Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
Clinic for General and Interventional Cardiology/Angiology Heart and Diabetes Center, NRW Ruhr University Bochum, Bad Oeynhausen, Germany.
Eur Respir J. 2024 Sep 5;64(3). doi: 10.1183/13993003.02338-2023. Print 2024 Sep.
Sleep disordered breathing (SDB) has been associated with less myocardial salvage and smaller infarct size reduction after acute myocardial infarction (AMI). The Treatment of sleep apnoea Early After Myocardial infarction with Adaptive Servo-Ventilation (TEAM-ASV I) trial investigated the effects of adding adaptive servo-ventilation (ASV) for SDB to standard therapy on the myocardial salvage index (MSI) and change in infarct size within 12 weeks after AMI.
In this multicentre, randomised, open-label trial, patients with AMI and successful percutaneous coronary intervention within 24 h after symptom onset plus SDB (apnoea-hypopnoea index ≥15 events·h) were randomised to standard medical therapy alone (control) or plus ASV (starting 3.6±1.4 days post-AMI). The primary outcome was the MSI at 12 weeks post-AMI. Cardiac magnetic resonance (CMR) imaging was performed at ≤5 days and 12 weeks after AMI.
76 individuals were enrolled from February 2014 to August 2020; 39 had complete CMR data for analysis of the primary end-point. The MSI was significantly higher in the ASV control group (difference 14.6% (95% CI 0.14-29.1%); p=0.048). At 12 weeks, absolute (6.6 (95% CI 4.8-8.5) 2.8 (95% CI 0.9-4.8) % of left ventricular mass; p=0.003) and relative (44 (95% CI 30-57) 21 (95% CI 6-35) % of baseline; p=0.013) reductions in infarct size were greater in the ASV control group. No serious treatment-related adverse events occurred.
Early treatment of SDB with ASV improved the MSI and decreased infarct size at 12 weeks after AMI. Larger randomised trials are required to confirm these findings.
睡眠呼吸障碍（SDB）与急性心肌梗死（AMI）后心肌再灌注减少和梗死面积缩小有关。急性心肌梗死后早期使用适应性伺服通气（TEAM-ASV I）治疗睡眠呼吸暂停试验研究了在 AMI 后 24 小时内接受经皮冠状动脉介入治疗成功的 SDB（呼吸暂停低通气指数≥15 次·小时）患者中，在标准治疗的基础上加用适应性伺服通气（ASV）对心肌再灌注指数（MSI）和梗死面积变化的影响。
在这项多中心、随机、开放标签试验中，将 AMI 发病后 24 小时内接受经皮冠状动脉介入治疗成功且合并 SDB（呼吸暂停低通气指数≥15 次·小时）的患者随机分为单纯标准药物治疗（对照组）或加用 ASV（AMI 后 3.6±1.4 天开始）。主要终点为 AMI 后 12 周的 MSI。在 AMI 后≤5 天和 12 周时进行心脏磁共振成像（CMR）检查。
2014 年 2 月至 2020 年 8 月期间共纳入 76 名患者；其中 39 名患者有完整的 CMR 数据分析主要终点。ASV 组的 MSI 明显更高（差异为 14.6%（95%CI 0.14-29.1%）；p=0.048）。12 周时，ASV 组左心室质量的绝对（6.6（95%CI 4.8-8.5） 2.8（95%CI 0.9-4.8）%；p=0.003）和相对（44（95%CI 30-57） 21（95%CI 6-35）%；p=0.013）梗死面积缩小均大于对照组。无严重与治疗相关的不良事件发生。
AMI 后早期使用 ASV 治疗 SDB 可改善 MSI，并降低 12 周时的梗死面积。需要更大规模的随机试验来证实这些发现。
