwent cardiorespiratory polygraphic recording prior to and after percutaneous mitral valve repair (PMVR). Beyond routinely established indicators of apneas and hypopneas per hour (respiratory event index), we manually analyzed apnea event lengths.

Results

MitraClip implantation led to marked reduction of MR severity and a reduction in left atrial pressure. These hemodynamic changes were accompanied by changes in SDB: the subtype of SDB switched from CSA to OSA in 4 patients. Likewise, quantitative indicators of SDB were altered in both forms of SDB with a reduction in circulatory delay (CSA 38 ± 14 vs. 33 ± 15 s.; p = 0.002 and OSA 34 ± 9 vs. 28 ± 6 s.; p = 0.02) and a corresponding reduction in ventilation lengths in CSA patients (42 ± 15 vs. 37 ± 13 s.; p = 0.05).

Conclusion

A reduction of pulmonary congestion as achieved by a decrease of left atrial pressure through successful MitraClip implantation is associated with a reduction in respiratory event lengths, further pointing towards a relation between SDB and HF.

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Abbreviations

REI:

Respiratory event index

AL:

Apnea length

CD:

Circulatory delay

CL:

Cycle length

CSA:

Central sleep apnea

CSR:

Cheyne-Stokes respiration

EROA:

Effective regurgitant orifice area

HF:

Heart failure

LVEF:

Left ventricular ejection fraction

MR:

Mitral regurgitation

NYHA:

New York Heart Association

OSA:

Obstructive sleep apnea

PISA:

Proximal isovelocity surface area

PG:

Polygraphic recording

PMVR:

Percutaneous mitral valve repair

RV:

Regurgitation volume

SDB:

Sleep-disordered breathing

RVEDD:

Right ventricular end-diastolic diameter

TTPV:

Time-to-peak-ventilation

VL:

Ventilation length

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Acknowledgements

We gratefully acknowledge Miss Cettolines’ technical help in collecting our data and Mister Perez’ help in analyzing the sleep studies.

Funding

JS has been supported by the ‘Else-Kröner-Fresenius Stiftung’ (Grant A109) and by ‘Kommission für Innovative Medizinische Forschung an der Medizinischen Fakultät Muenster’ (IMF Grant SP 11 18 15) outside this work. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter our adherence to Journal policies on sharing data and materials.

Author information

Correspondence to Ralf Westenfeld.

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Conflict of interest

JS has been supported by the ‘Else-Kröner-Fresenius Stiftung’ (Grant A109) and by ‘Kommission für Innovative Medizinische Forschung an der Medizinischen Fakultät Muenster’ (IMF Grant SP 11 18 15) outside this work.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the local Ethics Committee of the University of Düsseldorf.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Spiesshoefer, J., Spieker, M., Klose, S. et al. Reduction of sleep-disordered breathing following effective percutaneous mitral valve repair with the MitraClip system. Sleep Breath 23, 815–824 (2019). https://doi.org/10.1007/s11325-018-1764-x

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Keywords

  • Percutaneous mitral valve repair
  • MitraClip
  • Sleep-disordered breathing
  • Respiratory physiology