Vural Mustafa Gökhan, Çetin Süha, Gündüz Hüseyin, Özcan Abacıoğlu Özge, Akdemir Ramazan, Fırat Hikmet, Yeter Ekrem
Department of Cardiology, Faculty of Cardiology, Sakarya University; Sakarya-Turkey.
Anatol J Cardiol. 2016 Jan;16(1):34-41. doi: 10.5152/akd.2015.5751.
Obstructive sleep apnea (OSA) is associated with thromboembolic events. Compromised left atrial appendage (LAA) function due to left ventricular (LV) performance abnormality, often present in patients with OSA, may play an important role. The purpose of this study is to evaluate LV and LAA mechanical functions during sinus rhythm (SR) in patients with OSA.
LV and LAA functions were assessed in 43 OSA patients and compared with that of 20 control patients in SR. Tissue Doppler velocities of the LAA apex and emptying velocities (EV) of LAA were obtained on parasternal short-axis view.
The baseline clinical characteristics were similar except for AHI (apnea-hypopnea index), minimal SaO2, mean SaO2, hypertension, and body-surface area. Most of the LV echocardiographic parameters significantly deteriorated in OSA patients in comparison with those in the control group. LAA EV, LAA systolic relaxation velocity (SM), LAA early-diastolic velocity (EM), LAA contraction velocity (AM), left atrial (LA) minimum volume index, LA ejection fraction, LA conduit volume index, and LA reservoir volume index were lower in OSA patients compared with those in the control group (p<0.05). LAA AM was negatively correlated with AHI and the ratio of peak early diastolic flow velocity (E) to early-diastolic (E') and positively correlated with LA conduit volume (p<0.05). Multiple predictors for LAA AM were AHI, presence of diastolic dysfunction, and E/E' values (p<0.05).
LAA mechanical function is significantly depressed in patients with OSA and SR. LAA dysfunction may predispose these patients to thromboembolic events. The evaluation of LAA mechanical function by tissue Doppler study using transthoracic echocardiography (TTE) may become an alternative for routine work-up in OSA patients.
阻塞性睡眠呼吸暂停（OSA）与血栓栓塞事件相关。OSA患者常出现的左心室（LV）功能异常导致左心耳（LAA）功能受损，可能起重要作用。本研究旨在评估OSA患者窦性心律（SR）期间的左心室和左心耳机械功能。
对43例OSA患者的左心室和左心耳功能进行评估，并与20例窦性心律的对照患者进行比较。在胸骨旁短轴视图上获取左心耳尖的组织多普勒速度和左心耳排空速度（EV）。
除呼吸暂停低通气指数（AHI）、最低血氧饱和度、平均血氧饱和度、高血压和体表面积外，基线临床特征相似。与对照组相比，大多数OSA患者的左心室超声心动图参数显著恶化。与对照组相比，OSA患者的左心耳EV、左心耳收缩期松弛速度（SM）、左心耳舒张早期速度（EM）、左心耳收缩速度（AM）、左心房（LA）最小容积指数、左心房射血分数、左心房管道容积指数和左心房储备容积指数较低（p<0.05）。左心耳AM与AHI以及舒张早期峰值流速（E）与舒张早期（E'）的比值呈负相关，与左心房管道容积呈正相关（p<0.05）。左心耳AM的多个预测因素为AHI、舒张功能障碍的存在和E/E'值（p<0.05）。
OSA和SR患者的左心耳机械功能明显降低。左心耳功能障碍可能使这些患者易发生血栓栓塞事件。使用经胸超声心动图（TTE）通过组织多普勒研究评估左心耳机械功能可能成为OSA患者常规检查的替代方法。
