转甲状腺素蛋白心脏淀粉样变性患者中枢性和阻塞性呼吸暂停的临床及预后意义

Clinical and prognostic significance of central and obstructive apneas in patients with transthyretin cardiac amyloidosis.

作者信息

Gentile Francesco, Giannoni Alberto, Aimo Alberto, Castiglione Vincenzo, Bramanti Francesca, Iudice Giovanni, Degl'Innocenti Eleonora, Emdin Michele, Vergaro Giuseppe, Passino Claudio

机构信息

Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy.

Fondazione Toscana Gabriele Monasterio, Pisa, Italy.

出版信息

Eur J Prev Cardiol. 2024 Sep 23. doi: 10.1093/eurjpc/zwae297.

DOI:10.1093/eurjpc/zwae297

PMID:39308231

Abstract

AIMS

Central (CA) and obstructive apneas (OA) are highly prevalent in patients with chronic heart failure (HF) and transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized HF etiology. This study aimed to investigate the prevalence and impact of CA and OA in patients with ATTR-CA.

METHODS

Consecutive patients with ATTR-CA underwent a 24-hour ambulatory cardiorespiratory monitoring to evaluate the prevalence and severity of breathing disorders. The severity of these disorders was quantified using the apnea-hypopnea index (AHI). Accordingly, patients were categorized as having normal breathing (NB, AHI <5 events/hour), obstructive apnea (OA, AHI ≥5 events/hour with >50% being obstructive), or central apnea (CA, AHI >5 events/hour with ≥50% being central). The primary endpoint at follow-up was all-cause mortality.

RESULTS

Out of 142 patients enrolled (n=142, aged 77±7 years, 91% males, 96% wild-type ATTR-CA), considering the 24 hours, 20% had NB (39% at daytime, 8% at nighttime), while 35% had CA (45% at daytime, 39% at nighttime) and 45% had OA (25% at daytime, 54% at nighttime). After a median 2.3 (1.4-3.3) years follow-up, 24-hour, daytime, and nighttime AHI were higher in non-survivors vs. survivors (all p<0.05), independently of the prevalent apnea type (p=0.64). At multivariable regression analysis (adjusted for the possible clinical, echocardiographic, and biohumoral confounders), nighttime AHI ≥30 events/hour (hazard ratio 2.37 [95%CI 1.07-5.23], p=0.033) and hs-troponin T (hazard ratio 2.43 [95%CI 1.42-4.17], p=0.001) were predictors of mortality.

CONCLUSION

CA and OA are highly prevalent both at daytime and nighttime in patients with ATTR-CA and are associated with higher mortality.

摘要

目的

中枢性呼吸暂停（CA）和阻塞性呼吸暂停（OA）在慢性心力衰竭（HF）患者中极为常见，而转甲状腺素蛋白心脏淀粉样变性（ATTR-CA）是一种日益被认识到的HF病因。本研究旨在调查ATTR-CA患者中CA和OA的患病率及影响。

方法

连续的ATTR-CA患者接受24小时动态心肺监测，以评估呼吸障碍的患病率和严重程度。这些障碍的严重程度使用呼吸暂停低通气指数（AHI）进行量化。据此，患者被分类为呼吸正常（NB，AHI<5次/小时）、阻塞性呼吸暂停（OA，AHI≥5次/小时且阻塞性占比>50%）或中枢性呼吸暂停（CA，AHI>5次/小时且中枢性占比≥50%）。随访的主要终点是全因死亡率。

结果

在纳入的142例患者中（n=142，年龄77±7岁，91%为男性，96%为野生型ATTR-CA），考虑24小时情况，20%的患者呼吸正常（白天为39%，夜间为8%），而35%的患者有CA（白天为45%，夜间为39%），45%的患者有OA（白天为25%，夜间为54%）。经过中位2.3（1.4 - 3.3）年的随访，非幸存者的24小时、白天和夜间AHI均高于幸存者（所有p<0.05），与主要的呼吸暂停类型无关（p = 0.64）。在多变量回归分析中（对可能的临床、超声心动图和生物体液混杂因素进行校正），夜间AHI≥30次/小时（风险比2.37 [95%CI 1.07 - 5.23]，p = 0.033）和高敏肌钙蛋白T（风险比2.43 [95%CI 1.42 - 4.17]，p = 0.001）是死亡率的预测因素。