Acute and Chronic Effects of Noninvasive Ventilation on Left and Right Myocardial Function in Patients with Obstructive Sleep Apnea Syndrome: A Speckle Tracking Echocardiographic Study

Antonello D'Andrea; Francesca Martone; Biagio Liccardo; Mariano Mazza; Anna Annunziata; Enza Di Palma; Marianna Conte; Cesare Sirignano; Michele D'Alto; Nicolino Esposito; Giuseppe Fiorentino; Maria Giovanna Russo; Eduardo Bossone; Raffaele Calabrò

doi:10.1111/echo.13225

Acute and Chronic Effects of Noninvasive Ventilation on Left and Right Myocardial Function in Patients with Obstructive Sleep Apnea Syndrome: A Speckle Tracking Echocardiographic Study

Echocardiography. 2016 Aug;33(8):1144-55. doi: 10.1111/echo.13225. Epub 2016 Apr 5.

Affiliations

¹ Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy.
² Division of Pneumology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy.
³ Institute of Biostructure and Bioimaging (IBB) of the Italian National Research Council, Naples, Italy.
⁴ Division of Cardiology, Evangelic Hospital Villa Betania, Naples, Italy.
⁵ Department of Cardiology and Cardiac Surgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.

PMID: 27060461
DOI: 10.1111/echo.13225

Abstract

Background: In patients with obstructive sleep apnea syndrome (OSAS), repetitive hypoxia due to sleep-induced apnea adversely affects the interaction between myocardial oxygen demand and supply, resulting in the development of subclinical cardiac dysfunction. The purpose of the study was to analyze the different involvement of left and right heart myocardial function in patients with OSAS treated with noninvasive ventilation (NIV).

Methods: Conventional Doppler echocardiography, Doppler myocardial imaging (DMI), and two-dimensional speckle tracking echocardiography (2DSTE) of left (LV) and right ventricular (RV) longitudinal and right atrial (RA) deformation were performed in 55 patients with OSAS undergoing NIV (M/F 38/17; mean age 67.8 ± 11.2 years). LV and RV global longitudinal strain (GLS) was calculated by averaging local strain along the entire right and left ventricle, before and during NIV, and after 6 months of nocturnal NIV therapy.

Results: LV morphology was comparable before and during NIV, whereas LV ejection fraction and LV DMI early diastolic peak velocity were significantly improved in patients with OSAS during NIV, as was LV regional peak myocardial strain (P < 0.001). RV diameters were slightly increased in patients with OSAS during ventilation, whereas pulmonary artery systolic pressure (PASP), RV GLS, and regional peak myocardial RV strain were significantly reduced during ventilation (P < 0.0001). RA transverse diameters and RA area were also slightly increased during NIV, whereas RA lateral wall strain was reduced (P < 0.001). Acute RV myocardial impairment completely reversed at follow-up, with a decrease in PASP and subsequent increase in both RV and RA myocardial performance.

Conclusions: Conventional 2DSTE is a useful tool for assessing left and right heart morphology and myocardial deformation in patients with OSAS and for monitoring both acute and chronic effects of NIV.

Keywords: Doppler echocardiography; noninvasive ventilation; obstructive sleep apnea syndrome; pulmonary arterial pressure; right ventricle; two-dimensional speckle tracking strain.

Publication types

Controlled Clinical Trial

MeSH terms

Acute Disease
Aged
Chronic Disease
Continuous Positive Airway Pressure / adverse effects*
Echocardiography / methods*
Elasticity Imaging Techniques / methods
Female
Humans
Male
Reproducibility of Results
Risk Assessment
Sensitivity and Specificity
Sleep Apnea, Obstructive / complications
Sleep Apnea, Obstructive / diagnostic imaging*
Sleep Apnea, Obstructive / therapy*
Stroke Volume
Treatment Outcome
Ventricular Dysfunction, Right / diagnostic imaging*
Ventricular Dysfunction, Right / etiology*