Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany Both authors contributed equally
Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany Both authors contributed equally.
Eur Respir J. 2015 Mar;45(3):680-90. doi: 10.1183/09031936.00057014. Epub 2014 Oct 30.
Structural and functional integrity of the right heart is important in the prognosis after acute myocardial infarction (AMI). The objective of this study was to assess the impact of sleep disordered breathing (SDB) on structure and function of the right heart early after AMI. 54 patients underwent cardiovascular magnetic resonance 3-5 days and 12 weeks after AMI, and were stratified according to the presence of SDB, defined as an apnoea-hypopnoea index of ≥ 15 events · h(-1). 12 weeks after AMI, end-diastolic volume of the right ventricle had increased significantly in patients with SDB (n=27) versus those without (n=25) (mean ± sd 14 ± 23% versus 0 ± 17%, p=0.020). Multivariable linear regression analysis accounting for age, sex, body mass index, smoking, left ventricular mass and left ventricular end-systolic volume showed that the apnoea-hypopnoea index was significantly associated with right ventricular end-diastolic volume (B-coefficient 0.315 (95% CI 0.013-0.617); p=0.041). From baseline to 12 weeks, right atrial diastolic area increased more in patients with SDB (2.9 ± 3.7 cm(2) versus 1.0 ± 2.4 cm(2), p=0.038; when adjusted for left ventricular end systolic volume, p=0.166). SDB diagnosed shortly after AMI predicts an increase of right ventricular end-diastolic volume and possibly right atrial area within the following 12 weeks. Thus, SDB may contribute to enlargement of the right heart after AMI.
右心的结构和功能完整性对急性心肌梗死（AMI）后的预后很重要。本研究旨在评估睡眠呼吸障碍（SDB）对 AMI 后早期右心结构和功能的影响。54 例患者在 AMI 后 3-5 天和 12 周进行心血管磁共振检查，并根据 SDB 的存在进行分层，定义为呼吸暂停-低通气指数≥15 次·h-1。在 AMI 后 12 周，SDB（n=27）患者的右心室舒张末期容积明显增加，而无 SDB（n=25）患者的右心室舒张末期容积则无明显增加（平均值±标准差 14±23%与 0±17%，p=0.020）。多变量线性回归分析考虑了年龄、性别、体重指数、吸烟、左心室质量和左心室收缩末期容积，结果显示呼吸暂停-低通气指数与右心室舒张末期容积显著相关（B 系数 0.315（95%CI 0.013-0.617）；p=0.041）。从基线到 12 周，SDB 患者的右心房舒张面积增加更多（2.9±3.7cm2与 1.0±2.4cm2，p=0.038；当调整左心室收缩末期容积时，p=0.166）。AMI 后不久诊断的 SDB 可预测在接下来的 12 周内右心室舒张末期容积和可能的右心房面积增加。因此，SDB 可能导致 AMI 后右心增大。
