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Assessment of subclinical left ventricular dysfunction in obstructive sleep apnea patients with speckle tracking echocardiography

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Abstract

In this study, our aim was to evaluate the LV (left ventricle) subclinical myocardial dysfunction using the two-dimensional speckle tracking echocardiography (2D-STE) method on obstructive sleep apnea (OSA) patients with preserved left ventricular ejection fraction (LVEF) and without any confounding disease that may result myocardial dysfunction. Twenty-one healthy individuals and 58 OSA patients were enrolled in the study. The patients were categorized into mild, moderate and severe OSA groups according to the apnea-hypopnea index (AHI). Conventional- and tissue Doppler echocardiography imagings were performed in all the individuals besides the 2D-STE. The longitudinal strain (S) and systolic strain rate (SRS) values decreased as the severity of disease increased from moderate towards severe OSA. The circumferential S and SRS values were observed to be lower in the severe OSA patients. Despite the increase in the radial S and SRS in moderate and mild OSA patients, these measurements decreased in those with severe OSA. Although the longitudinal, circumferential and radial early diastolic strain rates (SRE) decreased as the severity of disease increased form moderate to severe, the late diastolic strain rates (SRA) were observed to increase. In the early stages of OSA, longitudinal systolic LV dysfunction is detected in addition to the diastolic dysfunction. The circumferential mechanics of the LV deteriorate in the later stages of the OSA. Despite a compensatory increase in the radial LV function in the early stages of OSA, in later stages, the LV radial function also deteriorates. The assessment of the myocardial functions using the STE method in patients with OSA with preserved LVEF has the potential to detect the subclinical LV dysfunction and might provide useful information for risk stratification.

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References

  1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  PubMed  CAS  Google Scholar 

  2. Schafer H, Koehler U, Ploch T, Peter JH (1997) Sleep-related myocardial ischemia and sleep structure patients with obstructive slepp apnea and coronary heart disease. Chest 111:387–393

    Article  PubMed  CAS  Google Scholar 

  3. Dursunoglu D, Dursunoglu N (2010) Heart failure and sleep apnea. Turk Kardiyol Dern Ars 38:135–143

    PubMed  Google Scholar 

  4. Fung JW, Li TS, Choy DK et al (2002) Severe obstructive sleep apnea is associated with left ventricular diastolic dysfunction. Chest 121:422–429

    Article  PubMed  Google Scholar 

  5. Sanderson JE, Fraser AG (2006) Systolic dysfunction in heart failure with a normal ejection fraction: echo-Doppler measurements. Prog Cardiovasc Dis 49:196–206

    Article  PubMed  Google Scholar 

  6. Aurigemma GP, Silver KH, Priest MA, Gaasch WH (1995) Geometric changes allow normal ejection fraction despite depressed myocardial shortening in hypertensive left ventricular hypertrophy. J Am Coll Cardiol 26:195–202

    Article  PubMed  CAS  Google Scholar 

  7. Cioffi G, Russo TE, Selmi A, Stefenelli C, Furlanello F (2011) Analysis of left ventricular systolic function by midwall mechanics in patients with obstructive sleep apnoea. Eur J Echocardiogr 12:61–68

    Article  PubMed  Google Scholar 

  8. Palmon LC, Reichek N, Yeon SB, Clark NR, Brownson D, Hoffman E, Axel L (1994) Intramural myocardial shortening in hypertensive left ventricular hypertrophy with normal pump function. Circulation 89:122–131

    Article  PubMed  CAS  Google Scholar 

  9. Rademakers FE, Rogers WJ, Guier WH, Hutchins GM, Siu CO, Weisfeldt ML, Weiss JL, Shapiro EP (1994) Relation of regional cross-fiber shortening to wall thickening in the intact heart. Three-dimensional strain analysis by NMR tagging. Circulation 89:1174–1182

    Article  PubMed  CAS  Google Scholar 

  10. Dandel M, Hetzer R (2009) Echocardiographic strain and strain rate imaging-clinical applications. Int J Cardiol 13:11–24

    Article  Google Scholar 

  11. Okuda N, Ito T, Emura N, Suwa M, Hayashi T, Yoneda H, Kitaura Y (2007) Depressed myocardial contractile reserve in patients with obstructive sleep apnea assessed by tissue Doppler imaging with dobutamine stress echocardiography. Chest 131:1082–1089

    Article  PubMed  Google Scholar 

  12. Manni R, Politini L, Ratti MT, Tartara A (1999) Sleepiness in obstructive sleep apnea syndrome and simple snoring evaluated by the Epworth Sleepiness Scale. J Sleep Res 8:319–320

    Article  PubMed  CAS  Google Scholar 

  13. Grover M, Mookadam M, Armas D, Bozarth C, Castleberry T, Gannon M, Webb D, Dueck A (2011) Identifying patients at risk for obstructive sleep apnea in a primary care practice. J Am Board Fam Med 24:152–160

    Article  PubMed  Google Scholar 

  14. Report AAoSMTF (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of sleep medicine task force. Sleep 22:667–689

    Google Scholar 

  15. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458

    Article  PubMed  CAS  Google Scholar 

  16. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Chamber quantification writing group; American society of Echocardiography’s guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of echocardiography’s guidelines and standards Committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  17. Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ, Tajik AJ, Seward JB (1995) New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function–a study in normals and dilated cardiomyopathy. J Cardiol 26:357–366

    PubMed  CAS  Google Scholar 

  18. Baguet JP, Nadra M, Barone-Rochette G, Ormezzano O, Pierre H, Pépin JL (2009) Early cardiovascular abnormalities in newly diagnosed obstructive sleep apnea. Vasc Health Risk Manag 5:1063–1073

    Article  PubMed  Google Scholar 

  19. Cloward TV, Walker JM, Farney RJ, Anderson JL (2003) Left ventricular hypertrophy is acommon echocardiographic abnormality in severe obstructive sleep apnea andreverses with continuous positive airway pressure. Chest 124:594–601

    Article  PubMed  Google Scholar 

  20. Dursunoglu D, Dursunoglu N, Evrengul H, Ozkurt S, Kuru O, Kiliç M, Fisekci F (2005) Impact of obstructive sleep apnoeaon left ventricular mass and global function. Eur Respir J 26:283–288

    Article  PubMed  CAS  Google Scholar 

  21. Tomiyama H, Takata Y, Shiina K, Matsumoto C, Yamada J, Yoshida M, Yamashina A et al (2009) Concomitant existence and interaction ofcardiovascular abnormalities in obstructive sleep apnea subjects with normal clinic blood pressure. Hypertens Res 32:201–206

    Article  PubMed  Google Scholar 

  22. Haruki N, Takeuchi M, Nakai H, Kanazawa Y, Tsubota N, Shintome R, Lang RM, Otsuji Y (2009) Overnight sleeping induced daily repetitive left ventricular systolic and diastolic dysfunctionin obstructive sleep apnoea: quantitative assessment using tissue Doppler imaging. Eur J Echocardiogr 10:769–775

    Article  PubMed  Google Scholar 

  23. Kasikcioglu HA, Karasulu L, Tartan Z, Kasikcioglu E, Cuhadaroglu C, Cam N (2007) Occult cardiac dysfunction in patients with obstructive sleep apnea syndrome revealed by tissue Doppler imaging. Int J Cardiol 118:203–205

    Article  PubMed  Google Scholar 

  24. Edvardsen T, Helle-Valle T, Smiseth OA (2006) Systolic dysfunction in heart failure with normal ejection fraction: speckle-tracking echocardiography. Prog Cardiovasc Dis 49:207–214

    Article  PubMed  Google Scholar 

  25. Tavil Y, Kanbay A, Sen N, Ulukavak Ciftçi T, Abaci A, Yalçin MR, Köktürk O, Cengel A (2007) The relationship between aortic stiffness and cardiac function in patients with obstructive sleep apnea, independently from systemic hypertension. J Am Soc Echocardiogr 20:366–372

    Article  PubMed  Google Scholar 

  26. Kim H, Shin HW, Son J, Yoon HJ, Park HS, Cho YK, Han CD, Nam CW, Hur SH, Kim YN, Kim KB (2011) Two-dimensional strain or strain rate findings in mild to moderate diastolic dysfunction with preserved ejection fraction. Heart Vessels 26:39–45

    Article  PubMed  Google Scholar 

  27. Rosen BD, Edvardsen T, Lai S, Castillo E, Pan L, Jerosch-Herold M, Sinha S, Kronmal R, Arnett D, Crouse JR 3rd, Heckbert SR, Bluemke DA, Lima JA (2005) Left ventricular concentric remodeling is associated with decreased global and regional systolic function: the multi-ethnic study of atherosclerosis. Circulation 112:984–991

    Article  PubMed  Google Scholar 

  28. Frey N, Katus HA, Olson EN, Hill JA (2004) Hypertrophy of the heart new therapeutic target?? Circulation 109:1580–1589

    Article  PubMed  Google Scholar 

  29. Mu Y, Qin C, Wang C, Huojiaabudula G (2010) Two-dimensional ultrasound speckle tracking imaging in evaluation of early changes in left ventricular diastolic function in patients with essential hypertension. Echocardiography 27:146–154

    Article  PubMed  Google Scholar 

  30. Haruki N, Takeuchi M, Kanazawa Y, Tsubota N, Shintome R, Nakai H, Lang RM, Otsuji Y (2010) Continuous positive airway pressure ameliorates sleep-induced subclinical left ventricular systolic dysfunction: demonstration by two-dimensional speckle-tracking echocardiography. Eur J Echocardiogr 11:352–358

    Article  PubMed  Google Scholar 

  31. Vitarelli A, D’Orazio S, Caranci F, Capotosto L, Rucos R, Iannucci G, Continanza G, Dettori O, De Cicco V, Vitarelli M, De Maio M, De Chiara S, Saponara M (2011) Left ventricular torsion abnormalities in patients with obstructive sleep apnea syndrome: an early sign of subclinical dysfunction. Int J Cardiol. doi:10.1016/j.ijcard.2011.09.030

    Google Scholar 

  32. Niroumand M, Kuperstein R, Sasson Z, Hanly PJ (2001) Impact of obstructive sleep apnea on left ventricular mass and diastolic function. Am J Respir Crit Care Med 163:1632–1636

    PubMed  CAS  Google Scholar 

  33. Kawanishi Y, Ito T, Okuda N, Emura N, Hayashi T, Futai R, Yoneda H, Kitaura Y (2009) Alteration of myocardial characteristics and function in patients with obstructive sleep apnea. Int J Cardiol 133:129–131

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Akdeniz University Faculty of Medicine, Dumlupinar Bouleward, 07070, Konyaalti, Antalya, Turkey

    Refik Emre Altekin, Atakan Yanikoglu, Mustafa Serkan Karakas, Aytul Belgi Yildirim, Huseyin Yilmaz & Selim Yalcinkaya

  2. Department of Cardiology, Kayseri Research and Education Hospital, Kayseri, Turkey

    Ahmet Oguz Baktir

  3. Department of Biostatistics and Medical Informatics, Akdeniz University Faculty of Medicine, Antalya, Turkey

    Deniz Ozel

  4. Department of Chest Disease, Akdeniz University Faculty of Medicine, Antalya, Turkey

    Aykut Cilli

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  1. Refik Emre Altekin
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  2. Atakan Yanikoglu
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  3. Ahmet Oguz Baktir
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  4. Mustafa Serkan Karakas
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  5. Deniz Ozel
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  9. Selim Yalcinkaya
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Correspondence to Refik Emre Altekin.

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Altekin, R.E., Yanikoglu, A., Baktir, A.O. et al. Assessment of subclinical left ventricular dysfunction in obstructive sleep apnea patients with speckle tracking echocardiography. Int J Cardiovasc Imaging 28, 1917–1930 (2012). https://doi.org/10.1007/s10554-012-0026-4

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  • DOI: https://doi.org/10.1007/s10554-012-0026-4

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