Buonauro Agostino, Galderisi Maurizio, Santoro Ciro, Canora Angelo, Bocchino Maria Luisa, Lo Iudice Francesco, Lembo Maria, Esposito Roberta, Castaldo Sabrina, Trimarco Bruno, Sanduzzi Alessandro
Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.
Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.
Int J Cardiol. 2017 Sep 15;243:544-549. doi: 10.1016/j.ijcard.2017.05.002. Epub 2017 May 4.
Little is known on right ventricular (RV) involvement in obstructive sleep apnoea (OSA). This study aimed at evaluating early RV dysfunction by standard and advanced echocardiography in OSA.
Fifty-nine OSA patients without heart failure and 29 age-matched controls underwent standard, speckle tracking and real time 3D echocardiography of right ventricle. OSA patients performed lung function tests and overnight cardio-respiratory monitoring with evaluation of apnea-hypopnea index (AHI).
OSA had significantly higher body mass index and systolic blood pressure (BP) than controls. RV diameters and systolic pulmonary arterial pressure (sPAP) were significantly higher in OSA, in presence of comparable tricuspid annular plane systolic excursion (TAPSE). OSA showed marginally lower RV global longitudinal strain (GLS) (p<0.05) and RV lateral wall strain (RV LLS) (p=0.04). Three-dimensional RV ejection fraction did not differ between the two groups. By stratifying patients according to sPAP, 18 OSA patients with sPAP≥30mmHg had lower TAPSE (p<0.05), RV GLS and RV LLS (both p<0.001) than 37 patients with normal sPAP. By separate multivariate analyses, RV GLS and RV LLS were independently associated with sPAP (both p<0.0001), AHI (p=0.035 and p=0.015 respectively) and BMI (p<0.05 and p=0.034) but not with age and systolic BP in OSA.
A subclinical RV dysfunction is detectable by speckle tracking in OSA. The impairment of RV GLS and RV LLS is more prominent than that of TAPSE and is evident when RVEF is still normal. GLS is independently associated with sPAP and OSA severity.
关于阻塞性睡眠呼吸暂停（OSA）患者右心室（RV）受累情况，目前所知甚少。本研究旨在通过标准及高级超声心动图评估OSA患者的早期右心室功能障碍。
59例无心力衰竭的OSA患者及29例年龄匹配的对照者接受了右心室的标准、斑点追踪及实时三维超声心动图检查。OSA患者进行了肺功能测试及夜间心肺监测，并评估了呼吸暂停低通气指数（AHI）。
OSA患者的体重指数和收缩压（BP）显著高于对照组。在三尖瓣环平面收缩期位移（TAPSE）相当的情况下，OSA患者的右心室直径和收缩期肺动脉压（sPAP）显著更高。OSA患者的右心室整体纵向应变（GLS）略低（p<0.05），右心室侧壁应变（RV LLS）也略低（p=0.04）。两组间三维右心室射血分数无差异。根据sPAP对患者进行分层，18例sPAP≥30mmHg的OSA患者的TAPSE（p<0.05）、右心室GLS和右心室LLS（均p<0.001）低于37例sPAP正常的患者。通过单独的多变量分析，在OSA患者中，右心室GLS和右心室LLS分别与sPAP（均p<0.0001）、AHI（分别为p=0.035和p=0.015）及BMI（p<0.05和p=0.034）独立相关，但与年龄和收缩压无关。
通过斑点追踪可在OSA患者中检测到亚临床右心室功能障碍。右心室GLS和右心室LLS的损害比TAPSE更显著，且在右心室射血分数仍正常时就已明显。GLS与sPAP及OSA严重程度独立相关。
