Department of Internal Medicine, Cham Hospital, Cham, Germany.
University Heart Centre Regensburg, University Medical Centre Regensburg, Regensburg, Germany.
Sleep Med. 2022 Jun;94:63-69. doi: 10.1016/j.sleep.2022.03.028. Epub 2022 Apr 10.
Left ventricular diastolic dysfunction is a predictor of adverse outcome after acute myocardial infarction (AMI). We aimed to test if sleep-disordered breathing (SDB) contributes to the development of diastolic dysfunction in patients with preserved left ventricular ejection fraction after AMI.
Patients with AMI, percutaneous coronary intervention and an ejection fraction ≥50% were included in this sub-analysis of a prospective observational study. Patients with AMI (n = 41) underwent cardiovascular magnetic resonance imaging (volume-time curve analysis) to define diastolic function by means of the normalised peak filling rate [nPFR; (end diastolic volume/second)]. In patients with AMI, the nPFR was assessed within <5 days and three months after AMI. Patients with AMI were stratified in patients with (apnoea-hypopnoea index, AHI ≥15/h) and without (AHI <15/h) SDB as assessed by polysomnography.
At the time of AMI, the nPFR was similar between patients with and without SDB (2.90 ± 0.54 vs. 3.03 ± 1.20, p = 0.662). Within three months after AMI, diastolic function was significantly lower in patients with SDB than in patients without SDB (ΔnPFR: -0.83 ± 0.14 vs. 0.03 ± 0.14; p < 0.001; ANCOVA, adjusted for baseline nPFR). In contrast to central AHI, obstructive AHI was associated with a lower nPFR three months after AMI, after accounting for established risk factors for diastolic dysfunction [multiple linear regression analysis, B (95%CI): -0.036 (-0.063 to -0.009), p = 0.011].
Our data indicate that obstructive sleep apnoea impairs diastolic function early after myocardial infarction.
左心室舒张功能障碍是急性心肌梗死（AMI）后不良预后的预测因素。我们旨在检验睡眠呼吸紊乱（SDB）是否会导致 AMI 后左心室射血分数正常的患者发生舒张功能障碍。
本前瞻性观察研究的亚组分析纳入了 AMI 经皮冠状动脉介入治疗且射血分数≥50%的患者。采用心血管磁共振成像（容积-时间曲线分析）对 AMI 患者进行检测，通过正常化峰值充盈率[nPFR；（舒张末期容积/秒）]来定义舒张功能。在 AMI 患者中，于 AMI 后 5 天内和 3 个月时评估 nPFR。通过多导睡眠图评估 AMI 患者的 SDB，并将患者分为存在（呼吸暂停低通气指数，AHI≥15/h）和不存在（AHI<15/h）SDB 两组。
在 AMI 时，存在和不存在 SDB 的患者的 nPFR 相似（2.90±0.54 与 3.03±1.20，p=0.662）。在 AMI 后 3 个月时，SDB 患者的舒张功能明显低于无 SDB 患者（ΔnPFR：-0.83±0.14 与 0.03±0.14；p<0.001；调整基线 nPFR 的协方差分析）。与中心型 AHI 相比，阻塞型 AHI 与 AMI 后 3 个月时的 nPFR 较低相关，这在考虑舒张功能障碍的既定危险因素后仍然成立[多元线性回归分析，B（95%CI）：-0.036（-0.063 至-0.009），p=0.011]。
我们的数据表明，阻塞性睡眠呼吸暂停会在心肌梗死后早期损害舒张功能。
